780G users and other closed loops

[SB2015]

I know that we have a few on here using the Medtronic 780G (such as @RiRi80 and @Maco ) and other closed loop pumps such as Tslim or ‘home made’ versions. Just wondering how things are going?

I have settled into using my 780G and finally felt that it was giong well enough that I would now have my HbA1c. The CareLink data that comes with the pump showed a Glucose Measurement Indiex (GMI) which I had never heard of. that was reading as 47.4. My HbA1c came back as 47 so a good match to the GMI. Also I am having far fewer hypos. From one or two every day, to one or two each week, and those are picked u more quickly.

I wake most mornings now after a good sleep at 5.5 which is my chosen target. At Connect One UK at the weekend someone commented that the Closed Loop systems were great until we got involved (such as meals and exercise). I manage the meals with appropriate timing if Bolus where possible and exercise is now a lot easier. My OH summed it up as
‘ You need to tell the pump what it needs to know to make it do what you want it to do’.
So right and I enjoy a few ‘free’ carbs each half hour on a long walk which the pump doesn’t get told about, and that seems to work well.

I am aware that I am already thinking less about diabetes and enjoying a lot more sleep, as well as relying on the pump to sort out any miscalculations in carbs, or late snacks. Whatever I go to bed on I end up pretty close to 5.5 when I wake. I still keep checking but I suspect that I will gradually test it more. I self fund the sensors and it now seems worth it.

It took me a long time to settle into this pump as I was hit with a variety of issues that are challenging on a pump at any stage, along with other external factors.

Any feedback from other loopers?

 

[everydayupsanddowns]

I am having a very positive experience of my Tandem tSlim on the whole.

I get on really well with the G6 sensors (though they are a bit pricey!).

My overnight levels with the ‘sleep mode’ have never been better. I almost never get woken by alarms as used to happen sometimes on the MM640G, and I almost always wake with BG around 5.5-6.8 and a nice flat line from 3-4am onwards.

It’s not perhaps as ‘hands free’ as I had hoped, I do still need to keep a pretty close eye in things as Control IQ is too slow to catch more rapid rises and falls.

The infusion sets aren’t brilliant for me unfortunately. I’ve had a fair few fail with ‘tunneling’ where the insulin leaks back out around the outside of the cannula rather than staying in the s/c tissue to be absorbed. This has happened enough times that now whenever I see an unexpected rise, rather than just assuming I cocked up, I will rub my finger around the infusion site to see if it smells of insulin.

Results are good though on the whole though. I’ve probably added 5-10% to my time between 4-9, with still only 1-2% of time spent below 4.

TIR for the ‘international consensus‘ thinghy of 4-10 over the last 90 days is 93% with 1.something below 4

Not had an A1c since I started, so I’ve no idea if it has had any impact on that.

 

[SB2015]

I am having a very positive experience of my Tandem tSlim on the whole.

I get on really well with the G6 sensors (though they are a bit pricey!).

My overnight levels with the ‘sleep mode’ have never been better. I almost never get woken by alarms as used to happen sometimes on the MM640G, and I almost always wake with BG around 5.5-6.8 and a nice flat line from 3-4am onwards.

It’s not perhaps as ‘hands free’ as I had hoped, I do still need to keep a pretty close eye in things as Control IQ is too slow to catch more rapid rises and falls.

The infusion sets aren’t brilliant for me unfortunately. I’ve had a fair few fail with ‘tunneling’ where the insulin leaks back out around the outside of the cannula rather than staying in the s/c tissue to be absorbed. This has happened enough times that now whenever I see an unexpected rise, rather than just assuming I cocked up, I will rub my finger around the infusion site to see if it smells of insulin.

Results are good though on the whole though. I’ve probably added 5-10% to my time between 4-9, with still only 1-2% of time spent below 4.

TIR for the ‘international consensus‘ thinghy of 4-10 over the last 90 days is 93% with 1.something below 4

Not had an A1c since I started, so I’ve no idea if it has had any impact on that.

Great to read that things are going so well.

Like you I had expected it to be more hands off, but it is still a lot easier than before.
I also find that it doesn’t catch rapid drops. I find that it does sort out rises and deals with odd miscalculations of carbs well.

I particularly like the quality of sleep, even with the odd alarm for a callibration.

I think this change is a bit like the switch from MDI to pump.
It is going to be hard to consider going back now.

I shall be interested to see how it copes with a severe illness.
That might require a switch back to manual.

 

[trophywench]

Well I should jolly well hope you don't find out how it might cope with severe illness any time in the foreseeable future!

If you do - that's an emergency - so we just have to do whatever we have to do.

 

[JohnWhi]

I have been with the 780G and Smartguard for about seven weeks. To some extent I am still learning about the system, and I think the software is still learning about me. One noticeable feature is that it has reduced my insulin requirements. By comparison with "manual" use, it seems to reduce boluses by 10-20%, allow the SG to go comparatively high, then deliver a significant number of Auto Corrections. Most of the time, this seems to work well, though there are exceptions. Yesterday, with about 20-30 grammes less than the entered carbohydrate, I ended up being over target for 46% of the time, along with warnings about checking the infusion set (I replaced it). To see how it would cope, I left it overnight. It was back to 5.4 the next morning.

 

[SB2015]

I have been with the 780G and Smartguard for about seven weeks. To some extent I am still learning about the system, and I think the software is still learning about me. One noticeable feature is that it has reduced my insulin requirements. By comparison with "manual" use, it seems to reduce boluses by 10-20%, allow the SG to go comparatively high, then deliver a significant number of Auto Corrections. Most of the time, this seems to work well, though there are exceptions. Yesterday, with about 20-30 grammes less than the entered carbohydrate, I ended up being over target for 46% of the time, along with warnings about checking the infusion set (I replaced it). To see how it would cope, I left it overnight. It was back to 5.4 the next morning.

Interesting to read how you are getting on.

I certainly found that it took time to settle and needed a ‘normal’ period to get this done, ie one without infections, COVID jabs, and other disturbances.

I have been surprised to see the pump start to reduce the bolus for larger meals. In manual I would have tended to increase my bolus for a bigger meal. However as my intention is to have to think less, and let the pump do more, so I let it get on with it, and does seem to work.

I have also noticed that if I have wobbly day, usually due doing exercise and forgetting to use a Temporary Target, I then have a slightly wobbly day for a couple afterwards. However that makes sense as the pump is drawing in the previous data from a few days to set the basal insulin each day.

it has been good to see that even if things are not spot on at bedtime, they settle out overnight with no input from me and I wake, most mornings on target.

So far so good.

 

[SB2015]

I had a review with the trainer from Medtronic yesterday.
We focused on the use of their data package Carelink and how I could use that to identify any changes I needed to make to my carb ratios, sensitivity or action time, which are the only three things that are in our control. I also reflected on the positives so far of using this pump in Smart Guard with the self funded sensors. Here they are

Positives of using 780G pump in SG mode
- better time in range with less effort (in the 70s before- now mostly in 80s or 90s)
- far fewer hypos : one or two each day before - now one or two per week
- rarely above 14 as pump kicks in and brings me back down
- hypos picked up more quickly with alarms, so rarely below 3.5
- slower delivery of bolus has led to fewer skanky cannula sites.
- Mio advanced cannulas easy to insert
- larger meals dealt with by autocorrections so less thought needed at meals
- inaccurate carbs corrected by autocorrections
- sight of all the info on the phone without doing anything.
- better sleep as pump sorts out wobbles and then settles.
- Carelink collates all data and provides very useful reports and easy to see what needs changing
- no Fasting basal tests to do.there is no point as the basal rates vary every 5 minutes.
- access to training excellent and given at an appropriate pace for each person
- telephone support line excellent and willingness to answer my detailed questions
- replacements sensors provided where things go wrong

Puzzles I am still working on
- strategies deal with exercise of different intensity

The one irritation
- having to access the pump to do anything
(Here’s hoping that in the next four years Medtronic manage to connect a handset via Bluetooth like in Combos)

 

[Pandora71]

Thanks for this thread. I've just had funding approved for t slim iq plus will go for funding for my Dexcom too so will report back as the looping bit is what has convinced me to switch from my Roche Insight.
I think I can see the data on my phone app.

 

[everydayupsanddowns]

I think I can see the data on my phone app.

Dexcom G6 will certainly display on your smartphone.

I believe there is a phone app planned for the tSlim, but unfortunately that is in that potentially never ending ‘soon’ timescale 🙂

 

[Bluesky]

I’m new to the 780 and began a trial today of the G3 sensor before making the decision to self fund.
Feels strange as I head off to bed this evening! Hoping all goes well overnight
So much to learn and put my trust in this system. Fingers crossed

 

[Tezza]

I have been on the Medtronic 780G just over a week now, was on the 670 before, and Im loving it.

I'm registered blind, so the app for me is brilliant, as my iPhone will use the accessibility feature " VoiceOver " to read what is displayed on my iPhone screen - a HUGE step forward for me. I have been learning the menu on the pump for a few months before I got the pump, so am relatively confident as to where each section I need to access is.

If Im not 100% sure, I use another app on my phone to read the screen of the pump - but dont have to do that very often. The 780G has been a game changer for me. I lost my sight 2 years ago, and was really struggling, and depended on my partner a fair bit - but now, its much easier for me. Im always ( so far ) in range between 85 and 100&!

The thing I also like about this pump is that it is much less needy than the 670, I have full trust in the pump and it just works.

 

[SB2015]

Welcome to the forum @Tezza

So pleased that you are finding your 780 is working so well for you.
It took me some time to settle into this, due To a variety of hiccups.

 

[SB2015]

Thanks for this thread. I've just had funding approved for t slim iq plus will go for funding for my Dexcom too so will report back as the looping bit is what has convinced me to switch from my Roche Insight.
I think I can see the data on my phone app.

I hope the switch goes well. I certainly find I think a lot less about my Diabetes, and have learnt to let the pump get on with it’s job.

 

[Fatterthantheshadow]

Such an interesting thread, I've learnt so much from it, unfortunately in my postcode there aren't really many options to get high end systems. Even if I was in a position to self fund the trust I'm with seems behind the times. I've built my Android Artificial Pancreas System for next to nothing, two MiaoMiao2 transmitters (just so I have a back up) about £260 in total. Everything else is funded or pre owned: pump, libre, smartphone and watch. My main investment has been time to study and build the system, two weeks self isolation helped to start things off. I've become much more knowledgeable in the last eight months compared to my previous 21 years as a t1d.
Agreed, waking up perfectly on target no matter how badly or well I've treated my diabetes the previous day is just amazing and it happens again and again.
The way I use my phones's gps to trigger temporary targets, arriving at the gym for example, really blows my mind.
I haven't been face to face with my diabetes team for one and half years now, I've tentatively discussed how I've been experimenting with technology but they haven't seen it for themselves. My hba1c is 6.8% (told you they are behind the times) and I've been put on yearly appointments, I used to be 4 monthly.
I remember closing my loop for the first time with some intrepidation and I'm so glad I made the step.

 

[SB2015]

I briefly looked at the insight pump as I was aware that it was possible to loop it with the Libre, but I was not confident enough to go DIY. having gone closed loop it has achieved for me what I wanted, having to think a lot less about my Diabetes.

It is a shame that your area does not offer a wider variety of pumps, but I think this will be related to the training they have in order to provide support. With my last change I did all my training with Medtronic via Teams. This development may also impact the way things progress in the future.

It sounds like using the Insight, you still have the TBRs available and also remote control of the pump (if that is the same as the Combo). With each system there are pros and cons and we each find tweaks that we can do to make it work for us. It Will be interesting to see what becomes available over the coming years. The cost of sensors are definitely dropping with the challenge of the Libre availability and the increased use of others.

I look forward to hearing more from you.

 

[trophywench]

I think Tezza is probably in America, or at least not in UK, as they mention BG between 85 & 100 being 'in normal range'. (which it is, in mg/dL)

 

[Fatterthantheshadow]

I briefly looked at the insight pump as I was aware that it was possible to loop it with the Libre, but I was not confident enough to go DIY. having gone closed loop it has achieved for me what I wanted, having to think a lot less about my Diabetes.

It is a shame that your area does not offer a wider variety of pumps, but I think this will be related to the training they have in order to provide support. With my last change I did all my training with Medtronic via Teams. This development may also impact the way things progress in the future.

It sounds like using the Insight, you still have the TBRs available and also remote control of the pump (if that is the same as the Combo). With each system there are pros and cons and we each find tweaks that we can do to make it work for us. It Will be interesting to see what becomes available over the coming years. The cost of sensors are definitely dropping with the challenge of the Libre availability and the increased use of others.

I look forward to hearing more from you.

The accu-chek Insight Handset/remote is a complete piece of trash, if the insight pump doesn't have a good name it's because of this item, I'm sure 95% of users would rate it so. Such a shame, it's a fantastic Pump just totally miss matched. Luckily an Android phone replaces the handset.
It's kinda hard to explain! Before I looped I had the option to set a + or - TBR for the usual stuff activity, illness etc, quite basic stuff. Looping, I set temp targets rather than TBR's. The system sets a new TBR every 5 minutes to keep you on target, you set the target the system adjust the rate, the algorithm also uses SMB's (super micro bolas) too. If I'm going to run a marathon or socialise hard I can do a percentage profile change, for example +150% will affect bolas, basal, IC, ISF, DIA across the board, I tend to up it some during my weekends off work. That's it in a nut shell, though in reality totally more in-depth, although the user interface really isn't overcomplicated, the devil is in the set up.

I've no experience what so ever with other systems, would you concur it's is similar with yours

 

[SB2015]

Your system sounds very similar to my 780. Using alterations in targets to adjust the basal insulin doses.
I think the tslim makes use of the underlying basal rate profiles in calculating micro boluses. The basics will be much the same with each.

Such exciting developments in recent years.