Day by Day With the 670g

[Finfan 4]

This morning I removed the sensor and put my pump back into manual mode.  I refuse to wear an alarm clock on my waist that goes off randomly and wakes me two or three times a night.  Medtronics can keep that piece of misery.

[don1942 230]

This morning at 4:30 am, I was awakened by my alarm telling me I was at 238. I'd rather be awakened at 4:30 am and be able to bolis for a high than awake up at 7:00 to a high of over 300.

Apparently, the drinks I had at dinner last night resulted in a liver dump at around 3:00 am.

[notme 2,910]

The phase of your pump waking you up several times a night asking for BG required is frustrating but necessary.  The pump is learning and it takes time for the algorithms to settle in.  I have had my ups and down with this pump but, I have to say after many months my blood sugar when I am fasting is absolutely perfect.  This tells me I need work on my IC ratio and active insulin time.  This pump requires you to have a more aggressive IC ratio and for me the AI is 2 hours and 15 minutes where it used to be 4 hours.  I rarely get woken up by the pump anymore.  I have turned off all alarms and I let it do it’s thing.  

 

My trainer Ned told me for some people the pumps learning curve can take many months.  My A1c is down to 6.3.  

[don1942 230]

Called My pump supply distributor on Friday and was advised that my Guardian sensors will be shipped on Jan 18. Delay as a result of my having to order a 30 day supply of Enlight sensors. Called my trainer and set an appointment for Jan. 28. 

 

Hopefully, I will be able to contribute my results shortly thereafter.

[notme 2,910]

That is 100% correct, Don.   I returned a box of enlights they sent to me while I was waiting.  They said insurance won’t allow you to order if you have gotten a supply.  I returned them and did without so they would ship.  Grrrr!!!

[Finfan 4]

I am still unconvinced that the automatic operation is worth the hassle.  My endocrinologist will be getting an earful during my next appointment.

[notme 2,910]

Finfan, a few months ago, I would have agreed with you.  Lately, I have seen such a great improvement .......I mean a huge improvement in my blood sugar, I now disagree.   My A1C has dropped so dramatically and haven’t had a nighttime low in months.  

 

It it takes a lot of dedication but, it is well worth it.  

[Finfan 4]

I have an appointment with my endocrinologist next week.  I am going to see what I can do in manual mode before I will deal with that monitor again.

[don1942 230]

My Medtronic trainer set me up with my new 670G. I previously took the on line survey, and I returned my 630G. What other step do I need to take to get my full refund ?

[notme 2,910]

You will be sent two surveys and each will give you back a certain amount and then you will need to do a testimonial to finish off your refund.   Most times, they never charge you in the first place.  To be on the safe side, just do the required surveys and testimonial.  

[don1942 230]

Thanks, Notme. Glad to be part of the club. Plan on going auto mode on Tuesday. Trainer recommended to turn it on after second calibration after changing the sensor. 

 

Basil suspension already been activated twice in anticipation of low(@124 with down arrow).

[notme 2,910]

Suspend before low was the most brilliant thing they came up with on this pump.  Suspend ON low is really a “to late” scenario in my view.  But suspend before low catches it and corrects it before it is to late.  

 

I hope you do do well in Auto mode.  The first few weeks to a month are a pain.  Hang tough.  

[don1942 230]

Engaged auto mode this morning and so far everything seems be operating properly. No spikes so far but over night will be the true test.

 

Unfortunately, I have been having trouble finding an approved supplier for my reservoirs and infusion sets under my new United Healthcare Group Medicare Advantage policy. The UHC reps don’t seem to know what I am talking about. Made one more call tonight and learned that Liberty Medical is an approved contractor.. However, my last reservoir is scheduled to run dry on Friday. (my previous one had a blockage and had to be replaced) Even if I call tomorrow, I doubt the order processing and shipping can be completed by Friday. I guess I will have to revert back to syringes for a few days. Medtronic was willing to send a replacement but they are out of stock on individual reservoirs.

 

Anyone know if you can reuse an empty reservoir?

[notme 2,910]

You can use an empty reservoir.  I have done it on occasion.  Make sure ALL of the old insulin is removed.  Insulin will degrade in the plastic.  I would not use it more than one extra time.  

 

Sent you a pm. 

[don1942 230]

Hey Notme!

 

Thanks for the reply and pm. As I stated in my second pm, Medtronic just confirmed that my order was approve and I should receive my order today. Thanks for your kind offer.

 

My first night on auto mode went well. For most of the night, I fluctuated between 130 and 121, but woke up with a 108. I bolused for a 55 carb breakfast and at two hours I hit 160. It is now three hours later and I am down to 129.

 

Compared to my previous pump, this pattern is a great improvement.l

[don1942 230]

I disconnected my pump this morning for about 15 minutes to take a shower I tend to other matters. When I got back to reconnect it, my BGs were up to 160. On my old pump I would do a small manual bolus before disconnecting. Is there a way to do a similar manual bolus on the 670 in auto mode?

[notme 2,910]

Not really.  About the only thing you can do is phantom carb your pump.  I hate doing it but I have to do it for coffee.  You just tell your pump you are eating a few c arbs and disconnect.  

[notme 2,910]

Your other option is to go manual mode for the few minutes you are in the shower.  

[don1942 230]

Thanks. I have used the carb option when I go high and the auto mode doesn’t seem to be taking care of  high as it should.

[don1942 230]

New question. I get a notice telling me I have been at minimum basil rate for 2.5 hours. Enter BG. According to my graph, I was between 88 and 95 which is exactly where I want to be. Why am I required to enter a new BG to remain in auto mode?

[notme 2,910]

If you have been at minimum basal rate for over (I think it is 2 hours) the pump requires you enter a BG to double check the ISG.  The pump will revert you to safe basal mode and then manual mode if you don’t enter BG and give it the double check it requires.  Sadly, for safety sake, the FDA required 120 as the set point for a perfect blood glucose and the pump will not allow a correction for anything 150 or under. For me, and apparently you, this number is much higher than we like.  As far as the pump is concerned, if we are in the 88 to 95 range, it thinks we are low.  I find their range for auto mode much too high.  

 

 

[don1942 230]

Thanks, Nancy. I appreciate your reply. However, I don’t understand the FDA’s logic. If I remain under 120 all day, which is where I strive to be, I will have to test every 2.5 hours, or 9 or 10 times a day. I currently test on average 5 times a day. Accordingly, I will have to request my doc to double the prescription quantity for test strips. Not sure my new UHC Medicare Advantage drug plan will approve that much.

 

[notme 2,910]

The logic behind the plan was to get the pump approved by the FDA.  It is a sad fact that we have to accept numbers way higher than we are comfortablebecause the FDA feels the need to have large safety margins to protect us from ourselves.   I, like you, don’t accept 150 as a good number number and I have figured out ways to keep my numbers in the 90 - 120 range.  Testing more can be avoided by using you CGM to its best advantage.  Test only three times a day when you calibrate and trust your numbers are slightly higher or lower that the CGM reveals.  Lower your IC ratio if you find you are climbing to high after a meal.  By to high, I mean in the 150 to 180 range because the pump won’t let you correct easily at those numbers.  The biggest improvement came for me when I was able to bolus at least a half hour before a meal.  Even if I am in the 60 - 70 range, I will bolus for a meal ahead of time. Sort of like going back on NPH insulin.  I rarely use phantom carbs to correct because the pump just will never learn and you.  

 

I have ave moments of absolute brilliance with this pump and I have had some dismal failures. But over all, I am finding my way and keeping my numbers in a better place than when I was on the paradigm pump.  I just wish this pump had a few more overrides for some of the insane alerts that won’t shut up until you turn them off.   I find myself swearing at this pump way more than I should.  

[don1942 230]

The 670 system seems to like me to average about 135. I am frustrated when I try to bolus for a reading of 140 and told that a bolus is not warranted.

 

My I:C ratio is currently 7 and 200 is not unusual after a meal, yet I can still go down in the 70s four hours later. May try lowering it to 6.5 and see what happens. I will also take your advice, if I can remember, to bolus 30 minutes in advance of eating. 

[notme 2,910]

So I will deny ever saying this and Medtronic will probably correct this in some future version of the 670g but I have learned how to cheat a little to lower my number by a small amount.  This being said, I wouldn’t do this often. I usually do this when I see an arrow or two or three up by my number and it will only let me correct for that specific number.......but, let’s say you are 140 with three arrows up.....you could do a “fill cannula” for a bit larger number than what you set. 😬

You need to remember that this amount of insulin will NOT show up in you IOB.

 

This practice really defeats the purpose of the 670g.  But I am a volatile diabetic with roller coaster type swings in my blood sugar.  So there are those times I know the pump will not keep up and I use this cheat to gain some advantage.  Start with a very small “fill cannula” correction.  I have gone low more than once since the pump doesn’t recognize this IOB and it sees your high numbers and will max bolus on you.