DISCLAIMER: THE FOLLOWING INFORMATION IS BASED ON MY PERSONAL EXPERIENCES. SOME OF THE INFORMATION PROVIDED INCLUDES NON-FDA APPROVED TECHNIQUES AND IS NOT ENDORSED BY TANDEM DIABETES. THIS BLOG IS INTENDED TO INFORM HEALTH CARE PROVIDERS OF REAL LIFE TIPS & TRICKS. THIS IS NOT CLINICAL ADVICE. PLEASE DISCUSS ANY QUESTIONS OR IDEAS WITH YOUR PRESCRIBER. ADDED 02/24/2020
I can’t believe it’s already been about six weeks since I started ControlIQ. To be honest, I was excited to give ControlIQ a try, but expected to go back to Loop. To my surprise, I’m completely content with ControlIQ! In fact, I’m still doing much better on ControlIQ than I was on Loop. I am amazed that with some minor tweaks and tricks I’ve achieved optimal time in range for weeks and I’m excited to share my secrets with you!
The most important tips (below) are for both Clinicians and ControlIQ users:
- Pattern management post ControlIQ start is so important! Pattern management has been key in my success with the system. I reviewed my patterns and made minor tweaks every few days for the first couple weeks. For example, even in sleep mode I was staying steady all night but waking up around 130 for a bit, so I increased my basal. Or, I noticed I was spiking after dinner, so I tightened my carb ratio. The system will help tackle blood glucose variability, but pattern management is still key for optimizing success.
- You may need to adjust insulin settings. My insulin settings are much more aggressive than they were on BasalIQ. I used BasalIQ prior to Loop and ControlIQ, and my carb ratio and sensitivity were significantly less aggressive. I did a lot of micromanaging when I used BasalIQ (temp basals, micro boluses, dosing for rising Dexcom arrows).
Key takeaway: YOU WILL NEED TO MAKE ADJUSTMENTS! PARTICULARLY WITH ENSURING INSULIN SENSITIVITY AND CARB RATIOS MATCH TRUE INSULIN REQUIREMENTS. I FIND THAT A LOT OF SENSITIVITY AND CARB RATIOS AREN’T ACTUALLY AGGRESSIVE ENOUGH.
What are my Other secrets?
- Personal profiles. This is a setting I didn’t take advantage of on BasalIQ, where I had one main profile. On ControlIQ, use three! One for typical weekdays, one for weekends with increased basal and carb ratios (I eat out on the weekends) and one for exercise. I use this feature in place of temp basals and it works well.
- Prebolusing. This is important. That is all.
3. Exercise tips. Exercise mode alone did not work well for me, even when activating it a couple hours in advance. Since I follow the same workout routine (45 min of moderate cardio in the morning), it was easy for me to figure out what worked for me. I put on my exercise profile at least 1 hour before working out, with the exercise mode. I leave both on for the duration of my workout and then about 1 hour post workout. This typically keeps me steady! My exercise profile has 40% less basal insulin and sensitivity than my typical profile. I figured this out based on the principle that I reduced my insulin by 30-40% on Loop and when using BasalIQ. Your exercise needs will differ based on your body and type of activity, but worth playing around with different profiles!
4. SLEEPMODE. Sleepmode 24/7 was not recommended to me by Tandem. But, after having success using sleepmode just overnight, I decided to try it 24/7. I was inspired by the “sleeping beauties” in the ControlIQ pivotal trial, and wanted to see if it really made a difference. It has been amazing for me. The more aggressive sleepmode algorithm (to shoot for a 110-120 target) work great with my circumstances and I am fine giving up the hourly autocorrections. Keep in mind, I am adult with minimal hormonal fluctuations, have accurate insulin settings, pretty steady blood glucose (few fluctuations), religiously pre-bolus, accurately enter carbohydrates and will give correction doses if I see myself riding in the 140s-170s. For someone who wants to do minimal work, leaving ControlIQ in its normal mode will work better as the hourly autocorrections might be needed. Please do not try this or anything on this blog without discussing with your prescriber.
It looks like I’ll continue using sleepmode 24/7 for the foreseeable future.
If it isn’t magical, then something might be wrong. This system doesn’t take time to get to know you like other commercially available systems. Of course, there is an adjustment period to any new device and it might take you a while to figure out what works. If you are consistently, crazy out of range though, it might not get a lot better… you likely need to make insulin adjustments.
If you are hesitant to start it because your HbA1c is <6.5%, I think you should give it a shot. If anything, it’s kept me at the same HbA1c or lower, with less variability. I haven’t noticed an increase in BGs at all, despite the rise in the BG target.
Again, this blog post was intended for healthcare providers, but if you have diabetes, please do not try anything without approval from your prescriber.
That’s all for now. Happy pumping, everyone!