Smartguard 780 pump and problems with hypos/highs

[Type 1 Teddy]

I started this pump with CGM and Smartguard system near the end of August. I'm finding it extremely challenging to use. Before this I used the manual 640 medtronic pump alongside my Libre (CGM just manual) after much work my control and HBA1C were excellent, I learnt to manage my basal so I reduced hypos and highs. I thought this new system would do the work for me and that's what I was told by the diabetes team. I can also on this forum that people have great results. However this hasn't been working for me. I have an appointment with my diabetes nurse on Monday morning but am interested to hear if anyone has experienced similar, and how they have tackled this.

I go into hypos a lot earlier than most people and 90% of the time can feel one coming when my BG is about 5, also I've always had to be careful with manual corrections (with my old pump) as my blood sugar would drop dramatically quickly even when the pump calculated the correction. Anyway possibly a bit too much detail below about the current problem.

I calculate my carbs very carefully, but with this new system I started going high 2/3 hours after meals, regardless of the food being high GI or not, the pump did correct and after a high in the evening I would wake up with a good blood sugar. However the last 2 days the highs have stopped and my pump seems to have been overcorrecting and I have ended up with awful hypos i.e. on Wednesday I must have had at least 50 g of carbs over 2 -3 hours (numerous glucose tablets, very sweet biscuits etc) for the first hour or so despite all of this i didn't get above a BG of about 4 and kept dropping - eventually eat a couple more biscuits which stopped it) I hoped this was a one off, I changed my infusion set etc yesterday, had both COVID and flu jabs, thought it was one of those days. However the same happened last night, I noticed the pump auto corrected when I was at 8.0 and then I was woken several times between 11 pm - 12.30 pm with low alerts. I took 3 glucose tablets and 2 biscuits, and work up this morning at 8.0.
I'm going to try a temp basal tonight and over the weekend as I can't keep eating this amount at night but any longer term suggestions, I understand the pump needs to get used to your patterns but how do i stop it over correcting?

Any suggestions gratefully received, and thank you for reading this very long post.

 

[SB2015]

Hi @Type 1 Teddy Sorry to hear the issues that you are having with the 780 whilst looping.

Firstly I found the transition to looping very difficult at the start, and gave up initially , but then started again and once I got used to letting it get on with its job things did settle, and for me it is now well worth it. I was getting good results before switching, but putting a lot of effort into doing this. Now I have times when I just leave the pump alone and ignore her.

I have a week of unexplained lows with no fathomable reason over a week. The only thing I could pin it on to was having had both my jabs at the start of that week. I lifted my target as you are doing at present and accepted slightly higher BGs to avoid the night hypos.

The system does sort highs after meals but I also find it helpful to time my insulin to give the insulin peak a chance of meeting the glucose peak at the same time. My pre bolus times vary through the day, and are also not always possible, such as when I eat out and can’t be sure when the food will arrive. I accept the spike and know the loop will settle things for me. I particularly like this in the evening where any bumps get sorted overnight and I usually flat line by about 2:00 am and I SLEEP.

As I said the only thing I could see was different last week was having had my jabs. One issue with the system is that it uses data from the past 72 hours in the algorithm, so a wobbly day can impact the following days a bit, but the autocorrections sort out those most of the time.

I am very glad I stuck with looping and find I do a lot less work now. I hope that things settle for you and do come back with any questions that you have.

 

[everydayupsanddowns]

Sorry to hear you are having a tough time with the 780 @Type 1 Teddy

On the tSlim you can adjust your basic settings to affect how the algorithm works (eg change your insulin sensitivity if corrections are over-reaching)… which is helpful in some ways, but does come with its own challenges too.

It seems to me that we each need to find a way of providing the pump/algorithm with the information it needs for it to work well for us, and to develop little hacks and workarounds over the initial year or two.

Hope you are able to find a way to get the MM780G to work for you.

 

[SB2015]

Mike’s suggestion is spot on. I tell the pump what it needs to know to get it to do what I want it to do.

I have found over time that I am able to be less involved and just let it get on with things, and found appropriate workarounds. I had considered swapping to t-slim next time because of being able to choose the underlying profile in which the pump can base its decisions, but it involves more decision making and is more fiddly, so now that I have the 780 doing what I want it to I shall stick with it for now.

We each have to find what suits us at the time.

 

[Type 1 Teddy]

Hi SB and Mike

Thanks very much for your responses they're really helpful. I have come close to throwing the thing out the window🙂 but I know I'm being childish and need to keep going and try not to be over anxious (currently not succeeding with this 🙄). I think for me, it's changing from a system I felt I could control, to one where it feels that's been taken away. If I can get the hypos to stop then for me that's the key thing, I can live with them when I know why they're happening but these have been scary. Seeing that you've also had them after jabs and/or for unknown reasons, made me feel better. I can see the pump is both autocorrecting and then stopping basal but the last 2 evenings/nights one has been too much, and the second too late. But the pump is picking them up and my sugars are correct as I'm using both my BG meter and using up the freestyle libres I've got left. So this gives me assurance. Thanks again for the advice. 🙂

 

[everydayupsanddowns]

I have come close to throwing the thing out the window

If you haven’t reached that point several times are you even a real insulin pump user???

 

[Type 1 Teddy]