780 pump users help

[Aob]

I’ve got a query about Medtronic 780 pump is there anyway you can alter you basal rate on the pump as each time I have been in contact with DN they change carb ratio length of active time of insulin how long I should wait to eat after giving bonus but nothing changes I go very low within an hour of giving insulin and 21/2 hours after meal they are high I think it’s my basal rates but all they say the pump will work it out eventually what is working for pump users any suggestions I would be grateful thank

 

[Pigeon]

Are you using it with sensors?

You can indeed alter basal rates, it's under Delivery Settings, I'm just wondering why your team say the pump will work it out itself. I don't have sensors so I don't know about that side of things. It definitely took a lot of tweaking to get my basal rates correct at first.

 

[SB2015]

I am using the Medtronic 780G in a closed loop with their sensors. In this mode you cannot make adjustments to the basal rate as the pump and sensor do this automatically every 5 min, basing their decisions mainly on the last 72 hours of data. I find that I need to remember this when when there are big changes in the temperature, as the pump takes a short while to catch up. It takes a bit of getting used to letting the pump do so much of the stuff that we had to think about.

The only things we can change are those that your DSN has listed. If you are dropping so soon after eating it may be that you need to reduce the time between your bolus and eating. We are all different and I find my interval between these changes through the day. It is a case of trial and improvement.
I am wondering which insulin you are using. I am aware that many find FIASP and Lyumjev become active a lot more quickly for some people. Again find what works for you.

The thing that I took time to work out on this system was extended periods of activity. I found that using the temporary target (lifting it from 5.5 to 8.5) before breakfast reduced any correction that was added in to my bolus, and then I needed to dribble in glucose (wurthers) throughout the day on a long walk without telling the pump. To quote my consultant, “tell the pump what it needs to know to get it to do what you want it to do”.

The biggest bonus I have found is the pump sorting out any minor errors in bolusing , and especially over night where I find four hours after eating the pump brings ma back to a nic flat line. No basal testing anymore and lots of sleep.

Getting to this position took me some time, and I switched back to my old pump after the first few weeks, but then tried again and now 18 months later I wouod not want to be without the closed loop system.
Fire away with any questions that arise. Happy to help.

 

[everydayupsanddowns]

Sorry to hear you are having some trouble with your levels. Sounds very frustrating for you. One if the nacks with sensor-augmented pump use does seem to be learning how to get the system to work well for your individual diabetes, and what information and behaviours it needs from you. They are rarely as ‘plug and play’ as we would hope!

Have you experimented with skipping meals to see how the pump copes when you aren’t adding bolus insulin into the mix? Ideally you’d stay fairly stable within +/-1.7mmol/L of where yoh started until your next mealtime

Out of interest, how have you got your Duration of Insulin Action set - this is generally around 4-6 hours, but some people have set their’s quite low which can cause a few hiccups.

 

[Aob]

Sorry to hear you are having some trouble with your levels. Sounds very frustrating for you. One if the nacks with sensor-augmented pump use does seem to be learning how to get the system to work well for your individual diabetes, and what information and behaviours it needs from you. They are rarely as ‘plug and play’ as we would hope!

Have you experimented with skipping meals to see how the pump copes when you aren’t adding bolus insulin into the mix? Ideally you’d stay fairly stable within +/-1.7mmol/L of where yoh started until your next mealtime

Out of interest, how have you got your Duration of Insulin Action set - this is generally around 4-6 hours, but some people have set their’s quite low which can cause a few hiccups.

My duration of insulin was changed 2 weeks ago to 4 hours from 31/2 hours I started off with 3 hours and now just looking at my report my time in range has decreased by 2% it was never great but I’m disappointed yes I’m not having as many lows but still after 2 hours of eating my bloods are going high anything between 9 -16 it’s very frustrating. Do you find it annoying when you have a hypo and your bloods go up but as they go up the pump kicks in with auto correction! I suppose I’ll have to have a bit more patience with the pump as I know myself any small changes can have a dramatic effect on my control.
Thanks to everyone who replied to my query

Aob

 

[SB2015]

My duration of insulin was changed 2 weeks ago to 4 hours from 31/2 hours I started off with 3 hours and now just looking at my report my time in range has decreased by 2% it was never great but I’m disappointed yes I’m not having as many lows but still after 2 hours of eating my bloods are going high anything between 9 -16 it’s very frustrating. Do you find it annoying when you have a hypo and your bloods go up but as they go up the pump kicks in with auto correction! I suppose I’ll have to have a bit more patience with the pump as I know myself any small changes can have a dramatic effect on my control.
Thanks to everyone who replied to my query

Aob

I have my action time set at 3 1/2 hours after some tweaking.

With this heat I have raised my target from 5.5 to 6.7 as I was having quite a few hypos. I have also used a temp target ( which lifts the target to 8.6) when I am out and about in this heat. I am accepting lower TIR, in order to reduce the number of hypos I was having. (This is my way of effectively doing what I would have done in manual mode where I would have done temporary basal reduction. A change of 2% on TIR would not worry me.

You mention going high after meals. Have you adjusted your pre meal bolus timing? This can help a great deal to reduce the spikes after meals. Another things that is useful is to avoid sitting down for 15 min after a meal. We are not going for as many walks but simply doing something. That also has a reduction in spikes.

Can you identify specific foods that lift you up to 16 after a meal? If there is a pattern you could try reducing the portion size of those meals.

I took some time to get used to the looping but I am better at telling what the pump m
needs to know in order to get it to do what I want it to do.

I hope that helps, but this hot weather will definitely being playing havoc with lots of peoples management.

 

[everydayupsanddowns]

but still after 2 hours of eating my bloods are going high anything between 9 -16 it’s very frustrating

9mmol/L after 2hrs is spot on. I’d be very happy with that.

If what you’ve been seeing is eat... big rise at 2hrs... back in range after 5hrs then my view would be that the doses are fine, it’s only the timing of the insulin that’s off.

If you are correcting at 2hrs, but then going low later it might be again that the original dose was fine, but that the insulin took longer to get going and giving it a bit of a head start (10 / 20 / 30 minutes) makes quite a difference.

I lowered my post-lunch levels from 12s-14s to 8s-9s by simply leaving a bit of a gap between dosing and actually eating the food.

You have to be a bit cautious, and be careful not to get distracted. Plus the ‘right’ gap might change over time. Sometimes it might drop away to almost nothing... other times you might need to wait longer. Plus, obviously, the speed of absorption of the particular food can need an adjusted approach.

This is easier to monitor if you have access to a sensor, but it can be a very powerful technique 🙂

 

[Aob]

Thank you I must give your suggestion a try it’s great getting fellow diabetics opinions and methods on how we can cope with ‘difficulties’