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.
