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Medtronic 780G Rough Start

H

Huntiejo

Newbie
Messages
1
Type of diabetes
Type 1
Treatment type
Pump
Hi All!

I've been Type 1 for 50 years and have used Medtronic pumps for the last 30. About a month ago, I upgraded from the 670 (manual mode + Dexcom CGM) to the 780G in SmartGuard + Guardian 4 CGM. The transition to closed loop on the 780G has been a heck of a challenge. On the plus side, my overnight lows have been largely corrected - I can sleep all night without having to eat a snack at 1am. And these levels also tend to remain steady during the day... until I eat. At that point, the honeymoon's over. The pump "adjusts" meal bolus doses down to half or even one third of the initial calculated doses. SmartGuard will not allow me to modify. Sooo frustrating!!

My CNE and Medtronic rep have tried adjusting my carb ratios, but doses are still cut short. My glucose readings spike after meals every time, and stay elevated for hours while the pump's auto correction slowly brings it back down. I've resorted to restricting carb intake and exercising to burn the little I do eat. There's gotta be a way around this. If you've experienced anythiing similar using 780G in SmartGuard, please share alternative approaches, tips, or tricks you've found helpful. Thanks!
 
If you’re Medtronic rep and medical advisor’s input, together with changes to exercise and diet are recent. Then referring to my own M780 experience (now very good) it may just be that a little more time is needed for it to fully adjust.
I believe @Prancy has recently started with the M780 and is US based, so also may be able to assist.
 
Hey Huntiejo,

i experienced something very similar to you when I switched from Medtronic 670 to 780. It was quite disconcerting. I was very overwhelmed and frustrated due to my initial results. I kept trying and it was a sad situation. I posted all over to get input. Called….I got a lot of encouragement from those who were proficient with 780, but it was difficult to keep my faith. I kept hanging in there and tried a couple of things and then it happened! Awesome results started occurring after several months. I now have the best results of my career with type 1. It’s amazing. So, please know that it is doable and great things are possible. Keep the faith.

It’s my understanding that you are in Smart Guard, correct?

I can’t suggest anything different than your professional team, of course, but this was my experience. My nights started out with lows too. Then, highs during the day.

Although not required, I calibrate twice a day. It keeps my cgm close to my meter. It really helps me.

Do you have feet on the floor syndrome? When I arise, my BG goes up quickly about 60 points. I don’t support entering false carbs, but what I do is bolus first thing in the morning for my coffee. It covers that morning spike and keeps me even most of the day from 90-120.

Some people insist on bolusing 30 minutes before eating. I haven’t been able to do that, but I suppose it works for some people. I would do it if I wasn’t getting the results I wanted after meals. Were you advised to do that?

Have you considered if your infusion site is suitable? When I run high, I change my infusion site. It might not be absorbing well. At times, that has made a difference.

Could you try to eat only things that you know exactly how many carbs are in it at meal time? Not something you have to gauge, but a definite amount. Only eat that one food and bolus only for it. Watch to see how your BG reacts. Slowly, add other foods to the meal. This may be tedious, but you can see what is causing it to run high and it can confirm if your I/C ratio is right.

I used to underestimate my carbs. Now, I don’t, since my 780 will protect me. I really trust it a lot now. I’m now often 100% TIR. I give 780 the credit, but I do eat a good healthy diet and I’m not heavy on the carbs. I know people who do eat high carb, but they do equally as well with the 780. I’ve lost a lot of weight on the 780.

You might speak to your doctor or educator about bolusing for fat and protein and if that is something you could consider. I have to do that. I bolus with plain coffee, which has negligible carbs as well as fats and protein.

Have you discussed your Sensitivity Factor setting? It determines how fast you want the insulin to be disbursed, I think. Mine is set conservatively, but it’s worth a look, if it could make a difference.

Others kept telling me the pump had to learn my body. I now believe that. It just took a while. I am complicated. Lol

I hope you get other responses. The 780 has changed my life. I pray you will hang in there until it turns around. Best of luck and I’ll watch out for your posts.
 
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Your situation sounds very familiar to what I’ve read a lot about in a Facebook group I’m part of called safe meal bolus. Where it reduces your bolus because it believe you already have too much insulin on board so reduces your bolus for “safety”. I’ve personally never experienced this phenomenon and as far as I know it happens a lot to people who have a low TDD. I’m not all that familiar with how it works as I’ve never experienced it but the group I am part of (https://www.facebook.com/groups/119376721997721/search/?q=safe meal bolus) goes into great detail about it and how to combat it.

If you get accepted into the group I would search “safe meal bolus”. There’s a detailed post from Kathy Leppert on the 31st of October 2023 on how to combat it or you can make a post yourself or DM Kathy as she’s extremely knowledgable on safe meal boluses with the 780g!
 
I belong to a Medtronic pump users group on Facebook. This was quite useful when I had similar problems to you, when I started on the 780G last year. All was well for breakfast and lunch but varying amounts of insulin were subtracted from my evening meal bolus. It reached the stage where up to 50% was subtracted, even when my BG was within range and there was no active insulin.

The Facebook group suggested a formula of 300 ÷ TDD as an approximation of carb ratio. This worked out to be roughly what my breakfast and lunch ratios were but was way out from my evening meal ratio. I used:
1u : 8.5g for breakfast
1u : 9g for lunch
1u : 5.6g for dinner.

I made changes to my evening ratio over a few weeks, till no subtraction was made and my BG stopped being high for hours after dinner. I reached a ratio of 1u : 7.5g but that has now risen to 1u : 7g. (due to the usual changes we all have to make from time to time).

This, of course, is the opposite of what is normally advised for high BGs but if it works, why question it? AND my BG was high due to the pump not giving the full bolus. My Diabetes team couldn't suggest anything that helped and this worked for me.
I hope you find something that helps you!
 
Hi I've been on 780 closed loop system for a couple of year and I had a similar problem to start with. The algorithm does take a while to adjust to personal insulin needs. But I modified my basel pattern set up slightly and I changed from Novorapid which you need to wait up to 20 mins before eating, to Lyumjev which only needs 5 to 10mins before eating, it's a much faster acting insulin and i get very few spikes now, the only bad thing about the new insulin is that it sometimes stings as it goes, but I can live with that.
 
Medtronic 780 pump - I’m currently using so much insulin than I did with pens.
My bloods are rocketing up to the 20 mmol.

Is this normal m, I had good control but feel totally out of control at moment.
 
I’m new to the 780 - I had good control with my ones but having a nightmare with pump.

Every time I eat I’m going to 20mmol. I’m giving more insulin than I ever gave for same meals. But it’s not working.

I’ve always needed a lot of insulin in the morning and by ratio is 1:5 - this is only carbs that I’m able to keep in range just!!
 
@Gafspa for how long have you been on the 780G?

Are you also using the G4 sensor?
 

Be prepared starting on any pump system means going through a period of feeling out of control, it's a different delivery system and WILL require tweaking, pumps can take a while to bed in but once adjustments to ratios are made it can come into it's own. Are you under the guidance of a healthcare team for your adjustments ? Also using a CGM ? I see you've posted the same query on another thread too, will ask the team to remove as it's helps to have all responses on one thread for visibility.
 
Hi, got a suggestion, you obviously know how to be careful, I have similar problems as have others, if I get a spike that refuses to come down with SG, I turn SG off, manually bolus a correction then turn SG back on, SG will ask you to provide a BM, if you trust the pump readings just put in the last one it showed or do a finger prick.
I may add that my success rate is about 75/25, so it's not full proof, you will occasionally get it wrong, but there's always Dextros.
 
Are you using Smart Guard, if you are it may be worth coming off it until you get used to the pump.
 
Can I also say that I am reluctant to offer advise on such a strong issue, you really should see your care giver.
 
I have just read your post from last year and am struck by the similarity of our experience with the 780g. I just got a new 780g last week, because the old one was out of its warranty period, and I am totally unimpressed with it. The reduction in meal boluses is frustrating to say the least but I think the SmartGuard feature verges on dangerous. On the new pump, it consistently drives me low. There has not been a single night during the last week when it has not woken me at around 3-4 am telling me I am approaching a low. Very wearing! Until I find a way around the problems, I've simply turned the SmartGuard feature off and I'm doing better.

Tim C
 
I hope you are able to fully utilize the 780 Smart Guard feature. It took me a little while (months) to get adjusted when I went from 670 to 780, but it did eventually happen. I worked with my endo team to make adjustments and allow the system to learn my needs. I was able to get get results and am amazed with its performance. I never thought it would really happen.

When you were seeing lows at night, did you check with a fingerstick to see if the low numbers were real or if the cgm was off? If you truly were low, I might revisit your bolus amounts earlier that evening or at dinner. A low can occur hours later. The pump will eventually decrease your evening basal, but there are limitations and it does take time. There are other adjustments your team might be able to adjust, such as Active Insulin Time, Insulin Carb Ratio, etc,

With my issues, I could usually trace my issues back to a bolus. I either over or under estimated carbs at a bolus. That tends to be my problem now, though it’s not common,

Some people might not care for Smsrt Guard mode, but I get good service and am there over 90% of the time.

Best of luck with everything. I know it can be frustrating.
 
That's exactly what I do and my time in range is always above 85%. I just accept what the sensor says my BG is and don't use it to calibrate.
 
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