Medtronic 780G & G4 experiences

[H//Tom!pumPing]

Burn out. 4yr warranty nearly up & I can’t wait!
I have insulin sensitivity, brittle diabetes plus loss of hypo awareness. Medtronic had first HCL 4yrs ago, hence this system.
I discovered 8 wks ago that my Initial training was incorrect. All the profound difficulties I had experienced weren’t my fault. My time in (algorithm’s) range was 83%, so appeared to be no problems. Apparently, I only achieved this ‘cos I’m smarter than the Algorithm. A consolation?
I had to reset the Algorithm incorrect data by being in manual mode for 7 days, then in safeguard (auto) 7 days in a gentle routine.
Nearly completed this Algorithm reset when a dangerous software malfunction developed during the night. The Basal delivery safety shut down failed, causing me to become low & continued to deliver Basal insulin keeping me low.
I immediately contacted out of hours technical support. I had difficultly understanding the accent. I slowly, carefully and repeatedly explained the issue. I was asked to upload pump data onto my carelink account, which I did. Then put on hold, whilst data assessed, reported on and I would be advised of action to take. After 40mins on hold, the call ended, cut off..
I recalled tech support, different person, again a difficult to understanding accent. Retold info, call put on hold whilst report read and reported on. Call ended after 25mins. No one called me back.
I called tech support during office hours - I
discovered my carelink data had not been read nor reported on! I had to repeat info for the third time. This time a conclusion, dangerous software malfunction and pump to be replaced immediately.
Consequences, we cancelled our imminent booked holiday, due to the required warming up of my new pump Algorithm, which requires 48hrs in manual mode commencing 00:00 hrs. Apparently after that it should be ok. I can assure you it takes a further 7 days, to be ok!
The reclaiming of holiday cancellation costs via GP letter is £35 and is not reimbursed. Thank you Medtronic.
Additional problems. G4 sensor inaccurate.
Algorithm seldom accepts finger stick blood glucose test results.
Algorithm will not adhere to my Carb:Insulin requirements data, thus causing hypers post meals.
Insulin reservoir mysteriously acquires large air bubbles whilst in the pump. I never had this problem with the excellent Animas pump system.
I could go on, but I’ve had enough!

 

[Inka]

Welcome @H//Tom!pumPing 🙂 What an awful experience! My first thought is have you reported this to the Yellow card system?

Can you change pumps - ie a different type? Could you not stay in manual mode? You say:

Apparently, I only achieved this ‘cos I’m smarter than the Algorithm

That’s one reason I turned down a loop - I don’t trust it to do any better than me or to make appropriate adjustments for exercise, etc. I have a fantastic pump (Dana i) but use it without a loop.

One thing I will say is that if your diabetes is brittle, I highly recommend the Dexcom G7 sensor. The accuracy is incredible, and it also has an excellent selection of alarms that alert you to fast drops and approaching lows.

 

[SB2015]

Burn out. 4yr warranty nearly up & I can’t wait!
I have insulin sensitivity, brittle diabetes plus loss of hypo awareness. Medtronic had first HCL 4yrs ago, hence this system.
I discovered 8 wks ago that my Initial training was incorrect. All the profound difficulties I had experienced weren’t my fault. My time in (algorithm’s) range was 83%, so appeared to be no problems. Apparently, I only achieved this ‘cos I’m smarter than the Algorithm. A consolation?
I had to reset the Algorithm incorrect data by being in manual mode for 7 days, then in safeguard (auto) 7 days in a gentle routine.
Nearly completed this Algorithm reset when a dangerous software malfunction developed during the night. The Basal delivery safety shut down failed, causing me to become low & continued to deliver Basal insulin keeping me low.
I immediately contacted out of hours technical support. I had difficultly understanding the accent. I slowly, carefully and repeatedly explained the issue. I was asked to upload pump data onto my carelink account, which I did. Then put on hold, whilst data assessed, reported on and I would be advised of action to take. After 40mins on hold, the call ended, cut off..
I recalled tech support, different person, again a difficult to understanding accent. Retold info, call put on hold whilst report read and reported on. Call ended after 25mins. No one called me back.
I called tech support during office hours - I
discovered my carelink data had not been read nor reported on! I had to repeat info for the third time. This time a conclusion, dangerous software malfunction and pump to be replaced immediately.
Consequences, we cancelled our imminent booked holiday, due to the required warming up of my new pump Algorithm, which requires 48hrs in manual mode commencing 00:00 hrs. Apparently after that it should be ok. I can assure you it takes a further 7 days, to be ok!
The reclaiming of holiday cancellation costs via GP letter is £35 and is not reimbursed. Thank you Medtronic.
Additional problems. G4 sensor inaccurate.
Algorithm seldom accepts finger stick blood glucose test results.
Algorithm will not adhere to my Carb:Insulin requirements data, thus causing hypers post meals.
Insulin reservoir mysteriously acquires large air bubbles whilst in the pump. I never had this problem with the excellent Animas pump system.
I could go on, but I’ve had enough!

I am really sorry that you have had such a bad experience with your 780, and with the technical support. I am pleased that they are replacing the pump. I can understand your not wanting to be away during the warm up for the new pump but sorry that you then had to miss your holiday.

It certainly helps if you are linked up to Carelink, as when you phone they can see exactly what has been happening. If for some reason I have not done a download (my phone is set to do this automatically at around midnight) I always do one before phoning for support.

I had a very difficult start when I started using the loop with the 780 but it settled down and I am now very happily using the 780, and even happier now that I have the new Simplera Sensors. I suspect that you will not want to stick with this pump now, but some of these thoughts that might apply to any looping that you might choose to use. It does not suit everyone and I hope that you can find a way of making a system work for you.

You mention using the system in manual for a week then back to Smartguard, and if I have understood you right you then continued to do this. This would equate to the first week in the pump again and again. The system uses the previous 6 days of data so it will be using your manual data for quite a bit of the time. I did this at the start and confused the pump. Once I stopped switching back and forth it settled down and I find that I am now happy to rely on it, but I recognise that as you do not have hypo awareness

The spikes after meals may be reduced by changing the timing of your bolus. If I am eating out I am not able to pre-bolus and have to accept that I will then get a spike. At home I find that timing my bolus before a meal, along with managing portion size, reduces the spike. I gradually increased the time delay between bolus and eating to find what suited me. This varies during the time of day, with a longer delay in the morning. Without the pre-bolus I find the spikes do settle without me doing anything, as the system will use the autocorrections, but if it is bigger than I am happy with I go in to the bolus calculator and it will often suggest an extra correction.

You mention that the algorithm does not stick to your carb ratios. I know that mine uses the ratios that I have entered into the settings. They vary through the day. Have you set these for different periods of the day? The bolus wizard uses my ratios but it will also make an adjustment according to the active insulin. Is this what you mean by it not adhering to your ratios?

I hope that you can get things set up so that it works for you.

 

[everydayupsanddowns]

Yikes Tom! Sorry to hear about your terrible time. You must be pulling your hair out.

I had the MM640G with Enlites which worked well for me, but G3s needed a bit more calibration, didn’t seem to suit my body so well, and alarmed for calibrations a lot overnight.

I had 4 years with the tSlim and Dexcom. Really good, but I had to do quite a lot of manual intervention (especially around hypo avoidance as the tSlim acted later and more gently than the MM640G for predictive low glucose suspend.

I’ve moved back to the MM780G with Simplera, and can offer the following thoughts (which you are probably already well aware of, but just in case)…

Additional problems. G4 sensor inaccurate.

Never tried the G4, but the Simpleras are suiting me well. Mostly matching fingerstick BG very closely. Seem to have a slight tendency to try to stay ‘just inside the lines’ for me - eg will stick at reading 9.9 when fingerstick is 10.1-10.7, or stay at 4.1 when fingerstick is 3.8-3.9, but very usable data, and rarely sufficiently ‘out’ to be a problem. Obviously a bit of lag, esp when things are moving, and around hypos. But all CGM have that.

Algorithm seldom accepts finger stick blood glucose test results.

Simpleras seem to accept calibrations gracefully. As long as they are within acceptable limits. Having said that I’ve rarely needed to calibrate, and over-calibration can apparently throw things put a bit.

Algorithm will not adhere to my Carb:Insulin requirements data, thus causing hypers post meals.

Two things here - MM780G does seem to make adjustments to carb:insulin ratios which I don’t expect. But after a little digging, it seems that part of this is bundled with the algorithm reviewing post-meal results from previous days. If you’ve been going low after meals at your defined carb ratio, it’ll helpfully knock a bit off without you needing to constantly tweak your ratios.

It seems to prefer to ‘play safe’ and reduce insulin rather than risk lows it will struggle to catch with basal suspend. It knows it can always top-up later with micro-bolus if needed.

Which leads me to… Superboluses. All MM780G boluses are super-boluses according to an experienced user friend who has asked Medtronic a lot about this. Superbolus was that technique of adding the next few hours of basal insulin up-front alongside a meal bolus (and then suspending basal for that amount of time) as a way of front-loading to reduce post meal highs. I’ve had to slightly ‘strengthen’ my meal ratios to account for the 30-90 minute basal suspend which follows pretty-much every bolus.

All the sensor-augmented pumps I’ve had have needed a learning period of working out what I need to tell them to get the algorithm to work for my diabetes.

Insulin reservoir mysteriously acquires large air bubbles whilst in the pump. I never had this problem with the excellent Animas pump system.

I could go on, but I’ve had enough!

The only way I know that this can happen (unless you are missing tiny ones that later combine) is through temperature change. I have to make sure that the insulin I’m filling the reservoir with is at least at ambient temperature, preferably a little warmer. Gasses are more soluble in liquids at lower temps, so as insulin in the reservoir warms next to your body, oxygen can be forced out of it to form bubbles. A bit like putting a glass of water on a sunny table. It’s important for me to have my ‘in use’ insulin out of the fridge, and I may hold it in my hands for a few minutes to gently bring it up to ‘wearing next to me’ temperature.

Hope your replacement pump works better for you.