Medtronic 670G: Experiences of a Mom + Daughter with T1D

Medtronic 670G Insulin PumpMy 15 year old daughter and I both started on the Medtronic 670G system in July. With 2 1/2 months of use under our belts, we have had common, yet unique, experiences with the Medtronic 670G tech.

As many people report, some magic happens between weeks 3 and 5. There was a turning point in which we both became happier with the results and user interface/ demands.

[Our initial experience, one week in, is documented in this piece: A Nurse’s Review: Medtronic 670G Insulin Pump.]

Chew on this: I don’t buy juice anymore.

This is huge, especially in a household that has two very active people under one roof – that both have T1D. I had the habit, on occasion, of pouring my daughter 3 glasses of juice overnight after a big basketball practice or some crazy family adventure in the mountains. I can thankfully report that this behavior is a thing of the past.

Like it or not, midnight picnics are common for those of us living with type 1 diabetes. Our dentists may agree that the 670G may be worth it’s weight in gold with the simple elimination of the sugar bath on our teeth all hours of the day and night.

Hands down, the best feature of this pump/ sensor combo is the near elimination of hypoglycemia (low blood sugar) – particularly overnight when we are at our most vulnerable.

Over the past few months I have put this thing to the test. I trained for and completed a 102 mile bike ride for JDRF Ride to Cure in Loveland, Colorado. I’ve spent a lot of time in the saddle with this sensor and pump over some strenuous miles at higher elevations.

My overall impression is quite positive at this point – I have no desire to go back to my previous pump or a pump/continuous glucose monitor (CGM) that don’t speak to one another.

Do I have high blood sugars? Yes.
Do I get frustrated? Yes
Are there gaps between my blood glucose and sensor glucose readings? Yes.
Is this system the best we’ll see? No.

The Medtronic 670G is a work in progress that will only continue to see improvements – and competition – over the next few years, but for now, it’s king.

My Positives:

  • Quality sleep improvements – Because my sugars are normal overnight, as are my daughters, sleeping has seen huge improvements. I’m worried less about her having lows overnight.
    ***I haven’t had 1 overnight low since I started on the 670G.***
  • Exercise – I do really love exercising with this system (minus the fact that there isn’t information sharing – so I can’t see my sensor reading on a watch). If I want to see my sensor reading, I have to take an awkward glance at my pump that sits on my waistband – with the updated vertical screen. This may be the death of my neck – so awkward from the user’s perspective. Medtronic would be well served to have a physical therapist on their team analyzing how their new products impact a person’s movements.
    I choose not to use the “temp target” feature for exercise, it always makes my blood sugar creep into the 200 range. I leave my pump as is, and eat free carbs throughout my ride – this is the only time I don’t tell the pump that I’m eating.
  • Eating – Eating is a new thing. I’m a thin person and not looking to lose weight, but I lost 7 pounds without trying. I’m actually trying to gain it back – my body, I think, is like – “Hey! Where are all the simple sugars?” I have actually been in bed trying to fall asleep, realized I was hungry and went to the kitchen to eat.
    It’s been an interesting transition for me, after 30 years of diabetes, not having to eat in order to keep my sugars in line. The adjusting micro-basal is so smart. I’m eating more healthy whole foods and larger portions at meals than I used to – I’m also getting more accustomed to this new pattern of “not eating for diabetes.”
  • Adjustments – There are only a few things to adjust on the back end with this pump – namely the active insulin time (AIT) and carb ratios (CR). Most people find themselves settling in with a 2 hour AIT or the pump won’t correct a high blood sugar in a timely manner. Carb ratios undergo serious changes for most people – especially those of us that had high basal rates prior to the 670G.
    When bolusing for meals, the micro-basal usually shuts down altogether. I believe this is why we need such tight carb ratios. It’s a bit of a science experiment to find the correct CR’s.

My Negatives:

  • Low blood sugars: As I mentioned previously I hardly ever get lows, but that doesn’t mean that the sensor doesn’t give me incorrect warnings.
    When this happens – and I’m not actually low (verified with a BG test), the micro-basal delivery turns off. During this time, if it’s telling me I’m 50 and I’m actually 100, it’s one of those times that you shouldn’t enter your BG or calibrate because the gap in numbers is too wide.
    So, if you leave the pump/sensor “as is,” it will result in a high blood sugar -  rather than leaving you at your excellent BG of 100. Yes, frustrating.
    I choose to revert to manual mode when this occurs or sometimes take insulin and eat carbs without entering a blood sugar and that helps bridge the gap. But ultimately, it means another BG to get things squared away with the sensor – usually 20 minutes later.
    And speaking of alerts, this system took a large step backwards without the communication piece to mobile phones and watches – especially if you are a parent of a child living with T1D. This pump/sensor duo isn’t the end all, it needs parental interventions. Kids need reminders and they really dislike when we have to look on their pump screen to find the data we are looking for. Nightscout has a workaround, but it demands a glucometer be attached to the the users phone. My highschooler would never go for that.
Arrow is pointing at the micro-basal delivery

Arrow is pointing at the micro-basal delivery

  • Sensor Life: Initially, I had some serious sensor failure issues. I would get the “Updating Sensor” warning which would ultimately end up with a failed sensor, on a regular basis. I have had 3 or 4 sensors last the 7 days they should since I started on this pump (ugh).
    I have figured out that there is some kind of an issue with my 670G and my work in recovery room at the hospital as a nurse. All I can figure is that the “loop” between patient cardiac monitors and vital signs that feeds information to the bedside computer is interfering with my “670G loop.” Medtronic doesn’t have any suggestions other than using manual mode which is unfortunate.
    *Medtronic did send me a new transmitter and that has helped with failing sensors a bit. They have also replaced every failed sensor.*
  • Algorithms: It takes a bit for the pump to “get to know you.” If you’re anything like me, I have my regular stuff, but I’m not the most predictable person in the world. Some days I’m working, some days I’m riding my bike 50 miles. I think the more predictable our behaviors are the better results we get from the algorithm.

Medtronic 670G

  • A Higher A1C? Well, I’m not sure if I should classify this as a negative, but I know my A1C will be higher. The predictive value on my pump for my next A1C is 6.8 – not bad – but I’m always 5.9 – 6.1.
    Here’s why – there are no lows to bring that value down. It is a solid 6.8 that I’m continuing to make pump adjustments for. This pump rarely keeps me at 120 like it says the target is, I often wish it adjusted me a bit tighter. I often check and I’m 140 when it says 120 on my sensor. I wish it had the option to adjust to 100.
    Rarely do I have sugars in the 80′s and 90′s like I once did. But I also had lows or was averting lows throughout the day.

I think with this tech comes the realization that our once coveted A1C value will change – and so should our perspectives about them.

  • “The Loop”: This endearing term (tongue in cheek) stands for one of the most frustrating things that occurs with this pump. The 670G, especially when fed too much information, or information at inappropriate times – freaks out.
    The best solution to this problem is to treat your pump like a 2 year old having a tantrum. Don’t feed into the issue at hand. Be patient, wait and don’t enter information if the BG and SG are more than 30% off, or you will experience the dreaded loop. Is this inconvenient? You betcha.

I realize nothing is perfect. As a parent of a child with the same 24/7 deal, I appreciate some aspects of the 670G, while I’m not so hip on the others. I’ve always said if our kids can have normalized blood sugars overnight, then that’s half of their life within range. That’s pretty impactful – right?

Kids aren’t as attentive as the average adult and this pump isn’t “hands off,” it has it’s odd set of demands – and they can be confusing. I’m most concerned with the negative feedback loop that occurs when the pump is asking for information, but it really doesn’t want you to enter it, or you will confuse the already confused system, and it may result in an aborted sensor.

With kids we are constantly drilling into their heads – “Just do it!” But with the 670G it’s become – “Don’t just do it!”

It requires thought, patience, and sometimes it’s a serious waiting game. But what kid wants to – or will – revisit diabetes 20 minutes later, when it keeps pestering with a beep or vibration to calibrate or enter a BG that the system might not be happy with. This is a serious flaw for a system built for all-ages.

My Daughter’s Positives:

  • “No Lows!”
  • “I like having the CGM and pump in one unit; when I’m at basketball, I can look and see what my sensor glucose is.”
  • “That it’s waterproof.”
  • “The sensor/ transmitter is really flat compared to the Dexcom and I like that – it’s less visible under clothes.”
  • “You can silence all of the alarms for a period of time for school and sports.”
  • “The pump prevents post meal highs when you nail the carb load correctly.”
  • “No overnight lows – I sleep better and can sleep in without getting low.”
  • “There is a setting to deliver insulin faster – I like that.”
  • “My A1C is improving a lot.”
  • “I don’t have to eat for diabetes all of the time.”
My Daughter’s Negatives:
  • “The red flashing light brings attention to the pump and me.”
  • “I have to take the pump off to use it now that it is situated vertically, not horizontally.”
  • “You have to count EVERY SINGLE CARB.”
  • “I get popped out of auto mode almost every single night – even with calibrating right before bed.”
  • “The pump alarms don’t wake me up from my sleep.”
  • “I’m still trying to gauge when to use the temp basal for sports or not – I’m not getting consistent results – sometimes the temp basal makes me high.”
  • “Sometimes it doesn’t give me one alert, they keep stacking on top of one another and takes time to work through them all.”
  • “The pump is bigger and more noticeable.”
  • “The battery only lasts 2 weeks and dies quickly – it’s larger – a AA. “
  • “When you calibrate it doesn’t give a number right away like my Dexcom did; I miss my Dexcom.”
  • “It bugs me that I can’t use my Apple watch or see my pump/ CGM data on my phone. Especially when I’m wearing a dress. You always have to pull your pump out to do anything.”
  • “There is a lot of button pushing to do for everything on the pump – much more than previous pump models.”

If you start on this system, I recommend joining one of the 670G Facebook groups. They not only provide a community of support, but it gives us crowd-sourced information from users, outlining the successes, technical issues and workarounds people are using that may not come with our training.

A Nurses Review: Medtronic 670G Insulin Pump

Medtronic 670G

Medtronic’s 670 G  hybrid closed loop system is the smartest insulin pump to hit the market, and people living with type 1 diabetes, including my daughter and I, have been gobbling them up.

As we embark into our second week on this new system, the majority of the time I’m all in, thinking: “This is amazing, I haven’t drank juice in days,” “I need to eat something – just to eat, not because I need to balance my diabetes,” “It’s so nice not to have T1D awaken me from sleep,” or “I feel less worried about my daughter.”

All remarkable thoughts.

A minority of the time, I’m thinking: “Why is this pump buzzing at me again?” “This algorithm isn’t really getting me into the 120 range,” “This sensor is frustrating – my Dexcom was so simplistic to use compared to this finicky Guardian 3 sensor,” “I wish I could calibrate anytime; there’s so much button pushing and user demand.”

It’s not all peaches and cream – it’s a work in progress.

Patience, I tell myself. It will get to know me better. Most people report that it takes a month to love the Medtronic 670G. Truth be told: I’m one week in, and I do love it 90% of the time – as does my 15 year old.

Getting Started on the 670G

We personally utilized the “Pathway Program” Medtronic offered through the end of April, 2017, placing us in a virtual line for the Medtronic 670G upgrade. We were fortunate enough to have purchased our pumps less than a year prior, so our out of pocket was expensive, but not unthinkable.

Word has it that 50,000 customers have ordered the Medtronic 670G pump, but customers have faced hurdles along the way with the age of their current pumps and/or lack of insurance coverage for a new pump. Owning a pump that isn’t out of warranty means we’re at the mercy of insurance companies, waiting, or paying out-of-pocket for upgrades that aren’t submittable to the insurance company.

Tweets and Facebook posts have highlighted similar patient plights with this process. Patients in the Pathway Program forced to upgrade to the 630G for the months prior to the 670G roll-out, the spring availability actually meant “we’ll start shipping in mid-July,” sensors not shipping, and/or issues with prompt training dates.

Try staring at the Medtronic 670G package for more than a few days [especially when you've already run out of CGM supplies for your Dexcom]. CGM supplies, by the way, can be a cog in the wheel if you order 3-month supplies. Insurance companies won’t let you overlap supply orders, even if you switch to a new system.

Diabetes can be as simplistic as we like or high-tech and high-dollar. We’re always left to break it all down, analyzing the details, deciding what to try on, what might fit us best, and what we can shoulder financially. Mid-process we’re left to hope and wonder: “Will this tech be worth its weight in gold?”

Diabetes is an expensive disease, one that is both financially and mentally draining, fraught with high deductibles, expensive supplies and a lifetime of worry.

I get the cost of healthcare as a nurse and as a patient. We have type 1 diabetes, times two, in our house.

expense, type 1 diabetes, medications

For once, our timing was pretty impeccable with the 670G pump roll-out. We were lucky enough to get trained, and connected, in mid-July.

I try my very best to practice gratitude, not losing sight of what was available when I was diagnosed in 1984: Regular and NPH insulin, syringes, urine strips – and no glucometers. With the ingenuity of the medical and diabetes community at large, DIY closed looping systems, data sharing apps, continuous glucose monitoring, and now – a closed loop pump, we have a lot at our disposal to choose from.

The Guardian 3 Sensor

As a parent, I’m mentally done with witnessing and intervening to this alert:

dexcom, blood sugar, continuous glucose monitoring

We have been super fond of our continuous glucose monitoring products Dexcom has offered over the past handful of years. I’m quite honestly going through “Dexcom withdrawl” right now – even being on the 670G.

Kudos to Dexcom: I may have, on rare occasion, knocked my sensor off my arm or gotten the “???” preceding a sensor failure (also at the start of a bike race – ugh), but I was never unable to calibrate, nor did I experience delayed catch-up times, dramatically “off” sensor readings, or question the readings during long athletic pursuits. Dexcom was most always accurate in my experience.

The “Getting to Know You” Phase

The new Guardian 3 Sensors for the 670G insulin pump are reminiscent of my OmniPod experience. I was stoked to start with both, and they work amazing well – until they don’t work at all. It can be finicky with the alarming, failures, high blood sugars and frustrations. Just yesterday, I questioned myself as to why I bought into this, as my CGM said 99, my glucometer said 230, quickly elevating to 415 after a hard training ride. [More on the why's and how's below.]

My A1C is usually 5.9 – 6.1 and I never have 400 blood sugars, especially after exercise. It makes me scratch my head. But as the days roll by the gap is closing and I’m becoming happier with the results.

The adjusting basal the 670G offers, in my opinion, tries its hardest to adjust the user to 120, even if that means no micro-basal for over an hour. One thing is for certain – I do have T1D, so I will always need some variation of basal insulin. I appreciate the pump not allowing me to go low during exercise, but I’m finding that it’s also leaving me in a state of insulin deficiency when I’m done pedaling.

I am sort of an outlier as far as exercising goes, which I realize, most people aren’t riding 150 miles a week. However, I do have high expectations that this system can meet my exercise needs. In manual mode, I normally turn my basal down 30%, even on 100 mile bike races. That means I’m getting 70% of my normal basal.

The days of free-carbs are over, even with exercise, I need to bolus for carbs because the basal is so minimal. I think this is key to thwarting my blood sugar issues.

I’m curious to see how this pans out as I wear it over more miles approaching my 100 mile Loveland, Colorado, JDRF Ride to Cure in August. I’ll continue to monitor trends and identify answers.

But as diabetes has always been, every similar situation also has differences. Thirty minutes on the treadmill and the basal adjustments perform fine. Intense high school basketball practice for my daughter has resulted in: Lows during, no lows during but highs after, and also a perfect 670G performance. All the situations were similar.

I’ll chalk it up to the “learning period” for now. Trust me – I am learning.

Two days after starting in the “manual mode” [a setting you must be in for at least 48 hours upon pump start], I cycled in a 70 mile charity event.

Knowing I would be relying on something new and different, finger stick results [not my CGM] were king. When you’re just trying to be an athlete, which I already had dialed with Dexcom, new equipment can be a pain in the @$$.

Five minutes before the start, I peeked at my pump and it said: 278. This ignited my potty mouth, out of pure frustration. I quickly checked with my glucometer, it read: 176. I erroneously chose to calibrate, which resulted in the system not taking the calibration, asking me to wait and renter the number. Super timely.

As an athlete, I was always able to ride and manage my diabetes on the fly – the simplicity was enjoyable. This pump has many bells and whistles, with multiple buttons to be pushed for every task. The system demands an educated and attentive user. It’s not without its regular hiccups. If your blood sugar reading is far off of the CGM reading you can’t calibrate or enter your blood sugar reading or you will be replacing your sensor – this is very different from our Dexcom practices.

Fifteen minutes into my ride the pump is screaming at me while I’m racing. I can only think:

Testing me

I push the home button through my jersey and it stops screaming for 1 minute. I did this every minute until I couldn’t stand it any longer. Turns out it was ready for a calibration. Really? In manual mode it’s that urgent?!

It took my calibration, but it was off by 100 points [higher than my blood sugar] so at the next stop I turned off my high alerts and and tried my best to ignore the results until I was done. I had these two lovely screens and changed my sensor 4 hours later when I returned home:

Medtronic 670G

The 670G “Screen of Death”

Medtronic 670G

What Was I Expecting – Why Did I Choose This Pump?
  • To decrease lows and highs, especially for my teenager.
  • To remove some of the continuous management decision making away from us.
  • To provide a sense of security for my daughter as she travels with her high school basketball team.
  • To have adjustments being made in the background as we exercise and travel.
  • To prevent dangerous overnight lows. Even manual mode has suspend on low and suspend approaching low features.

The Pluses:

  • The sensors are much less intimidating to insert than a Dexcom sensor. My daughter finally said goodbye to lidocaine cream to numb her skin first.
  • The inserter tucks everything inside and with the simultaneous press of 2 buttons, it’s in the skin.
  • Dexcom only functions an alarm  – one to be easily ignored by kids and teens. Having the sensor feedback to the pump is a huge safety mechanism and it takes some of the hard minute-to-minute work away from the user.
  • You can sleep in! The auto basal adjustments work their best magic when there are no other variables like food, exercise or stress. No more pouring juice down my daughters throat on weekend mornings when she simply wants to sleep longer than usual.
  • For chunks of time you can actually “forget” that you have diabetes. Yesterday I had a late start to the health club and errands, finding myself grocery shopping at 1:30 with no lunch after a workout. I would have gotten low without my 670G doing its behind the scenes work.
  • You can really see what’s going on with the basal rate by scrolling through the graph screen. I’m amazed at how consistently it gives little/ differing amounts of basal insulin.
  • The only things for us to tinker with are: Carb ratios and active insulin time. Many people report needing more insulin for carbs. I notice – especially with a busy day at the hospital – the pump hardly gives me any basal prior to lunch which stops me from going low, but then I approach lunch basal deficient, either going high after the meal or needing more insulin to cover the carbs in the meal.
  • I like the profile of the sensor better than the large, boxy Dexcom. It feels comfortable on my stomach, I always wore the Dexcom on my arm because of its dimensions.
  • You can temp basal for exercise it’s called a “temp target” where it tries to adjust blood sugars to 150, not 120.

The Minuses:

  • There is only one size of the pump available to fit the large reservoir. The size is a bummer for kids and those of us using small amounts of insulin. It also uses a AA battery – both of which make this pump larger, not smaller like many of us wish for.
  • Guardian 3 Sensors are a bit clunky and cumbersome to get from the package into the skin. For travel, you need the inserter, the charger and the large package the sensor is kept in.
  • The sensor requires more tape than I typically use; it may be problematic for the tape-sensitive folks out there.
  • I had 2 sensor failures in the first week following cycling, and my daughter had one following basketball practice.
  • My daughters blood sugars correlated quite well with her CGM readings, but mine were off by 50 – 100 points from the get-go with the first sensor. The second and third sensors were closer in accuracy.
  • Medtronic is very good about replacing the sensors that have issues and they do have replacements in stock – I’ve already received ours.
  • There is no remote monitoring available, although the smart people at NightScout do have a fix.
  • The pump has needs, and can have them often. It may ask for extra calibrations, blood sugars, bolus doses to fix a high, meal insulin, it will boot you out of auto mode into “safe basal” or manual mode if the sensor isn’t happy or you don’t complete the necessary tasks it asks of you.
  • All the button pushing begins with the variating safety screen [picture below]. I’m like of the horizontal screen in models past better. This pump design always has me either: pulling it off my waist, craning my neck to see it correctly – or trying to read it upside down.

Unlock screen 670G

 

 

 

 

 

 

The Best Prescription for Diabetes: Exercise

type 1 diabetes, exercise, JDRF, blood sugars

If you’ve contemplated the value exercise adds to a diabetes management regime – double it, triple it – heck, quadruple it.  The inherent benefits of moving the body with diabetes are countless; I’m actually uncertain how people manage their disease without it. [Read more...]

Glucagon App for Teaching

low blood sugar, seizure, diabetes, glucagon

Glucagon is an intimidating drug to administer.  Let’s face it – when someone you love needs it, you’re in panic mode.

I was so excited to find this free interactive educational glucagon app that Lilly produced.  I downloaded it and was pretty impressed by the quality.  I’ll definitely use this app to help teach others about what lives in the red box and how to use it.  Better yet, teachers can virtually practice from their android phone or ipad as well. [Read more...]

Taking Type 1 Diabetes To The O.R. – My Way

surgery, type 1 diabetes
I recently found myself outside of my usual hospital role – trading my scrubs for a hospital gown and taking my Type 1 diabetes on a trip to the operating room.  It’s always an enlightening place for a health care provider to occupy, perhaps even more so for a recovery room nurse. [Read more...]

Type 1 Diabetes – Life’s a Picnic

diabetes. type 1 diabetes, camp
You can always count on diabetes camp for a wet and wild experience.  After my last volunteer nursing stint, I’m reminded once again that my job is never done – even when its lights out.

 

Life’s a Picnic (with Type 1 diabetes)

One evening while watching kids gather around with lows, busting open juice boxes and tearing into snacks, I experienced a moment of diabetes truth: we eat ALL of the time with type 1 diabetes, hungry or not, day and night.  At camp, no sooner is a meal snarfled down and wiped up than preparations are made for the next one. [Read more...]

Aging Safely with Digital Healthcare

digital heathcareThe times they are a-changin’…  Bob Dylan had it right on the money didn’t he?  When we think about aging (we all are — of course), there are many things that come to mind.  Keeping our aging loved ones connected and not overwhelmed by these new digital healthcare technologies can be a challenge.

It is the age of digital healthcare, let us not forget.  As practices are exploding with patients and reimbursements are down many are looking toward the future of digital medicine and its possibilities.

There are so many choices for us to stay connected with aging loved ones.  Technology for this population must be simple, safe and fail proof or it will be shelved. [Read more...]

Beware of Hidden Gluten with Celiac Disease

www.canieathere.com{Editor’s note- This post is a guest blog by Juli La Porte, Co-Founder, www.CanIEatHere.com – check out their website!}

Have you been recently diagnosed with Celiac Disease?  Maybe you are not a newbie, but you are still getting sick, not feeling well, or simply not getting any better.  Although you are on a gluten free diet, the healing process can still be quite lengthy and unexpected.  Take heed and be aware of hidden gluten in the foods you may be eating.

Celiac Disease is an autoimmune disorder of the intestinal tract effecting 1% of the worldwide population.  Research by the Celiac Disease Center at Columbia University notes, that it isn’t uncommon for patients that have been diagnosed well into adulthood, to only see a 40% recovery of their intestinal tract.  This only proves to strengthen mandate requiring strict adherence to a gluten free diet.  The most common slip-ups can be everyday items that you may not realize you are inadvertently poisoning yourself with. [Read more...]

Medtronic Paradigm Insulin Pump Safety Notification

Medtronic paradigm inaulin pumpMedtronic releases a safety notification for Paradigm insulin pump users.  Loose drive support caps may spur issues with insulin overdosing and resultant hypoglycemia.

They suggest customers never push in a loose support cap as it is on the bottom of the insulin reservoir compartment.

If you are a Medtronic Paradigm insulin pump user, check out the notification letter here.

Medtronic also addresses electronic issues when pumps are submerged in water.  If you have jumped in the pool (only to discover your pump was still on) you will want to contact Medtronic.

 

 

 

Type 1 Diabetes and Bedtime Snacks

type 1 diabetes and bedtime snacks

With type 1 diabetes we never let our guard down- especially in the middle of the night.  One of the most vulnerable times people may encounter is during sleep which brings about the importance of a bedtime snack.

Safety with type 1 diabetes is always paramount.  When we are at rest, our awake clues of hypoglycemia become dampened.  Lets look at the importance of a solid bedtime snack with recommendations from Sara Pinson, Registered Dietician (RD).

[Read more...]

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