After sampling multiple AID systems last year, I decided to choose the iLet as my method of diabetes management for the time being. There are a few reasons, and I think it could be helpful to share them to better inform people with diabetes about the pros and cons of the system. Nothing is perfect, and there are things I love about the system and things that are challenging and frustrating.
Reduced Mental Burden
This was the absolute top priority for me regarding diabetes management. I work in diabetes, my family works in diabetes, I live with diabetes, it’s just, well, a lot. I need to be able to put my diabetes on the back burner right now to maintain my love of diabetes education (and my sanity). Basically, I couldn’t handle thinking about my own diabetes more than just a little bit, or I would be tipped over a proverbial ledge. I’ve considered this a period of burnout, which makes sense because my diabetes is about to turn 35. Still, I also think it’s very common for healthcare professionals who live with diabetes to struggle to stay invested in working hard on their own diabetes.
The iLet allows me to think about my diabetes less than I have ever had to. It allows me to avoid the stress of exact carbohydrate counting or trying to determine the fat or protein content in a meal. It doesn’t allow you to give correction doses; it does them automatically, reducing the mental toll of high blood sugar. The burden of carb counting and giving correction boluses is not something to dismiss. The amount of effort we put in as pwd, or caregivers or pwd, to count the carbs accurately enough is very defeating when the post-meal glucose levels don’t pan out how we had hoped. Then, we have to give corrections to help bring our BGs down to target, implying that what we did was incorrect. When the truth is the number of variables contributing to post-meal glucose levels is insurmountable, and the fact that we get dosing and counting right some of the time is nothing short of a miracle.
User Inputs
The only user input for the iLet, aside from changing the cartridge and infusion set, is selecting the size of the meal you are eating. The options are “Usual for me,” “More,” or “Less.” The amount of time and energy that goes into deciding one of these three is significantly less than that of traditional AID systems, where you input both glucose level and carbohydrate grams. To start the iLet, the only thing you need is your weight, which it will periodically ask you if you have fluctuated more than 15% of the weight that was entered. My iLet asked me a few weeks ago if my weight had changed outside of a range that was 15% below then 15% above the weight I originally entered.
Pre-Filled Cartridges
This has also been an incredible burden-reducing feature of the iLet. I did not anticipate how much relief I would feel when I was able to get the pre-filled Fiasp cartridges, but it has been a game-changer for me. It doesn’t seem like much, but the amount of time and effort that goes into changing the cartridge is significantly less with the cartridges. It’s honestly not as much about the time as the effort and the fact that you have to do it every two to three days…literally forever, until the end of time, or diabetes is cured, whichever comes first. Making the repetitive diabetes tasks easier or less work has significantly improved my mental well-being.
I will also mention that the cartridge fill process without the pre-filled cartridges is not the best. The device was made to have pre-filled cartridges, and the fillable cartridge system is a little clunky. The cartridge has to be filled on a flat surface, and it is only 180 units, so you have to do this more often than a pump with a larger cartridge. The pre-filled cartridges are not perfect, as they only hold 160 units. Fiasp is also known to be harsher on infusion sets, and I have had mixed experiences with the insulin. Some of my infusion sets burn when insulin goes in, and some seem to stop working prior to the three days that I like to get out of them. But all in all, I prefer the prefilled Fiasp to the fill process.
Swimming
The interesting part of using this system is that there is no way to manually give a correction, so when you disconnect for a time where you miss basal insulin, such as swimming, it may take some time to catch up. There was a recent software update that does help a bit, but you still have to be patient. The update allows you to tell the iLet that you are disconnected by stopping insulin, so when you reconnect and resume, it should play catch up with the knowledge of missed basal.
This summer, I have been swimming without using the stop insulin feature (because I hadn’t done the software update) and decided after the first couple of times to try eating right before and giving a bolus to help prevent the highs that can occur from missed basal. Of course, my adult version of swimming is much more chill than a child swimming, so I would be cautious doing this if you’re more active in the water. You also want to be more cautious if you’re swimming in wavy water versus still like a pool, as fighting the waves can increase the likelihood of lows. Overall, I don’t think this challenge of the iLet outweighs the system’s benefits for me personally.
Diabetes goals differ for people with diabetes and change over time depending on circumstances. For people who have a uterus, during pregnancy, you have to be extremely hardcore and keep in a very tight range. You want to avoid lows when you get older, as they can be more dangerous as we age.
For me, I knew what I needed was a decreased mental burden without significantly changing the amount of time I spend in range and my average glucose level. I highly recommend doing a lot of research before committing to four years of an AID system, and I hope you end up happy with your choice!
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES
