Hi-ho, Hi-ho, It’s back to Medtronic I go…

[everydayupsanddowns]

Goodness… 4 years comes around quick!

I’ve been pondering what to do next for some time, and looking at the options that were available to me. Thankfully, having been granted sensors on the NHS after many years or self-funding it seems that access to sensors is now assured.

The options I had were

To keep with Tandem tSlim or…

Medtronic 780G (loop)
Omnipod 5 (loop)
Omnipod Dash
Mylife Ypsopump and CamAPS

After a good deal of reflection (I’ve known this was coming up all year) I’ve opted for the MM780G.

I should have it some time in August, and I’m hoping that I’ll be able to start with the new Simplera sensors.

Will be interested to see how it goes!

 

[SB2015]

Depending on the timing of your replacement you may well be able to start straight in their new Simplera Sync sensors which I think will be a big plus for looping with the 780.

I shall be interested to hear how you get on, and I hope that you find it works well for you.

 

[Sally71]

You are just before us, I remember comparing notes last time!
We didn’t get offered the Omnipod Dash but apart from that got the same choice that you did. It’s the first time our clinic has offered Omnipod and my daughter really wants to try going tubeless (we have pet rabbits which like to bite tubes!). However because you are throwing away the pod each time they will only allow that if your average TDD is under 60 units, and my daughter’s was something like 75 when they checked at the pump clinic. She’s determined to try to get her average down, and she does have a fairly carb-heavy diet so there may be some wiggle room, neither I nor the DSN are convinced that she will be able to make enough difference but they’ve agreed to give her until the end of July to try. If they won’t allow her to have Omnipod then she wants another T-Slim. I’d be happy with that as it’s been a good system, but I have hardly anything at all to do with her diabetes management now and she turned 18 in May so it isn’t my decision any more! My daughter for some reason has never liked the idea of Medtronic so let us know how you get on!

 

[Tom1982]

Goodness… 4 years comes around quick!

I’ve been pondering what to do next for some time, and looking at the options that were available to me. Thankfully, having been granted sensors on the NHS after many years or self-funding it seems that access to sensors is now assured.

The options I had were

To keep with Tandem tSlim or…

Medtronic 780G (loop)
Omnipod 5 (loop)
Omnipod Dash
Mylife Ypsopump and CamAPS

After a good deal of reflection (I’ve known this was coming up all year) I’ve opted for the MM780G.

I should have it some time in August, and I’m hoping that I’ll be able to start with the new Simplera sensors.

Will be interested to see how it goes!

On a closed loop system what do you typically see in terms of time in range?

 

[everydayupsanddowns]

On a closed loop system what do you typically see in terms of time in range?

It varies. I’ve struggled quite a bit more with dodging hypos this year - which I think is largely alarm fatigue. I’m having to do a lot of the dodging manually, as tSlim doesn’t really act firmly enough or early enough for what my diabetes is currently doing.

However the results are pretty spectacular tbh. I’m just hoping to offload some of the decision-making. Which seems to be a thing many people comment on with the 780.

These are my current 90-day stats in Dexcom Clarity. I’ve only just had an A1c which came in at 6.0 / 42.

 

[Proud to be erratic]

Could I ask how did you get that screenshot? On my android phone the multi day stats for G7 display with a Clarity marker top left, but also Dexcom don't allow me to take a screenshot for "secutity" reasons (which is soooo irritating).

 

[Tom1982]

It varies. I’ve struggled quite a bit more with dodging hypos this year - which I think is largely alarm fatigue. I’m having to do a lot of the dodging manually, as tSlim doesn’t really act firmly enough or early enough for what my diabetes is currently doing.

However the results are pretty spectacular tbh. I’m just hoping to offload some of the decision-making. Which seems to be a thing many people comment on with the 780.

These are my current 90-day stats in Dexcom Clarity. I’ve only just had an A1c which came in at 6.0 / 42.

That’s a fantastic effort mate. Does it still take a lot of work or does it just seem to fall into place now? For what it’s worth (whisper it quietly!) I think we’ve solved the Omnipod/skin reaction issue. The last 5 have been great. 80-90% in range

 

[everydayupsanddowns]

Could I ask how did you get that screenshot? On my android phone the multi day stats for G7 display with a Clarity marker top left, but also Dexcom don't allow me to take a screenshot for "secutity" reasons (which is soooo irritating).

Ah I’m on a fruit-based phone and G6 with separate Clarity app. I can screenshot in Clarity with no warnings or threats of catastrophe. 😉

 

[everydayupsanddowns]

Does it still take a lot of work or does it just seem to fall into place now?

It does take work. But thankfully most days it just feels like part of the rhythm of life. Other days my diabetes gets in a strop and is much more demanding, and some weeks the ‘normal’ amount of effort seems unbearable - but I am aware that essentially the things are just the things, and it is my reaction to them that changes, and either positively or negatively affects my experience of them.

 

[Tom1982]

It does take work. But thankfully most days it just feels like part of the rhythm of life. Other days my diabetes gets in a strop and is much more demanding, and some weeks the ‘normal’ amount of effort seems unbearable - but I am aware that essentially the things are just the things, and it is my reaction to them that changes, and either positively or negatively affects my experience of them.

I still have a hard time separating myself from the “if I do this plus this, it’ll equal this” thinking. But who knows….. if we’re being philosophical, maybe it’s grown me as a person all I know is at the moment, it’s behaving. But I do now know we’ve got a long way to go before we can confidently say we’ve got it sussed!

 

[rebrascora]

I still have a hard time separating myself from the “if I do this plus this, it’ll equal this” thinking. But who knows….. if we’re being philosophical, maybe it’s grown me as a person all I know is at the moment, it’s behaving. But I do now know we’ve got a long way to go before we can confidently say we’ve got it sussed!

It took me a while to accept that there is a definite ebb and flow with diabetes management and I get good spells of plain sailing which might last several weeks if I am lucky, followed by periods of turbulence where I have to fight to maintain reasonable management and then I get back to smoother waters again. There is no particularly obvious pattern to it but much like my mental health issues, I have learned to just weather the storm through the bad patches in the knowledge that things will improve again and come right.... and they always do.

I know the engineer in you will want 2+2 to equal 4 every time but with diabetes it absolutely doesn't and over time you do come to accept this and just learn to work with whatever number it throws up today instead of the number you might hope for and expect. I am sure it is much easier to accept as an individual with diabetes rather than a parent of a child with diabetes but I find viewing it as a game that throws me different challenges every day helps me to manage it better both practically and mentally. Having CGM definitely made this mindset possible for me. I am not sure I would even want a pump or HCL because it would take away this mental approach to my diabetes as "a game" and I might end up finding diabetes frustrating again.

 

[helli]

I’ve struggled quite a bit more with dodging hypos this year - which I think is largely alarm fatigue.

I too am starting to feel alarm fatigue.
The question is how to raise the volume of the alarm fatigue alarm so that I hear it when I have alarm fatigue?

 

[rebrascora]

I get alarm fatigue if I set my low alarm too high. I know some people find 5.0 or even 5.6 right for them but above 4.5 I end up cancelling the alarm and then forgetting to keep an eye on things and ending up hypo.

 

[Tom1982]

It took me a while to accept that there is a definite ebb and flow with diabetes management and I get good spells of plain sailing which might last several weeks if I am lucky, followed by periods of turbulence where I have to fight to maintain reasonable management and then I get back to smoother waters again. There is no particularly obvious pattern to it but much like my mental health issues, I have learned to just weather the storm through the bad patches in the knowledge that things will improve again and come right.... and they always do.

I know the engineer in you will want 2+2 to equal 4 every time but with diabetes it absolutely doesn't and over time you do come to accept this and just learn to work with whatever number it throws up today instead of the number you might hope for and expect. I am sure it is much easier to accept as an individual with diabetes rather than a parent of a child with diabetes but I find viewing it as a game that throws me different challenges every day helps me to manage it better both practically and mentally. Having CGM definitely made this mindset possible for me. I am not sure I would even want a pump or HCL because it would take away this mental approach to my diabetes as "a game" and I might end up finding diabetes frustrating again.

I think without a CGM Jo would have no finger tips by now! 20 plus finger pricks a day was getting silly! The mental side of it, hard to admit, but I reckon it’ll get me at one stage. But I’ll deal with that when it comes!

 

[rebrascora]

I think without a CGM Jo would have no finger tips by now! 20 plus finger pricks a day was getting silly! The mental side of it, hard to admit, but I reckon it’ll get me at one stage. But I’ll deal with that when it comes!

I hope that you gradually find it easier and that you become more chilled with the variability of it all, so that you don't ever hit that crisis point. I know I have had a few wobble moments over the last few years but definitely more accepting of it not making sense some days/weeks and just learning to do the basics and ride out the storm.

 

[helli]

I think without a CGM Jo would have no finger tips by now! 20 plus finger pricks a day was getting silly! The mental side of it, hard to admit, but I reckon it’ll get me at one stage. But I’ll deal with that when it comes!

Wow! I am so glad I was diagnosed 20 years ago when CGMs were not a thing and we just pricked our finger before eating (or when we felt off).
I think a consequence of CGMs is that need to be "in control" at all times when, as you mentioned above, diabetes seems to have a mind of its own at times.
I have likened it to a class of young children - you can never control time and, for the sake of your sanity, it is best to accept this and let some kids (BGs) do their own thing as long as they do not go too far. You can't watch 30 kids all the time and you can't watch BG all the time.

I know the engineer in you will want 2+2 to equal 4 every time

As an engineer myself, I liken managing diabetes to physics. We can come up with all sorts of formulae to predict the results but it's rare to know the exact coefficient of friction on a real road or the exact wind speed and direction in advance. A good engineer knows they can only estimate the future: they do not know all of the parameters.

In fact, given the Tour de France is currently ongoing (yes, there is more sport than football on at the moment), you could think of managing diabetes the same as managing a team of professional cyclists.
You could give your riders a the best bikes and best nutrition and best kit and ensure they wash their hands to minimise the risk of getting ill but you can't control everything.
As well as road surface and wind speed/direction and sun and rain, there is also how well a rider slept or how they react to a crash or a member of the crowd (who I still find it bizarre they have no barriers) running out in front of you.

 

[trophywench]

Yeah Helli - and some of the riders have come down with Covid - can't stop anyone breathing in and out and encountering A Germ ......

 

[SB2015]

Goodness… 4 years comes around quick!

I’ve been pondering what to do next for some time, and looking at the options that were available to me. Thankfully, having been granted sensors on the NHS after many years or self-funding it seems that access to sensors is now assured.

The options I had were

To keep with Tandem tSlim or…

Medtronic 780G (loop)
Omnipod 5 (loop)
Omnipod Dash
Mylife Ypsopump and CamAPS

After a good deal of reflection (I’ve known this was coming up all year) I’ve opted for the MM780G.

I should have it some time in August, and I’m hoping that I’ll be able to start with the new Simplera sensors.

Will be interested to see how it goes!

There is a linked BG test kit which will send your Bg to the pump, but then you still have to confirm it in the pump so I never thought it was worth using and I stuck with my Accu Chek BG tester as like @trophywench I see no reason to change from my combo test kit. Also that allows me not to tell the pump if I choose not to eg (at end of warm up if I have just eaten too big a breakfast) and want to delay going into Smartguard until things have settled)

 

[SB2015]

As another scientist/mathematician I like 2 + 2 = 4 (but then it depends what mode we are in so it could be 11 … but I digress) Diabetes has definitely taught me to accept that things just don’t work the same every day and there are too many variable to sort out, so all I can do is the best that I can.

My HCL (Medtronic 780) has me with much improved TIR (80s/90s) with a lot less effort from me. I sleep with no alarms going off and wake up on target and I have times when I completely ignore it as I can trust Hermione (my pump) to do her job, and I know that she will get back to me if she is any doubt about things (still at the most inconvenient times, obviously!!!). Not perfect by any means, but a complete contrast to the burnout I went through.

In a weird way I am able to look back at the last 16 years and see ways in which my diagnosis has helped me to be more content. Things will never be perfect and having had to learn to accept that with diabetes, I think it has also helped me to recognise when ‘Good Enough is Enough’ in so many other things, and so to enjoy what I am able to do a lot more, and enjoy dabbling in things which I am not good at but do just for fun.

 

[adamrit]

On a closed loop system what do you typically see in terms of time in range?

I've been very irregular type 1 for 68 years until I started 780G and 4 sensors last December. The last 30 day average in range is 82%. That is the worst for the last seven months but I have had a bit of cough and cold, (not Covid). It has been 92% in range over 30 days. I still have irregular diabetes, meaning the same carbs have radically different effect day to day, but the 780G and the 4 sensors have changed my life radically for the better. The only problem is that the 780 tends not to want to give enough insulin to bring down highs, so I stay high for much longer than I like. I guess Medtronic are nervous they will get sued for causing dangerous hypos. Either that or perhaps when I get hyper, I get extra resistant to insulin. I used to have to do 9 finger pricks a day (no BG awareness) because my insulin sensitivity varied so much every day from one meal to the next, that my BG levels went from 12 to 2.3 (and visa versa) quickly and without warning given the same food, same insulin and same exercise. Type 3 sensors were almost totally uselessly inaccurate for me. I now do about one finger prick a week and trust the Type 4 sensors. I don't get much care from my diabetic clinic anymore in the shape of regular six month appointments and general blood tests because of staff shortages. Medtronic say to ask your Diabetic Team if you need advice. Giving extra non pump insulin is a bad idea because it will only confuse the algorithm which operates the pump.
I think the closed loop Medtronic 780 and 4 CGM has reduced the amount of time I spend thinking, worrying and dealing with diabetes by a lot over 3/4. That is a miracle.
Adam