Trying Automode on my Medtronic 670G again

Tips, Tech & Gear Pump
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Dearest @Eric,

I’ve gone back to my pump. :pensive: I had to. My mom actually asked me, as a favor, to do it. She’s got another big surgery coming up, and it just terrifies her that I’m not attached. It’s a little ironic though because it also terrifies her that I’m not in Auto… so that just goes to show you what I’m up against. :thinking:

I loved the break. Loved it. I have you to thank for it. I’ve been bummed all day about reattaching, which is a little over dramatic, but it’s the truth. I’m planning on taking another break soon and would like for you to repeat, again, what I will need for the next one… like pens with 1/2 units… prescriptions… I’d like my next vacation to be a couple of months. And I’d like to start tomorrow. :grin:

Anyway, I am planning on giving Auto Mode another try, and if you are willing to look at different numbers and a different kind of insulin delivery, I would absolutely love your input. I’ll just put it out there that I don’t trust Medtronic to tell me how to make this thing work, but I trust you. I have refused up until this point to mess with settings, but if you cared to participate, I would be happy to tweak a thing or three. No pressure though… I can always bail if it’s not going well.

Yesterday and today… I was happy with how they went. Definitely happy enough to write them down as my starting basal rates for when I return. The climb today was my attempting to transition back without asking for help. Just too hard to say goodbye. :cry:

Just kidding. I’m already happy extend-bolusing away. :grin: But I AM doing it all with my suspends turned off. I survived two weeks without them…shutting that down.

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I understand. Ya gotta do what your mom tells you.

Definitely get the 1/2 unit pen for next time.

And what about the idea of having some background basal going while on auto-mode? The Tresiba idea? Worth trying?

What do you mean? Tell me what you are trying to figure out here. I don’t know anything about the Medtronic witchcraft!

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There’s more puzzle in it than even YOU could wish for… wait. Let me get my keyboard, and I’ll fill you in. :grin:

And here’s what I think about the Tresiba… I think it might be worth a shot. It’s going to have some kind of effect on the algorithm, but I don’t think we’ll know what it is until we let auto try to kill me without any other intervention. :grin: That was a low blow. Sorry. I’d like to get a baseline… as much as is possible with auto. Then I could add the Tresiba. What I think is going to happen is the additional insulin will result in a more downward trend which will cause even less of a “dynamic” insulin delivery.

I can barely write the words without crying or laughing. That’s not exactly objective. Let me get my keyboard… and my serious face.

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And I do. I really do. She’s got surgery in one week, and she can’t take any more anxiety… but guess what I heard not 45 minutes into having it back on? “Are you sure you’re getting insulin, Nick??” That’s not NOT anxiety. I haven’t heard that question in 2 weeks… but she wanted this.

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I feel like I should also throw out there the very, very remote possibility that Auto Mode only didn’t work for me because of my severe lack of skill at last attempt. Just want to put that out there. Before I start with a keyboard and all the reasons why I think it didn’t work. That have nothing to do with me or my ability…

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I think it more likely the killer asteroid hits us overnight and we are all gone before morning.

Not a chance I would blame the failure of the Auto mode on you.

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Okay. What i am trying to figure out is how to get auto mode to give me enough insulin. That’s what it boils down to. In theory, auto is supposed to keep track of your insulin needs and your blood sugar trends for up to 6 days and is supposed to give you a “dynamic” insulin delivery based on your history, your IOB, any carb intake, and your current sensor glucose and trend. I think this is what makes up the algorithm. There’s also some debate over whether or not it takes into account your sensitivity factor, but supposedly it doesn’t use that OR your programmed manual mode basal rate. Now remember, all of this is based on your sensor… which is a whole other issue, but we’re not there yet.

Here are the basics… auto mode used micro boluses in order to deliver your “basal”. Auto will take all of those factors into consideration and decide on the appropriate size of each micro. The micros are supposed to target a BG of 120, but it will only correct down to a 150. The correction boluses are also calculated according to a whole bunch of things we’re not really sure of, but the corrections are WEAK. There were times that on a 300, it would give me .8 units of insulin. I believe this is called a “200 minute high excursion” as it is supposed to take that long to bring you back down. Many times it never got me there at all. What else?? The other way it “holds” you at 120 :rofl: is by withholding insulin all together. This can mean ONE skipped micro (meaning 9 minutes without insulin) but can reach 2.5 hours. There’s no communication during this. In fact, there’s no way to tell what you’re receiving at any point without adding up your micros (pink dots) on your graph screen (available for 24 hours) OR looking it up on Tidepool. I plan on using this, but I still haven’t gotten the chance to see whether or not it, in fact, shows micro size.

Over night, auto keeps people at a nice, flat line, but mornings are a beast. This is what I was trying to ask you guys about on Michel’s post yesterday about the difference between missed basal vs. correction bolus. You mentioned having reduced your basal to 65%, but then you never answered how you then avoid the rise. I am curious because I thought it was bad to have such a reduction, but maybe it’s not the reduction itself that’s the problem but the inability to manually adjust anything on the tail end. Which brings me to the next point… auto is the only cook in the kitchen. You can’t give yourself a correction, you can’t do an extended bolus or a temp basal of your choice. You have one alternative, and that is “temp target” that adjusts your target BG to a 150. You can also suspend.

Another thing you have to remember is that every single thing you do that affects your blood sugar is going to affect what auto is going to give you over the days to come. This is where it gets tricky… actually, where it got tricky is when you enter it, but it gets tricker here. If you exercise, if you have a really high carb meal, if your set is leaking insulin, if you disconnect… auto can only be aware of these things through the result its had on your blood sugar, but it will have no idea why. So if you exercise without suspending, auto might remember the next day your having a drastically reduced need for insulin at noon and start to hit the brakes the next day…

There’s so… much… more. People say to just let it learn you. I can feel my skin crawl when i hear that. I spent almost 3 months in before and was on my BEST EVER behavior, and we just couldn’t get it done. But as i said before, i wasn’t willing to change settings.

But i’ll tell you up front what my hesitation was… the theory is that you can increase the size of your micros by jacking up some of your settings. So people lower their active insulin time to the lowest it’ll go— 2 or 2.5 hours. They sometimes double their ICR. It was my belief that people were doing this to try to get back some of the insulin that they were missing in auto, but the reason i wasn’t comfortable with it is because auto never delivers the same thing. So if you buy yourself a bunch of extra insulin and NEED it, that’s great. If auto mode happens to offer your full amount, you plummet. And people do report some major plummeting. However, with your help, i’d Be willing to try a couple of these things.

But you don’t need to do it if you don’t think you want to. Honest. It’s going to be a ride.

I just wrote so much I don’t even feel like going back to proofread. If I need something to fall asleep to tonight, I’ll pull it back up. If you have anything to ask or say, I’d love to hear it, and if you are done hearing about it, I will respect that, too. And I MEAN IT. No hard feelings…

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That’s the most succinct explanation of Auto Mode that I’ve seen. And it, quite honestly, sounds terrifying to me. I view you as a Scientist Warrior since you’ve stuck with it despite the known drawbacks.

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You called me a Science Warrior…

I love you, @T1Allison. :hugs:

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Right back atcha, soulmate. I hope your mom’s surgery goes well.

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:two_hearts::two_hearts::two_hearts:
thank you. Me, too. :slightly_smiling_face:

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What about compromising and start using just suspend on low mode? Isn’t that what your mom is most worried about?

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Wow, there is so much in this post that gives reasons why you shouldn’t be doing this.

I am not trying to come out against the auto-mode. But your post says it all. I mean, so much of this stuff sounds like valid reasons to steer clear of this thing,

I think you have explained so much here :arrow_up:. What could I possibly add to all of this? I mean, yes you could probably tinker with stuff and change it. Possibly lie about your IC ratio or whatever. I know it may work for some people. But for you, with your circumstances, it sounds like a nightmare. And I think this whole post you made gives so many reasons.

I think you have highlighted so much here!

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That is absolutely the most reasonable thing to do. However… :roll_eyes:… I’m kind of combining things here. I’ve been in manual with suspend on low for about 9 or 10 months. I am happy enough doing that, I just needed a break. I’ve also been threatening to give Auto Mode another try for some time now. So I’m doubling up and getting things done.

I am hoping to bounce ideas off you all… and thinking I’ll maybe stay in for a week. If I can. I’m glad to have you guys though while I do it. I had no one during my last trip, and I kept feeling like I was losing my mind. :angry:

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That is absolutely the most reasonable thing to do. However… :roll_eyes:… I’m kind of combining things here. I’ve been in manual with suspend on low for about 9 or 10 months. I am happy enough doing that, I just needed a break. I’ve also been threatening to give Auto Mode another try for some time now. So I’m doubling up and getting things done.

I am hoping to bounce ideas off you all…

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Thanks! Meeting a friend in a while for coffee and will enjoy every drop! WYWH!

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Please hold. I’m preparing my case.

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“Because it’s there” ???

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No… no. Not that kind of case… what are you talking about? I’m talking about preparing the case I’m about to present to Eric and you since you’re familiar with all of this, too, for why you guys should help me see what I can do with my time in auto. 2 weeks max…

My parents were lawyers. I just try to say things I used to hear them say like “I’m going to prepare my case”. It might be more fun to be a lawyer, but in saying it alone there’s a little satisfaction. :grin:

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That the “challenge” of doing auto mode is what is driving your quest to get it to work.

Can you summarize your past experience with using auto mode? What have you learned or would change to make it work better. (Maybe I’m confused at some of your prior postings, and which mode you were using. )

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