- Messages
- 7
- Type of diabetes
- Type 2
- Treatment type
- Pump
Hello to my friends across the pond - and all over the world!
Just thought I'd share my recent experiences - maybe it will help some folks?
I am 62 years old -and a T2 (Highly Insulin Resistant) diabetic - using Medtronic pumps for about 20 Years. I use 5x concentrated U500 insulin (Humulin R) - which is considered 'off label' and not officially approved for use with Medtronic pumps here in the USA. But it has worked well in all manual mode pumps for years.
It also worked 'reasonably' well in the 780G - with some 'quirks' and annoyances (Some overnight and early morning lows - not due to over bolusing or other user error).
I was upset that SmartGuard was not throttling my basal rates to assist in preventing these lows. Originally I thought U500 was the sole culprit - after all it is a rather wonky & unusual insulin with unique Onset, Peak and Durations. I convinced my Doctor to go back to U100 (Novolog) - as a test - even though that would mean near daily replacements of reservoirs.
After originally training Smartguard on U500 rates - it was initially a challenge getting the pump to 'relearn' my new basal pattern rates which were now approximately 5 times higher using a U100 Insulin.
Working with Medtronic Tech support was a huge disappointment. Like talking with a robot - reading from a pre-pepared troubleshooting script. An offshore Phillipino - whom was friendly - but not familiar with diabetes, their pump, the mysterious SmartGuard or it seems anything else - near useless - with no further escalation path.
No one over there had the answers - no one had ever asked them how to put pump back into Smartguard Warmup and learning mode. They ended up sending me a refurbished pump (which I didn't use) as the the real answer came from a Medtronic Clinical Manager assigned to my Doctor for new user training. The answer was simple. Turn off SmartGuard and run the new Basal patterns in Manual Mode for at least 7 days. Turn SmartGuard back on - and voila - it learned my new rates.
Without going into detail - the pumps SmartGuard 'algorithm' - IMO - worked better using a Rapid acting U100 Insulin like Novolog.
This pump was doing a marvelous job at keeping me 'In Range' - better than I could do myself with manual mode pumps. But was it is really 'In Range'?
The real failure of this system (here it comes - NO suprise to many) - was the Guardian 4 sensors.
Worn properly on underside of upper arm - these sensors were consistently off by at least 30 mg/dl - and usually off by more than 50 mg/dl. Further, they seemed unable to measure and detect in my low ranges. I would be in critical low (<55 mg/dl) blood sugar (as measured by both Dexcom and by finger sticks and symptomatically) - yet Guardian G4 reported normal blood sugars values of 100 mg/dl or more. Calibrations were never effective - and they seemed ignored (no matter when they were performed).
So SmartGuard was managing me to a target of 100 (when in actuality it was a target of 150). Further, SmartGuard never saw low glucose trends - and as such, it never reduced or suspended insulin delivery - further contributing to my hypoglycemic events.
I have to wear two CGM's - Medtronic's to keep SmartGuard running - and Dexcom G6 to properly measure blood sugar and detect my lows. This is not sustainable.
I have decided to abandon therapy using this marvelous pump - due to the inaccurate and unacceptable G4 sensors.
Perhaps someday I will return - after they release their new sensor in the USA - or they wisen up - and start supporting sensors other than their own. G3 & G4 Sensors were both fails - will they ever get it right?
On the path to try a Tandem tslim X2 at my own expense (Insurance company won't pay for another pump for 4 more years). While the Tandem pump may have an 'inferior' algorithm/features to Medtronic's 780G - atl east it will be managing my rates based on true blood sugar levels - using a tried and true technology like Dexcom G6 (I like G6 better than G7). Good luck everybody!
Doug
(Melville, New York, USA)
Just thought I'd share my recent experiences - maybe it will help some folks?
I am 62 years old -and a T2 (Highly Insulin Resistant) diabetic - using Medtronic pumps for about 20 Years. I use 5x concentrated U500 insulin (Humulin R) - which is considered 'off label' and not officially approved for use with Medtronic pumps here in the USA. But it has worked well in all manual mode pumps for years.
It also worked 'reasonably' well in the 780G - with some 'quirks' and annoyances (Some overnight and early morning lows - not due to over bolusing or other user error).
I was upset that SmartGuard was not throttling my basal rates to assist in preventing these lows. Originally I thought U500 was the sole culprit - after all it is a rather wonky & unusual insulin with unique Onset, Peak and Durations. I convinced my Doctor to go back to U100 (Novolog) - as a test - even though that would mean near daily replacements of reservoirs.
After originally training Smartguard on U500 rates - it was initially a challenge getting the pump to 'relearn' my new basal pattern rates which were now approximately 5 times higher using a U100 Insulin.
Working with Medtronic Tech support was a huge disappointment. Like talking with a robot - reading from a pre-pepared troubleshooting script. An offshore Phillipino - whom was friendly - but not familiar with diabetes, their pump, the mysterious SmartGuard or it seems anything else - near useless - with no further escalation path.
No one over there had the answers - no one had ever asked them how to put pump back into Smartguard Warmup and learning mode. They ended up sending me a refurbished pump (which I didn't use) as the the real answer came from a Medtronic Clinical Manager assigned to my Doctor for new user training. The answer was simple. Turn off SmartGuard and run the new Basal patterns in Manual Mode for at least 7 days. Turn SmartGuard back on - and voila - it learned my new rates.
Without going into detail - the pumps SmartGuard 'algorithm' - IMO - worked better using a Rapid acting U100 Insulin like Novolog.
This pump was doing a marvelous job at keeping me 'In Range' - better than I could do myself with manual mode pumps. But was it is really 'In Range'?
The real failure of this system (here it comes - NO suprise to many) - was the Guardian 4 sensors.
Worn properly on underside of upper arm - these sensors were consistently off by at least 30 mg/dl - and usually off by more than 50 mg/dl. Further, they seemed unable to measure and detect in my low ranges. I would be in critical low (<55 mg/dl) blood sugar (as measured by both Dexcom and by finger sticks and symptomatically) - yet Guardian G4 reported normal blood sugars values of 100 mg/dl or more. Calibrations were never effective - and they seemed ignored (no matter when they were performed).
So SmartGuard was managing me to a target of 100 (when in actuality it was a target of 150). Further, SmartGuard never saw low glucose trends - and as such, it never reduced or suspended insulin delivery - further contributing to my hypoglycemic events.
I have to wear two CGM's - Medtronic's to keep SmartGuard running - and Dexcom G6 to properly measure blood sugar and detect my lows. This is not sustainable.
I have decided to abandon therapy using this marvelous pump - due to the inaccurate and unacceptable G4 sensors.
Perhaps someday I will return - after they release their new sensor in the USA - or they wisen up - and start supporting sensors other than their own. G3 & G4 Sensors were both fails - will they ever get it right?
On the path to try a Tandem tslim X2 at my own expense (Insurance company won't pay for another pump for 4 more years). While the Tandem pump may have an 'inferior' algorithm/features to Medtronic's 780G - atl east it will be managing my rates based on true blood sugar levels - using a tried and true technology like Dexcom G6 (I like G6 better than G7). Good luck everybody!
Doug
(Melville, New York, USA)
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