Looping Year In Review - 2020

It's been awhile since I've posted! 2020 was a busy year, with plenty of things that I'm grateful for, and plenty of circumstances and world events that I wish hadn't happened. I'm not getting into any of that. What I do want to share is how 2020 looked for me, as a Type 1 Diabetic who started using Loop in March - was this a better year for me? Did Loop make a difference?

TL;DR - Yes. Definitely yes. So much yes. 2020 was an excellent year for my diabetes!

Let's start with the month that I started using Loop. I didn't have all my settings dialed in or have an excellent grasp on how Loop would automatically adjust, and at the time I had a target glucose range of 100-120. As you can see, Loop did a pretty good job. I had my basal rates pretty well dialed in for my OmniPod already, so copying those over to Loop worked out pretty well. I also was pretty spot-on with my insulin to carb ratio previously (1 unit per 5 grams of carb).

I started to try to tweak settings, and things got worse, instead of better. I did some basal testing this month, tried dialing in my basal rates further, I may have experimented with the Autobolus branch. I don't really remember.

And then...wow. Things started clicking. I read Dr. Bernstein's book (The Diabetes Solution) and started implementing the principal of small inputs. I also changed my target glucose to 90-100 during the day, and to 80-90 at night. My wife and I also started keto this month (not exactly the same as Dr. Bernstein's recommendations, but close), and I started to come to the realization that keto + Loop was going to be a total game changer for me.

No, these aren't the same month. Yes, this is an 8-week stretch with an average glucose of 99, and a standard deviation of 16-17. This...is what a normal person's blood sugars look like, with a functioning pancreas!

That 8 weeks stretched into 12 weeks. Basically the same, average of 100 and standard deviation of 19. Estimated A1C of 5.7% - the high end of non-diabetic range, but still - in non-diabetic range.

16 weeks...looking back, I can see that I started relaxing a bit. Don't get me wrong, I'm super happy with these numbers and with the lifestyle that I developed, but I know I started eating a bit more carb, tracking a little less strictly, and trying to actively manage my diabetes less. It's a small change, but I can see my control is a little less tight - average went from 99 up to 101, and standard deviation went from 16 to 22. Estimated A1C is still 5.7%.

I started relaxing my diet and control a bit more as I got to the end of the summer - the numbers tell the tale! My average glucose was creeping up, as well as my standard deviation - and now my estimated A1C was up to 5.9%. The next couple pictures continue to show a more relaxed approach on my part - trying to find a long-term approach that didn't take up all of my time, but still yielded good results. I was comfortable with slightly higher numbers, if I could lower stress levels etc.

At the beginning of 2021, I realized that over the holidays (Thanksgiving/Christmas/New Years') I had relaxed a bit too much and I was ready to get back on track, with tight control - this was 99% diet related, to be honest. From November-January I got looser and looser with my diet and tracking macros in general, eating holiday food etc. After the holidays were over I started to get back on track.

Over the last two weeks I've gotten significantly more on track.

Over the last week you can see that I'm back in my happy place - low carb, which comes with a significant insulin reduction and less blood glucose volatility. Last week also included a new sensor, which explains that odd drop and scatterred lows in the week hours of the morning - that all came from one night, in reality, and it's not really a trend.

Here's what I've learned over the last year:

  • Loop isn't magic, even though it often feels that way. It's not intelligent, even though it seems like it sometimes. Loop is 100% dependent on the data that it's fed, it has predictive algorithms that crunch through a bunch of numbers and spit out a possible outcome, and other algorithms that then make changes based on those possible outcomes.
  • The biggest factor in managing my diabetes is my food choices. Loop makes managing my spikes and dips easier, but it's really just compensating for variables - how well I calculate carbs/proteins, how well I calculate how carbs/fats affect me when together, how faithful I am in entering quantities and how accurate I am when entering macro quantities, etc. A low carb diet means I am taking less insulin overall and that's a good thing. In another post I want to start sharing all the research I've been doing regarding diet/low carb as a lifestyle, but my main point here is that Loop can't fix bad choices - but it can help smooth out highs and lows without that rollercoaster experience that so many T1Ds deal with daily.
  • I'm grateful that I have the flexibility to adapt my care and management to what I feel works best for me - I'm not completely dependent on what insurance or state healthcare could provide, and I have access to Omnipod, Dexcom, and Rileylink.
  • I wasted years when I was first diagnosed thinking that I could eat whatever I wanted, as long as I took insulin for it. It's not a popular or fun opinion to have in the T1D community. Those of us who have opted for a low-carb lifestyle tend to get a lot of pushback from our doctors, but the numbers don't lie. As I approach 30 years old (17 with diabetes) I am in the best health of ┬ámy life. I wish I had done more research on my own much, much sooner.

Final thoughts:

I have a few memorable markers during my 16+ years of being a diabetic, times when I made a significant change in how I managed my care. I've mentioned that list before, but here it is again:

  • First insulin pump (Deltec Cozmo, with an attached glucose monitor)
  • Dexcom (I started on the G4)
  • Nightscout (Set up after I moved to the Dexcom G5, this let me stream my Dexcom readings to a Pebble smartwatch)
  • Omnipod
  • Learning about the "law of small numbers" from reading The Diabetes Solution by Dr. Bernstein - this got me started with low carb as a lifestyle, and how to eat this way safely
  • Loop

All of these markers significantly improved my health, but Loop has, by far, had the biggest positive effect. I was reminded just how much my life has improved when my Dexcom failed unexpectedly (first time I've had a major failure in over 5 years of using Dexcom). I had to go, overnight, from being on Loop to manually checking my glucose levels and managing my own basal/bolus rates. It was horrible. My diet didn't change, my lifestyle didn't change, but my glucose levels were all over the place. For 12 days, I tested 20+ times per day, and I couldn't come close to managing levels as well as Loop. I have become completely dependent on Loop working - I thought I had an adequate backup plan, but it didn't work as well as I had hoped.

Is Loop worth the financial and time investment? Definitely. Is it the only way to manage your diabetes? No, but it's the best for me. Will I stick with it forever? I hope not. I hope something even better comes along. For now...I'm quite happy with Loop.