I am using the the 780 and I find that Smartguard doesn’t address my dawn phenomenon. How much extra should I bolus to compensate for it?
This is the problem w the Medtronic algorithm. Where on my tandem I can program in basal rates and control it just adjusts from there. At 4 am I increase from 0.9 to 1.3 units per hour and it goes back to 0.9 at 630 when I wake up. So for me it comes to about 2 extra units. Of course I know nothing about your settings or how strong the DP is for you.
Waking up to bolus is a bummer though
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I have been on the 780 since the 22nd of March. It still doesn’t address my DP. My only other option is to add bogus carbs which aren’t really as my sugar rises as I wake up and I need that extra insulin to handle it. They said that when it was named automode that you might need to bolus for things that you never did before. When I had the 770 I would bolus for protein and fat about 1.5 -2 hrs after a meal and it did’nt seem to hurt the algorithm. I was getting 90%and better daily. I adjusted active insulin time to 2hours to make the algorithm more aggressive. So yesteday it delivered a bolus of 1.125 and today I did 1.825. Yesterday it went up to 11.5mmol. That is unacceptable IMO.
I tested at 708am about 45 min after eating and it was still 11.8 despite the increase in insulin. About 2 weeks ago I was playing with doses and see that I needed at least 3.2 units in the morning for DP and food. I have to add a crazy amount of carbs to make it work. I am thinking of exiting smartguard and do a bolus manually by the pump.
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I wonder if something else is happening.
DP usually happens while you are still in bed. For me it’s about 1.5-2 hours before I get up and my pump corrects it.
There is something similar called feet on the floor, where when you get out of bed your sugar jumps up similar to DP.
However you seem to have trouble with high sugars after you eat your first meal. I’m not sure it’s related to DP, but maybe you need a stronger carb ratio for your first meal.
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There is DP, Dawn Phenomenon which is hormones released that cause an increase in blood sugars for your body to get ready to waken for the day. Usually it commonly is around 5-6 AM. Then there is FOTF, Foot On The Floor, which is sort of the same thing, That happens after you are awake and your body increases blood sugars to get ready for the day. It’s called FOTF, because often it is after you put your feet on the floor and start moving around.
You can have one or the other or both. For me I have both, but for me one is usually significantly worse then the other. My FOTF actually occurs about an hour after I am awake. My DP is only requiring 1/2 unit extra, but my FOTF is requiring 1 1/2 units extra plus. They both usually cause insulin resistance for a few hours after since the release of hormones cause it.
I have extra insulin programmed into my Omnipod, but on a lot of days I am adding more for FOTF. I avoid eating in the AM unless I am snorkeling as it’s hard to judge insulin needs for food. I skyrocket easily if I eat in the AM. It’s like a blood sugar overreaction to food. I have a higher carb ratio in the AM, which is never enough. It’s easier for me to just avoid food most days in the AM. Unfortunately these things can vary which can drive you nuts.
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This was the problem for me with the 670G and why I stopped using it. Just couldn’t get it to recognize and head off DP even though it’s one of the most consistent patterns I have as well as being common as dirt among PWD as a whole. It was pretty much WHY I started using a pump to begin with, and I think for a lot of others as well. MDI just can’t handle it without you having to get up at stupid-o’clock in the morning for a bolus.
As @Timothy says, the Tandem approach is to USE your basal schedule rather than trying to replace it wholesale as Medt does, so you can still program in things like DP that recur every 24 hrs like clockwork and the algorithm just steps in to make adjustments as necessary. Nearest equivalent with Smartguard is to just turn it off overnight and revert to standard basals. Do you have a lot of unpredictable overnight instabilities that you’re trying to account for? Otherwise, if Smartguard’s not helping there’s no obligation to use it. I don’t think shutting it off when you don’t want it screws up the algorithm or anything. It’s not really that sophisticated.
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No, I agree, the pump is not that smart. The only time I need to fix is breakfast. My assessment graph showed more variability in the morning because the 780 wasn’t giving me a big enough bolus no matter how low I put my carb ratio. So this morning I exited smartguard and did a manual bolus. I still need a little more so i have adjusted my carb ratio accordingly. All my other meals are ok. I find if I eat some carbs /protein it keeps me more level at night but 3/4 of the time the sensor is off. It will say something like 4.2 when it is really like 5.6. I just leave it if I am not below 5mmol. I also started using the angled insets. I was using mio advance 90degree infusion sets and I kept getting them in blood and they weren’t very comfortable to wear. I could sometimes feel the cannula under my skin. The angled sets work much better for me. I insert them with a silserter. It is really easy.
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It is most likely FOTF syndrome asi as soon as I rise the number increases. I was talking to someone on Facebook that said I should talk to one of my Healthcare Providers about why in the morning when I bolus tthe bolus isnt near big enough. Whenmmy sugar is normal in the morning it does it. I eat a bowl of puffed wheat no sugar ceral with soy milk nocarbs in that. Some blueberries and a cup of coffee. I bolussed in manual mode today to get the size bolus I needed. I prebolus. My carb ratio is at 2.8 and when I input the 25 carbs I am eating it will only give me a bolus of 1.125. I trusted once and tried it and I ended up with an 11.9 1hour after. Very frustrating!
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I think it is more Foot on the Floor syndrome. My bloodsugars rise aftr I get up.
I have my basal rate set as .300 at 6am. The basal rates in the Medtronic pump have nothing to do when in Smartguard. I can’t increase my basal and hope that the algorithm adjusts. It goes off of your total daily dose. I don’t know why it doesn’t give me more insulin in the morning. It has been a long time since I have fasted so one day I should delay breakfast and see how the algorithm handles the morning. What do you think?
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In Smartguard of the Medtronic 780 insulin pump the only things that you can control are the carb factor and active insulin time. By shortening the active insulin time you make the algorithm more aggressive. I had mine at 2.15hours but switched it to 2hours as I would like the algorithm to kick in sooner. It does automatic corrections. I also lowered my target from 6.7 to 6.1.
I am wondering that when I go high should I leave it alone and let the pump’s algorithm take over? I had to change my site early because I normally fall between 3-5pm and this time I did a temp target at 3pm for 1.8 hours. My sugar rise all the way to 9.5mmol and that was before eating at 515pm. I delayed supper until my bloodsugar went to a more acceptable level. At 645 it rose after eating as I didnt get the full bolus. Right now it is 13mmol. I’m not even sure this site is working. Urghh!
I just started on SmartGuard 780 G system. It does not address the Dawn Phenonmenon, Although it tells me I am in range 80% of the time, I find I have too many highs and I don’t care how much of a bolus it gives me every 5 minutes it is not enough to bring it down and this is fasting in the morning. I have decided to go back to manual mode during the day where I can manage it better and stay on smartguard at night while sleeping to avoid night time lows.
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The one difference between MT and Tandem is that you can program times on tandem. I have my dawn pneumonia down to a flat line. I set my pump to increase basal at 4 am and decrease it back to normal at 6 am. I also run the algorithm to make adjustments, and it works really well. I stay in the mid 90s for TIR
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LOL autocorrect!
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I have very pronounced DP, and for me that was a primary reason for going on a pump in the first place. Also my biggest complaint when I tried the Medtronic 680G AID pump when it first came out. System just basically wouldn’t respond to DP, between the sensor not adequately picking it up and the algorithm being too feeble in its response, so I’d always start the day struggling to bring my BG down even before eating anything. Recently switched to a Tandem, which handles DP just fine. The big difference is that the Tandem system USES your basal settings as the foundation, only intervening to adjust delivery as necessary, whereas Medtronic ignores those settings in Automode and wants the algorithm to do everything. I read conflicting things about the 780’s success at that, but to me it’s just a wrong-headed way to do this. If you have your basals basically right, you don’t really need constant tweaking most of the time, so the pump just focuses on predicting and compensating when it perceives you’re trending out of range. And it doesn’t lock you out of all the parameters you might use to make adjustments yourself if you feel the need. Just a different design philosophy that works a lot better for me.
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Thank you DrBB. I have thought about the Tandem system since the 770G came out which was a complete failure. I have been type 1 for 44 years and brittle. I like some features of the 780G but do not like that I cannot dual bolus, that when it thinks I am going low it just stops giving insulin and I go extremely high, and am locked out of features. I will have to research the Tandem. Thank you very much.