If you weren’t able to tune in live (or you want to watch it again & again) here’s the recording from our Spotlight seminar, which featured an informative COVID-19 update and great info on CGM, looping, hybrid closed-loop systems, and tips on how to increase your time in range. Feel free to post any additional questions you have in the comments below!
Q&A with Dr. Edelman:
Re: closed loop hybrid systems: All of them have basal control, but how essential is bolus control? Does basal+bolus control improve outcomes? Also, how essential will liquid glucagon be as with Ed Damiano’s i:Let? Is the i:Let still the holy grail of hybrid closed loop? Is Xeris pharmaceuticals the only manufacturer producing stable liquid glucagon? -Adam L.
Yes all have basal control and the hourly bolus control help with TIR big time. The iLet is the bomb and is a totally closed loop…not a hybrid. There are a few other companies making glucagon including Zealand Pharmaceuticals.
What kind of support is there for school nurses? -Anonymous
Gosh…I really do not know specific ones, but for sure any CME for CDCES (formerly called CDEs) and other HCPs interested in diabetes would work.
Are we as type 1 diabetics considered high risk as say the elderly are high risk due to our risk of dka and sepsis if we contract covid-19?? -Michelle L.
Us type 1s in “good control” really are not at greater risk than others our same age. A1c close to 7% is key! The older we get the higher the risk.
My biggest concern as a senior with type 1 is that I am vulnerable to a cytokine storm if I do get Covid-19. Cytokine storms seem to be a problem with DKA and also with heart attacks with T1. The research article out of the UK today indicates that T1’s have a worse prognosis than T2’s. Am I the only one thinking about cytokine storms? -Adelaide L.
I read about the Cytokine storm as well and it is really scary. If your control is good and you are otherwise healthy, that is good and your risk is not different than someone else your age. Just be extra cautious and you will be fine. I do hear the antiviral meds can help people get better soon. Don’t worry too much.
Hi, LADA diabetic here. I have been told to use soda or candy to fight a low. Is there something healthier to use. Still waiting for my Tandem to go with my Dexcom6. Things will be better then but for now, help?? -Twyla W.
Hello Twyla…fruit juice like apple is pretty good. I get mine from Costco. Believe it or not…jelly beans work well since they are pretty much sugar…if you read the label you can see how many jelly beans make up 15 or 20 grams of carbs. THE CIQ is amazing!!!
Doctors and dentists are starting to call for in person visits? What are your thoughts? -Linda K
I think it is pretty safe. They are typically responsible at spacing out visits and keeping the place clean. My physical therapist’s office makes me wash my hands and checks my temp before I go inside.
I have a blood cancer called Polythemia Vera. I am type1. Does this disease affect my glucose because PV? -Barbara C.
PV should not affect it unless you are put on steroids to control it or any newer meds…check them out online to see if any other meds you are on raise your glucose levels. Good luck with your PV…not that common and of course I learned about it in Med school…which was a long time ago. Good idea to get your type 1 in control.
With the use of my pump, I have been using a lower basal rate for exercise and have used a smaller bolus for food before exercising. I am slowly getting better at using my pump and diet to not go low when exercising, but within an hour after exercising and sometimes for several hours after I have finished exercising, my sugar goes high. Since I thought that people generally continue to have lower readings after exercise, I am not quite sure why I tend to go higher for several hours after exercising and what I can do to combat the higher readings. I must admit, it seems to be risky to increase my basil rate after exercise just in case the sugar level drops. -Anonymous
Going up after exercise is not uncommon. If you reduce your insulin to avoid a low you can rebound once exercise stops. Also hormones like adrenaline go up during exercise that raise your glucose levels. I would not touch your basal rate…just a small bolus to prevent the spike. Exercise is a tough time to control for most type 1s.
Has anyone seen this data from the NHS? https://www.theguardian.com/society/2020/may/20/type-1-diabetics-type-2-coronavirus-nhs-study -Claire P.
That study was done in the UK and also showed that with good control and not being heavy the chances of a bad outcome are no higher. There are a lot of studies out there and none are perfect so stick to the positive news! Another good reason to get our control in good shape. Stay well.
How do you control your own blood glucose when you’re sedated on a ventilator? -Lisa H.
When on a ventilator, the doctors make all the adjustments. They will put an IV line in and give you an insulin drip and make adjustments on your glucose value. At least they are now using CGM in the hospital setting.
There was an ECHO Stanford webinar this morning and they said there was a recent study out of the UK that said that among hospitalized people with T1DM there, quite a few more of them died. Do you have a link to that study? They aren’t posting slides from the webinar for a few weeks. -PeggyEllen K.
Yes…see the question above which had the link. Also see my answer. Thanks
Scared to get tested as it seems that the testing centers are not changing gloves/masks, etc. as often and it seems that if it is that spreadable, then a diabetic (T1) may be more at risk by getting tested. -Anonymous
If you are feeling fine, no need to go anywhere to get tested. In San Diego our facilities are really good so getting tested is not an issue.
Discuss hydroxychloroquine. -Rich B.
Gosh…that is a big topic and sorry we did not get to it on the webinar. Personally I have seen several studies that look promising. The VA study did not show benefit. I know one thing 100% is that it is safer than the media is making it out to be. Rheumatologists use it often and also travel clinics and no safety issues. I know many hospitals are using it on patients, but it’s up to the doctor. I do hope better studies come out.
Am Looping – Autobolus branch, 63 y/o, T1D for 26 years. I have noticed lately, more and more in fact, that my post meal rise and return to normal is very gradual – like the continental divide with a middle plateau rather than a faster up and down. Can that be a sign of increased insulin resistance? I can break the gradual rise and plateau with a simple walk. Thanks. -James C.
Sounds like you are like the rest of us…Afrezza works well for that but need to deal with the algorithm of Loop. Walking sounds good but not always convenient. Try taking your insulin earlier, like at least 20 min before eating and of course if you can lower your fast acting carbs. Controlling the spike is tough. Good luck…you should have seen what a Hostess Twinkie did to me. 🙂
How often do T1D Covid-19 patients get DKA? -Terry O.
Not very often…like any illness or metabolic stress, it can drive up your insulin needs so testing and adjusting is the key. Watch the video on our web site about treating and preventing DKA.
How do we ensure hospital staff will maintain BG control, especially if we are looping and on a respirator? I’m guessing most hospital staff do not know about looping. -David W.
See my answer above about going on an insulin drip. You are so right…they will not know, but if you are in a regular hospital bed and not out of it, make sure they let you use it! Don’t worry too much even if your control is not perfect in the hospital.
This is going to be quite personal, but here goes….I am in quarantine alone and have been for 10 weeks. I want to go see the man I was dating before this whole thing started. He has children and shares custody with his ex. Is that too much of a risk for a T1D? I know there’s no real answer, but I’d like opinions please. -Jen B.
I would do anything you can to see him. If you have been careful and they have been cautious as well…just be safe and wear a mask (as much as you can) and wash your hands a lot, don’t touch your face and if the kids are small wash your hands after you touch them. Good luck!
How do we navigate our way if we end up in the hospital and we want to be able to keep our devices and manage our own care (provided we are able to) while hospitalized? -Gayle M.
Several questions on this. ..see above. In general, bring your stuff to the hospital, and if you are just on the regular floor and can think clearly, make them let you control your own diabetes. If you get into the ICU they will put you on an insulin drip and control your diabetes. Most will not know much about all of our devices.
Any thoughts on the risks of blood clot side effect of COVID in people with T1D? -Alanna C.
Scary stuff…I have not heard too much about blood clots in T1D…just those reports we saw on television. Not sure what else to say…STOP WORRYING!
Have there been any issues with insulin supply during Covid? -Evelyne P.
No issues at all with supply and all companies have programs to help with access and price. See our resources section on our website.
Is there any relationship with complications and BMI? -Jesse H.
YES YES YES YES…The heavier one is the worse off they are if they get sick. I do not think it increases anyone’s chances of getting COVID.
Discuss Vitamin D. -Rich B.
Typically low in T1D and supplementation is important to get your levels in the normal range. I get mine from Costco.
Do you see a time when geography no longer limits patients? My endo says that she may have to close her practice before the end of the year. There are limited endos available near me–and none that are “up to date” on new methodologies for treating T1. For instance, could I become one of your patients? Do you see this as a new way to serve T1s? -Sondra M.
Totally agree and I said this on the webinar…you can see pretty much any diabetes specialist you want but you need to work out the insurance issue or pay cash. Us endos are cheap!
Is there a way to do closed loop and still use some BASAL insulin? -Sarah M.
I think that would be tough since it would defeat the purpose of a basal rate modulator.
I’m really interested in looping but I think I’m going to have to convince my endo! Maybe I’ll become a patient of yours! -Susan M.
Absolutely…all of the endos at UCSD are familiar with Looping. Scott is the guy I mentioned on the webinar that can help. He is awesome. Scott Lohnes: firstname.lastname@example.org
Why not AUC instead of TIR? -Steven S.
AUC is more complicated and typically used for meal times. TIR covers highs and lows 24/7.
I’m using a tandem with the basal IQ not the CIQ as I’m am over 90% in range with an A1C of 6.2 -Barbara T.
Wow…you really like to brag, don’t you! I had a patient like that and after I convinced her to switch, she maintained her control but with less effort. Cannot do much better than you are doing…congrats!
Of the hybrid closed loop systems, which gives the user the most flexibility and control? -Kathleen C.
Looping and CIQ are the two best for sure. I looped on the Omnipod and now on CIQ. Both are excellent and it is a personal choice. See the article on our web site of the opinions of Jeremy and myself.
I take an oral chemo for my therapy. Consequently, it gives me false reading and I am unable to use the Dexcom or Libre. I am so disappointed to have to go back to finger sticks. -Barbara C.
Gosh…so sorry…Are you sure?? I did not think that it interfered with those devices. Do some paired testing and see if they are really off.
My time in range is typically 100%, in actuality. I measure BG with Glucometer to verify. My issue is that my CGM (G6) is not reliable and gives gross false lows the first 12 hours. It eventually finds its way. However, my data is now “tainted” by this how do I resolve this? My HCP always asks – what happened here? -Paul F.
I hear ya…first 12 hours is typically off on the low end for me as well. Even on the Dexcom web site they say that is possible. Congrats on your TIR!
Comment on the Medtronic 780 clinical trials. -Rich B.
I really do not know too much but the TIR, hypos, sensor are improved over the 670G. You can get a lot of info online.
What are your thoughts about t:slim’s control IQ software requirement to set insulin duration 5 hrs while using control IQ? -Randall S.
I do think it is too long personally…they are doing updates to the software so maybe we will have choices.
Is Ed Damiano’s dual hormone i:Let a true closed loop (i.e. not hybrid) system? Any news as to his progress in getting the dual hormone system to market? -Adam L.
Yes…it is not a hybrid but a real closed loop system. Clinical trials are underway so hopefully next year some time…OMG that will be so awesome.=
I went from loop (no auto bolus branch) to tandem CIQ. My time in range actually decreased quite a bit. I’ve basal tested on the tandem pump, so that’s not an issue. Is there anything else I can do? I feel like I’m riding the sugar coaster a lot more. -Pearl S.
Hello…that happened to me at first as well. If your correction factor and insulin to carb is set correctly you should do well. A lot of folks have issues with the CIQ and exercise getting low alot. The Looping algorithm is excellent…that is for sure.
Two Questions – If getting low in tandem control IQ how do you know if basal is too high or correction is off? Keep getting lows when in exercise mode on tandem control iq – even when not exercising (forgot to turn off) -Linda K
First, test your basal by doing an extended fast. Have an early dinner and watch your glucose overnight and do not eat or drink anything with calories for 12 hours. This will tell you alot about your basal rate. Second, see the many questions above about getting low during exercise with the CIQ. It is something Tandem needs to fix for sure. If you are playing tidly winks…no problem but if you are on a Peleton, it’s a set up to get low. I look to see if I have any insulin on board and disconnect for 45 min. You can also make a personal profile which allows you to cut your basal down during exercise, but don’t forget to turn it off!!!!!
Is the T-Slim a tubeless system? -Nia B.
NO..A typical pump with tubing. Go to Tandem’s website to see them. Only the Omnipod is tubeless.
What’s some good tips to avoid hypoglycemia when exercising in the heat? -Nia B.
Having a CGM is a must as your glucose values can go up or down. Keep your insulin from frying and stay hydrated!
I work out very hard and find myself going low even with the Tandem Basal IQ “Active” setting. Do you have any hints for how to not go low during working out? -Sheridan W.
A very common problem on the Tandem…please see some of my several answers above.
What do you do during exercise? -Jesse H.
Please see answers above.
Who makes the Therapy Timeline available. Not Clarity to the patient. -Larry C.
The timeline is from the Tandem app that caregivers use when someone comes in to be seen.
What are the options for android users? -Sarah M.
I do believe Androids users are being respected more and more. The companies send out updates all the time so check online as well.
What’s a Riley Link? -Farley G.
Oh My GAWD are you living in a cave? Just kidding. It is the small electronic device that transmits the glucose value from the G6 and sends it to the Omnipod or old Medtronic pump for Loopers.
How do you adjust bolus for low carb eating? Do you still count about 5g for about a cup of veggies? -Nia B.
I am not a big carb counter, but it’s pretty much trial and error. Depends on what veggies…some have a lot more carbs than others. Look them up on google. French Fries are my favorite veggie!
Let me know if you guys need another guinea pig. -Jen L.
Hi Jen…email Todd May who is the clinical coordinator for the artificial pancreas studies and other type 1 studies: email@example.com
When might we be able to get the iLet BP? -Wray G.
Hopefully next year.
When will that last system come out????? -Lisa T.
See above…the iLet may be out next year.
What are your thoughts on Omnipod Horizon vs Tidepool Loop once approved? -Anonymous
Tidepool loop is here and now, and works great. Do not know enough about the Horizon program but they are behind in the development.
Do you have any thoughts about whether the cost of these newer systems will be prohibitive? -Evelyne P.
The costs will not be prohibitive…there is competition thank GAWD.
Recommendations with using Symlin and the Tandem w/ Control-IQ? Any talk of Trihormonal pump? Symlin has helped me lose weight and improve post-meal blood sugars…but, I am tinkering on the Tandem. -Patricia S.
Symlin is awesome and they have looked at that with insulin in a bihormonal pump but nothing I have seen recently. They are also co formulating insulin and Symlin in a set ratio, and that will be very valuable. The algorithm may need to be tweaked.
What is Steve’s Time in Range? -Jesse H.
Hahahahahahaha! Typically in the low to mid to high 80s on average. I had a 62% the other day and OMG did I have fun that day!
Ozempic for Type 1s? -Laurie H.
Oh…Oh…Oh…It’s Magic…that song! GLP1s do work well in type 1s, but it is an off-label indication so go ask your doc!
So you can use the Loop app when you have Dexcom and Omnipod? It is something that you add to your system? -Maricarmen O.
Yes…it is awesome but not the Pods made for DASH. All you will need is a Riley Link which costs 150 dollars. Lots of help online as well as from Scott who I mentioned in my talk: Scott Lohnes: firstname.lastname@example.org.
This is all interesting but Medicare controls my use. I’m 72 and wonder if I will ever have a closed loop. Oh well. Nice presentation, looking forward to the next one. Thanks! -Twyla W.
Twyla….For sure you are a candidate for the CIQ by Tandem…they are working on a totally closed loop system.
How does the iLet Bionic Pancreas connect with your body? -Carla
Just like a regular pump with a dual insertion catheter.
I really like the Tandem Control IQ. But I find that sometimes it shuts off my insulin for too long (when I am at say 140 BG). But then it stays off for so long, that when it comes back to delivering basal, I get high as if the insulin has been off too long. -Alice D.
That is strange…It should not turn off at 140…maybe you are in exercise mode? It should only turn off if your glucose is predicted to be below 70 in 30 min? You can always call customer support.
What does Steve hope to see in the next 50 years? -Mike R.
Well…what do I hope to see…in the next several years a totally closed loop system but beyond that, a screening test to pick up folks who will come down with type 1 and an autoimmune modulator that totally prevents T1D in the first place. I do not think that is a pie in the sky possibility.
How do I get into an iLet Bionic pancreas study? -Patricia G.
You can try begging Ed Damiano. I have been doing that for years. See if they are doing studies in the city you live in and if in San Diego, give Todd May a shout.” email@example.com
Considering getting Tandem closed loop. I have a Samsung. Do I need an Apple phone? -Robyn T.
Just emailed my Dexcom connection and this site will tell you depending on what model: https://www.dexcom.com/faq/what-devices-and-software-are-compatible-dexcom-cgm-apps
My TIR is 85% and A1C 6.4%. I wear a Tandem but don’t use the loop feature. Is it likely that I would do better or worse on the loop. -Thelma D.
To be exact it is the CIQ hybrid closed loop system and I would say you would do just as well with less work and need for so much attention. That is what I like about it…it does a lot of the thinking and adjusting for me.
Where are the study sites for the iLet? -Lori B.
You can ask Todd May and he will let you know. He is the coordinator for our San Diego site: firstname.lastname@example.org
How do I get a chart giving my Glucose Management Indicator with a Dexcom 6? -Paloma W.
I am not 100% sure of what you’re asking, but the GMI is a calculation based on your glucose values and the formula may be a secret? Online you can look up some information.
What do you consider the absolute most accurate carb app? And, easiest. 🙂 -Bobbi S.
I am not a carb counter, but Calorie King is pretty good I hear! A huge chocolate chip cookie is only 10G…that is why I like it! 🙂