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Tandem

The Tandem t:slim X2

Tandem G6 2019Safety Reminder: When preventing DKA while using a hybrid closed loop pump

  • Place the pump in manual mode before giving insulin by pen or syringe.
  • Keep the pump in manual mode for at least 4 hours after the last injection of insulin by pen or syringe.
  • After resuming automated insulin delivery, check that the desired glucose target is set.

Pump Features 

  • Colour touch screen
  • Dexcom G6 CGM enabled 
  • Rechargable battery
  • Tubed proprietary infusion sets
  • Upgrades are done via software downloads after learning module completions.
  • Basal IQ, the feature in older models, only reduces basal insulin but also allows for individualization of glucose targets e.g. in pregnancy. Tandem provides loaners for clients on Control IQ currently wishing to transfer to Basal IQ during their pregnancy. 
  • Control-IQ is in the newest upgrade. It adjusts insulin delivery to help prevent highs (automated partial corrections and increased basal insulin) and lows (temp basal suspensions), while requiring the user to manually bolus for meals. Individualization of glucose targets is not an option. The algorithm uses a patient's programmed basal rates, and correction factors (ISF) and potentially other factors to make automated dose adjustments. Carbohydrate counting and food boluses are still required. When Control IQ is active, a patient can adjust basal rates, ISF, carb ratios but not insulin duration, and not glucose targets. 

How Control IQ Works

Tandem Contol IQ ActionsChart2021

 Tandem Control IQ Pump Icons 2021

 

Training

 

 

Notes for Dose Adjustments & FYI

 

Indications, TDD, Weight & other FYI

  • TDD and weight Indications for Control IQ are TDD 10-100 units per day and weight  25-140 kg. Patients beyond these indication levels have still used Control IQ; it is then an off-label usage.  These are the maximum allowable entries into the system at initiation.Control-IQ uses these initial entries to enable the algorithm to start working right immediately without awaiting past data for the algorithm. However, as time passes, the algorithm uses actual delivered TDD based on a rolling 6 day average. 
  • Max Basal Rate:
    If programmed basal rate is > 3u/hr, the system will deliver it if the CGM signal is active. However, for safety, if a CGM signal is lost for > 20 minutes the system reverts to 3u/hr as max even if their programmed rate is >3u/hr. To avoid this being an issue, suggest having the patient turn Control-IQ OFF during the two hour warm up on a new sensor every 10 days.
  • For basal modulations and automated corrections in Control IQ, the algorithm requires the following.
    • Programmed basal rates
    • Programmed correction factor (ISF)
    • The last 6 days of total daily insulin dose or the inputted total daily dose and weight at the start of using Control IQ. It’s recommended, but not required, to update these values on occasion. These should be updated to current values if resuming pump after having been off it.
    • Current and predicted glucose reading 30 minutes out
    • Glucose target (default, sleep or exercise mode)
    • Insulin on board
  • Bolus information
    • Maximum bolus size is 25u. Over that, patients would need two boluses for a meal.
    • Max extended bolus duration is 2 hours.
    • Control IQ suggests manual meal boluse and manual corrections doses using the same calculations of the pump in manual mode.
  • This cannot be changed in Control IQ
    • Duration of insulin action (set at 5 hours)
  • This can be changed in Control IQ
    • Basal rate and alternate basal profile
    • Carb Ratio
    • Insulin Sensitivity Factor e.g. Correction (may wish to make stronger if people are used to a shorter duration of insulin action e.g. from ISF of 3 to 2.5) 
    • The preset target from default (6.1 mmol/L)  to sleep to activity

Control IQ Start Tips, Suggestions, Experiences

Starting Control IQ (CIQ) at the time of pump start requires a conversation with the patient and healthcare team. As a reminder, patients can self-train and start on their own; that needs to be kept in mind with the conversations. Safety is the priority, especially with switches from considerably longer acting injected basals (Tresiba) to CIQ. Some suggestions for discussion are below. 

  • When setting up CIQ, consider inputting only 75% of total daily insulin into the field requesting this data. 
  • Consider using Exercise Activity (higher target) if using CIQ at time of pump start.
  • Depending on when Tresiba (degludec) or potentially other injected basal insulin was reduced or stopped, it may be safer to use one day (or more) of manual pump with a signifcant temp basal reduction before proceeding to CIQ using the Exercise Activity for the second day on pump. 

Hypoglycemia:

  • Prioritize your problem solving and change doses for actual hypoglycemia events that occur despite Control IQ suspending low.
  • Frequent basal suspensions in the reports (red bars) do not necessarily indicate hypoglycemia or indicate a need for a change in therapy. Problem solve or change doses if the suspensions are for longer periods of time and/or with a regular pattern. Tandem indicates short suspensions are 5-30 minutes. Long suspensions are more than 30-45 minutes. 
  • Tandem suggests using 5-10 g or rapid acting carbohydrate to treat hypoglycemia and evaluate. Since basal insulin delivery had already been suspended for some period of time, the full carbohydrate treatment may not be needed.

Hyperglycemia:

  • Frequent auto basal increases or hourly auto corrections in the Diasend reports do not necessarily indicate a need for change in therapy. 
  • Assess problem areas of high readings where the automated insulin delivery cannot address the hyperglycemia. 
  • The Tandem user guide reports the maximum insulin delivery rate is calculated using ISF (Insulin Sensitivity Factor or Correction Factor), estimated and recorded total daily insulin, and IOB (current insulin on board).
  • Hyperglycemia occuring in repeated patterns may be addressed with basal rate changes or depending on the timing, ICR. 
  • Hyperglycemia that is frequent but sporadic in timing and non responsive may, after troubleshooting, be addressed with changes to ISF.  Tandem uses an insulin action time of 5 hours. Some patients have found they need a more agressive ISF when in Control IQ. 
  • Patients may wish to set different basal profiles: A manual profile with usual (less aggressive) ISF when not using Control IQ; A profile for when control IQ is used on a usual day (may have a more aggressive ISF); A profile for when sick or menstruating which may have increased basal rates beyond the settings used for their usual Control IQ profile. 

 

Company Contacts & "Office Hours" for HCP Questions

  • Tandem Diabetes Care Canada Website
  • Territory Manager Kate Stephen This email address is being protected from spambots. You need JavaScript enabled to view it. (Phone: 403-512-2632 Fax: 858-224-6400)
  • Cllinical Diabetes Specialist: Naeem Hussein This email address is being protected from spambots. You need JavaScript enabled to view it. (Phone: 780-982-4492)

  

 

"Office Hours" for Healthcare Professionals ONLY to connect with Tandem Trainers are below: