It WAS Going So Well

This was originally posted to my blog, Diabetes Odyssey.

I really do not want to talk bad about the Medtronic 670g because it was working so well for me. For about three months my BGs were so great. Auto mode was the best thing to ever happen to me. I was finally able to control my diabetes for the first time ever!

Note I said it WAS working so well.

For the past few weeks I have had nothing but headaches, frustration, and at times total rage over this machine.

Sensors- At first the sensors were super accurate but I had trouble with them failing before their full week was up, no big deal but a bit annoying. But then the latest three sensors I put in have been super inaccurate. 3 sensors from two different boxes. I mean super inaccurate! They rarely were more accurate than 30 points below my actual BG and most often were upwards of 60 points below! I kept each of them in for the entire week, hoping they’d work out their own issue, but they never did and I got all kinds of alarms and calibration alerts and continually got kicked out of auto mode.

Now, we all know how important it is for our CGM to be accurate. Beyond the usual importance it’s also important for accuracy with the 670g in order to stay in Auto mode and get the proper amount of basal insulin! And I personally NEED my auto mode because it’s the only tool I’ve ever had that actually makes it possible for me to keep my BG in line!

Loop traps- For the past several weeks I have been fighting (and losing) the loop trap battle. With the 670g a loop trap is when you calibrate and then the machine immediately requires a BG to be entered for auto mode. OK, no problem, wait a few minutes then enter BG. Then the machine immediately wants another BG for auto mode! Then another! Then it wants another calibration! GAHHH! Stuck in a loop!

It’s annoying as hell! Just imagine having an alarm -Beep! Beep! Beep!- going off repeatedly all ■■■■■■■ day (and night)! Not to mention the constant finger pokes for the required BG checks for this loop trap (yes, I can and often do just manually enter a number similar to the last check)!

The only 2 ways I’ve found I can deal with it is to 1) wait at least 15 minutes between BG entries (in order to let the machine “catch up”). This sometimes helps to prevent or stop the loop… for a few hours, then it starts up again. 2) Disable my precious Auto mode for 8 hours then go back in (I usually disable at night so I don’t get bugged by the beeping if it gets stuck in the loop!). This often stops the loop trap for half a day or so…then it all starts up again!

I find myself going insane from all of this stupidness! I once got so pissed at the constant beeps and the frustration of not being able to stay in auto mode that I actually punched a brick wall. That was better than what I really wanted to do which was throw my pump at that brick wall!

The past two weeks my BGs have been running higher again…

A few times I’ve just broke down and sobbed. I had finally found something that actually worked. My BGs were so good. I rarely went above 170 or below 74. Then it was all so cruelly torn from me.

I’m not doing anything wrong. I follow the training, the manuals. I don’t abuse my pump or cut corners.

So why is it not working right?!

You’d think a machine valued at $10K would actually work properly…

Our health and lives depend on this machine! It should work properly!

Of course I went online to look up these issues, I’m not the only one having them.

Of course I called the help line, twice. They tried but were no help. They told me to do the things I’m already doing to deal with the issue. Literally, they tell you how to stop the current symptoms but they don’t stop the problem all together. “Whenever this happens you’ll have to turn off Auto mode for a few hours, then go back in.”

“Whenever this problem happens?!” WTF, FIX THE GODDAMNED PROBLEM, MEDTRONIC!

“Turn off Auto Mode for a few hours…” The whole goddamned reason I got this machine was for Auto mode! I rely heavily on that very feature to keep me healthy!!!

It shouldn’t be happening at all and I shouldn’t have to keep dealing with the symptoms of a bigger problem!

At least I have my pump and CGM reports that are really good to gather information on my insulin usage and BG patterns. I’ve adjusted my basal presets to match as closely as I can to my average pattern when in auto mode. This helps a bit to keep my BGs more stable when I’m unable to be in auto mode…but it’s still not nearly as good as being in auto mode!

Please, if anyone can give me some advice I haven’t already tried to deal with these issues, please do so.

Otherwise I’m probably just going to toss this brick out.

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Hey. Sounds like a roller coaster. I have had both the newer Dexcom CGM - last year’s and the 670g from Medtronic. I would like to say you are doing something wrong but I can’t. In my own journey it is hard to tell when you have a good site for absorption of insulin and then bad ones. One day they work and other days not so much. Same for the sensors. Areas are sometimes good and other times not so great. Even a little bit of weight exercises or stretching tends to mess with the reading or requires their removal. So frustrating. We need a non invasive way to get bg readings back to t he pump. More importantly, A better way to solve absorption problems for better consistency. There are just so many variables that play into the total solution. When you do have a solution with any of these companies it is always temporary and you just reinvent yourself each time. Good luck! Your doing a good job!

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I don’t see these AP systems making things significantly better for us until the pump companies can develop a better way to infuse insulin and more reliable sensors. Even Dexcom, as great as it is, can be off by a wide margin when I am sleeping or rising or dropping rapidly. I was so frustrated with a sensor last week I just took it off and haven’t put a new one on yet because I’m sick of all this technology making my life more complicated rather than simpler. The only thing I’ve found that works consistently is eating very low carb, but it’s so damn hard to stick to (I just had toast and peanut butter and damn was it good).

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I had an appointment with my CDE last week. I am on an Animas Ping with no CGM. She asked me what my plans were now that Animas is out of business and supplies will be available only until September 2019. I told her I would ride it out to the end and see what comes on the market in the interim. She then told me that she was not recommending any gadgets to her patients anymore because they were getting to be too complex and companies were not doing a good job of trouble shooting them. She said the pump/CGM salespeople were very unhappy with her.

I then asked her what she was recommending. She said Tresiba because it was an awesome insulin that lasted much longer than all the others and could be injected pretty much anytime. Well, I am not going to go on Tresiba, at least not right now. I thought her comment about the gadgets was very interesting, especially since years ago she was the one who got me on an insulin pump in the first place. I would love to know how many health professionals agree with her today.

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Meh, I think Levemir was a more important development than Tresiba and it never gets talked as much as it should.

I tried Levemir when it was first approved in the U.S. I take only about 13 units of basal insulin per day. Such a small amount meant that I would have to divide Levemir into 3 or 4 daily injections because it did not last. Duration of Levemir is longer the larger the dose. At the time, I was looking for an alternative to Lantus because it was causing me mental fog. My only alternative was to go to an insulin pump using Novolog as both basal and bolus. But Levemir is a great insulin for some.

I like the fact that it is splittable making it easy to adjust for different situations. I think this makes more sense than Tresiba for most (but not all) type 1s, since it is closer to a pump where you have some control over the basal at different times of the day. I agree 13 units would be tough to split though without taking more than 2 injections, which would make it a pain to use. Aside from all of this, I agree with your CDE that these new gadgets are just making everything more complicated, and I’m at a point where I’d rather see pharmaceutical companies invest in biological solutions over mechanical ones.

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Pharmaceuticals go where the bigger money is. Their targets for medications are T2s because there are many more of them than T1s. The gadgets are now targeting them as well as T1s. The money is exorbitant. And the return to the manufacturers is large as well. Were these monies invested in finding a cure (which I am not sure has not been found already), we would bring the income from all diabetic endeavors down to zero. Example: The Sabin and Salk polio vaccines in the '50s that put manufacturers of iron lungs and braces completely out of business. Pharmaceuticals learned from that…

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My endo isn’t pushy about anything, she just makes sure her patients know all their options and that they can make their own decisions about their care. She mentioned the 670g to me and noted that she was impressed by how great it had helped her patients that were using it. I had already been drooling over it and wanting it before she ever mentioned it to me. And it worked so damn well the first three months I was so happy! Now I’m falling into a depression over the huge letdown it’s caused me the past 2+ weeks. I’m hoping moving my CGM to an arm location (never done that before) will help the accuracy problem, but I have no idea what to do about the loop trap issue; it just won’t stop!

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Sounds to me like a technical problem that you should insist be solved by Medtronics. It is their machine and you are under warranty. Either you are doing something or their equipment is faulty. Either way, they should trouble shoot until the problem is solved.

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What if we assume you had bad sensors. You kept them in hoping they would improve. But what if this extended time of bad data ended up confusing the auto mode. Did medtronic support advise to keep using them ? I don’t use 670, but know it needs to “learn” from you, and makes certain decisions on what it learns. Maybe better to change bad sensors sooner. Hope that Medtronic support will help you out.

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When I told them I had left the first two in all week they had no response, positive or negative, to that. But you are correct, and I did think maybe I had caused the problem that was already happening (the loop traps) to get worse by doing this. The help line person suggested leaving my current sensor (which is totally inaccurate also) in for just a few more hours then removing it if the problem continues after trying the option we were working to correct it.

As of right now I am no longer even able to get into Auto Mode because the loop trap won’t stop and therefore there is no ability for the machine to activate auto mode. So I just officially turned it off and cried. I also removed the sensor because it was still horribly inaccurate and I have not bothered to put in a new one yet because I’m too upset and if a new one continues with problems I might just explode.

I was able to get ahold of my pump rep and made an in-person appointment for Tuesday to troubleshoot these issues and hopefully we can fix it all.

I’m actually hoping it was my error, at least in part, because then I can learn from it, fix it, and return to really good BGs with Auto Mode!

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Too bad there isn’t a reset switch, to have it forget the last x days and go back to how it was during the good days.

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I wish I could start fresh. I’m not aware of any reset options specifically to allow a fresh start. I’ve read the manual and don’t recall anything like that. If the battery is removed (shutting off the pump) it saves all info and when restarted picks up where it left everything. Anyway, I don’t think I’d be comfortable doing any kind of “factory reset” without a professional there to monitor. I freak out doing those kinds of things to my phone or computer! LOL.

I’m sure if there’s an option like that my rep will help with it when I see him on Tuesday.

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I found the following interesting, speculating (glean) on how the 670g auto mode may be working. (Compared to OpenAPS).

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I had to give up on auto mode because my hormones were messing my BGs up too much, buuuut, I also have had serious sensor issues because of my body chemistry (I kill sensors in 5-6 days more than half of the time.) I point these two issues out so that you will understand that I have spent a LOT of time with Medtronic Tech Support. Some of the operators are better than others, and the really good ones are often only available during day shift at their HQ (8am-6pm, Central time). It can be worth it to make time to call them then.

Also, have you considered that the problem may lie with the transmitter? I had problems with the sensors from day one. At first, they kept telling me of all of the things that I might be doing wrong … soooo irritating! Then we tried making sure that the sensor lot wasn’t the problem, but the replacement sensors (different lot numbers) had the same problems, so that wasn’t it. So the question became, was it the transmitter or was it me. So they replaced the transmitter. Before that, only one sensor made it to the 7th day - every other one had failed (1 out of about 15 sensors). After the transmitter was replaced, only about 55% of my sensors failed before the 7th day … doesn’t sound like much of an improvement, but the second sensor obviously works better than the first one did, though I am obviously the common factor in the problem. (I have evil sensor karma! :wink: )

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Sorry, at the end, I meant to say that the second transmitter obviously worked better than the first one did. Sorry for any confusion.

Your sensors dying early problem happens to me a lot as well. About 50% of the time my sensors will die on the 5th or 6th day. It’s annoying but not nearly as bad an issue as inaccuracy or loop traps. IDK, I just want to figure this all out. I get my times of total frustration and rage over it all and threaten to toss out this pump, but then when I calm down I resolve to figure it out and fix it because, I can’t stress this enough, Auto Mode is the only tool I’ve been able to find that actually works at keeping my BGs in line. I have so many health issues that make BG control near impossible that having a machine work constantly to keep up with my rapidly and frequently changing basal needs is the only thing that works. It’s obviously not perfect, but it’s the best I’ve found so far.

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OMG, OMG, OMG!!! After after all this time of big issues and several days without Auto Mode at all, Yesterday I noticed my sensor is accurate now, and it’s stayed accurate so far. So this morning I decided to punish myself by trying to activate Auto Mode again. It works, randomly, suddenly, everything seems to be working fine again. No sensor inaccuracy, no loop trap! I hope this sticks. I hope I never have issues like that again. Awesome BGs are back again! I’m going to be super patient and careful about BG entries and I’m still going to meet with my pump rep and discus it all and work out why it happened, how it got worked out, how to prevent it from happening again, etc.

Thank you all for your suggestions and support. You put things in different and better perspective, helped me to see the picture more clearly, and I’ve learned from this.

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I feel your pain. Its hard not to just start smashing the device with a rock when you know its not working. Congratulations on getting it going - sunshine in a bag ( https://www.youtube.com/watch?v=1V_xRb0x9aw)I’m sure that transitioning to new hardware and software is the pitts. But, the future is here! Do you feel like half a robo-cop, now with an auto-pancreas? Strange new world…

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