Auto Mode and FOTF

I’m frustrated. I’m trying the new Medtronic 770G pump and the Guardian 3 sensors and of course, Auto Mode. I don’t think its algorithms can handle the feet on the floor effect that happens to me. It’s been worse since I hit menopause a couple years ago.

Previously, in manual mode, I had my basals boosted, sensitivity numbers lowered and carb ratio adjusted. It helped, but it was still an hour before my BG came back into range. BG numbers jump 2-3 mmols in the hour and a half after I get out of bed. I would test with a finger prick and bolus while still in bed. Then I would (begrudgingly) have my shower before eating. I wouldn’t eat until my SG (Libre) numbers started coming down. FYI, I only have 13 grams of carbs for breakfast. Blueberries, Greek yogurt and diet cranberry juice. I used to be able to handle oatmeal in the morning and I miss it immensely. I digress…

Now, in Auto Mode, when my BS rises due to FOTF, the system thinks that the rise is from the food that I have bolused for, but I haven’t eaten a bite. And if I eat before my numbers come down I’m high all day because the pump never catches up. “Max. delivery reached” and all that.

Is there anything that I can do? Phantom bolusing seems to defeat the whole Auto Mode premise. (I found out about that on this forum. Thank you.) If I did do a phantom bolus, how would I time it? I could go to Manual Mode only for the morning and go back to Auto for the rest of the day. Or, I could give up the whole idea, not worry about how I’m going to afford these sensors, and just go back to the Freestyle Libre, which the government covers for me here in Ontario.

I would appreciate hearing how others have dealt with this and others who are more familiar with Auto Mode. In the meantime, I’ll read some of the posts about Auto Mode here on the forum and see if anything applies to me.

Thank you!

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I’m going to reply to myself. :slight_smile:

So I think I need to figure out how much phantom bolus to add to my breakfast bolus. Will try tomorrow.

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Don’t think of it as a phantom bolus, think of it as a correction I don’t have feet on the floor, but I have a strong predawn bump. My tandem has flattened it out pretty completely. But on the tandem, I have my basal set higher for the 5-530 am time, so it’s doing most of the heavy lifting. I know the Medtronic works differently because there are no set basal rates. The tandem does and then sugars allow it to correct as needed. Before I had a closed loop system I would wake up at 530 inject 3 units and go back to bed., we just do what we have to do


And then there are the days where I don’t have a rise from hormones. Coincidentally, the first day I try a “correction” bolus. Low alerts abound! Sigh…

770G here as well. I tell the system that I’m having more carbs than I’m taking in. My morning bolus is for 27 grams for a 12 oz mug of black tea. No milk, no sweetener. That typically brings my BG down to a range where Auto Mode can keep up. For comparison, as a low carb eater, my typical lunch is 20 grams of actual carbs.

No, it’s not good to lie to the system, but I value my feet more than I value the algorithm. It sounds trite, but Auto Mode is still in early days, and the current version basically forces me to use a meal bolus in the situations where I used to use a manual correction. At least the system knows how much insulin is on board. It’d be a worse situation if I used my backup insulin to do a manual correction that’s completely unknown to the 770G.

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Some good points. Thanks for your input.

I put my carb ratio to 1:5 when it’s 1:12 for the rest of the day.

Hey Frantastic, I’m using Omnipod 5; Auto mode is probably programmed a little differently but same premise. Since perimenopause hit, my insulin sensitivity in the mornings is just garbage, so I fast till noon. :wink: But after 3 months in auto mode, I agree that it just cannot account for FOTF…and it doesn’t help that three days a week I get up about 2 hours earlier than the other 4 days, so I don’t see how it can really learn my “pattern”. So I phantom bolus like you mentioned. And on the rare occasion I actually eat something, I will add additional carbs to get to my ultimate goal, which is 1.5 extra units of insulin to cover FOTF.

I know it takes Auto mode a long time to figure us out…due to hormone changes, about 25 days a month, my insulin requirements are nearly double, and so far, with only having used Auto mode for 3 months, I spend most of the day and evening taking correction boluses cause the algorithm consistently doesn’t give me enough insulin. I hope that I’m not working against it by correcting, but I just don’t feel like living my life at 150+ all the time…I just don’t feel my best when my sugar is that high.

Unfortunately, my endo thinks being at 150 is dandy, so I haven’t gotten much help from them in regard to tweaking things. I disagree, so all I can do is read here and futz with things on my own!

I hope that sticking it out will make Auto mode work better for you in the long run!! If you find any Ah-Ha’s! I hope you’ll post them for the rest of us that are similarly challenged. :slight_smile:


Exactly what I experienced with the 670G, and perhaps the main thing that caused me to give up on it back in 2017. Can’t believe we’re now 5-6 years and a whole new pump version later and it’s still not where it should be, at least by the standards of those of us who have maintained tighter control without it.


Thanks so much for your reply Sarah. I’m sorry to say, but it helps just knowing I’m not alone! :wink:

Let the futzing begin!

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I have a similar issue with my Medtronic 670G. I’ve recently returned to Automode in an attempt to get better control. For a couple of weeks things went well, but then they didn’t. Before I get out of bed, I’ll turn Temp Target off. I have to use it at night or I’ll go low. Then, I may do well or go very high……even if I eat little to no carbs and bolus correctly. Mine is related to emotion, I think. When I’m stressed, rushed, emotional, etc. my BS will spike to over 250….no food involved. I will bolus though, even in auto mode. I don’t consider it a false bolus. If I enter my BS number, it will suggest a bolus, which is a correction bolus. Often that is too much. If I allow it, I’ll always go low, so…I accept it and then halt it before the full dose is released. Convoluted I know. I have to discuss with my Endo or CDE. So, I guess I have no answers, just wanted to say that getting the system to work for us is challenging. I’m not giving up though. Oh, I also bolus for coffee, even if just Stevia and a splash of almond milk. I’ll usually do one unit for it.

If I’m in manual mode, I have different basal rates and the one for morning and early evenings are higher than other times.

I was instructed to not correct a sugar from adrenaline reactions like severe emotional stress or from when someone almost crashes into yo in a car.

The reason being, you liver releases sugar in the form of glycogen along with adrenaline which speeds up your metabolism and also consumes glucose the ways exercise does. Then your liver begins to remove glucose from your blood to replenish glycogen

It sounds like you are on that roller coaster. Instead I would do a very small correction and wait for your sugar to return to normal
This is something I used to struggle with when I was involved in competitive sports. I would get an adrenaline rush during the start of an event and then I would quickly crash afterwards.

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I gave up on Auto Mode. I would never wake up with numbers below 8 (144), starting the day already behind. In fact, I’ve also given up on the Guardian sensors. Too much fuss and money. Back to the Libre 2 and manual mode.

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Ahh good to see that I’m not alone with getting out of the AM in the Medtronic. And the joy of the Libre2 - is that it’s covered by my province here in Canada for those of us using insulin. So, not out of pocket like the Guardian 3 .

And I second @Frantastic 's comment above as well Sarah! Glad to see someone else struggling with Automode in the Medtronic 770g - I’ve been told by Medtronic to hang on for the 780g upgrade - and then decide whether to stay on this pump for next 5+ years (I live in Ontario - pump covered thank goodness by this province - wish technology was the same all across Canada - but alas - Houston we have a broken system.

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