Medtronic 670g v2 Australian review

It has been a while since I have written or posted about t1 or my life however I have been taking my time to really understand the latest version of the Medtronic 670g with the guardian sensors (g3). It has taken a while because I wanted to see it from multiple angles and to make sure I had it right. So with out delay here is my verdict for the first hybrid loop system that has been approved by the FDA here in Australia.

I have been pumping now for 14 and a half years and when I first heard about pumps that were going to do some of the thinking for you I was 100% for it and hopped beyond belief that it would work and work well in my lifetime. I began and honed my skills on the veo... learning how to make the micro adjustments to ensure my control was as good as I could get it.. I then was introduced to the 640g and in a very quick period of time understood the importance of the suspend before low function and to trust that it would stop the dangerous lows from happening without treating like I was used too... I proceeded to have the 640g on my side as I lost a third of my body weight and honestly it was the reason why I was confident in doing so...

So now we come to the biggest change so far.. the release of the 670g hybrid loop system and the new sensor. The pump was to remove the need for basal and to remove the need for the micro changes and the sensor was to be the closest and most accurate thus far... a lot to believe and take in I know but accepting change is a great ability we humans have.
The time came and I attended the educators office to get my new best friend hooked up. We were told that it would be different and it would take time for the device to get to know you and how your body requires it's insulin intake. We were told that the information you put in would help it make decisions and keep you in range... notice I didn't say keep you at a key number.... no longer should we be thinking that a perfect number is 5.5 but to think the range we need to maintain is between 4 and 10 and honestly if I think back to when I was diagnosed that range is one that I have been working with since then however thinking that 5.5 was the best number to get... I see 5.5 for split seconds on the way up or the way down so isn't it a false sense of security to think that a single number is what we aim for.
Anyway back to where I was...

I had read on the online socials about how people were having a lot of trouble keeping it in auto mode and it was frustrating... we heard that because of it now focusing on a range rather than an individual figure it was running people higher than they liked. I heard all this so the anticipation was of both fear and excitement.

After being hooked up we were told that after 48 hours of the pump being on we could then go into auto mode and let the pump start making some decisions by giving us micro boluses every 5 minutes depending on what the bgl reading was... being on manual mode was the same as the 640g however the sensor details I found to be even more accurate so that was exciting. I returned to the office 2 days later and turned on the auto function and began a month that I hadn't prepared for... one of frustration and elation... one of doubt and trust, one of fear and freedom.

The first 3 nights of running in the 10-12 bgl range I was ready to throw by new friend against the wall... I didn't want to have to get up multiple times a night to pee, I didn't want to wake up feeling like I had mud in my veins. I know 10-12 isn't too bad but for me who liked to sit between 4 and 6 it was a big change. I maintained communication with my educator and we make a few more adjustments to the carb ratios, sensitivity and insulin on board time. I made the changes and told my partner I'd give it another few nights to see if it would bring it down to where I felt like I was able to feel normal (if there is such a thing lol). After a night of ups and downs to the bathroom and alarms I just couldn't do it I gave in and switched back to manual mode to give myself sanity and life again. I turned all my setting back and went on with things.

Things went on as normal on manual mode just the same as it was before the 670 however I always had in the back of my mind it should be working and I was frustrated that it wasn't for me, or so I thought. After around 2 weeks on auto mode I finally gave it another chance to go onto auto mode and to work with me to keep me in range.

I made the switch and kept a close eye on what was to happen and to my surprise it was working. It was aiming for the middle of the range (6.7) and micro bolusing to manage it. I find it strange to say but the 2 weeks I had spent in manual mode allowed the pump to get to know me and how I worked. It was refining itself to work out what I needed. It was working hard in the background even when I thought it was off. Even overnight I would wake just to have a look and even though it wasn't perfect it was a lot closer this time and I was able to cope with it. I was delighted that I was wrong and that it was working with me and the technology was worth the wait.
Now that I was in auto mode and it was going well it was time to see what would happen when I push it through it's paces by maintaining my high impact gym and cardio routine. The 640g would stop the dangerous lows but what would the 670g do.

My routine consists of going to the gym 8-9 times a week and some days twice a day. It meant that the pump would have a lot of learning to do. In the beginning I think I scared the hell out of it as the drops were simular to the 640g with the alarm going off within 20 mins of beginning. Still not a problem as the dangerous lows were averted however I was interested to see what changes at all would occurs over time.

Routine continued and I kept watching and as the weeks went on I noticed the drops became less noticeable. My alarms minimised and I was able to do more. I had worked on giving my meal boluses with as close to 15 mins amount of time before eating and I looked at the importance of how protein is used in your body and how it does convert to a simpler carb over time.

My outcome now is that the only time Auto mode is disengaged is when I am switching my sensor and charging my transmitter. I sit here today with my time in range over the last 30 days being   86% with 2% being below range and 9% being above. Now when I say above I mean it goes into the 10-11 range and then back down. I am in auto mode 96% or the time and as long as I follow what the pump asks of me then I don't see that changing other than getting even better.

All in all the pump has lived up to every expectation and more. It continues to refine and get to know just what I do and what I need. I also know that this is only the beginning and if algorithms can be created to do this the closed loop system will be worth the wait.

Time in range... Why could it be better

After nearly 30 years of having everyone in the T1 community see and say a bgl of 5.5 is the perfect of course it is a hard sell to see why a pump that is brought to the market with a soft target of 6.7 is the best for all of us. What we don't link together though is the movement to move away from the average result that a A1C result gives us to a time in range percentage as a best practice.

So first of all lets look at the 2 individual numbers -

A1C - This is the blood test that looks at the 3 month average bgl and we use it as a measure of how well we are doing with our T1D management. As with all averages extremes happen and can have some major effect to the result. This result doesnt identify the highs and lows that are still happening each and every day. To see these we need to delve into our numbers and make adjustments from there. So is the A1C result a true reflection of management???

Time in range - So what they are trying to look at now is the amount of time that we as T1D's are within your given range. The CGM technology that we now have accessibility to allows us to be able to have a range that will be the best to be seen within. From diagnosis I was always told that if my level was between 5 and 10 mmol then I will be safe and minimise the chance of complications in the future. What was difficult though was to really see how long I was in that range with random snap shots using manual bgl tests. Now that the CGM technology reads our bgl every five minutes we are actually given extremely valuable information that determines how our control truly is.

Now back to my initial comment around the best number being 5.5 and not the 6.7 that the new Medtronic 670g pump has come to market with. Medtronic have made the first move to really focus their practice on emphasising the time in range readings and in doing so has created an algorithm that not only aims to remove some of the burden from your day to day thinking but also keep you within a range that will help minimise highs and even more so lows. It is now understood that the dangerous lows have a significant effect on the health of the brain as it takes a significant time to recover after a serious low and hence can never be good. I know that as I have been recovering from the dangerous lows I can sometimes go hours with a fog over my brain and thoughts which is not only scary in the short time but also for family and long term.

With a simple look at my pump now I can bring up a graph summary that shows me the average amount of time that I have stayed within my given range, the amount of time I am below and the amount of time I am above my range. You can also average things over different day periods so you can see the details for an individual day or you can average out over the month. Important as you can track your progress when making changes with your healthcare team.

Keep in mind however to get my head around this concept has taken time as my A1C result for the last 10 years has been in the high 4's or 5's however if I am honest with myself more lows have been sneaking into my days or weeks that I would like. I see the technology coming to market through the 670g and new sensors  to be a way to protect us all even more and to elevate some of the burden that we had by trying to work out where our changes to our basal rates are needed.

So, as I go off on tangents, the 6.7 is a soft target which as your pump gets to know you and your patterns tries to keep itself around this number by giving micro boluses in a live setting depending on the live data that is obtained from the CGM. Each and every 5 minutes the algorithm takes the CGM data and determines the tiny amount of insulin that is needed to keep you within a range that minimises the chance of highs and lows. As we are using synthetic insulin and also the fact that we are doing our best to imitate the natural process of the pancreas by counting carbs manually and entering them for a bolus we still run the risk of mis management and either shooting high or going low. As with all things with T1D though my philosophy is to live and learn but learn from everything we do. Mistakes and changes will happen but with the wrong results work out how to next time turn it to your benefit. To say there will never be highs or lows is to say there is a cure. We use technology to minimise these effects and stay within a range that will benefit the T1D, family and partners now and long into the future.

I sometimes see both experienced T1D's, new families to T1D and also new T1D's question if a pump is right, if the pump could fit into their life. For me after 16 years on MDI and 14 years on a pump I would never go back. Not only have I not spent a day within the 14 years without my pump I have never wanted to. Even when my daughter was diagnosed at 2 years of age I was not having her trying to manage on MDI. Now that the new technology and a focus on time in range is upon us I am excited for what the future holds and for results that will not see endo's look down there nose at you questioning their own test results as they then have to look for the extremes which is causing the results. Time in range is just that "TIME IN RANGE".

As I move forward with this technology I realise more and more how it has the ability to make a long term difference. My current time in range is 88%, I have some work to do around my work out periods however to not have to worry about constant adjustments and just watch the device do its job is a great feeling. Keep in mind though you still need to enter the correct information to get the best outcome but I'm prepared for that.

The government gets a small step closer

Well we have had further announcement that the Australian federal government will provide further funding for the life altering and saving CGM technology. The first announcement over 12 months ago gave access to type 1 diabetics under the age of 21. This was a great move however what about the people over 21 and what happens to the people who have access but when they turn 21 the funding is pulled and the technology may no longer be available to them due to the cost.

These were all the questions we were left with however with the recent announcement the funding is to be extended further. The CGM technology will become available to Health Care Card holders, Those that are hypo unaware, Those that have had recent bad Hypo events and also to those planning pregnancy or pregnant/breastfeeding. The further criteria hasn't been released yet however a few of the areas that are to be covered are quite subjective. Hypo events can range depending on so many things. The type of hypo for example insulin based hypo, exercise based hypo, emotional hypo or even loss of weight hypo can all have completely different effects and in some cases some you will be aware of and others you will have no idea at all.

Also the dangerous time that we all deal with is during sleep. A time where we are all unaware no matter how diligent we are. The CGM technology has the ability to minimize the danger by use of alarms or proactive algorithms to stop a low from happening without action allowing the individual to sleep safe and sound.

Over the last 18 months I have lost 40kg through exercise and changing my diet to high protein low carb. I mention this also because I strongly believe that this would have been incredibly difficult with out having my CGM in place for every second during this time. It have been my best friend always on my side telling me exactly what is happening during a workout or while eating so that I could amend my rates in my pump so that hypos were minimized as weight was dropped. Just the other day my sensor finished late in the evening and I made the decision that I would replace it first thing in the morning. Keeping in mind that my levels had been quite stable over the last few nights I took the RISK. I emphasis risk because it is just that a risk to life not to have the technology available to all Type 1 diabetics. Unfortunately by not having my sensor in place and working I was surprised by my partner at 2am pushing my mouth open and stuffing it full of Nutella to try and raise my blood sugar. After coming too I was also told that the ambulance was on its way as I had not responded while sleeping. Luckily no intervention was required by the paramedics however it was close.

As I say in the title we are a step closer which is great however I strongly believe that the CGM technology saves lives and helps T1 diabetics smooth their lives in trying to stay stable. Another step is required to ensure all T1 diabetics have access to the technology that they need.