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User Review: Looping With the Latest iLet Insulin Pump

The most recent closed-loop insulin pump available on the market stands aside from the group. The Beta Bionics iLet insulin pump operates quite in another way in comparison with its competitors — Tandem’s t:slim, Insulet’s Omnipod 5, and Medtronic’s MiniMed 780G.

The iLet “bionic pancreas” guarantees “diabetes without numbers,” a radically streamlined and simplified approach to blood sugar and insulin management. Partnering with a Dexcom G7 continuous glucose monitor sensor, the iLet guarantees to handle your insulin dosing routinely, with little or no input (and no math) from the user.

It’s so radically simplified that some members of the T1D community are skeptical — and we hear that some endocrinologists are even hesitant to prescribe the device!

Here’s a breakdown of what makes the iLet insulin pump so different:

  • The one data you enter is your body weight
  • No basal rate settings
  • No insulin-to-carbohydrates ratios
  • No correction aspects
  • No manual corrections
  • No manual adjustments to basal
  • No precise carb counting
  • Only three bolus options for food: “usual,” “lower than usual,” or “greater than normal”

The remaining is left as much as the iLet system to learn your body’s insulin needs with its intensive algorithm. Actually, there’s so little day by day patient involvement, the user guide is definitely easy to read … since it’s so short!

Diabetes technology has come a great distance: Just ask Bernard Farrell, who was diagnosed with type 1 diabetes in 1972. Here, Farrell shares the ups and downs of his experience during the last 4 months using the iLet with the Dexcom G7.

Waiting for the Bionic Pancreas Since 1972

“I used to be diagnosed in Ireland,” recalls Farrell, who’s 66 years old. “I used to be using glass syringes with steel needles. You may only test your blood sugar by dropping these tablets into little test tubes along with your urine. It might let you know what your blood sugar was six hours ago. I often thought, ‘What’s the point of this?’”

Back then, life expectancy with T1D was still somewhat fuzzy. Farrell recalls his wife asking his doctor, “Will he be around to walk our daughters down the aisle?”

As a father of six, Farrell has watched his children grow up and begin families of their very own. Despite also losing his hearing to a mix of tinnitus and general aging, being diagnosed with stage 3 kidney disease (which requires no treatment presently), and juggling adrenal insufficiency, Farrell resides a really full life. 

Farrell has also used nearly every insulin pump available on the market. As a retired software developer, he considers himself relatively tech-savvy and all the time open-minded to recent technology. 

“I do a complete lot less fascinated by my insulin doses since starting on the iLet,” explains Farrell. “For essentially the most part, if I just announce my meals to the iLet, and persist with the boundaries of what it’s discovered for me, it does a fairly darn good job.” 

Bernard Farrell and his iLet pump

A Very Dangerous Start

Farrell had a really rough start with the iLet, and he has a couple of very significant complaints, too — and things he hopes to see Beta Bionics address in the following version of the iLet.

Because recent users don’t program their basal insulin rate or insulin-to-carb ratio, the system has to start out by guessing how much insulin they need and adjusting those rates through trial and error. Beta Bionics’ founder Ed Damiano told Diabetes Each day that it often only takes about 48 hours for the iLet system to learn the way much insulin your body requires, but that wasn’t Farrell’s experience in any respect.

“I woke up one night with paramedics throughout my bed.” During this severe hypoglycemia episode, Farrell lost consciousness and was seizing. His wife called 911 and gave him a dose of intranasal glucagon, Baqsimi, which kicked in by the point the paramedics arrived.

Just days after the severe low blood sugar, Farrell says his blood sugar was very high for many of the day, and it wouldn’t budge.

“You’ll be able to’t give yourself correction doses with the iLet, so I just had to attend and wait. It was terrible,” says Farrell. He says it took almost a month for the iLet to learn his body’s insulin needs and “start behaving” consistently. “Those early weeks where the pump is learning your body’s insulin needs were tough,” says Farrell. “I used to be everywhere.”

Improved Time-in-Range With Less Work

While some may need been daunted by the episode of severe hypoglycemia, Farrell continued using the iLet insulin pump, and has enjoyed great results.

“It has absolutely improved my time-in-range, with far less work on my part and much less hypoglycemia,” says Farrell.

Here’s a take a look at his blood sugars, time-in-range, and body weight, before and after starting the iLet.

September 2023:

  • A1c: 7.6 percent
  • Time-in-range: around 55 percent with frequent lows
  • Weight: 175 kilos

January 2024:

  • A1c: 6.4 percent
  • Time-in-range: around 78 percent
  • Weight: 165 kilos

On the burden loss, Farrell says the iLet has taught him to snack less.

“After so a few years on NPH insulin, where you needed to eat an actual amount of carbohydrates every three hours, I used to be still within the habit of eating that way,” says Farrell. Before insulin pumps and rapid-acting insulin existed, individuals with T1D took NPH and regular insulin — which dictated exactly how much you had to eat on a rigorous schedule.

“With the iLet, I’ve learned tips on how to break from that habit and be more consistent, since it helps the algorithm,” explains Farrell. “I eat more rigorously.”

He’s also often sleeping higher, too.

“Overnight, I’m often flatlined from 10 p.m. to six a.m.,” a big improvement compared with Tandem’s t:slim, which Farrell says never worked well for him.

What Beta Bionics Must Address ASAP

While the iLet has won Farrell over, there are still various critical technical details he feels Beta Bionics really didn’t prioritize.

“Just two weeks ago, I looked down at my insulin pump and it was hanging open. It had broken,” says Farrell. “I even have no recollection of knocking it against anything. But I called Beta Bionics they usually overnighted a brand new pump to me.”

Farrell reluctantly relearned tips on how to manage his blood sugars via multiple day by day injections, with Lantus and Fiasp, until his substitute pump arrived.

“Once I got the brand new pump, I called them and asked tips on how to transfer my information to the brand new pump,” says Farrell. “It had just spent the last three months learning my body’s insulin needs.”

Farrell was shocked when the shopper service representative told him there was no option to transfer past data. The brand new pump and algorithm would need to learn his insulin needs all once more.

“I said, ‘You could have got to be kidding me … I even have to retrain all of it once more?’ That’s just ridiculous. I worked in software my whole profession; I do know they might prioritize this in the event that they desired to.”

Fortunately, Farrell found it easier to coach the pump this time — taking lower than per week before it began to “behave” — and he thinks using Fiasp as a substitute of NovoLog helped.

No Temp Basal Rates? What About Exercise and Sick Days?

One other shortcoming is the shortcoming to set a short lived basal rate for physical activity, sick days, or other times when you understand you won’t need as much insulin as usual.

“The one thing you possibly can do when exercising is unhook yourself [from the pump] and hope all of it works out,” says Farrell. This is simpler said than done: With a purpose to mimic the healthy body’s ability to cut back insulin levels during exercise, individuals with type 1 diabetes need to regulate their insulin delivery rates as early as two hours ahead of time.

When the snow melts and he returns to bicycling usually, Farrell anticipates having to eat extra carbohydrates before and through his exercise to counter the surplus insulin on board — something individuals with T1D shouldn’t really need to do within the 12 months 2024 in the event that they can properly reduce basal insulin rates.

It shouldn’t be that onerous to supply a temp basal rate for exercise,” says Farrell, who feels some sort of immediate basal intervention needs to be an option on the iLet. 

Farrell also got COVID in December and subsequently required steroids during his recovery. 

“I run very high when taking steroids. Often, with the t:slim, I might’ve adjusted my basal rate settings,” says Farrell. “With the iLet, I couldn’t change anything, but my numbers were actually in range 83 percent of the time, with a mean of 133 mg/dL.”

Alarms Are Too Quiet

Last of all, Farrell says the alarms are painfully quiet. So quiet that it doesn’t wake him or his wife up throughout the night — something that may be critical during severe hypoglycemia events just like the one he experienced.

To compensate, Farrell purchased a tool, the SugarPixel, that vibrates while you’re low, which he puts under his pillow.

“You furthermore may can’t hear the difference between high and low,” says Farrell, wishing the alerts were more recognizable. “The Sugar Pixel has been so helpful, I’m actually considering purchasing a second one to maintain downstairs.”

Farrell’s Take: A Good Product That Needs Some Improvements

“I’m going to maintain using it,” says Farrell, who appreciates the noticeable impact on his A1c, time-in-range, and weight. “But I do feel prefer it’s a extremely well-done school project that needs more work.”

“I spend a complete lot less time fascinated by diabetes typically,” continues Farrell. “It has trained me to stop snacking to feed possible lows. I’m generally living a more normal life with it.”

“I feel that is the way in which of the longer term. We’re going to see rather more automation in ways we don’t even understand without delay,” says Farrell. “I’d really prefer to see this succeed, but it surely’s got various challenges ahead of it. Each of my oldest friends on insulin pumps wish to try it but their endocrinologists won’t prescribe it. It looks as if the endos don’t like that they’ll’t adjust the basal rates and other settings.”

Farrell laughs at the concept of his next appointment together with his own endocrinologist. Often, they spend the complete appointment making tiny adjustments in all of his basal rates, correction aspects, and insulin-to-carbohydrate ratios.

“There’s nothing they’ll do now,” laughs Farrell. “He’ll probably just tell me to maintain doing what I’m doing and that’s that. Within the meantime, I plan to make use of this until the following generation is available on the market.”

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