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Issues with highs - 780g

@Oblomov my thoughts exactly. We have an algorithm that doesn’t work for a select few. I’ve looked at coming out of Smartguard as well but after you have had it for so long, the thought of testing bsl before each meal which for me is sporadic, made me go back into Smartguard each time. They’ve planted the seed, and they’ve done it well. For the record my 2 day old sensor failed on Xmas night in which I was away from home for without spare sensors or meter so I just had to “go by feel”. Survived and had a great time with family, probably the least diabetic stress I’ve had for a long time not having to worry about alarms.
 
That’s impressive. It’s so disappointing to read that 780g in Smartguard is not serving some very well. While not problem free, I’m so grateful. The last 7 days I’m 76% TIR with an average BG of 112. For me, that’s awesome. I also have periods of 100% TIR, but I don’t focus on that. Without Smartguard I’m really struggling.
 
Well what an awful meeting with pump specialist nurse that was. She says my expectations of the algorithm are too high and suggests I come out of safeguard into manual. Because I don't want to run at average blood sugar of 10. She says it's in range so is good enough. She says there's nothing more the hospital can do for me. I can't believe I'm being treated this way.
 
I'm so sorry you've had this happen to you. Personally, I wouldn't be happy running at 10 all day either. The 780 has 3 target levels, and none of them could be achieved by running at 10 all day long.

I'd suggest you ask for an appointment with the Consultant asap, or consider changing hospital clinics, or contact PALS.

Have you had any discussions with the medtronic rep at all, if so, could you contact them?

Sending hugs.
 
Upthread you mentioned dawn phenomenon. I used to have that too. I bolused in the morning for my coffee, even if it barely had any carbs. Usually, 7 carbs.

Also, I think there is a setting that limits the max number of units of insulin you can get within a certain amount of time. I can’t remember where it is, but I think it applies in Manual mode and Smart Guard.

If you aren’t pleased with Smart Guard, is there some reason you don’t want to try Manual Mode? It might provide you with information of what your insulin needs are to keep you in the range you want. I believe Medtronic says the 780 is not for anyone who uses more than 100 units per day.

I have run high with 780, but recently have run quite low, with some 50-60 for no apparent reason.

Good luck sorting this out.
 
Back again. Hope that's ok. Any advice anyone?

Still no better. My pump team keep telling me it's 'good enough'. It doesn't feel that good! Sometimes it's great, other times not so much. but I'm sure it could be better. But no one seems to have any interest in making it any better. Telling me it's good enough.

Yes I'm in range a lot.

But sometimes it's running me at 10 or 11 for hours, days, overnight or for 24 hours. so yes, I'm still in range but it's not that great.

Other times my blood sugar shoots up so quickly from 10 to 11 to 14 to 17 to 21 to 28 and then I'm physically sick, yellow bile. I change my pump obviously. But this happens a lot to me.

How can that be alright?

Yes, I'm in range quite a bit, a lot actually, but my quality of life isn't that great, sometimes . Yet the team insist it is.

I can't grasp how a Hospital team could think that this is ok? and that this is the best that you can get. Don't they even want to try to make things a little bit better? They don't seem to want to even try. This is what I can't get my head around.
 
I am on tslim so I don't know 100% if this will help, but when I started on the tslim I had very similar issues with prolonged highs. The 2 things that made the biggest impact was to change the hourly basal max, my highest basal setting ( need ) when in range is 1.5u but my pump is set at a 5u max now, that really helps the increase in basal needs when high. The second was to adjust my daily total insulin max, the algorithm will have to look at this and make sure you won't reach this limit at the end of your 24hr period so this will also limit the insulin it will give you. I know the 2 pumps work on different algorithms but if you can adjust these settings then I'm sure it will help you. There is nothing worse than watching the pump let you sit out of range for hours on end. I appreciate they are set to keep us safe short term but we have to think a little about the long term effect.
 
Coming out of Smart Guard sounds strange indeed. How long have you given the pump to learn your body needs? Initially, I was all over the place too. It took me probably a couple of months for the pump to learn me. After that it worked well. Not perfect, but very well. There are a few occasional times I might run high for no apparent reason. It could be emotions……infection…..something I can’t detect. So, I change out my infusion set. Maybe poor absorption. After years of injections and infusions….I may not be absorbing. Also, sometimes I might not bolus enough. The majority of a spike for me is due to an insufficient bolus.

But overall…..I’m happy with Smart Guard and 780. I will switch soon to either Simplera OR Instinct cgm. There is no reason your struggles can’t be resolved. I hope you can find the right answers to get you there.
 
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