My first month running Basal-IQ

Hi. I know this may read like an advertorial, but this is just me and my personal opinion, and I happen to be sharing it on the Tidepool blog.– Christopher Snider

A few weeks ago I completed my training through Tandem’s patient portal on their new Basal-IQ feature and updated my t:slim X2 insulin pump with their shiny new feature. I learned how my insulin pump was going to rely on Dexcom G6 CGM data to make decisions about how much insulin it was going to deliver. I confirmed I understood that my insulin pump’s new algorithm would look ahead 30 minutes and automatically stop delivering insulin if it detected my blood glucose levels would drop below 80 mg/dL or if my blood glucose is currently below 70 mg/dL and falling.

I must confess the specific act of updating my insulin pump scares me. I successfully updated my pump last time a new feature – integrating Dexcom G5 data – was available for my t:slim X2. Everything went fine then. And everything went fine this time. But working for a software company has opened my eyes to the challenging reality of thorough testing, quality documentation, and precise validation for any kind of update. Publishing a bug fix for Tidepool Uploader is one thing. Updating the technology that is literally keeping me alive day-to-day is another. Kudos to the team at Tandem for this one. I can only imagine the rigorous testing that was involved in getting this new feature ready for the public.

Once everything was up and running and I successfully inserted my first Dexcom G6 sensor (yes, it is as painless as everyone says), I waited the two hours it takes to get my CGM data flowing.

Since then, I’ve made a few observations about how this entire system — Basal-IQ and Dexcom G6 — has highlighted some specific aspects of how I manage my diabetes.

Observations from a Basal-IQ and Dexcom G6 system

Not having to calibrate my Dexcom G6 sensor was a huge relief. I actually forgot about the two-hour countdown and was surprised to see my CGM data was just there, like it was no big deal. It had become normalized in my diabetes routine to rely on alerts, alarms, and precise planning so I would have my meter with me at the exact moment I needed it. Now, I can devote that tiny portion of focus to something else.

Basal-IQ does not stop every single low from occurring. It doesn’t remove insulin you’ve bolused from your body. But for me, it has softened the harsh drops that can happen when I bolus too aggressively for dinner, or delay a low when I’m in the middle of walking my puppy. What’s surprising for me is looking back on a 24-hour period to see just how many times Basal-IQ has automatically intervened. I have chosen not to have any Basal-IQ alerts notify me when the system kicks in, but I have taken stock of each red section on my CGM graph indicating an automatic insulin delivery suspend event.

I think about my lows. A lot. To be honest, it’s an omnipresent thought, and has been since I started wearing an insulin pump four years ago. For the first week after I switched from insulin pens to my t:slim, I was convinced my insulin pump was going to kill me. Not because of anything my local rep or diabetes educator did or didn’t teach me, but because of the new reality that this device is attached to me and is always giving me insulin. Insulin always comes with risks, but it felt more real coming from an insulin pump than it did from a syringe or an insulin pen. I’ve come a long way since then, but seeing how Basal-IQ works has (re)opened my eyes to how much fear I carry with me about my diabetes every single day.

What Basal-IQ has taught me about my own diabetes management

All of those broader observations are great, but I’ve also learned some very specific things about how I manage my own diabetes.

1. My overnight basal rates suck. I’ve had this thought a few months now, but seeing how hard Basal-IQ is working between 12-6 AM shines a much brighter light on the fact that I need to put in the work with my CDE to make some changes. That said, I’m grateful for what Basal-IQ has done to even out my overnight blood glucose levels.
2. My approach to my insulin therapy pre-Basal-IQ wasn’t that far off from what Basal-IQ does automatically, but I’m glad I don’t have to do that on my own anymore. Over the last month, I’ve been using temporary basals a lot more to try to prevent extended lows. Of course, it’s much easier to set a temporary basal when you’re awake — all the more reason to be excited for the automation Basal-IQ brings to my diabetes management.
3. Basal-IQ doesn’t take away my personal fear of lows. Being privileged enough to have access to all this technology does not remove the fear. When I am low, I am still likely to raid the pantry and stare at my CGM readings even though I know it’ll be another five minutes before a new reading is displayed. That fear isn’t going away any time soon, but I believe Basal-IQ will help minimize it in the long run.
4. I’m becoming slightly more comfortable with trusting an automated equation to manage my diabetes. Sure, I’ve been doing mental math and using ad-hoc equations on my own ever since I was diagnosed, and a machine that is dedicated to this math should be better than my brain. Putting trust in that machine and algorithm takes time, and I expect that my trust and comfort will increase as my experience grows.
5. I’ve spent so much of my time thinking about my diabetes, that I’m not sure what to do with the part of my brain that I’ve gotten back now that there’s a small portion I don’t have to constantly think about.

Learning to trust technology

Offloading a portion of my diabetes care, of my life and safety, to a machine and a bunch of complex equations is a precarious position to be in. But, seeing how successful this has been for me so far builds my confidence in new and prospective hybrid closed loop systems. If I can trust an insulin pump and associated technology to help prevent lows, it’s not a stretch to think I can trust an insulin pump and associated technology to help curb the highs, too.

I know this isn’t necessarily new technology. Medtronic pumps have been running a version of low glucose suspend for a while, and of course, Medtronic 670G is addressing highs and lows with Auto Mode. And then there’s the DIY community, who have been trusting algorithms for years thanks to DIY Loop and OpenAPS. And of course, there’s Tidepool’s recent announcement that we’ll be commercializing the Loop app.

I see Basal-IQ as a stepping stone along the path to wider adoption of hybrid closed loop systems. Starting here, I can see the path forward for myself, my spouse, and so many others to invest their time and energy in more advanced and complex solutions that become commercially available. Basal-IQ sets the stage for future updates from Tandem, which has me excited, but it also sets the stage for future technology across the diabetes landscape. Making this stuff more accessible, no matter how incremental the advancement, is a really big deal.

All of this doesn’t ignore the fact that insulin is still too expensive. Or the fact that insurance in the United States is still a problem for a significant portion of the diabetes and broader patient community. And that all of this technology is quite expensive if you’re paying out of pocket. Those advocacy efforts will not stop, but I believe we can recognize the reality of the situation and still appreciate what is being offered and the potential it holds.

If you are in a position to use one of these devices, specifically this device, I think you should talk to your doctor about starting the process to update your insulin pump’s software. This is the kind of technology that we need to champion on our way to more accessible hybrid closed loop systems.

This is amazing.

Now, let me put my Tidepool hat back on.

I’m thrilled to share with all of you that we have just launched support for Tandem’s Basal-IQ data. Tidepool can now capture (and display) all of the data around your automatic suspends, as well as your Dexcom G6 data through your t:slim X2 pump. Be sure to download or update to the latest version of Tidepool Uploader to get started.

More from me, and the rest of the Tidepool team soon.

Yours in data,Christopher SniderCommunity Manager