Taming the Medtronic 780G and Sensor 4

[adamrit]

After 3 weeks with a 780G, I am much more even, but still with problems. You are supposed to let the pump algorithm learn how you work. It did that unbelievably well for the first 15 days (always between 4.9 and 6.8).And then everything got trickier. What do you do when you hypo? You can’t tell the 780g that you have just eaten 25gms of carb, because it will give you immediate insulin. If you don’t enter the carb it isn’t informing the pump algorithm, so it can’t learn.
The Medtronic User guide, written by defensive lawyers, gives no clue on how to deal with the problems that are normal for diabetics, given that we are all different.
They went on endlessly about Startright guidance for the first three months. So, at the end of week three I have two messages from Startright say to ring option 2 which says Startright doesn’t accept calls.
The Startright app is also not available in the UK!
I phoned Medtronic Diabetes Help about treating hypos with the 780. They twice said to ask my Diabetic Team.Yesterday, I had a whole day of highs, in spite of feeding in the correct carb values and the set insulin and the 780 giving me 2.6 units of corrections. There have been many comments about how slowly the 780 deals with high BGs, but my problem with that only happened on one day and not on any other.
Spaghetti always takes a longtime to increase my BG, so I used to give a Square Wave bolus taking 1.5 hours With the 640G. This isn’t possible with the 780 unless you turn off Smart Guard. Instead, I have been giving myself two doses of insulin, one 30 mins after starting the meal and the second an hour later. this has worked quite well, but it feels clumsy.With the 780g it is wonderful not having to BG test 5 times a day, and not worrying about glucose levels day and nigh. It would be nice to get it working well all the time.
Adam
Diagnosed 1956. 30 units Novarapid bolus plus basal. 780g pump and 4 sensors on NHS. 88% in range. 76kg 1.83m B 1940

 

[SB2015]

Hi Adam
I have been on the system now for over two years and I hope that these answers help.

Hypos
if you go hypo just treat it with your choice of carbs (JBs, juice, ..) and don’t tell the pump what you have eaten. I have picked up on here that glucose is absorbed quickly from the mouth so give it time to absorb, such as chewing a JB well.
I have a warning set on mine before I go hypo and I treat that and tell the pump about those carbs. This seems to head off the hypo, and the insulin the pump delivers will not be active for quite a while, so is not going to drop me further.

Hypers
if I am high I find that I can give the automated system and bit of help by just going to the bolus calculator, where it will often suggest a bit extra for the high, which I deliver. When in manual mode I always found that my sensitivity was a lot worse if I had highBG and I needed a bit more insulin. I have found this gets round that issue, but if ill I sometimes need to go out of Smartguard to get levels down before letting the automated system then keep me in target.

Multiwave bolus
Like you I found for pasta and pizza I needed multiwave bolus. In Smartguard I give about two thirds of the carbs to the pump which it will give me the upfront bolus for. I then let the automated corrections sort out the rest. I find that it gradually settle me down and I am confident enough to eat later and let the pump sort things out for me after an appropriate bolus.

Larger Meals
I found that if I ate over 60g of carbs at a meal I needed to adjust my bolus. Smartguard has the same issue for large meals, so it does not work as well for bigger meals.

User Guide
You are right that it doesn’t describe the practicalities, and we each develop our workarounds to suit us. I have found that later if I go back to the user guide what I do generally fits the advice but I read it differently at the start.

You might find it useful to have a look through the 780 Users thread for other tips and wrinkles.

780 Users

There have been quite a few posting that they are about to start or have recently started using the 780, so I thought it might be useful to gather our experiences together in one thread, so that we can support each other. Fire away with any questions about the system and finding workarounds for...

forum.diabetes.org.uk

come back with any other questions

 

[adamrit]

Very many thanks for your careful, considered and thoughtful reply. This forum‘s members like you are invaluable. I’ve stuck with Medtronic sensors for the last twenty plus years because of their hypo warning alarms. Smart Guard Sensor 4 is an enormous improvement over the very frequently inaccurate sensor 3. Having no hypo awareness means a wake up alarm at night is life saving. The 780 with sensor 4 has meant I haven’t had a single night hypo since I started using it. I wake up 5.5 or thereabouts every morning. The peace is extraordinary.
I have just read all the pumping and technology pages, which I should have done before putting my impatient ’pen to paper‘ as we used to say.
Many thanks
Adam

 

[SB2015]

Very many thanks for your careful, considered and thoughtful reply. This forum‘s members like you are invaluable. I’ve stuck with Medtronic sensors for the last twenty plus years because of their hypo warning alarms. Smart Guard Sensor 4 is an enormous improvement over the very frequently inaccurate sensor 3. Having no hypo awareness means a wake up alarm at night is life saving. The 780 with sensor 4 has meant I haven’t had a single night hypo since I started using it. I wake up 5.5 or thereabouts every morning. The peace is extraordinary.
I have just read all the pumping and technology pages, which I should have done before putting my impatient ’pen to paper‘ as we used to say.
Many thanks
Adam

I was amazed at how much better the Guardian 4 was over the G3. I was suspicious of their claimmm of just one finger prick per week but …. It was all true.
Keep the questions coming. No one minds. They always help others as well.