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T-Slim Pump & Control IQ Mode

A

AMP2

Newbie
Messages
2
Type of diabetes
LADA
Treatment type
Pump
Hello Community,
In Dec18 - I had a severe hypo and it triggered a fear of hypos which had to be addressed due to issues with high glucose levels as a consequence.
In Oct23 - I was fitted with the T-Slim pump Control IQ and had a negative experience with this: X3 hypos on the tube commuting back from work and X1 further hypo when I arrived home. The experience re triggered the fear.
Since then to date I have been using the pump in manual mode with no further success in glucose control.
I have recently tried the Control IQ again but unable to take that leap of faith in trusting the technology.
In addition - previously, and before the severe hypo episode, I used multi dose injections i.e. Fiasp and Tresiba flat profile background. I was much more successful with this. Fiasp I found was predictable. Novorapid used in the pump I find ineffective and unpredictable.
Has anyone else had a similar negative experience with the T-Slim and the Control IQ mode?
 
Hi @AMP2 and welcome to the DCUK forums.
I was put onto the tandem tslim about 18 months ago, in order to help with hypos, which I'd been having far too often. My previous treatment was lantus and humalog, and I found the lantus hard to get on with, even with a split dose.

While it's by no means perfect it has dramatically reduced the number and severity of my hypos. My dexcom g7 record has < 1% low all the time and 0% very low for the last two weeks with <1% very low if I go out further. I've also noticed improved hypo awareness because I am spending so much less time under 4mmol/L.

But it isn't perfect. You have to manually set your basal rates and carb ratios so if your needs change then you can just end up with too much insulin in your system. And if your pump loses contact with your cgm it won't necessarily pick up the start of a hypo.

How much help have your diabetic team given you with tweaking the various pump parameters?

Having said all that, pumps aren't for everyone, and not all pumps are the same. Maybe you'd be better off with a different pump or going back to MDI? But personally, I'd hate to be without mine.

Tagging @Juicyj who is also on a tandem and has more pump experience than me.

Once more welcome
 
Hi EllieM,
Thank you ever so much for your reply.
I have recently moved back to my local team as I no longer work at the hospital where the previous team was.
With the previous team - it was either their way or the high way in terms of the pump and so in essence I was just unable to work with them to move forward.
With the local team they are much better. The issue I think, is the complexity of comorbidity which includes varying doses of prednisolone which possibly causes issue with the algorithm.
For example - when the glucose level is very high (20 plus) due to steroid induced resistance the Control IQ will keep increasing basal and correcting until that level starts to eventually move, which usually turns into an aggressive drop. By the time the level reaches for example 8.5 the basal level reduces but the amount of IOB is unnervingly high even at that level.
So basically - the Control IQ does bring the high glucose level down, but the amount of insulin required to do that causes an issue as the level starts to lower.
The basal settings had been reduced and the correction increased (1:5.0) so that less insulin was required but this did not make a difference.
The DSN advised that a pump can only be changed every 4 years and I am about half way through that.
My thoughts are going back onto MDI for a while as I think the pump is not conducive.
 
Have you tried putting your pump on sleep mode? This is a bit of a stepping stone as it is technically on basal iq, it will only try to bring your sugars down by increasing your basal rate which I find suits me better. I don't want it to give me a correction bolus if I am about to start some physical exercise and if I'm not then I just add a basal correlation myself. Also I take most of my blouses on an extended/split bolus so it doesn't hit hard and fast.
 
Hello @AMP2 I have been using the t slim with Control IQ around 4 years now, I can honestly say for the first 2 years I was sat on the fence and wasn't sure it was the right pump for me, still having hypos and control was ok but not great, I used the Medtronic before without a sensor so was doing all my boluses manually and achieved a HbA1c of 42, it shot up to 54 with T slim. Background, I am also perimenopausal so hormones were erratic which also affects control, however on HRT now so more of a level playing field.

Here's what I learned..

Getting ratios correct was vital, so splitting my basal rates into 5 patterns throughout the day and basal testing to get the ratios tweaked and fine tuned was vital.

Easing off the manual pedal was vital to let control IQ and the algorithm intuitively learn my patterns, I was too hands on and ghost carbed and corrected highs too often, taking the foot of this pedal was vital, hitting a hypo meant playing the yo yo game with control and I was fighting control IQ too often, once I learned to back off and let Control IQ do it's thing then my control improved.

Switched from Novo to Lyumjev and things stepped up a gear here too - its a fast acting insulin so starts working pretty much straight away and although it's painful at infusion site, the benefit of having better control outweighs the pain bit.

Make sure your weight is up to date in the pump settings, this is vital.

I wouldn't opt for sleep mode in your current position - getting your basal ratios correct is your first job, do some basal fasting, if your unsure how to do it then use https://www.mysugr.com/en/blog/basal-rate-testing

I now also refer to Time in Range for my control guide and if i'm hitting around 80% am happy (NICE guidelines is 70%). I still have hypos but incredibly rare to have one below 3.4mmol/l and generally around 2-3 a week but exercise alot and this affects my control too.
 
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