Then the problem solves itself. Love it when that happens.
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YES! Exactly, Tia_G. This is exactly how I feel.
I really donât like diabetics calling each other names! Donât we have enough to deal with?
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Iâm probably one of the worst diabetics youâll ever meet. I eat and drink whatever I want whenever I feel like it. It is not uncommon for me to drink 6 or 7 non diet sodas a day, my favorite for the last few months has been Mt Dew. My current insulin usage is 28 units for my basal rate and another 30-40 in bolus units to cover food and drinks. I despise exercise and diets. My last 4 A1C results have been between 5.5 and 5.9, Iâm a very brittle diabetic. Iâm on an insulin pump and have been for longer than I can remember. If I donât take insulin Iâll die, period. Calling people names and slinging insults is no way to treat others who have found ways to manage their disease very effectively. I was diagnosed with type 1 when I was 5 in 1983, this new technology is mind blowing for people who were diabetics when the only option was to take shots with inch long needles full of insulin that wouldnât kick in for hours. I didnât like the 630g when I first got it because Medtronic omitted the safety features of the minimed connect. I have since gotten another one and will upgrade to the 670g when available. I welcome any technology that eases the constant worry of managing this horrible disease. If all this makes me a freak, then so be it. Iâd rather be a freak with a good A1C than jerk who calls me insulting names.
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If I drank 6-7 mt dews in a day Iâd be taking more bolus than that just to cover the soda alone! And somehow I still wouldnât be calling other people namesâŚ
I really am interested to hear from more users once the reports start trickling in. Iâm not that impressed by the devices ability to reportedly pin bg at 120 while not eating, but where the lines blur between basal and bolus and if it can pick up any of the slop for carb counting or bolus timing at all and smooth the spikes after meals-- that makes all the difference in the world in my mind.
Hereâs an interesting idea, found in another thread, that fools the 670G into acting like a 100 mg/dL is really 120 mg/dL
This idea, if it safely works, makes the 670G much more attractive to me. I wonder how far you could stretch the truth? Could you tell the 670G via calibration that a 90 was a 120 or even an 83 was a 120?
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If you artificially bias the CGM through false calibrations there may be other side effects. For instance the 670 supposedly will shut off insulin delivery if you get too low, but if you artificially bias downward by 40 mg/dl this feature may be useless in preventing a severe hypo since it may only shut off insulin delivery when it sees a CGM reading of say 55 mg/dl, but you are actually 15 mg/dl.
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I also suspect that the calibration is not the only thing that helps pin down the Bg number, so youâd likely have some drift in the anchor point over time in some unpredictable way.
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@Brian_BSC,
This is certainly true but if the 670G is anything like the 530G I have itâs possible to to set those thresholds independent of other settings. If this is the case you would simple set them accounting for the bias you calibrated in.
Personally I donât like the idea, all your BG readings are biased and you have to account for that when evaluating the data.
If there was some sort of tag in the data indicating there was a bias in the cal it would be more acceptable to me.
I love monitoring and evaluating my data. I donât think Iâd like a 20-40 mg/dL offset to actual values. I also wonder if this bias would be linear across the BG spectrum. I really look forward to riding an AP without the training-wheels.
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This would be my biggest concern: that the âartificiallyâ imposed bias would not be linear across the BG spectrum. After all, for many PWD, their ISF is not linear across this spectrum.
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Thatâs going to be tough run til we have some substantially faster insulin. With cgm data lagging blood by about 20 minutes and current rapid bolus injected insulins taking 20+ minutes to start working, and much longer to really kick in a 100% effective AP system with current technology would be trying to play catch up by 40+ minutes maybe upwards of an hour. BG can change an awful lot in that time span.
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While it is true that you can change the threshold suspend, it is within a narrow range of 60-90 mg/dl with the 530G. If you choose to bias your CGM calibration down 40 mg/dl then this would correspond to 20-50 mg/dl as the allowable range. Iâd be a bit worried about whether this invalidate any usefulness of the threshold suspend function.
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+1. Heck, ordinary home glucose meters arenât even linear across the spectrum.
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Sam, after reading your post, I found myself envisioning an AP that somehow utilizes Afrezza. Strange mental imagesâŚ
Thatâs a strong safety point, the first criteria in any tactic analysis.
I donât know what long term solution is but I think subcutaneous absorption will never be truly compatible with a REAL artificial pancreas⌠it just absorbs to slow. Some other pathway to get insulin into the bloodstream will ultimately have to be utilized to achieve perfect blood sugar control by automated insulin dosing. Which is why I suspect the technology may take a turn to a different direction at some point in the not too distant future
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We can partially mitigate this effect by sufficient pre-bolus timing â actually watching and waiting for the bend on a CGM.
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Which, by definition (at least by my definition) is not a true artificial pancreas if youâre planning your carbs well in advance and manually prebolusing.
Thatâs actually is not âstrange imagesâ. This is great intuition. 
JDRF has conducted research in this area since at least 2013 and has obtained great results combining the usage of AP and Afrezza. See this video regarding such research:
Additionally, JDRFâs 2015 top advances summarizes this as follows:
Mannkindâs Afrezza inhaled insulin shows promise as a good partner to AP system
In summer 2014, JDRF industry partner Mannkind received FDA approval for Afrezza, a rapid acting inhaled insulin that can be used at the beginning of meals to more tightly control the rise in blood sugar levels that occur after eating.
⢠A JDRF-supported study published in the Journal of Diabetes Science and Technologyâs May 2015 issue showed that use of Afrezza as a mealtime bolus in conjunction with an experimental AP system significantly increased the percentage of time that people using the system stayed in ideal blood-glucose range.
Itâs no competition for Mother Nature. The pancreasâs release of insulin into the portal vein of the liver is right where it needs to go. Subâq delivery is a crude approximation.