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notme

Day by Day With the 670g

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notme

So I thought I would give my impression of my journey with the 670g for anyone wanting to change to this new closed loop system.  

 

My my first thought when opening the box was "My God, there is a lot of information".  That being said, it really helped for me to talk to my trainer, who is a type one, and has been using this pump for several months.  I was definitely doing and thinking a little to inside the box for this pump.   It actually is more accurate than me.  It is just up to me to give it the right information to do the job to its fullest.   This is going to be an amazing ride.  Whether or not it is a good ride will be up to my learning curve.   

 

I find it it difficult to hand over control to a machine.   But, in order to get the full benefit, I need to do this.  After 30 years of trying to be in control, it is hard to hand over the reins.  It is also hard to be diligent during start up of this pump, so it can learn who I am and what my numbers do in any given situation.    Let me just say here that the button pushing does not lessen with this pump.  If anything it increases and I still would like bigger letters and brighter screen while outside or in the car for ease of use.  I know right now that would take a car battery to achieve.  

 

Right now, I am still in manual mode.  That means I can set the pump to "suspend BEFORE low" rather than suspend ON low like the 630g.  This means the pump senses when you are on a rapid descent and it suspends basal delivery BEFORE you reach your preset number of low.  The 630g suspends when you hit that number which really is too late.  You have to eat to correct.   Since I am able to function well at very low numbers, I set my pump to 50 (the lowest number it allows) as my suspend before low number.  This was the WRONG thing to do since I had to consume glucose to start raising that number.  My trainer said I had to learn to trust.  I reset my suspend before low number to 70.   WHAT???   This actually has worked well.   When my numbers hit 70 the pump does not alert me, it just suspends my basal rate until I get back in range.  Many times, I never even notice.  I set it for no alert.  So I can be out walking my dogs, my numbers start to lower below 70 and my basal shuts off.  I never know.  When I get back in range, it turns my basal back on.  I don't do the over eating roller coaster.  

 

I am am going on vacation soon and will be out of the country.  Notoriously I eat badly on vacation, so I have decided to not go full "Auto Mode" until several weeks after I return from vacation.  In full Auto mode the pump will also correct for high readings.   When in Auto mode your basal settings are not changeable.  When you go Auto Mode you have to have at least 48 hours with you set basal rate and insulin to carb ratio.   I know I will fall far out of norm on vacation.  I would like the pump to see my normal readings after I return for a few weeks. 

 

So so there you have my first long winded thoughts on the 670g.  I think this pump, for me, will be life changing.  I am not in control and I have to place my trust in a "smart pump".  I will write more when I am ready to go "auto" all the way.  

 

 

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notme

Update:  I have been running in Auto mode for just about five days now.  All I can say is WOW!  The 670g, in appearance, is very similar to the 630g with a few minor changes but the similarity stops there.   The screen on both is better than my paradigm but the look is not much to write home about.  The 630g functioned well and was durable but I realy didn't see much of a difference from previous pumps except it was massively annoying with all of its alerts and button pushes.  The sensor for the 630g was much better than the past Medtronic sensors and the CGMS is a hundred times more accurate. That being said, I still was not a huge fan.  For all the alerts and button pushes there was very little reward.  

 

The 670g didn't do away with the button pushes.  Actually, it may have added a few.  But the rest of the pump knocks it out of the ballpark.  As I noted in my previous post, I started on the 670g in manual mode.  It functioned almost identically to the 630g.  Manual mode means it is not adding insulin when your sensor glucose is going high.  It would however, shut off basal insulin when it detected I was going low.  Actually, it would shut down basal insulin before the low and it would give me an alert if I wanted one.  It would then resume the basal rate when the sensor noted I was heading back in the right direction.  Pretty cool.  I used the pump for almost a month in this mode because we were out of the country on vacation and I could not get an appointment, when we returned, for several weeks to train for full auto mode.  There are a lot more nuances with alert before low and alert on low functions as well as alert before high and on high functions.  But that is a lot of detail.  

 

When you get the 670g you will start it in manual mode.  Your pump needs to learn you and learn your patterns.  It takes at least 48 hours in manual mode before the pump will allow you to go full auto mode.  It actually is better if you give the pump a week to learn all about you.  My pump got four weeks.  There is a checklist of things the pump requires you to complete before it can be turned on to auto mode.  

 

So so the first thing you set up is your high number (somewhere between 180-250. This number depends on you and your doctor.  I set mine to 180 because I am a semi perfectionist.  The low number is set to 70.  Now before you get freaked out by these numbers you have to remember the pump Adjust "before" you get to your low number, so if you are like me and run around in the 50's without skipping a beat it is fine.  Because when you head for that magic low number you don't have to eat glucose tablets or skittles, you just let the pump do its magic.  You have to trust and do nothing thus, having your low number a bit higher than I would generally consider a treatable low.  Same thing for the high blood glucose.  When you start creeping to your high threshold  it will start giving you a correction.  So these numbers are set on the higher side of lows and the higher side of highs.  I hope that makes sense.  

 

I ended up up starting my auto mode before my training.  After a month of waiting and reading the book cover to cover, I knew I was ready.  I did it and then texted my trainer and told him.  I figured better to apologize later than ask for permission. It has been amazing.  Even on manual mode my Carelink has calculated my A1c at 6.4.   I know it will be even better the longer I am in Auto mode. For a type one, that 6.4 is a pretty decent number.  Instead of my daily charts looking like an electrocardiogram of a woman having a heart attack it is smooth and gentle.  I have been going to the gym and I let my pump take over.  I work out hard and usually halfway through my workout I see the dim red light letting me know my insulin was suspended.  I do nothing.  I just continue my workout and let the pump fix it all.....and it does.   No more looking for glucose tabs or sitting waiting for my blood sugar and brain to recuperate.   It does not wake me up at night anymore.  It just adjusts while I sleep.  Delightful!

 

All in all I would say this pump is the best thing that has happened to me since getting diabetes 30 years ago.   Is it a pancreas?  Nope, not by a long shot.  But it is a very very smart piece of technology that will make your diabetes life better.   

 

It it is a long and dedicated startup.  The button pushes are still annoying.  But this pump makes up for all the negatives.  

 

 

 

 

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notme

Today, I am confused by my pump.  It went into "safe basal mode" on high which means my blood sugar was over my high threshold for four hours.  Ummmm no....   then it did the same thing on low which means it was giving me the minumum allowed basal rate for over two hours.  

 

I called Medtronic for clarification and they were as confused as me.  Back to work on understanding these functions.  Ugh.  

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Kit

Hope you get it figured out.  From what you've been saying, this looks like its quite an advance in the technology and can be quite beneficial.

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notme

Thanks Kit.  After much frustration this appears to be a setting problem and not a pump problem.  Basal rates don't mean anything anymore, but carb ratio is huge!   

 

My carb ratio was softened according to my pump trainers suggestions.  I just put it back and we will see how it rolls.   

 

I hope I am not boring people but, I do think as more people start on this pump this thread may become more relevant.  

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don1942

Hey Notme!

 

i appreciate you keeping us updated on your progress. It gives me something to digest while waiting for my upgrade approval. 

 

My doc called last week to advise he received a request from Medtronic to provid a prescription and supporting documentation for the 670. I hope this means I am getting close.

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notme

I hope you get your upgrade soon Don.   I think this newest pump is really going to be amazing once it gets dialed in.  I have been on the phone with Medtronic twice in the past 24 hours.  I found a lady on the helpline that just got hers and she was interesting and extremely helpful.  They guy I talked to last night, not so much.  The difference is she wears a pump, they guy that tried to help was reading out of a manual.  

 

I think the the sooner they get the multitudes moved over the better off we will all be.  

 

I am am thinking my carb ratio is part of the problem.  My trainer felt like my ratio, when I was in manual mode, was causing lows.  I don't think so.   I think it is all the gym work I have been doing.  I put my ratio back and I am going to leave it for now.  

 

The biggest difference I have noticed between manual mode and auto mode is the alerts.  The alerts go down a lot when you just leave the pump alone and let it do its job.   Honestly, I have had thirty years of number jockeying.  It is hard to let go.  

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notme

So the past few days have been interesting.  I am doing a 60 day challenge at the gym so, it is challenging me and my pump.  

 

The first thing I have discovered is coffee is a huge insulin sucker.  I have to bolus for my one large cup of coffee in the morning about 25 carbs! 😳😳. I am going to lower the caffeine by using 1/2 decaf and 1/2 regular coffee tomorrow.  My TDD was 18.625.  I ate a total of 24 carbs and 20 of that was for coffee.  I was I. Target range 85% of the time with time below was 0% and time above was 7%.  A bit discouraging since my average blood glucose was 149.  The day isn't over, thus the 8% discrepancy.   

 

I know I am not eating enough for the high exercise I am doing.  My coach will kill me and I know he is right.  I am tired and hungry.  My carb ratio is set at 7.5 /1. That is ridiculous considering I am thin and fairly muscular.  It looks as if I may need to change it to 7.2 /1 and see if that helps my average glucose numbers.  In Auto mode you have no control of the basal rate.  The pump decides. The only other change I made was the length of time the humalog lasts.  It was set to 4 hours and I have lowered it to 3.5.  That definitely helped a bit.  To tweak things more, I will have to adjust one at a time.  I will start with my insulin to carb ratio.  

 

I have to to do this starvation diet in order to figure this all out.  I was never good at math and this is a challenge for me.  Every time I adjust one thing, it really affects something else.  So, it is going to be a slow, hungry process.  Except for coffee I ate 4 stinking carbs today.  Scrambled egg for breakfast.  Swiss cheese and chicken for lunch and bell peppers and chicken for dinner.  One cup of tea with 1 tbs of 1/2 and 1/2.  The stinking coffe is my big issue.  I am not giving up coffee!!

 

For those people who are waiting to get this pump, it isn't a half bad idea.  The support for the 670g is limited.  Only certain help line people have been trained.  They do have a team assigned to you for help but it is by a scheduled appointment on the phone.  My trainer is nowhere to be found.  He is swamped with start ups.  This pump really does take dedication to get started.  Make sure you have the time to give it a lot of attention during your phase out of manual and going auto mode.  Carelink is a "thing" again and Medtronic can view, with your permission, your downloaded logs.  Normally, I wouldn't do it.  But in this instance, I need all the help I can get.  Now I see why they had 630g users start first.  

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notme

I really understand your concerns Bar &In.  I am a control freak and giving up control was the hardest part for me.  I agree the enlite sensor pretty much sucked in every way.  The new Guardian Sensors are a hundred.......no, a thousand times better.  The insertion is easier, they last the complete seven days as promised and I have never had mine more then two points off from my meter.  

 

As as far as the pump goes, there are layers and layers of safety.  My pump went out of auto mode last night because it gave me the minimum allowed basal rate for ninety minutes.  I did not eat enough yesterday intentionally to try and figure out my carb ratio.  

 

I have always struggled with with blood sugar control.  I go from 50 to 200 by eating cheese.  I go from 50 to 250 with a cup of coffee.  For me, this has got to work.  I sure can't figure it out and I have been at this for thirty years.  I don't trust me so I am going to give this my best shot.  

 

 

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don1942

I quite often find myself above 230 in the middle of the night and if I do not wake up and manually boils. I could easily go over 300.

 

I can't wait to have the 670G anticipate my high and begin pumping insulin before I reach 230 and also prevent the 300 high. The process could possibly improve my retinopathy.

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notme

Hey Don.  Have you thought to increase your basal rate at that time of night?  talk to your doctor.  If you are seeing a pattern of nightly high glucose numbers in the middle of the night it might be due to dawn phenomenon.  

 

I cant wait for you to get the 670g.  I would love to have someone else to bounce stuff off of.  I have been on the phone with Medtronic at least twice a week since starting.  About half of them get the new pump.  

 

Call Li your doctor and make sure he has taken the training for the 670g.  They won't send out a pump until your doctor is trained.  

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don1942

I did actually increase my night time basil rate a few years ago. I actually increased it and then told my doc what I did and he agreed. 

 

The problem is my highs are not regular but only occur on nights when I miscalculate my carbs or have a drink or two with dinner.

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notme

So on those nights you have a drink or two have a protein snack at bedtime.  That should level out you numbers through the night.  It can be small like a little peanut butter and celery.  That might stop any rebounding also.  

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Finfan

Hello notme!  I'm brand new here and to the 670g.  Unfortunately I haven't yet received the continuous glucose monitor so I am using the Contour Next test meter.  Until a week ago I was doing 2 injections of NPH a day so this whole system is very strange to me.  It's hard trusting a machine.  I am also not yet very good at counting carbs so I end up doing hourly boluses to bring my readings down.  I learned quite a bit from this thread alone.  Coffee is an insulin sponge!?!?  Why is that?

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NoraWI

In some people, coffee causes the adrenals release cortisol (the fight or flight hormone). Release of cortisol raises blood glucose. I have been dosing 2 units of insulin for my single morning cup of coffee. The amount will vary for different individuals and some may not need to dose any insulin for coffee at all.

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notme

Coffee for me and apparently NoraWI is definitely and insulin sponge.  I have found however, I can drink a cup of tea with milk with no insulin at all.  My body is a symphony of contradictions. 

 

Celery and cream cheese I can eat, celery and peanut butter raises blood sugar.  Cheddar cheese.....nope, Havarti cheese.....thumbs up.  Macadamia nuts.....nope, pistachios.......good to go.  

 

So, right now, I am back in manual mode and my blood sugar is really good.  We are trying to give my pump a relearn few days.  A Medtronic trainer will give my Carelink report to my endo, make some adjustments and try again.  

 

I am am not ready to give up.  

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notme

Something is wrong with me or this stinking pump.  Blood sugar is close to 400 and definitely in DKA.  I am in contact with my doctor.  

 

So far this isn’t what I was hoping for.......

 

☹️😢

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Finfan
3 hours ago, don1942 said:

That is disappointing. Does the 670 tell you how much it Boluses when you start going high?

 

The 670 "Bolus Wizard" will show you how much it would give you for your high BG, how much active insulin it thinks you have, and how much it would give you for carbs if you add some.

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don1942

I thought the 670 automatically Boluses (correction) when you go high or anticipates when you are going high. What I wanted to know is if the pump advises you how much it is using for the correction

 

Also, if the 670 automatically pumps insulin when you are going high, how did it let you go up to 400?

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macksvicky
On 9/22/2017 at 11:33 AM, notme said:

Something is wrong with me or this stinking pump.  Blood sugar is close to 400 and definitely in DKA.  I am in contact with my doctor.  

 

So far this isn’t what I was hoping for.......

 

☹️😢

 

Are you OK? 

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