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Upgrading the 640g to 670g

Discussion in 'Insulin Pump Forum' started by aphex2k, Aug 26, 2019.

  1. aphex2k

    aphex2k Type 1 · Well-Known Member

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    Yes it does, but the dose it suggests to correct high levels are lower than I would use in MM, and it's much slower in AM to get back to range.
     
  2. dancer

    dancer Type 1 · Well-Known Member

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    I would have thought the correction dose is based on your Insulin sensitivity, which should be the same for both automatic and manual mode.
     
  3. aphex2k

    aphex2k Type 1 · Well-Known Member

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    Nope - it seems correction doses in AM are way lower in comparison. I don't believe sensitivity factor is different in AM once it's been set in MM. (Not precise numbers here...) But if I was at say, 12. AM correction dose would suggest 1,2 but manual mode would likely be double (and I'd guesstimate closer to 3u would be more along the lines of the dose I'd expect. But it's hard to figure this out in AM. Like, is AM frantically micro dosing me to get me back to target? Does micro dosing stop if you've just done a correction bolus?

    Here's where I am in AM

    Carb Ratio 9.0g/u
    Sensitivity 1.8
    BG Target 00:00 to 24:00 5.0 - 6.5
    Active Insulin 3hr

    I've been tweaking here and there. Does it take a week to work through and learn new settings? It makes sense but I'm hoping not as I don't want to wait a week to see if my tweaks are helping or hindering.

    I'm also familiarising with Tidepool as it looks like MT are working with them now possibly for rthe 780g and the new CGM/?
     
  4. aphex2k

    aphex2k Type 1 · Well-Known Member

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    And another sensors bites the dust. Fitted less than 24 hours. Woke this morning to "replace sensor". Looks like it died at 3am. Odd as the sensor told me I was hypo at 2.2 before bed but I felt spiffing and when I eventually BG tested I was 12. Grr.

    Now pump tells me I'm 2.7. I feel fine. BG says I'm 6.9 but I daren't calibrate again as I've not long done it after fitting new sensor). Pump is now TELLING me to re calibrate the sensor so I have no option but to or stay out of AM completely. So it's calibrating, but I'm not sure if it's going to work. I might end up with a 4th **** sensor thrown away in about a week. I'd only just sent Medtronic an email asking for a replacement to be sent. May as well send a box of 5 at this rate.

    Did I say "grr" already?
     
  5. aphex2k

    aphex2k Type 1 · Well-Known Member

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    Bloody sensors just died again. Balls.

    Off home instead of having a lunch break to pick up another sensor.
     
  6. DunePlodder

    DunePlodder Type 1 · Well-Known Member

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    Unfortunately this seems to be an all too familiar story judging by the messages I've seen across various forums. Such a shame.
     
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  7. aphex2k

    aphex2k Type 1 · Well-Known Member

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    It is very frustrating. Bearing in mind, I was kicked out of AM due to sensor dying while I was asleep and new sensor this morning died. The most recent one I've attached seems to be ok so far but of course, you wait for the warm up and calibration, again. So nearly 24 hours with very little CGM input/output. Levels are naturally all over the place today but seem stable now at 6.9.

    I don't understand how the previous box was good, yet the new box with the same calibration pattern and method (no arrows, no active insulin, levels stable when calibrating) can have a vastly different outcome?

    Time is running out for auto mode and I'm seriously considering manual mode. I never really had hypos I wasn't aware of, and my control was better. Yeah I appreciate it's learning, but I have a feeling that popping in and out of auto / manual to correct highs does nothing to help the algorithm work properly, so what's the point? I feel like an alpha tester of a new system (not even a beta tester).
     
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  8. dancer

    dancer Type 1 · Well-Known Member

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    If the difference between blood test and sensor reading is too big to calibrate, switch off auto mode for about 3 hours and switch back on again. You will be asked to calibrate, then asked to test BG for auto mode. This usually works for me and saves ruining another sensor.

    If a calibration is rejected for the 2nd time and you're told to change sensor, you can try restarting it as a new sensor - but this means carefully removing the transmitter without moving the sensor (sharp scissors can help here). You can't restart a sensor without recharging the transmitter.

    Obviously restarting the sensor won't work if there definitely is a fault in it, but it is worth trying.
     
  9. aphex2k

    aphex2k Type 1 · Well-Known Member

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    It's worked fine before it just seems to be this box. I've no idea why one died during my sleep. More worrying that suspend before low isn't automatically enabled when youre kicked from auto mode. Really cba with waiting all the time. Wait to warm up, calibrate, enter BG. Even when it does calibrate it chooses its own figure so to me calibration doesn't work. Often my BG doesn't get accurately sent to the pump.... The figure is close but to me, calibration means matching, not a rough close amount. Perhaps Medtronic can apply the same calibration calculation to my monthly sensor subscription and I'll send them roughly 250.... Like 230? Close enough isn't it Medtronic.
     
  10. aphex2k

    aphex2k Type 1 · Well-Known Member

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    Oh and would you believe it... Sensors just crapped out and lost signal. Searching for transmitter..... Again. Just eaten dinner and was about to meal bolus. Jesus H.
     
  11. aphex2k

    aphex2k Type 1 · Well-Known Member

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    New sensor hasn't died yet. Life goals!

    So the algo does little to correct highs. It just doesn't bring you down fast enough (plus the time while you were going high). It's just too long.

    My question is, am I screwing up the pumps learning by being aggressive in my corrections in mm, then going back into auto mode once the (more accurate) correction dose has been administered?

    Oh and did anyone see Tidepool and Medtronic are cosying up to each other. Hoping the future pumps will not only be more accurate, but these CGM inconsistencies are tightened up. Good bit of software that Tidepool. Much more user friendly than carelink
     
    #51 aphex2k, Oct 15, 2019 at 12:55 AM
    Last edited: Oct 15, 2019
  12. aphex2k

    aphex2k Type 1 · Well-Known Member

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    Yuck, ****** night.

    BG started going up around 7pm. Again I'm up at 12 wanting AM to help, but it doesn't. Manual mode and correction. Still rising. Changed cannula. Bolus. Still rising. 2 more "correction" doses and still rising so changed cannula again, checked for bubbles etc. All good. Woke up with 8.9. Ate a banana bolus for carbs and now the banana has kicked in but the insulin hasn't so I'm now 14, in manual mode for correction and hoping it starts to come down. Seems to be a very fine line

    Conclusion. Personally speaking, AM isn't working for me. Yes it's helping me with lows, but it's method for doing this seems to be keeping me high. I'm not liking this. I thought AM was better but it appears not, I've fallen for the marketing and the more I google people's opinions and watch you tube vids it seems I'm not alone in this perspective.
     
  13. dancer

    dancer Type 1 · Well-Known Member

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    Could it be that you need to change your carb ratios? My carb ratios all changed, for some reason, after going on auto mode. My lowest ratio has always been in the evening but that is now my highest. I was told that possibly, in the past, my bolusses were also covering my basal levels.
     
  14. aphex2k

    aphex2k Type 1 · Well-Known Member

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    No I don't believe it's my carb ratios.
    (Currently at 8.5g/u Insulin Sens factor 1.6/u and active time 3hrs, target 5.0-6.5)

    Not entirely sure why it allows an adjustable target range as I understood the pump only had 2 pre set targets 6.7 and 8.3. I don't know what, if any effect the user selectable target range makes any difference to the pumps inbuilt choices?


    The more I read other people's experiences, it has a lot to do with the algorithm and the fact the FDA and Medtronic really don't want people going hypo while connected to this kit, which is essentially the first hybrid close loop available to the general public. While I understand the reluctance to effectively manage high blood sugar, I would (and do) prefer manual mode for correcting. At the moment I'm still in the mindset of correcting and getting back to normal as quickly and safely as possible.

    Today, my level's been flat since midnight last night, bar a wee spike around 9am after my breakfast.
     
  15. aphex2k

    aphex2k Type 1 · Well-Known Member

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    Happier today but expecting a low as I forgot to test pre meal and now have 6u on board and a sensor glucose reading of 4.4 20191017_105927.jpeg
     
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  16. DunePlodder

    DunePlodder Type 1 · Well-Known Member

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    That graph certainly looks better!
    Looking at your parameters I wonder if your insulin activity time is a bit short? I know that the various DIY loop developers recommend 5 hours or longer. I think the new Control IQ for the Tandem T:slim uses 5 hours.
    Just a thought.
     
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  17. aphex2k

    aphex2k Type 1 · Well-Known Member

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    I'm really not sure - on the 670g user groups on Facebook the consensus seems to be shorter active time, some are as low as 2 hours. I was previously on 3.5. I might try jumping up to 4 hours and see what effect that has. I've been uploading my data to Tidepool as I find it much easier to navigate and view the information. Tidepool's prediction so far is an A1c of 6.9 which, if true, is not at all bad considering my teething issues.

    I'd flagged my concerns with my contact at Medtronic and one of their clinicians is going to call me next week to discuss.
     
    #57 aphex2k, Oct 18, 2019 at 1:55 AM
    Last edited: Oct 18, 2019
  18. DunePlodder

    DunePlodder Type 1 · Well-Known Member

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    I think the longer insulin activity settings are more about avoiding the problem of "stacking" insulin. If it's too short the algorithm assumes there is no active insulin on board when in fact there is. Studies have shown that insulin hangs around in our bodies for much longer than people think.
    I guess it's not really relevant to your current problem of too many highs though.
    I like Tidepool too.
     
  19. aphex2k

    aphex2k Type 1 · Well-Known Member

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    Yeah I think Novorapid starts to work in around 20 mins, peaks around 2-3 hours and lingers around for anything up to 5 (ish) hours, individual depending. I'm trying to be a bit more patient in AM and allow it to do it's thang. It does bring me down, just in no really hurry.

    Still learning (both the pump and me!) But I still feel I have a lot more flexability and control in manual mode over auto. Auto is great overnight when you're not eating and putting in carbs. I can pretty much stay flat and level for 8 hours. It's just the eating thing that throws things off!
     
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    #59 aphex2k, Oct 21, 2019 at 4:15 AM
    Last edited: Oct 21, 2019
  20. aphex2k

    aphex2k Type 1 · Well-Known Member

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    So I sent quite a lengthy email to my Medtronic contact who said they would get in touch with the clinical specialist team in Western Australia to give me a call. I had an email and a clinician is going to come down to see me at work, talk through some of my issues and concerns, and hopefully come up with some strategies to keep things ticking along nicely. I suspect that my questions about CGM accuracy and reliability might be left to towards the end of the session..... ;o)
     
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