As many companies and organizations in the diabetes world are coming out with innovative new tools, it can be hard to know how each option fits into real-life! At CIM, we’re committed to sharing our own experiences with diabetes tech and programming, to help your own learning experiences. Today, CIM’s Communication Coordinator, Kendra, will be sharing her own experience with the Basal-IQ feature for the t:slim X2 insulin pump alongside Dexcom’s G6 Continuous Glucose Monitor (CGM)!
Disclaimer: Please check out CIM’s Partners Page to learn more about the companies we work with. It’s important for CIM to recognize and to disclose that our writing may be biased based on the fact that Tandem Diabetes Care provides sponsorship and support to CIM. We work hard to get information into the hands of the diabetes community whenever we feel it may help people live life without limits.
First, a little bit about me. My name is Kendra, and I’m CIM’s Communications Coordinator. I’ve lived with type 1 diabetes since the year 2000 – not quite how I expected to ring in the new millennium, but what can you do? In January 2020, I celebrated my 20th diaversary. Exciting stuff, I know! It also marked 20 years of MDI, or multiple daily injections. I used to tell myself I didn’t mind injecting my insulin, that it worked best for me and that an insulin pump simply was not for me. For whatever reason, the magnitude of 20 years of living with diabetes totally shook up that mentality. Needles suddenly felt so clunky, and I was feeling more and more frustrated about the unpredictable outcomes that came along with MDI. That’s not to say pumping is incredibly easy in comparison – but MDI didn’t leave me feeling great about how was managing my diabetes.
The week after my diaversary, I called my endocrinologist and told him I wanted to start using a pump. He was shocked, to say the least – he was used to my totally anti-pump rhetoric, and was pretty excited to see I had changed my mind! When it came to picking a device, I was really interested in Tandem’s t:slim X2, primarily because of its Basal-IQ feature (and the hope to eventually update my pump using the Tandem Device Updater to get new features as they are approved by Health Canada!).† For those wondering, Basal-IQ technology uses a simple linear regression algorithm that uses Dexcom G6 CGM values to predict glucose levels 30 minutes ahead based on 3 of the last 4 consecutive CGM readings. If the glucose level is predicted to be less than 4.4 mmol/L, or if a single CGM reading falls below 3.9 mmol/L, insulin delivery is suspended. Insulin delivery resumes as soon as sensor glucose values begin to rise. As someone who has a history of overnight lows and hypo-unawareness, having my pump suspend insulin (and notify me of my low!) was incredibly appealing.
Since March 1st 2020 (which actually happens to be my birthday!) I have been using the t:slim X2 pump with Basal-IQ technology, and I am definitely pleased with my decision. I’ve found this technology to be a game-changer for my own diabetes management, and just want to share some of my thoughts and feelings on Basal-IQ, for anyone curious about it.
My mum & I with our matching pumps 🙂
Insulin suspension switching on automatically = less for me to think about!
Something I really enjoy about Basal-IQ is how the insulin suspends automatically when my blood sugar starts to drop or is predicted to be low. There’s no big fuss, or notifications telling me it’s working for me. Sometimes I don’t even realize it was ever on until I review my CGM data on my pump for the day and I see the red lines highlighting when the system took over! I enjoy this because not only is it one less thing for me to think about, it’s one less opportunity to be thinking about diabetes throughout the day. I’m sure we’ve all seen those statistics online about all the extra decisions and thoughts those of us living with diabetes make each day – so it’s almost a bit of a relief to have this one aspect handled.
My own pump using the insulin suspension option – the red lines/bars indicate when my insulin was shut off to prevent a low, and for how long. Where the red lines end, my basal insulin was resumed!
Less hypos, especially overnight!
As I mentioned before, I struggle with hypo-unawareness, and often don’t feel my low blood sugars until I’ve really crashed – if at all! This, of course, is aided by CGM technology which helps me catch those lows before they become a biiiiig problem. The Basal-IQ insulin suspension really helps with the severity of my lows, however. As my insulin is often suspended before I hit that low threshold, I don’t always reach as low of a reading as I may have if I had to wait to notice & suspend insulin myself – or, previously using MDI, not really had an option to correct for the insulin in my system. I also find the recovery from lows a bit easier when insulin suspension has kicked in.
Another bonus is I find myself sleeping through the night without low alerts from my CGM more often. The insulin suspension seems to help catch and prevent those near-misses with my lows, meaning I don’t wake up to the not-so-pleasant alarm from my CGM. This also means I don’t end up overtreating those smaller lows while I’m half asleep – hey, I’m sure we all do it 😉
When your pump has suspended your insulin, you’ll also notice a small red “S” on the upper right hand unit of the screen. The little diamond shape on the left side, underneath the pump battery, will also turn half red. PS – notice my dog, Eddie, in the corner! He’s the best hiking buddy.
You do have to complete online training before upgrading to Basal-IQ.
To ensure users understand the ins and outs of the Basal-IQ system, you’re required to complete some online courses before you can update your pump software. If you don’t do this training, you cannot upgrade to Basal-IQ. But, once you do, you can update your pump from your personal computer at home. For me, I found the videos quite useful as it was my first-ever pump. However, I’m sure for some, the information may feel repetitive, making it a long process. The training isn’t a huge time commitment though, so I think it’s worth it to be able to get more up-to-date technology.
Some insulin suspensions are unexpected…
While most of the time my insulin suspensions make sense in hindsight, every once in a while I do get confused by them. Sometimes I’ll look down at my pump, see a reading of 8.3 mmol/L with a slight down arrow, and realize my insulin has been suspended. There are likely parts of this algorithm I don’t understand, but sometimes I wonder how helpful some of the suspensions really are! If there were an option for my basal insulin to change instead of fully shutting off, that would be exciting. Maybe in the near future?
The software is really easy to download!
While I wasn’t using a pump before I also started using Basal-IQ, I did still have to download the Basal-IQ software onto my t:slim X2 using the Tandem Device Updater. Having minimal experience with insulin pumps to begin with, I was a little apprehensive about having to upgrade the software right away. Fortunately, it was a straightforward and quick experience – so if that’s something stopping you from updating software, I wouldn’t stress! To read more about Tandem’s Device Updater, head to our blog on the topic here.
Overall, opting to use Basal-IQ has been a win for me. My recently T1D diagnosed mum has also been using Basal-IQ since March 1st (which, coincidentally, is her birthday… but that’s a story for another time!), and she also finds it user-friendly and effective. If you’re currently using the t:slim X2 + Dexcom G6 CGM and are curious about upgrading to Basal-IQ technology, I’d definitely reach out to your diabetes care team & endo to discuss your options – it might also be a game changer for you!
Responsible Use of Basal-IQ Technology
Systems like the t:slim X2 insulin pump with Basal-IQ technology are not substitutes for the active management of diabetes. There are common scenarios in which automated systems cannot prevent a hypoglycemic event. The Basal-IQ feature relies on current CGM sensor readings to function and will not be able to predict glucose levels and suspend insulin delivery if a patient’s CGM is not functioning properly or his/her pump is unable to receive the CGM signal. It’s recommended your patient always uses the components of the pump system (pump, cartridges, CGM, and infusion sets) according to the applicable instructions for use and checks them regularly to make sure they are functioning as expected. Patients should always pay attention to their symptoms, actively monitor and manage glucose levels, and treat according to your recommendations.
† A prescription and additional training may be required to access certain future software updates. Only available to customers who are in warranty at the time they update their pump. Tandem may discontinue select software and features over time at its discretion.
