Medtronic 780G Corrections

[adamrit]

During the night 780g and sensor 4 works perfectly. Before it, I used to have terrible ups and downs during the night. My poor wife would have to cope with a sweating thrashing about monster who refused to eat sugar and struggled hard. Now two years of peaceful sleep for both of us. My almost guaranteed morning BG is 5.0-6.0.
The opposite during the day. I was 6.0 at 7.00. By 11.30 by BG was 9.0 in spite of no breakfast and 1.7U insulin corrections automatically given by the 780 plus CGM. During the day this is the normal result. The CGM never gives enough correction to bring BG back to level. How do you get it to correct the BG level in the daytime? At best, it keeps it at the same level.My BG is frequently high at lunchtime however much insulin I take, and the automatic corrections bring it down not at all. I have to do the corrections myself which means telling the pump I’m eating another meal when I haven’t. I understand that Medtronic doesn’t want people to hypo because of their automatic corrections, but the system works perfectly at night and not at all in the day.
Any suggestions? Adam
Type 1 for 69 years 7.8 right now after 25 minutes fast walking to bring BG down from 10.0. 76kg

 

[everydayupsanddowns]

Great to hear that your night times have been so improved @adamrit

You have a few levers you can use to make the MM780G act a little more firmly.

The most obvious is setting the Smartguard target as low as possible (5.5mmol/L).

You can also artificially shorten your duration of insulin action. Pharmacologically this is likely to be 4-5 hours, but you can set the Active Insulin Time as short as 2hrs, which means that the algorithm perceives less ‘insulin on board’ earlier, so is able to correct more freely.

You can also adjust your Insulin Sensitivity, and even Insulin:Carb ratios.

The MM780G algorithm has some ‘safe bolus’ adjustments it will make in certain circumstances (eg a basal suspend after each meal bolus) so I have a slightly beefier i:c ratio than I might actually need on paper, to cover the missing basal

 

[Natalie123]

I have a Yspsomed pump so this is general advice rather than specific to the Medtronic.

I had the same problem as you, the algorithm works brilliantly over night but during the day, I either had to eat as little carbs as possible or go for a brisk walk to get my sugar levels to come down. I got a bit fed up with not being able to eat what I wanted and going for walks at silly times. I shortened my active insulin time to 2 hours (I'm on Fiasp so it probably has an active time of 3 - 4 hours), this helped a lot because the algorithm thought I had less insulin so it was quicker to give corrections.

I also changed my insulin sensitivity during the afternoon when I was particularly high so that it gave me slightly more insulin ( I don't know if you can set different ratios at different times on the Medtronic though).

I have also found that I needed to adjust my carb ratio so that I take more insulin with meals. This stops me from going high in the first place and, because I don't have a basal rate anymore, I don't need to worry so much about going low.

These three things together have made a big improvement, particularly the first and last one.

I would suggest that you make one change at a time and see what happens. (I should really listen to my own advice because I changed everything at once - I was lucky this time but it could have gone wrong!)