How Control Iq Works
Like other automated pump systems, Tandems new algorithm works by pairing an insulin pump with a continuous glucose monitor to allow for automatic insulin adjustments based on predicted glucose values. In this case, Tandems t:slim X2 pump and Dexcoms G6 CGM will work together to keep blood sugars within the ADA recommended range of 70 to 180.
This is accomplished by multiple pathways.
To help avoid hyperglycemia, the automated system will increase basal insulin when blood sugar is predicted to rise above 160 within 30 minutes. If blood sugar rises above 180 the system can deliver a correction dose to quickly bring sugars back in range.
On the other end, Control IQ will automatically reduce basal insulin if blood sugar is predicted to drop below 112.5. If sugars are predicted to drop even lower, below 70, the system will suspend insulin delivery altogether until sugars begin to rise again.
The system also allows the user to set temporary glucose goals for times of increased activity to help avoid lows.
In a study published in the NE Journal of Medicine, this combination of control factors led to an 11% increase in time spent in range and a 2.6-hour daily decrease in high blood sugar, on average. These types of positive results were seen across a wide range of ages and baseline A1Cs.
How Does An Insulin Pump Help
If youre still contemplating the idea of whether you should use an insulin pump or not, here are some reasons that can help you decide.
More Flexibility
With an insulin pump, you can continue to live an active lifestyle without any issues. You dont have to find a special area to inject insulin into your body. Any area you normally would inject insulin will work for the pump infusion site.
Preventing the Risk of Low Blood Sugar
Insulin pumps have a CGM readings system incorporated in them. Medtronic 670 G and tandem control IQ systems are the best examples. This ensures that they monitor your blood sugar levels and automatically shut down or inject more insulin based on your blood sugar levels. Its a safe, easy, and healthier way to consume insulin.
Accuracy in Insulin Delivery
Insulin delivery can be set as needed. You have the freedom to set the dosage amount for the insulin. Even if youre new, this is not a hard feature to master and will ensure that you dont accidentally have too little or too much insulin.
The Future For Insulin Pump Companies: Who Will Survive
www.diabeticinvestor.com As problems for Tandem continue, and with Johnson & Johnson abandoning the insulin pump market, its beginning to dawn on some people that we soon could live in a world with just two insulin pump companies Medtronic and Insulet. Ok, to be fair, Roche also has a pump, but their market presence is lacking. Also, to be fair, Bigfoot is working on a system, but it isnt here yet. Plus, there is growing belief that patients can achieve optimum control using a CGM smart insulin pen system. Given where things stand today, the real possibility exists that when it comes to insulin pumps, patient choice will be very limited. This was a fear expressed by many when Medtronic signed an exclusive deal with UnitedHealthcare. Yet this agreement is not the cause of limited patient choice. Poor strategy is the real reason, as both Tandem and J& J have made mistakes that have put them in their current positions. Now, I will not list these mistakes as it serves no useful purpose there is no need to go backward. What I will do, however, is offer a path forward for any company that is bold enough to take on Medtronic. Keep in mind that Diabetic Investor has been covering Medtronic since it was known as MiniMed and no one, and I mean no one, has come close to giving them a run for their money EVER. The insulin puContinue reading > >
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How Does An Omnipod Insulin Pump Work
The Omnipod is basically managed with a Personal Diabetes Manager , that connects with the Pod.
From this PDM, you can see how much insulin on board your child has, you are able to do insulin doses from it, and manage your childs basal rate. The PDM basically looks like a cellphone, but its sole purpose is for the management of the Pod that is in session.
Let The Competition Begin
Medtronic’s monopoly of the closed-loop system market is quickly coming to an end.
In August, Tandem Diabetes plans to make a new feature called Basal-IQ available to users of its t:slim X2 insulin pump that will stop the pump from delivering insulin when CGM readings predict insulin levels in the future will be too low. Once this feature is available, users will be able to create a system like the MiniMed 670G that combines DexCom’s latest CGM, the G6, with the t:slim X2 to eliminate finger sticks and automate monitoring and insulin dosing.
It remains to be seen if Tandem Diabetes can outsell Medtronic, but Tandem’s system does have some advantages. Tandem Diabetes t:slim X2 pump is 38% smaller than the MiniMed 670G and the sensors for DexCom’s G6 can be worn for 10 days, rather than seven days for Medtronic’s CGM. Also, Tandem Diabetes solution essentially does away with fingers sticks, while finger sticks are still necessary to calibrate the MiniMed 670G.
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New Insulin Pumps 2019
Heading towards the closed loop system. Some people try and create their own DIY closed loop systems, but that will be a thing of the past with the advancement of technologies.
For example, Insulin pump makers Tandem Diabetes Care and digital health company TypeZero Technologies have just finished a pilot study of their hybrid closed-loop system It uses the Dexom G6, T: a slim X2 insulin pump, and TypeZero algorithms to automatically adjust basal insulin throughout the day.
This a cool article discussing some of the exciting things heading to the insulin pump market in 2019 and beyond!
The Flair Study: Summary Of Dr Richard Bergenstal’s 2020 Ada Presentation
Interesting study which compared the semi-closed loop 670G pump with the closed loop AHCL.
It’s the first pump study which compared two automated insulin delivery systems . Prior studies compared AIDs with MDI or pumps without sensors.
Prior insulin pump studies enrolled tech savy middle-aged “pumpers” with excellent glycemic control.
The FLAIR population was instead limited to subjects 14-29 years old. They’re traditionally the most difficult to manage due to lifestyle.
Enrollment was open to subjects with HA1c’s up to 11% . 26 % of FLAIR subjects had HA1c levels from 8.6 to11%.
Finally, subjects were allowed to enroll irregardless of prior therapy or exposure to technology.
20% of the subjects were treated with MDI.
38% of the subjects had never used a CGM.
The investigator’s goal was to broaden entry so that conclusions might apply to the general population of people with type 1.
The primary endpoint was daytime hyperglycemia.
111 subjects completed the study at 7 clinical sites in the US, Israel and Europe.
The mean entry HA1c was 7.9%.
All subjects were transitioned from their baseline regimen to a 670G.
Each subject was subsequently treated with a 670G for 90 days and the AHCL for 90 days.
The goal was to achieve a time in range of 70-180 for > 70% of the day with < 1% of the day spent with glucose levels < 54 mg/dl.
The time below range goal was < 4%.
What they found…
The 3% improvement with transition from the 670G to the AHCL was significant.
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Diabetes Tech To Watch For In 2021
The big story in diabetes tech in 2020 was one of delaysthe coronavirus pandemic threw our entire health system into disarray, and many diabetes businesses had to push back plans. Several of the innovations that we profiled in last years version of the same article havent yet made it to the market. With a COVID-19 vaccine now being administeredand with a greater level of comfort and normalcy around the telemedicine appointments that so many of us have resorted towe can hope that things will get back to normal, and that the pace of innovation will get back on track in 2021.
Next years big story should be the rise of the closed-loop insulin pump system. Tandems new Control-IQ system will have competition, as Medtronic and Omnipod both hope to release their own looping systems. Every year the dream of the artificial pancreas seems more and more realistic.
Here are the major new technologies and devices that we hope to see in 2021:
The Best Insulin Pump Brands To Choose From
Now that youre ready to pick an insulin pump, were listing down the top ones from renowned insulin pump brands. To help you make up your mind, were sharing the pros and cons associated with these devices as well. This can allow you to choose a device that meets your needs and gives safe and continuous insulin delivery.
Tandem pumps
Tandem insulin pumps are of two types the t:slim X2 and the t-flex. Both these pumps rely on basal IQ technology to deliver insulin based on the glucose readings. Most recently tandem came up with control IQ system in early 2020.
The following are the pros and cons associated with their usage:
Pros
- Recent improvements with control IQ system to prevent highs and lows. It also increases time in range
- They have a full-color, bright touch screen
- Chargeable batteries
- Integrates with smart devices like smartphones and CGM through Bluetooth
- No fingerstick blood sugar calibration is necessary. Integrated with Dexcom G6.
Cons
- With smaller buttons, the screen may go blank if the Patients miss the buttons while pushing in order.
- Tubing connector may snag on your clothes
- Unlock procedure is not simple and may cause hassle
- Both basal and bolus settings are in the same time slot, which can be time- consuming to adjust
- Has a weak vibration system
- Patients have to charge the pump 1-2 times per week
Medtronic Insulin Pumps
Pros
Cons
Pros
Cons
Omnipod
Pros
- Large and clear color screen with big readings
Cons
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What Is The Best Insulin Pump For Your Child
Every person is very different, there is no perfect insulin pump. All pumps do work very similar in doing very well their insulin delivery, but what makes them different is the settings.
My suggestion is to meet with your childs Endocrinologist, Diabetes Educator, and get all the information possible from them. Go home, have a nice sit down and study the pros and cons of each pump.
Each insulin pump company has a sales representative that are always willing to meet with patients and educate them on the pump settings and answer any questions you have. From my experience, most of these sales rep are Type 1 Diabetic themselves, and they actually wear the insulin pump they represent.
For us, the best insulin pump that suited our need was the Tandem T-Slim x2 insulin pump.
Before we started using Tandem, we were using the Animas Insulin Pump, but this amazing pump went out of the market , so we had to pick another insulin pump. So our transition towards the Tandem T-Slim was very smooth.
I see the Tandem T-Slim insulin pump as a small/mini computer for diabetics. Its a very technological little pancreas, that basically makes our lives in managing our daughters diabetes much easier.
Interoperable And Interchangeable Devices
To address these issues, the Juvenile Diabetes Research Foundation encouraged the FDA in August 2017 to consider an Open Protocols Initiative. The OPI allows plug-and-play AID components to be interchanged. Users would have more choices and better access.
In March 2018, the FDA gave Dexcoms G6 CGM its first plug-and-play iCGM designation. This allowed G6 CGMs to share glucose data with any other device that receives an interoperable designation. To get an iCGM designation, a CGM must show sufficient accuracy and work interactively with any iPump or iAlgorithm through BLE communication.
Interoperable devices became possible in 2010 when the 4th version of Bluetooth, called Low Energy, or BLE, was released. BLE enabled secure, reliable communication between nearby devices over greater distances with less demand on batteries than the older versions of Bluetooth. Bluetooth devied its name from King Harald Bluetooth Gormsson who unified warring factions in 10th century Denmark.
In October 2018, the FDA also introduced the alternate controller enabled designation for insulin pumps. Often referred to as an iPump, the ACE designation assures delivery accuracy, reliability, cybersecurity, and secure communication with compatible iCGMs and iAlgorithms.
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Training Needed For Users And Clinicians
Many pump wearers switch to AIDs using the same or similar settings to those on their insulin pumps. Unfortunately, pump setting errors are rampant, as demonstrated by the poor A1c results and excessive glucose varibility among pump wearers. Setting errors generate erroneous basal and bolus doses and, unless remedied, place those who start on an AID at a serious disadvantage. Training for clinicians and users is lacking.
Clinicians and users are also often unaware of which settings will even impact their glucose control after starting on an AID. Which setting should they change and by how much when readings remain erratic? Which have no relevance in the algorithm? Additional training and guidance are required for clinicians and users. We encourage you to visit our Pump Dose Guide for setting suggestions before starting on an AID or when attempting to salvage an inauspicious start.
What Are The Features You Should Look For In An Insulin Pump
Here are some considerations you need to take before choosing an insulin pumpfor your child:
- Is it integrated with Dexcom G6 ?
- Does it have the ability to shut basal off to prevent low blood sugars? This is based on the CGMs readings
- Is it touch screen? Easy to input numbers for corrections and bolus?
- What type of infusion sets does it use?
- What is the size and weight? How will it look for my child? Consider your childs body habitus
- Is there an ability to upgrade to new features or products, as technology progresses
- Is it waterproof?
- What is the warranty and durability of the pump?
- How is the customer service? Does they have 24/7 services? What happens if there is a pump failure?
- Does my health insurance cover the pump? If not, what are the costs for the pump and supplies?
- Where can I get the diabetic supplies? From the company itself or a third-party supplier?
So whatever pump you decide for your child, make sure you think of all the pros and cons of the ones listed here.
We have never regretted getting our daughter into a Tandem T-Slim pump and this can also be a great option for your child and your family.
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Are Low Energy Diets Best In People With Diabetes Summary Of Dr John Wilding’s Presentation At The 2020 Ada
Dr Wildin’g s presentation was the first in a discussion of diet options in people with diabetes.
He reviewed energy deficient diets , meal replacement diets and very low energy diets
Low energy weight loss trials in people with prediabetes or diabetes include the Diabetes Prevention Trials in the US and Finland , the LOOKAHEAD trials and the UK Diabetes Prevention Program.
He arrived at the following conclusions:
LED’s with a focus on healthy, whole foods were successful, especially if combined with exercise and regular counseling.
Modest energy restriction with normal food is easy to understand, inexpensive and effective. in the UK, their program resulted in a 2.1 kg weight loss.
LED’s with meal replacement are more effective initially but must include a transition to normal food
The effects of all approaches diminish over time
Tandem Diabetesicontroller And First Fully Interoperable Closed Loop
On December 13, 2019, Tandems Control-IQ software received the first iController status for its fully interoperable AID system. Combined with Dexcoms G6 iCGM, the Tandem t:slim X2 iPump, and Tandems Control-IQ iAlgorithm, this became the first interoperable AID system.
DreaMed Diabetes, an Israeli company developing personalized diabetes management solutions, has received FDA approval for its Advisor Pro fuzzy logic/artificial intelligence algorithm. This guide for insulin dosing decisions by healthcare professionals may be integrated by Medtronic into its AIDs. Medtronic is also working to improve its 780 pump PID algorithm using Tidepools Loop MPC algorithm. FDA approval is pending. Neither has iController status at this time.
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Jdrf And Fda Step Up To The Fast Pace Of Diabetes Technology
Interest in AID devices is quite high. The market share in 2017 of $90 million is expected to grow to $279 million by 2024.1 While encouraging, advances in medical devices and software for treatment often outpace insurance company policies that allow a pump or CGM to be replaced only every 4 to 5 years.
Historically, wearers have been often stuck with outdated equipment for months or years until their warranty allows them to replace the entire system. A new component may not work with older components and owners are constrained to one manufacturer when others offer improved technology.
Is The Insulin Pump Right For Me
Many people with diabetes use insulin pumps because they prefer a system with flexible and frequently adjustable insulin delivery. Some people use pumps to avoid taking injections. Choosing between injections vs insulin pump options usually hinges on a persons preferences. However, you should seriously consider an insulin pump if you:
- Frequently suffer from very low or very high blood glucose frequently.
- Have an active lifestyle and will benefit more from having changes in your basal rates
- Want flexibility in your diet and like precision in insulin dosing. Using the bolus calculator in pump helps for better precision in your doses
- You have gastroparesis a condition where the stomach is unable to empty itself in a normal manner
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