Itβs been 73 days since I started looping. I have had a difficult December with a sprained wrist from a mountain bike accident and myself, my daughter and my wife had gastro which resulted in very little sleep and some abnormal readings. In fact I am still having abnormal sensitivity to insulin, resulting in frequent lows or blood sugar swings. I also had two failed Dexcom sensors and moved to the code calibration method which resulted in two days of false high CGM readings in comparison to my blood glucose readings. I’ll add the CGM stats once I am finished the analysis. Hello 2022!
Blood Glucose Stats
Blood glucose stats
A marginal improvement in December over the fist two months, but I still have a lot of work to do to get to my goal of a 5.5% A1C. Interestingly enough, after the gastro I am now 40% more sensitive to insulin, so hopefully now that I am aware of this I can get back to better blood glucose readings. I will also need to run in open-loop when changing Dexcom sensors to avoid all the issues I was previously having with false high blood glucose readings causing my Loop to micro-bolus incorrectly or increase my basal in error. Still not sure how I will handle protein in open-loop.
Exercise Stats 2021-2015
Total distance exercised
Total time spend exercising
I more than doubled (55%) the amount of hours I spent exercising in 2021, mostly as I was working from home which allowed me to spend more time exercising. As my A1C lowered, my fitness levels improved dramatically.
I am finally starting to return back to normality after starting to pump/Loop. Its taken a few weeks of focusing my efforts on running to gain the experience I wanted to acquire in terms of keeping myself mostly in range while I exercise, so I feel like its time to shift my focus towards cycling and gym again.
Gym (resistance training)
The first gym session back was mostly good, the only issue being Dexcom not registering a pretty severe (2.9 mmol/l) hypo. My body would usually register a hypo way in advance but I was pretty tired from the exercise.
Muscles groups trained: Biceps / Triceps
A gruelling 40 minutes with 5.2 Tons of weight being moved (at least according to Garmin’s calculation from me inputting exercise name and weight), which as expected is less than my last arm session where I moved 5.6 Tons. I’m fairly impressed I did as much as I did, as I was expecting much less.
December blood glucose stats
December 2021 Blood glucose stats are looking better.
My December update is quite pleasing. I am almost at 90% in range (3.9 – 7.8) and I am eating about 30% more carbs than I ate previously to achieve these numbers. I am not sure if I mentioned this before but I did a 30 day muscle building challenge about 3 months ago and one of the difficulties I experienced was eating more calories (to gain muscle) and staying in range. I am very happy with the 5.5% A1C and the standard deviation of 1.4. I would prefer to be 1 or under but with the introduction of more carbs that’s rather difficult to achieve at the moment.
I also wake up in range a lot more frequently these days. I am noticing a few more lows creeping in, perhaps a result of me needing to retune the Loop with the introduction of more frequent exercise?
Recently I feel as though my Dexcom is letting me down. I had two sensors fail back to back, which resulted me being without a CGM for a few days. Also Dexcom seems to be so delayed that by the time it alerts me of a hypo I have already corrected it in most cases. I am using the finger prick calibration method rather than the code calibration, which is supposed to be more accurate. Perhaps I need to adjust my calibration schedule to see if that helps.
Today was a good day! After much trial and more research (through Facebook groups and medical literature) I finally figured out my recipe for staying in my range during cardio. It turns out I may have been too ambitious with my expectations of not eating before some heavy cardio.
The Process I followed was:
Set a temporary over-ride for my basal (40% reduction) and increase my target to 7.
2. I ate a pre-run snack in the form of low carb granola and yogurt.
3. Waited for my glucose to rise above 6 ( I started at 6.8mmol/l)
4. Ran. I kept the loop closed as I wanted to see what would transpire. All in all I think it went well π
Improved time-in-range during exercise with decreased exercise anxiety
Lets start with A1C and Time-in-Range (TIR)
If we look at my stats just prior to looping, I had an A1C of 5.6% and a time-in-range (TIR) of 78.5%. The GVI and PGS stats were also really decent (more on these metrics here https://bionicwookiee.com/2020/02/26/cgm-metrics-gvi-pgs/), with a GVI of 1.2 (non-diabetic) and a PGS of 29 (non-diabetic). A decent average of 6.4 mmol/l, and 3.4 % (1h4min) of time in the 3.0 mmol/l – 3.9 mmol/l range.
Now we look at my last month while on Loop. In order to reflect the learning curve involved from switching to a pump, I broke the stats into two (2) fortnightly blocks.
First two (2) weeks on LoopLast two (2) weeks on Loop
As can be seen in the charts above, some slight improvements are seen in all metrics discussed above with a 7.6% reduction in TIR and a 4.5% (-0.3) reduction in average blood glucose. The GVI and PGS metrics reflect modest variability and good control, as opposed to the previous non-diabetic results. I spent 22min (2%) in the 3-3.9 mmol/l range, down 10min from the previous periods 32min.
Reduce diabetic burden
This goal is subjective and difficult to quantify. Loop does make it easy to administer insulin, enable an over-ride, track carbohydrate absorption ( I was doing this with Spike) correct a hypo/hyper and even just wake up in-range. It does come with its own challenges and hurdles to overcome, like ensuring you have an up-to-date version, checking certificate expiry, ensuring your CGM is calibrated accurately, and then the challenges of constant site changes, reservoir and battery changes, insulin mixing and exercise.
Decrease food anxiety while increasing food options
It definitely feels like less of a burden to experiment with food or eat more carbs, as Loop can pick up any slack due to incorrect bolus calculations, or adjustments after exercise. I used to have 3.4 % (1h4min) hypos (3.0 mmol/l – 3.9 mmol/l) in a month due to incorrect dosing after exercise, but this number has significantly reduced to 2% (22min) while using Loop, as basal can be dynamically adjusted to fluctuations in blood glucose. Post prandial (meal) hyperglycaemia has also significantly been reduced, but I think in part due to Fiasp as it starts working immediately once injected.
MDI Average Carbs per day: 92.6 (*excluding ‘fake carbs’)
Loop Average Carbs per day: 121 (*including ‘fake carbs’)
*’Fake carbs’ are entered into Loop to manage the blood sugar spikes from gluconeogenesis (fat/protein synthesis into glucose)
Improve time-in-range (TIR) during exercise with decreased exercise anxiety
Unfortunately since switching to Loop the Python code I wrote to analyse blood glucose broke with the switch to Loop, so I only have the pre-loop analysis. I was quite happy with the control I had during exercise while on MDI.
I have included the table I have been updating while I work on the Python code, which doesn’t seem to accurately reflect the amount of hypo events I have experienced while running. On the whole cardio has been the item on my list I have struggled with the most, and has been a significant source of anxiety. I am quite certain that after a few months I will have a strategy nailed down and the anxiety associated with exercise will wane. As can be seen in the below table, I am currently focusing on running as its the exercise I am struggling to gain control over the most. I was able to stay in range for the entire duration of all my weight sessions.
I’ll write a follow up post in the next month before I start my Android APS experiment. Good luck fellow Loopers!!
An interesting development from moving over to a pump has been exercise. Whilst resistance training hasn’t resulted in any issues controlling blood glucose (BG), aerobic (cardio) training seems to be heavily impacted by the fast acting insulin being used as basal. My previous strategy was to have no insulin on board (IOB) and fasted, this approach doesn’t work as well when pumping. My ability to stay in range during runs are improving by including fast acting carbs (preferably in liquid form) prior to running, but there is still much tuning to be done. My strategy yesterday was ingesting about 25g of carbs before the run and injecting .3 units just prior to running. I wanted to try this because it was raining and I wanted to disconnect the pump when I ran, as apposed to how I was managing it by reducing basal (50%) 30 min prior to running and for the duration of the run. It was a terrible idea!
I ended up having a little low during the run and then rebounding from adrenaline ( I had a little race with my running partner) from sprinting. This resulted in me needing to wait an extra hour to bring my glucose back into range before lunch.
Time in Range was calculated at <3.9 mmol/l AND >7.8 mmol/l
The daily stats are definitely improving as can be seen by my time in range (TIR) stats above. The morning basal testing revealed that I needed to increase by basal from about 6am up from .8 U/hour to at least 1.1. U/hour, further testing is still required in order to confirm these numbers. I had around 100g of carbs, including ‘fake carbs’ which is added into Loop as 25% of protein and 10% of fat per meal. I’m still not convinced that Loop is particularly effective at managing gluconeogenesis (the conversation of protein and fat into carbohydrates) as I find that if I use 4 hour digestion times I go low and 5 hour digestion times I spike slightly. I suppose more testing in needed π
15 days into starting my Anubis transmitter with Dexcom sensor and so far its working fairly well. I’m interested to see how these sensors hold up on other parts of the body in comparison.
My A1C is still hovering at 6% ( avg 6.9mmol/l), a fair bit higher than the 5.6% (avg 6.3 mmol/l) I was before looping, but I am finding more days with improved time in range (TIR). One really interesting outcome has been the discovery that I need a really large amount of basal (compared to other days) at around 7am in the morning. I am still keen to try Android APS and evaluate the pro/cons between the two, but I like the idea I have to do comprehensive testing to complete objectives. This, I believe, will result in better looping outcomes.
On Monday I was extremely sensitive to Insulin, I can only assume due to cycling on Saturday. I attempted to go MDI for the duration of the cycle but failed to take into account the massive amounts of basal I am seeing I need at 7am, so I am thinking I may need in excess of 1 unit of insulin prior to riding.
I have also started creating a survey which I believe would result in interesting findings.
So I started my journey on the 20/10/2021. The first day was rough moving from MDI (Levemir and NovoRapid) to a pump with just NovoRapid.
The Reason I moved was due to;
Better / more control for exercise.
Better hypo control, due to being able to suspend the pump during a low
The idea of more freedom to eat a few more carbs
Looping. Letting the rig take care of some of the diabetic burden
So far it has not been an ideal journey, and its partly my fault. You need to dial in your setting and I have more than reluctant to fast in order to calculate basal rates. Cardio has been difficult and unpredictable and the whole process of having a pump attached 24 is something to get used to. Needless to say that after a little over three weeks my control has been worse than when I was on MDI, but I am slowly making progress.
The first day of my Fiasp trial, and how glorious it was! A noticeably lower standard deviation and a lower average was welcomed as I have felt like I have been fighting fires with the pump, basal testing and lack of sleep due to my daughter.
Last night went fairly well. The only big mistake I made was not injecting for protein/fat, but my guesstimates seemed to be pretty decent. Overall my weekly average is coming down, slowly but surely.