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I have slept through the night every night since November 11.

Discussion in 'Parents of Children with Type 1' started by jenm999, Dec 6, 2016.

  1. jenm999

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    I misread your post, Ali. Yes, for the Loop, you can set it to anything. It uses a Medtronic pump but is not a Medtronic AP - it's a DIY system.
     
  2. rgcainmd

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    If memory serves (because I am too lazy to hunt down the particular thread on the forum where I read this) the target is set at around 120. That particular target is way higher than what I'm comfortable with. Clinical studies demonstrated that people using the Medtronic hybrid loop system ended up with eAGs around 140 which roughly translates to an A1c of 6.5. This is why quite a few people with tighter control won't consider switching to this system because they get significantly better results on their own (with either MDI or pump.) My daughter's A1c is usually lower, sometimes significantly lower, than 6.5. So (even if my daughter would consider switching to a tubed pump), there would be no advantage in our case other than needing to do less sugar surfing. For me, the more desirable A1c/eAG my daughter experiences outweighs the reduction in effort this system would represent. That being said, I can see how switching to the Medtronic closed loop system would be an advantage for people with poorer control.
     
  3. Ali

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    FWIW, I have very very good control, not going to throw out my numbers, but I agree 120 could end up with my A1c being higher. However if you truly stayed between a very tight range at night right around 120 and then added your own adjustments during the day i suspect I could get the same A1c but with way fewer lows. I think there are ways to make it work while we wait for more options with the closed loop and AP systems. ali
     
  4. rgcainmd

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    The problem I see occurring is that whenever you try to correct to something lower than 120, the loop algorithm pushes you right back up to 120. If the target BG value is 120, you'll also be higher than 120 a significant amount of the time. That's why the eAG ended up being around 146 in clinical trials. I'd never go for a system that actively fought my attempts to fly at a lower altitude.
     
  5. jenm999

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    We have good control. Our goal is same A1c with more sleep and less time out of class. Average is the same but things are less volatile.
     
  6. Ali

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    I understand that is how it works, there are still ways to work with it IMHO for excellent results:)
     
  7. rgcainmd

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    Could you make this work with, say, programming in "false" ISF's and/or I:C's?
     
  8. Ali

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    Remember I am an over 60 long time T1 and while I still have challenges they are nothing compared to growing kids or even up into ones 50's. I will probably use it as is for three months to come up with really good average basal rates. I then would probably switch to letting it run at night on its own and then turning off during the day and managing on my own. When something unusual came up, i.e. a 4 hour hike, getting sick, an active busy day at Disney:) I would let it run on its own. Who knows I might discover that running on its own I get great results because of reduced number of lows which skew averages and the way I eat and decide to let it run all the time. Hopefully after a few years of real life results everything will get better and they will start making upgrades and changes to the system to allow for more user options with setting target goals. Based on both the development of the pump and CGMS the first few years of real world experience really allow more sophisticated fine tuning of systems. I can only speak for myself, some of you are doing incredible jobs with managing your children and for you it might not be a good option. For me the sleep, smoother lines, less emergency food snacking, more spontaneity to my daily life, less energy I have to spend thinking about and tweaking my numbers would be huge for my quality of life.
     
  9. Theo's dad Joe

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    I feel the same. Our pump "target" is set at 110, but that really represents the upper range of our target zone which will go down to anywhere from around 75 to 100 depending on the situation. We will correct down if over 110, but we will only counter correct or micro carb between 75-110 if the circumstances dictate (rates of change, activity level etc.) The meaning of a target changes if you are getting counter-corrective basal reductions when your child is at a nice 95 after dinner doing their homework on a Tuesday night. In fact, we tend to bolus in a way that puts him below the 110 target for 30-60 minutes after each meal. It sounds like the Medtronic system would be counter correcting him on a downward "bend" from a prebolus if he's in the 80s or 90s BEFORE a post meal rise. We spend a lot of time in range but below target (70-110). That is why I like the idea of a target range like the DIY system described. I suspect that a 120 hard target is going to hit all of the clinical goals (A1C of 6.0-7.0 with virtually no hypoglycemia). It may make it hard to get a system through that does better.
     
    Last edited: Dec 12, 2016
  10. sarahspins

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    Worth noting, I have been "looping" since July, and I use 90-90 as my target range, and it works well for me (plus I've disabled the "feature" that prevents the bolus calculator in the app from working when you are below target - common sense already tells me not to bolus if I was say, 60, but there's no reason not to if I was just 75 or 80, but I'm not comfortable setting my target range to include that). I use 120-140 for my workout mode (though rarely make it into that range - I tend to hover about 100-110), and that also works really well for me - I've yet to have any activity-related lows this way. My only lows have really been simple "I can't count carbs" or "I didn't remember to eat enough" problems... which Loop really can't account for, but those lows have really not been severe. Prior to looping I was in the 40's at least a couple of times a week, usually overnight. Now... most lows are only in the low 60's, and I haven't had any severe overnight lows.

    My last A1C was 6.0 (with about 10% of the effort I had previously put in the hover in the mid-6's) - a higher target such as the MM 670G uses would likely result in a higher A1C for me.... just because that target is 120 doesn't mean your average is 120. My average according the Dexcom has been in the low 120's, and that is with a target of 90. I imagine that 30ish point increase would still hold true with the 670G, making for an A1C at 7.0 or higher (with an average of 150+). I wouldn't be okay with that. I could probably push my average lower if I wanted to without much risk, but at the same time, this is working really well, and it's easy (less risk of burnout IMO), and I don't really want to mess with a good thing :)
     
  11. Ali

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    Thank you for this detailed response. I agree with you in that I would need it to be aiming for lower than 120 over 24 hours. I also would prefer to not have my A1c go up. I think I could get it to work but probably means mainly using for night and basal testing till they come up with some modifications to allow more user options. My on my own target is 80-80.
     
  12. Theo's dad Joe

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    How do you know your basal is right with the BP running? My understanding of BP's was that the concept of bolus and basal would change and that people would no longer set basal rates. (or carb ratios or correction factors) but that the BP would learn your patterns. Does this system learn your patterns? (does it do better from one day to the next?). Can you tell if your basal is set to high by how often it reduces your basal?
     
  13. Ali

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    Not sure if you are talking to me, but I figured just as I check patterns with my own corrections of temp nasals, and food etc, I would look backwards and see how often the pump did an automatic correction to the basal, either up or down and then see what my general basal rates on average where looking like. I think it does do all that but would want to know my own basal patterns for times I was not using the system.
     
  14. Theo's dad Joe

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    Good point. No matter what we need to know how to run MDI for a time.
     

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