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notme

Day by Day With the 670g

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notme

I am fine, thank you.  I contacted my doctor because the pump says absolutely not to use injection to lower blood sugar so I was at a loss as to what to do.  Excessive lows are a problem when you inject and wear a closed loop pump.  

 

I was definitely sick all day Friday and high ketones for most of the day, but once I injected it came down within four hours to a livable number.  

 

So I am starting from scratch a third time.  I have a team from Medtronic working with my doctor to get settings correct.  I am back in manual mode one more time and the trainer has adjusted my pump basal settings, IC ratio, insulin sensitivity and duration of active insulin time.  They have moved the IC ratio much higher than I anticipated and so far I would say, their calculations are off.  My blood sugar is running in the 180-200 range most all day and that is with corrections.  I think more tweaking is needed.  However, they upped my basal rate much higher than I had it and I feel like I can eat a bit more.  Starvation isn’t going to happen now.  I was beginning to wonder.  I have backed off my workouts for now also.  

 

The pump is supposed to do the corrections for me however, if you are off from the get go in manual mode the pump is not learning your needs and it throws everything off.  If anyone thinks this pump is a cake walk from the beginning, I can tell you it is NOT.  My IC ratio was always lower on my 630g because I took up the slack having a higher basal rate so, I stayed in range.  Insulin sensitivity must have always been set wrong on my 630g because they have changed that also.  Insulin on board is calculated by the pump but......you have to have the insulin duration time set correctly also.  All of these settings on my 630g did not need to be set in unison.  You could just fudge the numbers to take up the slack for one or the other.  On this pump it has to be accutate.  

 

I think the high high blood glucose was caused by the low I had at night.  At 2:30am my pump alarm went off alerting me of a low.  It had stopped insulin earlier that night but my blood sugar continued to dive so by the time I got to 50 I got the first alert and I slept through it.  By the time the second alert went off my blood glucose had dropped to 34 and a siren went off that woke the household.  I ate five skittles and checked blood sugar a half hour later and was 68 so I went back to sleep knowing it would continue to rise.   Boy howdy, did it.  By 8:00 am. I was 265 and after a cup of coffee and my normal bolus for coffee I think my liver panicked did a massive dump from the early morning low.   The pump was giving me maximum allowed bolus but it couldn’t keep up with the rapid rise.  By the time I called my doctor my blood sugar was in the mid 400 range and I was sick.  I think I finally got someone’s attention that this pump was out to kill me!!!

 

So here I am back in manual mode.  I found a Facebook support group for 670g users and I while I feel bad for many in the group, I am  happy to discover I am not alone in my struggle with this pump.  I was feeling like a total loser.  

 

Thank you you for the concern.  I am sorry I was dramatic.  I was so frustrated, sick and feeling low.  I am hopeful with the help of the trainers, my endo and the Facebook group that I will get this figured out.  If not, I have learned a lot in these past three months about my diabetes.  

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don1942

Good luck and I hope everything straightens out for you soon.

 

I guess I shouldn't be so mad at Medtronic for holding off on my order.

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notme

No.   Don’t be in a rush, Don.   Be double dam* sure you have your IC ratio spot on and your basal rate dialed in (although basal rate goes out the window in Auto mode).  While you are on your 630g make sure you also have the insulin sensitivity factor perfect as it can be and the active insulin time perfect.   

 

These are are the settings in Auto mode that count the most when the pump is trying to learn you. 

 

Be be ready to work hard and give up control.  That is the hardest part for me.  Once all of your settings are right this pump is supposed to make your life easier.  Luckily, you can do all of these things now on your 630g.  

 

I would hate hate anyone to have the frustration I have been living for the past several months. 

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notme

Sorry Don, I didn’t answer your question earlier.  

 

The pump does tell you the micro bolusing it does.  If you put the screen in the graph mode and you scroll back, you can read the amount of bolus given.  

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don1942

Called Medtronic today to follow up on my 670G order. I was advised now that the shut down of the manufacturing facility in Puerto Rico has created an inventory shortage.

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notme

I was wondering if that was going to happen, Don.   I have heard there is also a shortage of CGMS sensors.  I ordered yesterday and so far the order seems to have gone through but, I won’t be surprised if I get a call telling me they are rationing.  I ordered three boxes of sensors.  I have heard that sometimes you can extend the sensors past seven days.  I may give it a try.  I only have four left.  

 

Take me the time to really dial in your programming on the 630g.  I think I was way off and my basal rate was covering my lack of IC ratio and sensitivity.  Once you are dialed in it will be so much easier to switch over.  

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notme

I was reading today that some people have extended sensor use up to seven more days with the Guardian sensors.  I have decided to give it a try.  Why not?  If I even get a day or two more it is a big savings.  

 

Apparently, you have to gingerly remove the transmitter and recharge it.  I turned the sensor off, removed the transmitter while holding a finger down on the sensor, charged up the transmitter and then reconnected it and hit the “start a new sensor” button.  We will see.  Right now it has Warmed up and asked for calibration.  Will update later on this. 

 

So I saw my endocrinologist and I wasn’t really happy with the appointment.  This guy has been my doctor for seventeen years and it seems I am a very slow learner. He is a total numbers guy.  That is all he looks at......numbers, not the human behind the numbers.  He was only concerned with the A1c number (6.8).  I told him I got a 6.8 by not eating at all.  I am very very low carb and eating very very small portions if at all.  My BMI is 20.2 and he says that is underweight.  In his email to me he said I was overweight.  More numbers.  At the appointment he said I was too thin and pump anorexic and I needed to eat more.  I once again had to explain to him I had a choice with this pump.  Eat and have high blood sugar or don’t eat and have high blood sugar.  The only difference between the two would be how much insulin I had to take with eating to correct for the high numbers and then weight gain. He can’t explain why after trying carb ratios from 1-5 to 1-17 the pump was never able to keep up with my rising blood sugar.  Unfortunately, in Auto mode IC, AI and IS are the only control we get.  All basal is determined by the pump.  This pump has clearly not learned me yet nor has my endocrinologist.  

 

So I am back to go again.  He wants me to do Carb Ratio testing.  I will do it but honestly I used 1-10, 1-7.7, 1-6.0, 1-5.5, 1-5, 1-17 and 1-15 all in manual and then auto mode with little to no success at any level.  I will do what he wants but this is a giant guessing game.  

 

I may may need a new endo but, I will give him a chance.  He is learning too.  We were both grumpy.  

 

 

 

 

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don1942

Perhaps your Medtronic trainer would be willing to help. I made friends with mine when I first went on the pump and have used her as my trainer for the next two upgrades. She has encouraged me to call her with major issues

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Finfan

I am now at one month on the 670G.  I still do not have the CGM so I am learning to use it manually.  I am pretty sure my overnight basal rates are too low since I am always in the 180 to 200+ range first thing in the morning.  Once the trainer turns me over to my endocrinologist I will start experimenting on bringing that down.  There are too many lawyers in the world so I am sure they are being overly cautious to avoid my going low in my sleep.  So far I have experienced one bent cannula and a lot more highs than I had with the NPH regimen I was on.  I'll write that off as part of the learning curve. 

I was hoping I could use this as a way to have an occasional high carb favorite but I found that the meter will not deliver more than 10 units per bolus so it takes a lot of subsequent boluses to bring it back down.   I also found that when I change the infusion set it seems to take a while for the insulin to become effective.  Any ideas why that is?  Finally I have determined that many pajama pants need stronger elastic in the waistbands! :/

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NoraWI

I agree wholeheartedly on the pyjama pants waistbands! Good luck on continuing with the 670g. It is a lot different than using NPH in an MDI regimen. I just found out that Animas is going out of business so it is likely that Medtronics will be the only serious game in town. Too bad because the Animas Customer Service has been excellent over the last 7 years. Medtronics is taking over the service for Animas pumpers and also offering transfers to Medtronics pumps for certain ones. Interesting events. :wub:

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notme

Manual mode is very different from auto mode.  In auto mode, once you get sensors, your basal rates don’t mean anything.  The pump takes over you basal rate and the only control you have is insulin to carb ratio, active insulin time and insulin sensitivity factor.   Trust for the first weeks is hard.  I am at week six and still don’t trust.   This comes from thirty years of being in the drivers seat.  Now I have to learn to hand it over.   I am doing a little better in Auto mode but it takes time.  

 

The changes to your settings take take weeks to settle in.  Make small moves and wait it out.  Don’t rush.   Everything takes longer.  The pump needs to figure you out befor the algorithm is learned.  

 

I would guess if you are you are waking up that high in the morning that you need to set your basal rate higher during the early morning hours.  Look at the graph or your Carelink report and take counter measures during those hours.  Then when you go into auto mode, expect to have this issue again until the pump figures you out.  

 

Set at your pump to “alert BEFORE”low and not “alert ON Low”. This will give you time and information.  I set my pump to “alert ON high”and not before high because I was sick of all the alerts.  

 

I had had way to many bent cannula’s with the Quicksets so, I changed to Mio’s.  No more bent cannulas.  I tried Sure-T’s and didn’t like them.  I don’t have enough meat on me for them.  

 

You can can change the settings from only 10 units to a higher number.  I am glad there is someone else on the 670g.  

 

I have been with Medtronic for 16 years and so far customer service has been very good.  Help line is only helpful with technology issues or broken pump issues.  But I have always gotten a new pump when needed.  

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Finfan

Well, I am now at two months on the 670g.  Still no CGM.  I have heard that the manufacturing plant is in Puerto Rico so it may be some time before I receive that.  One thing I've noticed is that this system produces a lot of trash in the form of packaging, wrappers, and used reservoirs/infusion sets.  It also is a bit wasteful of insulin.  I've adjusted the initial amount I put in the reservoir so that I am usually on the verge of running out on the third day but there is still 10 to 20 units left when I remove it.  I also had an instance where the transfer adapter would not release from the reservoir and I ended up losing the whole amount when the cap pulled off.  Still my settings have been adjusted so that I am usually below 200.  My last A1C was 7.4 which was an improvement for me and that was after being on the pump for only a month.  I am hoping for a much better number on my next Dr. visit in January.

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don1942

I called Medtronic today to follow up on my "prioriety" upgrade from the 630 to the 670. The rep advised that she received a directive from "higher up" authorizing her to advise that the PR plant is back on line and that all priority upgrade orders will be shipped by the 24th of next month.

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don1942

Received a call today from Medtronic advising that my 670G will be delivered on Monday. As per my local trainer, I called back to confirm whether the shipment included the new transmitter and Guardian sensors and was advised that the Guardian sensors were not included due to short supply. My trainer and I agreed not to begin training until the sensors are received. My purpose in wanting the 670 was essentially to allow auto bolus corrections after midnight when I tend to go high.

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notme

Don, it is well worth getting the 670g without the sensors or transmitter.  

 

The 670g works a lot like the 630g.  There will be a lot of people getting the pump when sensors and transmitters are available in March.  People already on the 670g will get priority over people who aren’t on the pump yet.  I would say get your pump, place your order for sensors and transmitter and get your name on the list.  

 

There is a Facebook page for 670g users and people ordering the 670g.  Many of them are already getting updates and sensors earlier than Medtronic stated.  If you get the pump you are first in line for the rest.  I bet you will get them before March. Sign up for the Facebook 670g users page and you can read about the people who are getting supplies earlier than predicted by Medtronic.  

 

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don1942

Thanks Notme.

 

I was advised that the transmitter is included in the Monday delivery. Only the Guardian sensors are on back order.

 

I already experienced a month without the Enlight sensors (just got them Yesterday) and don't like living without instant access to my BG levels.

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Finfan

I've been told that my sensor would be delivered by the end of the year.  Now to wait and see if it happens.  

 

Also it is Thanksgiving Day in the U.S. or as it known in my house "The Day of Perpetual Snacking".  Today I am thankful for the ability to deliver corrective boluses easily!

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don1942

Called Medtronic on Friday to inquire about availability of the Guardian sensors. After waiting on hold for. 20 minutes. I was advised that they have been in stock for two weeks but I need to order them from CCS Medical, a Medtronic Medicare sub contractor. Called CCS and after waiting on holding for 30 minutes, I was advised that they would be shipped as soon as my doc signed the special prescription form so authorized a charge to my credit card.

 

My question is: were any Guardian sinsors included in the free upgrade?

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notme

They didn’t send them with the 670.  You had to run out of sensors for the 630 and when your insurance said you could order sensors, they then sent the Guardians.   I think it was supposed to be a seamless transition but, the hurricane and demand wrecked their idea.   

 

I dont know why why you have to order from CCS.  Who are they?  I just get them from Medtronic.  

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don1942
9 hours ago, notme said:

 

I dont know why why you have to order from CCS.  Who are they?  I just get them from Medtronic.  

Because Medicare is my primary insurance carrier, I have to order my supplies from an authorized Medicare subcontractor. CCS Medical was assigned to me by Medtronic. However, the pump itself is always ordered/replaced through Medtronic. I have recently been ordering my Enlite sensors one box at a time instead of a three month supply so I only have two sensors left.  I also extend the life of the sensors by recharging the transmitter, so the records should reflect an even shorter supply.

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notme

You are smart, Don.  Great way to handle the sensor issue.  I will love it when you get up and running.  Will be nice to have another 670g user to bounce things off.  It is a good pump.  Many people are struggling with the learning curve.  You are smart to start now. 

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1668880

Hello notme, Thanks for sharing your experience with the 760G. I was an Animas user who found out that Animas went out of business when I received a call from Medtronic letting me know that they were chosen by Animas to take over care for their users. So since my pump was out of warranty and it was close to the end of the year I went head and ordered the 670G and was told that I would get the sensors for it in December or January. Well they sent the pump when I told them I would not be in the country and it got returned to them. I am now waiting to hear back from them after calling and letting them know I was back home and wanted my 670G sent again. I was told that it would be shipping out but it has been 14 days and I have yet to receive the tracking number for it. So Medtronic is not making me feel real assured with how they do things. I saw were you said cr,ia & is are the things that you are able to change in auto mode. I am still using a Animas ping pump and know that it has the cr setting and isf setting and I am hoping that they will transfer over but I am preparing for a long 6 month trail and error period to get it dialed in just right. I have been using the Dexcom G4 Platinum with share CGM and was wanting to know how successful you have been with getting the sensor to last beyond 7 days. I know I can get my Dexcom sensor to last 14 - 25 days without losing much accuracy. How long have you been able to keep a sensor going and is it easy enough to bother with doing? Thanks for answering my questions.  

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Finfan

I ended up getting the monitor at the end of November and I am now in the calibration phase.  I will be attending the class tomorrow to convert it to automatic mode.  This should be interesting.  I also just recently retired so I am having to adjust to less physical activity in my world.  More highs but I haven't crashed since then.

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notme

I have been able to extend sensors with no problem in accuracy.  Mine seem to last about 12 days tops although some people were doing 24 with no problem.  I think my shorter duration has to do with my clumsiness with the sensors.  I bang and pull them constantly and once the tinsel starts to pull out the accuracy goes way down.  

 

Congratulations Finfan.  The pump has been amazing for many people.  I am still in a bit of a fight with the pump but I espect to win.  My A1c has dropped to 6.2.  It has never been that low.  

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