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Adjusting Your Settings

There will be times when you need to adjust your settings in order to keep your blood glucose within your correction range. The degree to which you adjust your settings will depend on a variety of personal decisions about how active you engage with your diabetes, how comfortable your endocrinologist may feel with patient-adjusted settings and the underlying reason for the change.

Troubleshooting before a change

The most common reason that people decide it may be time to adjust their settings is when previously great blood glucose control suddenly becomes elusive. What worked yesterday is no longer working today. Because of course, as soon as you test and dial-in all those settings, diabetes will throw you a curve ball and change your insulin needs. That's the way it works. It's not just YDMV (your diabetes may vary), it's actually YDWV (your diabetes will vary).

Before considering a change to your settings, the usual laundry list of possible other causes should be explored.

  • Bad infusion site (kinked cannula, blood in cannula, infected site?)
  • Bad insulin (cloudy? insulin exposed to heat/freezing?)
  • Unexpected food impacts (that diet coke wasn't diet, kid sneaking food?)
  • CGM damaged (poor calibration, damaged sensor site?)

Some signs that the issue is actually the result of equipment failure include the failure of blood glucose to decrease despite repeated bolus corrections. Often during equipment failure troubleshooting, you've blamed the food (and adjusted a carbohydrate count), given corrections, checked for hidden food wrappers, and maybe even open-looped rage bolused. Breathe deep, it is super frustrating to have equipment failure. One of the benefits of Loop can be that equipment failures can become a little easier to identify over time because blood glucose control becomes more predictable and reliable.

Assess the duration

Once you have eliminated equipment failures as a source of unexpected blood glucose control problems, it is time to determine if this is a short-term or long-term issue. This assessment tends to be a skill that people will get better with practice.

Before considering a change to your settings, you should assess if you expect the issue to resolve on its own soon or if the issue might be caused by a more long(er) term issue that should be addressed.

Short-term factors

There's a long list of short-term factors that may temporarily affect how well Loop can automatically keep your blood glucose at your correction goal. Of course, the definition of "temporarily" is also subjective. Some people grow impatient with blood glucose excursions within hours and other people don't consider the need to correct excursions for days. That difference in tolerance will affect a user's assessment of how quickly they will consider adjusting settings. For these discussions, short-term is referring to less than a day.

For the most part, it is not a good idea to adjust settings for very short-term underlying causes such as:

  • One or two meals that behave differently than expected
  • Stress from a final exam
  • Anticipation of holiday party buffet table
  • Sprinting in the airport to catch a plane
  • "Baggage claim" lows from pressure changes causing unexpected insulin delivery
  • Weather

Those are very short term factors and if you change your underlying settings too quickly from just one or two observed blood glucose excursions, you'll likely end up needing to undo the changes just as quickly. For these short-term factors, the best tools involve using temporary target overrides and a measure of patience. In some medium-duration cases (factors that last for at least several hours), people also use "fake" carbohydrate entries to mimic the extra insulin needed during temporary stress on the system which causes high blood glucose.

Long-term factors

The list of long-term factors is just as long, but the most common are probably:

  • Growth hormones
  • Menstrual cycle hormones
  • Illness
  • Medications
  • Travel
  • Beginning new consistent exercise routine (or suddenly becoming more sedentary)

For long(er) term factors, you may benefit from adjusting your underlying settings to reflect the insulin-need changes that have happened as a result of the factors. By adjusting your underlying settings, you will help Loop to better predict your insulin needs and therefore you'll be more likely to achieve blood glucose in correction range.

Assess the data

Once you have assessed that there's a need for a settings adjustment, the next step is to decide which setting(s) to change and how to adjust them.

Whether you undertake the adjustments by yourself and/or with your health care provider's input is at your own discretion. Ideally, you would have your health care provider's input and support to discuss the observations and concerns you have and develop an adjusted setting profile based on those discussions. Many endocrinologists are still becoming familiar with Loop and its algorithm, so providing them links to the various sites would be a good starting point for discussion. This can help the endocrinologist understand where Loop is similar/different than traditional pump therapy. If you and your health care provider are comfortable with your self-adjustments and Loop's algorithm, then proceed ahead.

To begin the process of settings adjustment, visualizing your data trends is important. You need to be able to piece together what was eaten, how it was bolused, what temporary basals were applied, and how your blood glucose was reacting. The Data section of LoopTips covers the various places you can find your diabetes-related data to help you during adjustments.