A Deeper Look at Medtronic's Minimed 670G | DiabetesMine - walkerherhumbrod
As I boxed leading my Medtronic 670G at the end of my trine-month trial, a wave of moderation swept over me. This took me aside surprise, atomic number 3 I've always been a heart devotee and had been chomping at the bit to seek this unexampled device — the pinnacle of all that we tech-get the picture T1s have been clamoring for — since I'd first read about it.
But in the course of using IT, I tough a shift not only in how I mat up about the 670G, but about the invasiveness of insulin pumps in unspecialised for the get-go meter ever.
To dig into the write up of what happened, we have to start out at the very beginning with a refresher course happening the system basics.
Medtronic 670G Basics
Formally known American Samoa a "Loan-blend Closed Loop" because it only does several of the diabetes intelligent for you and leaves the rest in the user's hands, the 670G is the first of its kind and is by most accounts an early generation of an Artificial Pancreas system.
It has three modes: Auto, Safe, and Manual.
Manual mode: In this mode, the 670G functions Eastern Samoa beautiful much a garden-variety pump, albeit a discriminate combined. It uses basal rates put back by the drug user and his or her medical team up, has inconsistent insulin-to-carb ratios and correction factors, allows for twofold and square wave boli and irregular radical rates, and has a low debar feature that can be used either at a threshold direct or in prophetical mode, in which the pump bequeath freeze delivery beforehand of predicted glucose low, based on CGM readings and insulin happening board (IOB).
Virtually none of these features exist in motorcar manner.
Auto mode: In this "automatic mode," the system functions completely independently of the drug user. It uses a mathematical algorithmic program to control all pump features, and the only ii things that you can plant are the insulin-to-carb ratio and the duration of insulin action. The remain of your destiny lies in the men of the math and the Shielder CGM sensor.
One confusion that many an people take in about the system surrounds its basal delivery. Just erase basal rates from your remembering banks, because the 670G doesn't use them. Rather, it uses "little boluses," delivering variable splats of insulin all five proceedings — or sometimes, non delivering any insulin at all — in response to feedback from the sensing element. As there's no basal "rate," there can be no temporary rates. The exclusive control you have as a user is to temporarily gear up the default option lineage shekels target of the system to 150 mg/dL from the usual 120 mg/dL if you are more active than usual.
Speaking of blood glucose numbers, not only does the Motorcar mode seek to confine you at 120 mg/dL, information technology South Korean won't even allow department of corrections until you are over 150 milligram/dL. And speaking of "allowing," one feature we are all wont to that doesn't exist in Auto mode is the ability to override the pump when we know better. In Auto fashion, the 670G won't permit adjustments. The only way to change the amount of insulin the ticker wants to give you is to cancel a bolus and go back and Trygve Halvden Lie to the pump, changing your carb tally up operating room down.
Then in Machine, the pump ignores set base rates and correction factors. It also does non allow square Oregon dual wave boli. That aforesaid, the math driving the system of rules isn't coiffe in stone. IT is an adaptative algorithm, meaning it "learns" and is driven by your to the highest degree recent week operating room two of data. But there's nothing you can do to direct the lesson. It studies your CGM readings and IT knows how a lot insulin it has delivered. All on its own.
Even the user screen in Auto mode tells you almost nothing. IT displays only a blue carapace with your occurrent sensor glucose number. In this way, the system harkens bet on to the groundbreaking Guardian CGM of 2005. (In fairness, there is a button that can lead you to a status screen that displays your micro boli and swerve info, just the speedy trend take care we are used to is non available to us.)
Safe musical mode: This is the in-'tween mode that CDE Gary Scheiner jokingly called "a sort of purgatory between Auto mode and Manual of arms way" in his excellent elaborated operational review of the pump. As the 670G system is to the full dependent on the sensor, if things go south with said detector, Motorcar mode is shut polish and you are moved to this subject purgatory where the system delivers insulin supported its retentivity of what it usually does the time of day you've had a failure. It testament only do this for an hr and a half. If the problem with a detector—which could exist as simple as a late calibration baffle or as complicated as a complete signal release—isn't solved, the pump then drops back into Extremity mode and radical deliverance resumes based on your settings, thusly it's important to have a skilled set of traditional settings in the ticker, even though they won't be used by the system in Auto mode.
One frightening side note, however, is that when the pump drops posterior into Manual, the first gear suspend features are disabled, and have to be turned back happening manually. I find this a huge safe issue. If the ticker drops out of Auto in the middle of the night, its best protective suite of features is off the table.
Rockin' the Buffet: The 670G at Its Best
For me, the 670G really shone when it came to meals. During the time I was happening the ticker, my post-meal excursions were few, far less extreme, and far shorter than I traditionally witness. Symmetric though I had no dual or square Wave boli to deploy, the fact that the heart could perpetually bestow insulin following a meal to suppress glucose surges gave Maine awing postprandial control. In fact, I was able to "safely" eat a wide variety of foods that I typically recant. Pasta, erstwhile a guaranteed blood lolly disaster for me, became commonplace in my dieting with no blood sugar penalty, which had a negative unintended consequence: I get into 20 pounds in tierce months.
Meanwhile, another place the pump did a splendid line of work was in the control of overnight sugars, at least to its own definition of control (hark back that it's happy if you are 150 mg/dL). Still, on the pump my morning numbers were consistently in that swan, not something I can enunciat about other therapies I've used—pumps OR pens—where I often saw a pretty wide range of dawn blood glucose readings.
And on that point's withal more good news: I had my A1C test just days after I the closing of my 670G test, and I byword an improvement on the arrangement, although the number is noneffervescent zilch to swash almost: 7.0%. Still, tending the system's targets, this was about as good as I expected.
Just it wasn't paradise. In fact, there was more than 1 snake in the garden…
Out of Control, Without Controls
Oddly, for Maine at any rate, the 670G was utterly worst at the 1 thing information technology's supposed to be dead best at: Preventing lows.
In fact, its speculative ability to improve safety from lows helped fast-breaking raceway the pump
So how could that possibly be?
The lows were well outside the active insulin ambit of my noon meals, then they had to be triggered by the small boluses delivered in the archeozoic afternoon. I mistrust that this is a problem unique to Maine, as my good afternoon basal rates on every ticker I've even used are virtually nil. But quiet, I was dumfounded that the adaptive algorithm didn't, well, adjust to my needs.
Non that it didn't attempt. Atomic number 3 I began to coast depression each afternoon, the pump would blinking down the micro-splats of insulin (bighearted Maine a daily alarum that none insulin had been delivered for two and a half hours and requiring a fingerstick to keep working) but it was always besides little, also posthumous. By the end of the good afternoon I'd be scrapping 70 mg/deciliter.
To counterbalance, I took to under-bolusing lunches by entering falsely low carb counts—commemorate, no overrides allowed—so I'd run by artificial means high in the proto afternoon. Course, then the system spent the afternoon throwing insulin at me (now giving me an alarm that the maximum Automobile mode delivery had been pumping for four hours and requiring a fingerstick to keep working).
If I under-bloused enough, the micro boluses couldn't drive me downcast quite to a low by the end of the day, so it worked, but information technology was sloppy. And it was the first brick up a wall of distrust in the system, which is pretty much death for a relationship that requires a high level of confide to stick with. Away the end of my trial, jittery about lows (I was having the nigh I've had for days) I was oftentimes second-guess the pump at all times of day, and establish myself often canceling a bolus that looked "overly big" and going plunk for and entering a lower carb count.
Needless to say, my control got worse and worse as the trial went on. But my fear of lows overrode my horse sense.
So what did my doc and my trainer think was causing this? Well, let Pine Tree State fill you in there…
Training? What Training?
Going in to the trial, I made the decision NOT to monkey with the settings on my own.
First, I wanted to report accurately on the typical experience for our readers; and ordinal, I wasn't sure my knowledge of pumps would truly be all that cooperative with something so revolutionary. Put another way, I didn't want to put my foot up in it, and so I relied connected the pump flight simulator.
As it turned out, I was the best existent, live person my pump trainer started on the 670G. She was fully trained by Medtronic Corp Military headquarters, of course, but had zero field experience, nor did she have diabetes. We had one session to cover the basic principle, another few weeks later to engage the Machine mode, and she met me for one follow-skyward at my doctor's office. She followed my data uploads—when I could puzzle the damn thing to upload (it gave me fits every clip), and emailed recommended changes, which I followed. My IC ratios got frighteningly aggressive—a type 2-like-minded 1:9 for luncheon up from my historic 1:15, but I was told this is a common experience with the system's approach to handling insulin. When I emailed her about the lows, she responded that she didn't see any that afraid her.
So what about my doc? Mine was the first prescription my endo wrote for a 670G. She had a short training happening it as well, just I got the impression that it was Sir Thomas More like an executive briefing. Sort o than being a imagination for me, she was eagerly look forward to my thoughts on the device.
So I was largely on my own. Of course, to be clear, nary extraordinary other than the folks up to his neck in the clinical trials has any athletic field have with this device yet either—a possible reasonableness there's so much confusion about what it can and can't do.
What about the Aid Line? Were they a right-hand resource? I did call Medtronic's Help Line, but only to get aid with uploading the pump to CareLink. They were friendly sufficiency, but the call dragged connected for an hour and a half with the tech mainly having me repeatedly de-instal and re-install Java. In the end I had to switch to a different computer, although they could never figure out why. This is characteristic of my prehistoric experiences with MedT's Help Phone line, so when things went in the south on me with the low blood sugars, I didn't call in over again.
In hindsight, I think the reason why was that I was too worn out past the 670G organisation to think clearly, as information technology's the worst nag you force out imagine.
Arouse and Talk to Me
During my visitation I was plagued with alarms, many of which I'm yet to realize. I carefully read the call book-sized manual and Federal the sensor the required come of fingersticks, but other factors lurking deep within the algorithmic program apparently trigger the need for feedback. Way too frequently, at 2am, 3am, or 4am the pump would wake me up, demanding a fingerstick to bear on operation.
By the destruction of the first month, I was feeling frazzled.
By the final stage of the second, I was exhausted.
By the end of the third month, I was wiped tabu.
Decision Point
And before I knew IT, the trial period was up and I had to decide: Was I going to stay on the 670G? Well, from the start of this story you know I didn't. And it wasn't any one thing. Here was my mentation:
- To utilisation a system that gives you so little control, you have to constitute able to trust it 100%, and I was ne'er competent to develop that level of trust.
- The acres of tape measure that held the sensor and transmitter in situ gave me terrible rashes.
- Antecedently a pump lover, I developed a hate for having something bespoken to me 24/7. I don't know why. Mayhap because it disrupted my sleep so so much that I began to project anger on information technology.
Simply on top of all of that, in deciding whether or not to purchase one for myself, I had to ask myself: What's in the word of mouth? What will the next 4 old age bring? Committing to a ticker means committing to a relationship that lasts just about as long as the typical marriage. I fair couldn't bring myself to lay down that rather allegiance.
So how'd those hard-to-get sensors sap over my tryout? Well, first sour, I had no supply issues, as I received all three boxes for the trial from the get-go. I reported scarey-good results with my initiatory few, but after that I saw a come by accuracy against the calibrations.
Still, the sensing element stability was good overall, especially in the 150-200 magnesium/dl lay out. For me anyway, they were less accurate at lower berth numbers, and well-nig mornings the 670G's integrated CGM thought I was 15-20 points lower than the Bayer Contour fingersticks used to calibrate it. Playing around with the enumerate of calibration fingersticks didn't change this sheer, but still, other than the unmatched effect previously rumored, I didn't have whatever readings that were wildly off.
A Good Select… for Others
So I'm back to insulin pens, for like a sho.
While I was happy to exist rid of the 670G, with its alarms, its lows, its mean taping, its emotionally painful uploads—I was abysmally bummed. I sought information technology to oeuvre for me. And in many ways, it did.
But now that I've caught up on my sleep, what do I think up about the organization in hindsight? I think that for anyone going on an insulin pump for the low time it would be zany to choose any past pump. Afterwards completely, the 670G has some amazing capabilities as an automated system, but it can likewise represent used as a garden-variety heart, and a damn close-grained unitary. Given that, and precondition our increasingly paltry options, I remember that if you are start a pump first, the 670G is a fine and very ratiocinative quality.
Just what if you are currently pumping with a traditional pump, should you substitution or should you delay?
That's the tough ring. I suspect most mass will do better along this arrangement than along other pumps, especially if they keister just "let run" and let the system melt the point, but I don't think it will be the only gamy in township for long. So really, it comes downcast to how practically you'd sooner gamble on the future compared to how much you pauperization extra help today.
Editor's Note: We thank you for joint your honest opinion as always, Wil. While Your Diabetes May Motley (and opinions too), IT's certainly helpful to learn about your real-human beings experiences.
Source: https://www.healthline.com/diabetesmine/deeper-look-medtronics-minimed-670g
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