T1D & Insulin pumps with CGM

Viewing 23 posts - 1 through 23 (of 23 total)
  • T1D & Insulin pumps with CGM
  • aphex_2k
    Member

    Just upgraded my Medtronic 640g to the 670g which does hybrid closed-loop management. I had a week of “manual mode” which is essentially the same as my old pump, but it learns how much insulin is used, when, carbs etc. Instead of focussing on HbA1c they look more at “time in range” where you’re levels are between 5 and 8 mmol/L. (My last a1c was 7.7)

    So after 6 days of being in auto mode now I’ve achieved a time in range of anything from 72% up to 84% yesterday and also appear to be using a fair bit less insulin. I’ve also not had a hypo or been close to hypo for a good week now, which is awesome news. Really, really happy with the new pump and CGM sensors.

    fossy
    Member

    My son is overdue renewal on his Accucheck pump by about 9 months now – it’s out of warranty.

    They currently are only doing the Medtronic 640g in our Trust.

    Good news indeed though.

    Premier Icon martymac
    Subscriber

    Wife uses a pump and cgm sensor.
    I don’t know which one, but the sensor communicates with an app on her phone, so she gets alerts on her iphone or watch.
    She’s been using a pump for 5 years now iirc, far better control of levels, and it has improved her quality of life massively.
    A great example of modern tech genuinely improving lives.

    aphex_2k
    Member

    Hell yeah. My previous pump and CGM got me down to a superb Hba1c…

    The old pump would suspend delivery if I was hypo. The new pump not only does my background basal, but also gives insulin if my levels start to rise. Target is 6.7mmol/L and you can set a temp basal of 8.3mmol/L when youre exercising. I can’t imagine my a1c getting better, but I may hit sub 7 when I do my next bloods in 6 months, which is ace.

    If you’re going the 640g route the avoid at all costs the Mio cannulas. They often work themselves out of your skin, so you levels rise, you bolus to correct a high sugar, but it doesn’t go in. So you end up high, and not getting any correction dose back to level out. The Paradigm Sure T cannula are 100 times better and I’ve only had one come out in 12 months + of using them – and that was play-fighting with the kids!

    votchy
    Member

    Which NHS trusts are you under as mine (Worcestershire) wont fund CGM? Cost seems to be everything to them as my GP’s keep suggesting I change meter and test strips to a cheaper variant even tho the cheaper versions do not communicate with the pump, I have been on a pump for 10yrs and wouldn’t give it up for anything but would like that additional improvement over my control that CGM would give vs finger prick testing 5-7 times per day.

    fossy
    Member

    We should be getting CGM with the 640 so we will have to see. My lad’s been waiting since february to change.

    Premier Icon kelvin
    Subscriber

    No CGM for my son yet. And pump also out of warranty. No idea what happens for him next.

    Your kit is damn exciting @aphex_2k … keep reporting your progress please.

    DickBarton
    Member

    Mine is due a change early next year – 640 but hoping to get the 670. CGM isn’t on prescription so self-funded and looks to be about £180 per month.
    Pricey and I’m not sure it’ll be a massive improvement over my 640 and Libre.
    Would like to try it though, but it needs a fingerprint check every 12 hours to maintain accuracy (which seems a bit odd)…
    I do think cgm and pump is the ultimate setup though so hopefully advances in tech (and affordable pricing – doubtful, it is an ever increasing gold mine after all) will make it more achievable for more people.

    DickBarton
    Member

    Excellent news, work and result for the OP! Forgot to mention that…

    Premier Icon Harry_the_Spider
    Subscriber

    Watching with great interest for my daughter. Currently getting 7.5ish with pens.

    How does the CGM pump deal with the Breakfast Spike?

    DickBarton
    Member

    Depending on the pump and the program, it’ll either ignore it or it can be set to increase a dosage – is what my understanding is…

    aphex_2k
    Member

    The new system is all quite…new to me.

    What you have with the 640g and CGM prevents hypos significantly. The basal insulin is set within the pump and you just bolus with carb counting (I do this very roughly but have usual foods which I’m pretty sure I’m close with carb levels). It’s great to see a graph on the pump and you can cut off highs before they happen, and far fewer hypos. You still do get hypos if you don’t fix a low BG that’s dropping.

    The new system 670g and CGM learns how much insulin you use across the day, how much you bolus etc. It doesn’t have a background basal insulin per se, but it does “micro bolus” as your levels rise out of the pre set range. The pump knows to keep you close to 6.7mmol/L and you can set a temp target range of 8.3 when you’re exercising. The keeps micro-bolusing to keep you in range, and stops if you start approaching hypo level. It’s really quite techy and a fair bit different to the manual mode (where you have multi-wave bolus and pre set delivery settings for low/med/high workout or sick days). It’s taken a little bit to adjust my mindset and trust the pump, but it seems to be working.

    As for cost. Well… I’m in Australia. The pump is covered by my medical insurance, and all of the consumables are discounted, but still cost me. I actually lost my 640g (disconnected it and left it on the roof of the car after a run!).

    So I pay for insulin, cannula, reservoirs and test strips, but cheaper than full cost. I also “rent” the pump which is $150 a month, and the sensors cost me $250 a month. I cannot go back to MDI – I had 2 weeks or so after I lost the pump where I was injecting again, and had 2 weeks of hypos in the night, crap sleep, tired and frustrated. Yeah it all costs me a fair bit, but when you’re getting a1c of 7.7 I’m super happy with that. The new pump focuses on “time in range” more than a1c.

    Happy to answer any q’s as best I can. I could not go back to injections now.

    DickBarton
    Member

    Agreed about cost…if it is affordable then the improvements are there to be had. I’m hoping the price drops a bit as I would like to try cgm when time for my new pump.

    Premier Icon Nalla
    Subscriber

    I don’t get on with the medtronic cgm sensors so currently run my own DIY closed loop using an accu chek combo pump and dexcom G6 sensors with an app on my phone.

    It will also bolus if high or increase basal and cut off insulin if dropping. Best thing ever for my diabetes care.
    Last hba1c was 39 or 5.7 in old numbers with less than 2% time below 4 mmol.

    It’s great as I can view my current levels on my watch and control everything via my phone.

    My hospital team are really supportive of it and there’s 6 others using it Derby hospital that I know of.

    There’s currently 3 DIY options depending on which pump and iPhone or android.

    If your interested the Facebook grouped ‘looped’ has info on all the systems.

    Or directly at

    https://androidaps.readthedocs.io/en/latest/EN/

    https://openaps.readthedocs.io/en/latest/

    https://loopkit.github.io/loopdocs/

    DickBarton
    Member

    Nice, thanks.

    aphex_2k
    Member

    Nalla these new Medtronic G3 sensors are very hit and miss. Conversely I had 0 issues with the Enlite sensors. The Guardian 3… I’m not sure.

    This morning I woke with a BG of 9.9. The pump had delivered minimal amounts over night and not kept me close to my target. So the sensor was fitted on Thurs night, this is Sunday morning. I calibrated as per usual, and had a correction dose. An hour later my pump is telling me I’m 2.2, but I had zero hypo signs. I tested again and my BG was 4.9.

    Calibration doesn’t seem to actually calibrate the sensors it just moves the figures closer to a match – I appreciate ISF lags behind BG, but to be so off in a short space of time… Weird. Then I got the message I love seeing…. “Sensor expired, please replace”. They’re meant to last up to 7 days. $75 a pop. Fortunately Medtronic replace them. I’ve seen people on the forums saying they’ve got 2-3 weeks out of restarted sensors. I can’t keep one accurate for 5 days! Really pissed me off today. (yes I eat well, hydrate well, fit n active etc)

    Your a1c is super low, are they happy with that? Do you even eat? And virtually no hypos??? Be interested to hear your diet tips. Can you even exercise without crashing low???? Unfortunately with work / 2 small kids and..

    It will also bolus if high or increase basal and cut off insulin if dropping

    The pump I have is hybrid closed loop. Does the same (well… meant to) I’d expect you went through a fairly intensive break in period too, getting yours dialled in? And there was me thinking my a1c at 7.7 was good. Show off! :p

    aphex_2k
    Member

    Still sorting out a few niggles – but getting there. Good days and bad. The new sensors are either really good, or bloody annoying. Today I’ve calibrated 3 times and will do another before bed. Both the CGM and my BG have been much closer. I’ve had a time in range (between 5.5 and 7.0) of 87% and that’s with fish and chips for dinner – I seemed to have got my meal bolus spot on.

    One thing that seems to help is properly hydrating. I am consciously drinking more water (and less coffee) and it seems that a pint of water before bed.

    Cheeky drop of single malt and off to bed.

    Premier Icon Nalla
    Subscriber

    Hi Aphex,

    Hospital team are really happy with the low hba1c especially as the reports show less than 1% of the time below 3.9 or in hypo.

    My system is a full DIY closed loop, it adjusts my basal up and down but will also give small micro boluses if it senses basal adjustment alone won’t keep in range.

    I use dexcom G6 and thankfully it’s calibration free and has proven accurate when I have checked with a finger prick…. Also easy to extend and I often get over 20 days.

    As for diet I eat what I want, including alot of carbs… If its below 50g of carbs I don’t even have to bolus as with Fiasp insulin and the unannounced meal feature in the app it just covers the rise.
    Usually though I just enter carbs in the app, give a little less insulin and let the loop cover the rest.

    Mountain biking or training on zwift I just hit the activity button and it sets a higher temporary target and aims to reduce insulin on board. It’s best if I select this about 30 minutes before.

    Honestly it’s the best thing to ever happen in my diabetes care.

    I’ve been diabetic 20 years but only went on a pump and cgm 2 years ago which in itself was amazing but the app linking them together takes so much of the constant work away that I don’t know how I managed without it.

    I really hope the commercial solutions catch up with the community work so this sort of thing is available to all rather than a few with compatible pumps.

    aphex_2k
    Member

    I’m learning calibration techniques with the Guardian 3 – it’s a shame it’s not “live” as the Dexcom is. I’m not entirely sure the Dexy G6 is available here but I did hear there’s an update soon for the T:Slim making it closed loop. I like the fact it’s live and doesn’t require as much faffin’ about calibrating. I don’t think the G6 and the 670g play nice together but there are a few looping apps OpenAPS, Loop, Nightscout etc.

    I can “upgrade” again in under three years. Stupidly I sold my old Accucheck pump to a guy who was going closed loop. I do still have my 640g though – I’ve asked for a mailing bag three times now and I’ve given up requesting one (hey, free $10k pump as a spare? OK!).

    There’s pros and cons of every system – sadly the constant calibration expectations are a bit of a pain in the butt. Also if it hits minimum delivery over night it goes into safe mode, stops tracking BG and I believe stops giving insulin if you don’t obey the “Require BG” threat, which is not ideal!

    I’ve had the odd bad day but that’s because it’s training itself to my patterns. I’m sitting here at 13mmol/L as I was silly and had 2 homemade burgers with cheese and wholemeal buns. I’m not usually a bread person so serves me right. Auto mode was giving my micro bolus and I’ve had a correction dose but I’ve also sat on my arse reading diabetes user groups and I know I should go for a run round the block (it’s 1015pm though). I’ve whacked it into manual mode, another correction tweak and set the pump to “sick” mode which gives me 130% basal rate until I’m closer to range then I’ll drop back into auto mode and bugger off to bed. Unfortunately I can’t just eat what I want I need to eat sensibly, and of course, we like to eat naughty stuff some times don’t we? 😀

    I’ve looked into FIASP but reports here is that it doesn’t last well in the heat, it’s less stable than Novorapid and I’m pretty happy with how this works on the days when it’s 35+ in the shade and “really farkin ‘ot” in direct sun.

    Still…. Tech eh? Bloody marvellous. Only problem is that it is now impossible for me to go back to MDI! I just couldn’t do it. (I actually had to last Christmas for nearly 2 weeks – Novorapid AND Lantus…. and hypos in my sleep…. Sod that)

    Glad there’s a few diabetics here. (Not glad you have diabetes and dodgy pancreas but you know what I mean)

    DickBarton
    Member

    This is all really useful stuff. I reckon I could juggle a few things (stop them) and be able to afford the cgm kit so I’ll chat with diabetes unit and see what prep I need before my next pump arrives early next year.
    DIY sounds great but I need to check costs of that as well…

    aphex_2k
    Member

    It aint cheap Dick, but I’m so far down the rabbit hole, cost is less of an issue – cost vs health benefit. I just go to my GP who does my bloods forms and referrals for podiatry and I have a fantastic optometrist. I’ve only seen a consultant endo once in the ten years I’ve been here and bar a tiny bit of (what the eye doc called “not even mild” retinopathy) I’ve been pretty good. My optomotrist spotted the retinopathy and referred me onto a specialist eye doc who was impressed the optomotrist saw the issue as it was super small.

    I’ll get my bloods done in 5 months and allow myself 6 months on this new system to see what impact it’s had on my a1c. I’d be super stoked it I got down to 7.

    (I’m back down to normal range now, from 13 down to 8.8 in an hour and a half – damn bread why do you taste so good but screw my sugars?!!?!?!)

    DickBarton
    Member

    Absolutely…I’m totally sold on the health benefits. Just have to work out how to make it work for me as anything that improves it is good.

    Premier Icon Nalla
    Subscriber

    I’m lucky/unlucky enough to get the dexcom G6 and pump funded via the NHS.

    I had zero hypo awareness (actually passed out looking after the kids which was scary) which was one of the reasons I was put forward for pump and cgm, meant I lost my driving license for just under a year.

    But thankfully having had virtually zero hypos and certainly no serious ones the old awareness has come back along with my license.

    Alot of the DIY options will also work with the Freestyle libre and the miao miao device which allows it to broadcast constantly rather than having to scan so that’s a cheaper option, although most people self funding the g6 find they can easily and reliably double the sensor life to lower costs.
    I extend mine mainly as its easier to not have to change it so often but also hopefully lowers the cost of my care a little to the NHS.

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