Hi ho! Hi ho! It’s back to Medtronic I go

Medtronic MM780G and Simplera Sensors
(Apple watch not included)

Hello. It’s been a while!

The embryonic posts I had in my mind about living with the Tandem tSlim never seemed to manage to make it to the top of the ‘to do’ pile, and remain unwritten - which I'm sure was a relief all round. But there’s nothing quite like a deadline to spur a (largely ex-) graphic designer into action. And tomorrow I am awaiting the delivery of my new insulin pump, as the warranty on my Tandem tSlim has elapsed. So it felt like a long overdue blog post could no longer be avoided.

Interestingly the ‘new’ pump isn’t particularly new at all. It’s the pump I rejected in favour of the tSlim 4 years ago. This might surprise some people. So why am I not sticking with the tSlim? Or joining the ever-growing horde of podders? But no, for me it’s the venerable MM780G, but with the fancy new Simplera sensors.

So Long tSlim

Confusion about my choice of ‘new’ (old) pump might be even more confusing because I have repeatedly said that I’ve never had better results than with the tSlim. My overnight readings in particular have been spectacularly good, very stable, and never required the alarm/calibration acrobatics that plagued my last days with my MM640G. Automated night mode suited me brilliantly, and I just expect to wake between 5.5-6.5mmol/L every day.

Non-shabby 90 Day Results

Control IQ added approximately 10-15% to my average ‘time in range’ which I choose to set 3.9-9.0mmol/L. My previous general 70-80% has become more like 80-95% most days. This is pretty spectacular with something as fickle, contrary, and annoying as Type 1 Diabetes.

Dexcom G6 mostly tracks my BG levels brilliantly. While I was self-funding (for approx 3 out of my 4 tSlim years) I was able to stretch most sensors to run for 20 days with a viable and solid flow of data, that I was confident to use for most corrections, alerts, and bolus calculations.

So in many ways, I am really happy with the system, and have certainly seen significant improvements from running a hybrid closed loop system. I’d really not want to go back to a pump which isn’t integrated with a sensor and making adjustments.

If anyone is considering the tSlim, I’d say go for it. It’s a very smart-looking and smart-behaving insulin pump. And it might really suit you well.

So why the switch?

Good question! With diabetes gadgets and gizmos over the years I’ve found that the devil is very much in the teeny tiny details. And that even something that’s brilliant, and well regarded, can somehow just not ‘click’ with you and your particular diabetes’ foibles.

This seems to be doubly true with algorithms.

An algorithm is based on a way they expect a person’s diabetes to behave. And how much of an adjustment that person might need to steer things in the right direction in any given set of circumstances. Your own individual diabetes may, of course, have other ideas. But commercial systems being what they are, they don’t really want to offer you much in the way of adjustment or personalisation. It is what it is.

Pretty soon after starting in the tSlim (with only Basal IQ at that stage) I observed that their predictive low-glucose suspend acted much later, and switched off much earlier than the one I’d been using on the MM640G for several years. There were a gradually phased series of basal reductions before a full suspend (really my body needs a full shut-off from the start), and the insulin resumed very soon after an up-tick in sensor values was seen. This was good in the sense that I didn’t have any of those occasional teeth-grindingly frustrating high BG alerts following an over-long suspend. But it was a bit rubbish, on balance, because only the most gentle downward-drifts were caught in time for me. Even when I activated ‘Exercise Mode’ for such strenuous exertion as wandering round to the shops.

In the old days I’d have set a Temporary Basal Rate to start things off early. But Hybrid Closed Loops don’t let your set TBRs, because... well... they are supposed to be doing all that stuff for you.

I experimented with setting essentially a fake TBR basal profile of 0.1u/hr for the 24 hours and activating that at the start of dog walks and such... But then, inevitably, I’d forget to switch back when I got home, because TBRs had always just cancelled themselves after a set time. Following an update of the Control IQ software I was able to completely suspend the pump for a defined number of minutes after which it alerts to restart. This was OK, but for reasons I cannot really understand this also silences any alarms of impending hypo/dropping BGs the pump might helpfully provide if basal-suspend isn’t enough on its own, and levels are getting a bit close to the edge.

Dex lag and alarm fatigue

Initially I was blown away by how well the Dexcom G6 tracked my BG levels. Whenever I did a ‘how are things going’ cross-check the results between fingerstick (Contour XT) and Dexcom G6 were only ever a few tenths of a mmol/L out. This gave me huge confidence. But at some stage in the first year I observed that the problems I was having with the late action of tSlim’s predictive low-glucose suspend were being compounded by a distinct lag between capillary glucose and sensor glucose. This isn’t news to me, and I understand exactly why this lag exists, but Dexcom seemed more reluctant to respond to changing values than any other sensor I had used. Almost as if part of it’s ability to match capillary glucose so well when things were stable was bound up in taking extra values and only updating sensor glucose every 5 minutes - perhaps it just waits until it's sure? For me Dexcom G6 is almost always a whole 10 minutes behind moving glucose. And when a ‘this hasn’t worked’ Control IQ alert is happening only 15 minutes before levels dip below 4.0 (and that ’15 minutes’ is what was happening 10 minutes ago) well... some of my increased number of low-level hypos were easily explained. From 1% below 4.0mmol/L to frequently more like 3 - 3.5% - still on target, but I've worked hard to restore flagging hypo awareness and this really can't help.

When is a 4.2 not a 4.2? When it's 10 minutes later

Added to that there were challenges at the other end too. I’d get told that the basal suspend wasn’t enough and to take preventative action after I was already low, and then 10-15 minutes later be told that levels hadn’t recovered, which prompted me to re-treat. Only to then discover that actually that hypo-treatment had been enough, and that the double-treatment was now gleefully pushing me into the teens. Maybe 5-minute updates 10 minutes behind reality are OK for some people - but when I really need to know how things are moving at the sharp end of hypo-dodging, they were causing me frustration and treatment errors.

The upshot was that pretty early-on I had to take the up reins of hypo-dodging myself again. I set my ‘low alert’ at 5.2mmol/L because (10 minutes behind), that gave me enough time to take action if necessary - with a sensor reading 5.2 and dropping I could easily be low 4s when the alarm sounded and need some rapid glucose to steer away from the 3s. I had the alarm repeat at 30 minute intervals, so that I’d get a reminder to recheck to see any action I’d taken had worked.

But of course it might be that I was just pootling along in the 5s. Getting little warbly nags every 30 minutes. Which was quite annoying.

Even more annoying

But nothing like as annoying as the tSlim’s attempts to actively sabotage my hypo-dodging efforts. Alongside a rapid resumption of the basal profile, the tSlim has, on multiple occasions, delivered a mini-bolus just as my levels were returning to safety after a hypo treatment(!). For meal mis-calculations, or dose-timing errors it never seemed quite so enthusiastic, or effective, at turning around a rising BG, but getting another low alert in the high-4s on a dog walk or while gardening, having successfully treated the last one - and then finding out that it was the tSlim that had caused it with a completely unnecessary mini-bolus, was the inspiration behind some particularly florid and lively outpourings of language over the past 4 years. I asked my consultant whether they knew of workaround/setting to prevent this. Alas none was available. So I had to hugely down-grade my correction factor during the likely hours of evening dog walk, which of course means Control IQ can’t work ‘properly’ during those times when dog walks have happened at other times. And again, setting or not setting ‘Exercise’ mode doesn’t seem to be the fix.

The hollow squares are tSlim autoboluses

 

Better results, but more effort

So yes, I have had better results, and the tSlim has handled many things really well for me. But the alarm fatigue has been pretty tough going. I’ve had a much higher numbers of non-severe hypos than I was used to on the MM640G, and I really miss the discovery that my pump has fixed something for me after the fact, quietly, in the background, with no alarms or notifications required.

Hopes for the MM780G

It was the memory of weeks and weeks with no sub-4 numbers that got me wondering about returning to Medtronic, and giving their hybrid closed loop a try. The pump is the same format, and the chassis is still as clunky and grim as ever (though I’ll be glad to have a screen that’s visible in sunlight again - the tSlim is awful in daylight), but they have updated the software, so it's not exactly like going back in time 4 years.

Medtronic G3 sensors never worked well for me and needed frequent calibration, including overnight. I gather the G4s were significantly better, and I have high hopes for the new Simplera sensors that I’ll be starting on.

I know quite a few people on the MM780G, and almost without exception they seem to get on very well with it. I know there will be frustrations and annoyances - there always are. But I’m hopeful I may be able to experience some of the “spending less lime thinking about diabetes” that others mention. On the tSlim I think I’ve had to think more - constantly checking up on what it’s doing, and fixing some very silly decisions it was making from time to time.

I’ll let you know how I get on.

Hybrid Closed Loop Insulin Pumps (Artificial Pancreas) - The Basics

Hello!

It's been a while eh?!

Sorry about that. Truth be told, it's all got rather busy for me, and actually since my last post in my early months on the Tandem tSlim x2, my diabetes has mercifully faded into the background a little, and while still very annoying, hasn't really given me all that much to write about.

But this week has seen the release of something really quite exciting, that I hadn't even realised was happening. It seems those smart cookies at NICE have been munching the clinical trial data and developing a Technology Appraisal for Hybrid Closed Loop insulin pumps (which is the latest bit of tech to be enthusiastically called 'the artificial pancreas', none of which so far are much like having an actual artificial pancreas, but I digress...).

NICE TA10845 is now out for consultation so that stakeholders can review it and make suggestions or ask some pointy questions before publication. It's the same process that the 2015 NICE Guidelines for Adults with T1 which I worked on went through. But what's potentially exciting about a Technology Appraisal, is that while NICE Guidelines are just that - an indication of what the evidence shows to be the better approaches - TAs potentially have more clout, and if the clinician decides that the TA recommends a treatment option for a particular person the funding has to be provided. If the draft is published in its current form it has the potential to open the door to the previously hen's teeth elusive pump-and-CGM combination to around 25% of people living with type 1 diabetes in the UK.

Of course some of these people may have little knowledge of this combination of technologies which has been around for a while, but access to which (certainly with funded CGM) has been notoriously difficult to obtain. And there's quite a bit to get your head around, because it's a combination of several different bits of diabetes kit all working together, but not completely automatically. For all the claims of 'artificial pancreas', there are still quite a few things that you need to do to as the wearer.

From my own experience, having some of my diabetes kit actively helping me out, and looking out for me has been a huge help and a massive leap forward. A hybrid closed loop can't do everything, but it really helps me smooth off the edges of my blood glucose guesswork. It gives me much more confidence, and my results have never been better. I'd find it very difficult to go back, even if (as seems likely from the draft criteria) I still need to self-fund my CGM sensors.

A year or two ago Diabetes UK were putting together an introduction to Hybrid Closed Loops, for which I recorded a bit of video. However in the end it was far too waffly for Diabetes UK to use, so they interviewed me for a few comments instead. But this recent announcement has seemed like the perfect opportunity to inflict it on the world. Sorry about that.

So here is a basic overview of what a Hybrid Closed Loop insulin pump is, how it works, and what it's actually like to live with.

Watch this a little larger on my YouTube channel.

Hype or Hope? Dexcom, Tandem tSlim review and 2020 round-up

Wait... hang on... December 31st? That can't be right! Have we actually had a year this year? And how come any of the things that happened this year seem to have happened at least 18 months ago? No time has passed. But it has passed at a snail's pace. And at the same time we've all become accustomed to living completely different lives.

Doing a sort of round-up post for the year that never happened doesn't seem worthwhile. There are only so many times I can talk about avoiding a Zoom-based diabetes thing before I'm going to run out of waffle. Yes even me.

tldr; 2020 was a bit pants. But I really like the tSlim and Dex.

Tandem tSlim with Dexcom G6

Out with the old
I've been meaning to write a post or three about my experiences of the Dexcom G6 and my switch to the Tandem tSlim:x2 (and subsequent upgrade from Basal IQ to Control IQ) since the Summer, but for all sorts of reasons that series of posts never arrived. I have lots of pics of pump and graph cluttering up my phone that were apparently going to eloquently show something or other, but it's all so long ago now that I can't really remember what it was I was going to say.

I am self-funding Dexcom G6 sensors, and it was the first time I had used Dexcom. Such is the relentlessness of the positivity around Dex, that I think secretly I might have been hoping that I wouldn't find it all that special. 

I sprung for the 'starter pack' which gives an official 30-day's worth of coverage before I committed to going for the tSlim, so that if my body chemistry didn't get on with the Dex I could opt for Medtronic's MM670G (or similar) with self-funded Guardian G3 sensors. I had always got on well with Enlites and to some extent G3s too, and I was pretty sure that I would have got on well with the MM670G if that was what I'd gone for.

Inserting the Dexcom sensors was really straightforward, and initially I ran the sensors with my iPhone (not yet having taken the plunge on the pump). They restarted easily, and I didn't even have to faff about with unpeeling tapes and removing the transmitter thanks to these instructions. What really struck me though, was how well the factory calibrated G6 tracked fingerstick results from my Contour Next Link 2.4 meter (still my go-to BG meter). The first few days were uncanny. Spooky even. It didn't appear to be hype at all - generally Dexcom was reading only a few decimal points away from any fingerstick I took.

Even a Dexcom G6 lags a little now and then

Reassuringly though, I did see a characteristic post-hypo-sensor-lag on about the 3rd day, where the Dex stubbornly continued bleating about low BG for 5-10 minutes after I was back above 4. So it was a regular CGM and not witchcraft after all. It was just that it was a really good CGM for me.

Joking aside, those early excellent matched pairs (against fingerstick checks) really helped me trust it as a new bit of kit though. 

And even better, while the factory calibration is excellent for me, and I've all but given up cross-checking with fingersticks, if I *need* to recalibrate the Dexcom G6 because it has drifted a little... I can! 

After a few weeks with the Dexcom I was confident to put in my request to switch to the Tandem tSlim when the warranty ran out on Threepio.

Switching to the Tandem tSlim:x2

I affectionately called my first insulin pump robot counterpart 'Artoo' (R2P2 - replacement to my pancreas #2), and kept with the Star Wars theme with my MM640G as 'Threepio'.  This bit of kit promised to be wiser and much more autonymous though, so I've taken to calling it HAL (hybrid automated loop), though of course it would be much funnier if a certain tangerine diabetic had made that joke, [affects creepily calm synthetic robot voice] "What are you doing Dave? I'm afraid I can't let you eat that biscuit..." etc.

Staying in its box until I was trained up.

As all this was happening while the healthcare system was in some degree of chaos, and all those buzzwords like 'social distancing' were in full flow I wasn't sure how any kind of switchover was going to be able to happen - but in the end, in classic 2020 style I did my pump training via a video call having had the box of goodies delivered direct to my house.

I had a few weeks with Basal IQ before switching to the smarter Control IQ. Both worked well for me, and each have their own idiosyncracies. I have tried to do as little fiddling as possible, taking an initial 7 days to see how each got on when left to their own devices to try to learn what they are good at, and where they struggle. Also learning how to give them the right information to get the best results.

For those outside the Tandem bubble (seriously 2020? another word you've mangled?!), Basal IQ is Tandem's 'predictive low glucose suspend' algorithm, which stops basal insulin in order to try to reduce risk of hypos. Basal IQ is a little more responsive I feel than Smartguard on my MM640G. In that it can turn on and off more quickly, and doesn't have a minumim duration or enforced gap after it has completed. There was a major irritation for me when running the Basal IQ algorithm in that the tSlim moaned at you if you set a 0% TBR, though ot was more than happy to set one itself. Indeed, the tSlim got very grumpy if a TBR was set that was less than 50% of your lowest basal rate. A degree of warbling which was as unwanted as it was unnecessary.

This irritation was short lived though, as I soon upgraded to Control IQ. One of the nice things about the tSlim is that you can plug it into a computer and upgrade the software on the pump. Which means that if they release fancier, smarter, or even just mildly less irritating versions of the pump software, then you don't have to wait until 4 years have passed to take advantage. All I need now is to find the email address of the person to send my Helpful Suggestions to, for inclusion in the next release 😉

Conclusions

I guess I've been on the tSlim a little short of 6 months now, and I can honestly say that I am really glad I made the switch. I loved the MM640G, but the clunkiness of the Medtronic chassis, and some of the million-presses-UX-interface-tedium was wearing me down. Plus the newer G3 sensors were a bit more flaky and prone to overnight calibration requests for me. There are things about the tSlim I would hope would improve - not least the reservoir filling, which is every bit as fiddly as people say. Their reservoirs really need re-engineering so that the 'white dot' behaves more reliably (tSlim users will know what I mean). 

And what of results? Well I've not really that the nerd-energy for much actual data comparison, but going on gut feeling I would estimate that the tSlim has bumped my TIR (time spent between 4.0 and 9mmol/L) by somewhere between 5% and 15%. What used to be a really good week of results is rapidly becoming pretty normal. Control IQ still needs watching as it often responds a little later than I need, and it's not perhaps as 'hands off' as I was hoping it might be, but Control IQ really nails the little adjustments for me. It struggles with circumstances which are a bit wobblier, but it seems very good at optimising gentle drifts. Overnight with Sleep Mode has been spectacularly good. Almost no alarms, and almost always waking in the 5s to 7s.

Gotta be happy with 28/30 days above 80% TIR

It will be really interesting to see if this has had any kind of effect on my HbA1c, but to be honest, I increasingly find A1c a poor proxy for how I feel my diabetes management is going from month to month. It may still be seen as an important stat as far as research goes, but I'd far rather focus on the ebb, flow, and varying proportions of BG values that lie behind it. But that's another post I'll probably never get around to writing...

Here's hoping for a peaceful, healthy, happy and significantly more stable 2021 for us all.

Guest Post: From Dx to X2 (Tandem T:Slim) by Robert S

This is a guest post by Robert S who dropped me a line via FaceTwit as he had been  writing down his 'diabetes story' but didn't have a blog to share it on. Apparently he has been good enough (or mad enough?) to read my ramblings in the past and offered it as a guest post for sharing here. His story echoes much of my own, and I am very interested to read that he has chosen the Tandem T:slim X2 insulin pump out of the current offerings, as that is one I have quietly got my eye on too. Here is Robert's story. Enjoy!

Tandem T:slim X2

My Diabetes Story, by Robert S

I was diagnosed in 1994 at the age of 38, about 10 years after my older sister who had (eventually) been diagnosed at a similar age. I was given a number of very vague, unhelpful leaflets & sent on my way.

I spent the next few years religiously taking insulin as instructed but with pretty poor results.

Diabetes clinics were a trial for me, with many 'must do betters' but precious little advice on how to achieve this. Several times I was mistaken for type 2 & had some very odd conversations. I probably presented as typical type 2, middle aged and overweight, and most people at the clinic were type 2. However they clearly hadn't read my notes which didn't inspire confidence.

I was divorced during this period so I was very much dealing with it on my own.

The internet arrived & eventually I discovered diabetes forums. Wow, what a revelation! There were other people having the same problems as me. A LOT of people! Bad news for them but a great relief that it wasn't just me.

Importantly some of these people were working to improve their diabetes & describing how.

At the time of my diagnosis carbohydrate 'exchanges' seemed to be going out of favour but for me, at least, carb counting was a very vague concept.

The forums prompted me to do the online carb counting course set up by Bournemouth Diabetes & Endocrinology Centre (BDEC). It didn't solve all my problems but for the first time I felt I had a method for moving forward.

By this time I had moved from 'Humulin I' & 'Humulin S' to a basal/bolus regime, which also helped.

My GP surgery contacted me suggesting that they monitor my diabetes now they had a Diabetes Nurse. Being rather disillusioned by my experiences in the clinic system I accepted.

I enjoy programming & wrote software for my phone to record everything & do some basic dosage computations. My HbA1c had never been really terrible, usually in the low 8s (8% or 64mmol/mol, Ed), but I honestly don't know how. Some hard work got it down to the mid 7s (7.5% or 59mmol/mol, Ed).

So the situation had improved somewhat & I felt more in control.

Sadly, another event encouraged my efforts, as my sister died from diabetic complications at the age of 64.

From the beginning hypos were an almost daily event. The worst being overnight. I've always had good hypo warnings, but at night hypos tend to progress further & I would wake up soaked in sweat.

By 2013 though, the overnight hypos seemed to be worse. I discussed it with the diabetes nurse at my GP practice but the best advice was always eat some supper & don't go to bed below 8mmol/L. I was already doing this.

I'd read about Continuous Glucose Monitors (CGMs) which looked very interesting, but were way too expensive for me and, I noted, you still needed to do finger sticks.

Things came to a head on Boxing Day night 2013. I was away staying (alone) in a hotel & I woke up with a hypo around 1:30. Dragged myself out of bed managed to force a some glucose tablets & a biscuit down me & fell asleep. The next thing I knew I was waking curled up in a ball under the duvet, sweating yet shivering to the point where my teeth were chattering continuously. The worst thing was that I couldn't move to do anything about it. Eventually I fell asleep wondering if I'd wake up.

I decided to self fund a Dexcom G4, at least for a while. By the end of January 2014 I was wearing my first CGM. I watched it obsessively. On the second day I attended a graduation ceremony and was offered a glass of Bucks Fizz & a blueberry muffin. I thought I was being sensible & only ate about a third of the muffin & bolused for it. The effect on my blood sugars was fascinating. I watched as the graph went up, & up & up. I don't remember how high but it was an eye opener.

Initially it was more about the alarms which warned me in time to stop low blood sugars. Still annoying at night but I no longer woke up sweating.

I began to learn from the readings. The first big thing I noticed was a fairly consistent dip in my blood sugars around 1:30 to 2:30 in the morning. This made it difficult get my overnight average to a sensible level & went some way to explaining the nocturnal hypos. I tried varying the time that I was injecting my basal (Lantus) moving it from evening to morning, or splitting the dose. Nothing was really satisfactory.

Someone in the DOC (Diabetes Online Community) suggested changing my basal insulin. After chatting to my GP I moved to Levemir. I had a lot of trouble sorting out the dose, being quite worried that I had to take so much more than I had of Lantus. It was a split dosage & gradual adjustments left morning/evening doses very different, but, it was working. I saw some fairly horizontal overnight graphs, something I'd never ever seen before.

This encouraged me & I also made other adjustments; splitting boluses for some meals, not being afraid to do corrections between meals & so on.

Nothing was perfect but I did feel more 'in control'. Things still went wrong but when they did I was confident I could put it right. My HbA1c went below 7% (53mmol/mol) for the first time.

Using online instructions I built a box of electronics which allowed my Dexcom sensor data to be transmitted to my mobile phone. Thanks to #WeAreNotWaiting I set up a NightScout website to display my data.

This was all great, but hard work. I was doing a lot of injections, up to 12 a day. Also absorption of my basal injections was rather erratic, sometimes as I would expect, sometimes not. The best location was my thigh, but despite rotating sites there were problems.

By this time I'd been reading about hybrid closed loop (artificial pancreas) systems. First the DIY systems OpenAPS, Loop, and AndroidAPS, then the first commercial system the Medtronic 670G. This was exciting stuff but it was clear that first you needed to have an insulin pump. I had in fact been offered one about 15 years before but was then horrified at the thought of being permanently connected to the thing.

I decided I would now like to try one. It was not something my GP surgery could sort out so I had to be referred back to the hospital. This proved to be a long process, several months. I still don't know why. Eventually it went through just before Christmas.

By the time I met up with the DSN at the hospital a month or so later I had all but convinced myself I was wasting my time as control was simply too good?

Sure enough the DSN was impressed with my readings but it didn't help my case. I pointed out that I was doing a lot of injections each day. Not relevant.

"How many hypos do you have?"
"Hardly any."
"Yes, but that's with the Dexcom you are funding?" This wonderful lady was on my side & looking to find a way.
"Lots, nasty ones, that's why I bought it"
"That's it! Now let's have a look at the pumps you could have."

What! Really! To be honest I would have accepted some dusty old pump from the back of a drawer..

But when I focused on what she was saying I could barely believe my ears. I'd done a lot of homework on pumps & she was mentioning the Medtronic MM640G & the most advanced, the 'Artificial Pancreas' MM670G.

Then she added the Tandem T:slim X2 to the list. Again I'd read about it but thought it was only available in the USA. Positively it would soon be linked to the Dexcom G6 I was already using. I love my G6 & it seems to compare favourably with the Medtronic sensors. (Not that I had any personal experience of them).

Uniquely the software (firmware) of the X2 can be updated & in the UK will soon include Basal-IQ, a system which automatically suspends insulin if it thinks you will go low. There is also the promise of a full hybrid closed loop option similar to the Medtronic 670G - again an over the internet update.

I made my decision; the T:slim X2. By mid March after a couple of training sessions, I walked out of the hospital attached to my pump. Very exciting & not a little nerve racking!

We had agreed a 30% reduction in the basal dosage compared to my Levemir. A profile was set up.

During the evening it became clear to me that this was still too much & changed to an 80% temporary basal rate (TBR).

My Dexcom woke me about 1:30. I dropped the temporary basal to 75% and had a small snack. Readings got 'stuck' in the low 4s & eventually I ate again and reduced to a 60% TBR.

So not much sleep but at least I was closer to the required dosage. One thing that I kept thinking that night was "How does anyone do this without a CGM??" Presumably they start with a much more conservative dosage.

I had worried about what to do with the pump at night, and it was a problem. Clipping it on my waistband sort of worked but it would slide along to an uncomfortable place or slip off completely. I now have a 'Spibelt' with a pocket for the pump which is much better.

A week in now & I'm doing remarkably well, some days over 90% of my readings have been 'in range' - between 3.9 & 9.9mmol/L. I know this is probably just a 'honeymoon period', having had type 1 for over 20 years I find I'm waiting for reality to reassert itself & everything to go wrong...

The pump itself is a very neat device. It is small & has a nice clear touch screen. If you are used to smartphones then it is easy to use. It seems well made, time will tell.

I've had some practice with temporary basal rates as mentioned but I've also been playing with 'Extended Boluses' a new concept to me, promising, but I need to experiment.

As with all pumps the big advantage is the same as the big disadvantage - namely that it is always connected to you. It's great that I don't have to remember my pens & I won't miss those injections - I stopped counting at about 50,000 several years ago.

A big advantage is that you have a record of every dose. No longer do I have to wonder 'Did I do that or not?'

There's also the precision of boluses & the in built Bolus Wizard (Calculator). I am learning to trust the IOB (Insulin On Board) figure on the pump. Previously I had tended to intervene too soon when blood sugars rose quickly.

I'm told that changing infusion sets on the X2 is slow, but it seems OK to me having never used anything else.

I'm looking forward to improving my settings & the upgrades mentioned above.

For the first time in my diabetic life I feel as though I am 'ahead of the game', and yes, I know I am lucky.

Diabetes has never been so interesting!

By Robert S.