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Oblomov said:
Thanks.
It feels very dismissive. I haven't replied to the email. I need to consider where I go from here
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@Oblomov Although she wasn’t very tactful I think the nurse is trying to suggest that you need to be able to accept mentally that the hybrid pump needs a different mental mindset from previous treatments. This means being able to let the hybrid loop pump do its own thing once the settings are in place. I know that because I’ve had diabetes for over 50 years both the Medtronic rep and the consultant were separately concerned that I wouldn’t be able to “lose control” to the pump but thankfully I have been able to. This photo is from my pump a few minutes ago - 5.9 and a smooth line - achieved by letting the pump do its own thing IMG_4699.png
 
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Oblomov said:
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.
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I think that going out of smartsensor mode needs to be kept to a minimum! The algorithms associated with the pump need constant information for good control.
To be clear, there are very few things that can be set in a situation of 780 G pump and smartguard 4 sensor:
1. Insulin active time: best at the minimum - 2hours
2. Target for Sensor blood glucose- most people choose the middle value, though I experimented with the lowest.
3. Carb ratios
4. Insulin sensitivity settings seem to provide a starting point, but I think the pump calculates its own every 24 hours at midnight.
5. The maximum bolus / basal the pump is allowed to infuse. I found this to make the most significant difference without causing hypos - but remember we are all different. In my case 20 and 15….,

Like you, I felt frustrated when I began with the pump. However, things did settle down and I became less fixated on keeping levels low and more focused on time in range. I once would have been concerned when BGlucose at 8 mmpl, but now am relaxed, knowing that this approximates the level of the lucky folk who do not have T1Diabetes.


If you exercise it is important, I think for me, to set the Smartguard Temp Target, preferably two hours before exercise but in any case.

I wish you well
 
RRE1 said:
5. The maximum bolus / basal the pump is allowed to infuse. I found this to make the most significant difference without causing hypos - but remember we are all different. In my case 20 and 15….,
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Ah of course! That’s a really good shout. I must check mine and see what they are set at 🙂
 
Simplera Sync Sensors.
I have had another two sensors finish after five days. I suspect that the new algorithm is over cautious and does an updating when it is not happy, and then tells me to change the sensor if it is still not happy.

Each time they have sent me 5 new sensors to replace the one that did not run the full seven days!! I am now going to report when a sensor does not do the full seven days, so that they have a clear picture of what is happening, but I will suggest that they do not replace it . I am currently in credit by 12 sensors.
As they do replace them I am going to keep to my convenient change over day, which suits what I have on during the week.

I am pleased that the system is cautious but it would be good to have some that make it to the full seven days.
 
Well what an awful meeting with pump specialist nurse that was. She says my expectations of the algorithm are too high and suggests I come out of safeguard into manual. Because I don't want to run at average blood sugar of 10. She says it's in range so is good enough. She says there's nothing more the hospital can do for me. I can't believe I'm being treated this way.
 
Hi @Oblomov if you come out of Smartguard at intervals you will reduce the reliability of the algorithm. It would be worth staying in Smartguard and then tweaking the variables. If your levels are too high the chart I was given recently advised me to try changing
Timing if boluses
Insulin to carb ratios
Insulin sensitivity

It is important to allow about two weeks after making a single change to see the impact and then make another change if necessary.

It takes time to get things right and it all keeps us on our toes. If you are not happy with your TIR (which should be >70%) then try making adjustments. It is impossible to be 100% in range.

I hope that you can make it work for you. It took me a good month to trust it to do my job.
 
Thanks SB but I've done all that. I've tightened up all my settings. I've done everything everyone on here has suggested. I've lowered my carb ratio again and again, upon instruction of pump nurses. I've been on smart guard, 780 and simplera for 4 months now. Before that a Medtronic pump for 25 years.

Still my TIR is good. I'm in range often 100%. But it runs me high, often at 10 or 11. How is that any good. I want to be running at 4.5 to 6 ideally.

Plus it can't cope with my dawn phenomenon. So she's now saying to come out of smart guard at night, wake myself up, once or many times between 4am and 7am, switch to manual, give an adjustment. Then go back into smart guard. What's the point of that?

Smart guard you need to stay in, so it learns. But because it can't work properly because the algorithm is so conservative, they are suggesting I jump in and out of it.

Can you not see the irony of what a stupid suggestion that it, it reeks of desperation by the hospital.

Plus until now. Their only suggestion was to lower by carb ratio. For 50 years I've been on 1:1, or 1 carb to 0.9 insulin roughly. Now I'm on 1:3. But she's now saying it's causing my basal to cut out. Sending me high post meal. So to increase it back.

And she's saying that I am in range. At 9.8 or 10, and I should be happy with that. They seem more focused of the fact I'm in range, than what my actual blood sugars are.

And if I'm not happy there's nothing more they can do, basically implying I either I leave the hospital or actually suggesting I see a psychiatrist. Was her suggestion.

Are you honestly suggesting this is good support, from one of London's hospitals which has a big diabetic dept?
 
Oblomov said:
Are you honestly suggesting this is good support, from one of London's hospitals which has a big diabetic dept?
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No I am not. I was just trying to suggest things that I have found for myself that it is useful to work through step by step.
I found the transition very difficult myself. If it is not helping you perhaps revert to what you were doing before.
 
Something I have noticed recently

For the last three sensors at the end of the warm up period it doesn’t ask me for a BG and just puts me in Smartguard. I am wondering whether this is because at the time my SGs are pretty level at the time as the sensors have gone in a good couple of hours after a meal. Has anyone else experienced this. In Guardian sensors it always insisted on having a BG.
 
Hi SB, that’s what happens when I finish a sensor and start a new one. I think when the old sensor finishes a countdown starts giving you 4 hours to get a new one started and you will see the countdown on your screen along with the warmup timer. If you get it all done within the 4 hours then it won’t ask you for a BS but if you take longer then you will be asked. I suppose you could argue it’s looking for continuity but the cynics ( me included) might argue it’s a clever marketing ploy to insure people are always inserting their sensors on time. I try to enter a BS anyway when the new sensor goes live to allow it calibrate itself, I think this prevents some of the shaky readings you get with the first few hours of a new sensor.
 
MatC said:
Hi SB, that’s what happens when I finish a sensor and start a new one. I think when the old sensor finishes a countdown starts giving you 4 hours to get a new one started and you will see the countdown on your screen along with the warmup timer. If you get it all done within the 4 hours then it won’t ask you for a BS but if you take longer then you will be asked. I suppose you could argue it’s looking for continuity but the cynics ( me included) might argue it’s a clever marketing ploy to insure people are always inserting their sensors on time. I try to enter a BS anyway when the new sensor goes live to allow it calibrate itself, I think this prevents some of the shaky readings you get with the first few hours of a new sensor.
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Thanks Mat

In Guardian 4 it would not move into Smartguard without a BG. This change is another improvement, possible with the integrated transmitter. I had noticed the exit in 3 hours … min when I disconnected the old sensor. I was also turning off the sensor before replacing which I did not do the last few times.

I tend to put in a BG where the pump goes into ‘updating’ in the hopes of resurrecting the sensor, which works sometimes. Providing my levels are reasonably steady I have not put in a BG at the start, it probably still a good idea to do so.
 
So I have had a bit of a problem and I need a rant.

My most recent sensor has definitely not been behaving as usual. I have been woken early with lows about 4:00 am, today I have had a repeated hypos and finally one where SG was 6.8 and BG was 3.8. Glad I went with my symptoms rather than sensor.

I phoned Medtronic to check whether changes I planned to make to sensitivity factors would impact on algorithm, but got a lecture about how I should not be making any changes on my pump without first consulting my HCP. Ever since I have been using a pump I have done checks and made changes to ratios as necessary. I have only contacted DSN where I am uncertain about things. I have thought that any pump user would be doing the same. Am I right?

The advisor looked at my data which I had downloaded, and told me that I had been entering false carbs. I asked why she thought that and she referred to last night. I had been at a long supper party and had no idea what or how much I would be eating so had added in carbs through the evening as necessary. No ‘false carbs’ just what I had eaten through the evening. Not an ideal way of doing it but previously the algorithm would then do any auto corrections and flatten things out by the early hours.

I eventually agreed with her that I would replace my sensor and she would send a replacement. When I took it off there was fresh blood and it was very soggy under the sensor. I think I realised why things had been so awry today and now have now sensor in from a new box.

I have always had very useful conversations with the Medtronic reps on their pump line but today, fuse would not give me any advice just kept telling me that I should not change anything without speaking to my DSN. I have always done my own changes. I would not expect to be able to speak to a DSn but happily email them and find that they will reply within a day. Most of the time they simply confirm what I had thought. I had picked up at the training for my most recent pump, make changes as necessary of 10% and wait at least two days before making further changes. Anyone else make their own decisions?
 
SB2015 said:
I have thought that any pump user would be doing the same. Am I right?
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I think the vast majority yes. I have always ALWAYS made adjustments to my own factors and sensitivities on every pump I have used. HCLs are no exception. I have far far more data about how I am reacting to consistent meals and routines and whether things seem to have changed behind the scenes.

Up until morning to the 780 I’d be making changes anything from 3 monthly to 3-4 times a MONTH! There is no way on earth I could have that much access to a DSN.

Sorry you had such a frustrating and negative experience with Medtronic support. I wonder if this was a new call handler who had only been recently trained and the official line is that people should “check with their HCP before making changes”. Accusing you of entering false carbs is a bit more problematic though. I’d almost consider an official complaint about that so that the call (if recorded) could be reviewed.

As you may recall, my introduction to MM780 was in a tent in a field with the rep. They talked me through a basic set-up, and I said I’d adjust from there depending on how my diabetes got on with the algorithm. It was never suggested that this was a Bad Idea. That was last summer, and I haven’t seen or spoken to any DSNs about pump setting since, only a few emails to sort ordering glitches.

Current TIR is 98% so making my own tweaks seems to be working OK?
 
Has anyone else had a few dodgy sensors?
I am on 50% failure rate from starting in October 25, with rather a large number of them this week.
 
Some solutions to my recent difficulties:

Sensors
I looked back and found that I was changing a sensor as soon as it failed and in some cases this was soon after a meal when glucose levels were changing quickly. My DSN pointed out that this is not an ideal time to change over - A different pair of eyes on data spots a different pattern) Better to change it when my levels are more stable, for me over an hour before a meal- allows warm up to complete and then pre bolus time. I shall see if this helps reduce the failure rate and reduce these to just the standard skanky sites that can affect anyone.

Night hypos
I was dropping around 3:00 am and being woken with alerts or a hypo. I had tried changing insulin sensitivity factor but this does not impact the algorithm. No bolus active as long time after last meal. I have now changed my active insulin time (increased the time - softens the action of corrections). Mine is quite a bit higher than the standard settings, which bothered me at the training and I had tried reducing it. My mistake - We are all different . Now sleeping through the night. (@Oblomov wondering whether this might help you)

Medtronic pump support blip
After my unusually unpleasant and experience in the support line where the advice I was given was incorrect, I was able to provide some feedback. Hope that helps the person.
 
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