Medtronic 780G, new pump user!

[Wjohn]

Dear Maco ,
Thanks for the reply ,sorry to keep on asking ,
what do these extra sensors do ? I cannot find out what extra they would provide ,maybe I’m looking at the wrong page .
For how long do these extra payments carry on for ?
Thanks again John

 

[dancer]

Hi ,would like to ask for advice/ guidance on the Medtronic780G pump plus the additional sensors .
I’ve been a Type 1 for just on 60 yrs now at 82 yrs I’ve been told I may be offered a 780G pump ,but informed that I would have to pay about £1000+ for additional beneficial sensors ,so ,Help , So is it worth all the Effort and do the extra ,beneficial sensors help in my control ,are they worth the extra cost ? Is there any reading that I should look at ?
Many thanks ,I’m quite nervous about it all ,
Thanks Wjo

I
If it is your first pump there will be a lot to learn. There is no doubt insulin pumps do improve diabetic control but I wonder why the sensors were mentioned, if you have full hypo awareness. If you don't have full awareness, then they should at least prescribe the Freestyle Libre 2 which would be free with the NHS.

The continuous glucose monitor shows your blood sugar on the pump screen, along with a graph showing whether your BG is level, rising or falling. The pump alerts you to low and/or high blood sugars and cuts off insulin when going low. The 780G can also give corrections, whereas earlier pumps just alert you to high blood sugars and you have to start the correction procedure yourself.

I don't know if the new Medtronic sensors are available yet. They are supposed to be much better than the present Guardian 3 sensors. To get the FULL benefit of the 780G the use of sensors is necessary, as the pump will then be able to give any necessary corrections. However, you can get good control using only the pump. I don't know the cost of the new sensors but they must be more expensive than the Guardian 3, as I believe last longer (2 weeks?). The Guardian 3 would cost at least £200 per month. I think the transmitter costs around £500 and is guaranteed for 1 year. Transmitters last anything from 1 to 3 years.

Is the pump worth all the effort? Yes, definitely.

Would the sensors help your control? They can be a pain in the neck at times but they have helped me. If you are having problems with hypos sensors definitely help. If you have trouble with highs, possibly the pump on it's own would be enough.

Pumping insulin by John Walsh was recommended reading when I started on the pump over 10 years ago. I don't know of any other books.

Good luck!

 

[Maco]

@Wjohn Hi John, my last reply was a little rushed so I’ll go into more detail with this post.

Basically the 780G is like an artificial pancreas if you are running it alongside the Guardian 3 CGM sensors. The pump will automatically shut off insulin when it senses you going low & give you an alarm, it’ll also automatically give you correction insulin if your blood glucose levels start to raise. What that means is your carb counting doesn’t have to be a perfect science & you can be a little bit off every now and then. The 780G also automatically gives you ALL of your basal insulin, you don’t have a set amount per day like you do with insulin pens. The pump adjusts your basal rate every 5 minutes to keep your glucose in range.

If you don’t use the guardian 3 sensors then you will lose all of these features & basically just have a insulin pump that needs to give you a set amount of basal per day like your insulin pen & it will only give fasting acting insulin when you tell it to when you eat. No automatic correction doses & no basal adjustment every 5 minutes.

As for costs, you will need to pay for the sensors for as long as your using the pump. If you take out a plan with Medtronic it costs £1820 for a years supply of sensors which also includes the transmitter which usually costs £500 on its own. The sensor needs to be changed every 7 days & in all honesty coming from a 26 year old it can be very fiddly. When you first insert a new sensor you will need to calibrate it after 6hrs, after that you’ll need to calibrate every 12hrs at a minimum. What I mean by calibrating is you check your blood glucose with a blood test like you normally would and tell your pump the results. This is basically just to make sure your sensor isn’t a mile out compared to your blood glucose results.

Now I will be completely honest, these sensors can be really frustrating & it’s certainly not as easy as inserting a sensor and leaving it in for 7 days then changing it for a new one. These sensors can randomly decide to fail, the pump can decide it doesn’t want to accept a calibration and it’ll keep asking for one every 15 minutes until it accepts. You will without a doubt get alarms going off from your pump at 2/3/4am asking you to get out of bed & do a blood test for no reason whatever.


I would not recommend using the 780G without the sensors because it is an amazing piece of kit, my time in range over the last 14 days is 97%. My a1c in January was 83 & it’s now 45. The kit really is amazing!

Luckily for me I get the pump & sensors fully funded.

 

[Wjohn]

Dear all ,
Thank you for all the replies with good information ,please keep them coming ,I’m learning ,nothing said to me about calibrating ,blood ,pricking,and testing etc .,so ,
Many thanks ,John

 

[Maco]

Dear all ,
Thank you for all the replies with good information ,please keep them coming ,I’m learning ,nothing said to me about calibrating ,blood ,pricking,and testing etc .,so ,
Many thanks ,John

There’s a few steps you’ll need to do every few days.

Firstly you’ll need to change your infusion set every 3 days. The infusion set is a tube that goes from your pump into your body that transports the insulin. That will need changing every 3 days as a minimum. Alongside changing your infusion set you’ll need to draw up a reservoir full of insulin. You’ll need to learn to do this yourself, your insulin will come in a bottle to be drawn up. Again this needs doing every 3 days alongside your infusion set change.

As for your sensor change. This will need doing every 7 days. You have 2 parts to your CGM, the first is the part that goes into your body & the second is a little white disk called the transmitter which you insert into the sensor. When it comes to sensor change day you’ll also need to charge the transmitter for at least 30 minutes. Then you can go ahead fitting your new sensor. Firstly you insert the sensor into your body, you then place 1 piece of oval tape over the sensor. Secondly you insert the transmitter than fit a second piece of tape. Usually you need someone to help you fit the tape & transmitter because of where you need to place the sensor you usually can’t reach it with both hands.

Once everything is fitted and in place, the sensor will ‘warm up’ for 2hrs. After which you’ll need to check your blood & enter the reading into the pump. The sensor will then come to lift, 6hrs later you’ll need to do another blood calibration.

here is a video.

 

[Allen50yearsT1]

Add another to that count! I've just swapped from the medtronic 640G and gaurdian CGM system to the t-slim and dexcom. The dexcom is in a different league - far more accurate, a LOT less faffihg about inserting it (you need literally 2 pairs of hands if you want to stick the enlite sensor from medtronic anywhere other than your abdomen), it lasts 10 days rather than 7 and doesn't need calibrating 2-3 times a day. I don't know about the 780G but I know the model before it used to kick you out of the automode (medtronic's closed loop system) if you failed to calibrate it, or if it lost contact etc. I've used the libre before and the dexcom is very much like that, although doesn't last 4 weeks and of course is a cgm not flash

The t-slim is excellent with one exception - using fiasp in it has a lot of potential issues.

I self funded the Libra 1 for a couple of years but couldn't really afford to keep doing that. I then managed to get them again via the NHS. Due to IR I had a bad hypo during the night on 1st January, I might add that I had no alcohol at all that night. My partner couldn't bring me round, paramedics had trouble too. As I came round I heard them say my BS was now just above 1.0.

I asked my consultant for the Libra2, as it was the same price and had alarms which would have help prevent the hypo, but the government hadn't approved it so he couldn't but he did get me the Dexcom. In theory it was good, but in practice it was very annoying, yes it woke me up with a high bs, and/or a low bs, but every 5 minutes it would alarm until the problem has been sorted. To get a BS of 15 down involves eating fast acting carbs/sugars but these still have to metabolise before there is enough to stop the alarm, believe me to get my bs to drop from 15 down below 7 or 10, takes an appreciably long time, with the Dexcom pinging every 5 minutes. Not ideal during the night. Plus the fact the Dexcom is more expensive , only lasts 10 days, is more of a fiddle with its transmitters and a double wait time to initialise compared to the Libra. I had to power my mobile off so my partner could sleep, luckily I had let the remote rundown a couple of days before because it's impossible to shut it up.
Horses for courses I guess.

 

[james555]

Hi maco as you are after being on the 780g for a while now do you still think its a very good pump and what percentage in range are you having many thanks

 

[adamrit]

Type 1 for last 65 years, on pump for last 20 years (640G). I had long nightmares with Medtronic sensor inaccuracy but changed from abdomen to putting it on my thigh. Accuracy very improved. Type 3 sensors also better than type 2. I've always stuck with Medtronic because of the automatic insulin suspension when BG low. Used to get drenched in sweat hypos frequently at night leaving poor wife to desperately try to feed sugar down my throat. Hasn't happened once since the 640G automatic cut off of insulin when BG low. and automatic restart when BG OK. I've also lost about 5kg by eating less (smaller plate, less carbo, stopped the wine) so feeling better. I have another three years of the 640G before I can get a more modern artificial pancreas system.