Diabetes Tech: Moving into the Future

2020 has brought long-awaited changes to my life with diabetes. I am using my second Dexcom G6 sensor and so far it has been fabulous. Of course there is something quite pitiful that a diabetes device is the coolest thing in my life and I am not bragging about a new Tesla or Coach purse. But that’s life with a chronic disease….

Those of us on Medicare are late to the G6 game and you can find tons of reviews online and don’t need a review from me. But I will quickly say that the insertions have been painless and I am seeing more consistent accuracy with G6 than I ever saw with G5. (And I considered G5 to be very good.) Here is an image from Day 9 of my first sensor.

I am thrilled with not having to calibrate the sensor. One, it is not required for accuracy in most cases. Two, it eliminates the constant calibration notifications on my phone, watch, and pump. I calibrated the first sensor twice. On Day 6 it was reading super low in the 50’s when my BG was 110. A calibration quickly brought it back in line without the delays or rebounds common with G5. But the next day all of a sudden the sensor was reading too high and I had to do a reverse calibration of the previous day. The two calibrations essentially cancelled each other out and I wonder if I shouldn’t have done the first one. To be determined as I gain more experience….

If my first two sensors are a valid test, I can say without doubt that Dexcom G6 is an improvement over G5. But the biggest change in my diabetes tech life is….

Basal IQ.

As described on the Tandem Diabetes provider website: “Basal-IQ technology uses a simple linear regression algorithm that uses Dexcom G6 CGM values to predict glucose levels 30 minutes ahead based on 3 of the last 4 consecutive CGM readings. If the glucose level is predicted to be less than 80 mg/dL, or if a CGM reading falls below 70 mg/dL, insulin delivery is suspended. Insulin delivery resumes as soon as sensor glucose values begin to rise.”

For many years I used temporary basal rates of zero to head off lows. But frankly although it was a helpful technique, it didn’t always work great. The insulin suspension took too long to work and often resulted in highs later on. The difference between my attempts at manipulating insulin and Basal IQ is that the Tandem pump suspends insulin predictively. It is smarter than I am. I am smart, but Basal IQ is smarter.

I have been using Basal IQ for 2 weeks and there is no doubt that I have had fewer lows. I have had a few nights where I had no Dexcom alarms for lows. For me that is monumental. But in typical diabetes fashion I have had a few nights with moderate highs that repeated boluses are slow to bring down. There is some comfort in knowing that I can bolus more aggressively than in the past because Basal IQ will ameliorate (but not necessarily prevent) the inevitable resulting lows.

One thing I like about Basal IQ is that I can chose no notifications when it turns on and off. I am a poster child for alarm fatigue with my diabetes devices. Basal IQ prevents a lot of my lows resulting in few alerts from the Dexcom app. But I still rarely have a night with no diabetes issues and either need to completely stop snacks in the evening or raise my high alarm threshold.

I think it is interesting that Basal IQ can be considered to be a basal test. One might argue that if you repeatedly have a 3-hour period overnight where your basal is suspended for almost the whole time, your basal rates might be too high. Or if you have a period of sustained highs and never have suspended insulin through another period, maybe your rates are too low. I assume that somewhere in between is the “sweet basal spot.” But maybe not — because I have always suspected that there is not a perfect basal profile that works for every day. Remember the Diatribe 42 factors that affect blood sugar. 

In the online community, especially the Seniors with Sensors group on Facebook, there are many seniors doing really well with their diabetes. The definition of “really well” differs from person to person. But at my age if you’re satisfied with your care, your D-numbers, and have a supportive doctor, I think you’re doing really well. Some seniors using the Tandem pump and Dexcom G6 are thrilled with Basal IQ and appreciate help avoiding lows. I am mostly in that group. Others are frustrated with post-insulin-suspension highs or are convinced that a sensor-augmented insulin delivery system can’t match their manual results. A lot of seniors are going to have a hard time giving up manual control of their diabetes and their concerns are valid. In contrast the diabetes world has a whole generation of CGM users growing up not knowing anything other than complete trust in their sensors. And soon that will be the norm, not we old folks who used pee-strips, urine-testing chemistry sets, and 15 BG meter tests a day.

Tandem’s Control IQ has been approved by the FDA and will soon be available via a software update to all of us with in-warranty Tandem X2 pumps. Even those of us on Medicare! My A1c and average BG will rise if I use Control IQ. Will the reduced mental burden be worth it? Statistics and my endo might argue that I would be healthier and living with less risk if my A1c increased. Am I old enough that I should be modifying my targets and treatment? Do current risk studies for seniors with Type 1 diabetes reflect the adoption of CGM technology that protects us from most severe lows? How good does my diabetes control have to be? The questions go on and on.

I know people online who will never adopt new technology that they don’t trust or that might raise their A1c’s out of the low 5’s. I know others who are always open to trying new things and are willing to take some risks on the path to diabetes nirvana. And for sure there are people who have struggled every day of their diabetes lives and are willing to let smart technology take control of their physical and mental health. I am not sure exactly where I stand on these decisions and know that I will be writing more in the future about Control IQ.

At the moment, I am still learning Basal IQ and feel my D-life has been improved with this technology and the Dexcom G6. One roadblock that might prevent me from updating my pump to Control IQ is that I will not have the option to go back to just Basal IQ. They are completely different pump software configurations and algorithms. By going with Control IQ I am limited to the programmed target blood glucose levels for highs and they are higher than I currently target. Basal IQ just addresses lows and leaves highs to me. Does it matter? I don’t know and plan to stay on the sidelines a while before making the commitment to change.

If you are considering Control IQ, I suggest that you listen to this Diabetes-Connections podcast where Stacey Simms interviews Molly McElwey Malloy from Tandem. After listening to the podcast I was comfortable that Control IQ would be good for me. But I know I need to learn more before committing. This coming Wednesday (1/15/20) Tandem will have a live presentation on Facebook explaining Control IQ and answering listener questions. I don’t have a specific link but here is a screenshot of the email i received from Tandem. For sure you’ll hear more from me in the future about Control IQ–my opinions and those of my fellow seniors with diabetes.

 

9 thoughts on “Diabetes Tech: Moving into the Future

  1. Laddie,
    This is an excellent update withe the Basal IQ and G6. I’ll be able to get my Tandem X2 one year from now as the “Medicare/CMS Warranty” on my current pump will time out. Certainly looking forward to that change.
    I have my G6 kit, but have been using my G5 until supplies dwindle to naught. My current G5 transmitter has about one week left and I have another one (transmitter) on the shelf, but only have enough sensors for 6-weeks.
    I’ve been planning this to help build up a small supply of G6 products. I’ll be getting a new G6 transmitter in the next two weeks so will be slightly ahead of the curve … so to speak.
    I may transition to the G6 when my current G5 transmitter battery runs out.
    I’ve also been using (testing) Fiasp for the past 2-1/2 months and I really like it. I have one vial left (my Endo gave me 5 vials to trial). My quarterly visit is early February and I’m considering getting an RX for Fiasp to replace the Novolog. I’ve read where many Fiasp users have no problem getting via Part B (DME) and they are also using in their X2 pumps without any problems. So that is a good sign for my “plan”.
    Anyway … I’m excited about the technology changes and looking forward to Basal-IQ to help minimize my overnight lows.
    Again … very good post and update.

  2. Hey I had not heard of the seniors with sensors group. I may see if I can join. Being 63, I might not make the cut off. I am glad to hear your pump and sensor is firing on all cylinders. That is awesome.

    • Rick, you should definitely join the Seniors with Sensors group because not everyone is on Medicare yet. Most of us are using Dexcom because that is what Medicare covers, but there are still some people who love their Medtronic system and are hoping for Medicare coverage of Medtronic sensors. Plus it is a good source of information about all things senior and diabetes.

  3. Great to hear you got the G6 and now can also use the Basal IQ! I love it too, and have the same hesitations about switching to the Control IQ. I’ll wait and see for a bit…

    I want to thank you for your bandaid trick!! I’ve been using it since your post, and it has changed my life, truly. (don’t want to jinx it though…) I’ve actually had to decrease my already low basal rate, as I was having so many lows, and taking even lower boluses. It’s also allowed me to use sites (sides of my thighs) that previously didn’t work well at all, which is hugely helpful. Thank you! You never know when something you write about will have this kind of impact on someone’s life.

    • That is weird that you talk about lows because I have had a bunch of them and wonder if I am absorbing insulin better with a more shallow insertion. But maybe it’s a coincidence….

      • I definitely can correlate my increased lows with using the bandaids. It’s been a dramatic shift! And I’m happy because it means I’m getting great absorption now in spots I couldn’t use before.

  4. I’m encouraged to read about your overall good experience with the G6 and Basal-IQ. Like Nolan Kienitz, I am in G6 accumulation mode as I use up my existing G4/G5 supplies. I am mostly concerned about G6 sensors not making it to their stated 10-day wear time. I did an informal poll on the Facebook G6 forum and found that a large majority of people (over 500 responses) report getting at least 10 days out of their sensors. It’s good to see that Basal-IQ is working so well for you. I would be wary too of switching to Control-IQ when B-IQ performs well and there is no return path to B-IQ once C-IQ is downloaded. Your tactic of waiting for some time to see what the early adopters report will add to your knowledge and improve your decision. As usual, you are exhibiting great common sense. Good luck with all this new tech!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.