Community Table: Women’s Health and Living Empowered with Diabetes

This content originally appeared on Beyond Type 1. Republished with permission.

During our third Community Table discussion, Beyond Type 1 sat down with a group of experts and community members to discuss women’s health and living an empowered life with diabetes within both the type 1 and type 2 communities, and share helpful resources and personal perspectives. Watch the discussion in full!



Speakers included:

Partial transcript of conversation below, edited for content + clarity.

What’s the one thing you wish someone had told you about women’s health and diabetes?

Dr. Gomber: It’s okay to not strike that perfection of 100%. It’s absolutely all right if you can’t figure out how to deal with everything, including your hormones. As a person living with type 1 diabetes and as a trained physician, I realized it by trial and error by realizing that hormones are something which I need to adjust, make a balance myself.

Lexie: There are so many things that can affect your body in so many different ways. Nobody ever really explained to me what insulin resistance was, and everything that can come from insulin resistance. I recently got diagnosed with PCOS (polycystic ovarian syndrome) at the beginning of 2020 and it’s been a crazy journey. My husband and I have been trying to get pregnant and for the past 3 or 4 years, I’ve had irregular menstrual cycles. I just thought it was normal.

Doctors never put two and two together for me that PCOS and insulin resistance are linked in a lot of cases. Years ago, when I was in college, I had an endo tell me, “Hey, you’re showing signs of insulin resistance.” But he never said anything else. I thought, “Okay. Well, my A1C isn’t that bad so I’m good.” I never made any changes because I didn’t know what that actually meant.

Whenever I was going to see my OBGYNs they never really connected the dots for me either. When I said I was having irregular cycles it was just, “Okay, well let’s put you on birth control.” It wasn’t, “Maybe this is linked to your diabetes.” I never had any idea until I went and did my own research.

Jessica: How many people actually have diabetes, and I wish I would have told myself to reach out to other people with diabetes sooner. When quarantine hit, I made an Instagram just so I could talk to other people because I’m the only one with type 1 and no one in my family has type 2. It seemed like I was an outsider sometimes and I really needed to know that I am not alone in this.

Marina: Diabetes management is much more than counting carbs, then giving insulin, and having a blood sugar of 110. It is so much more than that. It is emotional health, it is wellbeing, it’s so much more. Sometimes we want to have a feeling of control, and we control the food or we control whatever thing we can. That’s really the beauty of what I do is ask how we can have a positive relationship, and a holistic view in how we eat.

What should people know if they’re heading into the age of menopause that might help them out a little bit with that?

Dr. Porter: It is important to understand everyone’s body is going to react very differently to menopause, and you need to be your own advocate with your OBGYN to tell her that things are not going right. They might need to adjust your blood sugar management routine because it’s counterproductive.

When it comes to menopause, there is this one massive hormone called progesterone which acts as a complete monster when it comes to blood sugars. Progesterone actually increases your blood sugars. You need to adjust your insulin regimen to understand how your body is going to react to progesterone. Also, during menopause, there are other additional things that you can incorporate into your regimen like incorporating exercise or yoga. Which will improve your insulin sensitivity and help incorporate that resistance that is coming up with progesterone in your body.

What’s a challenge that you’ve faced that taught you how strong you are as a woman living with diabetes?

Marina: I just bring it back to pregnancy. I think that’s been my most challenging moment because again, I’ve studied. It wasn’t necessarily new to me, but these are new human beings. Once they were born, it was like, “Wow, you’re healthy.” That is all that matters, nothing else. That really proved to me how resilient people with type 1 diabetes are. We really have an extra skill, like we have two brains. We’re able to not just manage our blood sugar, but also be a mom, be a doctor, be a wife, be all of these different things on top of all of the demands of diabetes.

Lexie: There have been different phases years of my life that always reminds me how strong I am. So, the first thing was looking back at the time I didn’t realize it, but Aussie kids, little young kids on Instagram, like giving themselves an injection or changing their pump site. And I’m like, “Oh my gosh, they’re so young.” And then I’m like, “Let’s see. You were doing this same thing.” Then I’ve given myself insulin while driving. I inject it, and in my mind, before I would go somewhere, I’m already calculating, “Okay, I’m going to be gone for this long. Let me go ahead and get this number of snacks.”

Growing up with a chronic illness, it forces you to have compassion for any and everybody which has helped me be able to support others. I don’t think I’ve ever really felt more accepted and loved by a community like the diabetes community. It just teaches you to love people.

A question from a community member: “I was diagnosed at age 41. I’m now 44. I also live with Hashimoto’s. I’ve been using Dexcom for a year and the Tandem pumps in september. Will I ever learn my body?”

Jessica: Yes, you will! Obviously my experience is different than yours, but you just got to take it day by day. Again, find someone who is just like you. There’s someone else out there dealing with the same thing.

Lexie: I agree that you will learn your body, but also know that your body is going to change all throughout your life and diabetes is literally a journey. You’re never going to get to like a destination where it’s like, “Okay, I’ve got it. I’m good for the rest of my life.” That’s why it’s definitely important to connect with other people who are going to be with you on this journey literally for the rest of your life. Because your body is always changing. Like everybody has said, it makes such a huge difference to feel like you’re not alone.

Lala: You’ve only had diabetes for three years, you’re a baby. There are things that you’re going to keep learning for a very long time. I’ve had type one for 23 years. As you know, I just learned new things from this conversation. There’s always a learning curve and the learning curve is long. Have patience with yourself.

Marina: Sometimes it just takes either a visit to somebody that knows to say, “Hey, have you noticed this, this and that?” And it might take somebody that might have that experience or that education or that has gone through the same thing to say, “I did not know that.”

So just know that there are people that are educators, doctors, or people that have diabetes that could just help you out in a professional way as well to say, “Hey, look at your Dexcom. This is what’s happening. Have you noticed this?”

Source: diabetesdaily.com

Athlete & YouTube Sensation: Elijah

Tandem Diabetes Care Pump

This content originally appeared on Tandem Diabetes Care’s blog. Republished with permission.

Elijah is 11 years old and doesn’t let diabetes slow him down — not while pounding the pavement running cross country, and not while playing basketball, football, baseball, or his favorite, golf.

Having spent most of his life with type 1 diabetes, Elijah is a pro at overcoming challenges and adapting. He started on an Animas pump at four years old, then later switched to a tubeless pump. With support from his family, all of this change was manageable.

What Inspired Elijah to Try a Tandem Diabetes Care Pump?

One day, Shawn, a family friend and Tandem Diabetes Care team member who met Elijah the day he was diagnosed ten and a half years ago, proposed the idea of switching to a Tandem pump, but Elijah was reluctant. Elijah liked his current pump. Plus, he still had lingering worries from when his dog grabbed on to his tubing when he was four years old.

“Elijah did not want to switch,” explained mom, Molly. “And we understood, change is hard. He does a great job, but things were not going in a direction we felt good about… he was doing well, considering diabetes is a tough disease, but he had three consecutive A1c results, each higher than the one before it.”

Elijah wasn’t satisfied either. “My first experience wearing and using a pump was great, but I was always going really high and low. My blood sugars were not controlled well,” he explains. It also made some of his favorite activities more challenging, “My blood sugar, especially during baseball, would go low.”

The innovative Control-IQ® technology available for the t:slim X2™ pump piqued his parents’ interest. Around this time, they also moved in next door to Shawn. This created an opportunity for Elijah to get the feel of a Tandem pump, without an infusion site. He wore one around as a test drive of sorts.

Known by his family as a “numbers guy,” Elijah was really interested in the tech and advancement, and his parents reminded him that his body awareness had improved since he was four. They were optimistic the tubing would be less of a challenge, and it was a perk that the t:slim X2 pump offers a variety of infusion set choices.

It didn’t take long before he told his parents, “OK. Let’s do it.”

In October 2020, Elijah officially made the leap. He adjusted with help from some “diabesties” (friends in the diabetes community) and essential mentor, Shawn. By November, he was enjoying his newfound freedom.

“Everyone needs a Shawn,” exclaims Molly. Having that person, whether it be a diabetes educator or Tandem representative, can be an essential part in bridging the gap in “pump 101.”

Tandem Diabetes Care Pump

What Does the Family Love Most About the t:slim x2 Pump?

Elijah’s pump has settings for activities like Exercise and Sleep that can adjust basal rates and deliver automatic correction boluses, and it’s helping him focus more on his sports. “Putting my pump on the Exercise setting makes a big difference.” Whether he’s up to bat or sinking a hole in one, his blood glucose levels are on his mind a little less often these days.

“I sleep all night now,” says Molly, who loves the Sleep feature. “I can’t remember sleeping through the night before.”

These days, Elijah can go to bed at 200 mg/dl and wake up in the morning at 90 mg/dl–now that he wakes up with better numbers, it sets the tone for the rest of the day. After-breakfast spikes are also less likely. Molly describes the switch to Tandem like many often do, “It’s been a game changer.”

After trying a couple different infusion sets, Elijah has found his favorite, the TruSteel, which is rigid and is inserted manually. “He likes it because he controls it going in,” explains Molly. Elijah found that the automatic insertion of this tubeless pump would cause him anxiety each time it was changed. He counted every click in anticipation and was bothered when the timing differed from insertion to insertion.

“I was a little scared of tubing at first, but I don’t even notice it anymore,” says this active guy.

After a few months of use, it was time to see the endocrinologist. Starting at a 7.6 A1c in October, Elijah had achieved an impressive 6.8 by January. While they wish they would have made the switch to the t:slim X2 pump sooner, Molly wanted to wait until her son felt he was ready.

“As a parent, it changes the diabetes game 100%.” Molly goes on to say she knows that highs and lows are still possible, but are far less extreme with Control-IQ technology. When asked who, in her opinion, is a good candidate for a Tandem pump, she replied, “Anybody with type 1—if I was diagnosed tomorrow I’d go on one.”

Tandem Diabetes Care Pump

What Is Elijah Working on Now?

As for Elijah, his focus is on other things. He is hard at work on his own YouTube channel, Diabetic Dude, which features feel-good content and messages about diabetes awareness. “I mainly started to show people what type 1 diabetes is. It’s a serious disease, but I want to show people I can still do everything normal. I’ve started making more fun and hilarious videos.” He hopes his channel becomes lucrative, so he can donate proceeds to JDRF, a nonprofit 501c organization that funds type 1 diabetes research.

“I feel like he has more freedom, I feel like he can be a kid,” Molly says, excitedly explaining how nice it is that he can just have a popsicle at a friend’s house if he wants one. Elijah and his family have only good things to say about other diabetes devices, but Tandem has brought them to that next level of diabetes achievement. They leave us with this insight about Tandem, “The tech is just better. “

We thank Molly and Elijah for sharing their story and wish Elijah a very happy 1-year anniversary of Diabetic Dude! Check out his channel and be sure to subscribe!

Tandem Diabetes Care Pump


 

Responsible Use of Control-IQ Technology

Even with advanced systems such as the t:slim X2 insulin pump with Control-IQ technology, you are still responsible for actively managing your diabetes. Control-IQ technology does not prevent all high and low blood glucose events. The system is designed to help reduce glucose variability, but it requires your accurate input of information, such as meals and periods of sleep or exercise. Control-IQ technology will not function as intended unless you use all system components, including your CGM, infusion sets and pump cartridges, as instructed. Importantly, the system cannot adjust your insulin dosing if the pump is not receiving CGM readings. Since there are situations and emergencies that the system may not be capable of identifying or addressing, always pay attention to your symptoms and treat according to your healthcare provider’s recommendations.

From time to time, we may pass along suggestions, tips, or information about other Tandem insulin pump user experiences or approaches to the management of diabetes. Please note, however, individual symptoms, situations, circumstances, and results may vary. Please consult your physician or qualified healthcare provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information before using a Tandem Diabetes Care product.

Source: diabetesdaily.com

10 Ways to Avoid Overnight High Blood Sugar

My biggest challenge when it comes to managing my blood sugars is the overnight hours. I know it is largely in part to the fact that I am a nighttime eater, consuming most of my calories after 7 pm. But I have also done some investigating and noticed my blood sugars naturally rise around 9-10 pm, so I am fighting an uphill battle. I started looking for some tips and tactics to try in order to improve my nighttime blood sugar levels.

Here are 10 tips on how to lower your overnight numbers, which will give you a better night’s rest too.

1. Basal Testing

This should come first no matter what issues you are having when it comes to your blood sugars. Without knowing the proper dose of “background” insulin your body needs, it becomes much more difficult to figure out how to dose for meals, creating a rollercoaster of events. In Gary Scheiner’s book “Think like a Pancreas” he explains basal testing in an easy-to-understand and methodical way.

2. Don’t Eat Too Close to Bedtime

Many people confuse this statement to mean that you can gain more weight by eating late at night. This simply not true. It comes down to a science and so long as you are in a caloric deficit, it doesn’t much matter when you take in your food. However, if you eat too close to the time you shut your eyes, it becomes more challenging to stay on top of your blood sugars. Eating about two hours prior to when you shut the lights will give you more time to assess how your blood sugar is trending, and (if needed) get your blood sugars back in range so you can get some sleep.

3. Take Advantage of Technology

If you are fortunate enough to own a continuous glucose monitor (CGM) , you should make the most of its features. Keep the alarms set to a high and low blood sugar number that you are comfortable with to help wake you if damage control is needed. You can also share Dexcom with a loved one who could alert you of dangerous numbers if you are unable to wake from the alarm on your own. Pumps like Tandem Basal Control have become extremely popular, as they can release insulin if your blood sugars get too high allowing you to focus solely on dreaming of a cure!

4. Try to Relax

It is known that stress can lead to higher blood sugar numbers and can also contribute to insulin resistance. When stress hormones like cortisol kick in, it can raise blood sugar levels, which is often what you see in the morning with dawn phenomenon. Additionally, stress hormones are known to increase insulin resistance. “Hyperglycemia is particularly exaggerated by elevations of cortisol and epinephrine in diabetes as a consequence of an altered response of the liver to these hormones,” scientists summarize. Put down your phone, drink some hot tea or read a good book in order to relax and put yourself in the right mindset for both in-range blood sugars and restful sleep.

5. Carb Count and Dose Accordingly

If you are taking insulin, this is something you likely do on a regular basis. Since I am so picky and stick to the same foods, I really don’t count carbs at all. I use the “WAG” strategy (wild a** guess), but this could wind up costing you a good night’s sleep. Make sure to count your carbs, know your carb-to-insulin ratio, time your dose correctly and keep your fingers crossed. Pumps have calculators built in to help make this easier for you and if you are on shots, you should check out the InPen, which has been a lifesaver for me in regards to getting my doses right and keeping my blood sugars in range.

6. Set Alarms and Stick to a Routine

Setting alarms will not only help remind you to take any oral medications and/or insulin but setting an alarm in the middle of the night can allow you to do a quick correction or chug some water if you are experiencing high blood sugars. Many times, if you take your medication or basal insulin an hour too soon or too late, it could impact your blood sugar levels.

7. Adjust Doses If Necessary

We are often so busy that we forget that many different things can affect both our medication and insulin doses. If you recently lost weight, started exercising, are taking steroids, changed your diet, or have become pregnant, to name a few, you should check in with yourself and your health care team to make sure you are taking the proper amount of medication. Ensuring that you are will no doubt give you better results at all times including the hours of rest.

8. Don’t Exercise Too Close to Bedtime

Many of us have busy schedules that only allow for nighttime workouts. If this is the case, try to fill up on protein-rich foods prior so that you don’t wind up with too much insulin in your system a few hours later when you are trying to fall asleep. Also, weight training can spike our blood sugar meaning you may wind up having to correct it. Being awake and alert for a few hours after a workout can only help your blood sugar management.

9. Be Wary of Delayed Blood Sugar Spikes Due to Protein

There are many times when two hours after dinner I am pleasantly surprised by my blood sugar number. But, I notice it starts to slowly creep up shortly after. Unlike carbs that quickly break down to glucose, protein can trigger a blood glucose rise that takes place over several hours. If your dinner is protein-heavy make sure to check your blood sugars a few hours after to troubleshoot any blood sugar spikes.

10. Stay Hydrated

Water plays a key role in keeping blood sugars in range. If we are adequately hydrated, the glucose levels in our blood can’t become too concentrated resulting in hyperglycemia. Water has the ability to reduce blood sugar by diluting the amount of sugar in the blood. Staying hydrated can also help you in your weight loss efforts. My advice is to make sure you get your water in throughout the day so you’re not paying for it with trips to the bathroom all night!

It isn’t easy to schedule in “troubleshoot my overnight numbers” to our already busy schedule, but taking the time to heed some of the above advice is sure to help your numbers improve, allowing for a more peaceful night.

Do you have trouble with your overnight blood sugars? Do you have any advice that worked for you? Share and comment below!

Source: diabetesdaily.com

Tech on the Horizon: Where Will Automated Insulin Delivery (AID) be in 2021?

This content originally appeared on diaTribe. Republished with permission.

By Albert Cai

What AID systems are currently available, what can we expect in the next year, and where is AID technology headed?

Want more information just like this?

As we enter 2021, we’re taking a look at what’s ahead for automated insulin delivery (AID) systems. Because the COVID-19 pandemic delayed many clinical trials and FDA reviews in 2020, several companies are expecting to launch new AID systems in 2021. This list covers many of the most notable upcoming products, but there are likely others on the horizon – if you know of a system you think we should track, please let us know.

Click to jump to a product, organized by expected launch date. You’ll find detailed descriptions and possible launch timelines for each, reflecting US availability.

What is automated insulin delivery (AID)?

Automated insulin delivery has many names – artificial pancreas, hybrid closed loop, bionic pancreas, predictive low-glucose suspend – but all share the same goal: combining continuous glucose monitors (CGMs) with smart algorithms to automatically adjust insulin delivery via an insulin pump. AID systems aim to reduce or eliminate hypoglycemia, improve Time in Range, and reduce hyperglycemia – especially postmeal and overnight.

When thinking about the development of AID technology, it’s often helpful to think in stages.

  • Stage 1: The most basic AID system might shut off the insulin pump whenever the user’s CGM readings drop below a certain number, such as 70 mg/dl, to reduce time spent in hypoglycemia and help prevent severe hypoglycemia.
  • Stage 2: The AID system could predict when glucose is going to go low and automatically reduce or stop insulin delivery to further help prevent hypoglycemia.
  • Stage 3: The AID system may be able to automatically adjust basal insulin delivery depending on whether the user’s glucose is trending up or down, and taking into account other factors, such as insulin on board. This adjustment of basal insulin would aim to increase Time in Range (TIR), and help prevent both high and low glucose levels. At this stage, the user would still have to manually give meal boluses and correction boluses.
  • Stage 4: The AID system will be able to deliver correction boluses when glucose values are high. These small adjustment boluses would be a further step in improving TIR, with less time with hyperglycemia.
  • Stage 5: The systems will be able to detect meals and automatically deliver a system-calculated meal bolus to reduce postmeal high blood glucose levels. With the elimination of manual meal bolusing, the system is considered to be a “fully closed loop” System.

Currently available products are in stages 3-4. By the end of 2021, we may have multiple stage 4 systems available.

Medtronic MiniMed 670G and 770G – already available 

AID

Image source: diaTribe

Now available for people over the age of two.

What is it? Medtronic’s MiniMed 670G has been available since spring 2017 and was the first stage 3 AID system to be cleared by the FDA. Prior to the 670G, Medtronic released stage 1 and stage 2 systems (Medtronic MiniMed 530Gand 630G, respectively). More recently, the MiniMed 770G system was cleared in the US in September 2020. Both the MiniMed 670G and 770G systems use the same insulin adjustment algorithm, which adjusts basal insulin delivery every five minutes based on CGM readings, targeting 120 mg/dl. The target glucose level can be temporarily raised to 150 mg/dl when low blood sugar (is a concern, such as during exercise or sleepovers for children. Both systems come with Medtronic’s Guardian Sensor 3 CGM, which has seven-day wear and requires two fingerstick calibrations per day (although four are recommended). See our article from 2016 for a full breakdown on the MiniMed 670G and from September for more on the 770G.

What’s the difference between the MiniMed 670G and 770G? As mentioned, both the MiniMed 670G and 770G systems use the same insulin adjustment algorithm and the same CGM. However, the newer MiniMed 770G has an improved pump: the 770G pump includes Bluetooth connectivity and can be paired to the MiniMed Mobile smartphone app (available for the iOS and Android) for users to view their CGM and pump information without pulling out their pumps. The app also allows users to share their data with others in real-time. Note: users can only view information but cannot control the pump (e.g., deliver a bolus, adjust basal rates) from the app. Bluetooth connectivity also means the system’s insulin adjustment algorithm can be updated. Medtronic has promised current MiniMed 770G users a free upgrade to the MiniMed 780G when that system becomes available (more below). Finally, the MiniMed 670G is only cleared in the US for people over the age of seven, while the MiniMed 770G is cleared for people over the age of two.

Medtronic management recently shared that algorithms will become an increasingly important part of the diabetes ecosystem, and presumably, a key differentiator for companies – lots of exciting times ahead with AID, that is for certain.

Tandem Control-IQ – already available in US

AID

Image source: diaTribe

Now available for people six years and older.

What is it? The Control-IQ system from Tandem was cleared by the FDA at the end of 2019 and launched to customers in January 2020. It’s precursor – Basal-IQ – was cleared in 2018. The Control-IQ system uses Tandem’s t:slim X2 pump, Dexcom’s G6 CGM which requires no fingerstick calibrations, and the Control-IQ insulin adjustment algorithm. In addition to automatic basal rate adjustments and predictive insulin suspension, the Control-IQ system is the only AID system with automatic correction boluses: when it predicts glucose to be above 180 mg/dL in 30 minutes, the system will deliver 60% of the correction bolus needed to reach a target of 110 mg/dL. Control-IQ targets glucose values between 112.5 and 160 mg/dL, though users can turn on or schedule “Sleep Activity” mode to achieve 112.5-120 mg/dL by the morning. This past summer, Tandem launched the t:connect smartphone app (for iOS and Android), which allows users to check their pump and CGM data on their phones.

What’s next? With the current t:connect smartphone app, users can view information but cannot control the pump (e.g., deliver a bolus, adjust basal rates). Tandem has already submitted an updated app with pump control to the FDA and expects to launch that functionality in 2021. Tandem has also mentioned enhancements to the Control-IQ algorithm that are expected in 2021. While we haven’t heard many specifics, we believe it’s likely that these enhancements will focus on improving glycemic outcomes, personalization, and usability of the system.

Insulet Omnipod 5 – expected early-to-mid-2021 

AID

Image source: diaTribe

FDA submission is likely coming soon (if it hasn’t occurred already), and Insulet aims for a “limited” launch in early-to-mid 2021. Insulet has completed the clinical trial for Omnipod 5 but has not shared the results.

What’s new? Omnipod 5 is Insulet’s AID for its popular Omnipod disposable pumps, also called patch pumps. If you’ve been following the field, you’ll know that Insulet previously called the new system Horizon – same system, new name. Omnipod 5 uses Dexcom’s G6 CGM, and Insulet expects to launch the system with smartphone control capability; users can still opt for a dedicated controller device, since smartphone control will be available for Android users first. Insulet is working on an iPhone version for Omnipod 5, though that will not be available at launch. Insulet is also working with Tidepool (more below) on an iPhone-based AID system. Omnipod 5 will have adjustable targets between 100 to 150 mg/dl. Because the Omnipod pump will store the algorithm and communicate directly with Dexcom G6, the system will work even without the smartphone or pump controller nearby.

Medtronic MiniMed 780G – expected mid-2021

AID

Image source: diaTribe

Pivotal trial completed for 780G and presented at ADA 2020. Medtronic aims to submit the system to the FDA by January 2021 with launch coming around mid-2021 for adults (either ages 14+ or 18+).

What’s new? The MiniMed 780G will be Medtronic’s second AID algorithm and a significant upgrade over the MiniMed 670G and 770G systems. In addition to automatic basal rate adjustments, the MiniMed 780G will include automatic correction boluses and an adjustable glucose target down to 100 mg/dl. The system will also have fewer alarms and simpler operation with the goal of further increasing Time in Range. The MiniMed 770G and MiniMed 780G pumps are identical, meaning MiniMed 780G users will also be able to use the MiniMed Mobile smartphone app for viewing pump data, uploading pump data wirelessly, and updating their pump wirelessly. As the pumps are identical, Medtronic has promised that those who purchase the MiniMed 770G now will be able to wirelessly upgrade to the MiniMed 780G for free when 780G does become available. Finally, the MiniMed 780G will use the same Guardian Sensor 3 CGM as the 670G and 770G, which requires two fingerstick calibrations per day and has a seven-day wear time. As a sidenote, an improved CGM sensor is in development by Medtronic, but isn’t expected to be available when MiniMed 780G launches.

The MiniMed 780G is already available in many countries in Europe, and data from a clinical trial was presented at the ADA 2020 conference. On average, the 157 participants in the study (ages 14-75) saw their Time in Range improve by 1.4 hours per day (69% to 75%) while using the system – that’s particularly notable given the low baseline of the A1C. Speaking of A1C, the A1C improved by 0.5% (7.5% to 7%) after using the system.

Beta Bionics insulin-only iLet – expected mid-to-late-2021

AID

Image source: diaTribe

Pivotal trial underway with completion expected in the first half of 2021. Launch expected mid-to-late-2021, though this is subject to change.

What’s new? Beta Bionics is a Massachusetts-based startup developing an AID pump and algorithm called iLet. iLet will work with Dexcom and Senseonics’ CGMs (and possibly others in the future) and is designed to be especially user-friendly. diaTribe founder Kelly Close participated in an early Beta Bionics trial (2013!) and raved about the system and how easy the pump seems. At set up, users only need to enter body weight (no insulin-to-carb ratio, sensitivity factor, basal rates, etc.), and the system will learn more over time. To bolus, users will use icons to describe meals as containing more, less, or the same amount of carbs as usual (no carb counting). The insulin-only clinical trial for iLet began in the summer of 2020 and is expected to wrap up in the first half of 2021. Beta Bionics aims to launch iLet mid-to-late-2021, though this could be delayed as the FDA continues to prioritize COVID-19-related devices.

What’s next? Beta Bionics’ iLet is unique from the other pumps on this list, because it is designed to work in either insulin-only or insulin-and-glucagon configurations. With glucagon, Beta Bionics believes the system can reduce hypoglycemia while maintaining stable glucose levels and potentially even better-than-average, lower glucose levels due to availability of glucagon. Currently, there are different views on using glucagon in an AID system – in addition to the potential for improved glycemic management, there are uncertainties around glucagon pricing and availability. Regardless, the insulin-and-glucagon version of iLet is still a few years away.

Tidepool Loop – launch timing unclear

AID

Image source: diaTribe

Online observational study completed, and launch timeline depends on FDA progress.

What’s new? Unlike the others in this list, Tidepool is a non-profit and is working on the AID algorithm only; Tidepool does not have its own insulin pump or its own pump and CGM combination (like Medtronic). About two years ago, Tidepool announced plans to submit the do-it-yourself (DIY) Loop app to the FDA to become an officially supported app available on the Apple App Store, compatible with in-warranty, commercially available pumps and CGMs. For now, DIY Loop is a free, publicly available, open-source, non-FDA-approved AID system that works with Dexcom and Medtronic CGMs and old Medtronic and Insulet pumps. Read about Adam Brown’s experience using DIY Loop here. For those who are very interested in the project, there is a great deal to learn from notes that Tidepool shares about its communications with FDA – the latest notes are from a mid-2020 meeting.

Initially, Tidepool plans to launch with Insulet Omnipod and Dexcom G6 compatibility. To set it apart from the DIY-version, Tidepool Loop will have different colors, guardrails around certain settings, and a built-in tutorial for new users. A 12-month, completely virtual study was performed with Loop users and will support Tidepool’s submission of Loop to the FDA. The six-month data was presented at ATTD 2020 showing a Time in Range increase of about 1.4 hours per day (67% to 73%) with Loop. Tidepool also announced in November, 2020 that its human factors study had also been completed – this is another required step of the FDA submission. Much of what Tidepool is doing is unprecedented, so the launch timing is unclear.  In an update on January 8th, Tidepool shared that it has now completed FDA submission of Loop.

Source: diabetesdaily.com

Tackling Carbs with Tech

Many people who live with diabetes avidly avoid eating carbohydrates, as historically speaking, it has been notoriously difficult to cover carbohydrates appropriately with exogenous insulins. But with access to better, faster insulins and the uptick in the use of patient-friendly technology, things are changing, and people’s diets (and their feelings of freedom) have expanded more than ever. Here are the best tech-friendly hacks to tackle the carbohydrate conundrum.

MyNetDiary

This popular app has a searchable database with nearly a million food entries for people to access and look up carbohydrate counts on the go. The company also has a separate Diabetes app that allows users to track blood glucose levels, HbA1c results, and insulin doses, to track their progress over time. If you’re looking to lose weight, MyNetDiary can create a diet plan to meet your needs. You never have to feel restricted when eating meals with family or friends, having all your carbohydrate counting needs right at your fingertips.

Photo credit: GreaterGoods

GreaterGoods Nourish Digital Scale

This food scale is a game changer for those who cook with lots of fresh produce, where carbohydrate counts can vary quite a bit. This scale lets the user view nutrition facts for over 2,000 foods in the scale’s built-in database, and create up to 99 more custom entries. Measure individual ingredients, track full meals, and calculate daily carbohydrate intake much easier with this digital scale.

InPen

This revolutionary device is the only FDA-approved smart pen insulin system that helps prevent users from “stacking” their insulin doses and take the right amount of insulin at the right time. This device works in tandem with a phone app, where users can track insulin on board/active insulin, personalize your doses, sync with continuous glucose monitor (CGM) or glucometer data, and share reports with others. The pen itself is compatible with Humalog, Novolog, and Fiasp, and will even dose in half units. Eating carbohydrates has traditionally been much harder on multiple daily injections, but advancements such as the InPen are making strides to make life much easier for people with diabetes.

Use Alternative Pump Boluses

If you are an insulin pump user, dosing for a high carbohydrate meal can also be difficult, especially if the meal also has a moderate amount of protein and fat (which can delay the absorption of the glucose in the meal). To handle that, try opting for a combination bolus (a.k.a. Combo Bolus or Dual Wave Bolus,  for Animas or Medtronic users, respectively; Omnipod, Tandem t:slim users will use “Extended Bolus”). This is a hybrid delivery mode: a specified portion of the total insulin bolus is delivered upfront, as a normal bolus, while the rest is delivered over a specified period of time as an extended/square wave bolus.

For example, given a 12U dose delivered as a 60/40 combination/square wave bolus over 3 hours: 60% of the total dose (7.2U) will be delivered within seconds of pressing the “deliver” button; the remaining 40% (4.8U) will be delivered equally every few minutes over the next three hours. The result is an initial dose to cover faster-digesting foods, plus an extended amount of insulin action to deal with the slower-digesting foods (which tend to be fattier or have more protein), and to prevent postprandial spikes in blood glucose. Utilizing these settings can be extremely helpful when you’re eating foods like pizza, pasta, Chinese food, Mexican food, or ice cream. Always consult with your diabetes healthcare provider before making any changes to your dosing routine.

Dexcom CLARITY Diabetes Management Software

Photo credit: Dexcom

Dexcom Clarity App

This software can be helpful for patients already using the Dexcom continuous glucose monitoring system, but are wanting to track and change problematic patterns in their blood glucose. This app lets you set target goals for your blood sugars, will track time-in-range, detects patterns of highs and lows and will alert you to them, and will even give the user a predicted HbA1c result. You can also choose to share your data with your health clinic to make changes to your insulin routine or insulin to carbohydrate ratio in real time, and to really find what will work best for you for optimal management.

Living with diabetes is never easy, but thankfully technology has made counting carbohydrates and eating easier than ever before. What apps or tech has helped you to navigate food, eating, and counting carbohydrates? What’s worked best and what hasn’t? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

Tandem’s Control-IQ Cleared for Ages 6-13: Automated Insulin Delivery for Children!

This content originally appeared on diaTribe. Republished with permission.

By Divya Gopisetty, Hanna Gutow, and Albert Cai

In exciting news, Tandem announced expanded clearance for the hybrid closed loop Control-IQ. The system is now available for children ages 6-13

The FDA cleared Tandem’s automated insulin delivery (AID) system, Control-IQ, for children ages 6-13, last week in the US. This system is designed to increase time in range for users and it does – see below for the data!

To date, the only other hybrid closed loop system available for children is Medtronic’s MiniMed 670G, which is approved for children seven years and older. Control-IQ is the first system with automatic correction boluses and no fingerstick calibration (thanks to the Dexcom G6 sensor that it uses).

Control-IQ launched in January of this year for people 14 years and older. Since then, more than 40,000 t:slim X2 pump users have upgraded their pump software to Control-IQ. We saw very positive real-world data presented at ADA this year – in the first 30 days using Control-IQ, users’ time in range increased by 2.4 hours per day, and individuals were in active closed loop 96% of the time.

At the ATTD conference in February, the trial for Control-IQ in children presented strong results. Results from that trial were used to get this week’s FDA clearance. In that trial, we learned that:

  • Children using Control-IQ spent 67% time in range, compared to 55% for children using a sensor-augmented pump. This is a massive difference that equals nearly three more hours in range each day.
  • Children using Control-IQ reached 80% time in range overnight, compared to 54% in the control group – similarly, this change is even bigger, at over six hours more daily time in range.

Control-IQ still should not be used in children under the age of six, in people who require less than ten units of insulin per day, and in children who weigh less than 55 pounds.

For more information on the system, check out Kerri Sparling’s Test Drive of Control-IQ where her time in range improvement was quite impressive! You can also Katie Bacon’s piece on one family’s takeaways (her own!) from the first month of their teenage daughter using Control-IQ.

Source: diabetesdaily.com

Control-IQ: The Good, the Challenges, and Tips

This content originally appeared on diaTribe. Republished with permission.

After a month of her daughter using Control-IQ, Katie Bacon reviews the pros and cons of the algorithm and shares her family’s tips and takeaways

When the email came through in early April that our daughter, Bisi, could now download the software to run Control-IQ on her t:slim insulin pump, the timing seemed perfect. After all, our family was staying at home due to COVID-19, so we had plenty of time together to do the training and figure out the new system and how it worked for Bisi and her blood glucose levels. Plus, from everything I’d read about COVID, keeping blood sugars as stable as possible was more important than ever, and it seemed like Control-IQ could help us with that. (The Control-IQ algorithm uses data from Dexcom’s CGM to lower insulin delivery when a low is predicted and to increase insulin when a high is predicted – learn more about Control-IQ here.)

Bisi has now been on the new system for about a month, and while it hasn’t been a magic bullet and we’re still learning, Control-IQ has improved Bisi’s time in range by about 5% (and we’re hopeful that her time in range will continue to improve). Also, even more importantly, it’s improved her quality of life – and ours, as the parents who watch out for her. When I sat down with Bisi recently to ask her about the change, I got her perspective on the burden she feels diabetes has placed on her ­– and the power of Control-IQ to lighten that load. She told me that before using Control-IQ, at any given time 30-40% of her focus was on diabetes. I was taken aback by this percentage, since Mark (my husband) and I have always tried to take some of the weight for her. As she told me, “It feels demanding, like a lot of pressure, as if someone’s poking my head.” But with Control-IQ, she says, she doesn’t need to worry about much except bolusing insulin at mealtime. She has fewer highs, fewer lows, and she says she feels better physically than she did before. “For as long as I can remember, diabetes has been a main focus of my life, but it really shouldn’t be that way. So it’s been nice not to focus on it as much,” she said.

In terms of what Bisi has experienced over the past few weeks since switching to Control-IQ, I’ve divided my thoughts into the pros and cons of the system as we’ve experienced it; I’ve also included tips drawn from what we’ve learned from Bisi’s endocrinologist and DCES.

Pros of Control-IQ:

  • Graph

    Image source: diaTribe

    We’ve found that Control-IQ works particularly well at night, when Bisi isn’t eating anything or bolusing. While our nights had already improved with Basal-IQ (which did a good job minimizing Bisi’s lows), Control-IQ brings down any highs as well (see the graph on the right). I’d say that when Bisi’s pump only dealt with the lows, we still had to wake up maybe six to eight nights a month, on average – and sometimes multiple times in one night. But in the month since Bisi started on Control-IQ, we’ve only had to wake up three times. This is a big change in our quality of sleep (and quality of life).

  • Control-IQ helps keep blood sugars down during the day. As before, Bisi’s blood sugars are less stable during the day, when her activity is variable and when she’s eating meals and snacks. But now, Control-IQ raises her basal rate when she’s headed high and gives modified boluses (60% of what’s called for) if the highs are sustained. We’ve found that her blood sugar does not rise as steeply, according to her CGM, and also that it often tops out at a lower number than it used to.

Cons of Control-IQ:

  • There were a few instances where Bisi had sustained lows that were more difficult than usual to counteract with carbohydrates. These instances have all been when she’s started exercising with a lot of active insulin on board, due to Control-IQ turning up her basal rate in response to a high. Before using Control-IQ, if Bisi’s blood sugar was high, she (maybe with a reminder from me) would have to make a decision to either turn up her basal or give a correction. If she knew that she was going to get exercise in the near future, she wouldn’t do either of those things. But now they happen automatically, so she’s sometimes stuck with too much active insulin on board. It requires a different kind of thinking and a different kind of planning than before.
  • Both Bisi and I wish there were a little more flexibility in Control-IQ so she could set her own target. Bisi used to set her target at 100 day and night, and would often run at 80 or 90 while she was sleeping. With Control-IQ’s built in Sleep Mode target of 110, Bisi runs a little higher than she is used to, especially at night.

Thoughts and Tips for using Control-IQ:

  • We have found that being consistent about pre-meal bolusing is even more important with Control-IQ than it was before. If Bisi waits too long to bolus, her blood sugar goes too high, she gets more basal and an extra 60% bolus from Control-IQ, and then her blood sugar goes too low later on.
  • While it might seem like Control-IQ could enable people to be a little freer in what they eat, so far it has emphasized the benefits of eating low carb as the best way to avoid food-related spikes and insulin-related dips. No matter how good an algorithm is, it’s always going to be reactive rather than proactive, and we’ve found that the smaller the inputs in terms of number of carbs eaten, the more smoothly Control-IQ works. (I think this is partly why it tends to work better for Bisi at night, when she’s not eating anything, than during the day.)
  • Bisi’s endocrinologist validated our sense that exercise-related lows can be steeper with Control-IQ, since you tend to have more active insulin on board. Because you can’t do a temporary basal rate with Control-IQ, she suggested that we set up an alternate program with basal rates cut by 50%. If Bisi knows she’s going to exercise, she can turn on this alternate program 90 minutes to 2 hours before. Or, if she’s eating beforehand, she can put in fewer carbs/give less insulin. Either way, the trick is remembering.
  • During Bisi’s most recent appointment, her endocrinologist pointed us to a feature of Bisi’s Tandem reports that’s helpful to look at as a way to adjust settings. She told us to focus on the difference in the Logbook section between the Basal Total Delivered and the Basal Profile Setting, as a way to tell whether her basal rate at any given time should be raised or lowered; the closer the settings are to the amount of insulin that’s being delivered, the more smoothly the Control-IQ algorithm will work. She also suggested that we “Marie Kondo” (streamline and declutter) Bisi’s basal rates, which had proliferated over time, to help us see more easily where adjustments need to be made.
  • We realized that if Bisi has a random high blood sugar, particularly at night, we should assume that something has gone wrong with her pump site. Before Control-IQ, pump site failure was only one of several reasons – including the dawn phenomenon and the meal she’d eaten the night before – that her blood sugar might have gone high. This realization has helped us reduce that middle of the night detective work, when your brain is at its foggiest. If Bisi has a persistent high, the problem is most likely the pump site, not the algorithm.
  • One adjustment that Bisi has struggled with is remembering to turn off her insulin when she takes off her pump to shower or play sports. (The Control-IQ algorithm is thrown off when the system doesn’t have an accurate sense of how much insulin you have on board.) This is a work in progress for us.

Even though we still feel like we have more work to do in terms of getting the best out of the new algorithm, Control-IQ has improved Bisi’s life in important ways. As Bisi’s endocrinologist told us, “It’s not perfect, and you need to think more about active insulin than you did before. But the goal with this is to have diabetes interrupt your life less than it did before.” For Bisi, the important aim of staying in range now requires less mental effort. As she said recently when looking at her CGM graph after 24 hours of Control-IQ: “This is pure gold.”

This article is part of a series on time in range made possible by support from the Time in Range Coalition. The diaTribe Foundation retains strict editorial independence for all content.

About Katie

Katie Bacon is a writer and editor based in Boston. Her daughter, Bisi, was diagnosed with type 1 diabetes in August, 2012, when she was six. Katie’s writing about diabetes has appeared on TheAtlantic.com and ASweetLife. Katie has also written for The New York Times, The Boston Globe, and other publications. 

Source: diabetesdaily.com

A D-Mom’s Changed Perspective Using Basal IQ

Technology continues to make managing our diabetes easier. Continuous glucose monitors, apps for carb counting and insulin pumps have all alleviated some of the stress of managing our condition. Tandem Diabetes created Basal IQ technology, which allows us to spend less time worrying about going low and let our devices do the work. For a person living with diabetes, this means less stress and more sleep.

Basal IQ technology helps reduce the frequency and duration of lows by predicting glucose levels and suspending insulin if the blood sugar level is thought to go below 80 mg/dL or the Dexcom reading goes below 70 mg/dL. Insulin delivery will start automatically once the blood glucose starts to rise again.

Basal IQ is different than the newly released Control IQ, in that Control IQ can adjust insulin delivery, including the delivery of automatic correction boluses as needed, therefore helping patients avoid episodes of hyperglycemia. Using either one of these systems also means fewer fingerpricks, as you will no longer have to get manually take your blood glucose reading.

Basal IQ technology has given many people living with diabetes, and those who love them, a little more rest and some peace of mind. A pivotal study showed the use of Basal-IQ Technology on the t:slim X2 Insulin Pump demonstrated a 31% relative reduction in time spent below 70 mg/dL when compared with a CGM-enabled pump without Basal-IQ Technology. Important to note, the less amount of time spent at lower glucose levels did not mean more time spent at higher glucose levels. Maintaining your target range has become a lot easier thanks to Basal IQ technology.

Photo credit: Allison Hoffman

One woman, Allison Hoffman, who helps manage her 10-year-old daughter, Becca’s diabetes, raved about the changes to her overall well-being since switching over to Basal IQ technology after relying on Omnipod for the past few years.

Here is her story:

For 7 years my mornings were absolute hell. While I would see others sleeping in, meditating, going to the gym, etc, I was a slave to Becca’s whackadoodle blood sugar swings, which would often start around 5:00 AM. My body learned to wake up at this time, and that I doubt I’ll ever be able to change.

My mornings would include me running up and down the stairs entering the bedroom, praying I wouldn’t wake her and deny her the right to sleep in, suspending insulin (audible beep I couldn’t silence), sticking glucose tabs in her mouth, often with the pay-off of a horrible blood sugar spike. I would start 95% of my days this way.

And the frustration! No adjustments to her settings were right. If I reduced her insulin she’d go high; .35 too low, .4 too high. I would wake up at 3:00 am to set a temp basal to get the amount she needed that Omnipod didn’t have as a preset-still wouldn’t work. Nothing I did was right.

Since starting on t:slim pump with basal IQ, I finally have my mornings back. It allows more fine-tuned insulin delivery and suspends when it predicts her to go low. As long as her sensor is good, and her insulin settings aren’t way off (I will always need to determine her insulin needs, it isn’t automatic), I can have a pretty peaceful morning now.

I can watch the news, or another show, or read, and my coffee doesn’t go cold. I can sit with my dog on my lap and not have to jump up every ten minutes to go deal with diabetes. I can breathe. And Becca can sleep peacefully.

I’ve made four seesaw activities for my students this morning and she’s still sleeping.

7 years of hell. I finally have my mornings back.

If you are living with type 1 diabetes and are considering a pump, you may want to look into t:slim X2 pump along with the Dexcom G6 so you can make use of the new Basal IQ or Control IQ technology. Their slogan is “live more and worry less” and I am so glad this seems to be the case for so many.

Have you tried out this technology? How has your experience been?

Source: diabetesdaily.com

Co-Managing His Daughter’s Type 1 Diabetes During COVID-19

Chris is a devoted father and husband and takes care of his daughter Maggie who lives with type 1 diabetes. Chris is very active in the diabetes online community. You can follow Chris’s journey with his daughter Maggie @t1ddad on Instagram.

Chris, thank you so much for taking the time to talk to me. The COVID-19 pandemic has left us all in fear, especially for those who are elderly or have pre-existing conditions. Knowing that you fit this demographic, or have someone you love who does, adds an extra layer to this challenging time. I am sure you are anxious about your daughter, Maggie, who is living with type 1 diabetes. I see you are very active within the diabetes online community and doing your part to advocate, educate, and support others dealing with this disease. I thought it would be helpful for our readers to hear the perspective of such a dedicated dad!

At what age was Maggie diagnosed, and how old is she now? 

Maggie was diagnosed when she was 3.5 and is now almost 11.

Photo credit: Chris

How did your family and daughter initially handle the diagnosis?

It came as quite a shock for us. I have a first cousin that has type 1 diabetes, but I didn’t know what that meant as he lived further away, and I didn’t even see what that meant for him. Maggie was constantly drinking and urinating, and we noticed that she seemed to be losing weight. We reached out to our doctor, and he was very quick to test, then admit her to the hospital with DKA, which we are extremely grateful for his quick response. Within a month after diagnosis, we also found out we were pregnant with our youngest son as well, so there was so much going on at the same time that we had to take in and figure out as well.

Before this pandemic started, how were things going? How was Maggie’s management? Does she use any technology? Are you still very involved?

In July 2019, we came up to the 5th year of her being on an insulin pump. We had already been using the Dexcom G4 system to monitor and track her blood sugars remotely and, after doing some research, decided to upgrade to the Tandem t:slim X2 pump and upgrade to Dexcom G5. In January, we upgraded to the G6 along with the release of Tandem’s Basal IQ update. I’m so glad that these upgrades and updates all happened, so we had time to get used to them and see their benefits before all this came about.

I provide the primary care for her diabetes as my wife’s health is very poor right now as well, and I’m still quite involved in the overall monitoring and management of her day-to-day care. She can calculate most carbohydrates and give herself insulin for meals, but adjustments, corrections, etc. are all done by me. She has always been afraid of needles as well, so I also still do all the insulin pump, and CGM site changes too.

Photo credit: Chris

Once you heard COVID-19 was picking up speed in your area, what was the first thing you did to prepare? 

So it’s interesting. The timing of everything seemed almost perfect. I was due to refill her insulin prescription right at the beginning of March, and the doctor gave us a prescription for 3 months at a time to reduce filing fees. So before all the panic started to build, and before pharmacies began to limit the amount of insulin they would dispense, I was able to get her normal supply, which I am very grateful for. I also ordered an extra box of infusion sets and reservoirs right around the same time, but I don’t have as long of a supply for that, so I will have to watch carefully and order that a little further ahead to allow for extra time to deliver.

How is your daughter handling what is going on in the world? How did you go about explaining the severity without completely scaring her?

We have been fairly open to all our kids within reason. We try to be clear what’s going on, and there was some talk in school before it was temporarily shut down as well. Once we got word that schools were shut down (right as we were getting ready to start March break here), we had a family meeting and were clear that everyone needed to pitch in and help out so that I can keep working as much as I can to provide for the family and that everyone would need to respect each other’s space since we wouldn’t be able to get away from each other in quite the same way. We try to keep some structure while being flexible and understanding of the situation.

Photo credit: Chris

How has the stress of this affected Maggie’s blood sugars? How about her overall management?

I’m really not sure if stress has affected her blood sugars or not. I know she is not nearly as active currently as she was at school, so we are finding her blood sugars are a bit higher on average, so I’ve made some adjustments to her bolus ratios and basal rates to compensate. It’s finally getting warm enough here that we should be able to have the kids play in the backyard more, so I’m hoping that will help.

One thing we have is time. Do you plan on using this time to tackle anything diabetes-related? For example, some are using the opportunity to do basal testing. Other’s are hoping their kids get more involved with their management, etc. Or are you just taking the time to let Maggie relax and be as stress-free as possible?

The one advantage I have to her being home is having a little more control to monitor and correct compared to when she is at school. So, I’m not letting her blood sugars get quite as high before making adjustments or corrections as she would have at school. Otherwise, I have a lot on my plate, so I haven’t had the time to let her take on any more responsibility for additional things quite yet.

Photo credit: Chris

If there is one piece of advice you would offer to other parents who are going through the same thing, what would you tell them?

I think that maintaining some structure, even if it’s not school work-related is very important to keep things more ‘normal’ for my kids, and for managing diabetes as well. Keeping bedtime at around the same time, meals at fixed times etc. helps to keep the day flowing instead of it just being one long day lying on the couch with one Netflix show after another. Kids feel our stress, so hiding what’s going on isn’t going to help, but allowing them to feel free to express what they are feeling as well so we can all get through this together is very important!

If there is one positive to come out of this crisis, what would it be? I think we could all use a silver lining!

Connection & finding opportunities to love. I know for me personally, my skills, talents, and experience give me tremendous advantages and flexibility to help people. Especially small businesses and nonprofits understand that now, more than ever, they need to get clear on their message and communicate it to their clients, prospects, and those they serve. I have no clue when or if they will be able to pay me, but I continue to do what I can to help.

I have also found that myself, as well as my family, have taken the opportunity to reach out with an email, text or Facebook message, or video chat with many of our friends and family, probably more frequently then we might have even done previously in person because those relationships are so important. I hope that when we come out on the other side of this crisis, we can continue to make relationships an important part of our lives and continue to serve those around us.

Thank you so much for taking the time to talk to me. I hope you and your family continue to remain safe and healthy!

Source: diabetesdaily.com

Automated Insulin Delivery: Six Universal Observations and Understandings

This content originally appeared on diaTribe. Republished with permission.

By Laurel Messer

Six universal facts about automated insulin delivery systems, and the things you should keep in mind about this revolutionary technology

Automated insulin delivery (AID) systems are moving towards the forefront of diabetes management. AID systems combine continuous glucose monitors (CGM) with smart algorithms to automatically adjust insulin delivery.

The Tandem Control-IQ system was recently cleared by the FDA, and the Insulet Horizon and Medtronic Advanced Hybrid Closed Loop systems are beginning pivotal trials. These are encouraging developments. As more systems move through the pipeline and eventually into the commercial market, important patterns are emerging in user expectations and user experience. As a diabetes nurse, certified diabetes educator and research investigator, I, along with my team at the Barbara Davis Center, have worked with nearly every AID system in the pipeline, and other systems that will never make it to market. Here are six insights we have gleaned, which seem to be universal (thus far) to all AID systems:

1. You can always beat an AID system with compulsive diabetes management

Many people with diabetes compulsively attend to diabetes care in order to achieve ultra-tight glucose ranges – and are the first to ask about automated systems. What ends up happening is that these “super-users” are invariably frustrated that the system is not yielding the same results that they were able to achieve with their own calculations and management. An important point is that many automated systems are excellent at reducing mental burden for taking care of diabetes, excellent at reducing hypoglycemia, and adequate at improving glucose levels. Humans can beat automated systems if they attend to diabetes care near-constantly. The individuals who will likely be satisfied with AID are those who are comfortable with an A1C in the 7s or above, but they want to reduce the mental load of adjusting settings and micromanaging high glucose levels. The most important question to ask is, “Why do I want to start using an automated system?” If it is to achieve near-perfect glucose levels, the system will likely disappoint. If it is to reduce the burden of “thinking like a pancreas” all the time, it may be a good option. AID will excel at the marathon of diabetes care but may disappoint in the hour-to-hour sprint.

2. Systems work best when you let them work

Using both research and commercial systems, we have seen all the ways to “trick” AID systems—entering phantom carbohydrates, changing set points, performing manual corrections, overriding recommended doses. More often than not, these behaviors lead to glucose instability – reactionary highs and lows from the system destabilizing. All systems will perform best if they are used according to user instructions. This is difficult for the individual who would prefer to micro-adjust settings or desire control over all insulin delivery. Most systems work best when users learn to trust them.

3. Give the system a chance – 2-4 weeks before deciding long term potential

It may benefit us to think about AID like a new significant relationship – it can take some time to “settle.” I mean this both on an interaction level (learning how to respond to alerts, when to intervene, when to let it ride) and on an algorithm level (allowing the system to adjust internal algorithm parameters based on usage). In addition, programmable user settings may need some adjustment in the first few weeks of use, so working with diabetes educators can be helpful for initial set-up and early follow-up.

4. Bolusing is still king

If I could go back in time, I would caution device manufacturers against any whisper of not needing to bolus with AID systems. Bolusing is the singular most important action a person with diabetes can do to optimize insulin delivery on current and near-future automated systems. This will be true until insulin action time gets exponentially faster or artificial intelligence gets better at predicting human behavior, neither of which is on the immediate horizon. In order for people with diabetes to see the best performance on any system (automated or manual), they need to bolus before carbohydrates are consumed. Specific to AID, the timing of the bolus (prior to carb intake) is especially important, as the system will automatically increase insulin delivery after an initial rise of glucose levels, so a late bolus (e.g., after the meal) could lead to insulin stacking and hypoglycemia.

5. Rethinking low treatments

Low glucose levels (hypoglycemia) still happen when using automated systems. What is different with AID is that the system has been trying to prevent the low by reducing/suspending insulin, possibly hours before the low occurs. This means that an individual may need to consume significantly fewer carbs to bring glucose levels back into range – perhaps 5-10 grams of carb at first, reassessing 15-20 minutes later. This can be difficult when wanting to eat everything in sight; however, it can reduce the chance of rebounding into the 200s after over-treating.

6. Infusion sets are still infusion sets

While AID algorithms are revolutionary, the infusion set is not. It is the same plastic or steel cannula that occludes, kinks, or inflames. This hardware limits automated systems and can very quickly lead to hyperglycemia or diabetic ketoacidosis (DKA). It is important for people using AID to recognize signs of infusion set failure – persistent hyperglycemia, boluses that do not bring glucose levels down, ketones, vomiting, etc. Knowing how to treat ketones (via syringe injection of insulin and set change) can prevent a hospital admission or worse.

I love that the diabetes community learns from its members and experiences. Check out our Barbara Davis Center PANTHER (Practical Advanced THERapies for diabetes) website for our team’s latest insights on automated insulin delivery, and tools for people with diabetes, clinicians, and engineers.

Are you considering AID? Feel free to share this article with your healthcare team. For more information about AID systems that are currently available or in the pipeline, click here.

About Laurel

Laurel H. Messer is a nurse scientist and certified diabetes educator at the Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO. She has spent the last 15 years studying how to best utilize new diabetes technologies, and remembers fondly teaching families to wrap up their corded CGM system in a plastic shower bag for bathing. Ok, not that fondly, but look how far we have come! Dr. Messer works with the Barbara Davis Center PANTHER team (Practical Advanced Therapies for diabetes), conducting clinical research trials on promising technologies to make life better for children, adolescents, and adults living with type 1 diabetes. Get in touch at Laurel.Messer@cuanschutz.edu

Source: diabetesdaily.com

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