Medtronic 780g in manual mode vs smartguard

Hello all, I am in a bit of state and would really appreciate some insight or experience from other people who are using the 780g.

Is there anybody on the 780g who have decided to use it only in manual mode?

I was previously on the Medtronic 640g pump with Freestyle Libre 2 sensors. I have been moved on to the 780g with Guardian 4 sensors and put into smartguard / automode. I have only been in smartguard for 8 days and I know it takes much longer to 'learn' about you. However I don't think I can handle being so reliant on this thing.

I thought the pump was fantastic during the 2 day warm up period, I could see it suspending my basal and preventing lows which was amazing. I felt very confident.
Then smartguard kicked in and it was great for two days, until the algorithm decided to adjust all my meal boluses and only give me maybe half of what I needed. This has resulted in highs that last all day and only come down whilst I'm sleeping. Time in range is about 40%-50% as opposed to the 80% and above that I had during the warm up and first two days.

I have had an issue with a sensor that gave up early and I was back in manual mode for a few hours with high sugars and no idea what to do. I had a horrible night of panic with elevated ketones. I had another panic last night when the pump just stopped giving auto-corrections for no reason - called the Medtronic helpline and the lady clearly had no idea why it would do that but blamed me for changing a carb:insulin ratio earlier in the day?? Eventually managed to fix it by turning smartguard off and on again, and completely changing my reservoir and cannula set, this all seemed to kick it back into gear and then it gave me one big correction bolus, so I stayed up most of the night to watch that it wouldn't send me low.

I am absolutely filled with anxiety, stress, panic, and I am not eating much due to being high all day. I am at my wits end with it and just want to go back to how things were during those first couple of days. I did actually turn smartguard off for a day but my sugars were still so high, I felt I had no choice but to go back onto smartguard to have it bring me back down gently. Now I am panicking that I am stuck relying on this piece of tech and I no longer have to ability to manage my sugars myself.

Really sorry for the long ranty post - but I feel completely hopeless. I know it sounds dramatic but I have cried every day since smartguard started making these decisions. I have lost all confidence, I think about nothing else all day long, shaking with anxiety and pacing around. My poor husband is calming me down from panic attacks every day.

Has anybody else decided that smartguard was not for them?

Thank you

Nicola M said:

I’ve only ever used in in smart guard so can’t really comment on going back to manual mode.

Some things to consider though, since it has only been 8 days it does take a week for the pump to “learn you”. The issue with it adjusting your insulin with every meal time sounds like the common issue I’ve read about called “safe meal bolus” one of the safety features I suppose to prevent you from going low although as many have found it doesn’t actually do that it just makes you go high. There’s lots of information surrounding this and people who can help in a Facebook group I’m a part of - https://m.facebook.com/groups/119376721997721/

In terms of it not giving you corrections it could be that you maxed out on corrections and until you enter a blood glucose it won’t give you anymore, part of another safety feature to make sure it isn’t giving you too many and sending you low.

A lot of things go into smartguard and making it right for you and unfortunately it isn’t the quick fix everyone thinks it is, it took me a long time to get where I am now with lots of adjustments with time in range and carb ratios, it’s all about trial and error until you get it where you need it to be and remembering that after every change you need to give it a week before you change anything else. Personally I would say keep at it as you’re only a very short time in and I’m no expect but the Facebook group above is extremely helpful for a lot of smartguard related issues you may be having.

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Hi Nicola,

Thanks so much for your reply. I had seen that facebook group before but my request to join is still 'pending' for now.
I found the same advice from other forums where people say to enter a bg reading to make the corrections start again, but this did not work for me. It seems like a flaw to silently stop corrections rather than alert me and ask for a bg reading. The medtronic rep seemed clueless as to why this would happen and I did ask if there was a limit to corrections and she said no.

The idea of having to make so many adjustments in order to make smartguard work for me is also terrifying to me - because then I have absolutely no idea what to do in manual mode. I am an anxious person and like to feel in control. If something went wrong with a sensor and I'm stuck in manual mode for hours - how could I ever replicate what smartguard was doing for me?

My time in range wasn't bad on my old pump and I have achieved better control in the past when I have eaten healthier and kept on top of pre-bolusing and such. My main problem was fear of hypos so I was sometimes keeping myself at higher levels, so 'suspend before low' worked wonders for me. I also think the Guardian 4 sensors are fantastic and way more accurate than Libre.

Smartguard is just causing me so much stress and I don't know if it's worth it for me personally. At the moment I am a shell of myself I am just trying to get through the bank holiday so that I can speak to my specialist team tomorrow and hopefully get an emergency face-to-face appointment with them.

rajeshm said:

You do enter the carb before the meal right?

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Yes, always. Since starting on the 780g I have followed the advice of bolusing 10-20 mins before eating (usually 15 mins), and I have always been truthful with the amount of carbs. I have only been eating things where the carb content has been available on the packaging and I have weighed it out, so I am confident that the carbs are correct.

I noticed today that it is allowing me to have more of my meal bolus than yesterday, so perhaps it is learning something, but it's still sending me high, which didn't happen during warm up or for the first couple of days of smartguard. I can only think that it has changed my basal amount and so now my carb ratios will be incorrect. But if I change them to work with smartguard, they will surely no longer be correct for manual mode?