I'm late to the 670G Party, but

I’ve been running in auto-mode for about a week. A couple of things I’m noticing, I’m bumping up my carb counts. Whatever I know the carbs should be, I’m adding about 5-10g extra on top of it. It’s causing a few lows, but I’ve been running in the 200s for a solid 7 days and it’s making me low grade nauseous and foggy at this point.

I know it’s going to get better, the CDE who trained me showed me hers and her chart looked beautiful.

I’m averaging 40 units of insulin a day. 18 from boluses and 21 from automode. Is it my insulin or should I eat fewer carbs than I do? I’m averaging about 120-130g per day. My high trends are from 6-8 am, 2-4 pm and, 6-8 pm so they are all meal related.

Any tricks or do you think the algorithm will smooth out soon?

that is a lot of carbs, IMO. I’m a T1, nearly 6’5", 212 lbs and I take roughly 25 units per day when eating sensibly. My 14-day average: 24.5U total per day,basal is 48% of total (that’s where it should be-basal to bolus should be roughly 50%).

When I eat incorrectly, my total insulin per day exceeds 60U/day and my bg’s are very wild, necessitating (without a cgm) an average of 17 tests per day with some going over 25 tests per day.

Eating properly is the foundation to good glucose control. That control is reflected in the pump data and CGM (if it’s an accurate CGM, that is) data.

My A1c’s when I don’t eat properly are not showing the true problem, as my A1cs are only 6.1 when I’m eating junk. When dieting & on a CGM, it is 5.7. Not a big difference. The difference is that I dont swing as much and my insulin requirements are far lower when eating properly: Fruits, veggies galore, avoid white foods, meat, fish, chicken, avoid processed foods.

I am yet to be convinced about using MM algorithm. :slight_smile: I’m using a 551 pump. I use the bolus wizard much of the time, in recent months, but I’m not convinced that the 670’s “intelligence” is as good as MM would have one believe. I’m totally open to being convinced otherwise if many people show me data of their own that the pump’s auto mode has improved their control, reduced highs and lows, decreased total insulin usage,etc.

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Yes, I know my carb totals are artificially high. I know I’m inflating them. I had one tbsp of coffeemate in my coffee this morning and counted it as 20 carbs. Then I had a boiled egg for breakfast, but there were home-made pecan sandies at work and I had a very small one and counted that as 20 carbs. And my blood sugar is still 150 right now.

But I’m having to right now because I’m running so high in auto-mode.

How long have you used MM pumps, other than the 670?

Since 2000, I’ve never used any other.

There is no downside to experimenting with fewer actual carbs. You report that you feel nauseous and foggy with current BG levels. Eating fewer carbs may help the 670 deliver better control than you’re currently experiencing.

a few points. First, you must expect adjustments in both insulin duration, many are finding it lower than 4 hours and carb ratios. You much strive to count carbs as good as possible. The ratio is the most important not the total amount, you cannot compare total insulin usage between people. You have to get yours correct.

Now here is the thing, everyone I know who has been successful says the same thing. The first two to three weeks are tough. Mine were tough and so is everyone else i know who loves it.

Now about week 3-4 you will hit the sweet spot and the sweet spot is great. I suggest talking to you CDE about adjusting insulin duration and carb ratios. If you are over dosing and your carb counts are correct it has to be the ratio. Find a nice telephone app to use for food. It is a life saver. I found I had to unlearn much of what i knew about pumps to use the 670G effectively. But stick with it. It is totally worth the effort.

Note, I am a Medtronic patient Ambassador. I am not paid (ok I got a shirt and mug) and my opinions are strictly mine. Trust me a shirt and mug is not worth an untruth on my part.

Dave that’s great control and I’ve finally seen the light regarding white food. It really is the devil. I’ve used the the 670G since last May or so just after starting my new diet and using Jardiance the year before. I’ve dropped my A1C from the mid to low 7’s to 6.5 since. I still think the 670G would help reduce your lows and improve your overnight control. It will stop microbolus (basil) deliveries and stop almost every low. Overnight it flattens out your blood sugar by actively changing delivery. It’s really amazing. https://youtu.be/a4PTNUaQ-QI

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perhaps it might, if TWO things were to happen.

Number one: Medicare would have to cover the MM sensors.

Number two: I’d have to trust a MM branded sensor. I’ spent countless hours with MM support due to failure after failure of their sensors to work properly. They always read way, way to low when I’m reclined or laying down. They were so inaccurate they were useless to me for about a year or so. They were just a tiny bit better than the Sof Sensors, for me. My wife didn’t have near the problems with either, but for me they weren’t worth the aggravation. I’d love to get back all the time I spend dealing with those things!

Also, I’m not eligible for 2 years, to get a new pump.

Coffeemate. Really? 20 carbs?

Are you pre-bolusing for your meals? It sounds like meals are the main problem right now. Did your basal rates before the 670g increase around meal times? Meaning, could you possibly have been using your basal to help cover your meal times in the past?

There’s no harm in lowering your carb intake for a bit, but I’d probably test out timing on meal boluses first. Especially if you will eventually revert back to your current carb intake eventually anyway. Consistent 200s sucks though, so whatever you need to do to bring your levels down!

I don’t use the 670g, but pre-bolusing is generally necessary with most diabetes management methods. I figured I’d mention it just in case it hadn’t yet been considered.

I had the same misgivings about the 670G. I had been very happy using a Dexcom CGM with my MM pump and was skeptical about the Guardian 3s, based on what everyone (well, lots of people) said about Enlites. But the guardians are at least as accurate (I wore both CGMS together for about 2 weeks), and MUCH less prone to dropouts.

None of which is to say that the 670 auto mode is for everyone. @Rphil2 says 3-4 weeks to hit the sweet spot, but I finally threw in the towel after 9 weeks of struggling, so YDMV as always. Adjusting AIT was the most powerful tool, and that did help, but nothing I could do seemed to solve the problem of dawn phenom. Starting the day at 180 is just frustrating, and the pump is just way too conservative about corrections (which don’t even target 120 but 150!), so I’d still be higher than I’d like at lunch time, which is when I usually allow myself some carbs, and pre-bolusing didn’t work at all, so I’d have another big excursion in the afternoon that the “corrections” only sl–o--o–owly brought down. By week 9 I’d made some progress, but it seemed to have stalled out and I couldn’t figure out any more parameters to tweak (really there are only two: carb ratio and AIT). Burnout was starting to set in. I frankly had to ask myself, is this thing working as hard for me as I am for IT? Finally decided the answer was no.

I sincerely wanted to make the thing work, and am envious of those who are finding such success with it, but like I say, it’s not for everyone.

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It will only correct you down to 150? That’s just terrible. That’s practically my upper limit for post-meal spikes. Why is it so conservative?

Problem is that the 670G doesn’t make the same distinction between bolusing and basal that pumpers are used to. “Basal” is a continuously adjusting “microbolus” that is being recalculated every 5 minutes. Once you take a meal bolus, that just goes into the whole equation, and you see the microboluses stop because it figures you’ve got way more insulin on board now. It basically zeroes out the microbolus calculation. So I found pre-bolusing was way less effective.

I actually felt like the whole design philosophy was rooted in the deep misgivings the medicos have always had about the fact that they have to let us dose ourselves with this dangerous stuff. So the message again and again is “this stuff is scary! are you sure you want to do that? I mean really really really sure?”

Maybe that’s a negative way of putting the idea that what it’s trying to do is make things easier by doing everything for you. But to me it felt like all the tools I’d normally use to fix things when they’re getting out of line were locked up and only the Algorithm had the key. Even in manual there are signs of this, where you have to click as much as 9 times to get to a final confirmation screen, where the default is always “NO.” F’r cripesake guys, I had to click and click and click to get here, couldn’t you assume from that that I MEANT to do whatever it was?

ETA:
Re the correction target of 150: it’s a little confusing because the standard algorithm target of 120 still remains in effect. So to clarify: on auto, the correction dose comes up as a recommendation if you enter a finger-stick BG over 150. It’s calculating that dose based on the 150 target, but once you hit 150 it’s not going to just leave you there; it’s still going to keep microbulsing to get you down to 120.

Ha! I wonder if this was a MiniMed issue or an FDA issue. It’s funny, because if we all followed the advice of the medicos, we’d all run into way more problems long term. Thanks for explaining all of this. I don’t think this pump would be a very good fit for me.

Hopefully @laceyma can find some ways to make it work. Sounds like cutting carbs or adding more fat might be a good idea to handle the post-meal spikes.

Given that many people are ecstatic about it, it’s definitely worth trying. I wanted to be ecstatic about it too, and went into it knowing it would be tough at first… but I just couldn’t get there.

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the tiny xmitter of the MM system is likely the reason that the distance to the receiver (or in the MM system’s case, the pump) is woefully short. I would constantly have failures to communicate when my Enlite sensor would be to one side of my abdomen and the pump was on the other side. How lame is that? The distance would be less than 10" apart and it would lose the signal.

Yesterday, I forgot that I left my G5 receiver in our master bedroom. I spent at least 20 minutes in another room. No dropouts. The signal had to go through THREE walls. that is a huge deal IMO.

Like I say, I’ve run both–I’m a big fan of the Dexcom–but a lot of things can disrupt BT reception, including other devices crowding the wavelengths. I never had dropouts happen with either device because of distance, but I live in a big building in the city, so those other factors are in play. In any case when I was wearing both at the same time the Dexcom dropped signal a lot more often. Not a huge issue but it was very noticeable.

There are other things that weigh more on my preferences. I’m actually considering switching back to the G5, since I’m not really using the features that the Guardians are designed for.