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MEDTRONIC 670g

Discussion in 'Insulin Pump Forum' started by masonbason63, Oct 6, 2019.

  1. masonbason63

    masonbason63 Type 1 · Well-Known Member

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    I was going to upgrade to another pump originally but with a lot of discussions etc and pros and cons, I’m starting on the above mentioned pump with CGM etc tomorrow.

    Although I have reasonably good control HbA1c between 5.5 & mid 6. I seem to have gained these figures by hypos etc well a few too many for my liking and I’m not getting hypo awareness.

    I’ve not had any other pumps apart from the early days of pumping than AccuChek and they’ve been very reliable etc.

    I’m very apprehensive about the whole thing I’ve been checked that I can see all the figures, controls etc (can’t see much) I’ve used the Insight the last 8 years and I’m very lucky (and very grateful) that I’ve been fully funded through my pumping years 23 of them.
    But couldn’t get funding for the LIBRE so self funded till I couldn’t do this anymore.

    I’m hoping that all what it says on the website and reviews lives up to expectations.

    I know I’ll have to run an even tighter ship than normal but the only downside I’ve noticed from what I’ve been told and read NO Pre filled cartridges. Ive watched videos etc on the sets , insertion and priming, just hope I’ve made the right decision.

    I’d like any useful comments about this pump if people can give me some tips Thanks
     
  2. aphex2k

    aphex2k Type 1 · Well-Known Member

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    New convert here so happy to answer any questions, either within this thread, or the one linked above.

    It's not an easy transition, I'll tell you that. I'd "learnt" the 640g quite well and got down to a a1c of 7.7. I seem to having good and bad days with the 670g but you have to rethink a few things, just gotta be patient. You'll hear this a lot.

    Whethere you'll be able to keep your a1c sub 6 i'm not entirely sure. You have to focus on time in range more than being reliant on a1c as an indicator of good self management. I've had days when I've been 75% + time in range, but I've also had days when I've not been so good. I'm not even sure if it's really worth the extra effort even aiming for sub 6?

    The new method appears to not favour snacking / grazing, which is how I have always managed my meals and bolus's. I've had a few "ping pong" days when I've gone high, over corrected, dropped down, then over corrected again and gone high.

    Going 640-670 you lose temp basal rates for low/med/high activity. Same for "sick" basal level too. You don't get a few other options like suspend before low/high.

    The new sensors are hit and miss. I've had three that have lasted 5 days. The last one lasted the full 7 + 2 more days extended. They seem to last if you're not bombing them with re calibrations all the time. I've found for me the best calibration regime is 20 mins after I've got up - before I eat. Then again before lunch. Again before dinner, and once again before bed. 4x calibrations per day. Plus the extra "input BG" messages you get through the day. Don't calibrate if you're more than 30% above or below "range". Don't calibrate with either the up or down arrows!

    Um.. what else.... Er.....

    I have found that trying to recover from a high BG is harder (slower) with auto mode. I can generally do things faster with a bolus and manual mode / sick 130%. Is this the right way to do it? I'm not sure. I just like being closer to my good range and getting there as quickly and as safely as I can.

    Nights are extremely pleasant. My BG usually stays the same until I wake - I don't get DP or liver dumps etc - not requiring insulin anyway.

    So far I'm favouring auto through the week, and manual mode at weekends. But as everything diabetes related, your experience will be different.

    Breathe, relax, ask questions here. You'll be fine.
     
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  3. Gary61

    Gary61 Type 1 · Well-Known Member

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  4. aphex2k

    aphex2k Type 1 · Well-Known Member

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    Good stuff mate. I was thinking of doing the same but I'm not consistent enough to maintain a blog. I guess I'm almost doing one here, in a way.

    Woke up at 8.4 with BG at 8.9 so pretty close. Stable overnight. Today will be a good day.
     
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  5. tim2000s

    tim2000s Type 1 · Expert
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    One thing I'll mention is that it's designed to maintain a glucose level that results in an Hba1C of 6.5%, so as long as you're happy with that, long term it is supposed to reduce the amount you have to do day to day.
     
  6. aphex2k

    aphex2k Type 1 · Well-Known Member

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    For those aiming for super tight control and low hba1c, would love to know why this is the target for you and does your specialist agree with this target or were you told "this is what you need to aim for"? If my next bloods come back and I'm lower than my current 7.7 I'll be happy, but I doubt I'll physically feel any different? I appreciate the current NICE guidelines were updated to suggest T1 should ideally be sub 6.5% to reduce risk of long term cardiovascular risk.

    I wonder if the new "time in range" focus is more a marketing / selling point of using the 670g and CGM or if other pump/cgm offerings also favour TIR as a better measurement than hba1c? I note NICE guidelines also focusing on CGM state TIR of 70% or better now too.

    Blood glucose targets
    1.6.13Advise adults with type 1 diabetes to aim for:

    • a fasting plasma glucose level of 5–7 mmol/litre on waking and

    • a plasma glucose level of 4–7 mmol/litre before meals at other times of the day.
     
  7. tim2000s

    tim2000s Type 1 · Expert
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    The time in range targets do equate to Hba1C levels to some extent, but they also relate to less variation in BG, which is starting to get more focus, as there is some evidence that significant fluctuation leads to greater oxidative stress at the cellular level, which in turn leads to damage.

    I'd argue that having an Hba1C of 6.5% would make you feel substantially different to 7.7%. 7.7% is an average glucose level of around 9.7mmol/l, which is very definitely high. 6.5 is equivalent to 7.7, which is high normal.
     
  8. aphex2k

    aphex2k Type 1 · Well-Known Member

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    Hmm interesting...

    So what does a TIR of 70% equate to in hba1c %

    I can only compare my previous higher a1c's to my current one, and for all intents and purposes I don't feel any different, per se. I think for a non-diabetic a1c can be anything from 4- 6 but is that realistic target a T1 should also aim for?

    I'm also finding that even though my target is 6.7mmol/L on the pump, it seems to keep me around 7.5-8.5 so I'm not entirely sure just how much the micro bolus gives me if it's hovering above the pumps target? (Very noticeable when viewing night time results when there's not bolus given for food and no significant spikes/troughs. Micro bolus seems to be a mysterious figure of "some but not a lot" insulin - I've been told it varies but from how little to how much an individual MB event is.... I haven't got a scooby!

    I guess my bloods will show whether I have improved, and if the new pump is benefiting me or not.

    The more of this journey I go on, the more I'm thinking super low carb is the way to go. I'm not saying keto / paleo or anything like that, but the days I'm conscious about meals, are the good days when it comes to my levels. EG Saturday morning used to be my fry-up day - including toast and hash browns. Now I'm more than happy with a spinach omelette with some bacon or a sausage or two. Filled up until lunch. No BG spikes or crashes. Just content but not stuffed.
     
  9. Gary61

    Gary61 Type 1 · Well-Known Member

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    I agree that if a person is looking for the best results that can be achieved, then a super low carb will probably do that. Bit I feel that a Type 1 diabetic needs to feel as normal as possible if only to help mentally which is s big factor for many of us. I absolutely love eating all sorts of various foods and on occasion have had to bolus huge amounts of insulin to compensate. And although you say low carb is for the long term well being, I'm still alive and kicking after 40years so I do believe that if you are sensible and look after yourself, it is possible to lead a reasonably normal life doing normal things.
    I will however be very interested on what my Hba1 will be after 6 months of use with my new pump.
     
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  10. Gary61

    Gary61 Type 1 · Well-Known Member

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  11. Gary61

    Gary61 Type 1 · Well-Known Member

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    No problem, that was an interesting and valid comment to make.
     
  12. aphex2k

    aphex2k Type 1 · Well-Known Member

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    Just reading the blog post about curry Gary. 200g + of carbs? That doesn't sound right. I just checked how much insulin that would give me. 25u!!!! Curry should be relatively low carb. Basmatic rice low GI. How many grammes of carbs are you estimating the naan bread had in?

    Although I wouldn't say I particularly focus on low car meals, I just seem to naturally eat that way. Even the medtronic clinician commented on my low carb diet. I just eat healthily. I make home made curries and prefer paratha or roti over naan bread. I LOVE naan bread with garlic or keema but I know what it does to me "great, 4 hours later I'm rising again!
     
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  13. Peter03

    Peter03 Type 1 · Well-Known Member

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    Nan bread 70 grams at least, I have to bolus 25 units over 6 hours for a good curry
     
  14. LooperCat

    LooperCat Type 1 · Expert

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    I aim for non diabetic levels, my specialist is totally on board with this and is of the opinion that years of BG higher than normal is what results in complications. I run a DIY artificial pancreas system where I can set my parameters to whatever I choose - the 670 keeps things too high for my own personal targets. If my BG reaches 6.7 I’d be thinking about correcting down, although my Loop system mostly does that for me. My target range is 4-7mmol and I achieve that >85% of the time, and almost never go into double figures. In my opinion, that’s the nearest I can get to a guarantee of optimum diabetic health, and this approach has reversed the complications I had developed. It can be hard work but for me, it’s totally worth the sacrifices I make.
     
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  15. Gary61

    Gary61 Type 1 · Well-Known Member

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    Yes, I am not uncomfortable with 25u of insulin. I don't do it too often but think it's worth it for a good curry.
     
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  16. Gary61

    Gary61 Type 1 · Well-Known Member

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    Live life to the full Peter lol
     
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  17. aphex2k

    aphex2k Type 1 · Well-Known Member

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    I'm all for a good curry, I just wouldn't expect to use that much insulin. Are you including micro basal amounts plus the bolus for food? I'd probably subsitute rice for a veg dish and perhaps share a naan with the missus. Lots of my meals are sub 30g carbs but I do fall off the wagon sometimes and scoff a whole (thin and crispy) pizza. EAFaNL (eating adjusted for a normal life).....

    It's funny, as I was talking to my Medtronic rep about missing the option to use multiwave. She said to basically do a large bolus, and then consider another bolus in a couple of hours depending on level. I found this odd as the information is generally not to "phantom bolus" as it messes the algorithm up, yet this is exactly what she suggested to do for big meals when I would have used a multiwave to give an instant hit with more later when the food is digested.

    Having a rough couple of days with levels creeping up and slow to recover. This morning I went from 8 to 12 from leaving home to getting to work (didn't eat, had a black coffee, walked to work!). Dipped a bit but then picked up and I'm struggling to get below 12 still. It's a fairly new vial of insulin but I'm going to swap out Wonder if I have an underlying infection or cold on the way. Plus it's 35c here which is a little toasty (you might have seen the bush fires we're having over here on the news?)
     
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  18. Gary61

    Gary61 Type 1 · Well-Known Member

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    The vast majority of meals that I eat are in excess of 70g carb. And yes I micro carb quite often. The pump is good but can't cope sometimes with the amount of carbs I eat. I just did a 3 month review on my pump figures and it gave me a Hba1 of 6.2% which I was very pleased with. I honestly think from what you're saying is that you sound very much like you are coming down with something. It is very frustrating at times when you're sugars show no signs of coming down and I've been in that boat as well. When I'm ill, I can easily pump 3 times my normal dose and it really is an uphill battle sometimes. The way my body works, never ceases to amaze me and even now I can't always rely on getting it right with the same carbs but on a different day. That's why I micro carb so much. I get told off for doing it so much but it works for me and that's what it's all about at the end of the day. I think u'll find my next blog article very interesting as I've just made a dramatic change to my diet. Going to take my dog for a walk first and will then write about it when I come back. Hang in there pal
     
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    #18 Gary61, Nov 13, 2019 at 8:12 AM
    Last edited: Nov 13, 2019
  19. aphex2k

    aphex2k Type 1 · Well-Known Member

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    True story... It's not that it goes high, it's the recovery process that takes too long for me. I don't want to be creeping up for an hour or two, then spending 3,4 5 hours trying to get back to a normal range.
     
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  20. Gary61

    Gary61 Type 1 · Well-Known Member

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    That often happens to me as well so I know what you mean. I think what I've changed lately will go a long way to helping me with this problem. I'll explain in my blog
     
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