Trying Automode on my Medtronic 670G again

Tips, Tech & Gear Pump
41

Thank you. :blush: I’m already back in manual mode. :rofl:

Yeah, not really. I have a Facebook group of 650 people… I can think of 4 that have true success stories. 1 is getting it done by leaving it to “do its thing”. The other 3 are doing manual injections.

I should’ve read that first… before writing all of the other stuff. I probably could’ve broken it to you a little easier. :grin:

I spoke with Medtronic today for almost 2 hours. The most important thing I heard them say was just to return to manual if you need insulin. This was different than what they said the first time around. They used to tell people to stay in… to let it learn… there was a spot of shaming involved if you didn’t stick it out. All very bizarre. So it was nice to hear that today, that at LEAST they are recognizing that people need more insulin. In reality though, I was doing this the first time around…leaving to get my insulin. In effect, I could get auto to work by limiting what auto was allowed to handle. In reality, it was way higher maintenance of a strategy than just hanging back in manual and getting my settings straight. However, for this little trial, I can go in and out and see if there’s a way to get in sync. I say that from a blood sugar of a 220 without having eaten anything. That’s that minimum delivery. And even exiting, I’m really left guessing what I should do to bring it down.

So maybe I give it a week…

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42

@MM2, I don’t know if you’re around, but I have a question… it IS in reference to what happens with my 670, but it’s also a general diabetes question.

I have been trying to ask this, but I’m obviously not phrasing the question right. And still might not. … And it might be a made up idea anyway…

So my blood sugar right now is a 230. It’s a result of all of that minimum delivery. I would see this on a regular basis the last time I was in. I would have not eaten ANYTHING, so there was no effect from food. I would have received maybe an hour or two (or, in this case, 2.5 hours) of minimum delivery, which is a suspend. That alone is going to rock my world. However, I often wonder how far BACK I could consider as a part of the problem that led me to the 230.

I’m not doing much better here… but I’m trying. Be patient. :slight_smile:

So let’s say I know I haven’t received insulin at all in 2 hours, in the one hour before that I received about 90% of my regular basal rate, in the hour before that I received 60%, in the one before that maybe 43%, the one before that 118%… but then just 23% in the one before that…

I’m not trying to be stupid. I’ve actually added these micros up time and time again and have tried to figure out how much of the last, say, 10 hours could be responsible for a blood sugar climb. Is there an accumulative effect? Even if there had been a stray hour or two where I had received enough, or even slightly more than enough, can I still look back and average the hours from the beginning of the reduction to look at it more as an average over that period of time? In my example, would it be accurate to say that over 7 hours, I averaged 47% of my regular basal rate? I feel like sometimes it’s NOT just that last 2 hours that’s to blame…

Am I making ANY sense at all??

I thought this is what Michel was saying in his post about the 5% reduction, but I didn’t receive either confirmation or denial of my comment where I attempted to apply it in 670G world. So maybe I’m wrong. My concern is, as I head into the overnight, that auto mode is going to cut back my insulin tonight, probably starting around 2 or 3, and I will accumulate a BIG reduction in insulin by the time I awake. It’ll give me a nice line tonight and then will wreck my morning. If I can attempt to account for the missed basal overnight through a preemptive bolus in the morning, I’d be happy to give it a shot. What I’m not interested in doing is spending my entire morning doing repeated corrections and not being able to drink my coffee because i’m lingering at 300…

I know what I’m trying to say, and I know I’m not communicating it well. If I knew what the answer was, I’d stop bothering you all. :smiley: But you made the last bit of eye contact, so I present it to you.

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43

It works well overnight. It just achieves it by reducing my insulin. This sets me up for disastrous mornings.

I… actually think this is just what it is.

I am a broken record. I annoy myself in repeating this, but I also can’t stop myself… Auto Mode doesn’t struggle with my dawn phenomenon. Auto mode struggles with the morning rise that it has set me up for with that reduction I mention up there. It just can’t keep up with itself. Because I experience a lag with my sensor, auto mode will continue to hold back my insulin far beyond the time I’ve begun to rise. My sensor might be showing an 80, but my blood sugar has already surpassed a 160 and is rising fast. By the time auto even learns of it, I could be in the upper 100s. Auto tries to throw big micros at it, but they’re just not enough. There are lots and lots of people who report this, and most of them start off thinking they’ve just all of a sudden developed a really bad case of the dawn phenomenonies. :smiley:

Anyway, that’s my story, and i’m stickin to it. :smiley:

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44

For what it’s worth, when I’m really dialed into my insulin needs and make a 5-10% change in basal, my bg responds in about an hour to two hours to a new leveling point.

Also, once I get above 200, everything takes longer (3-4 hours) and needs more help from boluses.

I think your last 3-4 hours of basal are most important…and then it’s a matter of how much extra help your body needs to get out of the 200’s.

Just my best guess even though you weren’t asking me!! :grinning: Am I annoying yet? I do participate a lot…

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45

The “black box” aspect of auto mode would drive me crazy. Sort of reminds me of the wizard of oz, you can’t look at the man behind the curtain. I need to know what my inputs are to make any sense of the trend.

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46

I’m always asking you. If I’ve asked something, I’m asking you, too…

In fact, I can’t believe I asked a basal question without calling you by name. You ARE basal. :two_hearts::two_hearts:

:woman_facepalming:

And I like your answer very much… so you don’t think there’s an accumulative effect then? That if you’re at a reduced rate for 8 hours it could have a more profound effect than just the last 4??

Even as I ask… I can identify something is seriously wrong with either the question— or my thinking. :grin:

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47

And I’m like you. I think the theory is that you don’t have to worry bout a thing. It’s all paid for. :grin:

But it’s not. There’s a scary bill coming, and you have no idea what you’re paying for. :thinking:

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48

I think as long as we’re dealing w Novolog or Humalog, the last four hours matter most. But I could be wrong about that. Basal is a bit of a beast that I continually wrestle with since everything in Diabetes is so elastic.

Also, to verify, are you talking about in a fasting state? Or during eating hours? That might change some minutia…maybe…

49

I actually get that!

But here’s what it means to me. Auto mode seems to be reactive, and with lag of sensor glucose to BG, it’s always lagging and playing catchup. I got a good review from this, and statement that auto mode was like steering a big ship with a small rudder.

Article by Gary Scheiner

With my 523 pump, I have a known basal pattern, and can easily project my current “basal on board” based on setting, and temp basal change. That’s valuable to me, but I get the idea there is no easy tracking on 670 to know equivalent. And IOB on 523 let’s me know insulin from bolus. No complicated guesses on what may be active at the moment, as basal or bolus. So if my BG is flat, rising or falling, or I just exercised, or about to exercise, I know what to do. I’m a control freak, so can’t imagine letting a pump make those decisions for me. Heck, I don’t even use the bolus wizard.
So… I’m not sure what I can offer to help you, the 670 speaks in secret codes, maybe even secret handshakes.

I wouldn’t even be asking this with 523, so don’t know how to help.

In this case, I might bolus the correction amount, then add another unit as catchup for the missed basal, knowing that my basal is about .5 units per hour.

Lastly, I tend to be generous with adding correction insulin, and monitor BG. Always nice to get a treat if I overshot the target.

Bottom line, you are taking in way more data to calculate the right number, and I wing it, then adjust. Does that make sense?

50

Right. The last few hours have a big impact, but the overall lower basal for many hours can set you up for horrible outcomes.

I always follow any length of zero basal with a big bolus to prevent that. I have told DM about that same thing, that when she has been on zero basal for 4 hours for swimming, she needs to put some of that back right away. I have told her exactly this same thing, that as soon as she gets out of the pool she needs to inject insulin. Immediately.

After every extended zero basal, I take a bolus right away, every time. Even if I am low.

I have said this many times - basal is the foundation of your house. You need a strong foundation at all times.

I can give you some medical info about it. I have said it a number of times, do a search on FUD for " Glycogen Synthase".

But the simple answer is that yes, lower basal for long periods can cause you problems. You are not imagining this.

I know exactly what you are saying. Same planet. :wink:

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51

You showed. Okay. And it is not going to be my problem this morning because I hit minimum delivery late last night, so it ended up being plenty of insulin early morning. So I’ve been pushing down since I got up. This is pattern 2. It’s not the common one, but it happens.

And yes, I can show you my numbers this morning, but it’s not going to be representative of my typical Auto morning… or my diabetes. But I’ll bring it.

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52

Actually, I think this is very good news. I look at it this way, yes Auto Mode (sometimes) reduces your overnight basal rate, but it does that ONLY to prevent you from going low. Since you are waking up with an in-range BG, then when you wake up and turn Auto Mode off it is simple: all you need to do is bolus the amount you need to handle your “morning rise”. Apparently Auto Mode doesn’t do well handling your “morning rise” - but that is fine since you turned Auto Mode off now that you are awake and you can handle your “morning rise” yourself in the way you always have.

I really think you should not make this more complicated than that - you don’t need to look at how much your basal was reduced while you were asleep and bolus extra for that. Any reduction or addition was to keep your BG in normal range, so when you wake up you’re starting with a clean slate - and an in range BG. Simply bolus as much as you need to handle your “morning rise” plus coffee plus breakfast, and take it from there.

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@Nickyghaleb, I set up your new posts on returning to the 670G on their own thread, so that they can be useful to others who have 670G questions. Thanks so much for sharing it all with us!

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No, thank you all for putting up with it. :grin:

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It’s really not. Auto mode does do a good job overnight, but there are consequences. If I wake up at the tail end of not receiving any insulin for almost 3 hours, that “morning rise” is not a naturally occurring rise. It’s a rise that is a direct consequence of not having received insulin for an extended period of time. It happens to me all throughout the day, too. In fact, I have JUST exited auto because I have acquired approximately 2 hours of no insulin at all. The only reason I made it this far is because I went back to manual for an hour to catch up on some insulin as well as to do a sizeable bolus to counter the previous 2 hours of no insulin.

This I know. The question I keep asking myself is whether or not there’s any part of doing this that makes the effort worth it. I haven’t had a bad day. My numbers have been great. I’ve also watched auto like a hawk and have left it on numerous occasions to break up the reduced rates. According to Medtronic, this is okay to do, and auto can learn how much insulin I need. I’m skeptical. I’m actually very skeptical about the entire “learning” aspect. Maybe it tracks something, who m led, but what I see it doing day in and day out is responding to its own actions. And that’s the problem with the overnight. If it has delivered a lot of insulin in the earliest morning hours, it then has to hit the brakes. Around 3 or 4 am, it starts slowing it all down, and I’m often receiving almost nothing by the time my alarm goes off. I did this for a couple of months where I would just exit auto and not try to correct for anything… just bolus for my coffee and such. I would be in the 2 and 300s for hours. I’m not complicating things, I’m trying to figure out a solution to a complicated problem.

It would be awesome if this were, in fact, the way it worked. Every now and then it does, but usually it doesn’t.

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Since I was just talking about my overnights anyway, I figure I would add a picture of last night’s graph. Very generally speaking, I tend to see two patterns of delivery over night. One will cause me to rise in the morning upon waking while the other will cause a drop. The first scenario makes up for approximately 75% of my nights.

Last night, however, was a “pattern 2” example. Because 12 am to around 3 am carried a significantly reduced rate, it caused auto to respond to the resulting rise by increasing the micro size. As a result, that 4 am to 6 am window was pretty packed full of insulin. When I woke up and bolused for my coffee, I began to fall. I’m guessing tonight I’ll get the more typical pattern and will have to deal with a rise in the morning.

Don’t know if this makes sense. I figure the more I talk about it in here, the more that will become clear. Even if it becomes clear that I’ve misunderstood something.

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And here are two very mild examples of the delay I experience. In the case of the auto mode value of a 122 with an actual BG of 157, auto mode would probably be STARTING to give some micros again, but they could still be small. It is still thinking my blood sugar is low enough to keep the delivery conservative. At a 157 and rising, I do not need a conservative delivery.

In the case of the auto mode value of 67 with actual BG of 93, I’m not getting any insulin at all. It could easily be 20-40 minutes before auto mode becomes aware of the actual blood sugar, and it can putter around with small micros for some time before it starts to really hit it.

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57

A single daily shot of Tresiba at a small percentage of your basal requirements - like 25% of what you need - would prevent the “zero” thing.

As clever as Medtronic thinks they have made their pump, it won’t be able to remove insulin from your body. They can’t give less than zero. :wink:

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58

:rofl::rofl:

Perfect

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:rofl: :rofl: that’s funny. :smiley:

Okay. Tresiba it is, BUT I’ll start it on Saturday. Weekday mornings are pure chaos. I can really plummet. Saturday is also pure chaos, but there’s no rushing out the door…

So 25%… of… what? Just the one shot??

60

Ha.
:stuck_out_tongue:
Me.

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