Anyone on the Medtronic 780 (currently using Guardian 3) and can share some tips for making AutoMode work better

[FatCatAnna]

Hey there - was coming onto the forums here to get more insight into a closed looping pump (I've been trialing the 780G here in Canada - and so far - being a tightly controlled T1D of almost 60 years - well - it's a love/hate relationship with the AutoMode). The pump is publicly funded here in the province of Ontario (why did I leave the UK again - urrrhhh - our socialised health system in Canada varies so much sad to say) - but if I return this pump back - and go with a handme down #670G that someone decided they didn't want to use - and went onto Tandem instead (it's like wow - really - that pump is $$$). So, until I can afford the Dexcom system out of pocket with perhaps a Tandem - that's the route I'll go if I don't get answers from Medtronic as to why I'm having such a rough time (it's been over a month now in AutoMode).

I just know my A1c since going onto the Medtronic #770G / #780G (Guardian 3 took a bit of getting used to - but it's pretty spot on despite it's quirkiness compared to Dexcom/Libre system) has gone from it's usual mid 5% and I'm now in the upper 6% (freaks me out to no end as I'm sure it would with those of you that are tightly controlled).

So, what I'm trying to get help from Medtronic on (my CDE's are reluctant to help me since majority of pump users where I live in Cornwall, Ontario use either Tandem / Omnipod) - is to fix those darn highs in the AM . I go to bed at a responsible number in 5-6 mmol/l range - but it starts to creep up where I'm waking up to 9 mmol/l ... so not used to this and hate eating when I'm that high.

Note, before going onto the AutoMode - I ensured my basal settings in Manual worked - which they do - but for one reason or another - I've had to increase my basal by almost 30% (I've always been insulin sensitive - but with age - I'm like a teen again). So, all good in the Manual mode - but I've had a very interesting month of being in AutoMode - with the #780G - where either it's not Suspended when I'm low (e.g. 2.8 mmol/l) - or has done AutoCorrect when high. I had to cancel a hike last because of the pump going wonky with going high (e.g. went up to 16 mmol/l) and no AutoCorrects were done - along with Alarms for blockages. Never had so many problems with an insulin pump since starting back originally on an Animas in 2008.

So anyone with similar stories or suggestions as to how to get rid of those AM highs, since the basal program doesn't come into play with AutoMode - would be great. Note, I have changed the IOB to 2 hours - found that out from an Alberta CDE website - and I changed my ISF level lower to help with corrections when high - as well as I:C carb ratio. I almost feel like diabetes is taking over my life these past 6 months, and can now understand what it feels like to be a newly diagnosed diabetic, especially when you don't have any support from either the manufacturer/your own health care team (Pandemic and hacking into our hospital system recently hasn't helped).

Over and out - from Cornwall, Ontario - Victoria Day long weekend !!! R&R hip hip hooray!!!

 

[FatCatAnna]

Just thought I'd BUMP this up - incase it gets lost in all the posts here! Am attending a virtual course tonight for the 780G here in Canada - and hopefully will learn a bit more about the system. Good news - have had 4 calls from Medtronic Support - so tagging in social media - does help. If you have similar story(stories) to share on your adventures with the Medtronic 780G - would love to hear from you.

Meanwhile, my way around to get the pump to correct to the 5.5 average I'm trying to attain - is to do "ghost carbs" ... so basically doing what the pump algorithm is doing when above 10 - but just giving an extra .1 - which is about 2 grams of carbs. So far, this seems to be doing the job - and perhaps after being on SmartMode now for 6 weeks - the pump has finally learned a bit about me. For my sanity and OCD ways as a T1D of 57 years - that's a much welcome reprieve.

Now back to work I go (don't tell my boss I snuck into the forums).

Anna from Cornwall, Ontario

 

[FatCatAnna]

Just posted this reply in another thread with 780G/Guardian 4 (so you maybe scratching your head - but was in reference to the IOB setting for the SmartGuard) - but thought I'd share what I learned at a virtual event held for folks here in Canada that are new to the 780G (it's been rolling out slowly since being approved by Health Canada in December - I only started on it in April because I whined about wanting to new toy to play with - mew mew mew). Anyway, if this helps anyone with trying to understand the "closed looping" system of the Medtronic 780G - here's a few things I learned ..

Last night I attended a Medtronic virtual event for those new to the 780G (still on G3) here in Canada. Overall, it went really well with learning some tips - and how my "phantom carbs" (I had called them ghost carbs when I wrote in the Chat box for the discussion afterwards) - and that's a big no no for helping the algorithm to learn the individual. So last night, I went to bed at 9 (I like to be between 5-7 at night when doing manual mode in pumps / MDI) - and woke up to 6.9. So that's not to bad.

And yes, the IOB being set at 2 hours with the closed looping system I've seen mentioned in many forums (I'm self taught on pumps through places like this) - and also CDE verified it in discussion last night. From what my nontechnical brain can fathom (and anyone who is more brill in that area - pop in and correct/explain) - the algorithm is set for the time. The CDE had given a case story of someone who was on 3 for their IOB - and when comparing the before and after - just with that change - it really made a difference (they were having lows overnight).

Also, learned that the correction factor that the algorithm uses when say you're calculating your carbs/AutoCorrect - it doesn't use the 5.5 setting but the 6.7 (I like to be tightly controlled - and maybe reason for little complications from 57 years of the D ??). So that does explain why I never quite get close to the lower numbers I like, and why my phantom carbs I'd take (when the AutoCorrect would give .1 unit ... I'd add a few more based on bolus calculator I use on my mobile that's set up with same settings as the pump).

Also, I had my bolus increment set at .1 units - the CDE at this virtual event - said it's best to keep it at .025 - since it allows better increments of insulin rather than the .1. I have had to set my I:C ratios to a point I never thought would be what they are - but I guess with age - I'm the opposite of what the CDE said last night - that as we age we need less insulin. Ha! Ha! I always seem to go against the norm - but all good - since someone reading this - maybe you - we don't all fit into that cookie cutter mold - so what works for one - may not work for the other. I never used to think so much about diabetes until starting on technology - and seeing it constantly telling you if you're up/down/all around - can be right mind boggling depending on how you view it all. The joys of being OCD and having discovered after a stint in a mental ward - I've got quite a few mental quirks from having been a diabetic for so long. Hopefully, pumps like this, and well informed / up to date CDE's, etc. will be able to help those who can get it. I live in a small town, full of a lot of retirees, and of course, sadly many are Type 2 diabetics.

Hoping this makes sense @Jess1D - and sorry for babbling on (having a late lunch break) - this is all new to me - having a pump do all the work - instead of me. I'll see how it goes with my first CDE appointment at my local hospital here in Cornwall (Ontario - not the UK) - and see if there's some more tweaks they can offer to me - as I tend to run high after the same breakfast every day - which I don't get when in Manual mode or MDI.

Cheerio for now. Lunch break ... is over!

 

[Prancy]

Do you have an update on your progress?

 

[faustus67]

A late reply to this, but I had the same issue when I started on the SmartGuard. What helped me (sounds like you've done this anyway) is changing the target to 5.5 and lowering the Active insulin time to 2.5 hours instead of 3. It helped me - I usually wake up between 5.5 and 6.5 now. As with everything diabetes related, your mileage not only may vary, it will vary.