What a brilliant set of choices you’ve been offered
@Paulh696
Not everything that’s available, but certainly a really good range of options.
I haven’t ever used a pod-based pump, so can’t compare, but I have used HCL with both Tandem tSlim/DexG6 and MM780G/Simplera
The M780G is a real lump, and I have to find a way of wearing it horizontally on my belt because ot the silly sticky-up bit for bigger reservoirs I’ll never use (when developing the MM640G they were going to have small and large versions, but in the end went just with the large reservoir shape). However its screen is better than the tSlim in sunlight.
The tSlim does have a slightly more fiddly reservoir fill, but actually I didn’t find that anything like as much faff as some people seem to. It’s small, neat, and the touch screen is pretty slick.
Both have a range of straight and angled sets. Medtronic even now has one that’s licensed for 7day wear. Mio 30s and Autosoft 30s are identical save for the connector, and may even be made in the same facility under license or somesuch.
For the algorithms, these operate very differently. Neither offer TBRs, which is annoying if you a predict an event you know the algorithm won’t ‘catch’.
Tandem tSlim
TSlim Control IQ offers you a lot more control. The adjustments the algorithm makes are based on a profile you set, including basal pattern, meal ratios and sensitivity. The insulin active time is fixed at 5hrs, but you can change pretty much everything else. My experience was that tSlim was far more gentle in its action. Suspends on the tSlim came much later, and I would add correction boluses as BG were rising. You can still use extended boluses and dual waves when the algorithm is running, which is very helpful.
TSlim has an exercise mode (not very effective for me). And a
brilliant sleep mode. I had brilliant overnight levels an almost never any alerts or alarms. I just woke up 6.5-5.5ish everyday.
I has
significant improvement in Time In Range on the tSlim, but it was more work. I had to set low alarms in the low 5s to check whether I needed to take action/suspend if BG was dropping because the algorithm was just too little too late for the way my BG behaves.
Medtronic MM780
Smartguard on the MM780 takes a few days to kick in. It observes how your levels behave with the profile you set, then takes over in ‘Auto mode’. The Medtronic algorithm is much more effective at both edges for my diabetes. You can change insulin acting time (down to 2hrs) which allows it to be more assertive with corrections as it sees you as having less active insulin.
Smartguard suspends earlier, and catches far more drifts into low BGs for me. I’ve actually lost weight on it (about a kilo) and am needing to buy noticeably less full sugar coke and Skittles to pre-treat drops toward hypo territory. I was hoping this wouldbe the case, because the predictive low suspend on the MM640G was similarly effective. I am no longer so fatigued by alarms. The Medtronic also doesn’t ‘correction bolus’ in response to hypo treatment like the tSlim sometimes did which would drop me right back down again.
You can adjust meal ratios and correction factors, and set one of 3 ‘mid-point’ targets to make the algorithm more or less assertive.
It also seems more enthusiastic about high BGs, and will micro-bolus in quick succession if levels are rising more boldly than the tSlim would. You DO have to carb count accurately, and I’ve found I need to pre-bolus in different ways. The Medtronic also takes a look at recent days, and will sometimes make quite hefty adjustments to bolus calculations if it thinks you are over-doing it (knowing that it can always add the insulin later). There is NO way to add a manual bolus for a correction without pretending to take on carbs you aren’t eating. And you are really best advised NOT to do this because the algorithm learns from day to day, and if you give it inaccurate information, it’ll make wrong adjustments. If I get frustrated by a rapidly rising BG that I think it won’t catch I’ll just walk around the block for literally 5 minutes to ‘activate’ the microboluses, but even then I’ll set a short ‘temp target’ (the Medtronic version of exercise mode) so it knows I am doing activity.
You don’t have a basal pattern in Auto Mode. The pump makes adjustments based on previous days’ results. This can mean if you have a period of illness that it takes a day or two to catch up, but the major benefit for me is that I’ve not had to tweak my basal profile since the Summer. I’ve needed to tweak basal pattern a few times a
month for years on other pumps.
I find myself thinking about my diabetes a lot less on the MM780G. The pump
needs you to hand over control to it. To just give it the information it asks for (accurate carb counts, prebolus times, and only add carbs when you are actually eating them), and it will make adjustments day-to day to improve outcomes.
Current 14 day average TIR is running at 92%, with only 1% below 4.0. On tSlim, my TIR might have been similar, but my time below was often more like 3-4%
