670G Auto Mode: Better Numbers or Same Numbers?

I use the Auto Mode feature of the 670G & Guardian 3, and in general, I think it is very good. However, every once in a while it does something that I am not sure why it did. This is about one of those times. I was in bed, and my numbers were getting very low (in the 40s and 50s). Yes, I should have treated them or had some juice, but I have had times when it would come back up itself around that time, so I decided to wait a little while. This is where the unexpected happened. The numbers did not come back up as they sometimes do, but they also did not go down (meaning I never had the Below 40 message). Also not good, but not extremely strange. But Auto Mode was continuing to give me insulin/microboluses. Why is it trying to give me insulin when I am in the 40s and 50s? It may not be able to give me juice or Glucagon or anything else to bring me up, but it can stop giving me insulin, right? I have also had similar scenarios for being high where I was high and it was only giving me enough to keep me there (not going up, not going down) instead of giving me the max to try to bring me down. Has anybody else had scenarios like these where it keeps you level instead of trying to bring you back into target range?

The microbolus feature anticipates where you are going based on how accumulated insulin and trend and past performance. It will bolus (remember these are micro boluses) depending on what it knows about you during the last seven day period.

I am a Medtronic ambassador. My opinions are my own. They did not pay me to say nice things. OK, they sent me a shirt and a cup but even I am more expensive than that.

I guess with some of my unusual numbers in the past week I can believe that. Although I still think that if my numbers are in the 40s & 50s that it should do 0 regardless of the past, and wait until I am at least above the Low Alert level. I guarantee that I will never jump from 60 to 120 in 5 minutes, so I think it will have plenty of time to start doing the microboluses again before I get high. But I guess I can forgive it once in a while if I my past week was a little bit unusual numbers.

Does anyone have or mind posting your numbers in auto mode? I’m also wondering the same thing. Have your numbers gotten a lot better during automode? I use an old Medtronic pump without this feature. I am hoping to get an updated pump with this type of feature though.

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If you would like to see my numbers in Auto Mode, I can try to get a screenshot of one of the reports generated by CareLink (just let me know). I am currently “re-tweaking” my settings after tweaking the settings when I first started Auto Mode. The area that I have done the most tweaking is the morning carb ratios. When I first started Auto Mode, I had huge spikes after breakfast (often as high as 300), so I had to (a little bit at a time) adjust the carb ratios, and eventually I had reasonable numbers. Now, a few weeks later, I am often getting low after the spikes (supposedly because the carb ratios were over-adjusted), but I am confident that within a couple weeks I will have good numbers again. Something I want to let you know (so that you don’t become one of those impatient, easily frustrated people when you start using Auto Mode) is that it will require several tweaking sessions before everything is perfected. It is good to use a “Scientific Method” sort of approach, change only one setting at a time, work on only one issue at a time (for example, I worked on my breakfast spikes before trying to adjust my dinner & bedtime settings). And one of the most valuable pieces of advice that I have been given with the 670G (I wish I had been given it earlier, because it would have saved me months of frustration) is to “only do what the pump asks you to do”, which basically means not overcalibrating. I could go on and on about all the stuff I have learned since starting Auto Mode, but there is obviously not enough space here, but I (and probably most of the other people here) are always willing to help you in any way we can. Good Luck!

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That would be great to see if it’s not too much trouble. I have similar issues like lows overnight and highs after eating in the morning. Thanks.

Kristy - it depends. if you are in the high 5’s for an A1c, it is likely your numbers will go up to about 6.1- 6.3. if you are over 7 it is very likely your A1C will drop. If you are in the 8’s or 9’s it will drop a lot.

I am a Medtronic ambassador. My opinions are my own. They did not pay me to say nice things. OK, they sent me a shirt and a cup but even I am more expensive than that.

Kristy:

I do not think there is anything confidential here. if there is someone let me knwo and i will take it down. I have not uploaded in October so i picked the last two weeks of September. I hope this helps.

and of course:

I am a Medtronic ambassador. My opinions are my own. They did not pay me to say nice things. OK, they sent me a shirt and a cup but even I am more expensive than that.

phillips pump readout for two weeks.pdf (317.3 KB)

I am usually in the 7’s. I have had a lot of lows and have Hypounawareness. So every time I try for a lower A1C I end up having too many lows.

Thanks, that is really impressive to me. I have had a lot of issues controlling my blood sugars over the years. Mine used to be a lot worse though and I am somewhat controlled in the 7 A1C range. I would like to be lower, but, the harder I try the more low blood sugars I have. So I have gotten to the point where a lot of time I aim higher. I definitely try to run higher if going out anywhere.

If you use the 670G you must work very hard to get the carb counts right. What is not reflected in my numbers is that I use an app to track and calculate every bit of food. The more you accurate you are the better the numbers.

I am a Medtronic ambassador. My opinions are my own. They did not pay me to say nice things. OK, they sent me a shirt and a cup but even I am more expensive than that.

So as I am new to pumping and new to the 670G and automode I am not sure if this will help or not. My experience so far as my numbers have improved. This is kind of shocking to me as I felt my numbers were decent when I was injecting. The thing that impresses me the most is that when I go for a training run I can really get the impact of how my workouts affect my BG. I agree with Rphil2 when he says you need to get the carb counts right as I too use an app and calculate everything.

Do you test with a meter often enough to have confidence that your numbers from the CGM are accurate? I have no faith in Medtronic sensors. I know SOME people claim the new ones are accurate but that’s not what I hear from my endo and others. After having 22+ sensors replaced in about a year’s time I would never give Medtronic another chance to fool me with their sales pitch that “these sensors are much better than our previous version”.

I find the sensors are as good or better than the Dexcom G5. I have not used a Dexcom G6.

Note: I am a Medtronic ambassador. My opinions are my own. They did not pay me to say nice things. OK, they sent me a shirt and a cup but even I am more expensive than that.

I am very, very interested in this topic.

My A1c runs in the low 6s. This takes a lot of daily adjusting.

I was all set to go with the t:slim for my next pump, but I’m having reservations about the lack of waterproofness and the touchscreen with extremely small, low-contrast fonts (I’m legally blind).

I’m interested in success stories that people have had with the 670G. Is it possible to maintain an A1c in the low 6s, without massive spikes, on this system?

I’ll be honest: if the 670G used Dexcom sensors, I would have signed up already. The Medtronic sensors concern me because of their shape (I have a refined system for taping my Dexcom that I’ve developed through the years) and because I self-fund my CGM supplies and use a Dexcom sensor for a month on average, something I gather is impossible to do with Medtronic sensors.

Ah, dilemmas.

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I would really not be concerned about the water with the Tandem. Ours gets wet. It is fine. Tandem Customer Support told me directly they would cover it under the warranty if there is any water damage.

The issue of being able to operate the pump is a very real issue. Certainly one only you can decide what works best.

Have you been able to physically hold both of the pumps you are considering?

I should probably specify that I’m thinking of swimming when I’m thinking of waterproofness.

In general, I have not had good success trying to disconnect from my pump while swimming. So I’d rather something I can keep connected.

My understanding is that Tandem does not recommend their pump for swimming (or showering, etc.).

Oh - lol - Yeah. That is totally different.

I think trying to swim with anything other than an Omnipod would be quite challenging.

When my T1D goes in the water, the pump is certainly disconnected. Bolus for 2 hrs worth of Basal (taking into account likely exercise) and then disconnect. 2 hrs later, check BG, connect, bolus then disconnect.

Strictly for comfort and being able to more easily move around. Not related to concerns about water hitting the pump.

I haven’t seen them side-by-side. But I have physically held both. Plus (and this is what’s really got me thinking) I’ve been playing with the Tandem simulator app on the iPhone.

The font on the 670G is definitely larger than on the t:slim. Plus, the buttons mean you don’t have to get your thumb or fingers between your face and the pump (no one understands this struggle till you’re trying to work a touchscreen with the pump half an inch from your face, and have to pull back to make room for your finger, but then can’t see whatever you’re trying to tap on clearly enough to tap on it accurately…alternative is using the iPhone camera to magnify, but that has its own annoyances).

I basically began wondering if I want to deal with that sort of thing every single time I interact with the pump. That could get annoying very quickly. The 670G has a font size similar to the Animas pumps, if not even a little larger. That is large enough that I can pick up the pump and look at IOB or an alarm and at least get an idea of what it says (0.25 units or 2.55 units), even if I do decide in the end that I want to magnify to be totally sure. The t:slim, I wouldn’t be able to take a guess without the magnifier.

So the 670G has its downfalls, such as not using Dexcom and the generally horrible reviews of auto mode. If I got it, I could always use it as a regular pump with or without the CGM. The only real downside is if I hated it, I’d miss out on Tandem’s updates, which (if Basal-IQ is any indication) I’ve heard nothing but positive things about.

If Tandem had gone with a colour other than red-on-grey, orange-on-grey, and grey-on-grey and a larger size (which there is room for in all of the menus I’ve seen!), this decision would be made somewhat easier. And also if you could swipe, versus having to aim for those little up and down arrows, which make scrolling while looking through an iPhone camera with limited field of view due to the zoom much slower.

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I swam with my Ping regularly. I was swimming lengths for one to two hours at a time. Sometimes aquasize, too.

I found keeping the Ping connected no problem. I’d put it in the front of my bathing suit and not notice it.

I tried bolusing before and disconnecting, but that inevitably led to lows. I also tried just disconnecting, and that also led to lows. I tried a reduced basal for two hours and then disconnecting, and that led to horrible highs and ketones and feeling sick. I found the most successful was a two hours reduced basal run through the swim session, then a bolus about half an hour before I finished.

This was before CGM, so with CGM data, this would probably be refined some.