Use of medtronic 780 Smartguard: adjustment before bolus


I am
New in here and my daughter has just started the 780 medtronuc pump. She had had it for 2 months now and one should think it by now has learned enough. Problem arises when i put in carbs in smartguard , the 780 adjusts insuline also when there is no active insuline onboard. The medtronic expert says it is because it incalculates the basal given eg during the night so the insuline i give before breakfast is Too little it does not match the carb ratio and result is going too high… has anybody had this problem. They advise me to trust the system and it works this way because the 780 does not want the person to go too low… instead the person goes too high. If i lower carb ratio it still adjusts … only way is to put in more carbs so i match the carb ratio and give less food but i guess with such a smart system it is not advisable. Any advice?


So that pump allows you to enter a different carb ratio for the morning, but still gives to little insulin? It’s hard to predict what would happen if you put in more carbs. It might work. Sometimes you need to game these systems to make it work best for you. But if you do that, be careful, because it could mess up boluses (not sure if it’s still called bolus with these smart systems?) for other meals.
That medtronic expert’s answer makes no sense to me. I know pump manufacturers and endos usually think preventing hypos is usually more of a priority than preventing hypers, but the assumption that people go low if you don’t take into account nightly basal insulin, where did they get that from?

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Yes sounds strange to me too and preventing too many highs should be the One of the new gamechanging features by this 780 so i wonder why the 780 is not so smart to figure that one out.

Strange that it incalculates the Basal hivrn in the night for the bolus( yes is still called bolus) in the morning… i will try to ask somebody else by medtronic… thanks for thinking with me on this one

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When I used the 670 I would regularly overbolus. That was because the system was better at dealing with lows than highs, so I’d prefer to have a bit too much insulin on the front end and let the system catch up. Not sure how this changes with the bolusing features on 780.

Is “incalculates” a new Medtronic term or a typo?

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My daughter uses omnipod/loop/G6/Humalog
she has have never used medtronic.

My opinion is that putting in slightly incorrect carbs for a meal is ok especially if you are confident that you can manage it - obviously you can.
As an example for my daughter 36g carbs of rice vs 36g carbs of pasta requires different insulin amounts - 3.1 vs 4.0

for me using omnipod/loop it is a bad idea to use “fake carbs” for a correction bolus.

Another rule of thumb that I use is that if BG regularly goes above 140 within 90mins of a meal then the carb ratio should be changed.


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Sounds really frustrating. When the automatic systems don’t make life easier then maybe they aren’t worth the effort.