Best pump to cope with monthly cycles / periods

[CarrieJ]

My daughter is currently on a Medtronic 670G, but it uses the last 6 days data so doesn’t cope well with her monthly cycles. Her insulin needs change pre, during and post her period. She’s due a new pump soon and has been offered the Medtronic 780 or the Tandem T-slim.

Does anyone know if either copes better with monthly cycles? Or maybe an easier question - do you have experience of one or the other that you could share?

Thanks in advance!

 

[Finn]

I have a Tandem t:slim X2 and one of the reasons I wanted it was because you can create 6 different basal/bolus profiles. I use four of them for cycle-specific profiles and I can switch between them easily. My insulin needs change a lot during my cycle (+/- 30% of my average at different stages of my period) so multiple profiles was definitely a feature I wanted.

 

[helli]

I have a Tandem t:slim X2 and one of the reasons I wanted it was because you can create 6 different basal/bolus profiles. I use four of them for cycle-specific profiles and I can switch between them easily. My insulin needs change a lot during my cycle (+/- 30% of my average at different stages of my period) so multiple profiles was definitely a feature I wanted.

Do you use the T-Slim as closed loop?

 

[Finn]

Do you use the T-Slim as closed loop?

Yes, I loop with Tandem t:slim X2 and Dexcom 6. I'm in Germany and this was one of the four pump combos offered to me at my clinic.

Looping, and Tandem's sleep mode, is great for avoiding overnight lows. Tandem t:slim suspends insulin if it see you're going low and increases basal if you're going up.

There's also an exercise mode which targets a higher blood sugar (7.7 rather than the usual 6.1). I don't use exercise mode often. I prefer to reduce my bolus the meal before.

 

[SB2015]

My daughter is currently on a Medtronic 670G, but it uses the last 6 days data so doesn’t cope well with her monthly cycles. Her insulin needs change pre, during and post her period. She’s due a new pump soon and has been offered the Medtronic 780 or the Tandem T-slim.

Does anyone know if either copes better with monthly cycles? Or maybe an easier question - do you have experience of one or the other that you could share?

Thanks in advance!

Hi Carrie

The new guidelines suggest that the hybrid closed loop will be offered to U18. This is available On the two pumps that you have been offered. The advantage of these systems is that they are constantly adjusting basal insulin, based on a check in between the pump and sensor every five minutes.

I currently loop with the 780 and the Medtronic sensor G4. It requires one callibration (finger prick) per week (I was very sceptical about that when I read it -It is true). The basal is adjusted every 5 minutes without my intervention. I can choose one of three targets for the looping to aim to keep my glucose levels to. I use the lowest level but make adjustments in some more unusual circumstances. I also use a temporary target if I am doing prolonged activity. With these auto adjustments made by the pump, which includes suspensions and auto corrections, I usually have a TIR in the 90s. I suspect that these adjustments, which I don’t need to set up, would cope well with monthly cycles, (but can’t say as I am way beyond needing to worry about those in my 60s).

For meals I still count carbs and make adjustments to take account of fat content, but find that the automated system deals with the more difficult fatty meals and levels things out, and I don’t need to worry about deciding how to deliver the bolus.

I suspect that the t s,I’m works in a very similar way. I found changing to a different manufacturer (Accu-Chek to Medtronic) when switching to the 780 was a hassle initially, so it will take a lot to make me from Medtronic unless there were massive benefits to be had.

If you have any questions, come back to me.

 

[helli]

Thanks @Finn.
I had a vague memory that the Medtronic and T-Slim do Closed Loop in slightly different ways.
One learnt your habit - sounds like that is the Medtronic approach which uses your last 6 days.
Whereas the other has a profile which it uses as the basis and then suspends, etc. based on your CGM readings - sounds like this is the T-Slim approach.

Based on this, the T-Slim does look better for this use case.

(OMG did I just write "use case"? Please blame work for this!)

 

[Finn]

Thanks @Finn.
I had a vague memory that the Medtronic and T-Slim do Closed Loop in slightly different ways.
One learnt your habit - sounds like that is the Medtronic approach which uses your last 6 days.
Whereas the other has a profile which it uses as the basis and then suspends, etc. based on your CGM readings - sounds like this is the T-Slim approach.

Based on this, the T-Slim does look better for this use case.

(OMG did I just write "use case"? Please blame work for this!)

I'm not sure about Medtronic, but the t:slim doesn't 'learn' your patterns. It goes by whichever profile you have active for everything - basal rates, insulin to carb ratios and correction factors.

If looping, it adjusts the basal based on CGM readings - it decreases basal if going low, suspends if low, increases if going high and gives a correction once high (I don't remember the levels it does each at, but they're fixed and can't be changed, which is one downside).

For people whose insulin needs vary based on hormones, work/school or just unpredictable schedules, I would think set profiles that you can switch between, like the t:slim, would be massively beneficial. My needs fluctuate a lot and it's nice to be able 'shift gears' to a more or less aggresive profile as needed.

 

[Thebearcametoo]

Tslim looped with dexcom would cope if she’s on control IQ or you can choose manual basal profiles for different parts of the cycle. I don’t have any experience with Medtronic so I can’t compare.

 

[everydayupsanddowns]

I have a Tandem t:slim X2 and one of the reasons I wanted it was because you can create 6 different basal/bolus profiles. I use four of them for cycle-specific profiles and I can switch between them easily. My insulin needs change a lot during my cycle (+/- 30% of my average at different stages of my period) so multiple profiles was definitely a feature I wanted.

The other thing about the tSlim’s hybrid closed loop @CarrieJ, is that it adjusts insulin (and basal) based on whatever profile you have active.

So if you are more (or less!) sensitive to insulin at some points of your cycle you can have a profile with different insulin sensitivity factors, and any correction boluses will be larger (or smaller) as needed.

 

[SB2015]

One learnt your habit - sounds like that is the Medtronic approach which uses your last 6 days.

I know that we need 72 hours of data when first looping but then the basal is adjusting based on your current readings and direction of travel for glucose levels.

I would be interested to know where the 6 days info comes from. Is it the average of those six days used?
why six days?