Bruce Stephens
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She talks about the experience in the most recent episode of the podcast she hosts, Type 1 on 1.
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The biggest thing to happen to me in 28 years, article on HCL by Jen Grieves
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trophywench
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Harumph - want one even more now. Not heard the '180 times a day' comment before - is it that many or how many it feels like?
Bruce Stephens
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I'm sure you have. It's a common enough meme. I'm also not sure what it's supposed to mean, or what "a decision" is, exactly, let alone how you'd count them.
Easing the burden for people with diabetes
According to research conducted at Stanford university people with diabetes (particularly those using insulin to manage their condition) make 180 more decisions each day about their health than someone without diabetes. So, the frustration of someone asking if that means you have to eat loads of sweets or questioning your diagnosis because you are not fat, must at times be truly overwhelming.
Inka
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Thanks for linking to that @Bruce Stephens Interesting reading and well-written too. I feel guilty but I’m still not convinced. I turned down an HCL more than a year ago. I totally get the bit about relieving the mental load a bit, but I guess I’m a control freak 
Seriously, I have a lot of questions and there doesn’t seem to be a FAQ anywhere. I’ve learnt a fair bit from kind loopers here who are happy to share their experience and answer questions, but I still seem to have more, many of which are probably trivial. I think they mainly boil down to how good the algorithm would actually be. What I’d like is a pump that allowed tinier basal adjustments like the Animas Vibe did. That was fantastic.
Anyway…thank you again for posting that. I wouldn’t have seen it otherwise 🙂
Seriously, I have a lot of questions and there doesn’t seem to be a FAQ anywhere. I’ve learnt a fair bit from kind loopers here who are happy to share their experience and answer questions, but I still seem to have more, many of which are probably trivial. I think they mainly boil down to how good the algorithm would actually be. What I’d like is a pump that allowed tinier basal adjustments like the Animas Vibe did. That was fantastic.
Anyway…thank you again for posting that. I wouldn’t have seen it otherwise 🙂
Bruce Stephens
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I subscribe to a lot of podcasts, including Type 1 on 1. (I don't listen to that many episodes of any of them but this was an episode that I did listen to.)
From the sounds of it she's an unusual pump user, making vastly more manual adjustments than most. I can believe HCL would matter much less for some pump users than others.
Inka
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Good point @Bruce Stephens I thought that was a lot of adjustments too. It sounds like her control didn’t reflect that level of investment either.
Bruce Stephens
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As I understand things, they vary a lot. While systems have been around for years, I presume the increased usage will trigger lots of work to improve things; I seem to remember one system being described as having a simplified bolus where instead of a carb estimate you could just say small, medium, or large (because you don't really need to be precise, but suggesting to the algorithm to be less or more aggressive when it sees a rise might be about as effective).
My concern with HCL is how it coped with exercise.
My exercise is not every day, at different times when I do and different types of exercise so the BG affect can be wildly different. Over the years, I have learnt to suspend my basal at least 30 minutes before starting a spin class but increase it by 40% when I start climbing whilst decreasing it by 30% when hiking for 4 or more hours. However, if I head to the gym for a cardio workout straight after breakfast, I do not need to adjust my basal at all
I know some HCL have an "exercise mode" but when I know my needs vary so much depending upon type, intensity, duration and time of day so how does one mode cope?
My exercise is not every day, at different times when I do and different types of exercise so the BG affect can be wildly different. Over the years, I have learnt to suspend my basal at least 30 minutes before starting a spin class but increase it by 40% when I start climbing whilst decreasing it by 30% when hiking for 4 or more hours. However, if I head to the gym for a cardio workout straight after breakfast, I do not need to adjust my basal at all
I know some HCL have an "exercise mode" but when I know my needs vary so much depending upon type, intensity, duration and time of day so how does one mode cope?
Inka
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Absolutely @helli That’s one of my biggest issues too. Everything I’ve read about loops seems to suggest exercise is a problem. I know people have mentioned adjustments they can make, like changing the target blood sugar, changing this, changing that, but frankly if I’m having to faff around with all that, I might as well just set a temp basal.
nonethewiser
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Really good read & agree with lot of her points on living with type 1, been looping for 6 weeks now & it certainly does take away a lot of manual fine adjustments but it's not sone miracle device that media make it out to be by any means.
Helli Inka, on my pump you have option to switch to manual mode for short time if needed, imagine others would do likewise. So if exercise was issue on automated mode you can switch to make manual adjustments to your basal delivery.
I'm away from home at moment so staying in hotel, as breakfast is more protein fat based than normal I switched manual mode as you can't extend bolus on automated mode, my bg tends to react quite shockingly to high fat protein meals & affect can last several hours, in automated mode just find its a bit slow to react to changing bg after such meals so prefer to switch back to manual mode as I did before just using pump & using prebolus & extended bolus feature.
For normal changes in bg find automated mode is incredible at predicting & adjust insulin delivery to keep bg in range, its a clever piece of tech.
Hope what Ive said makes sense but if it doesnt will try to explain further.
Helli Inka, on my pump you have option to switch to manual mode for short time if needed, imagine others would do likewise. So if exercise was issue on automated mode you can switch to make manual adjustments to your basal delivery.
I'm away from home at moment so staying in hotel, as breakfast is more protein fat based than normal I switched manual mode as you can't extend bolus on automated mode, my bg tends to react quite shockingly to high fat protein meals & affect can last several hours, in automated mode just find its a bit slow to react to changing bg after such meals so prefer to switch back to manual mode as I did before just using pump & using prebolus & extended bolus feature.
For normal changes in bg find automated mode is incredible at predicting & adjust insulin delivery to keep bg in range, its a clever piece of tech.
Hope what Ive said makes sense but if it doesnt will try to explain further.
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As I’m a bit of a fiddler, there have been various times when I’ve really wished TBRs were retained in HCL pumps, so that I have the option of acting earlier if I know that the algorithm’s adjustments will be a little late and not quite dramatic enough in certain circumstances.
In my experience living with HCL is just like living with basal:bolus. You quickly get to know its strengths and weaknesses and develop workarounds for various situations where the algorithm and your particular diabetes don’t fit perfectly.
The main difference for me between predictive suspend pump and hybrid closed loop was not less effort. It was much better results overnight, and about +20% TIR.
Inka
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Thank you @nonethewiser That makes total sense. If I did loop, I think I’d be switching to manual mode for things like exercise too. The fact you can do that is great.
@everydayupsanddowns Interesting. Again, that makes sense if overnight is an issue and I can see how well a loop would work for that. Luckily, barring illness or dodgy cannulas, my overnight line is pretty flat, kind of staying within the same range with only very slight movements up and down a few decimal places.
Thank you both. I found all that most helpful. I turned down the loop around 16 months ago but now seeing people enthuse about it did make me question my decision. What you’ve both said has reassured me. I think part of the problem is the media hyping it up.
@everydayupsanddowns Interesting. Again, that makes sense if overnight is an issue and I can see how well a loop would work for that. Luckily, barring illness or dodgy cannulas, my overnight line is pretty flat, kind of staying within the same range with only very slight movements up and down a few decimal places.
Thank you both. I found all that most helpful. I turned down the loop around 16 months ago but now seeing people enthuse about it did make me question my decision. What you’ve both said has reassured me. I think part of the problem is the media hyping it up.
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