Review: The First Year on Control IQ

I’ve been using a Tandem t:slim x2 insulin pump since 2018 after I rallied distributor AMSL Diabetes to give me one of the first units to hit our shores (#tslimforfrank). I took advantage of its integration with the Dexcom G5 CGM system in 2019. I trialled Dexcom G6 in 2020, but ultimately costs were prohibitive. When I finally got a better paying job in 2021, one of the first things I did was shell out the $330 a month for the sensors so that I could update my pump’s software to Basal IQ and get some predictive low glucose suspend action into my life.

In March 2022, instructions landed in my inbox to update my pump software to Control IQ – an automated insulin delivery system whereby my pump and CGM talk to each other (if you don’t know what the system does, check out this piece from Diatribe). I quickly completed the training modules, sent the paperwork to my endo to sign, and a few weeks later I had the update code in my inbox.

I left that update code sitting in my inbox until December 2022, in my usual indecisive fashion, while I deliberated over whether (and when) to go through with the update.

Ultimately, I couldn’t give diabetes the love and attention it deserved while trying to juggle everything else going on in my life. I was definitely at a point where I needed this tech in my life, and I figured it couldn’t possibly make things any worse.

I run the system in night time ‘Sleep Mode’ 24/7, which means I receive automatic adjustments to my Basal insulin that targets a blood sugar of 6.1. When run in normal daytime mode, the system also offers automatic correction boluses, however the threshold to trigger these automated adjustments is a higher blood sugar. I didn’t feel the system could bring down a high as quickly as I could, due to its constraints around the delivery of an automated bolus (check out the Diatribe piece here). So I’m happy to take the more aggressive basal adjustments of Sleep Mode and handle corrections myself.

What I’ve learned with this system is that being able to carb count and bolus properly is very important. My endo took one look at my graph back in April and told me to bump up my carb ratio so the system didn’t have to work so hard to mop up the mess (it’s also incredible how sometimes all you need is a fresh set of eyes to point out the glaringly obvious…)

Undoubtedly the biggest impact this system has had is on my sleep. I don’t go to bed wondering what my blood sugar is going to do during the night. I rarely get woken up by CGM alarms anymore. The system keeps me more or less around that 6.1 target for the whole night. I wake up in range every single morning. That’s a third of my day, which my endo pointed out when I didn’t believe my last a1c result.

When I started using the system a year ago, my 30 day stats had me at 52% time in my target range of 4 and 8 mmol, my average BG was 8.5 and my standard deviation was 3.0. My most recent 30 days has my time in range at 61%, average BG at 7.8 and my standard deviation at 2.5.

When I’ve been talking to people about this system, I often comment that the algorithm could be more aggressive. That the system still requires effort on my part – in bolusing for meals and taming high or low blood sugars. It doesn’t completely alleviate the burden of managing diabetes. I would obviously love if those stats were better than what they are – even though I know I am being too hard on myself.

I am managing my diabetes with a lot less effort, even if it’s not as little as I’d like. I am seeing a lot more consistency in my day to day blood sugars. I do feel physically better than I did before Control IQ. I find that my health goals are becoming increasingly broader and less related to blood sugar management these days, which is nice as well.

With my pump warranty up in a few months, I am considering all of my options. As much as I love this system, there is no news in terms of any updates to the algorithm in the pipeline – which is something to consider.

This system isn’t perfect, but then again no system will be able to tick all of my needs and wants. I just have to stick with the one that bothers me the least.

N.B. I have no affiliation with AMSL Diabetes, Tandem or Dexcom.

New Year, New Blog Post.

Isn’t that how the saying goes?

Diabetes has definitely been on the back burner since I last wrote here on my blog and embarked on a new career 18 months ago.

I used to have a lot of structure in my day as a shift worker. I’d wake up and start work at the same time each day. I’d have my breaks at set times, and I’d always clock out at 4 o’clock on the dot. I’d come home and do some variation of coffee, snack, walk, exercise, dinner, study, write, read and bed. Can you tell I’m a creature of habit?

My day to day is a lot more spontaneous now. I don’t have to be at work by a set time each morning. I definitely go out a lot more, whether that be for coffees, lunches or Friday drinks. For those times where I just need a day or two at home? No problem. Then there are also times where I’ll have to work past 5pm. I have to try a lot harder to set those work/life boundaries that just used to be there.

The last 18 months or so have been challenging, but also incredibly rewarding in terms of personal growth. Like being outside of my comfort zone. Learning new things. Meeting new people. Doing stuff I’ve never done before.

Between full time work, Accounting busy seasons and progress toward a Graduate Diploma in Chartered Accounting, the reality is that I want to spend my spare time offline. Walking along the coast or going for a run, spending time with my family, grabbing a coffee with friends, making a nice lunch on Sunday or just looking after myself.

I have a friend at work who I always tease for having the Group teams chat on ‘mute’ and never participating, to the extent that I forget she’s even in the chat. Until I see her in person and she’s up to speed on everything about everyone.

I’ve been around in the DOC and peer support spaces for long enough to know that people’s needs evolve over time, just like my own. One of the best things about the diabetes community is that it’s big and wide and broad enough that it’s always going to be there in whatever shape or form I need it.

Like my friend at work, I’ve been more lurking quietly in the background these days. I’ve also been reading more and getting my peer support in person.

I’ve had a few conversations about this blog over the past year or so, and one friend in the diabetes community recently put all of this into perspective for me. She thought it was fantastic that I didn’t feel the need to update my blog so often. It meant that diabetes was in the background, and not at the forefront of my mind. Second to life.

I think that’s a pretty good note to start the New Year on.

Happy New Year. Wishing you the very best for 2023.

2022 highlight: Ticking the Pinnacles Desert off my bucket list.

Not Just a Patch

Admittedly, I don’t particularly like having to wear any adhesive over my CGM sensor. I’ll usually hold off on applying an external adhesive for as long as I can, although I have been caught out once or twice in recent weeks. I only just managed to rescue last week’s sensor by the skin of its teeth (it was dangerously dislodged from my arm).

However, adhesives have become a necessity in order to get my sensors to the 14 day mark. Occasionally I’m able to get my sensors to 21 days, but I don’t find the readings too consistent or reliable.

I’ve been trying out the ‘Not Just a Patch’ adhesives in-between sensors over the past few months, which were gifted to me by the Not Just a Patch team.

Back in January, I had a brief Zoom chat with founder Pete, a fellow type 1 from Sydney. Pete went to uni in Perth and could instantly recognise the Fremantle Doctor blowing away as I sat on the steps outside the loading dock during my lunch break.

I guess what makes Not Just a Patch a little bit different from its competitors is that the patch covers the entire sensor. Pete explained that the biggest point of difference with these patches, unknown to me at the time, is that they are designed to be easily removed and replaced. Check out how easily they pull off in my video below!

Pete did warn me that G5 was a little more challenging compared to slimmer sensors such as FreeStyle Libre or Dexcom G6, and I did find these a little bulky to wear. On the plus side, they were much easier to apply and I liked not having to stress about getting the perfect application around the edges of my sensor.

You can find Not Just a Patch here. Pete’s also got a podcast called ‘The Dialogues’ featuring some familiar diabetes advocates, which you can also find in your podcast app.

Go With The Flow

It’s definitely been Easter week in my corner of the world. Hot cross buns and Easter eggs have been getting me through work and uni this week, counting down the days to a much needed four day long weekend. My personal picks are the yellow bags of Cadbury mini eggs and hollow hunting eggs. Bonus points if you picked them up on sale at Woolies last week.

This past week has been disgustingly humid. It’s the second spell we’ve had here in Perth this month that doesn’t seem to want to go away. You know, the kind of weather that sucks the life out of you, amplifies the irritating chirps of the crickets at night and also throws you some unexpected and nasty lows.

Like this morning, while I was in the midst of resetting my transmitter clock and replacing my sensor. I didn’t have access to reliable readings. I’d switched off my phone’s Bluetooth connection and Dexcom notifications earlier after persistent alerts to unreliable patches of readings that came and went. I’ve already been running reduced basal rates of around 10% for much of this month.

All of a sudden, I found myself struggling to go through the motions of my task at hand. My hands were clammy. I was sweating, but perhaps it had simply been mistaken for the weather. I reached for my meter, whose reading gave me a reaction of ‘yikes.’

I reached for a jukebox from the drawer, and guzzled it down. I had to sit down. I slowly began to feel warmth return to my body, but I was still craving something comforting and more pleasant than juice. I nibbled on a jellybean from the drawer, and eventually followed up with a cup of tea and biscuit.

If there’s one skill I’ve learned about living with diabetes, it would have to be learning to adapt to my surroundings and just going with the flow.

It’s Easter this weekend. There will be chocolate, there will be food, there will be drinks and there will be good company. I could choose to impart rules and strategies for how I will navigate Sunday lunch and the Easter egg hunt.

But quite honestly, just like every other day of living with diabetes, I think I’ll just go with the flow.

The Vaccine Edit

I was really surprised (and still am) to learn that we have our first Coronavirus vaccines that will be rolling out in Australia today and over the coming weeks. Admittedly, I knew very little about vaccines before Christmas.

I’ve been checking into the excellent Coronacast podcast throughout 2020, and it’s become a daily listen on my way to work or on my walks. Hosts Norman Swan and Tegan Taylor have such excellent views on epidemiology that I’d be more than happy for them to be making our decisions around outbreaks. Did I mention that they are only around a 10 minute listen?

In recent weeks, Coronacast has provided some considerable insight into vaccines. To mark today’s commencement of the vaccine rollout in Australia, I thought I’d paraphrase some of what I’ve learned here (to the best of my ability).

I’ve learned that the vaccines have been proven to protect against COVID-19 disease if infected. It would likely mean that fewer people would become severely unwell or end up in hospitals.

What we don’t yet know is whether vaccines can prevent transmission of COVID-19. Could a person that’s been vaccinated still spread the disease to another person? Time will tell. If the latter were the case, then we would need 100% of the population to be vaccinated (which is unlikely) for our vaccine strategy to be successful.

Australia has two vaccine frontrunners, Pfizer and AstraZeneca. A small supply of imported Pfizer vaccines are being rolled out this week to front line workers such as those working at our quarantine hotels, borders and healthcare professionals in those kinds of settings. Also in ages care settings. 3.8 million imported doses of the AstraZeneca vaccine were also approved by the TGA last week, with locally manufactured doses of this vaccine pending approval. This is the vaccine that most Aussies will be receiving, should they choose to be inoculated.

Then there’s the issue around the efficacy rates among these vaccines. Efficacy is the percentage reduction in disease among the group of trial participants who received a vaccine compared to those who did not. I believe the Pfizer vaccine had an efficacy rate north of 90%, while AstraZeneca’s was only around 62%.

Per Coronacast, Astra’s trial was a little messy – with some participants receiving an unplanned half dose and then a full dose of the vaccine – leading to a higher efficacy rate among a sub group of around 2,000 trial participants. The TGA has recommended two full doses of the Astra vaccine 12 weeks apart and, per Coronacast, this should see an efficacy rate nearly as good as Pfizer.

We’re also being told to expect that these vaccines may become seasonal in the same nature as the flu shot. It might be that we need a booster shot, the vaccine needs adapting as the virus mutates, or a combination of both.

Assuming that diabetes meets the criteria of a ‘medical condition,’ Aussies with diabetes are likely to be offered a vaccine in Group 2, with approximately 5 million people ahead of me in the queue – as per this handy tool from the ABC. But again, I’m not particularly interested in drawing lines between diabetes and COVID19. I’ll be happy to wait my turn, because there are definitely people who need it more than I do.

The prospect of a vaccine still gives me a little anxiety. I don’t think it’s going to be a replacement for good hygiene or physical distancing for quite some time. I do worry that the complacency that’s clearly set in will only be accelerated. While the virus continues to ravage on overseas, we cannot afford to get complacent. Nor is this a reason to open our international borders anytime soon.

Despite our privilege here in Australia, I think it’s fair to say that 2021 hasn’t been much different to where we ended 2020. Just like diabetes, the nature of this pandemic has changed thanks to more transmissible variants – just when we thought we had it under control. We’ve had some scary escapes from our strict hotel quarantine measures in Adelaide, Sydney, Brisbane, Perth and most recently Melbourne – all of which resulted in various forms of short localised lockdowns and restrictions.

So, I’m definitely feeling hopeful that these vaccines might give us a little more stability here in Australia has we continue our unique way of life inside this amazing bubble.

Highly recommend listening to Coronacast – they’re very easy 10 minute daily episodes – check it out here.

Start with this episode on what/what not to expect from a vaccine. Everything in the last month or so has been highly relevant to vaccines.