Top tips moving to Hybrid Closed Loop (HCL)

[PhoebeC]

Hi all,

So I have had my date for the HCL set up, 10th Dec, much quicker than I thought.

I am currently part way though a 6 week pump Dafne course, last session 16th Dec. I have learn't things and it has good to be reminded of the basic's again, I haven't done any of the basal or bolus testing, as it hasn't yet fit in with my life ha! And the idea of fasting even for a few hours or not exercising, doesn't work with me, or the new puppy.
The other patient is on HCL already, and it is only me and him so the DSN has been covering both. And he will do the set up with the Omnipod rep. I have been on the libre 2+ since June, seems the same as Libre 2 with that extra day (15 days).

I found the set up from MDI to pump (Omnipod dash + Libre 2) very smooth, and better from day 1. Life changing for the better a week in.

DSN said people don't normally have issues, don't need time off etc., but I have heard very mixed things about going onto HCL in general and the Omnipod 5, so just wanted to ask for any tips.

Thanks as always 🙂

 

[Sally71]

My daughter found it pretty straightforward, switched it on and blood sugars stayed instantly better in range than they had ever been before! The only thing I would say is that it’s worth having an idea of how your system works so that you can be aware of any pitfalls. For example, on the T-Slim if you’ve done a food bolus it won’t do any correction boluses for at least an hour and a half afterwards. We’ve also had some minor issues with hypos, due to daughter delaying her meal bolus until after eating if she wasn’t sure how much she was going to eat, by which time the pump has detected the BG rise and done a correction, so when she then does the food bolus on top of that she ends up going low. There must be ways around that, maybe check how much correction it’s done and knock that off the food bolus? (I don’t have much to do with it any more, daughter is 18 now and pretty much gets on with it on her own.)

We also got caught out once by the fact that it becomes less easy to work out how long the pump will last on the remaining insulin. Took her to college one afternoon, she only had 4 units left in the pump but was only going to be in college for an hour and the highest her basal goes is 2 u/hr in the evening, so should be no problem. Except that at some point it detected a BG rise and dumped in a correction which used up all the remaining insulin and we had to drive home with the “cartridge empty” alarm going off every few seconds (you can’t turn that one off on the T-Slim until you’ve actually started the refill process). Lesson learnt!

I hope it all goes well for you, and that you find the system useful! It does take some of the headache out of things, we’d thoroughly recommend it. Good luck 🙂

 

[PhoebeC]

Thank you for sharing, good to know. I am glad the manual settings are the same as my current pump, that will help.

This has been such an improvement in the quality of my life, that I am excited, and also nervous.

 

[nonethewiser]

It's all pretty straight forward @PhoebeC believe me, on day of my changeover to hcl had appointment with pump dsn & we did a zoom meeting with pump rep, it was pump rep who went through everything & think it took about 90 mins in total.

After leaving it can take pump a few days to work things out in automated mode, but it will & you will find that overall bg control is much improved, I did anyway.

If not already get switched over to Dexcom G6 asap, just so you get use to it before day of changeover.

System if used correctly is excellent just like a standard pump is, not forgetting that you have reassurance to put pump into manual mode if any issue arises.

Just be sure to set up online accounts for Omnipod 5 & Dexcom G6, sensors/transmitter & pods will then be automatically sent out but you will be notified when a order is being prepared.

Pleased you've got start date btw, good luck.

 

[PhoebeC]

It's all pretty straight forward @PhoebeC believe me, on day of my changeover to hcl had appointment with pump dsn & we did a zoom meeting with pump rep, it was pump rep who went through everything & think it took about 90 mins in total.

After leaving it can take pump a few days to work things out in automated mode, but it will & you will find that overall bg control is much improved, I did anyway.

If not already get switched over to Dexcom G6 asap, just so you get use to it before day of changeover.

System if used correctly is excellent just like a standard pump is, not forgetting that you have reassurance to put pump into manual mode if any issue arises.

Just be sure to set up online accounts for Omnipod 5 & Dexcom G6, sensors/transmitter & pods will then be automatically sent out but you will be notified when a order is being prepared.

Pleased you've got start date btw, good luck.

Will be using the libre 2 plus which I am already on.

Thanks for the input, it’s reassuring.

 

[everydayupsanddowns]

I’m on my third sensor augmented pump now.

First was predictive low glucose suspend. Then a HCL, now a different HCL with a different algorithm.

Here’s what I’ve found:

Be prepared for some uncertainty and frustration. You and the ‘system’ have to learn how to get along.

Life is complex and unpredictable. Algorithms work best with steady, consistent, every-day-the-same behaviours. So there will be a degree of workarounds needed, but these take time to become clear. Don’t give up hope, and try not to chuck anything out of any windows in frustration in the meantime. It WILL get better, and easier.

To begin with, spend some time observing. Try (as much as you can) to leave the thing to do what it does for at least a couple of weeks without fiddling too much - as long as you are safe.

Different algorithms have different tweaks that can be made, and some are more tweakable than others. It’s highly likely that at least one or other thing you are used to using (eg TBRs) may have been removed. This is annoying, but you’ll find HCL equivalents (eg exercise mode or whatever).

Essentially you have to work out what settings, ratios, correction factors, insulin acting time, prebolus timings etc etc the algorithm needs to work well for you and for its adjustments to generally steer things the right way. These may be different to the settings you know work for you when doing things manually. For example on my latest MM780 HCL I have to prebolus for evening meals (never needed to before), and have an artificially short DIA, way way shorter than it actually is. But that means the pump gets the numbers it needs to make half-decent adjustments.

Good luck with it, and let us know how things go 🙂

 

[JohnWhi]

When I went on to HCL four years ago, the best advice given by the pump clinic consultant was: 'From now on, there is nothing I can do, and there is nothing you can do. You have to leave the algorithm to do its work.' As everydayupsanddowns has explained, this is not strictly true, but it is a reasonable strategy, at least to begin with. My insulin requirements were reduced, hypos more or less eliminated, time in range (I was told 98% over 30 days at the last appointment, though they may have misread it) impressive. You may find that sources of advice are limited, because ther are not too many doctors or nurses with extensive experience of the particular system. DAFNE pump sessions were good, but the best were seminars arranged at the local hospital by representatives of the pump manufacturer (Medtronic in my case). This enabled two-way communication. Patients were able to say where we found difficulties, the Medtronic people took us through all the available settings, with suggestions and explanations, as well as giving information on new developments planned for future years. After 43 years with Type 1, for the first time I am in a position where I don't really need to bother much about it.

 

[Miggs]

Hi all,

So I have had my date for the HCL set up, 10th Dec, much quicker than I thought.

I am currently part way though a 6 week pump Dafne course, last session 16th Dec. I have learn't things and it has good to be reminded of the basic's again, I haven't done any of the basal or bolus testing, as it hasn't yet fit in with my life ha! And the idea of fasting even for a few hours or not exercising, doesn't work with me, or the new puppy.
The other patient is on HCL already, and it is only me and him so the DSN has been covering both. And he will do the set up with the Omnipod rep. I have been on the libre 2+ since June, seems the same as Libre 2 with that extra day (15 days).

I found the set up from MDI to pump (Omnipod dash + Libre 2) very smooth, and better from day 1. Life changing for the better a week in.

DSN said people don't normally have issues, don't need time off etc., but I have heard very mixed things about going onto HCL in general and the Omnipod 5, so just wanted to ask for any tips.

Thanks as always 🙂

Hope it's going well. Personally, my only disappointment, is lack of tech advice, from the courses, that I've been on. Obviously tech, can be helpful, but unless you're tech savvy, I'm not, it's what to do, when it fails, that I've struggled with, even asking so called experts, has been patchy,. I've scaled back the tech to just using a pump, with cgm info, all shown on that...the extra app on mob, didn't work for me...but my general blood sugar, has improved , with the new system, so I'm happy to have stuck with it and did receive great advice, from folk on this forum. Good luck with it all.

 

[SB2015]

I found it hard to follow the advice to let the pump do its job at the start and kept interfering. As a consequence the algorithm struggled to match what I needed, and I gave up after a week. I then started again a month later, leaving it to get on with it, and it has worked well for me. Now four years in I would not want to be without HCL.

As @everydayupsanddowns said you need to work out what to tell the pump in order to get it to do what you want it to do. Each of the systems has different things that can be changed and it is a bit of trial and improvement as with all the tech we use. I have found it helpful to tap into the practical experience of others on here, as well as frequent use of the tech support at the start. They were so patient, and happy to talk me through things, with sight of my data through the daily uploads.

Where things are less consistent in a day I sometimes need to get involved, but in ‘normal days’ the algorithm works well for me and correct minor errors in carb counting, lack of pre bolus time, ….( It doesn’t compensate for my forgetting to bolus!!!!)

Let us know how you get on @PhoebeC