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Issues with highs - 780g

S

sprockette

Newbie
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4
I have just started the 780g about 4 months ago and after a stressful rocky start, it is finally beginning to settle down. Mostly... to me, it seems very restrictive compared to the 670g which I had before. So far it seems like I could have perfect control as long as I keep to a strict routine, eat the same things every day and don't dare eat anything too high in carbs so else I go shooting up.

I feel like it's only me having these problems with highs (to be fair, I am a self-confessed control freak, I am on this pump because I've been too tightly controlled for years and had some serious hypos). I have let go the control though as I know I have to to let the settle down. But I go up to 14-16 most days and this is eating normal low GI food. If I go out for dinner, I will go up to 20 which to me is not acceptable. I know I'm not on it that long.

I am really really missing the temp basal for if you expect to go high. I have asked my contact at Medtronic if any changes are planned in that regard but she doesn't seem to want to answer. I am at my lowest weight ever because if I try to eat something extra, my blood is too high to eat it (I wouldn't eat something extra if my blood was up at 14).

So. Is everyone else perfectly controlled or has anyone had these issues and found a way round them? For me, it's more the issues about lack of flexibility. /rant
 
I have no experience of the 780g or Medtronic. But have seen similar issues in the past on my t:slim. Firstly for a temp basal, my pump also does not allow it with its "loop" capability enabled, others turn looping off or set up a different basal with higher levels that they switch to during the time they need a "temp basal". With regard to eating and high BG's, over last few years my BG's go much higher after eating so have cut back on high carbs like bread (flour based foods) and potato's, also have increased my basal too (plus correction factors) to almost 50% more than two years ago. Lastly I always find my BG's rise when weather gets colder then drop when it gets warmer.
 

Hey, really sorry to hear about your issues. Obviously I won't be able to "solve" anything in this post - but I would say that management of diabetes shouldn't mean that can't keep your bloods in a reasonable range (most of the time) and that you shouldn't be needing to restrict food to achieve that. Here's what I'd do to try and get things under control (I'd do these in order as a problem in the first affects the second and so on).

1) Make sure your basal is right - there are complicated ways to check but an easy approximate method is just not to eat anything after an early dinner and then over night check that you BG is stable and in range. If it appears consistantly higher in the morning then increase basal, if lower then decrease basal. You'll need to do this several times before you're confident as it's normal for each day to be a bit random.

2) Make sure your bolus is right - record your blood glucose before a meal. (if it's in range and stable then...) accurately calculate the carbs in the meal, inject and eat, record your blood glucose 3-4 hrs later. If it's much higher, you need more insulin; if its lower or you needed a snack to avoid a hypo then you need less. You'll need to do this a few times also until your confident that the number is roughly right.

3) Work out your pre-bolus time. Insulin takes sometime to get to work - usually around 15 to 30 mins but it varies for every person and with different types of insulin. If you don't pre-bolus the food gets a headstart and will cause your bloods to spike after a meal and then crash back down once the insulin catches up. The best way to get this right is to borrow a CGM like a Libre or Dexcom. If you don't have one then ask your diabetic team if you could borrow one. With that, try injecting 5 minutes before your meal and then slowly increase that time until you see that the post meal spike is much smaller.

If you take some time and get those 3 things sorted, then I'd say you'll be like 90% of the way there. If you want to ask anything more, feel free to message me. I hope things get better.

Doug
 
My pump is now automated, so no temp basals for me either. I miss those! I wouldn't mind going low carb too much, my diet is mostly high fat, but unfortunately I find it hard to gain weight without carbs. Currently weigh 42kg, my lowest ever. I'm eyeing up Christmas suspiciously which is mostly about food for me!! I might talk to my diabetic team about the correction factor. I've only started recently so not too well up on it.
 

I'm lower carb mostly because I need to also loose some weight, please be careful as it looks like you do indeed need to put on some extra kilo's. These auto pumps are amazing although not really auto, you still need to bolus and set right basal levels. I would suggest you set up another profile where you copy your existing basal and add x% then use this as your temp basal by switching to the other profile, this way the pump still does its auto functions too.
 

I have the 670g (ie the not as clever version), and when using the auto-mode (using the sensors) its works out the basal, I have absolutely no say in the matter, whilst there is a temp basal its a set thing and is for exercise so its set to let your sugars run higher so you're less likely to hypo.

Obviously mine is not the 780g so things may have changed slightly, but yeah unless I turn auto-mode off I have no say in the basal whatsoever, and I cannot change what its aiming for (it aims for an average BS of 6.7 - and its set at 8.3 for the temp basal)
 
Hmm, I have the 670, and the only thing you can change is carb ratio and AIT - active insulin time

Temp basal is available in manual mode, not AM

It’s not a good idea to constantly switch between the two, the pump has to learn what your needs are. It updates it’s algorithm


So you might need to adjust your carb ratios or AIT, possibly take pre bolus into consideration
 

Agree switching lots from auto to manual is maybe not good idea but many ladies have multiple "auto" basal profiles to cope with the monthly challenges they have.
 
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Apologies if I was not clear, they are not fully closed loop "auto", you still need to set up your basal and bolus needs before you let the pump do its auto adjustments and also enter carbs etc for bolusing.
 
Chas C said:
Agree switching lots from auto to manual is maybe not good idea but many ladies have multiple "auto" basal profiles to cope with the monthly challenges they have.
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No, I did ask about switching to manual for Christmas (I am NOT going to restrict what I eat over Christmas!), but I was told I would need to stay manual until my routine is normal again so it doesn't screw up the algorithm. Too much hassle). I'll ask my Medtronic contact about that, multiple autos would be great.
 

Hiya, did you ever get anywhere with this? We are having very similar issues and cannot work out what to do next. Blood sugars will not go down and despite Medtronic 780g and smart guard apparently having the ability to address highs it just doesn’t seem to want to issue more insulin (which to us seems required) and seems happy for sugars to float around the 13 area all day every day.
 
Hi, I’m the same I only got the 780g in Aug this year and I’m having a total nightmare with it, exactly the same problems. Spoke to DNurse today and they couldn’t help. I had really good control before with the old pump.
I feel like I have no control at all now, ridiculous highs for hours on end, the pump only gives a really small amount of insulin for a correction, I’ve even started pretending I’ve had carbs so I can bolus to bring bloods down quicker. It’s driving me mad, I’ve been thinking I’m doing something wrong
 
Hi. Same story here.I had excellent control on 670g pump. The 780g is killing me. Smartguard auto corrects meal boluses (it HALVES my breakfast bolus). Then it starts “adjusting” by adding micro correction boluses only after I go high. It then just keeps me high for hours waiting for the bg to start to come down.
It won’t let me give correction boluses and the only way to correct is to lie and tell it I’ve had extra carbs. Then when the correction kicks in, bg crashes into hypo because the ****** pump has been stacking micro boluses for 3 hrs.
I have tried changing every setting: ISF, carb ratios, target bg, insulin duration—none of it works and, as I know my true values were correct before I started, idk *** is wrong with their algorithm. It’s like it’s designed on data from type 2 diabetics and totally useless for type1 with high insulin sensitivity and low insulin/carb ratios.
I’m going back to my old pump soon as this thing is literally making me too sick to think.

mod edit to remove expletive
 
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I assume you have first transferred your basil and bolus settings from your previous pump had already been setup to match your body's insulin request and control. So, you are already starting with a known control point for your A1c and should not see the ramping up of your BS's.
The difference is the infusion set has changed with the new pump and you may have to modify the installation of the MiniMed.
When you remove the needle protective cap, never pull it but rotate only until it disconnect's or the needle will pull back into the sleeving before insertion.
This will result in the soft plastic tubing rolling on the edge due to the pressure of the skin as the needle is tapered and this will affect the delivery of insulin to your body.
Hope this helps, as I also had a similar problem when changing over to the new infusion set.
 
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My wife is on the 780 and it’s poor with highs or periods or illness for that matter. It’s old tech - the closed loop algorithm was ‘bought in’ from 3rd party developer about 7 years ago. General my wife finds it’s slow to respond especially to trends/highs/periods/illness with a lag of 24-48hours often means she can run very low after a day of being high. It seems a very basic closed loop system - having read a lot on closed loop systems ( Tim Street etc.) unlsss you put in on very aggressive settings it’s really not great. Would be interested to hear from anyone who has used the 780 and the Tslim - at least this has an aggressive mode the 780 is either smart guard or back to standard basal rates. It could do with having at least a more aggressive setting.
 
When you are treating lows, I use 6 oz. of milk as it will not cause a spike in your BS then wait 10 minutes to see if you have gotten above 70, then repeat if still low. The CGM allows the convenience to monitor how fast your BS rises, plus limit overtreating the low BS symptom. That is the advantage of CGM, letting you know in real time when you are reached a safe level. The system 780 has to adapt to your body's requirement for insulin, so you have to feel comfortable and not overcompensate, as the CGM is your fulltime backup warning. I know, it is scary when you see the lows, but you should learn to start having more confidence in the closed loop system. This applies to when you are home, but always have sugar pills while outside and take several if you hear the low warnings and repeat if your meter continues warn after 10-15 minutes. We are all different and the absorb rate of insulin differ based on exercise, stress and other factors in our lives, so we have to constantly evolve to control our diabetes.
 

Unfortunately my wife has Hashimoto’s thyroiditis as well so milk is definitely off the cards as an answer for lows - she’s had Diabetes for 40 years so well versed in controlling lows and highs generally. She is really unimpressed at how slow the 780g is in responding to trends. It really can’t handle highs from things like periods and illness - others have said the same in the user group she’s in from the hospital. It’s not designed for women was one persons quote.
 
The one thing that comes to mind it the auto basil delivery, if you make only a small change to this setting then see if increasing the average dosage per day to see if it helps with the highs. Normally it would be in the 20u default range per day, so if you make a change to increase the amount on insulin it will still only inject what your body needs to maintain the BS. It would seem your wife needs more insulin than what you have programmed to maintain BS control. Since the CGM is monitoring your BG, it will shut down the Basil delivery if the levels are dropping, so it goes into a self-protection mode.
Also being a type 1 for 55+ years, you learn to listen to your body to make decisions based on your feedback from your BG and A1c levels.
 
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Hi my son's on day 2 automode in 780G and I'm having the same issues, it seems to want to float around 13 even at night when he's sleeping and doing nothing. I will see in the next couple of days how it will pan out before I'd call DE to tweak the basal. I have satisfactory experience with 670G closed loop and I have high expectations in this one.
 
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