First Impressions of Control-IQ
By Kerri Sparling
More time in range and lower stress! In this Trial Watch, Kerri Sparling shares her experience with Tandem's Control-IQ
In January 2020, I received an email from the Tandem Diabetes Care team that my t:slim X2 insulin pump was eligible for the Control-IQ update. I was excited.
Control-IQ is the newest software update from Tandem Diabetes Care. Tandem describes Control-IQ as “an advanced hybrid closed-loop system that uses an algorithm to automatically adjust insulin in response to predicted glucose levels to help increase time in the American Diabetes Association-recommended target range (70-180 mg/dL).” This is a big deal, to me, because it helps alleviate some of the diabetes daily to dos.
And “excited” doesn’t really cover how I felt. I may have yelped. Because my Achilles’ heel in diabetes management for the last few years has been correcting high blood sugars. As the mother of two kids (my daughter is nine and my son is three), I was really good at preventing lows (with help from Basal-IQ), but sometimes I wouldn’t remember to correct highs. They always seemed less acute, less urgent, but I know that they have the most potential to contribute to long-term harm.
Admittedly, I struggled to stay on top of those highs, and both my time in range and my A1C showed it. I’d done a lot of research on Control-IQ, and I was stoked to try it.
Full disclosure: I have been using the Tandem t:slim insulin pump and, since 2016, have been part of Tandem’s Life in Full Color Speaker Series. You can read the full disclosure at the bottom of this article. My opinions are colored by that bias.
Okay, now we can get into it.
Updating the pump
Updating the software was not an issue. First, I had to get my endocrinologist to write a new prescription. This was unusually easy, as I had an appointment scheduled for early January, so I brought the paperwork with me. Then, I watched the required training videos. I understand that the videos are necessary. They are also tedious, always trying to catch me not paying attention. “Click on this button,” or “press the next arrow,” asking me for different actions after completing a training section to make sure I was engaged. But I was grateful to be able to train from the convenience of my home, on the computer, instead of having to attend an in-person training. After the training was done, I received an email to download the new software.
For me, the timing was just right for the update: I was due to change out my insulin cartridge and infusion set, which is required after updating the pump. I sat down at the kitchen table with my laptop and my pump. The scene was not calm; my daughter was asking me about her math homework, my husband was using our obnoxiously loud blender, and my son ran by with pants on his head and socks on his hands. Loud, busy house. But no worries – the download and update process were thankfully smooth.
I changed the infusion set, made sure my Dexcom transmitter information was good to go, confirmed my pump settings, and toggled the Control-IQ setting to “on.” It was time to put this system to the real-life test.
Going with the flow
I looked constantly at the icons on the pump to see how it was working: watching the red bars show up on my graph to indicate that the insulin delivery had turned off, or watching as my pump delivered a correction bolus to lower blood sugar – it was like magic. Only it wasn't magic. It was technology, finally taking big steps closer to what my pancreas would have done, were it not so compromised.
The system is set at a target blood sugar of 110 mg/dL, and the insulin duration is five hours (this is how long the insulin will stay active in the algorithm’s “insulin on board” calculations) – these targets and durations are not changeable. (I could tighten them, but that would mean turning off Control-IQ.) I worried that these settings would have me waking up at higher-than-I’d-like blood sugars, but overnights have been more than acceptable. On average, I wake up at 100 mg/dL using Control-IQ, and this is only slightly higher than my fasting blood sugars before using Control-IQ … and with more stability overnight.
There are two activity modes – Sleep and Exercise – and I used them both regularly. I have Sleep Mode programmed to start automatically, set to kick on at 11 pm every night. The optional Sleep Mode sets a target blood sugar range of 110 – 120 mg/dL but doesn’t allow for automatic correction boluses. Setting an automatic schedule for sleep, for me, was good because I wouldn’t forget to do it every night, and it was also a mental incentive to go to bed at a normal hour. (“What? No, can’t work late into the night. Sleep mode is on … sorry!”)
Exercise Mode sets the target blood sugar between 140 – 160 mg/dL, and it’s decent. I tend to be very insulin-sensitive while exercising, so I haven’t found a happy medium for working out yet. I’ll be experimenting with turning Exercise Mode on earlier and hopefully laying off the juice boxes or snacks while exercising in the future.
On the second day, I caught Control-IQ giving me a correction bolus. “Correcting the high!” I said to myself. My son heard me. “Give it a high five for correcting the high!” he said, so I pretended to high five the pump tubing. He seemed satisfied. And after the first few days, which turned into the first week or two, I realized that I wasn't thinking about diabetes the same way anymore. There was a confidence baked into my day-to-day activities, one that had not ever been there before. Yes, I’ve had pockets of exceptional diabetes management, like when I was pregnant, but that was the result of tremendous effort: I tracked blood sugars, I micromanaged my diabetes, I thought about this stuff all the time. But seeing solid numbers, reliably stable graphs … without me doing anything extra?
This felt different. I felt lighter.
The moment that really threw me, emotionally, was when I had my first string of days that were mostly in range. Prior to Control-IQ, I was struggling to maintain a time in range around 50%. When I saw that my time in range had increases to 80%, I was very moved. (I may have teared up a bit.) There was something so cathartic and so liberating about doing less to manage my diabetes in a way that was clearly better.
Not perfect, but better
Control-IQ, and wearing diabetes devices in general, isn’t perfect, and it still requires work from me. It’s just better, in my day-to-day, than multiple daily injections (MDI) and going without continuous glucose monitor (CGM) data. I need to acknowledge that I have only been using Control-IQ for a little over a month, which means that I am still in the honeymoon period. I know I’ll have a fight or two with the system, and that long-term use will show me both successes and hurdles going forward.
My skin still gets a little irritated from the adhesive of the sensor. And sometimes I still am annoyed by how much I beep. And I beep often – when my blood sugar is high, when it’s low, when the Bluetooth connectivity is struggling, when the reservoir is low, when it wants its back rubbed … last one is a lie – but I will adjust to the noise. I also have to trust the algorithm, instead of occasionally overriding it; this is the learning curve of letting something else drive my diabetes a little bit.
Control IQ still requires work from me. I calculate the carbs in my meals. I administer meal boluses. I’m carrying glucose tabs in case of lows. And I am required to wear an insulin pump and a continuous glucose monitor in order to make use of this technology, dealing with access and payment issues for these medical devices. It’s not a set-it-and-forget-it contraption, and I still think about diabetes.
But this system makes diabetes feel like it's less heavy. It makes stress feel less. After 33 years with type 1 diabetes, I’m grateful that technology is approved and becoming more accessible. As a community, we need to continue work to ensure that people with diabetes can access what they need to live well.
For me, diabetes has always been a concern that I kept on the front burner, mentally. It wasn't boiling over and it was rarely on actual fire, but it was always at a rolling boil. This new tech, this Control-IQ, has helped put diabetes on a back burner. The burner isn’t off, and I’m still thinking about diabetes, but more at a comfortable simmer.