Pump start 780G

[Maco]

Phil, what is ISIG? Also I’d have to agree with Phil there my sensor change over time is no longer than 2.5hrs at the most. Like Phil it’s a quick transmitter charge & then a 2hr warm up. I’ve even heard of people from America fitting a sensor the night before to speed the warm up process up.

 

[Phil65]

Phil, what is ISIG? Also I’d have to agree with Phil there my sensor change over time is no longer than 2.5hrs at the most. Like Phil it’s a quick transmitter charge & then a 2hr warm up. I’ve even heard of people from America fitting a sensor the night before to speed the warm up process up.

Hi Maco,
ISIG is Interstitial Signal, an electrical reading that is proportional to BG. In other words you should Calibrate when you are in normal range, say, between 4 and 9, anything outside that sort of range could lead to inaccurate readings. Look at calibrating if you have had a reasonably flat profile for the previous 30 mins. Do not cal soon after eating or eat straight after a cal, as the CGM is counting on your BG remaining stable for 15 minutes.

 

[SB2015]

Back on track after a bit of a break!!!

I have finally managed to get all my stuff including sensors, transmitter, as well as cannulas. For me if something could go wrong it did, whether it was ordering, delivery, .... However this was unfortunate timing with Brexit, Covid, Christmas, infection, .... I remembered (too late) how pleased I was that my pump change over was not due until after B....t. However when the opportunity came for the 780 I forgot and got hit by everything.

I have now been in manual mode for a month, and I have my training for going over to sensors at the end of this week. I am making a note of the positive things about this pump, such as slower delivery, reminders when I have forgotten to do the final press for a Bolus. Apart from those it basically works in manual mode much the same as any other. I have made adaptations to clothes to enable easy access to the pump, but management from the handset will still be top of my list for next choice of pump

Looking forward to next phase and seeing the impact of the alarms when using a sensor in manual mode, and then the benefits of transferring to Smart Guard, auto corrections.

 

[Maco]

Back on track after a bit of a break!!!

I have finally managed to get all my stuff including sensors, transmitter, as well as cannulas. For me if something could go wrong it did, whether it was ordering, delivery, .... However this was unfortunate timing with Brexit, Covid, Christmas, infection, .... I remembered (too late) how pleased I was that my pump change over was not due until after B....t. However when the opportunity came for the 780 I forgot and got hit by everything.

I have now been in manual mode for a month, and I have my training for going over to sensors at the end of this week. I am making a note of the positive things about this pump, such as slower delivery, reminders when I have forgotten to do the final press for a Bolus. Apart from those it basically works in manual mode much the same as any other. I have made adaptations to clothes to enable easy access to the pump, but management from the handset will still be top of my list for next choice of pump

Looking forward to next phase and seeing the impact of the alarms when using a sensor in manual mode, and then the benefits of transferring to Smart Guard, auto corrections.

Im sure you'll love automode, I had quite a few sensor issues but in all honesty now I've sorted the problems its the best piece of diabetic tech ive used. Automode is absolutely fantastic, Especially when you have a naughty cheat meal like I do every Saturday. Usually id spike into the high teens and wake up the next morning at 17/18mmol. With automode I still might spike to 14ish but the next morning ill be back into range at around 6-7mmol. Ive never been out of range throughout the night as of yet, automode is that good.

Before the 780g my a1c was 83, with Carelink my predicted is 48.7.

 

[everydayupsanddowns]

Thanks for the update @SB2015

Sounds like you are finding your feet with it, and pleased to hear you’ve been able to make some clothing adaptations as I know that was a big change for you. You are coping really well with it this time around, and had the courage to take a break when you needed to, so give yourself a pat on the back.

I really hope the sensors and automode work brilliantly for you - if they work as well for you as Smartguard did for me, I think you’ll find it really hard to go back to a non-hybrid-closed-loop option the next time around - Just hope there’s one with a handset by then!

 

[SB2015]

Thanks for the update @SB2015

Sounds like you are finding your feet with it, and pleased to hear you’ve been able to make some clothing adaptations as I know that was a big change for you. You are coping really well with it this time around, and had the courage to take a break when you needed to, so give yourself a pat on the back.

I really hope the sensors and automode work brilliantly for you - if they work as well for you as Smartguard did for me, I think you’ll find it really hard to go back to a non-hybrid-closed-loop option the next time around - Just hope there’s one with a handset by then!

Thanks Mike

The next steps will be interesting, and with lockdown I have more time and more consistency with both carbintake and levels of activity, which will help me to get used to things.

One thing I had wondered about was why there is no concern about having the pump orientated with the tubing down so that bubble rise away from the delivery point. No need. The fill system is excellent, much easier and I just don’t get any bubbles at all. I also like the fact that you cannot forget to prime the cannula.

Another bonus with this pump is the alarm when I forget to do the final stage of a Bolus. No more spotting a rapid rise after a meal way beyond what I expect, and then spotting that I had not delivered the Bolus. On this I get an alarm. It also reminds me to change my cannula if I forget, shows me how much insulin is left, shows the battery life left, ... All things that probably seem normal to Medtronic users.

Pros and cons for all the different makes of pumps, which you don’t realise until you are actually using a different one.

 

[SB2015]

I started on the CGM on Friday afternoon, still in manual mode for now.

The sensor needed a calibration after 2 hours, 6 hours after that and then another 6 hours after that. It didn’t take much working out to realise it was going to be a disturbed night.
Lesson 1 Put new sensor in in the morning so calibrations are all done before bed.

I set up a suspend before low. It seemed good to know if I was heading to a hypo rather than wait for it to arrive. However my levels are usually around 5 overnight. This dropped me into the suspend zone, so I had alerts throughout the night and was too sleepy to work out what to change.
Lesson 2 Stick to suspend on low, and just look at the screen to see what is happening.
This will be sorted anyway once I go into auto mode but I shall check about alerts at the next training session.

Once the alerts were sorted, yesterday went smoothly and back to TIR in the 80s. It is a lot easier having the display on my phone with all the info there including active insulin, etc and not having to swipe to check.

One thing that surprised me was when we were told that the CGM readings were not valid for pre driving checks. This seems to contradict the statements from 2019 when Libre became a valid check. What I have read seems to suggest that any flash and CGM is okay for driving.
Has anyone else’s been told this? Can anyone clarify?

 

[Maco]

I started on the CGM on Friday afternoon, still in manual mode for now.

The sensor needed a calibration after 2 hours, 6 hours after that and then another 6 hours after that. It didn’t take much working out to realise it was going to be a disturbed night.
Lesson 1 Put new sensor in in the morning so calibrations are all done before bed.

I set up a suspend before low. It seemed good to know if I was heading to a hypo rather than wait for it to arrive. However my levels are usually around 5 overnight. This dropped me into the suspend zone, so I had alerts throughout the night and was too sleepy to work out what to change.
Lesson 2 Stick to suspend on low, and just look at the screen to see what is happening.
This will be sorted anyway once I go into auto mode but I shall check about alerts at the next training session.

Once the alerts were sorted, yesterday went smoothly and back to TIR in the 80s. It is a lot easier having the display on my phone with all the info there including active insulin, etc and not having to swipe to check.

One thing that surprised me was when we were told that the CGM readings were not valid for pre driving checks. This seems to contradict the statements from 2019 when Libre became a valid check. What I have read seems to suggest that any flash and CGM is okay for driving.
Has anyone else’s been told this? Can anyone clarify?

On lesson 1, Your first two calibrations are always 6hrs apart so yeah its always a good idea to start a sensor on a morning. You dont need to stick to the calibration times though, if say your 5hrs away from the pump asking for a calibration but your heading to bed then just do a calibration. Thats what I've done a few times & it always works fine. After the 6hr period I calibrate first thing on a morning, with my lunch & then before bed.

On lesson 2, Personally I didn't like the suspend before low setting or alarms. If I remember correctly Medtronic told me it usually kicks in between 5.4-6.3mmol or something along them lines. I didn't see the point in having tight control & getting my reading down to the 5mmol mark for the pump to suspend. Fortunately like you've already said once your in automode the suspend before low feature is turned off & the pump will just shut off insulin as & when needed.

On the driving, I just presumed you could use the CGM to drive like you could with libre. Wasn't told otherwise from Medtronic's training team or the hospital so personally ive never done a blood test to drive in over a month unless I felt high/low.



What I will say is don't always rely on automode to fix a big high. Yesterday for example me and my partner decided to try out a new very traditional Chinese restaurant that was doing take-aways. I knew the sauce was doing to be stacked with sugars & it was impossible to count the carbs so I just did a bolus for a large amount of carbs. My though was id rather start to go low & I would easily correct it instead of being sky high. The complete opposite happened & within 30minutes of eating I rocketed to over 16Mmol. I tried to ride it out for a few hours but from what I could see on my graph automode wasn't giving me any auto corrections so eventually I went & grabbed my pen and injected. Checked my readings around 2am & I was back in range, from there I thought the pumps automode would take back over but unfortunately an hour later I started to rise sharply again so once again had to grab my pen.

Not completely blaming the pump because I know the food was absolutely stacked with carbs, but its definitely not as easy as Medtronic make it out to be. I remember the trainer saying, if you miscalculate for a takeaway auto mode will happily correct for you. No chance was this happening last night 🙄

 

[SB2015]

I am now on Day 2 of the automode Smart Guard.

It coped well with a meal that I would normally have done a multiwave Bolus, eaten later than usual (It was another Big1 gathering last night) as well as a short walk afterwards. I slept through with just one loo visit and staid level all night. I woke on my target value of 5.5 and was already on 85% time in range. A good start.

Today I tried a longer walk using the temporary target. I made it home just before I went hypo, so that will need a bit of adjustment perhaps around the timing of setting up the temp target.
I then hypoed again this evening during a Pilates class before dinner. Another puzzle.

At present the basal pattern is using is based on the two weeks before I starter Smart Guard. During that time I had has kidney stones and my vaccination to which I reacted a bit. I think it is a bit confused at present so need to allow it time to settle into my normal patterns.

I look forward to my settling into this, and apartment from exercise I have been very happy with the levels. So often I look and I am 5.5! With no effort on my part. Any ideas welcome @Maco and any others using this pump.

 

[Maco]

Hi @SB2015, pleased to hear your settling into automode. I’m currently 94% in target range over the last 7 days, this pump really does work wonders. Where I use to struggle to be in range, I now struggle to be out of range!

As for exercise, set your temp target 2hrs before you start then take into account the time you’ll be exercising then add another 2hrs post exercise. So if your going to exercise for say 1hr then set your temp target for 5hrs and start it 2hrs before you plan to exercise. Starting it 2hrs early let’s the pump adjust & start to back off your basal.

All that being said I still regularly run very close to hypo territory when I go walking/running/crosstrainer etc etc. Think the main problem is the pump keeps you in such a tight range that you might be starting exercise at 5/6mmol so you haven’t got much to play with. I usually keep some glucose tablets or fresh orange with me & soon as I see a drop off I’ll eat or drink.

 

[SB2015]

Thanks @Maco .

I am off for another walk this afternoon so will try setting the temp target before lunch. It is a case of finding tweaks for this pump as I did with my previous one. Lovely overnight flat lines, and 94% TIR so as you say it does work hard for us.

I got woken up early (for me) this morning asking for a BG, in spite of a calibration at 23:00. There was a bit of a break in the SG values, and I wondered whether it could have been that I had been lying on the sensor. Have you had this? I had planned a lie in, but the sun was out so decided I might as well get going now that Humphrey had woken me up.

 

[JohnWhi]

Joining in here as I started with 780G and sensor this morning. Guided by Medtronic rep and the nurse who set me up with the 640G just over four years ago. Struggling as three calibration attempts were "not accepted" and the "change sensor" alert came up. Telephoned Medtronic and a first person told me that I should only attempt calibration if I knew that BS was stable. (The Freestyle Libre suggested a sharp rise after a meal, though I did not know this at the time of calibration.) At that point the line dropped and I had to phone back. The second person suggested I needed to check that the sensor had not come adrift. It had come unstuck. She expressed astonishment that I had not been told to use an alcohol swab to clean the site beforehand, and to avoid anywhere that might have come into contact with soap. (!!!) Also to ensure that any body hair had been shaved away. (I certainly do that when applying infusion sets, but the Diabetes Centre seminar room didn't have facilities at hand!) Both under the instructions of the Medtronic rep and having watched the videos on applying the sensor, I am less than confident on the exact positioning of the oval tapes, and exactly how the pieces of paper are supposed to move as one pulls them away. Somebody here may be able to offer suggestions ...

 

[SB2015]

Welcome to the forum @JohnWhi sorry to hear that you had problems with your first sensor, especially if you are self funding!!

To address the issue of alcohol wipes, I was advised at my training that that was included for the USA training but not recommended over here. They do clean the site but they also harden the skin and we don’t need that to happen. Just shower before applying the sensor.

Having had your sensor go adrift I was told to contact the Product Support team (but stick to between 9:00 am and 5:00 pm to get the UK team (unless it is an emergency) and if there is a problem they will replace the sensor if you have done as instructed around the site of insertion. I have found all the team to be absolutely brilliant on the phone.

For applying the sensor, I used the videos and on the advice of another user, stopped and started it as necessary as I did each stage. That was a brilliant bit of advice. I did my second one with the video again, and realised that the tapes exact position is not so critical but understanding what each of the tapes is trying to do has helped. On my first one I mucked it up totally and just stuck a tegaderm over the whole thing which worked. I unfortunately had to abandon my first one after three days as I ended up needing a CT scan!! A costly scan as a self funder.

In an ideal world we would calibrate when our BG is stable, BUt the world doesn’t behave like that does it. On the 780, unlike the earlier ones every BG you give it is used as a calibration. I don’t use the Guide Link meter (too fiddly for me with arthritic hands) but I manually enter BG before each meal. Only once I was on a steep decline but it seemed to cope.

I am only on the third day of SG and I am amazed at how I just sit around 5.4 or 5.5 most of the day and throughout the night without any effort from me. I just do my beat before meals, applying the same timings for my pre Bolus as before, and the pump sorts out the rest.

The only bit I am still working on is exercise. I gardened in the spring sunshine this morning and managed to hypo, and did my walk this afternoon in manual mode so that I could use Temporary basal rates and top ups of glucose without getting the pump out.

Keep in touch and let us know how you get on and we can all help each other. It is such a new pump so great to be in touch with others using it.

 

[SB2015]

Ps
I contacted Product Support about the interruption. Again impressed by their ability to look at my data, suggest explanations but also their wanting to check out other things and get back to me which they will do tomorrow. They have been amazing.

 

[JohnWhi]

Many thanks for that @SB2015 . I started a new sensor this morning, pausing the video at each stage and reading the written instructions. Looked a bit different from the first attempt with the Medtronic trainer. It accepted calibration, and is now giving readings. Pulling the backing paper from underneath the oval rings is difficult. I am told everything may be easier when we have the new-style sensors in a few months.

 

[Maco]

Many thanks for that @SB2015 . I started a new sensor this morning, pausing the video at each stage and reading the written instructions. Looked a bit different from the first attempt with the Medtronic trainer. It accepted calibration, and is now giving readings. Pulling the backing paper from underneath the oval rings is difficult. I am told everything may be easier when we have the new-style sensors in a few months.

Hi John, where are you inserting the sensor? I know this may sound daft, but try to pick a very fatty area. I used the back of my arm when I first started & had 7 sensors do what yours has done in the same day. I also couldn’t get away with the from of my stomach, these days the only place I have success is on my love handle area towards my back. Anywhere else my sensor fails before the 2hr start up has even completed.

As SB has also said, try to Calibrate when you are stable. Don’t calibrate just before or after a meal either just incase your bloods rapidly raise or fall because it may lead to a sensor failure. Once you get the hand of things you’ll absolutely love it!

 

[Maco]

Hi @SB2015, my sensors have usually been pretty good with keeping to the 12hr calibration. Think I’ve been woken up once since I started. As for lying on the sensor, I place mine on my love handle area & usually sleep on my right side so I try to place it on my left as much as possible. Not always available because of sensor rotation but I try to do that as much as possible. But to answer your question No I’ve never had an issue with lying on a sensor as of yet.

 

[JohnWhi]

Hi John, where are you inserting the sensor? I know this may sound daft, but try to pick a very fatty area. I used the back of my arm when I first started & had 7 sensors do what yours has done in the same day. I also couldn’t get away with the from of my stomach, these days the only place I have success is on my love handle area towards my back. Anywhere else my sensor fails before the 2hr start up has even completed.

As SB has also said, try to Calibrate when you are stable. Don’t calibrate just before or after a meal either just incase your bloods rapidly raise or fall because it may lead to a sensor failure. Once you get the hand of things you’ll absolutely love it!

Thanks Maco. Left of abdomen, similar to the picture in the instructions. I gather from Medtronic that I should have simply ignored the calibration alert, but the BS test for initial calibration was the first indication that things were not stable. (Nothing of the kind shown on Freestyle Libre.) Useful advice to avoid automatic entry of a BS test before a meal as all entries serve for calibration.

 

[Maco]

Thanks Maco. Left of abdomen, similar to the picture in the instructions. I gather from Medtronic that I should have simply ignored the calibration alert, but the BS test for initial calibration was the first indication that things were not stable. (Nothing of the kind shown on Freestyle Libre.) Useful advice to avoid automatic entry of a BS test before a meal as all entries serve for calibration.

Once your in automode you won’t need to accept every BS as a calibration, it’ll give you a “YES/NO” option. Comes in handy if there’s a big difference between SG & BG results

 

[SB2015]

Thanks @Maco

Check in the night
When I checked with Product Support about my interruption whilst my line was absolutely flat, they suggested that it could have just been that the line was so flat it needed confirmation that this was okay! It hasn’t happened again.

Exercise
I have opted for switching back into manual mode for now. My walks are more spontaneous rather than planned a few hours ahead. It is so easy to switch into manual and it means I can trickle in carbs as necessary without accessing the pump to keep it informed. It is as I did before but with the bonus of the alerts when going low and ease of viewing my graph on the phone.
I had initially thought that I ‘ought to be able to do this in auto mode’. But my pump is just my tool to manage levels in the way that best suits me.

Still lots to learn and try out.