Whether you’re coming due for a new pump soon or just staying up to date with the latest in type 1 technology, you may have seen exciting announcements about sensor augmented pumps recently and wondered, is this right for me?
In this article we are going to discuss the pros, cons and options available for this technology.

What is a sensor augmented insulin pump (also known as hybrid closed loop)?

A sensor augmented insulin pump uses a continuous glucose monitor (CGM) and a specialized algorithm to allow the pump to make adjustments to the insulin being delivered, with the goal of keeping blood sugars within the target range. This includes increasing, decreasing and even stopping insulin delivery in response to the information it is receiving, and the trend in blood sugar that the CGM is predicting. The goal of all sensor augmented insulin pump systems is the same – to keep blood sugars in the target range more often, and reduce the number of pump related decisions a user may have to make in managing their diabetes.

What are the pros of this technology?

One of the biggest benefits of this technology is that the insulin pump can help manage the ups and downs in your blood sugars that may be difficult to predict. Did you know that there are over 42 known factors that can affect our blood sugars throughout the day? Most of these factors aren’t easy to predict or manage (check out this article on the 42 factors affecting blood sugars from DiaTribe for more https://diatribe.org/42-factors-affect-blood-glucose-surprising-update) .

These can include things like:
⦁ poor sleep
⦁ increased stress
⦁ exercise
⦁ hormonal changes

Sensor augmented insulin pumps can help manage the unpredictability of life with type 1 diabetes by changing insulin delivery to match what blood sugars are predicted to do rather than just delivering a set insulin rate like in your traditional pump. This can help with improving your time in range and your A1c.

While using a sensor augmented insulin pump doesn’t mean you can just “set it and forget it”, they can significantly reduce the burden of blood sugar management by dramatically reducing the number of decisions you need to make throughout the day. In fact, in most cases, these pumps work best when they have the least amount of intervention from the user.

Sensor augmented insulin pumps also do a great job at preventing and reducing the severity of low blood sugars. As your blood sugars start to drop, an automated pump will reduce or suspend your insulin temporarily to help keep your blood sugars in range. Think about times when you may have been more active than usual unexpectedly, or your meal may have been unexpectedly delayed, or perhaps you had alcohol and your blood sugar had started to drop without you knowing. These are all situations that can be improved with the help of a sensor augmented pump.

What about cons to this technology?

With all of these great features, it’s hard to imagine the downside of sensor augmented pumping. Here are a few things to consider:

⦁ Sensors may not be covered by your health insurance plan and they can add significant cost to your pumping budget. Before considering a sensor augmented pump, it is always best to look at the costs involved and sort out insurance coverage if available. A great resource is this calculator from Connected in Motion https://www.connectedinmotion.ca/ontario-diabetes-cost-calculator/

⦁ Some people simply don’t like having another piece of hardware attached to them. While sensor augmented pumps can be used in the traditional, non automated mode, to get the benefit of the technology means wearing both a pump and sensor 24/7.

⦁ Using a sensor automated pump requires the user to give up some control and put trust in the system for it to work its best. This can be difficult for some people who are used to constantly making adjustments to their pump or micro-bolusing. Consider your personality type and whether you will be able to relinquish some control of your pump management to a new automated system

⦁ You still have to carbohydrate count and deliver food boluses. Luckily, an automated pump can help reduce the impact of the inevitable inaccuracies that come with carb counting.

⦁ Currently in Canada, this technology is only available with tubed insulin pumps If you’re currently using a tubeless pump or are new to pumping and feel like tubeless is the most important feature for you, keep in mind that automation isn’t available at this time.

Although research has shown improvements in time in range and reduction in hypoglycemia with this technology, no system is perfect and therefore this is not guarantee. Luckily, with the help of your health care professional, usually improvements can be seen.

Think you’re ready to try sensor augmented pumping?

There are currently two options available: the Tandem T-Slim pump that pairs with the Dexcom G6 and the Medtronic 780G which pairs with the Medtronic Guardian sensor. Here is a chart comparing both pumps.

Pump Company	Medtronic	Tandem
Pump Name	Medtronic MiniMed® 780G™	Tandem t:slim X2™
Unique/New Features	⦁ Minimed Mobile App – Allows pump and transmitter to communicate with each other. ⦁ Carelink™ App allows data to be automatically uploaded. ⦁ Carelink™ Connect – Data sharing app ⦁ Upgradable via software. ⦁ You can choose: 5.5, 6.1, 6.7 mmol/L as target instead of just 6.7mmol/L with 770G ⦁ Temp target of 8.3 mmol/L	⦁ Control IQ when used with Dexcom G6 – pump adjusts insulin delivery based on 30 minute predictions. Also delivers an automatic correction bolus up to once per hour when sensor glucose (SG) is predicted to be above 10 mmol/L in 30mins. ⦁ Control IQ target: 6.1 mmol/l ⦁ Control IQ sleep mode: allows for tighter glucose control overnight ⦁ Control IQ Activity mode: prevent hypoglycemia with temporarily increased blood glucose targets.
Key Features	⦁ SmartGuard™ Auto Mode capability when used with Medtronic’s Guardian™ (3) Sensor System – pump adjusts basal rate based on sensor glucose (SG) reading. Automatic correction boluses are delivered up to once every 5 minutes. ⦁ Integrated CGM with Suspend Before Low: insulin delivery automatically suspends 30 mins before reaching your preset low blood sugar level	⦁ Basal- IQ technology when used with CGM (Dexcom G6) – pump automatically suspends insulin if sensor glucose (SG) readings are predicted to drop below 4.4 mmol/L in 30 mins, and resumes as soon as SG begins to rise. ⦁ Touch screen ⦁ Upgradable via software ⦁ Share or review glucose data with the Dexcom Clarity or Dexcom G6 Apps. Manual download required to share all pump data.
Connection	Infusion set & tubing	Infusion set & tubing
Reservoir size	300 units	300 units
Max. bolus	25 units	25 units (with an option for additional 25 units)
Battery type	AA battery	Internal Lithium Polymer rechargeable battery
Water Proofing	Water proof up to 12 feet for 24 hours	Water resistant at 3 feet for 30 minutes. Recommended to remove for bathing, showering, swimming
Contact information	1-866-444-4649 www.medtronicdiabetes.ca	1-833-509-3598 https://www.tandemdiabetes.com/en-ca

If you would like to learn more about these as well as other pump options or if pumping is right for you, check out the LMC Diabetes Education Program Pump Ready Workshop! You can register by clicking this link: https://lmcvirtual.as.me/

With the colder weather approaching, you might notice some changes in your blood glucose levels. This can be for a number of different reasons, such as changes in what you’re eating, your physical activity level or even the temperature outside. Here are some helpful tips to help keep your readings steady through the changing seasons.

• Brush up on carbohydrate counting. Winter months may come with an increase in carbohydrate intake as we switch from cold salads and grilled meats to warm and comforting soups, stews and casseroles. These mixed dishes can sometimes be a challenge to carb count for, especially if they are home made or come without a food label. If you have a favorite home made recipe that you enjoy often, consider taking the time to calculate the carbohydrate in your recipe. While it can be tedious to do the first time, once its done you’ll have a good idea of how much to count each time you enjoy your home made favorites. Check out this great online article that outlines the steps: https://waltzingthedragon.ca/diabetes/nutrition-excercise/carb-counting-mixed-recipe-home-baking/. This article focuses on baked goods, but the same steps can be used for any mixed dish.
  
  As always, if you think you might need a carb counting refresher, please feel free to attend a free LMC Diabetes Education virtual workshop: https://acuityscheduling.com/schedule.php?owner=15031958
  
  
• Make sure your insulin is stored correctly. You may have heard that your insulin can be affected by the heat, but did you know it can also be damaged by the cold? It’s recommended to never use insulin that’s been frozen, so be sure to bring in your prescriptions from the car after a trip to the pharmacy. Change out your reservoir, pod or cartridge in your insulin pump early if you think the insulin has been frozen after spending a day outside in the cold. Keeping your insulin close to your body when you’re out on cold winter days (think ski days, for example), can help prevent it from freezing.
  
  
• Keep active. Similar to a changes in diet, we also may be less active in the winter. Summer activities seem endless and fun-filled while fall and winter may bring visions of darker evenings, colder weather and snow shovelling. You may have to be creative to find activities you enjoy in the fall and winter. Fall is a great time to go hiking and biking through scenic trails. Once the winter weather hits, try brining your exercise indoors with some home workouts (DVDs, online exercise classes etc), or bundle up and enjoy winter activities such as skating, snow shoeing or skiing. Check out your local community centre for indoor exercise options at an affordable price.
  
  You may notice you need more insulin in general if you are less active in the fall and winter. This is because exercise can increase insulin sensitivity. Speak to your healthcare team if you think your insulin doses need changing and you need help.
  
  
• Stay on track with meal planning and preparation. Summer may feel more relaxed with longer days and kids being out of school. Fall and winter brings back-to-school and major holidays to prepare for. This can make it difficult to stay on track with healthy meals. For a busy week ahead, check out Diabetes Canada’s 1 week meal plans: https://diabetes.ca/nutrition—fitness/meal-planning/7-day-diabetes-meal-plan.
  
  Looking for more meal tips? Check out the LMC Diabetes Education ‘Meal Planning’ virtual workshop for more tips on staying on track with meal planning. Click here to register: https://acuityscheduling.com/schedule.php?owner=15031958.
  
  
• Don’t forget to “fall back”. Daylight savings time ends on November 5th this year. If you’re using an insulin pump, don’t forget to change the time on your pump, along with all of your other devices to ensure that you’re getting the right insulin delivered at the right time. Changing the time on your meter and sensor can also help you and your healthcare team make sure that you’re correctly identifying when patterns are happening.

While summer seems to always go by so fast, there are so many great things to look forward to and enjoy in the fall and winter. We hope you can embrace some fun fall activities and enjoy your favorite comfort foods this season, along with spending quality time with family and friends during the many holidays that will be celebrated in the coming months.