The Auto Mode experience: 670G two weeks in

Yikes, that is a super conservative algorithm, I think I would go crazy with that. To be fair, I recently had that type of persistent 200+ situation after a big Thai meal with friends – I just couldn’t resist – but for a relatively normal day I’d be looking at what was wrong with a sensor, with the insulin, or something…

Same here. We’re just starting to tweak things. I tightened up the AIT setting 24 hrs ago and it has helped. There are a few things other users have recommended that I haven’t tried yet b/c I’m keeping to my trainers’ recommendations, but I’m at the point where I feel like I know it well enough that I’m going to take matters into my own hands soon.

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I’ve been on the system since the first of July and have had many of the same problems mentioned in most of these posts. I still don’t like the fact that it wants me at 150 instead of 100, but maybe that will happen with the next upgrade. Please, please, please contact your trainer. I have spoken to mine multiple times via phone, email and in person. Every time I see her, we tweek my carb ratio and alter my basal rates based on my pump downloads via carelink. This has made a huge difference in my averages. Despite more elevations after certain meals, my A1c is now 6.4% with <1% listed as low (<50). This is a great improvement for me. Hope this helps. Good Luck!

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Good advice to all. I’ve been uploading my data and emailing them (I have two trainers) status updates every day. Over the last week we’ve changed one of my ICR settings, and more significantly, tweaked my AIT twice, moving it down from 3hrs to 2. This does seem to have gotten the thing’s attention. The problem I’m having right now is that the sensor keeps undershooting my BG by a non-trivial amount, which means the pump thinks it’s doing a lot better than it is doing, and as a result it’s still not putting out what it needs to get me down to that 120 area during the times when my BG tends to run high already. You’re not supposed to confuse it with too many calibrations, so I’m trying not to totally overdo it, but dammit…

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Hi all. Checking in here, sorry for being away but I’ve been kinda busy the last week.

I think the constructive advice on this thread is very useful. Definitely work with your Medtronic trainer/CDE on your setting if you can, and can reach them. Unfortunately for me my Medtronic trainer and CDE where my endo works have been “out to lunch” so to speak, and rather than offer suggestions/advice have offered nothing.

Ok, so much for the ranting on that. I am, after 1 month in Auto Mode, having great success thanks to a lot of advice and guidance from 670G Facebook groups.

The biggest challenge with transitioning to Auto Mode, in my opinion, is that what we understood AIT (active insulin time) and CR (carb ratio) to be before is NOT the same in Auto Mode. Essentially, in Auto Mode, those settings influence the aggressiveness of how the Auto Mode algorithm behaves.

There is only one AIT setting so that’s where I began tweaking things (lowering my AIT from 3 to 2 hours) since it was easiest. Currently my AIT is 2 hours. Making that change improved things quite a bit, but it was still not optimal since I only had one CR (carb ratio) setting and it was 10 and not doing the trick.

So I began (myself) tweaking down my CR, setting up multiple CRs for different time ranges of the day - and things improved tremendously. I made these changes using my Carelink 670G data (especially the assessment report), and continuously monitoring my pump’s 24 hour trend graph to see what patterns were happening at different times of the day.

That all took awhile, and a lot of patience…so work with whatever help you can get from Medtronic, your CDE, and endo to improve things gradually. It will take time, at least a month or so before you get satisfied with your results.

Also - make sure you are inserting your sensor in body locations where you are getting the best most accurate results. My abdomen did not work well for me. I currently use back of my arm (the flubby part) and sides of my calf (lower leg) and am getting fantastically accurate SG results as compared to blood sugar testing. Can’t compare this with the Dex since I never had an opportunity to try it (although I tried before going on the 630G/670G). But I am completely satisfied with SG accuracy with the 670G.

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See my first thread on this topic–my first week, in Manual, I was wearing both. Far as I could tell they were about the same, maybe a bit of an edge in favor of MDT. Accuracy aside, another big plus for Guardian 3: connection drops. Having way fewer of those than with my Dexcoms.

Good point. I’m still finding the thing much harder to attach than my G5 (complicated taping that my MDT trainer wants me to do scrupulously by-the-book) and have been sticking to my abdomen and “love handles” b/c it’s easier to see what I’m doing. Used to use my upper arm with my G5, but never tried my calf. Hmmm… Anyway, my problem on the last two sensors is that they’ve been registering ~20u low compared to meter, particularly overnight. With an ordinary pump that’s not nearly such a big deal, but with this one, those numbers are directly controlling what the algorithm is telling the pump to deliver, so it really matters. In my case it’s offsetting the effect of dialing down my AIT somewhat. But taking it from 3 down to 2 is definitely improving things for me as well.

Side of the outer calf has been the absolute best place for me. There is a video in the Medtronic 670G Users Facebook closed group that shows how to do it. Just make sure that you position your leg so that the side of the calf are you insert it in is somewhat flubby. For me it’s a completely out of the way place, even better than back of the arm! Insertion doesn’t hurt at all even though you would think it would!

I’ve not had any problems with taping - use provided Medtronic 670G Oval Tape. I do put Skin Tac on the area after insertion before putting the Oval Tape on which helps a lot. I’m kind of an exercise freak / work out a lot. Have had no problems with oval tape holding.

Oh - another thing on calf area - it’s a good idea to shave it before inserting the sensor.

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My G3 sensors have all consistently been within 10 mg/dl of blood glucose lately…actually closer in many cases. Extremely accurate and very responsive to glucose-level changes. I’m ecstatic with it, life changer!!!

Thank you so much DrBB- I’m almost.at the end of my 2 months in Auto. I experienced nearly everything you’ve mentioned. I thought I was crazy or just incompetent. To get the 670G algorithm to bring me somewhere closer to running between 120 and 150, I had to change my Carb Ratio to be less carbs per unit and lower my insulin active time. Also, I have to be super accurate when carb counting. Each and every single carb has to be entered and I need to always prebolus.

They keep saying the pump needs to learn me but I’m sure it’s just me getting use to how this pump works and completely change how I do things. It is getting better but it’s been a rough learning curve.

The best thing about this pump is it has dramatically reduced my lows. That’s the one thing that keeps me on the 670.

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Yes! It’s definitely a two-way street.

:+1:

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Yeah, I completely understand. As listed in another thread in this conversation, I have multiple carb ratios with each meal. This has really helped. But now, “ding dong” (what I somewhat affectionately call my pump) is waking me up between 2:30-4:00 am with “high” reading and it’s been at max for 2 1/2 hours…sighhhhh. I have no ready explanation for this yet. My AIT is down to 2:30 and it has helped a lot. Hang in there (I’m talking to the choir too!). But my understanding is that it “shoots” to keep us at 150 and not 120 like we’d like. Good luck!

There does seem to be some ambiguity about that. What I understand is that the official “correction” doses (when it says “bolus recommended”) are calculated to 150, while the regular microbolusing is targeting 120. But that leaves a pretty big fuzzy area. Those “bolus recommended” doses are so much smaller than what it would normally take to get you down even to that higher target (I’m at 230 and you give me a 0.3u correction? WTF???) that I can only assume the algorithm figures it in as well somehow. I mean, it’s supposed to be anticipating highs as well as lows, so presumably it’s ramping up anyway, just not enough…?

The other thing I’m trying to get clear about is whether or to what extent the CR figures into the microbolus rate. My CDE said it didn’t, that it was just for meal bolusing, but he’s a newbie too and I hear otherwise from people in the user group, so I’m trying to get a clearer answer from my MDT trainer. Pretty sure it MUST have an effect because otherwise all you’ve got is AIT, and once you’ve hit the lower limit of 2hr there’s nothing else to tweak.

IMO, anything that “shoots” for keeping me at 150 instead of ~100 will raise my A1c from it’s usual 6.1. No thank you. Nor can i trust Enlite sensors to do their part in feeding accurate data to the pump. Not on my life!

Go to the sensitivity screen and reset your sensitivity. Mine is 1 unit will decrease me 100 points. I’m very sensitive to the insulin.(please verify this with your trainer/MD too). My numbers have become closer (Fingerstick vs sensor) when I moved the site to my lower, inner upper arm. I’ve had DM for 46 years and have lots of scar tissue/lipodystropy, so finding sites has been a trial.

To be accurate, and I think this is in the thread somewhere, the target is still 120; it just uses a different one when calculating a correction. But the baseline microbolusing is still aiming to bring you down to 120. And it uses Guardian 3 sensors, which are very different from Enlites and far more accurate. During my initial week I wore both a Dexcom G5 and a Guardian 3 in parallel. The Guardian was at least as accurate as the G5 and had far fewer dropouts.

I was told pretty authoritatively that the sensitivity setting only applies in manual mode.

I also am wondering about the no exercising. I had that discussion with my CDE about basal testing. One thing they always say is to not exercise when basal testing. But I said if I walk to and from work everyday at the same time, shouldn’t that be part of the basal testing? It would be silly to test without it if I do it at the same time every day. So my basal testing is done with those daily walks to and from because that is my normal day. Right?

So sorry for the confusion…I thought it took all those numbers/ratios into the equation to change the dosing with food/blood sugars. I’m all out of ideas…it’s such a frustrating part of my life now. I’ve only been pumping for 9 months now. On multiple daily injections for 40+ years. I used an earlier version of medtronic pump without sensor about 10 years ago; this got my A1c back down under 7.0% and I went back to injections. The pump/sensor is a great idea, but it’s a lot more work that the injections were.

Hopefully, it will get better soon for both of us. Good luck!

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I was so excited for this closed loop system, then my doctor told me that the goal blood sugar is 120 and there is no way to change that. With my current pump and CGM my average blood sugar is 90. I would hate to lose all that valuable ground changing to the new system. For now I guess I will suffer through all the work and calculations of a normal pump until they can come out with a system accurate enough to venture into lower averages!

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