To paraphrase the great Winston Churchill, “I cannot forecast to you the action of the 670G. It is a riddle, wrapped in a mystery, inside an enigma.”
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Here’s how it has come to be that I’m here preparing to go in again… I was in auto for approximately 2 1/2 months. I loved it for the first couple of weeks because it just kicked my butt. I refer to it as a “diabetes boot camp” because it really is that for lots of people. It teaches you discipline, it forces you to test, it makes you consider your settings and food choices and what makes your blood sugar rise and fall and all of the things you guys are already doing. It didn’t take long before I was ready to tighten everything up. That was where I started to feel differently. In particular, I wanted not to hit a 350 for hours following exercise. I wanted to not hit a 250-300 for hours at random throughout the day. I wanted to be able to wake up in the morning and not hit a 300 with my first sip of coffee. These were consistently trouble areas for me, and I was ready to improve them, but there was little in the way of accomplishing the task. People say to stay in auto and let it “learn you”. Medtronic blames the morning rise on dawn phenomenon. But let it learn you…They make it sound like this could take weeks or even months to take place. In reality, I think it does use 6 days’ worth of your insulin history, but I don’t think it uses months’ worth. We’re not dating. So I think what people are doing is tweaking their own settings over that month or two and are attributing the changes to auto’s having learned them. I’m reality, I think they’ve created a scenario in which they’re buying themselves more insulin. Does that make sense?
In truth, I am about 93% positive, as @Eric said up there, that auto mode is not for me. I’m not 100% positive that there wasn’t something I missed though, and that part eats at me. I can’t say for sure I wouldn’t have just abandoned auto completely if it weren’t for the fact I have a pretty substantial Facebook group that I actively participate in. In truth, I can’t say I wouldn’t have just decided to disconnect completely and continue on MDI… I was happy working on it. For a number of reasons though, I reconnected, and because of my own mental hangups, I feel it’s time to give Auto another shot, knowing I’m a far more capable diabetic. I have a gut feeling it will yield the same results, and I have a gut feeling that the final decision will be whether or not I’m willing to do things like fake carbs, manual injections, and even “fill cannula” tricks to get my needed insulin. Because what I’m learning right now is precision, I feel like agreeing to these things is actually counter——-everything I’m learning to do. It’s an Apple cider vinegar fix for high blood sugar rather than a calculated injection. That’s harsh, but it’s at the core of how I feel. HOWEVER… people say the real trick is in changing these settings, and I just haven’t done that. Which leaves me 93% sure that auto isn’t for me, and probably just not for everyone, but not 100— 99% sure. I’d take that. I’ll never not have a doubt. That’s the curse of being me.
I’m suffering from thumb cramps right now. I’m doing this from my phone. I will tell you what I saw in auto, why I think I saw it, and what people say the fixes are. THEN… and only after Eric says he isn’t interested in doing it either… will I drop it.
I’m not trying to be annoying. I’m being humble. I don’t think this thing works, but I also know a fraction of what you all know. Maybe there’s something I’m missing.
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I think there are a lot of useful ways that a pump can adjust your basal. And for many people it may work great. Maybe people who do the same thing. Or eat the same. Or have the same activity at the same time. Maybe there are scenarios where it can work. And maybe for many people it affords them the opportunity to not have to pay as much attention.
But there are so many things they implemented in this pump that just don’t seem like they are easy to deal with. Like no bolusing for corrections or “circumstances”. My gosh, that just seems like it would drive me mad.
Also, if you are doing your own dosing, you can be proactive, not reactive. Seems like the 670G is only reactive, and is basing it on (an inferior?!?) CGM.
I am sure there are all kinds of ways to dupe that thing. Tell it you are gonna eat, and then don’t! Change your carb ratios. Who knows what other nonsense you could feed it.
But here is what I am not understanding:
Interested in what? Figuring out ways to make the 670G work better for you? I will always want to help you, I won’t lose interest in that. But what type of help are you looking for?
I have known you for less time than the 670G, but I think by now I know you better than that pump ever will. 
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@Nickyghaleb, from the outside, trying to make the 670G work by tinkering with settings to outsmart it does sound like trying to grocery shop blindfolded with one arm tied behind your back. It’s one of those things that you could do, but there are a lot of other ways to grocery shop that accomplish the goal a bit easier…or a lot easier.
If you want to try tinkering, rock on. But I do wonder about the benefit of trying it since it seems to be the path of most resistance. Especially as a woman with changing hormone levels, I can’t imagine that a 6 day look back will be of much assistance. A 6 day plan-ahead would be more useful for my body and my sensitivity changes.
I also wonder if you have boundaries set up for yourself of when enough trying is enough? I know you mentioned two weeks (I think?). Because your commendable stubbornness might lead you to keep trying just one more change…and that might not be helpful.
Back when I was on shots, I did have a much better A1C. There were drawbacks to shots, but there was only so much I could change with how my Lantus behaved so it was always a fish or cut bait situation. I knew I would go low at 2AM and 3PM and I just worked around it. With my Omnipod, my A1C’s are higher for a few reasons, but my variability is lower, and my lows are almost nonexistent which is my current priority. But having so many settings that I can change does sometimes get me hung-up on individual trees and I lose sight of the forest. I just don’t want to see that happen to you with the 670G if you can achieve similar or better control in an easier/safer fashion. And it might help your mental load, as well.
Just my outside perspective. You have my support to try tinkering with Auto Mode settings if that matters. But I do worry about the above stated possibilities…
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If you want to use Automode, then you should do what is recommended for OpenAPS startup: use it at night only. When you aren’t eating or exercising (i.e. sleeping) your BG is much more stable and should be rising or falling much more slowly, and this is where Automode is best suited. Turn Automode off when you wake up, and spend the day bolusing as needed. Then turn it back on the next night.
If this is successful, then you can try using it during the day, or during parts of the day. It is most likely to be useful at night, so take advantage of that, and if it is useful, only then should you consider expanding it to be used during the day.
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I think part of the danger of messing with the numbers on the pump is that there are unintended consequences.
Some simplistic examples of what I mean.
For example, suppose every morning you know you have a spike. So you start taking insulin for that spike by using a pen, but you don’t tell your pump. Your pump sees that your BG is now starting to drop below 120 after you wake-up, so it cuts basal in the morning even more!
Or if you do correction boluses through the pump by saying you are eating, but don’t actually eat. It looks at your BG dropping and “learns” that. So when you are actually eating, it thinks you don’t need as much insulin as you really do need.
I think there are a lot of scenarios where this kind of stuff can come back and bite you.
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I met my first happy 670 Auto mode user. His A1c dropped from the 8’s and 9’s to low 7’s. He was over the moon about it,and I am very happy for him, since it has improved his control immensely.
I asked him about further lowering of his A1c and he isn’t interested, but is very happy to be/stay in the low 7’s.
Seems reasonable for him, I am just hopeful that the second and third generation auto modes allow the user to get into the low 6’s and high 5’s without the OpenAPS work.
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To talk me through whatever changes you would make if it were your pump. That’s it. Everything you’ve said is what I believe this pump is all about. It requires trickery and tiptoeing, and I don’t know what else. I just want to say I went in, I made the adjustments to settings…
I know what I want. I want a discussion about what’s happening to my blood sugar, and what you think about it. A logical discussion. The last time I was in, I was tracking everything, but I lacked a lot of general diabetes knowledge. I’ve gained a lot since, but I’d like some discussion. Even if I don’t make the settings changes. Maybe there’s just discussion about what would happen if I did.
As you know, I have just a little bit of respect for you and for this group. You guys are the most valuable diabetes resource anywhere. I’d like to hear your thoughts or to hear you all attempt to explain what is happening.
Is that a question? Do you know what I want now??
AND I’d like to ask you again about the overnight basal rates. That was my biggest struggle in auto… the morning rise. I’d like to show you guys one of my graphs, show you one of my rises, and then listen to you and your people in here bat it around.
You are most definitely mostly a very nice person. 
You do, Eric, and you haven’t hightailed it. I’m not that hard to deal with… right? 
… yes, you do. I wish you could just give me my insulin. 
It’s why i stayed away for 9 months… or however long it’s been. I’m doing it to keep my word. I said i would go in and give it another shot, so… i’m going in and giving it another shot. Integrity’s a real $#%#.
Not my strength, sure…
Two weeks, yes. If that. If this thing just blasts me, I’m out. I can take a couple of highs, but I’m not willing to sit around and take abuse. Trust me, I know that thinking, that “just one more change”, but that’s not going to happen with auto. I have a short list of 3 things I’m willing to try, and I’m not expecting any of them to work. I’m TRYING to go in with an open mind… and failing.
Nicest group in the world. Thank you for looking out for me. 
My husband tells me all of the time not to mistake people in my groups for friends… As usual, he’s completely wrong. 
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You’re absolutely right. That was my transition period. I actually did just that for about 3 or 4 months. The problem was my morning rise, and that happened as a result of the overnight delivery. Too little insulin. Big rise. My solution was to set my alarm for 4:30 in the morning to exit auto so that when I got up at 6:15, I would’ve made up for some of my missed insulin. But this brings me back to those rises, @Eric, that i keep hinting at. Some mornings there would be a big rise, nothing more. Some mornings it was huge. And some mornings were insane. I just fought it and fought it. I think it had something to do with that drastically reduced rate…
And as I am explaining away, I realize what good advice this is. I know it’s not going to work over night. I figured I would just let it happen and go through the motions. I’ll have to think this point over…
I believe this to be 100% true.
Yes, and yes. I tried one day, just as an experiment, just doing insulin through fake carbs. I kept testing every hour or so, would calculate my insulin on board, would calculate my calibration factor, and would try to stay ahead of the climb by giving myself a few small boluses. It was a scary looking graph, at least to me, after about 8 or 9 hours. ALL of my micro boluses were gone. No micros whatsoever. Every time I did a fake carb bolus, it would knock them out. So it turned into 9 hours of food boluses and nothing more.
And I have my limits. I did my fake carb test and didn’t like it. In general, I have no interest in tricking my insulin pump. No “fill cannulas”. No manual injections… I don’t think. People have posted pictures of their graph screens during a BG of 35… and they’ve been receiving micros of .3 or .4 PER micro (every 5 minutes). I think this is what happens when you do some of these things. Auto mode, like Christine, can turn on you and unleash its power.
Now you’re getting me to tell ghost stories. I just want you to look at my graphs and do this for a week or two. Then I know I’ve done it and either have gotten something to work or know it really can’t.
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I get this. I completely get this. I had said on here that I was going to go back on Nuvaring to see if it dampened my insulin sensitivity swings throughout each cycle. I almost felt like I had to since many FUDders had stated how interested they were in seeing my results from the experiment. But then researching the safety of it, and connecting the dots between Nuvaring and my two complex migraines that I’d had (i.e. scariest health scares I have ever been through…not being able to communicate with anyone or interpret blood sugar test results? that’s terrifying stuff), I realized it wasn’t on the table for me. I would love to be a birth control guinea pig for my good but more importantly the greater good, but what I’ve learned on closer inspection doesn’t permit it in the interest of my overall health and safety.
I don’t say that to dissuade you. But I do say that to say I understand committing to something and wanting to follow through. It’s not in my nature not to honor my word. But this is different.
My second point:
Here is my graph for this afternoon and early evening. You’ve probably read my posts where I talk about getting “stuck” at a number based on my insulin resistance due to hormones? Today’s one of those days. I used +10% from 1PM on after a fast drop after breakfast on +15%. ANYWAY, +10% basal kept me stuck at 180ish at work despite correction doses. But I left it at +10% knowing I’d be headed home from work soon and any extra above 10% would tank me the minute I got home. And I was pretty much right. I’m hovering around 135 despite a huge dinner. My point is two-fold:
- If you’re in Auto Mode, you won’t get a chance to learn these facets of basal management. Personally, I want to know as much as possible about my own care just in case any aspect of it fails, I can’t afford it due to life changes, etc. I just wonder if 670G Auto Mode is what kept you in the dark about some of your own self-care. It would certainly keep me in the dark.
- Blood sugar management is a precision game with still imprecise tools, in my opinion. My blood sugar management is still victim of untrackable female hormones (why is there not a fingerstick or pee test for progesterone/estrogen/other to help us out?), pump sites wearing out, air bubbles, etc etc. I just wonder if Auto Mode is the bluntest of tools to use for this precision disease.
Really, I’m not all-out against an Auto Mode attempt. But I am all for doing things as important as this for the right reasons. If you think it can offer your management something that you haven’t found yet, totally go for it. But you don’t owe anyone here or elsewhere anything. For reals. You’re baller enough already.
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I will look at it. But the problem - I think - is that your pump is kind of keeping everyone in the dark about what it is doing, right?
So even though we look and see things happening, we don’t really know why they are happening. I think that is a big problem with this system. 
And also the fact that it is so difficult to make changes for differences in your day. I mentioned my 65% basal a few nights ago. I knew to do that, and knew the reasons. Is there anything at all that lets your pump know to make changes in what you need from one day to the next?
Anyway, let’s take a look at everything that happens and see what we can figure out.
There are worse ways we could spend a few weeks.
I mean, we could be stuck in the break-room of the Progressive car insurance company. That might suck worse.
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Maybe.
And I appreciate it, by the way… in case I haven’t said so.
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There are people who are happy with it. I even have them in my group. The conversation always starts off a little shaky, but we find a way to be cordial in the end.
I’m not an auto mode hater… every time I open my mouth, I sound like an auto mode hater. It helped me improve my control, too. It really did. I just outgrew my teacher.
(thinking positive thoughts)
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Yup. There’s some pressure, for sure. No one else is putting it on me, but you understand.
Half for the group… half for me. I’m curious, too. I used to go in for a couple of hours at a time just to see what auto would come up with, but I could never bring myself to stay in for longer than an afternoon. I also understand the danger in doing things that way. I’m not learning a thing, and I’m not getting an accurate glimpse of anything. If I’m going to do it, I need to give myself a little time to settle into it, and then I can log to my heart’s delight. That’s the part that’s for me— to be able to observe it in the wild. The part that is for the group is that I do it properly and TRY to refrain from going in only to see flaws.
I’m still working on that piece.
Absolutely valid point. My only response is that it’ll be for 2 weeks, if that. This last year and some of my life has been a diabetes journey. Up until then I was just living with diabetes. Auto mode played a role in the change. It doesn’t make me like it more, but I think it could be interesting to pass back through for a week or two. I’ll learn stuff in it, too. Nothing like what I’m learning outside of it…
A week or two. That’s all.
Again, it’s why I’ve been away. Here I’m learning an art, and I have to leave it all at the door once I go back in. However, there is something interesting to watch in auto as it is doing its own form of sugar surfing… only without any information… It does increase and decrease micro size according to your trend, current SG, and IOB. It’s interesting to see how it decides when to cut you off, when to turn it up, etc. The imprecise part is not being able to adjust anything. Pretty much the opposite of precision. But 2 weeks.
I rarely do things for the right reasons.
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Rock on, @Nickyghaleb, Science Warrior! Looking forward to seeing what you think of it with fresh eyes!! 
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This isn’t good. If Auto Mode doesn’t work for you overnight, then it seems to me that there is no way it can work for you during the day, and if you try to use it during the day before you get your overnight results pinned down, then it will just complicate things for you and seems doomed for failure
Auto Mode should be able to adapt to changing basal needs like dawn phenomenon, and if it can’t do that, then IMHO there is no way it can deal with the much greater complexity of daytime meals. By the definition I could find, Dawn Phenomenon is a rise of about 50 mg/dl or so, and you are not unusual in seeing it only on some days. That’s why an Auto Mode pump should be perfectly positioned to deal with this need. I can’t imagine any pump adjustment (AKA “messing with the numbers on the pump”) that can help with dawn phenomenon - you need to rely on Auto Mode to notice that increased need and raise your basal to accommodate this.
NB: If you’re seeing a rise of more than about 50 mg/dl, it could well be something other than Dawn Phenomenon.
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Nicky, can you post your BG test numbers when you first wake up each morning on the pump? Let’s see what it looks like.
Test right when you wake up, and then maybe 30 minutes after. Let’s see what getting out of bed does to you.
If we see a consistent pattern, there are fixes that can be done (in manual mode).
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Go for it, good luck
I know you mentioned another group of 670G users, and must be hearing some success stories from real people.
Unfortunately, I’ve mostly heard about the struggles and failures. Maybe you can change my mind. After 20+ years of using Medtronic pumps, the next one will break the trend.
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