Does the 780G+G4 work well when eating low carb?

[Rianne]

Hi all,
I have been testing the 780G + Guardian4 sensor for about 6 weeks now but have not yet felt very much improvement in comparison with my former system (Ypsopump + FSL2). I recently learned from Medtronic that using a low total daily dose might cause the algorithm to have less possibilities in correcting/adjusting optimally. What I see in my graphs is that the algorithm stops basal for 30 or 45 minutes after bolusing for a meal. My bloodsugar rises than, and the system restarts basal and later on gives lots of autocorrection microboluses. It causes spikes after meals which seem not correctable within 2 hours or more. I tried different carb ratio's but keep seeing the same behaviour of the algorithm. I do bolus about 20 minutes before meals. Bolusing more time in advance gives hypo's so that is no solution. My total daily dose is about 27 units of novorapid and my total daily carb intake is about 110 grams. Does anyone recognize this problem and have you any tips or solutions? Anyone eating low carb and have success with the 780G+G4? I only have 1 week left for testing and have to decide than whether to choose the 780G or not.
Thanks for any help!
Rianne

 

[Nicola M]

I'm by no means low carb so can't help on that front. I think you may find this group (https://www.facebook.com/groups/119376721997721) on Facebook helpful. It's for people with 780/G4 and everyone has varying carb intakes. Perhaps someone with a similar carb intake as yours can weigh in over there!

 

[Rianne]

I'm by no means low carb so can't help on that front. I think you may find this group (https://www.facebook.com/groups/119376721997721) on Facebook helpful. It's for people with 780/G4 and everyone has varying carb intakes. Perhaps someone with a similar carb intake as yours can weigh in over there!

Thank you, Nicola, I have already posted my question in a Dutch 780G FB group but will nonetheless try there too.

 

[chchcharlotte]

Hi Dianne, I'm sorry to say I dont have any answers for you but this is really interesting to me as I have an option to start on the 780g in a couple of weeks - currently trying to decide between that and the tslim. My TDD is around 17 units and my carbs are under 100g every day so if this is a 780g specific issue it would definitely affect me. I'd heard that the bedding in can take some time but one would hope after 6 weeks you would be getting somewhere. I hope you find some answers soon!

 

[chchcharlotte]

Hi Dianne, I'm sorry to say I dont have any answers for you but this is really interesting to me as I have an option to start on the 780g in a couple of weeks - currently trying to decide between that and the tslim. My TDD is around 17 units and my carbs are under 100g every day so if this is a 780g specific issue it would definitely affect me. I'd heard that the bedding in can take some time but one would hope after 6 weeks you would be getting somewhere. I hope you find some answers soon!

Rianne! Sorry auto correct got me there!

 

[Rianne]

Hi Dianne, I'm sorry to say I dont have any answers for you but this is really interesting to me as I have an option to start on the 780g in a couple of weeks - currently trying to decide between that and the tslim. My TDD is around 17 units and my carbs are under 100g every day so if this is a 780g specific issue it would definitely affect me. I'd heard that the bedding in can take some time but one would hope after 6 weeks you would be getting somewhere. I hope you find some answers soon!

Thanks for your reply, chchcharlotte. Indeed the bedding in can take some time, and seems to differ per person. That makes it even harder because trial time is relatively short. I will let you know here if I find more information from others. Good luck with your choice!

 

[Antje77]

Thank you, Nicola, I have already posted my question in a Dutch 780G FB group but will nonetheless try there too.

I'm not in that group, but you can try tagging Marjan Doornenbal over there if she hasn't reacted yet. She's not low carb but she has used that pump for ages and is very knowledgable about it. Just tell her Antje said to tag her.

 

[Rianne]

I'm not in that group, but you can try tagging Marjan Doornenbal over there if she hasn't reacted yet. She's not low carb but she has used that pump for ages and is very knowledgable about it. Just tell her Antje said to tag her.

Hi Antje77, thanks for your reply. Marjan indeed already responded to my post but she is not low carb. But she is always very helpful, like you are here! Thanks!

 

[Rianne]

I did find some earlier posts on FB in the meantime from low carbers or ketogenic eaters. For some the algorithm works well, comparable to others who eat a normal diet. Some mention that the algorithm is built to help T1D's to live a normal life with a normal diet, which means it is not really fit for low carb. Several people experienced problems. Some of them even increase their carb intake to have the algorithm give better results in their bloodsugarlevels. Others increase there carb input in the bolus wizard with 10% to deal with the proteins, others increase the number of carbs in the bolus wizard with 50% of the protein count of the meal, others bolus for the carbs before the meal and bolus for the proteins f.e. 2 hours later. I personally find it a lot of extra work, which is disappointing. For this portion of pump therapy the dual bolus in a 'dum' pump is even more practical. I have 1 week to go and am going to test what happens when increasing and/or splitting the boluses to deal with the proteins. I will let you know later how it worked out!

 

[Gordontoo]

I have the 780 and G4 . I typically consume between 100 and 130gms carb per day, mainly in one main meal. I too have had a similar problem and my solution, if you can call it that, is to check the pump about an hour after eating and "add" some ghost carbs to deal with the increase in sugar levels. Cheating I guess, but at least for me, it solved that little issue..
Good luck with your decision and journey.
Regards Gordontoo.
P.S. I believe that the 780 upgrade is actually light years ahead of the 770, but the Guardian 4 is a real pain to work with.

 

[Chas C]

I'm low carb but with the t:slim. I think the issue is likely not your pump or its algorithm but perhaps the way your using it. I've been pumping for over 10 yrs, if my BG's are normal (not low) I always use the pre-bolus and extended for meals. I pre-bolus maybe 10-15 mins before meals a given % then the rest over anything from 45 mins to few hours depending upon food type. However now I'm on low(er) carb I don't need long extensions as I don't eat flour, root veg or pasta/pastry so 30-60mins is normal.

All the above assumes your settled with the pump and have the right basal and bolus settings, as your trialing the pump for 6 weeks it may be a good few weeks tweeking until you get these settled (in my experience it does change between pump types). I've in the past trialled an Omnipod and that was for 3 months, which for me was about the right timescale.

 

[Rianne]

I have the 780 and G4 . I typically consume between 100 and 130gms carb per day, mainly in one main meal. I too have had a similar problem and my solution, if you can call it that, is to check the pump about an hour after eating and "add" some ghost carbs to deal with the increase in sugar levels. Cheating I guess, but at least for me, it solved that little issue..
Good luck with your decision and journey.
Regards Gordontoo.
P.S. I believe that the 780 upgrade is actually light years ahead of the 770, but the Guardian 4 is a real pain to work with.

Thanks for sharing your method, Gordontoo! Indeed questionable if we should call it a solution ;-) but happy to read that it works well for you. My diabetes nurse and Medtronic trainers stipulate NOT to enter ghost carbs so I did not do that so far. But I will take your method in consideration anyhow. In my view it is similar to increasing number of carbs with a part of the grams of proteins.
In an older post on FB someone wrote that she had adjusted parameters like insulin sensitivity and max basal. I am told that the only parameters in SmartGuard are carb/insulin ratio and active insulin time. This was what others replied on her post as well. She however said that after adjusting the other parameters her results were much better. Since I think the knowledge of the professionals is not that impressive I am wondering what information you have received on parameters in SmartGuard? I have already (that is a few hours ago after reading the post) adjusted my max basal in hope for easier improvement than entering ghost carbs or protein carbs...

 

[Rianne]

I'm low carb but with the t:slim. I think the issue is likely not your pump or its algorithm but perhaps the way your using it. I've been pumping for over 10 yrs, if my BG's are normal (not low) I always use the pre-bolus and extended for meals. I pre-bolus maybe 10-15 mins before meals a given % then the rest over anything from 45 mins to few hours depending upon food type. However now I'm on low(er) carb I don't need long extensions as I don't eat flour, root veg or pasta/pastry so 30-60mins is normal.

All the above assumes your settled with the pump and have the right basal and bolus settings, as your trialing the pump for 6 weeks it may be a good few weeks tweeking until you get these settled (in my experience it does change between pump types). I've in the past trialled an Omnipod and that was for 3 months, which for me was about the right timescale.

Hi Chas C, thanks for sharing your thoughts and the way you handle bolusing. I am also a 'pump-veteran' (about 23 years now) and before I had a cgm I worked like you describe. With the cgm I still bolus about 15 mins in advance but extended bolus (dual bolus) is not possible in the 780g algorithm. I can only split up boluses as you describe: f.e. a pre-bolus and a bolus an hour later. As mentioned earlier, I find that a disappointing feature of a cgm-monitored algorithm.

 

[Dexta]

I am told that the only parameters in SmartGuard are carb/insulin ratio and active insulin time.

You may also want to consider your SmartGuard Target of 5.5/6.1 or 6.7mmol/L.

I believe most users choose 6.1 including myself, but it’s good to have a choice.

 

[Rianne]

You may also want to consider your SmartGuard Target of 5.5/6.1 or 6.7mmol/L.

I believe most users choose 6.1 including myself, but it’s good to have a choice.

Thanks Dexta, I started off with 6.1 indeed but because of the problem mentioned I already after 1 week lowered it to 5.5. I do not really see it striving for 5.5 though.

 

[Chas C]

Hi Chas C, thanks for sharing your thoughts and the way you handle bolusing. I am also a 'pump-veteran' (about 23 years now) and before I had a cgm I worked like you describe. With the cgm I still bolus about 15 mins in advance but extended bolus (dual bolus) is not possible in the 780g algorithm. I can only split up boluses as you describe: f.e. a pre-bolus and a bolus an hour later. As mentioned earlier, I find that a disappointing feature of a cgm-monitored algorithm.

Apologies didn't realise you were a veteran too . I did not know the 780g does not support extended bolus, like the t:slim does. I don't split bolus's, I use extended with the pre-built in pre-bolus. It does now sound like a pump related operational issue

 

[Kirtomy]

Hi all,
I have been testing the 780G + Guardian4 sensor for about 6 weeks now but have not yet felt very much improvement in comparison with my former system (Ypsopump + FSL2). I recently learned from Medtronic that using a low total daily dose might cause the algorithm to have less possibilities in correcting/adjusting optimally. What I see in my graphs is that the algorithm stops basal for 30 or 45 minutes after bolusing for a meal. My bloodsugar rises than, and the system restarts basal and later on gives lots of autocorrection microboluses. It causes spikes after meals which seem not correctable within 2 hours or more. I tried different carb ratio's but keep seeing the same behaviour of the algorithm. I do bolus about 20 minutes before meals. Bolusing more time in advance gives hypo's so that is no solution. My total daily dose is about 27 units of novorapid and my total daily carb intake is about 110 grams. Does anyone recognize this problem and have you any tips or solutions? Anyone eating low carb and have success with the 780G+G4? I only have 1 week left for testing and have to decide than whether to choose the 780G or not.
Thanks for any help!
Rianne

Hi Rianne,
I started on the 780G and Guardian 4, a month ago. Before that I was on the 670 with libre freestyle.

I follow a low carb keto diet and my carb intake is quite a bit lower than yours, but I am having similar problems to you.

I found the first week on smartguard excellent, but since then I am struggling with it a bit. The last 2 weeks my average TDD is 24.9 units and my mean daily sensor glucose value is 8.8 +/-2. Time in range is 75% which is less than i had on manual, but I've had no hypos.
So it's great in many ways.

The benefits first though, its great having cgm rather than having to swipe and I don't have frustration and time wasting of wondering where I put my libre "swiper"
I like that I don't need to pay it much attention, I just let it work away in the background. Night time has been largely uninterrupted sleep.

However, I find it frustrating that it keeps reducing the bolus ( by about 40% or more) even if my blood glucose is up. This is clearly to keep me safe from hypos but the dose is not sufficient so I then go up to 10, 11 12 or even 14mmol/l one day. Then, when I'm up there the corrective the smart guard allows are tiny and ineffective. The consequence is that the pump keeps having to make autocorrections, which are small, and it takes many hours to bring it back down. I tend to level off at 10mmol/l a lot.
I feel that it is over cautious.
I thing just following what it suggests is not enough and if I stay in smartguard i will need to "manage" it by telling bit I'm having more carbs either at mealtimes and /or adding a false snack an hour or two after eating I'm not sure yet.

I have started to tell it that I'm eating morevthan I am.

My basal needs range widely during the day and in the morning I need quite a high dose. The pump does not manage that as well as I did.

I am still working with Medtronic, but I suspect I will either go back to manual mode, or just use smartguard at night (I'm not sure if I can do that), or tell it I'm eating more than I am!

I like to understand the calculations and where the numbers come from, but at the moment it is a black box.

It's interesting to hear you are having similar problems, thanks for posting

Good luck with your decision.

Jane

 

[Kirtomy]

I will just add that it keeps me generally level, but too high, around 9mmol/l.

 

[Rianne]

Hi Rianne,
I started on the 780G and Guardian 4, a month ago. Before that I was on the 670 with libre freestyle.

I follow a low carb keto diet and my carb intake is quite a bit lower than yours, but I am having similar problems to you.

I found the first week on smartguard excellent, but since then I am struggling with it a bit. The last 2 weeks my average TDD is 24.9 units and my mean daily sensor glucose value is 8.8 +/-2. Time in range is 75% which is less than i had on manual, but I've had no hypos.
So it's great in many ways.

The benefits first though, its great having cgm rather than having to swipe and I don't have frustration and time wasting of wondering where I put my libre "swiper"
I like that I don't need to pay it much attention, I just let it work away in the background. Night time has been largely uninterrupted sleep.

However, I find it frustrating that it keeps reducing the bolus ( by about 40% or more) even if my blood glucose is up. This is clearly to keep me safe from hypos but the dose is not sufficient so I then go up to 10, 11 12 or even 14mmol/l one day. Then, when I'm up there the corrective the smart guard allows are tiny and ineffective. The consequence is that the pump keeps having to make autocorrections, which are small, and it takes many hours to bring it back down. I tend to level off at 10mmol/l a lot.
I feel that it is over cautious.
I thing just following what it suggests is not enough and if I stay in smartguard i will need to "manage" it by telling bit I'm having more carbs either at mealtimes and /or adding a false snack an hour or two after eating I'm not sure yet.

I have started to tell it that I'm eating morevthan I am.

My basal needs range widely during the day and in the morning I need quite a high dose. The pump does not manage that as well as I did.

I am still working with Medtronic, but I suspect I will either go back to manual mode, or just use smartguard at night (I'm not sure if I can do that), or tell it I'm eating more than I am!

I like to understand the calculations and where the numbers come from, but at the moment it is a black box.

It's interesting to hear you are having similar problems, thanks for posting

Good luck with your decision.

Jane

Hi Jane,
Really similar to my situation, what you describe. Indeed very frustrating. Geting recognition from you and others makes it a bit more bearable, thank you for sharing. I also would like to know more about the calculations. Especially because the diabetes nurses do not really have solutions for situations like this. I find it a quite a shortcoming from Medtronic to keep us stuck in experiencing the pump as a black box, especially since the last few years eating low carb becomes a lifestyle for more and more people. It was one of my first questions and the answer was that the algorithm would take care of it. The information that with a low daily dose the algorithm hasn'nt enough 'room' to correct sufficiently made me raise my carb/insulin ratio. The thought is that when the portion bolus of the daily dose gets lower, the portion basal and autocorrection may get more room. So Medtronic said: increase the carb/insulin ratio so you get less bolus per meal. But the diabetes nurse says: you have too high after meal peaks so decrease your carb/insulin ratio. I am slowly increasing, because the low ratios did not help me. But time is running out. And. just like you, in general levels stay too high during the day, far off the target of 5.5. I also do not know if it is possible to only use SG during the night. I guess it will work OK, because the algorithm than only has to work with de bg. There is most of the time no food or exercise involved than. I have in the last few days lowered insulin sensitivity, increase max basal and max bolus. As said earlier/above, I do not know if these have influence, but my bg's seem a bit better since 1,5 day. Do not know either how soon changes in settings take real good effect. And do not know if it increases hypo's. Thanks again for your story. I hope things will improve for you. I will post any further improvements if I do experience them!

 

[Rianne]

Interestingly: I just found this text on the website of Medtronic:

WARNING: Do not use the SmartGuard™ feature for people who require less than 8 units or more than 250 units of total daily insulin per day. A total daily dose of at least 8 units, but no more than 250 units, is required to operate in the SmartGuard™ feature.

I wonder if the algorithm has sort of an optimum result when total daily insulin dose is 'in the middle' (f.e. between 75 and 150 or so) and decreases when distancing from this 'middle'.....???