New pump user - questions and medtronic 780g vs tslim x2

[EllieM]

Nearly tagged in on the medtronic vs tslim thread but as I am a new pump user have even more questions....

I'm in New Zealand and have had issues with lantus (the only basal supplied here) and my team have just authorised a pump because I have problems with lantus and hypos. I reckon I also have problems with varying insulin needs and managing dawn phenomena.

I am very nervous about canulas but I guess both pumps are similar on that.

Looks like both systems are closed loop (sort of) , smartguard for medtronic and control iq for tandem.

My ratios and basal needs seem quite variable to me, and I also need higher correction doses for higher bgs. When my morning levels go up (eg if I go on a morning walk or bike ride) my insulin seems to act like water and I have to keep adding more, do the pumps cope with this or is it all manual?

I currently use the dexcom G7 and could easily go back to the G6, I just need to pre insert sensors by 12 or 24 hours because they tend to read low for the first 24 hours on me and dexcom clam you shouldn't calibrate too early.

How often do you calibrate the guardians?

Comments welcomed, plus suggestions for questions to the reps.

 

[Nicola M]

I’ve only ever known the Medtronic Guardian.

Depending on which sensor you are provided with as I don’t know what New Zealand have yet..

Guardian 3 - warm up of 2 hours, input blood glucose, calibration required 6 hours after that and then 12 hourly after that.

Guardian 4 - Doesn’t need any calibrations at all, when you first apply a sensor it will probably ask for one but unless it requests a calibration you don’t technically have to do one although Medtronic recommend doing at least 2 a day still for accuracy.

I’m on guardian 4 and personally I don’t calibrate unless I’m either asked to or if I feel that the sensor is not reading quite right. It’s not very often that it is far out though.

SmartGuard learns from you and takes into account the last 7 days of information it has collected and gives corrections based off of that, the only flaw is that if it hits the maximum amount it can give correction wise it won’t tell you, it just won’t give you anymore but you can enter a BG and manually give more if needed. It will constantly alert you if you are above 14mmol though and it’s pretty persistent It will give you more basal as well if you’re high and if you hit the maximum for that for around 6 hours it will then alert and ask for a BG
reading. My pump copes pretty well with my lunch time rise and that can be awful at times.

I wouldn’t worry too much about cannulas, you soon get used to them being there and unconsciously being a little more careful with certain things.

My basal changes day to day, I’ve had days where I had as “little” as 17 units and other days as much as 28 units. I think the pump copes well with basal changes, bolus is a little more difficult but you can have different bolus amounts for different hours of the day.

Also yay for a pump, I was also a lantus and low constantly person pre-pump which was one of the things that went in my favour to be approved for one!

If you have any questions please do ask me, I’m sure I’ve probably missed saying something!!

 

[EllieM]

Thanks @Nicola M can you turn the alarms off or put them on silent? eg in a cinema? I've been known to put my phone on silent then with my dexcom though I suspect it might be safer to turn it off.

 

[Dexta]

On the Medtronic M780g you can silence or adjust the Sound level and silence the Vibration alerts.
You can also adjust the parameters of what triggers an alert eg the length of time an alert would be given before reaching a high and what you consider to be ‘high’.

If the Extended (7 day) Infusion Sets/Reservoirs are available in NZ then I strongly recommend them. Owing to their much less frequent cannula changes this seems to have much less impact on infusion sites.

 

[Deleted member 527103]

I sue neither but have read quite a few comments about the two pumps.
They seem to vary in the way they do Closed Loop.
The Medtronic "learns" what is normal BG behaviour for you.
The T-Slim has basal profiles (you program it for a "typical" day's BG pattern) and the intelligence switches the basal off if you go too low and gives you extra if you go too high. But it is all based around the profile you gave the pump. You can set up multiple basal profiles. So, if your typical basal needs are different on certain days due to monthly hormones or your weekends are more chilled than hectic weekdays or your holidays are more active or you need more when unwell or when you get a covid vaccine or ... you can set a different basal profile.
From what I have read, the T-Slim approach makes more sense. This maybe because I am used to setting different basal patterns and switching between them with my "manual" pump. But basing something on a learned pattern only works if there is no variation to this pattern.

Both have a choice of cannulas. I know there are a few forum members who have struggled to find the most appropriate cannulas for their body but these are the minority. When I started pumping, I tried two cannulas and stuck with the second one. My problem was that I didn't have enough fat for the "standard" cannula and needed one that inserted at an angle. Most people have more fat than me ... and I don't mean that they are overweight. I am lean due to exercise,

 

[Nicola M]

Thanks @Nicola M can you turn the alarms off or put them on silent? eg in a cinema? I've been known to put my phone on silent then with my dexcom though I suspect it might be safer to turn it off.

As Dexta has already said you can silence alerts, I’ve done so many times before if I’m somewhere where I don’t want it to go off. You can silence them anywhere from 30 minutes to 24 hours. I always have my alerts on vibrate but if you “ignore” the alert after so many times it’ll beep out loud and then if you still ignore that it’ll beep continually like a siren until you clear the alarm

 

[Prancy]

Can anyone who had the training to start their Medtronic 780G, please describe the process? I called them and started the intro part the the training on their website, but it looks like there’s a break of a few days to weeks between the time you do the first live session and the second live session. I need to go into automode immediately with no down time. I have av670G, so I’m already pretty familiar with everything.

 

[Dexta]

Unfortunately, you will be unable to avoid the ‘down time’.

I’m in the strange situation where my faulty 670g (reservoir issue) was replaced by Medtronic with the m780g in April and despite me only having it for 6 months they’ve also just had to replace that one to comply with the original 670g warranty expiry a few days ago.

This meant that during the set up of my new pump 2 days ago - using exactly the same settings, I still had to go through the 2 day ‘warm up’ in Manual Mode, which started at midnight on day 1. This was so my new pump would learn from my actual usage before allowing SmartGuard to take over.

Contrary to Medtronic’s advice
if you’re using a sensor at the moment you could try turning SmartGuard on now, just as I did, but if you refer to the SmartGuard Checklist on your pump it will show it’s ‘warming up’ for 48 hours. You would still be able to see your sensor glucose levels on the pump and phone app, despite being in Manual Mode.

I hope this all makes sense, but it’s well worth it when you see how effective SmartGuard is.

 

[Prancy]

Unfortunately, you will be unable to avoid the ‘down time’.

I’m in the strange situation where my faulty 670g (reservoir issue) was replaced by Medtronic with the m780g in April and despite me only having it for 6 months they’ve also just had to replace that one to comply with the original 670g warranty expiry a few days ago.

This meant that during the set up of my new pump 2 days ago - using exactly the same settings, I still had to go through the 2 day ‘warm up’ in Manual Mode, which started at midnight on day 1. This was so my new pump would learn from my actual usage before allowing SmartGuard to take over.

Contrary to Medtronic’s advice
if you’re using a sensor at the moment you could try turning SmartGuard on now, just as I did, but if you refer to the SmartGuard Checklist on your pump it will show it’s ‘warming up’ for 48 hours. You would still be able to see your sensor glucose levels on the pump and phone app, despite being in Manual Mode.

I hope this all makes sense, but it’s well worth it when you see how effective SmartGuard is.

Thanks for the info. I can survive 48 hours without auto mode, i guess.

Did you actually have a live class? That’s what they are saying on the site.

 

[Dexta]

Thanks for the info. I can survive 48 hours without auto mode, i guess.

Did you actually have a live class? That’s what they are saying on the site.

Yes. I did have just one online class with Medtronic back in April during which we actually switched SmartGuard on.

I guess Medtronic will do things differently depending on whichever country you’re in.

With my newest pump my NHS hospital team is monitoring it through Carelink and they know I’m already familiar with it.

 

[Chas C]

I sue neither but have read quite a few comments about the two pumps.
They seem to vary in the way they do Closed Loop.
The Medtronic "learns" what is normal BG behaviour for you.
The T-Slim has basal profiles (you program it for a "typical" day's BG pattern) and the intelligence switches the basal off if you go too low and gives you extra if you go too high. But it is all based around the profile you gave the pump. You can set up multiple basal profiles. So, if your typical basal needs are different on certain days due to monthly hormones or your weekends are more chilled than hectic weekdays or your holidays are more active or you need more when unwell or when you get a covid vaccine or ... you can set a different basal profile.
From what I have read, the T-Slim approach makes more sense. This maybe because I am used to setting different basal patterns and switching between them with my "manual" pump. But basing something on a learned pattern only works if there is no variation to this pattern.

Both have a choice of cannulas. I know there are a few forum members who have struggled to find the most appropriate cannulas for their body but these are the minority. When I started pumping, I tried two cannulas and stuck with the second one. My problem was that I didn't have enough fat for the "standard" cannula and needed one that inserted at an angle. Most people have more fat than me ... and I don't mean that they are overweight. I am lean due to exercise,

Its Basal IQ that turns on and off the Basal on a t:slim. Control IQ works like a tap turning the basal up and down as needed (also off if going too low). I agree with @In Response I prefer t:slim with the Dexcom, the algorithm works well for me and can set up different profiles for different days or activities. I'm expecting the Dexcom G7 will soon be released for the t:slim so shorter warm up etc.

 

[Dexta]

I think it’s good to know that most of us have at least some choice of pumps etc be it Tandem, Medtronic……….or Tubeless and they all have dedicated users.

This should certainly help to keep all these medical technology manufacturers on their toes, so we should all benefit.