In Which All I Want for Christmas Is a Closed Loop System

We're visiting my parents for Christmas right now, which we do every year. Because of this, we always open our family Christmas presents before we travel. It just doesn't make sense to lug a bunch of presents with us only to lug them all home again. This is especially true given that we'll be staying in three additional places during this trip. However, the kids often bring their favorite gift along with them. For Kittygirl this year, this was a hoverboard. They don't actually float like the ones Back to the Future promised my generation our kids would have, but they're pretty awesome nonetheless.

Kittygirl has taken to riding the hoverboard all around the house, prompting one of my brothers to start calling her a cyborg. I commented that this was particularly fitting given that her insulin pump is akin to a robotic pancreas. The thing is, though, in its current incarnation, it's a pretty pathetic robotic pancreas.

As anyone in the diabetes community already knows, despite the impression that some people outside the community has, an insulin pump is in no way equivalent to a pancreas. It doesn't automatically give you insulin (except for the basal insulin you've programmed it to give you) and even the pumps that do more in combination with a CGM don't give the results that a fully functioning pancreas gives.

As I've shared before, having diabetes does not feel like a huge burden to Kittygirl at this point. It annoys her sometimes, because we don't always let her eat exactly what she wants exactly when she wants to eat her. Her skin is sensitive and her pump and sensor sites are nearly constantly itching, and she gets annoyed when she's about to do something and we ask her to pull out her pump. However, overall, diabetes is just a small bump in the road of her life.

However, the burden is much heavier on me as a caregiver. This is particularly true because I've done my own research and I am constantly aiming for an A1C and time in range that are closer to nondiabetic numbers than to the minimum recommended by official sources. I'm still only mediocre at that, and it's a lot of work.

I've heard stories of kids who ask Santa for new diabetes technology or even for a cure for Christmas. Kittygirl has never done anything like that. I don't believe a magical being is going to lighten the burden of being a diabetes caregiver for me, of course, but I do see technology on the horizon that has the potential to do this.

Currently Kittygirl's Tslim X2 insulin pump runs a program called Basal IQ which shuts off the basal insulin when her blood sugar starts to drop and it predicts it's going to go low. There are people who have had few or no low blood sugars since starting to use Basal IQ. That has not been the case for Kittygirl. It does prevent some lows and help mitigate others (I know this for sure because I was fed up with it not working as advertised and turned it off one day, only to realize it really was helpful).

Just over a week ago, Tandem's latest  update, Control IQ, gained FDA approval This system will feature a much more advanced version of cutting off basal when it predicts low blood sugar, including reducing basal before cutting it off. More importantly, however, it will automatically both increase basal and give extra corrective doses of insulin as blood sugar starts to rise.

I'm very excited about this update. I think it has the potential to change our diabetes experience for the better. However, unlike many people,  I'm not excited in the main because I think it will greatly improve Kittygirl's A1C or time in range. Based on the data that has been shared from trials of the system, my sugar surfing skills produce numbers that are at least as good as and sometimes better than those the system produces for the average person.

The difference is that I only achieve those numbers through constant vigilance and frequent microdoses of insulin through the pump or small doses of fast acting carbs to head off a low blood sugar. There are times (and these times are increasing as Kittygirl does more activities independently) when I'm not available to do this. There are other times when I'm wrapped up in doing something else or  engaged in an activity that makes it impossible for me to use the pump (like driving). Though I still anticipate doing some of the things I do now when I'm with Kittygirl after her pump gets Basal IQ, I will have more peace of mind when she's away from me or when something else in our lives hinders me from being so vigilant.

I'm not actually getting this for Christmas, of course, the FDA approval of Control IQ makes it likely that I'll get it in the first quarter of 2020, which is pretty exciting.

My ultimate dream is for a system that requires even less interaction and doses glucagon for low blood sugar instead of just cutting off basal insulin. There's been a system like that under development for a long time, but it isn't approved yet. They've been predicting that it will be approved in a year or two for at least five years, so I'm not holding my breath. In the meantime, I'll take the reduced burden that Control IQ is likely to give me.

Kittygirl, meanwhile, will enjoy her new cyborg status as she rolls around grandma's house on her hoverboard with her far from perfect but still fairly advanced robotic pancreas.