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780 Users

Btw I'm not new. I've been on many nice chats with the lovely trophywench and other very knowledgeable and kind posters, over the years.
 
Hi @Oblomov

Sorry to read that you are not finding that Smartguard is working for you.

Having read through your post I have just a couple of questions:
  • Are you prebolusing for your meals? I find that if I don’t do this I get spikes after a meal and the algorithm does take some time to get me back in range
  • What insulin are you using in your pump. I have only used Smartguard with Novorapid and I am not sure how well the algorithm matches other insulins such as FIASP
When I first started on this system I abandoned it as it was not doing the job properly. I kept intervening and confusing the algorithm, which was why it did not work for me. I am now very happy that it brings me back in target, especially overnight, and getting TIR in 90s most of the time.

I cannot think of any other variables that you can change and as you say you do have them all set at the tightest end of things. Sorry not to be able to make any other suggestions. I will tag @everydayupsanddowns as he is new to Smartguard and more analytical than me so may be able to make some suggestions.
 
SB2015 said:
Hi @Oblomov

Sorry to read that you are not finding that Smartguard is working for you.

Having read through your post I have just a couple of questions:
  • Are you prebolusing for your meals? I find that if I don’t do this I get spikes after a meal and the algorithm does take some time to get me back in range
  • What insulin are you using in your pump. I have only used Smartguard with Novorapid and I am not sure how well the algorithm matches other insulins such as FIASP
When I first started on this system I abandoned it as it was not doing the job properly. I kept intervening and confusing the algorithm, which was why it did not work for me. I am now very happy that it brings me back in target, especially overnight, and getting TIR in 90s most of the time.

I cannot think of any other variables that you can change and as you say you do have them all set at the tightest end of things. Sorry not to be able to make any other suggestions. I will tag @everydayupsanddowns as he is new to Smartguard and more analytical than me so may be able to make some suggestions.
Click to expand...
 
Hi,
Thanks.
1)Yes I do give pre meal. I try to do it 20 minutes before, as they reminded me in the training I had when 780 arrived, but occasionally I forget and it's only 5 minutes before I sit down to eat.
2) Novorapid , I've been on that for 30+ years, pre getting a pump.
 
Hi @Oblomov I’ve been diabetic for 53 years since I was 2. I first used the Medtronic hybrid system at the beginning of the year. I found that I made occasional changes in the first 4 weeks and then completely let it do its own thing. The only exception being when I have cocodamol as the paracetamol falsely elevates my levels for two hours afterwards so that the Medtronic can say, for example. up to about 13 when BG is 8. After three months I was very happy with a time in range of over 90% for the three months and HBA1C was 6.4.
I then had a break from it as I couldn’t afford to continue to self fund the sensors. My NHS funding came through on November 20th and I’m starting from scratch with the sensors week by week as long as I don’t keep trying to alter it.
I’m on Humalog insulin.
 
Thanks AJ. So do you have any suggestions? I'm 2 months in to the 780. Why is it running me so high? I feel they don't know what to do next, it reeks of desperation, and they are clutching at straws. I mean are they gonna start telling me to brush my teeth at 7.10 am instead of 7.05am, I'm teasing!
 
I'm going to request an Hba1c and see if that gives me more evidence to suggest that this whole thing just isn't good enough.
 
Mmmmmmm

Replacing sensors
I have now used 10 of the new simplera sensors since switching from Guardian 4. They work fine when they are working but I have had four of them finish 1 or 2 days early. They always replace them for me so not a problem, and I am happy that the system errs on the side of caution and asks me to change it if the system is in doubt, but that does seem quite a high rate of early finishes. I shall monitor and see what happens.

Manual mode on 780
Apart from brief periods when a sensor is warming up or at the start of a new pump I have not used the Medtronic pumps in manual mode. As we were out and about today when my sensor stopped working I went into manual mode. I knew that I needed a temp basal rate as we out walking. BUT where is it in the pump. Help from Medtronic users. I set up a pre set basal of 70% but then couod not see how to activate it. Can any Medtronic users help: @everydayupsanddowns , @Oblomov , @AJLang , @adamrit …
 
Oblomov said:
Thanks AJ. So do you have any suggestions? I'm 2 months in to the 780. Why is it running me so high? I feel they don't know what to do next, it reeks of desperation, and they are clutching at straws. I mean are they gonna start telling me to brush my teeth at 7.10 am instead of 7.05am, I'm teasing!
Click to expand...
Provided that your target is set at 5.5 I would honestly leave it for a few weeks, at least 12 weeks, so the algorithm can find the right levels then get a HBA1C. Have you gone into the carelink webpage so you can track it’s improving week on week? . I’m assuming you don’t take paracetamol?
Oblomov said:
I'm going to request an Hba1c and see if that gives me more evidence to suggest that this whole thing just isn't good enough.
Click to expand...
provided your target is set at 5.5 and you are accurately carb counting my advice is leave the settings exactly as they are for 12 weeks - don’t change anything - that way the algorithm can learn what it needs to do for you - 12 weeks won’t cause any complications. Do you know how to compare week by week and month by changes in results on the web page of Carelink? That can help to monitor whether your results are improving. If you phone Medtronic they they can provide further guidance on how to use the web version of Carelink. The website for accessing it is https://carelink.minimed.eu/app/login
 
SB2015 said:
Mmmmmmm

Replacing sensors
I have now used 10 of the new simplera sensors since switching from Guardian 4. They work fine when they are working but I have had four of them finish 1 or 2 days early. They always replace them for me so not a problem, and I am happy that the system errs on the side of caution and asks me to change it if the system is in doubt, but that does seem quite a high rate of early finishes. I shall monitor and see what happens.

Manual mode on 780
Apart from brief periods when a sensor is warming up or at the start of a new pump I have not used the Medtronic pumps in manual mode. As we were out and about today when my sensor stopped working I went into manual mode. I knew that I needed a temp basal rate as we out walking. BUT where is it in the pump. Help from Medtronic users. I set up a pre set basal of 70% but then couod not see how to activate it. Can any Medtronic users help: @everydayupsanddowns , @Oblomov , @AJLang , @adamrit …
Click to expand...
Hi SB2015 temp basal turn off Smartguard, which I think you’ve done, go into the insulin bottle in the middle of the screen, tap on basal and temp basal is there
 
AJLang said:
Hi SB2015 temp basal turn off Smartguard, which I think you’ve done, go into the insulin bottle in the middle of the screen, tap on basal and temp basal is there
Click to expand...
Thanks Amanda. I had been thrown out of Smartguard but had not turned it off.
Sorted. Thank you
 
Sorry to hear about your negative experience with the MM780 and smartguard @Oblomov

Sounds like you’ve already got most of the settings on the ‘stronger side’.

Good that you have the lower target set. And a stronger-than-actual meal ratio can help to offset the ‘superbolus’ basal suspend after meals. Additionally the artificially short Duration of Insulin Action at 2hrs will mean that the pump is free to correct earlier as it’ll read you as having less IoB sooner.

I’m not sure I saw you mention your Insulin Sensitivity Factor. How much does the pump think 1u will reduce your BG by? Could you perhaps cautiously strengthen that to make the corrections more effective?

One other thing to check (and this is only my own observation, not something that was suggested in training), in terms of ongoing basal-adjustment from Smartguard, and helping it keep track of my changing basal requirements I have found it important to ‘log’ any BG-lowering activity (even just a gentle walk) by setting a Temp Target. My gut feeling is that the pump recognises this as a flag for ‘exercise’, and knows your BG may fall, rather than assuming your BG is dropping because basal is too high.

Similarly it’s vital for me not to succumb to frustration and enter ‘ghost carbs’ that I never intend to eat. They might help on the day, but I think they can mangle the longer-term adjustments that are being made.

See also: Trying not to calibrate sensors, especially when it’s just sensor lag.

Hope you can find a way to make it work better for you.
 
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AJLang said:
The only exception being when I have cocodamol as the paracetamol falsely elevates my levels for two hours afterwards so that the Medtronic can say, for example. up to about 13 when BG is 8.
Click to expand...
One work around I use for paracetamol Amanda is to raise my target to 6.1 when taking them (which is quite a lot of the time). This protects me against the elevated BG that occurs but I don’t think mine is such a big gap as yours. Is it worth looking at raising the target to 6.7 or even use a temp target for the couple of hours?
 
everydayupsanddowns said:
Sorry to hear about your negative experience with the MM780 and smartguard @Oblomov

Sounds like you’ve already got most of the settings on the ‘stronger side’.

Good that you have the lower target set. And a stronger-than-actual meal ratio can help to offset the ‘superbolus’ basal suspend after meals. Additionally the artificially short Duration of Insulin Action at 2hrs will mean that the pump is free to correct earlier as it’ll read you as having less IoB sooner.

I’m not sure I saw you mention your Insulin Sensitivity Factor. How much does the pump think 1u will reduce your BG by? Could you perhaps cautiously strengthen that to make the corrections more effective?

One other thing to check (and this is only my own observation, not something that was suggested in training), in terms of ongoing basal-adjustment from Smartguard, and helping it keep track of my changing basal requirements I have found it important to ‘log’ any BG-lowering activity (even just a gentle walk) by setting a Temp Target. My gut feeling is that the pump recognises this as a flag for ‘exercise’, and knows your BG may fall, rather than assuming your BG is dropping because basal is too high.

Similarly it’s vital for me not to succumb to frustration and enter ‘ghost carbs’ that I never intend to eat. They might help on the day, but they mangle the longer-term adjustments that are being made.

See also: Trying not to calibrate sensors, especially when it’s just sensor lag.

Hope you can find a way to make it work better for you.
Click to expand...
Oooo that is a useful list of tips @everydayupsanddowns . Thank you.
Everyday is a school day.
 
SB2015 said:
One work around I use for paracetamol Amanda is to raise my target to 6.1 when taking them (which is quite a lot of the time). This protects me against the elevated BG that occurs but I don’t think mine is such a big gap as yours. Is it worth looking at raising the target to 6.7 or even use a temp target for the couple of hours I
Click to expand...

Thank you @SB2015 . I’ve got it sorted for me as I take it four times a day at about the same time each day. My target is normally set at 5.5 with no hypos. I’m not worried about the “highs” because I know they are false readings. The only time I have to act is putting on the temp target for two hours with the afternoon cocodamol. The rest of times the algorithm appears to have adapted ie despite it falsely reading high it doesn’t over treat to cause a hypo. Does that make sense?
When I’ve cross checked with finger prick BG’s after the cocodamol the readings are always normal despite the sensor saying fast rise up to 13, I’ve cross checked it a few times at different times after taking the cocodamol.
 
I've reduced my insulin sensitivity from 4 to 3.
Many changes have been made by my London hospital every 2 weeks or so, but it's not helping.
I guess I now need to run it for a while, see how it goes.
 
Oblomov said:
I've reduced my insulin sensitivity from 4 to 3.
Many changes have been made by my London hospital every 2 weeks or so, but it's not helping.
I guess I now need to run it for a while, see how it goes.
Click to expand...
As @AJLang said it takes time to get to know you. So let it run with the changes you have made and see how that works. It does take a bit of time to tweak it for your own needs, but I hope that in the end you find it worth it.
 
Hi
I had similar frustrations. I have found that increasing the Max Basal/bolts settings makes a difference for me.
Settings / Delivery Settings / Max Basal/Bolus.
I had to keep increasing but it did seem to improve things. You will see a warning saying only change under guidance…. But I ploughed on….. what you do is up to you …best to discuss….
I finished doubling and then doubled again from the default!

The other thing is to note that the recommendation now is for insulin bolus to be in the system 10 to 20 minutes before eating. This makes an enormous difference for me. I find that if SBG is low, then I take the insulin around 5 minutes before food. If I’m a bit on the high side I wait for the full 20 minutes.
One last tip: if you can manage it, 10 minutes of activity after my meal helps reduce the peaks….

As the pump is used for longer, making its own calculations on insulin sensitivity, the results become tighter.

Really hope this helps.
 
Thanks RRE. I've adjusted that too.

I've had a very disappointing email back from pump specialist nurse saying nothing more can be done.

Suggesting I speak to a psychologist if I'm not happy.

Also suggested that if it is not dealing with my dawn phenomenon enough, I set an alarm early hours of the morning, wake up, switch off smartguard, back into manual and give adjustment. Seriously? Every day? My old manual settings dealt with my dawn nicely. I couldn't believe what I was reading as advice!

Because I'm in target enough. This is true. I am in target at least 70% which is Medtronic objective.

But I'm not happy with being run at BG 8 or 9. Mind have been 10.3 and 11. Or running me for 6 hours at 8.

I want to be 4-6.

I have read many others posting the same. On Reddit or other forums.

This just isn't cutting it for me.
 
@Oblomov That seems a pretty shocking response from your DSN. I am guessing they are stressed!
Why not go back to manual mode if you are not happy with the closed loop performance. You have to balance out the benefit of it managing things for you versus it possibly not managing things as well as you could manually yourself.

I do think that there will be some people who end up disappointed with HCL because it isn't able to achieve the results that they could, particularly if people have very good diabetes management already. I can achieve high 80s to low 90s TIR with MDI and Libre with an HbA1c in the 45-50 range and I doubt I could achieve that on HCL. I put a fair bit of work into it but I don't find that a significant burden at the moment although I accept that could change at some point in the future. I just wonder if people feel that more technology has to be better and that isn't always the case and it is OK to step back from that technology if you feel it isn't beneficial to you as an individual.

I suspect your nurse has many patients who really struggle to get anywhere near 70% TIR and therefore her focus is probably on helping them improve. I know many clinic staff are under a lot of pressure from an ever increasing workload, so I can sort of understand the response you got but not good nevertheless.
 
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