LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Wednesday, January 23, 2013

Profiles: A new approach to programming a pump

Most insulin pumps are like a Monopoly game board: You program your insulin-to-carb ratio over there on Kentucky Avenue; your correction factor across town on St. Charles Place; your target blood sugar up on Marvin Gardens; and your basal rates down on the Boardwalk.

And just like Monopoly, if you screw up your programing, you land in jail.

The t:slim tears up the old board and institutes some excellent new city planning, placing all these key metrics of insulin delivery in the same place, called Personal Profiles.

What does this mean for you, should you adopt the sexy new t:slim as your next pump? It means easier, faster programing, and a new level of control not previously available with an insulin pump. Read on.

A profile works kinda like a traditional basal rate, but it’s a basal rate on steroids. You can create up to six different profiles, and each one can have up to 16 time segments—what I call steps or legs. But in addition to just telling the pump how much to adjust your background dip of insulin either up or down, at each step you can also change your other three key metrics of insulin delivery: the correction factor (called insulin sensitivity by some folks); the insulin-to-carb ratio; and the target blood sugar.

The bottom line is that instead of wandering all over the fucking game board to program your pump’s most basic settings, you can program and adjust all of them from one place.


How’s it work in the real world? It’s tap-and-go. Suppose you wanted to add a new basal step. All ya’ gotta do is go into the profile, tap “Start Time” add the time you want it to start. A new leg is created, and it automatically copies all four values from the previous leg. This lets you adjust just the basal, if that’s all you wanted the change. The other three values stay the same.

If you need to change your IC ratio for dinner you can just duck into the profile and change that one factor at that one time and everything else stays the same. If you don’t have a time leg that works right you can add a new one in seconds, modify the one metric that’s pestering you, and leave all the others alone.

Hey, suppose you wanted to create a whole separate profile for the weekend. You can copy an entire profile with a few finger strokes and then modify it. There’s no need to enter all the data manually like some other pumps make you do.

Editing anything in an existing profile is a breeze. Tap on what you want to change and the familiar phone-pad style keyboard pops up so you can enter the new value. Of course, the Big Brother personality of Mr. Pump comes through here as well. Be sure tap DONE, then SAVE, then CONFIRM—all on separate screens—or all is lost. Literally.

Like all t:slim operations, this sounds more time consuming on paper than it really is.
The t:slim is to normal pumps what the first Apple Mac was to MS DOS computers. (Any of you old enough to remember that horrible “operating” system?) The bottom line is that the user interface of the t:slim pump makes sense. It’s intuitive. If you just use common sense and do what comes naturally, doing anything on this pump is fast and easy.

What about that new control I teased you with in the lead? On the pumps we have today we can have multiple basal rates, and we can change our IC ratios and the like by time of day; but as far as I know, none of the other pumps us have different IC ratios on different days. With the t:slim profile system you could have a different IC ratio or correction factor at the same time of day, in different profiles.

Why one earth would you want to do that?

Well, instead of talking about living for the weekend, we need to talk about living on the weekend. Most of us are either more active or less active on weekends than we are during the week. Some of us spend our weekends vegging-out in front of the TV, others climb mountains. So it’s common for pumpers to have a different basal pattern for weekends than for week days. And any pump will let us do that.

But there’s really more to it than that, isn’t there? Your activity level makes a difference to your insulin uptake. If you’re seeking the ultimate control, just changing your basal for the weekend isn’t enough. You also need to adjust your insulin sensitivity and your carb ratios. I guess you could do that on a traditional pump, but you’d have to go to Kentucky Avenue and then over to St. Charles Place every Friday night, manually change the numbers via massive scrolling; and then remember to change them back every Monday morning.

Yeah. Right.

However, with the t:slim, a weekend profile could have alternate correction factors and carb ratios built in, as well as changes in the underlying basal rate.


Oh. Right. But I need to tell you where the genius stepped on his own dick. This near-perfect system is ruined by the fact it can’t be automated. It wouldn’t have taken a bunch of rocket scientists to have added a simple line of code to tell the pump what days of the week a given profile should be active. I hate the fact that profiles have to be manually turned on and off. I work three jobs and my activity level is very different at each job. I wish Tandem had designed the profiles so they could change automatically by day of the week.

Sure. I could do it manually. But I won’t because I’m tired. I’d likely forget to either turn one on or turn one off. Instead, I’m designing a happy-medium profile. One that balances my varying needs to best (safe) advantage. It’s too bad, though. I could have had much better control with the simplest of features, damn it.

Still, for those of you who have your shit together better than I, you can now have a whole new level of control at your fingertips—just a screen tap or two away.

Next week: No pump is accident-proof


Anonymous StephenS said...

So Wil, I'm wondering: How many keystrokes, so to speak, are we talking about to create or edit a profile? And how do you like the touch screen? My last phone had a touch screen and I hated that it wasn't sensitive enough for my callused hands. Thanks for the info.

8:05 AM  
Anonymous Anonymous said...

It's probably a good thing it isn't automated. It's great if every weekend or every weekday was going to be exactly the same. But on the days that are different, then you have to remember to turn it off, which you might not think about when something is automated. I mean, what if you decide that this Saturday you *weren't* going to go rock climbing. Your profiles should be built around activity levels, not day of the week, because most of us don't have a rigid schedule. You do need personalization, but not so much personalization as it's going to mind-read what you do every day.

11:31 AM  
Blogger Scott K. Johnson said...

C:\> win

I'm a fan of automation. We should have to adjust for the exceptions in our schedules, not the routine.

3:48 PM  

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