The Four Tales of Fasting

[Best viewed on a widescreen]

In the examples below you can see how RADD manages to keep blood glucose values in range, in significantly different ways, during the same time of day, for the same person.

The time range for each graph is 2:00 AM to 6:00 AM, specifically chosen to reflect a pure fasting period as it's well after dinner and before breakfast. These are 4 arbitrary days in a single month, each no longer than a week apart.

The specific 4 days are chosen, as they exhibit an explainable behavior - not because they deviate from a "norm". The purpose is to demonstrate that there are no obvious hourly patterns to basal insulin.


1. Minimal deviations

Insulin administration is almost constant and mostly uninterrupted.


2. Unexpected peaks and lows

While total infusion remains roughly the same as in Figure 1, insulin delivered at the 03:30 and 05:15 marks is more than twice in comparison. Yet pump basal schedule is suspended most of the time.


3. Increased sensitivity

Compared to Figure 1, less than half the amount of insulin is administered. Note the infrequent insulin peaks and programmed basal schedule is suspended half of the time.

Sensitivity increase in this particular example is due to Metformin taken 4 hours prior, whose effect can vary significantly and is unpredictable.


4. Decreased sensitivity

Four times more insulin delivered during the same timeframe as in Figure 1. While RADD still manages to keep glucose levels in check, they remain in the higher part of the range.

The so-called 'sensitivity decrease' in this example is in fact the result of infusion site deterioration. (Pod running for over 48 hours)


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Technical Details
Setup:
  • 4 different infusion sites / pods (back of the arm)
  • Unfiltered CGM sensor data, noise unusually absent.
  • No additional insulin injection.
  • No glucagon infusion.
  • Pump programmed with 0.8U/h basal schedule over 24h at all times.
RADD Setup:
  • Target: 5.5 mmol/L (100 mg/dL)
  • Low target: 4.4 mmol/L (80 mg/dL)
  • Extreme low: 3.3 mmol/L (60 mg/dL)
  • Targeting mode: Balanced
  • Analytic data going back ~2 years
Hardware Setup:
  • Omnipod Eros with Fiasp
  • Dexcom G6 Sensor & Transmitter
  • OmniCore Oyster Prototype for reading CGM data
  • OmniCore Oyster Prototype for expedited pod comms