It was almost noon on Christmas Eve morning. I was slowly coming back. I looked around me. Orange peels and kit kats where everywhere. My 2 year old son was trying to sit in my lap. He was crying and saying between tears, "mommy, it's okay. You're okay, mommy. You're okay. It's okay, mommy."
I had a scary low. I hadn't had one of those in a LONG time. But even as a Dietitian, and a Diabetes Educator, a crazy low can still happen.
I got the new Tandem T-Slim X2 pump during my pregnancy, used it for about a week, but then decided to stick with my old Medtronic pump, and use up my supplies before making the switch. Because of this, I had all my extremely high basals and insulin settings already programmed into my Tandem when I finally did make the switch after having my baby.
The issue. I thought I had all the latest postpartum settings in my new Tandem pump. Right before delivery, I was taking about 120 units...a day. Right after delivery, I was taking a daily average of 25 units. That's almost 5X more insulin. That's a HUGE difference.
Therefore, when my nighttime basal adjustment didn't save. My blood sugar took a very scary turn for the worst the eve of Christmas Eve. My blood sugar was around 90 mg/dL before bed, but as I slept, it kept trailing downward into the danger zone.
TOO LOW FOR TOO LONG
On Christmas Eve morning, my blood sugar was too low and for too long. With the high basal dose and a slightly faulty Dexcom sensor that thought I was about 15 points higher than I actually was (which is a rare occurrence, but just so happened the night my Tandem basal settings were grossly too high). It was the perfect storm.
My husband knew something was up, when I didn't wake up at my usual time and even slept through my newborn's cries.
As soon as he knew what was going on, he begin asking me simple questions to check if I was having a low. I wasn't able to answer anything. All I could do was blankly stare back at him. That's when he knew he needed to work fast to bring me back.
SURROUNDED IN WRAPPERS, PEELS AND TERRIFIED CHILDREN
After 5 mini oranges, and and a fun size kit kat bar. Surrounded in wrappers, peels, and terrified children, I slowly begin to come back. On my left side, I was holding my very tender-hearted, tear-filled 2-year old son, on my right side, I was holding my ravenous, tiny 1 month old daughter.
As I looked into my babies' eyes, I couldn't help but to weep.
These two, were my beautiful little babies. These babies and my husband were my world, and in a moment, I could have been taken from them, forever.
As I held my babies in both arms, I couldn't stop myself from crying as thought, "what would have happened if my husband hadn't been there?" I couldn't answer my own question. I just held my babies closer, and let the tears roll down my face.
Later that day, I decided it was time for the Basal-IQ.
BASAL-IQ IS A LIFE CHANGER
To give you a little background. As a Diabetes Educator, I am a certified pump trainer for Medtronic, Omnipod, and Tandem. I think each and every pump works well, but it depends on the person and his/her needs.
However, when it comes to treating lows, Basal-IQ with Tandem, is a life-saving piece of software.
HOW BASAL-IQ WORKS
Basal-IQ Technology uses a simple linear regression algorithm that predicts glucose levels 30 minutes ahead based on 3 of the last 4 last consecutive CGM readings. If the glucose level is predicted to be less than 80 mg/dL, or if a CGM reading falls below 70 mg/dL, your basal is stopped. Insulin is then resumed as soon as the Dexcom G6 sensor glucose values begin to rise. Insulin may be suspended for a minimum of 5 minutes and a maximum of 2 hours within a 2.5-hour time window (1).
LIFE AFTER THE BASAL-IQ UPDATE
Since I updated to my Tandem T-Slim X2 pump with the Basal-IQ software. I have been able to sleep better, and not worry about an over zealous basal, a little extra bolus from a meal, or the effects of an extra intense workout.
These days, I feel as if I got an extra hour added back to my day. As a controlled type 1 diabetic. I had to manually turn off and put on 0% or drastically decreased temp basal often. Because of Basal-IQ, I not only don't put have to take the time to tweak, BUT I have also significantly reduced time spent below 70 mg/dL.
PREVENTING LOWS WITH BASAL-IQ
As soon as the Basal-IQ tech projects that I will be going below 80 mg/dL, it automatically (and silently) turns off my basal, and the moment when my blood sugar starts going in the positive direction, the Basal-IQ tech resumes my insulin.
For instance, I may be 96 mg/dL projected to go down, but the moment I start raising, even if it is just by a single mg/dL, my insulin resumes.
In my opinion, this algorithm works and works well. It significantly decreases lows AND it does not over correct and cause hyperglycemia. It is as sensitive as turning off insulin for 5 min, up to 2 hours within a 2.5 hour time window. Also, you can turn off the alerts of your basal being suspended and resumed.
THE MEDTRONIC 670g SYSTEM IS A LOT OF WORK
This my friends, is great tech. I was very skeptic. Especially after working with the latest 670G Medtronic "closed loop" system. The 670G Medtronic "closed loop" system is the first to prevent against highs and lows when it comes to basals, and keeps the blood sugar in the in-range time as well as 80% of the time, when used correctly. The issue is that the "in-range" blood sugar numbers are 70-180 mg/dL.
Patients who see me at the Endo office that are putting in a lot of work while on the 670G Medtronic system, are often averaging a blood sugar around a 140-160 mg/dL. That computes to an average of a 7.0% HbA1c. In my opinion, the Medtronic 670G "closed loop" system is a LOT of work, to be averaging around a 7.0%.
the GUARDIAN vs the g6 sensor
Another difference from the 670G Medtronic "closed loop" system is that the Basal-IQ uses the Dexcom G6. For those who do not know, the Dexcom G6 lasts for 10 days and requires ZERO calibrations. I can't explain how nice it is not to have to test. I do test whenever I feel that the Dexcom number is off, but those times are rare.
As a Diabetes Educator, I do make it a priority to try all the diabetes tech. Therefore I have tried the Guardian sensor by Medtronic along with the G6 sensor by Dexcom. To keep it short. The Guardian sensor by Medtronic had great accuracy, but so does Dexcom. My issues with the Guardian sensor were that I seemed to have a bit more bad sensors, it only lasted 7 days, and the minimum of 2 calibrations a day gave me anxiety.
AN EXTRA HOUR OF LIFE
Today, with the Basal-IQ, I feel that I have been given an extra hour of my life back. The Basal-IQ is working around the clock (like Medtornic), but with much less work. Yes, Tandem does NOT have software that corrects hyperglycemia like the Medtronic "closed loop" system...yet...but they are working on it.
Also, I want to throw out there. The Omnipod by Insulet, is working with Dexcom to do a closed loop system similar to Medtronic, BUT the target blood sugar is not hard set for 120 mg/dL, and the algorithms for preventing lows and correcting highs are different. I was told by the Omnipod rep that they are hoping to release this upgrade in the next 1 - 1.5 years AND they are working on an app that will work instead of your PDM.
Yes my friends, life with diabetes is only going to get better.
BASAL-IQ DOES THE HEAVY LIFTING
The Basal-IQ does all the heavy lifting for me. I don't mean to biased, but I am so grateful for this piece of technology. It is a total life changer for the individual with diabetes, but more importantly, for those who deeply care for that individual with diabetes.
On Christmas Day, I told my dear husband, that the Basal-IQ was his Christmas present. It was a bad joke, but he definitely appreciates the tech from Tandem and Dexcom.
Oh, and my husband knows I'm not a huge fan of kit kats. I tried to explain to him that the fat in the chocolate would only delay the glycemic response, so it would take longer for my blood sugar to raise. He response was that he knew how annoyed it would make me to feed me kit kats when I was out, that way I wouldn't get low on him again.
He's a smart guy. Kit kats are the last thing I want to eat when I'm low. If I'm going to eat them, I better consciously enjoy them! That stinker.
on a positive note
With diabetes, we are never given a day off. We are constantly checking and worrying about how food, exercise, stress, sickness, geez, I feel like even the breeze outside effects blood sugar some days. Diabetes however, allows us to deeply empathize with others and to become a stronger, and more disciplined individual. In a weird way, I am grateful for my diabetes. It has made me who I am today, and has connected me to many wonderful people.
Out of all the diseases out there. Diabetes makes us eat well and exercise consistently. When we don't, we quickly see the consequences. My family often tells me that even though I've had diabetes 20+ years, I'm going to outlive all of them because of nutritioin and exercise habits. Diabetes is the root of my motivation. Yes, diabetes is hard, but there is so much great tech out there to help us manage it and it makes us more health-minded people.
A little about me...
I work as a Diabetes Educator 2 days a week at a Diabetes clinic, but on my days off, I work through my Online Private Practice with people with type 1 and type 2 diabetes across the U.S.
If you are in need of someone to help you make adjustments with your insulin/diabetes medication or pump settings, you feel all over the place and need help making sense of your diabetes, you need help with your nutrition and/or fitness, send me an email so we can schedule a face-to-face video call.
I truly care about my patients, and I want to help you learn how you can manage your diabetes and be in better control. Together, we will comb through your blood sugars and your nutrition and exercise routine, and help you achieve a much improved HbA1c and well-being.
Email is the best way to reach me: firstname.lastname@example.org
Your friend, dietitian, T1D, and Diabetes Educator
Ariel Warren, RD, CD