Which pumps have low glucose suspend?

[Rokaab]

Hi all,

So recently I've been having awful problems with dawn phenomenon - as in for the last three weeks I keep waking up between 3am and 5am and my sugar level is rising dramatically (this morning my body woke me up at 4:30am and my BS was at 16.5 - at about 2am it had been about 6!), it's either flat or a very gradual drop before then, this has been happening for about the last 3 weeks and well I'm exhausted now (my alarm for work goes off at 6:15), anyways I've got my review at the diabetic clinic at the hospital tomorrow so was gonna see if I could persuade them to give me a pump. Anyways, I don't always get DP, it comes and goes so I was trying to find out which ones have a low glucose suspend - because the last time I went and asked they said a pump would be no use cos my DP is intermittent, but with low glucose suspend I presume I could set it give me more insulin at about 3am and if DP didn't kick in then it could suspend.

So far I've found the Medtronic 640g and 670g, the Medtrum A6 system and the t:slim X2 - so anyone know if there are any others available (in the UK)?

Or does this sound like a silly idea?

 

[Juicyj]

Hi @Rokaab Am not sure if you're barking up the wrong tree here, but what about just using a CGM system like the Dexcom G6 ? Also getting access to a pump can take months, you need a solution soon.

If you were to use say the G6 or the libre and miaomiao both of which could alert you to high/low and you can then take action with insulin.

I'd speak to your team tomorrow to see what potential options are available to you as they can answer questions about pump funding and CGM funding for you.

 

[Rokaab]

If you were to use say the G6 or the libre and miaomiao both of which could alert you to high/low and you can then take action with insulin.

I think the main problem I'm having at the moment is that the dramatic rise in blood sugar is waking me up in the middle of the night which I can deal with then and there - mostly it's been rudely awakening me at about 10-12 at which point I take some insulin - I think it didn't wake me earlier this morning cos I'm exhausted

And yes I know a pump can take a while to get a pump even once approved - but I hoping it will eventually help me.

The occasional reading of 16 I can deal with, the being woken up in the middle of the night virtually every day for 3 weeks I cannot cope with

 

[Juicyj]

@Rokaab The idea behind the Dexcom G6 is that you set the parameters on your alerts, so mine is set at 9.6 and once I go over then I get an alarm to wake me and I can administer the insulin needed then and wake up in range. It's useful when there's no rhyme or reason to your DP, mine is rare now a days, however if I eat late or eat fat at dinner and I get a rise during the night I can correct so I wake in range.

 

[Rokaab]

@Rokaab The idea behind the Dexcom G6 is that you set the parameters on your alerts, so mine is set at 9.6 and once I go over then I get an alarm to wake me and I can administer the insulin needed then and wake up in range.

True, but the reason I'm hoping to get a pump is so that I'm not being woken in the middle of the night (either by dramatically rising sugars or an alarm)
And one with a low glucose suspend in case my DP decides not to show up, thus the reason I was wondering if there were any others that had that functionality - mainly so I can go in tomorrow and know which ones can do the job I'm hoping that they'll be able to do

 

[Capt-Slog]

Hi Rokaab

I know exactly what you mean as I have had Dawn Phenomenon for over 18 months. I had become so tired and irritable due to a lack of uninterrupted sleep.

I have the Libre/MiaoMiao combo in conjunction with XDrip. Although it warned me that my levels were going up that just meant that I have to inject insulin. (3am on the dot, every **** day until the clocks went back!)

Like you said, a CGM on its own doesn't fix the issue, it just allows you to apply a correction before your BGs go too high.

I pressed my Diabetes team into allowing me to have a pump.
Then I pressed them further to allow me to have the Tandem t:slim X2.

The primary overriding reason for getting this pump was to use it in conjunction with the Dexcom G6 sensor. This combo allows you to set your night time insulin levels high enough to combat the dreaded DP.

So if you set your night time Basal rate to give you more insulin to combat the DP, then on the occasional night when DP decides to "give it a rest" then the Basal IQ software in the pump will stop delivering insulin if your levels start plummeting.

I think that this is what you have in mind.

I have an X2, and I really love it.
I haven't got the G6 sensor yet, but I am getting it very soon.


I am not SURE if the Medtronic 670g can suspend insulin on low as well. I think it can.

 

[Capt-Slog]

Ignore my last post. I realise 5hat you already listed the t:slim X2.
Doh

 

[boxing]

Hi Rokaab

I know exactly what you mean as I have had Dawn Phenomenon for over 18 months. I had become so tired and irritable due to a lack of uninterrupted sleep.

I have the Libre/MiaoMiao combo in conjunction with XDrip. Although it warned me that my levels were going up that just meant that I have to inject insulin. (3am on the dot, every **** day until the clocks went back!)

Like you said, a CGM on its own doesn't fix the issue, it just allows you to apply a correction before your BGs go too high.

I pressed my Diabetes team into allowing me to have a pump.
Then I pressed them further to allow me to have the Tandem t:slim X2.

The primary overriding reason for getting this pump was to use it in conjunction with the Dexcom G6 sensor. This combo allows you to set your night time insulin levels high enough to combat the dreaded DP.

So if you set your night time Basal rate to give you more insulin to combat the DP, then on the occasional night when DP decides to "give it a rest" then the Basal IQ software in the pump will stop delivering insulin if your levels start plummeting.

I think that this is what you have in mind.

I have an X2, and I really love it.
I haven't got the G6 sensor yet, but I am getting it very soon.


I am not SURE if the Medtronic 670g can suspend insulin on low as well. I think it can.

 

[LooperCat]

How confident would you be setting up your own system? I’ve got a diy artificial pancreas system going using Omnipod, which is my pump of choice because of having no tubes (I’m a trainee paramedic, so having tubes hanging off me isn’t ideal) - it suspends at whatever level I tell it, unlike the proprietary systems which I believe suspend insulin at a relatively high level. I believe the lowest possible target for the 670G is 6.7mmol, and that’s too high for me personally. If it’s something that might interest you, there’s loads of information at loopdocs.org

 

[boxing]

As I have mentioned before, I have the tandem x2 with basal technology also I use the dexcom g6 .
Sometimes around 2 to 3 am , when my BG goes to 3.9 and lower my alarms start going haywire although the insulin gets suspended I wake up plus the rest of the household .I have a chocolate and go back to sleep My BG rises and the insulin gets to start working again. Best pump ever In the past I would never know if it was going low .The combination of the pump and dexcom work wonders

 

[Rokaab]

Ignore my last post. I realise 5hat you already listed the t:slim X2.
Doh

Thanks for letting me know it does work like that though, much appreciated.

How confident would you be setting up your own system?

Currently not very confident at all, mainly due to the fact I've never had a pump before and I live on my own so don't have anyone to rescue me if I set it up wrong, and admittedly overnight I'd be happy with it at 6.7 - though this may be due previously being on Lantus which often dropped me into the red on the libre unless I started at about 9 or 10 (currently on Tresiba - but I still don't like going to bed too low just in case)

 

[crumpy]

How confident would you be setting up your own system? I’ve got a diy artificial pancreas system going using Omnipod, which is my pump of choice because of having no tubes (I’m a trainee paramedic, so having tubes hanging off me isn’t ideal) - it suspends at whatever level I tell it, unlike the proprietary systems which I believe suspend insulin at a relatively high level. I believe the lowest possible target for the 670G is 6.7mmol, and that’s too high for me personally. If it’s something that might interest you, there’s loads of information at loopdocs.org

Do you use the omnipod in conjunction with the dexcom loopercat? How long do you manage to stay in range (%)? We're looking at your route in order to get some more 'alarm free' nights.

 

[LooperCat]

Do you use the omnipod in conjunction with the dexcom loopercat? How long do you manage to stay in range (%)? We're looking at your route in order to get some more 'alarm free' nights.

I’ve only just got the G6 - I was using Libre with a MiaoMiao before. I’m around 80% in range (3.8-7mmol) for the last three months, but less than 2% low. The last few days since getting the G6, I’ve been 89% in range with a standard deviation of 1.0 - which I’m thrilled with.

 

[aphex2k]

The 670g can stop giving insulin before a hypo, or during. This is manual mode though. There's no suspend feature if you're using auto mode but it does stop micro-basal (yes, I know it's technically micro bolus but this all happens when not eating so really it's micro basal).

I've not noticed DP since being a CGM user. My nocte charts are pretty flat and if you're stable and not going up or down then it generally does nothing. It can ask for BG if there's an extended period when the pump hasn't given any insulin so it's not an entirely full nights sleep but for me, my experience has been my sleep is better and less broken.