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CategoriesBlog post,  Newsletter

To Automate or not to Automate? Your Guide to Sensor Augmented (aka Hybrid Closed Loop) Insulin Pumping

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 CompanyMedtronicTandem
Pump NameMedtronic MiniMed® 780G™
Tandem t:slim X2™
Unique/New FeaturesMinimed 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 FeaturesSmartGuard™ 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.
ConnectionInfusion set & tubingInfusion set & tubing
Reservoir size300 units300 units
Max. bolus25 units25 units (with an option for additional 25 units)
Battery typeAA batteryInternal Lithium Polymer rechargeable battery
Water ProofingWater proof up to 12 feet for 24 hoursWater resistant at 3 feet for 30 minutes. Recommended to remove for bathing, showering, swimming
Contact information1-866-444-4649

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/

CategoriesBlog post,  Newsletter

5 Tips for Managing Blood Sugar this Fall and Winter

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.

CategoriesBlog post,  Newsletter,  Type 1

Strategies to Manage Physical Activity with Type 1 Diabetes

We’ve all heard that regular physical activity is important to your overall health and wellness. But why? Being active helps to improve your mood, clear your mind, minimize stress, provide more energy, build and maintain muscle, manage your weight and protect your heart.….just to name a few. The recommended amount of physical activity is 150 minutes per week that includes 2 days a week of muscle strengthening activities, also known as resistance training. Did you know that just 20 minutes of resistance training twice a week can lead to major improvements in body weight and blood sugar levels? Examples of these types of exercise include walking, biking, swimming, weight lifting, running, gardening, doing chores around the house and even being intimate.

For people managing Type 1 Diabetes, being physically active can get a little tricky at times. When you are active, your muscles use sugars that are either stored in your body or are floating around in your blood stream for energy like gas for a car. Certain types of exercise can lead to low blood sugars while other types of activity can lead to high blood sugars. It is important to understand how activity and exercise affects blood sugars so that you can plan ahead to stay safe and enjoy what you are doing! As you exercise more, your body may become more sensitive to insulin, increasing the risk of low blood sugars during physical activity or for up to 48 hours after. Finding the right balance with carbohydrates and insulin to manage blood sugars during and after activity can be a challenge. Your diabetes educators are here to help you!

Let’s review the three types of exercise:

  • AEROBIC – light to moderate intensity exercise for more than 10 minutes.

Blood sugars tend to drop more often during and after aerobic exercise
e.g. cardio, running, swimming, biking, skating

  • MIXED – alternating periods of moderate to high intensity exercise.

Blood sugars tend to stay the same, but you should still watch closely
e.g. basketball, soccer or high intensity interval training (HIIT)

  • ANAEROBIC – high intensity resistance exercise.

Blood sugars may spike (go high) and you may need to correct after anaerobic exercise
e.g. weight training, resistance bands, cross-fit, jumping rope

Planning Ahead for Exercise

There are a few different ways you can prepare for exercise to help prevent low or high blood sugars.

Consider using technology:

Take advantage of technology by wearing a continuous glucose monitor sensor that gives you quick access to your blood sugar readings. Use trend arrows to help make decisions about whether to have a snack or take a break from activity. If you do not wear a sensor, check your blood sugars more often with a finger poke while you are exercising and for the next 48 hours after. Set an alarm on your phone to check blood sugars around three o’clock in the morning; especially if you have a very active day.

Adjust insulin before or after exercise:

If you wear an insulin pump or manage your blood sugars with multiple daily injections (MDI), you may want to adjust your pre-meal bolus dose depending on how intense the activity will be, how long you will be active for, how much insulin you have on board (IOB) and when your last meal or bolus was taken. You may need to adjust your insulin up to 90 minutes before starting any activity.

If you are going to be active within two hours of your last meal, or your blood sugar reading is under 7.0mmol/L, you may want to eat 20-30 extra grams of carbs or take only half of your usual insulin dose. If you are wearing an insulin pump and plan to be active more than two hours after your last meal, you may want to run a temp basal rate for 90 minutes before you plan to start exercising. Set it to run during your activity and up to 1-2 hours after you are finished to help manage blood sugars. You may also want to consider setting a temp basal rate at bedtime to reduce your insulin by 10-20% to avoid having a low blood sugar through the night. Your needs may be different, especially as you exercise more or try different activities. Speak to your diabetes educator to find the right temp basal setting for you.

Be careful where you inject insulin before exercise:

Be sure not to inject insulin in or around muscles in your arms or legs before exercise. As muscles get warmed up, sensitivity to insulin increases, which means the risk of a low blood sugar also goes up if insulin is injected in areas that muscles are being used.

Consider ExCarbs:

Speak to your diabetes educator about another strategy you can used, called ExCarbs to help figure out how many grams of carbohydrates you should eat before, during and after your activity or how many units of insulin you should subtract from your usual pre-meal dose.

Stay Safe:

Plan your activities with a friend or loved one who knows how to recognize symptoms of a low blood sugar and what to do to help you if you have a low blood sugar. Make sure to wear medical alert identification and proper shoes that fit well. Do not exercise if you are not feeling well or have ketones.

Follow the GOLDEN RULE: make sure to ALWAYS carry low blood sugar treatment supplies like glucose tablets, juice boxes, regular pop or candies and drink extra water to stay hydrated. As a general guideline, you should drink water before starting activity and drink 250mL of water for every 20 minutes of exercise.

Watch and see how physical activity affects you! 

It may take some time to learn what works best for you to manage your blood sugar when exercising. Try different kinds of activity or make changes to the intensity or amount of time you exercise until you find the right fit. Remember to check your blood sugars before, during and after activity to see how your body reacts to exercise.  You may want to keep a journal to track and look back on what you have already tried and how well it works or what changes need to be made. Always speak with your healthcare team before starting a new activity for help adjusting your insulin or pump settings. Happy Exercising!

Join Diabetes Depot for the ‘Adjusting for Activity’ workshop on July 6th from 7:30 to 8:30pm ET for more information. Click the link to register: https://diabetesdepot.ca/index.php/workshops-ask-the-expert-sessions/


Diabetes Canada – Planning for Regular Physical Activity

Diabetes Canada Podcast – Diabetes 360 with Dr. Mike Riddell (Season 1, Episode 7)

CategoriesBlog post,  Newsletter,  Type 1

Pump Tips for Summer Activities

Summer has arrived!  As the weather gets warmer, an increase in activity or insulin sensitivity might affect your blood sugar management.  Here are some insulin pump tips:

Exercise & Activity

Working up a sweat feels good and helps cool down your body, but it can expose your pump to moisture without you even realizing it. Keep your pump dry while exercising and on hot days by wearing it in a case made from water-resistant materials; such as a sports or nylon case or on your belt clip. If you decide to disconnect your pump while working out, make sure it’s put in a safe place.

Summer Pumping

If you’re a ‘podder’, your pump is waterproof, your PDM is not! If you are wearing Medtronic or Tandem pumps, your pump is water resistant, but should be disconnected near water. If you are heading to the beach, pool, or waterpark for the day, consider staying connected to your pump until entering the water, then disconnect and put your pump in a shaded, dry spot. Take breaks from being in the water so that you can check your blood sugars and see if you need to connect to give yourself a correction bolus dose.

Make adjustments to your pump settings or insulin doses if you are more active or if your insulin is working better in the warmer weather.  Not sure how to do this?  Ask your CDE or attend the Diabetes Depot / LMC Diabetes Education workshop ‘Adjusting for Activity’ on July 6th from 7:30 to 8:30pm ET for more information. Click the link to register: https://diabetesdepot.ca/index.php/workshops-ask-the-expert-sessions/

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