September 30, 2025 • 27 mins
In Episode 54 of Think Like a Pancreas—The Podcast, the Trynamic Trio of Dana Roseman, Tavia Vital, Jennifer Smith, and Kathryn Alvarez share their thoughts on the Trio Open-sourced Insulin Delivery System.
Hear the challenges that they faced as users and how they learned from their experiences to better help their clients at Integrated Diabetes Services.
MEET YOUR HOSTSDana Roseman, MPH, CDCES, RDN, LDN, is the Director of Technology and Applied Research for Integrated Diabetes Services. She is a Certified Diabetes Care & Education Specialist and Registered Dietitian with a Master’s in Public Health from the University of Illinois at Chicago, a Bachelor’s in Science from the University of Texas at Austin, and clinical nutrition training from UT Southwestern Medical Center. Diagnosed with Type 1 Diabetes, she has spent nearly 20 years improving diabetes care through technology, research, and patient education—including expertise with insulin pumps, continuous glucose monitors, and hybrid closed-loop systems.
Jennifer Smith, RD, LD, CDCES is the Director of Lifestyle and Nutrition for Integrated Diabetes Services. She is renowned for her expertise in nutrition, diabetes education, and athletic performance. With a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin, Jennifer is a Registered Dietitian, Licensed Dietitian, Certified Diabetes Care & Education Specialist, a certified trainer for insulin pumps and continuous glucose monitors, as well as a published author. Having lived with type 1 diabetes since childhood, Jennifer offers unique insight into day-to-day diabetes management, pregnancy, sports nutrition, and technology integration.
Tavia Vital BSN, BA, RN, CDCES is the Director of Intensive Diabetes Management for Integrated Diabetes Services. She earned a Bachelor of Science degree in Nursing from Regis University in Denver, Colorado after receiving a Bachelor of Arts degree in Spanish from the University of Iowa. Tavia is a Registered Nurse, Certified Diabetes Care and Education Specialist, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. Having lived with type one diabetes for over 40 years, she understands that each person’s experiences and needs are unique. She strives to be an expert resource on intensive diabetes management options.
Kathryn Gentile-Alvarez, MS, ACSM-CEP, EIM II, CPT, CSNC, CDCES is the Director of Exercise Physiology, Teen/Young Adult Specialist for Integrated Diabetes Services. As a Certified Diabetes Care & Education Specialist and Exercise Physiologist, she specializes in sports performance, technology integration—including open-source and DIY systems—and counseling young people and families affected by type 1 diabetes. Diagnosed herself at age twelve, Kathryn holds degrees in Exercise Physiology from Ave Maria University and West Chester University, and certifications from ACSM and ISSA. Her work focuses on using advanced technology and personalized exercise prescriptions to help people with diabetes manage their health and thrive.
WHAT YOU’LL LEARN:
✔️ The value of learning the Trio language.
✔️Valuable information found onscreen.
✔️ Trio requires more extreme experimentation than Loop.
✔️The value of Trio for teens and athletes.
CHAPTERS00:11 Welcome and disclaimer
00:36 Meet the Try-namic Trio
02:26 Starting Trio in a refreshed state
03:41 Favourite Trio Features
08:53 Trio + Steroids = Great blood sugar control
10:18 The Freedom of Unannounced Meal Bolus
16:58 Tighter Standard Deviation with Trio
18:23 How to basal test with Trio
22:05 Who should use Trio?
25:14 Recap
RESOURCES MENTIONEDIDS Diabetes Experts, The Trynamic Trio Share Personal Experiences with Open-Source Application
https://youtu.be/peMzQHn1j9w?si=-oe74TUOIWGy287w
https://integrateddiabetes.com/diy-services-support/
https://integrateddiabetes.com/some-technology-updates-from-the-diabetes-world/
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:11):
Welcome to Think Like a Pancreas,the podcast where our goal is to keep
you informed, inspired, and a littleentertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:31):
healthcare provider before implementing.
Welcome back to today's episode ofThink Like A Pancreas, the podcast.
My name is Tavia Vital.
I'm a registered nurse, certified diabetescare and education specialist, and
I'm the director of Intensive DiabetesManagement and the the Torah, the
Espanola Integrated Diabetes Services.
Today I'm joined by threeof my esteemed colleagues.
(00:55):
We met briefly... oh, probably a monthago, didn't we guys to talk about Trio?
Yeah?
Okay.
At least a month ago.
Yeah.
At least a month ago.
It seems like a long time, but yeah.
Let's just go around really quick.
Say who's who, and then our goaltoday is to talk about some of the
features that we personally, or thatour clients totally love about Trio.
(01:16):
Sound good?
Great.
Yeah, sure.
I'm Jenny Smith.
I am a RD, CDCES, Director ofLifestyle and Nutrition with
Integrated, user of Trio, previoususer of Loop for many years.
And yeah, we have lots oflittle tidbits to share, so...
I am Kathryn Alvarez.
(01:36):
I am the Director of Exercise Physiologyand I am, I used, actually, I'm using
Loop right now, so that'll be funto discuss on our long podcast, but
I'll go back to Trio pretty soon.
I'm just trying out that food AI feature.
Yeah!
I keep forgetting to do it,but we set it up together.
(02:00):
We got it.
Paid for ready to go, butjust gotta remember to use it.
Yeah, actually do the thing.
And I am Dana Roseman.
I am the director of Technology andApplied Research for Integrated and
also a Registered Dietician, CDCES andum, a proud Trio user since January.
(02:24):
I had a rocky start last summer when youguys originally started and kind of took
a break and then I think I just had towait until I had bandwidth to get back
started and, and very excited I did.
That was kind of, I thinkwe did the same thing, Dana.
'cause I restarted using Trio inFebruary this year after taking
(02:47):
a fall and into winter break fromit with-- I went back to Loop.
Um, so yeah.
And now my frustrations arenot, they're not there like
they were last summer with Trio.
So...
Well, I think there is a transition.
We talked about this a little bitin our first podcast, but there
for sure is a transition goingfrom Loop to Trio and it is not one
(03:08):
size fits all in terms of settings.
And I think maybe it took a littlebit of time for us to figure
out what, what knobs to turn.
And I think those knobs are also alittle bit different as the developers
have adjusted things and learned more.
And we've all, we, we also all, I kindof think we chimed back in, in February
together because we signed up to dothe beta testing of the development
(03:31):
branch of Trio that went, that had alittle bit more fancy feature to it.
I think that is, has definitely led to oneof my favorite things about Trio now was.
That one, if I remember correctly, thebeta had in it the ability to add, um, or
use like a reduced bolus strategy, right?
(03:53):
Well, at first it was called likea fatty meal, and now it's called
reduced bolus, which I love.
Yeah, I love it.
I use it all the time.
That's my favorite thing.
Yeah, but it also, you know, kind ofspeaks to the other thing I really like
about Trio is entering protein and fat.
And I have, um, it actually has reallyhelped me keep track of my macros in a
(04:15):
way because I can see on my, um, healthkit just kind of my protein for the day.
And um, you know, there just wasn't agreat way to do that embedded in Loop.
So now this is kind of like an easy hack.
I love it.
That's a UAM, so I love it.
Yeah, yeah, exactly.
Oh, you are, you're only using it?
No entries.
No entries.
(04:35):
Yeah.
Well, I enter my carbs, butfor protein fat coverage?
Mm-hmm.
I don't enter anything.
Just
You don't enter anything.
Yeah.
I want UAM to pick up and do it.
You know, the funny thing is that Ifound that it will work both ways for me.
If I enter the fat and protein or Idon't, but for me, I feel like when I
(04:56):
add the fats and the proteins, not onlylike you, Dana, that I can actually
be a little bit more accountable
mm-hmm.
To those, and I can see it inmy, you know, my health data.
Um, but I feel like it tends tosmooth things out a little better.
Again, my N of one.
That's my experience.
I also have really found thatentering that and using that reduced
(05:19):
bolus, definitely works better too.
So I don't know.
And then you guys were, were like, Jenny,have you turned on your dynamics yet?
And I was like, no.
So I did a couple weeks ago and thathas even like further smooth things.
So
Yeah, Dynamics is a game changer,but I also was kind of nervous
(05:42):
for some reason to turn it on.
I think because of way back when inlast summer, I kind of just had so
many lows, but I think it was justan issue of user error for sure.
It wasn't the dynamic per se.
Yeah, because in the beginning Ithink we didn't understand that at
least it was the case for as far asI know, all of us, that we needed to
back off on our sensitivity factors.
(06:03):
Yeah, yeah.
To be able to make Trio workreally effectively without
causing a bunch of lows.
At least that's what it wasfor at least three of us.
Was that the same for you, Kathryn?
I think, yeah.
I think when I did it the first timearound, I just like saw all the things
and set them like super aggressiveand just was completely willy-nilly.
(06:23):
I was like, oh, this sounds great.
I'm just hardcore.
So, I mean, God only knows wheremy autosense min and max and,
uh, everything was set, but.
Actually understanding thosesettings now and being able to-- it
took, took some time, but dialingin AutoSense, min and max, those
SMB and UAM basal minutes, adjust.
(06:43):
Well, it's just vocabularythat's not in any other system.
So of course it's gonna take timefor us, you know, as patients
and providers to kind of figureout what all of that is doing.
And I think a lot of 'em come froma, um, Android APS and open APS.
Many of the, not all of thefeatures, but most of them do.
And so that was one way that I,that helped me learn is to go back
(07:04):
and look at the documentation forthose other systems that have been
around for a while to get the gist.
There were more stories told and moreparagraphs and different diagrams
with the math for each segment.
So if I put them all in a rowthan I'd go, okay, I got it.
I know what adjustment factor is, andI have an idea about if I change this
setting, what it should be impacting,so then I can change the setting.
(07:27):
Look for a few days and go, yeah,it's doing what I wanted it to do.
That was the thing I needed to do,versus going, I think I have half of it.
I, I'm not really confident about it,which is how we all started, right?
Like
Right.
Some things to learn in the beginning.
I think the other thing that is reallya fantastic feature and that, a hundred
(07:47):
percent kudos to the developers andeverything for doing it, is Trio now
has very, very clear description ofeach and everything that you could
potentially put your fingers on and turn.
And the search bar.
And the search bar, you can find itto search through all your menus, but
that information button is so nicewhen you're thinking, I have this
(08:10):
issue, would this address my issue?
Mm-hmm.
And it even gives you, you know, thedefault and why you may or may not
really want to go beyond the default.
So anyway, that's a anotherone that I really like.
Or you forget what the default was, so youneed to go back to restart and reset it.
Yeah, absolutely.
I think one of the interesting thingsthat we all learned about really
(08:32):
recently, I don't know Dana, if you'rewilling to share your recent adventure,
because that was a part where weall contri... Dana had a question.
We all contributed and said, Ithink this adjustment should help.
This adjustment should help.
And then it ended up being all of thoseplus one other really important thing.
And it was another.
Yeah.
And that was a huge game changer.
(08:54):
So I had, um, a steroid injection,which I have unfortunately had many
of these in the past three years forjust some complications with my back.
And so with these steroids as everyonewho, um, has diabetes-- type one or
type two knows, that those steroidsare gonna directly impact blood
sugars and make you extremely insulinresistant for a certain period of time.
(09:18):
And I-- we talked amongst ourselvesabout making adjustments and even with
aggressive changes, I just wasn't ableto get my blood sugars back in range
that was gonna work for me until Ichanged the target, and that was such
a eye-opening way in terms of the waythat the algorithm was adjusting, and
(09:43):
then kind of with dynamic, with moreaggressive settings, and then setting
a temp target to allow the systemto get me to that temporary target?
Things were immensely easier, and thenI kind of slowly, as I was further away
from the day of my steroid injection,maybe even 7, 9, 10 days later, kind of
(10:05):
still titrated back a little bit insulin,and now I'm kind of back to normal.
Thank goodness.
What about you, Kathryn?
What about, what's your favorite thing?
My favorite?
My favorite thing, honestly, I think isunannounced meal covering the things that
I just don't have to think about anymore.
(10:27):
I think it's been incredibly helpful.
Definitely on Trio, Ican disengage myself.
. Um, much more than I canwith any other system.
I definitely pay a lot moreattention using other things.
Now I will say, initially, like my timein range when I was paying a little bit
(10:48):
of attention to Trio went up drastically.
I don't even remember what it is now.
But now that I've been running Loopagain, uh, my time in range is for
the past seven days is plus 3%.
So, you know, I think in some way likewhen you pay attention, you have a
(11:10):
little bit more time and range, but
true enough,
it's so for like our mentalhealth and everything, to be
able to disengage and still haveexcellent outcomes is really great.
I agree.
I'd like to do a study on the percentfocus you're, you're having on your
diabetes and how that correlatesto a percent increased time and
(11:31):
range, or subtraction, whatever.
I don't know how we would designthat, but let's put it on our list.
And I like that all of us liked afeature, not necessarily the same
feature or for the same reason.
For example, our two dietician,spectacular dieticians, really like
the fact that they can track andget dosing for protein and fat.
(11:51):
Whereas Kathryn and I are like,reduce Bolus or whatever, like
just let it take care of it for me.
But I do think that UnannouncedMeals Bolus is really what
people love about Trio.
I think that's what makes itdistinguished from the other systems.
Right.
And I think the fact that the SMBs andthe UAMs that are, they don't, stop basal.
(12:14):
Like you don't get those littleboluses and then the basal is
stopped, but rather it's grabbingthe basal, giving it to you sooner.
And then on top of that, if you needadditional info in-- insulin for
food you didn't dose for, or forcorrection, then it can still provide
that, which is, that's a differencein the algorithm between Trio and
AAPS and so on compared to Loop.
(12:36):
It's just a,
mm-hmm.
So you have to adjust, you have tounderstand the parameters and adjust them
to make the system work well for you.
And I think that's a really key piece thatseparates, if you're going from Loop to
Trio for example, understanding how thatworks will help you be able to better back
off and look at your settings and adjust.
People get confused in those aspectsthough, 'cause they think like...
(12:59):
I see it all the time posted on theFacebook page, like people think
that they're not getting basal.
It looks, 'cause if you lookin Nightscout, it's taking it
away and they're like, why isTrio not giving me any basal?
Like my blood sugar is elevated.
And it is, it's just, you'regetting it in a different,
you're getting it in a bolus.
Right.
Right.
(13:21):
Yeah.
So I know it's, uh, I think that'ssomething with other systems too, beyond
even Trio that navigate things similar.
There are longer stretchesof missing basal.
Mm-hmm.
And loop didn't really work that way.
There were stretches of missing basal, butnot as dramatic as what you see in Trio.
(13:43):
So if you are somebody that was payingattention heavily to almost the minute
by minute kind of adjustments, it can getfrustrating seeing four hours of, sort of
suspended basal when you're really not.
I mean, that's not the rightword 'cause it's not suspended.
But I think that's also a positiveof Trio is you really see in real
(14:04):
time exactly what's going on interms of that insulin delivery.
Whether it's the supermicroboluses or, or basal.
I mean, it's all just right there and thescreen is so chock full of information.
Um, that can sometimes I think, bedaunting, but once you live with it
and see it for a while, I think that'swhat you really well, that's what
I really enjoy about that display.
(14:26):
Yeah, I really like being ableto push and see the details.
Why is this happening right now?
This is what I was anticipating.
This is different.
Let me see.
Especially if you have dynamics turned on.
Maybe my insulin sensitivity factoris set at, I'll just-- 80, but
Right.
I'm running higher, so I'll look andsee and Dynamics is like, yeah, but
(14:46):
today you need like a 48 and so, right,you're running high because you're
more insulin resistant or your site'snot working, something's going on,
and instead of letting me be 300, it'srapidly adjusting based on parameters,
based on the settings that I give it.
You know, there's guide rails in there.
It can't just do what math it calculates.
It has to stay within the,the safety parameters too.
(15:09):
Um, but I think that's anotherfeature that I really like is the,
the connection between the autosends min and max and the dynamics.
The options within dynamics.
Um, and I really like that you can, basedon your situation, you can even adjust
the percent total daily dose impacton how it's calculating the dynamic
(15:33):
flow, which for some people is justthe difference between night and day.
I feel like with a lot ofkids, that's a huge win.
Being able to address that.
Absolutely.
Or certain times of the monthor when I had my steroids.
I mean, all of that really impacted,um, yeah, that total daily dose.
Sometimes it's helpful,sometimes it totally is not.
(15:56):
Is that something you adjusted whenyou did your steroid adjustment?
I did, yeah, because it didn'treally make a difference.
I needed just more.
I just needed more.
Yeah,
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(16:38):
4 and select option three.
And now back to our program.
One of the things I'm seeing forsome of my clients who are using
Trio, which has been interesting,that are, let's call 'em converts.
I don't know, that we're on Loop andnow they're using Trio is they're
seeing a lot more smooth time of day,um, graphs more often between meals
(17:03):
than they used to because of Dynamics.
So you think their, theirstandard deviation is tighter?
Yes.
Yep.
Yeah, I agree.
I see that too.
Yeah.
Most of the clients that I haveon, that are working with Trio, are
focused on tight time in range, andthey have been better able to do
that without becoming distressed andfocusing every five minutes on it.
(17:27):
It's, it's because of the tools andthe parameters they've been able to
achieve what they set up to achieve.
Right.
So I think that'sinteresting to see in action.
Yeah, no, I would agree with that
In terms of analysis and sort of, Ithink Trio is definitely the system
that does require some expectationof more extreme experimentation.
(17:49):
Agree.
Agreed.
Understanding all the things that youcould possibly make an adjustment to,
but then being willing to say, well, Ithink this sounds like the right thing.
I'm going to adjust it thisway, and then taking the time to
evaluate for two or three days.
Did that actually hit theway that I wanted it to?
And if not, there's usually something elsein the picture that needed to be adjusted.
(18:12):
Right.
Yeah.
Um, but kind of as a starting placetoo, even those moving to Trio, you
know, it does start with settings.
Right?
In a more optimal place and I knowa lot of people often ask, well,
how do I basal test with Trio?
Yeah, that's a good one.
It's a different strategy than youwould do with Loop or you would do
(18:33):
with Omnipod five, or you would dowith, you know, the other systems.
So Tavia, what do you tellpeople for basal testing?
Well, I, I first was tellingthem the wrong thing and
then, then I learned that was,
That's why I brought it up becauseI was like, I think we were all
telling them something that wasa ha-- kind of like a half truth.
Right?
Well, it was what we broughtthat from other places, right?
(18:55):
Right, right.
So what, what we thought, in the beginningwas that you would open Loop for Trio.
You would toggle it so it'snot in closed Loop fashion.
Right.
Um, but then the drawback is it's notpinging every five minutes to the app.
So there were some, a few missing pieces.
One is when you do that, you getzero inflow about the basal that's
(19:16):
actually being delivered during thetime you have that toggle to open.
. So that's not helpful because you're trying to study the basal
delivery and it looks like you'regetting nothing, which makes
It looks like a blank.
Yeah.
Right.
So that wasn't the answer, right?
And then, and then I tried,um, setting a higher target.
Like let's just go low target normal.
Because that's what you kind ofdo in closed Loop basal testing.
(19:39):
Yeah.
Yeah.
Let's go just like 180 and then atleast you won't be getting these
other little boluses or whatever.
Well, then that sort of workedsometimes, but not everywhere.
So let's see, do we allland at the same place?
How do you do basaltesting instructions now?
I think that's the progress that we made.
We went like that step,then the next step.
And now what do you guys do?
(20:00):
So now it's max basal, right?
And the default, I think issix, if I'm correct there.
I might be a little off, butessentially setting max basal at zero.
Yeah.
Right.
Actually a... and then obviously noteating or anything in that basal testing.
Right.
And having a fasted state.
Yeah.
And having truly just, it's not gonnadeliver anything extra-- technically
(20:25):
and you're gonna be able to see thetrue basal rate that's running and if
and when it's doing something to it.
And that's a more true,Trio basal evaluation.
Yeah.
And then an easy, like a sort of ain-betweener that worked really well
for a teenager that I was workingwith was, we did set a higher target
(20:45):
and we turned off SMBs for the night.
Oh?
Just so that we could seewhat the basal by itself did.
Because you can see the basaldisplayed clearly if it's
cranked up or paused or whatever.
Um, so that was, that's kind oflike going into the temp basal
branch in Loop and then just runningkind of an extended target range
and kind of working it that way.
(21:06):
Yeah.
So it wasn't a true basal test, butit was more comforting to the parents
Yeah.
Than not allowing any extra if thingswere gonna go wonky or, or whatever.
So, yeah.
And then did you stillput the max basal to zero?
Yeah, we did.
We didn't the first time and thenwe did the next time when they saw
that it was, uh nothing dire happenedovernight with, um, turning off
(21:28):
the SMB feature for the evening.
Right.
So yeah, there's more thanone way to get the job done,
which I think is interesting.
But I think the
so well, and to clarify too,we're talking about max basal not
being set at zero units per hour.
We're talking about max basal IOB, right?
Yes.
It's, it's the max basal IOBso that really, it's not...
(21:50):
giving extra above what'sprogrammed in, yeah.
Correct.
Yeah.
Just for clarification.
Yes.
No, that was a, that wasa good one to clarify.
Yes.
I was gonna just kind of ask more andmore as we get kind of comfortable
with Trio and see the benefits, whoare you guys maybe suggesting it to
you that is, um, maybe a differentpopulation than you were before?
(22:12):
I mean, for me, teenagers, I think if theyhave a good kind of support system and
understanding and, um, and the parentsare obviously comfortable with it.
To me, I think teenagers are a great groupof people who benefit so much from that.
Um, UAM.
And I, I would a hundred percent agree.
In fact, two of my more early teen,teens, last week that I worked
(22:36):
with, I, you know, they're alwaysasking, is there something new?
Is there something I should be...
right.
Is there a new adjustmentto the algorithm?
And I was like, well, you know, yourkiddo is becoming much more independent.
And with that, those fluctuations postmeal, that could be potentially better.
Hormones.
Hormones, and all the things.
I was like, here's theinformation about Trio.
(22:58):
It is very different, butyou're very knowledgeable.
You've been using Loop forat least a year with really
mm-hmm.
Effect and understanding of it.
You're definitely a primary,good potential for Trio.
Yeah, I agree.
I think the other subgroups inthere are-- so in order to make
Loop work extremely well, right?
(23:19):
To get the biggest benefit fromit related to food, you really do
need to push the buttons to pickdifferent food absorption times.
Yeah, yeah.
It's a little bit easier, quote unquote,easier for adults than it is for kids.
I feel like unless they're reallyyoung kids and the parents are the one
pushing the buttons, once they get tolike, especially middle, middle, middle
(23:41):
age, middle school and high school.
They're so busy doing their schoolthings and their kid things that
they stop being experts often at theright absorption time to help them
get the bolus at the speed they need.
So using Trio, we can set up percentbolus, or we could tell them for
suppers, hit the reduce bolus buttonor something that's not as-- it's
(24:03):
not as time consuming for them.
Right.
Yeah.
And get the benefits of the behindthe scenes pieces of the algorithm.
Mm-hmm.
That and growth spurts and monthlycycle hormones for teenage girls.
Dynamics for the win.
Sigmoid.
Yeah.
That I think works well, um,for that group of people because
it's just such a huge challenge.
(24:25):
Is it growth?
Is it PMS.
Right.
Is it ablation?
Is it bad site?
So many possibilities, right?
But that dynamics can reallyhelp out so there's less.
It doesn't make it perfect, but there'sjust less sort of wildness to the glucose.
Yeah.
When those features are all dialed in.
That's what I've been seeing.
Okay.
On my end.
Yeah.
(24:46):
Agreed.
The other bit that I love about Triofor a lot of athletes is to again,
turn off the, um, the SMBs just so thatyou-- so many people, even on commercial
systems, you know, those correctionboluses, just drop them so much with
activity in the mix and you can turnall that off with Trio, which is lovely.
(25:09):
Excellent.
All right, well, I think thisis a good place for us to stop.
We plan to set up another time andreally dig in a little bit more about
how the algorithm itself works inTrio and I suppose we can dip into how
the algorithm in Loop works becauseit's, they're similar, but they
(25:29):
are definitely distinct algorithms.
All right, so we havea plan to be continued.
Today we discussed some of themany features and settings that we
individually have found useful forourselves and our clients when using Trio
to help manage our Type one diabetes.
We also spent a little time talkingabout what the experience was like for
(25:50):
us from transitioning from Loop overto Trio and how there was an actual
learning curve involved, that didtake us some time to navigate through.
And the fact that we all had to get oversome uncomfortable feelings of making
changes, volunteering to try things thatwe aren't familiar with in order for
(26:12):
the greater good so that we can helpclients who want to pursue utilizing a
system such as Trio, but also so thatwe can individually benefit from some of
the many different features and optionsand, um, settings, adjustments that are
a possibility inside of Trio to makemanaging our own type one diabetes,
less cumbersome and less burdensome.
(26:35):
It's really been a greatexperience for our team.
We got some team building outta theprocess as well as you, anyone who is
actually watching the video instead ofjust listening may have picked up on.
We got to share our, and show off ourgreat purple Trio t-shirts that we
had made up and that was fun for usto be able to share with you as well.
(26:55):
We hope you enjoyed your time with usand we look forward to producing, um,
some upcoming related to Trio and otheropen source content in our future, not
too distant future podcast planning.
So we look forward tospending more time together.
And if you have any questions aboutanything we discuss today, please do
(27:20):
not hesitate to reach out to our team.
We would be more than glad to answer anyquestions you have about using open source
technology or other diabetes relatedmanagement questions that you have.
Thanks again.
Have a great rest of your day.
Thanks for tuning in to ThinkLike a Pancreas, The Podcast.
If you enjoy today's episode, don'tforget to like, follow, or subscribe
(27:43):
on your favorite podcast app.
Think Like a Pancreas-- The Podcast isbrought to you by Integrated Diabetes
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care is personal because we live it too.
Our team of clinicians all livingwith type one diabetes understands
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(28:04):
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From glucose management to self-carestrategies, the latest tech,
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(28:24):
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On behalf of Think Like a Pancreas, The
Podcast.
I'm Gary Scheiner, wishing you a fantastic
week ahead.
And don't forget to think like a pancreas.
Welcome to Think Like a Pancreas,the podcast where our goal is to keep
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The information contained in thisprogram is based on the experience
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Please discuss any changes to yourtreatment plan with your personal
(00:31):
healthcare provider before implementing.
Welcome back to today's episode ofThink Like A Pancreas, the podcast.
My name is Tavia Vital.
I'm a registered nurse, certified diabetescare and education specialist, and
I'm the director of Intensive DiabetesManagement and the the Torah, the
Espanola Integrated Diabetes Services.
Today I'm joined by threeof my esteemed colleagues.
(00:55):
We met briefly... oh, probably a monthago, didn't we guys to talk about Trio?
Yeah?
Okay.
At least a month ago.
Yeah.
At least a month ago.
It seems like a long time, but yeah.
Let's just go around really quick.
Say who's who, and then our goaltoday is to talk about some of the
features that we personally, or thatour clients totally love about Trio.
(01:16):
Sound good?
Great.
Yeah, sure.
I'm Jenny Smith.
I am a RD, CDCES, Director ofLifestyle and Nutrition with
Integrated, user of Trio, previoususer of Loop for many years.
And yeah, we have lots oflittle tidbits to share, so...
I am Kathryn Alvarez.
(01:36):
I am the Director of Exercise Physiologyand I am, I used, actually, I'm using
Loop right now, so that'll be funto discuss on our long podcast, but
I'll go back to Trio pretty soon.
I'm just trying out that food AI feature.
Yeah!
I keep forgetting to do it,but we set it up together.
(02:00):
We got it.
Paid for ready to go, butjust gotta remember to use it.
Yeah, actually do the thing.
And I am Dana Roseman.
I am the director of Technology andApplied Research for Integrated and
also a Registered Dietician, CDCES andum, a proud Trio user since January.
(02:24):
I had a rocky start last summer when youguys originally started and kind of took
a break and then I think I just had towait until I had bandwidth to get back
started and, and very excited I did.
That was kind of, I thinkwe did the same thing, Dana.
'cause I restarted using Trio inFebruary this year after taking
(02:47):
a fall and into winter break fromit with-- I went back to Loop.
Um, so yeah.
And now my frustrations arenot, they're not there like
they were last summer with Trio.
So...
Well, I think there is a transition.
We talked about this a little bitin our first podcast, but there
for sure is a transition goingfrom Loop to Trio and it is not one
(03:08):
size fits all in terms of settings.
And I think maybe it took a littlebit of time for us to figure
out what, what knobs to turn.
And I think those knobs are also alittle bit different as the developers
have adjusted things and learned more.
And we've all, we, we also all, I kindof think we chimed back in, in February
together because we signed up to dothe beta testing of the development
(03:31):
branch of Trio that went, that had alittle bit more fancy feature to it.
I think that is, has definitely led to oneof my favorite things about Trio now was.
That one, if I remember correctly, thebeta had in it the ability to add, um, or
use like a reduced bolus strategy, right?
(03:53):
Well, at first it was called likea fatty meal, and now it's called
reduced bolus, which I love.
Yeah, I love it.
I use it all the time.
That's my favorite thing.
Yeah, but it also, you know, kind ofspeaks to the other thing I really like
about Trio is entering protein and fat.
And I have, um, it actually has reallyhelped me keep track of my macros in a
(04:15):
way because I can see on my, um, healthkit just kind of my protein for the day.
And um, you know, there just wasn't agreat way to do that embedded in Loop.
So now this is kind of like an easy hack.
I love it.
That's a UAM, so I love it.
Yeah, yeah, exactly.
Oh, you are, you're only using it?
No entries.
No entries.
(04:35):
Yeah.
Well, I enter my carbs, butfor protein fat coverage?
Mm-hmm.
I don't enter anything.
Just
You don't enter anything.
Yeah.
I want UAM to pick up and do it.
You know, the funny thing is that Ifound that it will work both ways for me.
If I enter the fat and protein or Idon't, but for me, I feel like when I
(04:56):
add the fats and the proteins, not onlylike you, Dana, that I can actually
be a little bit more accountable
mm-hmm.
To those, and I can see it inmy, you know, my health data.
Um, but I feel like it tends tosmooth things out a little better.
Again, my N of one.
That's my experience.
I also have really found thatentering that and using that reduced
(05:19):
bolus, definitely works better too.
So I don't know.
And then you guys were, were like, Jenny,have you turned on your dynamics yet?
And I was like, no.
So I did a couple weeks ago and thathas even like further smooth things.
So
Yeah, Dynamics is a game changer,but I also was kind of nervous
(05:42):
for some reason to turn it on.
I think because of way back when inlast summer, I kind of just had so
many lows, but I think it was justan issue of user error for sure.
It wasn't the dynamic per se.
Yeah, because in the beginning Ithink we didn't understand that at
least it was the case for as far asI know, all of us, that we needed to
back off on our sensitivity factors.
(06:03):
Yeah, yeah.
To be able to make Trio workreally effectively without
causing a bunch of lows.
At least that's what it wasfor at least three of us.
Was that the same for you, Kathryn?
I think, yeah.
I think when I did it the first timearound, I just like saw all the things
and set them like super aggressiveand just was completely willy-nilly.
(06:23):
I was like, oh, this sounds great.
I'm just hardcore.
So, I mean, God only knows wheremy autosense min and max and,
uh, everything was set, but.
Actually understanding thosesettings now and being able to-- it
took, took some time, but dialingin AutoSense, min and max, those
SMB and UAM basal minutes, adjust.
(06:43):
Well, it's just vocabularythat's not in any other system.
So of course it's gonna take timefor us, you know, as patients
and providers to kind of figureout what all of that is doing.
And I think a lot of 'em come froma, um, Android APS and open APS.
Many of the, not all of thefeatures, but most of them do.
And so that was one way that I,that helped me learn is to go back
(07:04):
and look at the documentation forthose other systems that have been
around for a while to get the gist.
There were more stories told and moreparagraphs and different diagrams
with the math for each segment.
So if I put them all in a rowthan I'd go, okay, I got it.
I know what adjustment factor is, andI have an idea about if I change this
setting, what it should be impacting,so then I can change the setting.
(07:27):
Look for a few days and go, yeah,it's doing what I wanted it to do.
That was the thing I needed to do,versus going, I think I have half of it.
I, I'm not really confident about it,which is how we all started, right?
Like
Right.
Some things to learn in the beginning.
I think the other thing that is reallya fantastic feature and that, a hundred
(07:47):
percent kudos to the developers andeverything for doing it, is Trio now
has very, very clear description ofeach and everything that you could
potentially put your fingers on and turn.
And the search bar.
And the search bar, you can find itto search through all your menus, but
that information button is so nicewhen you're thinking, I have this
(08:10):
issue, would this address my issue?
Mm-hmm.
And it even gives you, you know, thedefault and why you may or may not
really want to go beyond the default.
So anyway, that's a anotherone that I really like.
Or you forget what the default was, so youneed to go back to restart and reset it.
Yeah, absolutely.
I think one of the interesting thingsthat we all learned about really
(08:32):
recently, I don't know Dana, if you'rewilling to share your recent adventure,
because that was a part where weall contri... Dana had a question.
We all contributed and said, Ithink this adjustment should help.
This adjustment should help.
And then it ended up being all of thoseplus one other really important thing.
And it was another.
Yeah.
And that was a huge game changer.
(08:54):
So I had, um, a steroid injection,which I have unfortunately had many
of these in the past three years forjust some complications with my back.
And so with these steroids as everyonewho, um, has diabetes-- type one or
type two knows, that those steroidsare gonna directly impact blood
sugars and make you extremely insulinresistant for a certain period of time.
(09:18):
And I-- we talked amongst ourselvesabout making adjustments and even with
aggressive changes, I just wasn't ableto get my blood sugars back in range
that was gonna work for me until Ichanged the target, and that was such
a eye-opening way in terms of the waythat the algorithm was adjusting, and
(09:43):
then kind of with dynamic, with moreaggressive settings, and then setting
a temp target to allow the systemto get me to that temporary target?
Things were immensely easier, and thenI kind of slowly, as I was further away
from the day of my steroid injection,maybe even 7, 9, 10 days later, kind of
(10:05):
still titrated back a little bit insulin,and now I'm kind of back to normal.
Thank goodness.
What about you, Kathryn?
What about, what's your favorite thing?
My favorite?
My favorite thing, honestly, I think isunannounced meal covering the things that
I just don't have to think about anymore.
(10:27):
I think it's been incredibly helpful.
Definitely on Trio, Ican disengage myself.
. Um, much more than I canwith any other system.
I definitely pay a lot moreattention using other things.
Now I will say, initially, like my timein range when I was paying a little bit
(10:48):
of attention to Trio went up drastically.
I don't even remember what it is now.
But now that I've been running Loopagain, uh, my time in range is for
the past seven days is plus 3%.
So, you know, I think in some way likewhen you pay attention, you have a
(11:10):
little bit more time and range, but
true enough,
it's so for like our mentalhealth and everything, to be
able to disengage and still haveexcellent outcomes is really great.
I agree.
I'd like to do a study on the percentfocus you're, you're having on your
diabetes and how that correlatesto a percent increased time and
(11:31):
range, or subtraction, whatever.
I don't know how we would designthat, but let's put it on our list.
And I like that all of us liked afeature, not necessarily the same
feature or for the same reason.
For example, our two dietician,spectacular dieticians, really like
the fact that they can track andget dosing for protein and fat.
(11:51):
Whereas Kathryn and I are like,reduce Bolus or whatever, like
just let it take care of it for me.
But I do think that UnannouncedMeals Bolus is really what
people love about Trio.
I think that's what makes itdistinguished from the other systems.
Right.
And I think the fact that the SMBs andthe UAMs that are, they don't, stop basal.
(12:14):
Like you don't get those littleboluses and then the basal is
stopped, but rather it's grabbingthe basal, giving it to you sooner.
And then on top of that, if you needadditional info in-- insulin for
food you didn't dose for, or forcorrection, then it can still provide
that, which is, that's a differencein the algorithm between Trio and
AAPS and so on compared to Loop.
(12:36):
It's just a,
mm-hmm.
So you have to adjust, you have tounderstand the parameters and adjust them
to make the system work well for you.
And I think that's a really key piece thatseparates, if you're going from Loop to
Trio for example, understanding how thatworks will help you be able to better back
off and look at your settings and adjust.
People get confused in those aspectsthough, 'cause they think like...
(12:59):
I see it all the time posted on theFacebook page, like people think
that they're not getting basal.
It looks, 'cause if you lookin Nightscout, it's taking it
away and they're like, why isTrio not giving me any basal?
Like my blood sugar is elevated.
And it is, it's just, you'regetting it in a different,
you're getting it in a bolus.
Right.
Right.
(13:21):
Yeah.
So I know it's, uh, I think that'ssomething with other systems too, beyond
even Trio that navigate things similar.
There are longer stretchesof missing basal.
Mm-hmm.
And loop didn't really work that way.
There were stretches of missing basal, butnot as dramatic as what you see in Trio.
(13:43):
So if you are somebody that was payingattention heavily to almost the minute
by minute kind of adjustments, it can getfrustrating seeing four hours of, sort of
suspended basal when you're really not.
I mean, that's not the rightword 'cause it's not suspended.
But I think that's also a positiveof Trio is you really see in real
(14:04):
time exactly what's going on interms of that insulin delivery.
Whether it's the supermicroboluses or, or basal.
I mean, it's all just right there and thescreen is so chock full of information.
Um, that can sometimes I think, bedaunting, but once you live with it
and see it for a while, I think that'swhat you really well, that's what
I really enjoy about that display.
(14:26):
Yeah, I really like being ableto push and see the details.
Why is this happening right now?
This is what I was anticipating.
This is different.
Let me see.
Especially if you have dynamics turned on.
Maybe my insulin sensitivity factoris set at, I'll just-- 80, but
Right.
I'm running higher, so I'll look andsee and Dynamics is like, yeah, but
(14:46):
today you need like a 48 and so, right,you're running high because you're
more insulin resistant or your site'snot working, something's going on,
and instead of letting me be 300, it'srapidly adjusting based on parameters,
based on the settings that I give it.
You know, there's guide rails in there.
It can't just do what math it calculates.
It has to stay within the,the safety parameters too.
(15:09):
Um, but I think that's anotherfeature that I really like is the,
the connection between the autosends min and max and the dynamics.
The options within dynamics.
Um, and I really like that you can, basedon your situation, you can even adjust
the percent total daily dose impacton how it's calculating the dynamic
(15:33):
flow, which for some people is justthe difference between night and day.
I feel like with a lot ofkids, that's a huge win.
Being able to address that.
Absolutely.
Or certain times of the monthor when I had my steroids.
I mean, all of that really impacted,um, yeah, that total daily dose.
Sometimes it's helpful,sometimes it totally is not.
(15:56):
Is that something you adjusted whenyou did your steroid adjustment?
I did, yeah, because it didn'treally make a difference.
I needed just more.
I just needed more.
Yeah,
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(16:38):
4 and select option three.
And now back to our program.
One of the things I'm seeing forsome of my clients who are using
Trio, which has been interesting,that are, let's call 'em converts.
I don't know, that we're on Loop andnow they're using Trio is they're
seeing a lot more smooth time of day,um, graphs more often between meals
(17:03):
than they used to because of Dynamics.
So you think their, theirstandard deviation is tighter?
Yes.
Yep.
Yeah, I agree.
I see that too.
Yeah.
Most of the clients that I haveon, that are working with Trio, are
focused on tight time in range, andthey have been better able to do
that without becoming distressed andfocusing every five minutes on it.
(17:27):
It's, it's because of the tools andthe parameters they've been able to
achieve what they set up to achieve.
Right.
So I think that'sinteresting to see in action.
Yeah, no, I would agree with that
In terms of analysis and sort of, Ithink Trio is definitely the system
that does require some expectationof more extreme experimentation.
(17:49):
Agree.
Agreed.
Understanding all the things that youcould possibly make an adjustment to,
but then being willing to say, well, Ithink this sounds like the right thing.
I'm going to adjust it thisway, and then taking the time to
evaluate for two or three days.
Did that actually hit theway that I wanted it to?
And if not, there's usually something elsein the picture that needed to be adjusted.
(18:12):
Right.
Yeah.
Um, but kind of as a starting placetoo, even those moving to Trio, you
know, it does start with settings.
Right?
In a more optimal place and I knowa lot of people often ask, well,
how do I basal test with Trio?
Yeah, that's a good one.
It's a different strategy than youwould do with Loop or you would do
(18:33):
with Omnipod five, or you would dowith, you know, the other systems.
So Tavia, what do you tellpeople for basal testing?
Well, I, I first was tellingthem the wrong thing and
then, then I learned that was,
That's why I brought it up becauseI was like, I think we were all
telling them something that wasa ha-- kind of like a half truth.
Right?
Well, it was what we broughtthat from other places, right?
(18:55):
Right, right.
So what, what we thought, in the beginningwas that you would open Loop for Trio.
You would toggle it so it'snot in closed Loop fashion.
Right.
Um, but then the drawback is it's notpinging every five minutes to the app.
So there were some, a few missing pieces.
One is when you do that, you getzero inflow about the basal that's
(19:16):
actually being delivered during thetime you have that toggle to open.
. So that's not helpful because you're trying to study the basal
delivery and it looks like you'regetting nothing, which makes
It looks like a blank.
Yeah.
Right.
So that wasn't the answer, right?
And then, and then I tried,um, setting a higher target.
Like let's just go low target normal.
Because that's what you kind ofdo in closed Loop basal testing.
(19:39):
Yeah.
Yeah.
Let's go just like 180 and then atleast you won't be getting these
other little boluses or whatever.
Well, then that sort of workedsometimes, but not everywhere.
So let's see, do we allland at the same place?
How do you do basaltesting instructions now?
I think that's the progress that we made.
We went like that step,then the next step.
And now what do you guys do?
(20:00):
So now it's max basal, right?
And the default, I think issix, if I'm correct there.
I might be a little off, butessentially setting max basal at zero.
Yeah.
Right.
Actually a... and then obviously noteating or anything in that basal testing.
Right.
And having a fasted state.
Yeah.
And having truly just, it's not gonnadeliver anything extra-- technically
(20:25):
and you're gonna be able to see thetrue basal rate that's running and if
and when it's doing something to it.
And that's a more true,Trio basal evaluation.
Yeah.
And then an easy, like a sort of ain-betweener that worked really well
for a teenager that I was workingwith was, we did set a higher target
(20:45):
and we turned off SMBs for the night.
Oh?
Just so that we could seewhat the basal by itself did.
Because you can see the basaldisplayed clearly if it's
cranked up or paused or whatever.
Um, so that was, that's kind oflike going into the temp basal
branch in Loop and then just runningkind of an extended target range
and kind of working it that way.
(21:06):
Yeah.
So it wasn't a true basal test, butit was more comforting to the parents
Yeah.
Than not allowing any extra if thingswere gonna go wonky or, or whatever.
So, yeah.
And then did you stillput the max basal to zero?
Yeah, we did.
We didn't the first time and thenwe did the next time when they saw
that it was, uh nothing dire happenedovernight with, um, turning off
(21:28):
the SMB feature for the evening.
Right.
So yeah, there's more thanone way to get the job done,
which I think is interesting.
But I think the
so well, and to clarify too,we're talking about max basal not
being set at zero units per hour.
We're talking about max basal IOB, right?
Yes.
It's, it's the max basal IOBso that really, it's not...
(21:50):
giving extra above what'sprogrammed in, yeah.
Correct.
Yeah.
Just for clarification.
Yes.
No, that was a, that wasa good one to clarify.
Yes.
I was gonna just kind of ask more andmore as we get kind of comfortable
with Trio and see the benefits, whoare you guys maybe suggesting it to
you that is, um, maybe a differentpopulation than you were before?
(22:12):
I mean, for me, teenagers, I think if theyhave a good kind of support system and
understanding and, um, and the parentsare obviously comfortable with it.
To me, I think teenagers are a great groupof people who benefit so much from that.
Um, UAM.
And I, I would a hundred percent agree.
In fact, two of my more early teen,teens, last week that I worked
(22:36):
with, I, you know, they're alwaysasking, is there something new?
Is there something I should be...
right.
Is there a new adjustmentto the algorithm?
And I was like, well, you know, yourkiddo is becoming much more independent.
And with that, those fluctuations postmeal, that could be potentially better.
Hormones.
Hormones, and all the things.
I was like, here's theinformation about Trio.
(22:58):
It is very different, butyou're very knowledgeable.
You've been using Loop forat least a year with really
mm-hmm.
Effect and understanding of it.
You're definitely a primary,good potential for Trio.
Yeah, I agree.
I think the other subgroups inthere are-- so in order to make
Loop work extremely well, right?
(23:19):
To get the biggest benefit fromit related to food, you really do
need to push the buttons to pickdifferent food absorption times.
Yeah, yeah.
It's a little bit easier, quote unquote,easier for adults than it is for kids.
I feel like unless they're reallyyoung kids and the parents are the one
pushing the buttons, once they get tolike, especially middle, middle, middle
(23:41):
age, middle school and high school.
They're so busy doing their schoolthings and their kid things that
they stop being experts often at theright absorption time to help them
get the bolus at the speed they need.
So using Trio, we can set up percentbolus, or we could tell them for
suppers, hit the reduce bolus buttonor something that's not as-- it's
(24:03):
not as time consuming for them.
Right.
Yeah.
And get the benefits of the behindthe scenes pieces of the algorithm.
Mm-hmm.
That and growth spurts and monthlycycle hormones for teenage girls.
Dynamics for the win.
Sigmoid.
Yeah.
That I think works well, um,for that group of people because
it's just such a huge challenge.
(24:25):
Is it growth?
Is it PMS.
Right.
Is it ablation?
Is it bad site?
So many possibilities, right?
But that dynamics can reallyhelp out so there's less.
It doesn't make it perfect, but there'sjust less sort of wildness to the glucose.
Yeah.
When those features are all dialed in.
That's what I've been seeing.
Okay.
On my end.
Yeah.
(24:46):
Agreed.
The other bit that I love about Triofor a lot of athletes is to again,
turn off the, um, the SMBs just so thatyou-- so many people, even on commercial
systems, you know, those correctionboluses, just drop them so much with
activity in the mix and you can turnall that off with Trio, which is lovely.
(25:09):
Excellent.
All right, well, I think thisis a good place for us to stop.
We plan to set up another time andreally dig in a little bit more about
how the algorithm itself works inTrio and I suppose we can dip into how
the algorithm in Loop works becauseit's, they're similar, but they
(25:29):
are definitely distinct algorithms.
All right, so we havea plan to be continued.
Today we discussed some of themany features and settings that we
individually have found useful forourselves and our clients when using Trio
to help manage our Type one diabetes.
We also spent a little time talkingabout what the experience was like for
(25:50):
us from transitioning from Loop overto Trio and how there was an actual
learning curve involved, that didtake us some time to navigate through.
And the fact that we all had to get oversome uncomfortable feelings of making
changes, volunteering to try things thatwe aren't familiar with in order for
(26:12):
the greater good so that we can helpclients who want to pursue utilizing a
system such as Trio, but also so thatwe can individually benefit from some of
the many different features and optionsand, um, settings, adjustments that are
a possibility inside of Trio to makemanaging our own type one diabetes,
less cumbersome and less burdensome.
(26:35):
It's really been a greatexperience for our team.
We got some team building outta theprocess as well as you, anyone who is
actually watching the video instead ofjust listening may have picked up on.
We got to share our, and show off ourgreat purple Trio t-shirts that we
had made up and that was fun for usto be able to share with you as well.
(26:55):
We hope you enjoyed your time with usand we look forward to producing, um,
some upcoming related to Trio and otheropen source content in our future, not
too distant future podcast planning.
So we look forward tospending more time together.
And if you have any questions aboutanything we discuss today, please do
(27:20):
not hesitate to reach out to our team.
We would be more than glad to answer anyquestions you have about using open source
technology or other diabetes relatedmanagement questions that you have.
Thanks again.
Have a great rest of your day.
Thanks for tuning in to ThinkLike a Pancreas, The Podcast.
If you enjoy today's episode, don'tforget to like, follow, or subscribe
(27:43):
on your favorite podcast app.
Think Like a Pancreas-- The Podcast isbrought to you by Integrated Diabetes
Services where experience meets expertise,passion meets compassion, and diabetes
care is personal because we live it too.
Our team of clinicians all livingwith type one diabetes understands
the challenges firsthand.
(28:04):
We're here to help no matterwhere you are in the world.
From glucose management to self-carestrategies, the latest tech,
sports and exercise, weight loss,type one pregnancy and emotional
wellbeing, we've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
(28:24):
Wanna learn more?
Visit integrateddiabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Like a Pancreas, The
Podcast.
I'm Gary Scheiner, wishing you a fantastic
week ahead.
And don't forget to think like a pancreas.
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