Showing posts with label T:slim. Show all posts
Showing posts with label T:slim. Show all posts

Monday, August 28, 2023

Hybrid Closed Loop - My Thoughts


The future has arrived! Yes, I know many of you reading this will have been managing your diabetes with Hybrid Closed Loop for a while now and that it's not exactly new news for you. 

At Dad Towers, I've been hesitant to take the "next step" from insulin pumps and CGMs to the "all in one" of HCL since I began using an insulin pump in 2021. I didn't feel the urgency to change what was already working well for me, I didn't feel inspired to learn about closed loop, HCL, AID, APS and host of acronyms which were, to be frank, a bit of a turn off. I write those words as somebody who is very pro-tech when it comes to diabetes management and as somebody who understands most of what HCL means. Still, in the last couple of years, I felt in no hurry to try it.

As is often the case, conversations with peers, particularly well-meaning peers within #GBDoc, resulted in the change. As is also often the case, I've done this without the "blessing" of my consultant or an agreement with any of my HCPs. We'll talk about access later on.  The kind-hearted folk within #GBDoc have taken care of me on so many levels in the last 6 years, so I suppose it's not really a surprise to have transmitters, sensors and even different CGMs sent to me to try out. It's not a surprise, yet my heart bursts with gratitude when others offer the time, energy and often money to support me. I'll do what I can to pay that forward, of course.

Right, let's get into it; HCL, is it any good? 

Firstly, take a look at the image above. That's a screenshot from Dexcom Clarity. A nice splattering of green days and impressive time in range. For the system I'm using (Control IQ via Dexcom and T:Slim) those numbers didn't take long to achieve. The first day or two on HCL was fascinating to watch. My pump was constantly adjusting my basal rate, administering little boluses, reducing basal, suspending insulin, etc. Basically, it was micro managing everything and doing so for 24 hours a day. I love a little micro managing action myself, but even I can't do that for 24 hours a day. Impressive stuff and the results were almost immediate, lines have been flatter, spikes less spiky, hypos less severe, and I imagine my next HbA1c will reflect this improvement in management...

...management? Yes, you're still the boss, you can still administer a dose, you still need to carb count and pre-bolus for your meals & snacks. You're not a complete passenger with HCL but, if you're anything like me, you'll need to learn to let the machine do it's thing and trust in the tech. 

I've put HCL to the test a few times, including early on when I purposefully carb counted 50% lower than the meal actually contained. I expected a spike and it did happen, yet HCL sprung into action and upped my basal rates quite dramatically. It caught my purposeful error and brought me back into range within an hour or so. Wow!

Recently, I spent a few days away on a short break. That included a day at the beach. Walking and warm weather is a recipe for a hypo for me, but I thought I'd put HCL to the test again. I left my hypo treats in the car and armed only with a debit card to purchase food and drinks from a little cafe, I set about wandering around the sands... some running around too, with a Cocker Spaniel enjoying the new environment to sniff and explore. I kept an eye on Control IQ, which displays my blood glucose alongside exactly what's going on insulin wise. From a starting BG of 7.6 mmol/L, things dipped to 5.8 mmol/L and at that stage my insulin was suspended by Control IQ. Trying to not worry, I headed to the cafe to buy a sugary drink and as I cracked open the can of brown fizz, my BG was back to 6.4 mmol/L. No input from me, closed loop did all the work.

Of course, I'm not suggesting ANY level of exercise won't require some input from you when you're using HCL but, for me at least, walking around a beach for a few hours wasn't the huge problem it once might've been. And I definitely don't recommend leaving your hypo treats behind - That's just silly. 

However, that's a tremendous thing about closed loop; it reduces the worry, the decision making. You can just crack on with whatever you need or want to do and if any problems arise they're likely to be minor ones that need minimal input from you. 

It's not a cure. It's definitely not an "artificial pancreas". What it is, is an advanced way to manage T1D. Now, the only issue for me, as it was with pumping, will be to convince my consultant that HCL is right for me. That means obtaining Dexcom G6 funding.... or does it?

Whaaaaaaat?

Well, the thing is, Dexcom One sensors will work perfectly well with G6 transmitters. The sensor codes have been "hacked" and a list of Dexcom One code: 2222 = Dexcom G6 code: 4444 (as an example) is freely kicking around on your Interwebs. So, essentially, I only need the transmitters while I'm prescribed Dex One sensors. Conversations are to be had! 

Finally, you've probably noticed that Partha & co. have been working hard on making HCL accessible in NHSE. There'll be criteria, and from the outset it looks less stringent than the insulin pump criteria of old (7.5% A1c vs 8.5%) so, that's a good thing. I imagine access will be more relaxed as the next few years roll by until we reach a point where all with T1D can access closed loop in England and Wales. Perhaps that's called the Libre Point? Remember in 2017/18 when access to Flash was the big issue? Here we are, 5 years later and still not cured, but access to that tech is no longer a problem.

If you enjoyed this blog and you'd like to support me over the time that I give to others, my online content, or if you'd like some direct support from me then check out these links:

BUY DIABETIC DAD A COFFEE HERE

BECOME A BLOG MEMBER

GET MENTORING SUPPORT FROM DIABETIC DAD

Prefer PayPal?

BUY DIABETIC DAD A COFFEE THROUGH PAYPAL  


 

Wednesday, November 30, 2022

Review - The T:Slim X2 Insulin Pump

The T:Slim X2 insulin pump home screen

It's been a long time in the coming, just how long? You'll need to read through some of my blog posts from the summer of 2021 to get an idea. However, let's not dwell on time frames and fighting for funding. The title of the blog should indicate that I'm going to tell you all about the T:Slim X2 pump. I'll try! 

The above image was taken a few moments before I began writing - I'm almost at 48 hours on this pump, now and it was handed to me, fully charged. It was suggested that the battery would last between 5 and 7 days for normal pumping (not looping) and that seems correct, right now. I think most of us could cope with one "big charge" of the battery every week or so. Although, the suggestion of charging it for 10 - 15 mins each day seems like a good one. Perhaps it's worth popping on charge while you take a shower or a bath, with the pump unplugged from you at that stage. I'm happy with a rechargeable battery, rather than a disposable one, as it seems more planet friendly and a once per week charge or a few mins each day is not going to disrupt my life.

The pump feels very smooth, almost slippery, to hold. It's made from aluminium and it feels very strong and well manufactured. It's also a very small and light weight pump. If you've ever used a Combo, it's smaller than that. How about one of the Medtronic bricks? It's much lighter and thinner. I actually have some pocket space again! 

How about usage? The image above shows the home screen and the numbers 1, 2, 3. To unlock the pump you tap the numbers; 1, 2 and 3. That's not your PIN! If you want that second level of security then you can add a PIN in your pump settings. I like this form of unlocking, it prevents accidental unlocking and the tapping of functions. If you do leave it unlocked and randomly tap an area of the screen which is not a pump function then, after 3 taps, the pump will recognise that you're not purposefully trying to activate a function or setting and it will lock itself again. You can manually lock the screen by pressing the T button on the top of the pump - that's your on and off switch, in effect. Yes, the pump does still carry on pumping when you press the T button to turn the screen off.

The screen, just like any mobile smart phone - you tap to navigate around but there is no swiping or scrolling, just the tapping of arrow buttons to move up and down the pages or to go back and forth between options. And the display? It's bright and this is my first, albeit tiny, gripe; There is no obvious way to reduce or increase screen brightness. During the evening, I'd like the option to reduce that just a little so it's a bit kinder on the eyes. It is only a minor gripe and in comparison to my old Combo screen it is far superior and easier to look at.

Is it loud? Oh, yes! Fortunately, there ARE options for volume! From high, medium and low volumes on all the important pump functions - and if low is still too much then you can set it to vibrate instead.

There is wizardry in the form of a bolus wizard. I'm delighted to report that it's really very good. It'll take into account your insulin on board (IOB) and your target blood glucose along with your carb to insulin ratio before delivering a bolus. I've used it for every meal, every snack and every coffee for the last 2 days and my time in range has been 99% and 94% for those days.

Insulin to carb ratios and basal rates should be set up before you begin pumping. It's very easy to do those things, you'll probably learn how in your pump start up appointment and they can be adjusted by you at any time.

Temporary basal rates can be set, extended boluses are an option - standard stuff, these days, but they're very useful features and certainly ones that I use from time to time. How about stopping insulin delivery? Because, you know, you might have a hypo sometimes. Easy! it's just a couple of taps away. Insulin can be suspended for a minimum of 15 minutes or you can specify an amount of time in that menu.

Insulin? Ah, yes, that's pretty important. You'll need to draw up your Banting Juice in a syringe and inject it into the cartridge, doing all the air bubble avoidance and removal things. It's a little bit fiddly because the pump and carts are so small. If you have issues with your grip or a visual impairment then you might need to seek assistance at this stage. Also, it's a NovoRapid or equivalent insulin only pump. So... yeah, no Fiasp or Lyummy! *cough, cough*

How about the Infusion sets? AutoSoft 90 was provided and I think they'll be the best option for most people. Other sets are compatible and there is a steel option so, find the one which works best for you - YouTube is your friend, here.

What else? There is s belt clip and a cartridge removal "tool" although, you can remove those with a coin if you'll do what I'm very like to do and lose the tool. You might also get a lot of "suggestions" for places to shop for belts, pump stickers, etc. But! I don't mind a little spam if it comes with a free pen and a ketone check monitor.

So far, I'm very happy with this pump. It is a million miles better than the Combo and I really loved that pump, too. However, it's early days, problems might happen later on and I'll report back if they do.

Thank you so much for reading this blog. I do appreciate your visit and your support. As you might know, I LOVE COFFEE! So I've teamed up with a thing called Buy Me A Coffee. If you enjoy my content and appreciate the time it takes to create such things then you can buy me a coffee! If you leave your Twitter @ name when you buy me a coffee, I will personally thank you. If you'd rather be anonymous then that's totally cool. Thanks for the caffeine!