Medtronic 780g Correction doses

[LauraR88]

Please someone help me. I’m at my wits end chasing constant highs and lows

Long story short, I had a gastric sleeve 6 months ago. I’ve lost nearly 4 stone, my body is changing and so are my insulin levels. In the last couple of weeks I’ve been having up to 6/7 hypos a night.

I’ve eventually had an appt with diabetic nurse and she’s made some changes, but even my partner states I appear to be having more hypos since. And the headaches I’m getting from chasing highs and lows are unbearable at times.

I don’t know if the nurse has set my correction doses too high, I was hoping someone with the Medtronic 780g could tell me if under the insulin sensitivity (correction doses), does the higher the number mean you are getting more insulin or less. If that makes sense?

I’ve attached a picture of my current level, but I’m more of that means 1 unit of insulin drops me 4 OR I need 4 units of insulin to drop 1

I hope this makes sense. Apologies if not, o am just off a nightshift and in my 5th hypo

Thanks in advance for any help xx

 

[eventhorizon]

Hi.

That means 1 unit of insulin should lower your blood sugar by 4 mmol/l.

So in other words the smaller the number the more your insulin the pump will deliver to correct a high blood sugar.

I hope that makes sense.

 

[dancer]

Many people require different correction levels for different times of the day. Mine range from 3.5 to 5.

Losing weight can cause hypos, so carb ratios would need changed, as your insulin requirements fall. Again, you can have different carb ratios for different times of the day.
if you use a carb ratio of 1:10 (one unit for every 10 grams of carbs) but find you hypo a couple of hours later ( for 2 or 3 days) you need less insulin for that meal. The 1:10 ratio could be changed to 1:15 ie, 1 unit for every 15g carbs. This would be far too much of a difference for me, as I am insulin sensitive (I would need to try 1:11 or 1:12). Everyone is different.

You should wait 2 or 3 days before making further changes.

Are you on Manual Mode? If so, and you are only having hypos when on nightshift, perhaps it would be better to create a nightshift basal pattern, with less basal during the times you hypo.

If you are on Auto Mode, apparently the only things you can change to make a difference to hypos are carb ratios and insulin activity time. The most effective AIT for the 780G is 2 hours, but this doesn't suit everyone. Some change this to 2.15 or 2.30 hours but a few require the recognised 4 hours activity time. Good luck!

 

[Juicyj]

Just a house keeping thing with pumps - but are updating your weight on your pump when it changes ?

 

[LauraR88]

Apologies for late reply, been a rough couple of days between work and managing these hypos.

I thought that was the case regarding 1 unit of insulin drops my bloods by 4mmol but needed to check. Since I have done this it seems to have helped quite a bit, albeit not completely.

I think on my days off I’m gunna do some testing on my carb ratios to see what I can do with them. I was just really frustrated over the last month or so.

I’m in auto mode on 780g I find that when I hypo if I unplug myself from the pump I recover ALOT quicker than if I was to keep myself attached which is strange and I’ve raised my DN who seemed just as surprised as I was.

Juicyj on the Medtronic it doesn’t allow you to put your weight in ……. Well not that I am aware of anyway

Thanks for the advice guys I really do appreciate

 

[Gordontoo]

Hi LauraR88. You sound like you have been through the wars. Pumps can be pernickity creatures. You can suspend delivery, without unplugging from the machine. That is what I do if I feel a hypo on the way, well that and a couple of jelly beans.

Since switching to the 780 upgrade, I have lost several kgs and have also reduced my basal rate from 23u to 13u. Increased exercise and a change to my dietary regime, by eating what I need, rather than adjusting my insulin intake to accommodate what I wanted to eat, were the biggest factors. but if I may be so bold as to suggest that baby steps are always best. I adjusted my basal rate down along with my carb intake slowly and over several months. So far so good. I also noticed that there was a constant time about 0300-0500 hrs where I was getting regular lows, so I adjusted that section of my basal intake down further to prevent those hypos.

Good luck on your journey and fingers crossed.

 

[Nicola M]

From reading your post it seems you are in Automode or as Medtronic calls it SmartGuard. Just to better understand are you using a G3/G4 sensor and have it linked to your pump?

If you are then changing the insulin sensitivity will not make any difference. The only things you can change in Automode are your Active Insulin Time and carb ratios. Because you’ve lost so much weight you may find your insulin needs are going to change a lot until your weight finally settles and you stay at a similar weight regularly. The pump is probably struggling to keep up with your changing body.

I would possibly change your Active Insulin time to be longer and look into your carb ratios as you may be giving yourself too much insulin now, I would also look into changing your target to the highest target (I think it’s 6.7). If you’re still finding you’re going low overnight you can set a Temp target of 8.3 for a specified amount of hours which means it won’t give you any corrections at all during that time.