780 Users

Hi @Diabolized
I have been using the 780 in closed loop (Smartguard) for over three years now and it is working very well for me. I did get training at the start, and I found the switch from a Combo to a Medtronic pump was a main difficulty, as ell as handing over responsibility to my pump for a large amount of stuff that I had done myself before

Setting up the 780 in manual mode is much the same as it was for your 640, so I doubt that you will have any issues around that. There are good videos available from Medtronic if you have any concerns, and it would be useful to familiarise yourself with the manual operation before using Smartguard, and to do some basal rate tests to check your profiles. ( For me it was a new language as Combos used other words for things).

The manual is clear but some pointers.
BEFORE you insert a sensor and activate Smartguard you need to pair your transmitter with your pump (so that they can talk to each other) . I only do this once a year when I get a new transmitter so forget how and just follow the instructions in the manual. Take your time and work through step by step. The transmitter also needs to be fully charged before being inserted.

For Smartguard you need to insert the sensor and then the transmitter. They suggest that you do this in your arm but I find I need two hands for this so if I am doing it myself I put it in my abdomen. Now my partner does it most of the time and uses my arm. Once the transmitter is out of the charger I activate the sensor on my pump. Bottom right on menu and device settings.

In the early days I phoned the helpline and they are VERY patient and will stay on the call whilst you work through things step by step.

I hope it suits you as much as it does me. This thread includes lots of tips and wrinkles to help, but come back with any questions.
 
SB2015, many thanks for your reply.
I just wish my Diabetes Clinic would reply as quickly. Since Covid their service has gone down hill.
I haven't started using the closed system yet because I want to read the literature first.
Still puzzled as to why the clinic said there would have training for those switching to the closed loop system and then said set it up youself.
 
I hope that your transition goes smoothly.

You will already have the manuals that arrived with your pump and sensors. There is a bit of going and firing between manuals and sections in the main book but the info is there. Add in the support line, which are brilliant, and all the info is there.

There is also a good collection of webinars on specific topics, with a regular programme each year. I have noticed that these have changed as they have gathered info from people using the system.
 
Today I finally had a phone call with the DSN responsible for pump users.
The new pump and equipment for the HCL (hybrid closed loop) system should have been sent to the clinic and not my home address. Someone made an error.
DSN has been on annual leave which explains the poor communication.
I should not have been told to set the up HCL system myself and will receive training.
The clinic wants to switch pump users to HCL and are running group and individual training sessions for the new system.

Also found this on the NICE web site:
Need for specialist support: People with diabetes, their families and their carers need training and specialist support to use insulin pumps, glucose monitors and hybrid closed loop (HCL) systems effectively.
(https://www.nice.org.uk/guidance/ta943/chapter/4-Implementation).

I feel this sorry episode is a reflection of poor communication and a service that is under extreme pressure.
Before Covid I received excellent service from the clinic but sadly this is no longer the case. I feel very sorry for the staff struggling to do their job in these difficult times.
SB 2015 your support was much appreciated. I'm also very grateful and much relieved that the DSN finally called me back. Just a pity it took so long and caused unnecessary worry.
 
Diabolized said:
Today I finally had a phone call with the DSN responsible for pump users.
The new pump and equipment for the HCL (hybrid closed loop) system should have been sent to the clinic and not my home address. Someone made an error.
DSN has been on annual leave which explains the poor communication.
I should not have been told to set the up HCL system myself and will receive training.
The clinic wants to switch pump users to HCL and are running group and individual training sessions for the new system.

Also found this on the NICE web site:
Need for specialist support: People with diabetes, their families and their carers need training and specialist support to use insulin pumps, glucose monitors and hybrid closed loop (HCL) systems effectively.
(https://www.nice.org.uk/guidance/ta943/chapter/4-Implementation).

I feel this sorry episode is a reflection of poor communication and a service that is under extreme pressure.
Before Covid I received excellent service from the clinic but sadly this is no longer the case. I feel very sorry for the staff struggling to do their job in these difficult times.
SB 2015 your support was much appreciated. I'm also very grateful and much relieved that the DSN finally called me back. Just a pity it took so long and caused unnecessary worry.
Click to expand...
let us know how you get on.
 
Radders said:
I have been AWOL a long time as I became somewhat obsessive and decided to stop checking in as part of relegating diabetes to where it belongs in my list of “interests”!

However my third pump (accu chek Combi #2 after a 6 year stint with a Spirit) has now reached the end of its warranty and I have been offered the choice of a Medtronic 780G, Omnipod Dash or Tandem T-Slim. In an ideal world I’d like another Combi but that’s not a possibility.

The Medtronic is top of my preferences, mainly because of deal-breaking features of the other two (rechargeable batteries, lack of buttons, inability to adjust pump position).

I moved from MDI having done DAFNE to a Spirit first which had no remote control, no bolus wizard etc so I got very accustomed to doing all the sums in my head. Apart from very rare occasions on cruises where wardrobe requirements meant I had to, I don’t use the meter as a handset to control the pump, and just press the buttons on my pump to dose insulin. I don’t feel I need the closed loop system, especially since having the alarm on my Libre.

Am I right in thinking that this is possible with the 780 please? I don’t want to tell my pump my full life story every time I eat. Can I just use it as a standalone insulin delivery device?
Click to expand...
Two year late reply. I have a 780G and a 4 sensor. I basically don't count carbs, but I do pay attention. I take about 4 units plus for each meal and increase it depending on the meal. I am between 92-95% in range, probably because I've been living with Type 1 since 1956 and trust the 780G. It has to work a lot giving multiple small extra doses if my BG goes up and stops the background basal if it goes down. Before starting the 780G, I had to work constantly to keep at all upright with constant demand for sugar when hypoing and needing several extra shots when too high. The worst was never knowing how my body would react to food. Before 780G, I used to weigh my 38 gms muesli every morning and take 4 units, and BG would either shoot up or down in wild variations without reason. Different every day. The 780G has just changed everything for me. The sensor tells me if I am going low and the 780G automatically give me the correction doses when high. The constant never ending diabetic anxiety has gone. Admittedly, I don't have mad urges for rhubarb crumble when I've already had enough food. I just eat what feels right. My weight is stable at 74kg and 1.8m.
So although the whole 780G system is based on carb counting, when I just increase the carbs until the insulin dosage feels right, usually about 4.3units, I press GO. I couldn't rely on carb counting when I used a 640G because it didn't work and I use judgement, not carb counting, to decide on insulin dosage with the 780G and it works. Ten years ago, I was 59% in range, now it's above 90% with no worry and minimum input. I change the sensor once a wek and the infusion sets every four days (against all advice) because I am lucky and they last exactly that long without exception, though many people have to change every couple of days. O lucky man
Adam
 
LoLiz said:
Hello! I am on the 780 plus G4 sensors and have been a for a few months. I'm totally NHS funded as I have no warning symptoms and drop like a stone. I've found it hasn't managed to sort out my morning rise in BS - I think it's because I have a fairly small TDD, and it won't correct too much as a percentage of that - but I need lots of insulin in the morning and hardly any in the afternoon. I have to have a no-carb breakfast and give myself an insulin bolus of 15g pr more for nothing! Apart from that it is great fun having a pump that does seem to keep me ok most of the time. Still have a few hypos though. Just got my results today and despite not being that good, it's at 49 which in old money is 6.6. However, I've had a crash with my egfr which is always at 90 - it has gone down to 71 which has shaken me. Have to be retested.
Click to expand...
If you change your sensitivity ratio in the morning, the 780G will sort it out. I have a 5 to 1 ratio (5gms carb per unit of insulin) from 6.30-10.00 and 10 to 1 for most of the rest of the day. I give myself 4.3 units before breakfast and everything calms down. 92% in range.
Type 1 since 1956. 780G and 4 sensor on NHS for 3 months and 640G before for 25 years. No hypo or hyper awareness. 73kg 1.8m h. TDD 33 units
Adam
 
Can I ask what sort of training other users of Medtronic 780G received from the company before starting on the pump? How did it happen?
 
Last edited:
Headley said:
Can I ask what sort of training other users of Medtronic 780G received from the company before starting on the pump? How did it happen?
Click to expand...
Mine was done when the HCL first got NICE clearance, so my DSN was learning with me.

I had a training session with Medtronic rep and DSN and two other people through zoom. This got me onto the pump and using their sensor. A month later I then had another session just with Medtronic and DSN to switch to HCL. After that I had support from DSN.

I found it hard to allow the system to do its job and kept interfering, which then mucked up the closed loop. I gave up on it for a couple of weeks and then started again with another sessions with DSN. I also had a follow up with Medtronic through their support programme for newbies.

All training was via Zoom.
 
adamrit said:
Two year late reply. I have a 780G and a 4 sensor. I basically don't count carbs, but I do pay attention. I take about 4 units plus for each meal and increase it depending on the meal. I am between 92-95% in range, probably because I've been living with Type 1 since 1956 and trust the 780G. It has to work a lot giving multiple small extra doses if my BG goes up and stops the background basal if it goes down. Before starting the 780G, I had to work constantly to keep at all upright with constant demand for sugar when hypoing and needing several extra shots when too high. The worst was never knowing how my body would react to food. Before 780G, I used to weigh my 38 gms muesli every morning and take 4 units, and BG would either shoot up or down in wild variations without reason. Different every day. The 780G has just changed everything for me. The sensor tells me if I am going low and the 780G automatically give me the correction doses when high. The constant never ending diabetic anxiety has gone. Admittedly, I don't have mad urges for rhubarb crumble when I've already had enough food. I just eat what feels right. My weight is stable at 74kg and 1.8m.
So although the whole 780G system is based on carb counting, when I just increase the carbs until the insulin dosage feels right, usually about 4.3units, I press GO. I couldn't rely on carb counting when I used a 640G because it didn't work and I use judgement, not carb counting, to decide on insulin dosage with the 780G and it works. Ten years ago, I was 59% in range, now it's above 90% with no worry and minimum input. I change the sensor once a wek and the infusion sets every four days (against all advice) because I am lucky and they last exactly that long without exception, though many people have to change every couple of days. O lucky man
Adam
Click to expand...
Good to hear how well this is working for you, and that the extended infusion sets are working for you.
 
I have had a message asking me to update my iPhone in order to continue using the NHS app. However my phone is wanting to update to v17, however the minmed app is compatible with versions 15 and 16, but does not mention V17.
Is anyone using their minimed mobile app with V17
 
I got my closed loop system a week ago, with an hour's training on Teams from a rep. First few days were great but now I'm so sick of hypos, I don't know what to do. I just seem to yo-yo all day and if I don't eat sweets when I'm heading low I go hypo (yes I have tried leaving it). Hypos in the middle of the night most nights. Hypos after most meals. Hypos every time I do minor activities. Went for a long bike ride on Tuesday, used activity mode for 24 hrs after but still hypoing now. I have reduced the insulin sensitivity at all times of the day. I've raised the target BG to 6.1 (having started on 5.5). Not sure what effect changing active insulin time would do- I used to have it on 4.15hrs, the rep made me change it to 3 but said 2 was ideal. I feel that would make the yo-yo ing worse but not sure I understand it well.

Any more suggestions?

Don't really want to chase my nurse as I'm on holiday next week so can't really chat, maybe I should try to book an appointment for the week after or something.


Thanks for reading if you got this far!
 
It takes some time to settle down and ‘learn’ what insulin you need. I was told to run the pump in manual for 72 hours before switching to smart guard.

I have weird data when things don’t go sensibly and sometimes I have no idea why. However it does settle down after a while.

For extended exercise I find the switch to temporary target isn’t enough. I would set this at least two hours before I start, but then I still find I need to drip in glucose in throughout the day.

There are workarounds so stick with it if you can. The HCL deals with the hum drum but you will have to be more involved in the extremes. Still worth it.
 
Thanks for your reply, SB2015. Sorry, I should have explained I've had Medtronic pumps for 7 years, it was just the sensor that was added last week. Had a better night (swung between 8 and 5 so at least no hypos) so feeling a bit more positive this morning.

Does everyone else have a wiggly line overnight? I expect smoother line, but mine is line a sine wave.
 
Hi @Pigeon
I am glad that you are familiar with the pumps. When you say you are now using the sensor are you using the pump in Smartguard or in manual mode?

In Smartguard, however long you have been using the pump, initially you will need to have the sensor in and work the pump in manual so that the pump has 72 hours of sensor data before you ask it to operate in Smartguard (HCL). This is only when you start for the first time. After that you just go through the two hour warm up with each sensor.

My graph is a bit wobbly at night but I find that I do not worry now if I eat a bit later. I know that the pump will do any corrections or stop basal to get me back on target. If you expand the graph to more hours (enter the graph mode -Top RH button) it shows three hours of data initially. I. The morning this looks a bit wobbly and then settles to sine curve with much smaller peaks and troughs. I tend to look over a longer period (us the up arrow and it goes to 6 hours, then 12 then 24) wobbles look smaller.

I hope that things settle soon. Try to trust it and spot over time when you need to intervene, or even lie to the pump. If I am exercising for a full day (for me walking) I use a temp target and set that at least an hour before we start walking. I will still pre-bolus for lunch as best I can, but knock off some of the carbs. I will also dribble in glucose in the form of Wurthers through the day. It works a lot of the timkmme, but not always, but then when I was working in manual things went wrong. In HCL there are a lot more easy days and fare fewer horrors.
 
Hi there, thanks for your latest reply. I'm using Smart Guard, the rep took us through inserting a sensor then we turned on smart guard there and then so that it started after the 2 hour warm up. So maybe that means the first few days we're not "true" smart guard as it didn't have 72 hrs sensor data?

Someone rang me from Start Right today and they reckoned it could take 2 weeks to bed in so maybe it just needs time.
 
If takes time for Smartguard to learn the patterns of your life. Think how hard you work doing this. Give it time and then you will just be helping it with the out of the ordinary bits.

The tech support team on the pump Careline are brilliant during office hours. Also if any sensors stop before the seven days is up claim a replacement. This is never an issue. You can do a lot through the app Penny but I prefer to speak to someone .
 
I’m having problems with my sensors saying that my BG levels are much higher than they are and thus causing hypos. So for example today it said a steady line of 6.4 fortunately I didn’t feel right and finger pricked and it was 3.4!
Over an hour later finger prick says 7.3 and sensor 9.4 - the problem with this is it has given 1.5 units of active insulin so high chance I will hypo again. When I did hypo I had 25 carbs which should have put me a lot higher than 7.3 (i didn’t tell the pump I’d had the 25 carbs)
This isn’t the first time that the sensor has said higher readings, given insulin for the higher level, automatically given extra insulin that has led to a hypo.
Ps until these problems I’ve been on Smartguard for four months and been hands off with it.
 
Hi Amanda
I had a box of sensors that just were not reliable. These were replaced when I called.
You have already found that the system works for you normally so well worth getting replacements, especially as the readings are so far out and causing hypos.
Let me know how you get on.
 
SB2015 said:
Hi Amanda
I had a box of sensors that just were not reliable. These were replaced when I called.
You have already found that the system works for you normally so well worth getting replacements, especially as the readings are so far out and causing hypos.
Let me know how you get on.
Click to expand...
Thank you but at the moment I don’t trust it. It’s going down fast again now, but I only know because of finger pricks. I have these because of hypo unawareness so scary when they put in too much insulin.
I’ve already, in four months had problems with six sensors that have needed replacing for various reasons. I’m still owed three of these and fed up about hearing about their stock problems.
 
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