Disclosure:  I have a sponsorship agreement with Tandem Diabetes Care – details are on my disclosure page.  This post is written with that bias in place.  Tandem did not ask me to write this post. Neither did my pancreas, because that thing doesn’t do much.

The hardest part about the Basal IQ update was waiting for my endo to sign off on the prescription.

When the email came in, I pounced on it immediately, signing into the patient portal and clicking the link to generate a prescription request for my endo’s office.  I checked back every … six minutes? … until the office finally signed off on the request, which took over a week.

The irony of the delay was that during the week of waiting, I was having lows every frigging morning.  Not aggressive lows, but intrusive enough to wake me up at 4 am and require either a temporary basal rate of 15% for 45 minutes or two glucose tabs.  These lows were annoying and were making me tired, creating a little bit of a fog that settled over my ability to parent and work, a reminder of the steady hum of background noise that diabetes creates even on its best behaved days.

Which is why updating my pump was an excellent move.

Once the prescription was issued, I received an email from Tandem with a link to the training modules that I needed to complete before I could download the Basal IQ update.  These videos took about 30 minutes to finish in total, and had small interaction moments throughout (probably to make sure I wasn’t just running the video while doing something else), and once they were over, I took a short quiz to confirm that I was paying attention.  After finishing those, I received the actual software download email with the update specifics.

Thing was, when that email actually came in, I was in Bar Harbor with my family on an end-of-sumemr vacation.  So I was covered in kids and chaos and actually had to hide in the top bunk of the kids’ room, pretending not to be there, in order to have 20 minutes to set up and update the pump.  (My kids like to be in my face, but the upside is that they seem to actively like me?   I’ll take it.)

In total, it took about 10 minutes for my pump to update.  And since I was already mid-session with a Dexcom G6 sensor, my pump and my sensor synched up in a matter of minutes, enabling Basal IQ right away.

There are a lot of pros, from my perspective.  The Basal IQ system has an algorithm that (via diaTribe) “looks ahead 30 minutes and suspends insulin when glucose is predicted to drop below 80 mg/dl or if glucose is currently below 70 mg/dl and falling. The system resumes basal insulin delivery once glucose values start to rise – without alarms.”  You can decide if you want to have the Basal IQ alerts active (alarming) or to have them work silently in the background (which is my preference).  It kicks on automatically and your basal resumes after your blood sugar starts to rise.  (The screenshot below is from the Tandem website.)

The afternoon I updated my pump was immediately followed by a hike in Maine, so I had a chance to really test out the technology.  As in, I was able to go for a hike and my pump turned off three different times while I was hiking and I spent the majority of the hike at 90 mg/dL.  THIS IS FRIGGING MAGICAL TO ME.

Also, after a week of early morning low blood sugars, having the Basal IQ system intervene without disrupting my sleep is freeing.  I like waking up at 99 mg/dL.  More of that, please.

What makes it awesome is that I am not required to check my blood sugar to calibrate my Basal IQ system (because thank you, Dexcom G6, for being finger stick-free).  And also, the system turns my basal off predictively, taking the edge off of a low blood sugar before it actually starts.  The Tandem website describes it as “the ability to predict low glucose levels 30 minutes ahead of time and suspend insulin delivery to help reduce the frequency and duration of low-glucose events.”  I’ll call it the “ability to avoid lows without doing a damn thing.”  It’s also helpful when I rage bolus down a high blood sugar.

This sounds stupidly easy.  But it’s so effective.  And looking at my pump, I can see how many times it kicks Basal IQ into action so I can continue to exercise, or snuggle my kid, or drive my car, or sleep.  You know, basic stuff that humans do.  Not having to calibrate the CGM or set a temporary basal rate is freeing.  Not having my blood sugar tank is also pretty damn freeing.

There are ways that I can accomplish this process manually and of course there are other DIY methods that work amazingly for people, but for me, this is optimal in this moment.  I’m not interested in carrying more shit around with me.  This is what keeps me from doing OpenAPS or Loop something similar, because as supportive of and amazed by the concept as I am, I’d fail at keeping the system active due to moving parts, access to the bits and pieces, etc.  I’m at peace with (and grateful to be) wearing a CGM and a pump, and having these two items starting to communicate with one another without any extra input from me is exactly what my life has the capacity for these days.

That’s what makes the Dexcom/Tandem pairing most effective for me; it requires no extra attention.

There are cons, but I am not sure what they might end up being, apart from access (which is forever a problem in the diabetes community).  I’ve been using Basal IQ for about a week and so far, every time it’s turned off, I haven’t resulted in a high blood sugar.  Instead, I seem to even out and avoid lows.  It seems to work as advertised.  Maybe the battery charge on my pump might run out a little faster?  I’m not sure about that, since I charge my pump every few days anyway.  This week, I’ll consciously let my pump go without charging to see how long it takes for the battery to crap out.

It feels good to taper some of my hypo fears.  It’s nice to have the systems I’m familiar with starting to work together.  Sorry, test strips, for not using you as much as I used to.  Same goes to you, glucose tabs.  I guess I’ll have to adjust to being more in range.  🙂  But overall, this makes me SO EXCITED for Control IQ to become a reality, because if this is what it’s like to have the “bottom half” of a closed loop system enabled, I’m stoked for the future state of no finger sticks, fewer lows, and fewer highs.

Please, more ease-abetes.

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