My doc loves AM more than I do

#1

I’ve been on a Medtronic 670G since Sept '18 and have had the (unfortunately) typical hate-love-hate relationship with the sensor, transmitter, looping nonsense, sticky tape goop, the whole bit. (Although I did receive my new/updated Guardian G3 transmitter in the mail about 3 weeks ago, after requesting it in January, and it HAS made a vast improvement on the calibration-loop problems; I’ve even gotten a full 7 days out of sensors a couple times this month!)

I don’t think my control is any WORSE than it was pre-670G, but it’s certainly not better. I, like a lot of other long-term T1Ds, have become accustomed over the decades to programmable basal rates, square wave boluses, and all those wonderful tools that aren’t available in AutoMode. The mental shift has been hard, to somehow retrain myself to think that “ok, now we’re CHASING blood glucose levels instead of trying to proactively control them”… And also all the alarms, etc. have aggravated my anxiety/depression disorder somewhat in the past few months (although that’s a different post).

Since I am an experienced Medtronic pump user (since 1999!) my doc was eager to get me into AutoMode as soon as humanly possible after my training session… he just programmed in my basal rates from my 530 and away we went. He is a 670G user himself, and so as his patient I think I get a mix of clinical expertise and personal bias of his own experience, which is good on some days and frustrating on others (“well this is what works for me, I can’t figure out why it doesn’t work for you.”) And he LOVES AutoMode. When we meet to review my numbers, the first thing he zeroes in on is how much I’ve been in AutoMode since our last visit… and if it’s a smaller % of time than previous, then we have to discuss why. (As if the ultimate goal of all of this is “time spent in AutoMode” instead of “achieving stable BG control in a way that doesn’t make me want to scream.”)

It occurred to me recently that with all this, it has been a friggin LONG TIME since I’ve actually tested my (still programmed) basal rates to see if they’re still appropriate for the times when (for whatever reason) I’m NOT in AutoMode. I asked my doc about testing them and he said I could if I wanted to, but he didn’t see the point since I’m supposed to be in AutoMode as much as possible. (facepalm) So rather than kick him in the shins, I went home and pulled a basal-testing protocol (given to me by a prior endocrinologist) out of my files, and I’ve been moving through that for about the past week with about 2 more weeks to go.

The results have been positive… So far, my basal rates seem to still be mostly appropriate (maybe need a bit of tweaking, understandable) but my levels have been way more stable – fewer high-low swings, a LOT less alarms. (I know this is due in part to the fact that i’m eating less because I have to fast at different times of day/night as part of the testing protocol… but still.) But more importantly, it’s SUPER REFRESHING to feel like I’m driving the bus instead of it driving me. And it’s really made me realize that chasing/reacting to BG levels is bull$hit, when we still have the technology to tackle them proactively.

I’m not going to bother asking if there are folks here who have concluded that AutoMode just isn’t for them. I know you’re there :wink: I’ve got an appointment with my doc in a week and I’m going to share my basal test data with him, and let him know that I’m thinking of giving up on AutoMode. I’m truly just happier when I’m not on it, and also I think that going back to “old school” programmable basal rates might help solve a morning glucose pattern that I’ve been struggling with for months.

That’s all for now. It’s been a while (years?) since I posted in here and I wanted to share this line of thinking. If anyone else has a doc that really pushes for you to be in AutoMode, possibly beyond the point of usefulness, I’d be interested to know how you handle that.

#2

@abcpav

Has your doc ever revealed what sort of control (A1C’s) he sees using a Medtronic 670G?

I’d be surprised if it’s anywhere in the range of non-diabetic range (4.6-5.6)

#3

oh no doubt. And he (as a T1D himself) is aggravated that the SG target is an immutable 120 mg/dL. I’ll ask him what his A1C is next week.

#4

This really strikes home for me as a former 670 user (and welcome back, btw!). You say your Dr is obsessed with how much time you spend in auto, which tends to confirm my view of the 670 as “the pump only a doctor can love.” The whole concept of having to let us dose ourselves with this dangerous stuff 24/7/365 runs deeply contrary to all their training, and thank goodness here is a device that will put a stop to that nonsense. The promise is that the pump will do it all so you don’t have to, which sounds liberating, and might be great if it was seamlessly good at it. But I felt like I was spending far more time and effort trying to satisfy my pumps needs than it was spending satisfying mine. I found myself concerned all the time about how to constrain my life to what automode required of me rather than relaxing while automode did everything for me. Straining to fit my life into my treatment, rather than the reverse, in a way I hadn’t experienced since the old R/NPH days. Like “all those wonderful tools that aren’t available in AutoMode” had been locked away because I couldn’t be trusted with them. The psychological signals, so to speak, were just all wrong for me.

#5

I actually decided to turn off auto mode on my 670 a couple of weeks ago. I am trying desperately, and with not a lot of success, to bring down my insulin usage and resistance. I wanted more control over exactly how much insulin I was getting. My thought process is that I’d rather be 160 and use less insulin than 120 using a bunch more. (This is all based around the recommendations I have gotten for pregnancy). Anyway, it has worked fairly well until a day like today when I woke up over 300. Seriously!? I hadn’t anything since the day before and it wasn’t bad. I do have DP, but it is not usually that bad. Yesterday, I swung from 90 to 245. Today I started at 315 and have swung down 178. I turned auto mode back on for the time being, just to regain some control. I don’t know. I’ve been really discouraged that I can’t seem to get consistency.

@DrBB and @abcpav - my doctor loves auto mode. She likes to see me in it as much as possible. I like the “a pump only a doctor could love” idea. It makes a lot of sense, but it is super frustrating. ***

#6

Hi @SarahMichelle!

Have you looked into using Metformin? I’m not sure if it’s safe with pregnancy, so you’d have to ask your doctor about it. I have Type 1 and use a small dose of Metformin ER to increase my insulin sensitivity. It has worked wonders.

I’m not sure what your doctor said about using less insulin and staying at 180, but an average of 180 puts your A1c at 8%! That’s well above the recommended range for someone who is pregnant or aiming for pregnancy. Perhaps you’re already aware of this? My apologies if I misunderstood what you were saying.

I’ve actually noticed that the higher I am, the more insulin I need! My correction ratios increase the higher my bg is… for example: at 180 I might need 1 unit to correct down to 120 (1:60 correction ratio), but if I’m 240 I might need 3 units (1:40 correction ratio). In that example, at 150, I’d need less than a unit to reduce my bg by 60 down to 90 (perhaps a correction ratio around 1:80).

Someone without diabetes generally hovers in the 80s and 90s most of the day with short peaks up to around 120-140 after mealtimes (max around 160). These are difficult numbers to attain without dropping low frequently, but I think it’s good to keep them in mind. 180 is well outside of this range and puts you at risk for long-term complications. It’s probably not a big deal to peak at 180 temporarily, but aiming for that number could be a major problem long-term.

If you’re interested in reducing your insulin usage, then exercise is a great way to do it! Exercising regularly heavily impacts my body’s responsiveness to insulin. A heavy workout can impact my insulin use for 1-2 days afterward. Daily exercise is probably the absolute best medicine for insulin resistance, but it’s hard for me to fit that much into my schedule so I just do my best.

Exercise can pose challenges in adjusting your basal (temp basals can work great!) and bolus insulin doses, but it’s worth it!

My understanding is that automode doesn’t use basal rates, but manual mode uses your pre-programmed basal rates. When switching back to manual mode, you would need to re-asses your basal rates and insulin-to-carb ratios. You may want to run some tests and titrate these to your current insulin needs. There are lots of posts on this site about doing this :slight_smile: and your doc may have some helpful suggestions (if she can get past her automode bias).

If you hadn’t eaten anything since your blood glucose levels were in the target range, then this is likely an indicator that your basal rate is too low.

I know I just posted a lot of information! I looked through a couple of your past posts, and it looks like you’re fairly new to your type 1 diagnosis (coming from someone who has had it for 23 years :wink:). I’ve learned so much during that time! Most of all, I’ve learned that the more I understand how my body responds to all the variables (exercise, food, stress, etc), the better I’m able to control diabetes so that it doesn’t get in the way of the rest of my life :slight_smile: Good luck on your journey! There are some amazing resources on TUD for this. @DrBB is one of them!