Ask Dana: Why am I still having highs and lows with my new automated insulin delivery system?
IDS Director of Technology and Applied Research, Dana Roseman
QUESTION:
Dear Dana,
I’m 24 and have had T1D since I was 10. I recently upgraded to an automated insulin delivery system with a CGM and hybrid closed loop. My diabetes educator and endocrinologist told me that it would help keep me in range more often with less lows. I was excited to finally get more control after years of being all over the place during college. But now I’m finding I still go high after meals or low when I exercise. I feel like I’m doing “everything right.” What should I be expecting from this new system?
Avery Harrison
Washington DC
ANSWER:
Dear Avery,
I hear this question often – “Why am I still struggling with my blood sugars after getting all of this new technology?”
First, you should be so proud of recommitting to your diabetes management. The transition from college to a more predictable routine is a great time to revisit your diabetes goals. With the most up-to-date technology, it is common for providers and PWD to think an automated insulin delivery system will “just handle” diabetes. But here’s the hard truth: none of the modern algorithms can support diabetes management without a solid understanding of the basics. Successful diabetes management still relies on understanding how insulin works, how certain foods will impact your BGs, and how to manage your favorite physical activities.
https://integrateddiabetes.com/wp-content/uploads/2025/08/automated-insulin-delivery-system.jpg
Insulin, for all its upgrades in fancy algorithms and technology methods, still behaves much like it did 20 years ago.
Even the fastest “rapid and ultra-rapid acting” insulins don’t work instantly. They take time to start lowering blood sugar, peak after a certain amount of time, and remain active for several hours.
So, if you eat a meal and dose insulin at the same moment, or even afterwards, it is likely your system isn’t helping to prevent a post-meal spike.
And it is vital to remember the importance of your personal settings.
Even the most advanced AID system needs a solid foundation of insulin settings. If your carb ratio doesn’t match your real needs, or your basal rates haven’t been updated since before college, the algorithm is starting from a flawed foundation. Even systems that have limited settings to program into the AID system, the algorithm will require certain adjustments and fine-tuning to achieve the best outcomes.
It is also important to have realistic expectations of your technology.
Hormones, illness, stress, travel, or even just the randomness of life can impact your blood sugars in a way that can be unpredictable to your AID system. Making sure you have realistic expectations about your personal time-in-range and management can help with the frustration and disappointment around your technology. If your expectations don’t align with how these tools were designed to perform, it’s easy to feel like something’s broken when really, things are working just as intended.
Our IDS team specializes in helping people get the most out of their technology by going back to the fundamentals: settings, timing, pattern recognition, and real-life troubleshooting that can make all the difference. Let us help you make your AID system work best for you!
If you need more individualized guidance, connect with our team here at IDS!
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