Control IQ Basal IQ: No, It’s Really Mental Health

I purchased my first Tandem X2 pump in December 2016. Shortly after that in April 2017 I transitioned to Medicare. Thus when my original pump went out of warranty in early December 2020, I was free to choose a new pump. I am sad that there are not more pump choices these days. I hated Omnipod and it is a poor financial choice under Medicare. I liked my Medtronic pumps ways back when, but I would never abandon Dexcom for Medtronic sensors. So it is Tandem again. I was not unhappy to continue with Tandem but I was sad to miss the excitement of a new D-device, because the new one is the same as the old one.

But not entirely.

I had the choice of purchasing a Tandem X2 pump with the Control IQ software or a Tandem X2 pump with the older Basal IQ software. So I chose Basal IQ and I am now in the unique position of being able to choose between Basal IQ and Control IQ depending on which pump I am using. 

I have never been completely satisfied with Control IQ and chafe at target ranges that are higher than I prefer and significant insulin suspensions that result in highs later on. Basal IQ is much quicker to resume insulin after suspensions and I was excited to get back to it. Initially I was happy with somewhat better BG readings and more control over my pump behavior. 

But after a month, I chose to go back to Control IQ today.

Why?

One of the reasons is minor. I really missed the automatic population of my sensor reading when I was bolusing. Somehow it has been a step backwards (okay, I am lazy!) to have to type in the number. Minor, but significant.

Another reason is that my initial excitement and honeymoon period with Basal IQ ended quickly and I wasn’t doing better with it than with Control IQ.

But mostly I missed the constant basal adjustments that Control IQ makes to tweak my blood glucose. (Please note that I use Sleep Mode 24/7 so I don’t get automatic boluses by Control IQ.) Because our infused insulin is slow, slow, slow, these adjustments don’t work as quickly as my inpatient self would hope, but they do help. Control IQ gives me better and more consistent morning wake-up numbers. It also allows me to occasionally forget about diabetes when I hike and play golf. 

I have never figured out “perfect” pump settings with Control IQ and previously took an injection of Lantus every evening to give me insulin that Control IQ couldn’t take away. https://testguessandgo.com/2020/09/25/going-untethered-with-control-iq/ That worked well but I have not missed the daily 7:30PM phone alarm beeping “Time to take a shot, Laddie!” So I am going to try to do without the untethered regimen, but that remains to be determined.

I have a history of my doctors thinking I am doing great regardless of my diabetes regimen. I was one of the last Type 1 patients to start Lantus because my world-renowned endocrinologist thought I was doing well on NPH. During the 2015 Blog Week (remember Blog Week?!?), I wrote that the biggest improvement in my diabetes care was the result of an internal medicine doctor switching me to Lantus. So much for world-renowned endocrinologists….

https://testguessandgo.com/2015/05/14/my-blue-ribbon-first-place-change/

That being said, I think that I am capable of getting the same A1c on injections, pumping without sensors, pumping with sensors, Basal IQ, and Control IQ. I truly believe that I am safer with sensors, but I can get reasonable BG numbers without them. Not completely true, because there would be some bad lows. But what I truly want is easier diabetes and that seems to be an elusive goal.

The biggest weakness in all of my regimens is “ME.” Imperfect me, who works hard at diabetes every day, but who constantly makes less than optimal decisions. Second glass of wine resulting in too many post-dinner cookies. Thinking there is a way to successfully bolus for pizza or Kraft Macaroni ’N Cheese. Buying a Diet Coke at a convenience store and being too lazy to check to see if it is really regular Coke. (It happened this week. A perfect flatline in the 90’s up to the mid-200’s in 20 minutes.) There is no end to the ways to screw up. And I am a master at thinking WTH as I muddle through my days.

But WAIT!!!

I am not perfect but the real culprit is TYPE 1 DIABETES. It is amazing how incredibly difficult it is to control blood sugar without a functioning pancreas. When I make good decisions, I get a bad pump site. I wake up at a good number and don’t do anything “wrong,” but my BG soars today while yesterday it stayed in target range. I am a senior with skin and tissue issues that sometimes rebel at infusion sets and adhesives. I am really smart and experienced, but sometimes I have no idea what is causing highs and lows. My lab tests confirm that my body makes zero insulin and this is hard.

I am very cognizant of the fact that the more my insulins and technology improve, the more I raise my expectations of what my diabetes numbers should be. So I am always falling short.

I think that once again I am writing about diabetes distress. My endocrinologist is very satisfied with my diabetes numbers. She believes that at my age (68) with 44 years of diabetes, my Dexcom tracings are perfect. And I am really, really, mostly, mostly okay. But I could do better.

By switching back to Control IQ, I am going to work to accept the help it gives me and not stress over the limitations of the algorithm. And the limitations of my insulin. And the limitations of my behavior.

My old pump has battery issues and ultimately I will have to decide whether to update the new pump to Control IQ. But right now I am happy to have CHOICE. I may choose to go back to Basal IQ on the new pump next week. I may choose to stay with Control IQ on the old pump.

I like choice.

Unfortunately one thing I don’t have choice about is having diabetes….

11 thoughts on “Control IQ Basal IQ: No, It’s Really Mental Health

  1. Thank you for your input. I echo your same thought process about all the frustrations wanting to have better control even when the Dr. is content. I’ve experienced the same. I appreciated your opinions on the different pumps, CGMs etc as we are close to the same age and years being a Type 1. I am so very thankful for the progress of these tools that have given us major improvements since the old days of controlling our BG’s and how it has made our diabetes life so much more manageable . Here’s to more good things ahead and opportunities to share ways of encouragement to uplift one another!

  2. Laddie,
    Another excellent essay, but doggone it … I thought I was the only ‘imperfect’ one with T1D ??!!

    My MedT 630G warranty times out in a couple weeks and paperwork from the Big Chief Tablet with Crayola markings on it will being the processing for my new pump that will be the Tandem X2. I’ve not had a choice nor any such controlled experience so will just go with Control IQ. One less thing for me to muddle about with in my 70+ year old gray matter.

    I was on a ‘wait list’ to see my Endocrinologist last week in case someone would have cancelled their appointment. Didn’t happen so now I’m waiting to see her on April 2nd. That will be 6+ plus between appointments. Wonder what Medicare will say about pump coverage with that big of a gap? Probably nothing, but can be frustrating at times.

    Even though we all know many of us don’t need to see our Endos every 3-months.

    Short of that and we’re charging forward into the new 2021 and I’m cautiously optimistic of an overall improvement as related to the C-19 stuff. Of course my wife and I are doing all we can to keep a very low profile and stay as safe as possible.

  3. Another thoughtful and thought-provoking post, Laddie. I wonder if our expectations to *manage* T1D get mixed up with illusions that we should really *control* it. After all, many of us have X years/decades of experience with it and enjoy Y IQ points. For most pursuits, the combo of deep experiential knowledge and the capacity to learn and integrate new knowledge yields stellar success.

    And it happens, in the eyes of endo and CDEs, the results you achieve are labeled stellar. And still, we always want to do better.

    What a journey T1D is – not just the accepting the near 24×7 mental/emotional/intellectual toll of living with a chronic disease, but the bittersweet “life sentence” we get with so many tools,
    Insulins, and research that helps us – the very same suite whose variability & imperfection thwarts our ever achieving non-T1D glycemic control.

    Still I wouldn’t trade “my T1D” for any other disease …

  4. Thanks for the update Laddie! It’s so interesting to me, as I’m easily frustrated and disappointed when the CIQ doesn’t work as hoped/expected. I was thinking of trying your idea of the Lantus, and then was excited to hear how it was with the BIQ again… and in the meantime, my numbers have been the best they’ve been yet, still using Humalog and CIQ! Nothing really changed… though I did have a bad phase while trying some Canadian Novolog that seemed much slower to respond than expected, and perhaps a series of bad infusion sites…

    It’s SO satisfying when my BG is responding as expected, and is a reminder, once again, of how many variables there are, so many of them out of our control… It’s also a good reminder to not be so hard on ourselves when we’re doing the same things and getting different (frustrating) results!

  5. Thank you Laddie, I’m also 68 and live in Bemidji but, not on Medicare yet because my husband is still working. My Medtronic 670 warranty expires next November and I’m planning to switch to Tandem at that point. My Endo, who thinks I’m doing great, 🤪 told me to let him know 6 months before I wanted to switch and he would have me meet with a Diabetic Educator to help me decide which pump I want. (The last time I met with her, several years ago, I was teaching her stuff.) I’ve refused to go back. Because I live in a small town, my resources are limited. So, I get most of my education from browsing and following people like you, who are going through the same stuff and “understand “. I had my husband read this blog and he said, “gosh, you could have written that”. I am thankful for the technology breakthroughs in our lifetime and that I’m pretty much complication free after 55 years. I have had a couple of very good Diabetes Educators in my lifetime that got me through 2 pregnancies and starting the pump but, they are long gone. Thank you for taking the time and doing such a great job of articulating what it all feels like!

  6. I upgraded to the medtronic 770g recently and love it. But what i love most about he modern pump market is that i think the manufacturers are feeling heat form pumps not even introduced as yet. With Lilly reentering the market next year, the European pump manufactures coming and new sensors and pumps close, I the the future looks great.

    Hopefully Medicare will keep up with the technology that is on the horizon.

    By the way Happy New Year Laddie !!!

  7. After more than 50 years with diabetes, I realize that the human body is amazing and that, while all the technological improvements have been so beneficial, the bottom line is that we cannot replicate with technology (yet) that which the pancreas and other hormones do in a normal state of function.

    So when things go awry, as they often do, I am first to blame myself – but then I realize all the variables that go into being human and operating with this ‘artificial’ pancreas. We are not robots. Sometimes we have to be satisfied with the ups and downs – literally – as we strive to do better while living life.

  8. Great post! Even though I cannot identify with the CIQ issues, I certainly identify with the struggle to manage. I especially appreciated your comment about the second glass of wine that then enables, actually ‘encourages’ one to eat a sweet or two – in my case chocolates. Ugh! Last two holiday weeks had my time in range hovering around 75%. Merry Christmas & Happy New Year to us all. It is a new year and I plan on being ‘in range’ 90+% of the time. Thanks so much for your good post. You write so well!

  9. once again, a thoughtful post. I turned 72 today. I’ve been using humalog for about 15 yrs. so that’s 1 difference right there. I’ve been following your problems w/CIQ the whole time and it’s interesting the different approaches. I wonder if I just might not be as particular. In any case I really like CIQ. I use sleep mode when I sleep. Off when I wake up. I love the way CIQ corrects but I’m still not adjusted perfectly as it will sometimes make me go low…but I’m close. Once again I appreciate your effort, insights and frustrations. I guess that’s why you call it testguessandgo…😊

  10. I can relate to all your issues with pjmp types a insulin being too slow. I tried Tandem but sent it back after constant occlusions. My situation is aggravated even more drastically being on steroids fir Addisons. My BG can jump to 400 at the drop of a hat. No carbs would be the solution, but….

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