Medtronic’s 670 G hybrid closed loop system is the smartest insulin pump to hit the market, and people living with type 1 diabetes, including my daughter and I, have been gobbling them up.
As we embark into our second week on this new system, the majority of the time I’m all in, thinking: “This is amazing, I haven’t drank juice in days,” “I need to eat something – just to eat, not because I need to balance my diabetes,” “It’s so nice not to have T1D awaken me from sleep,” or “I feel less worried about my daughter.”
All remarkable thoughts.
A minority of the time, I’m thinking: “Why is this pump buzzing at me again?” “This algorithm isn’t really getting me into the 120 range,” “This sensor is frustrating – my Dexcom was so simplistic to use compared to this finicky Guardian 3 sensor,” “I wish I could calibrate anytime; there’s so much button pushing and user demand.”
It’s not all peaches and cream – it’s a work in progress.
Patience, I tell myself. It will get to know me better. Most people report that it takes a month to love the Medtronic 670G. Truth be told: I’m one week in, and I do love it 90% of the time – as does my 15 year old.
Getting Started on the 670G
We personally utilized the “Pathway Program” Medtronic offered through the end of April, 2017, placing us in a virtual line for the Medtronic 670G upgrade. We were fortunate enough to have purchased our pumps less than a year prior, so our out of pocket was expensive, but not unthinkable.
Word has it that 50,000 customers have ordered the Medtronic 670G pump, but customers have faced hurdles along the way with the age of their current pumps and/or lack of insurance coverage for a new pump. Owning a pump that isn’t out of warranty means we’re at the mercy of insurance companies, waiting, or paying out-of-pocket for upgrades that aren’t submittable to the insurance company.
Tweets and Facebook posts have highlighted similar patient plights with this process. Patients in the Pathway Program forced to upgrade to the 630G for the months prior to the 670G roll-out, the spring availability actually meant “we’ll start shipping in mid-July,” sensors not shipping, and/or issues with prompt training dates.
Try staring at the Medtronic 670G package for more than a few days [especially when you've already run out of CGM supplies for your Dexcom]. CGM supplies, by the way, can be a cog in the wheel if you order 3-month supplies. Insurance companies won’t let you overlap supply orders, even if you switch to a new system.
Diabetes can be as simplistic as we like or high-tech and high-dollar. We’re always left to break it all down, analyzing the details, deciding what to try on, what might fit us best, and what we can shoulder financially. Mid-process we’re left to hope and wonder: “Will this tech be worth its weight in gold?”
Diabetes is an expensive disease, one that is both financially and mentally draining, fraught with high deductibles, expensive supplies and a lifetime of worry.
I get the cost of healthcare as a nurse and as a patient. We have type 1 diabetes, times two, in our house.
For once, our timing was pretty impeccable with the 670G pump roll-out. We were lucky enough to get trained, and connected, in mid-July.
I try my very best to practice gratitude, not losing sight of what was available when I was diagnosed in 1984: Regular and NPH insulin, syringes, urine strips – and no glucometers. With the ingenuity of the medical and diabetes community at large, DIY closed looping systems, data sharing apps, continuous glucose monitoring, and now – a closed loop pump, we have a lot at our disposal to choose from.
The Guardian 3 Sensor
As a parent, I’m mentally done with witnessing and intervening to this alert:
We have been super fond of our continuous glucose monitoring products Dexcom has offered over the past handful of years. I’m quite honestly going through “Dexcom withdrawl” right now – even being on the 670G.
Kudos to Dexcom: I may have, on rare occasion, knocked my sensor off my arm or gotten the “???” preceding a sensor failure (also at the start of a bike race – ugh), but I was never unable to calibrate, nor did I experience delayed catch-up times, dramatically “off” sensor readings, or question the readings during long athletic pursuits. Dexcom was most always accurate in my experience.
The “Getting to Know You” Phase
The new Guardian 3 Sensors for the 670G insulin pump are reminiscent of my OmniPod experience. I was stoked to start with both, and they work amazing well – until they don’t work at all. It can be finicky with the alarming, failures, high blood sugars and frustrations. Just yesterday, I questioned myself as to why I bought into this, as my CGM said 99, my glucometer said 230, quickly elevating to 415 after a hard training ride. [More on the why's and how's below.]
My A1C is usually 5.9 – 6.1 and I never have 400 blood sugars, especially after exercise. It makes me scratch my head. But as the days roll by the gap is closing and I’m becoming happier with the results.
The adjusting basal the 670G offers, in my opinion, tries its hardest to adjust the user to 120, even if that means no micro-basal for over an hour. One thing is for certain – I do have T1D, so I will always need some variation of basal insulin. I appreciate the pump not allowing me to go low during exercise, but I’m finding that it’s also leaving me in a state of insulin deficiency when I’m done pedaling.
I am sort of an outlier as far as exercising goes, which I realize, most people aren’t riding 150 miles a week. However, I do have high expectations that this system can meet my exercise needs. In manual mode, I normally turn my basal down 30%, even on 100 mile bike races. That means I’m getting 70% of my normal basal.
The days of free-carbs are over, even with exercise, I need to bolus for carbs because the basal is so minimal. I think this is key to thwarting my blood sugar issues.
I’m curious to see how this pans out as I wear it over more miles approaching my 100 mile Loveland, Colorado, JDRF Ride to Cure in August. I’ll continue to monitor trends and identify answers.
But as diabetes has always been, every similar situation also has differences. Thirty minutes on the treadmill and the basal adjustments perform fine. Intense high school basketball practice for my daughter has resulted in: Lows during, no lows during but highs after, and also a perfect 670G performance. All the situations were similar.
I’ll chalk it up to the “learning period” for now. Trust me – I am learning.
Two days after starting in the “manual mode” [a setting you must be in for at least 48 hours upon pump start], I cycled in a 70 mile charity event.
Knowing I would be relying on something new and different, finger stick results [not my CGM] were king. When you’re just trying to be an athlete, which I already had dialed with Dexcom, new equipment can be a pain in the @$$.
Five minutes before the start, I peeked at my pump and it said: 278. This ignited my potty mouth, out of pure frustration. I quickly checked with my glucometer, it read: 176. I erroneously chose to calibrate, which resulted in the system not taking the calibration, asking me to wait and renter the number. Super timely.
As an athlete, I was always able to ride and manage my diabetes on the fly – the simplicity was enjoyable. This pump has many bells and whistles, with multiple buttons to be pushed for every task. The system demands an educated and attentive user. It’s not without its regular hiccups. If your blood sugar reading is far off of the CGM reading you can’t calibrate or enter your blood sugar reading or you will be replacing your sensor – this is very different from our Dexcom practices.
Fifteen minutes into my ride the pump is screaming at me while I’m racing. I can only think:
I push the home button through my jersey and it stops screaming for 1 minute. I did this every minute until I couldn’t stand it any longer. Turns out it was ready for a calibration. Really? In manual mode it’s that urgent?!
It took my calibration, but it was off by 100 points [higher than my blood sugar] so at the next stop I turned off my high alerts and and tried my best to ignore the results until I was done. I had these two lovely screens and changed my sensor 4 hours later when I returned home:
The 670G “Screen of Death”
What Was I Expecting – Why Did I Choose This Pump?
- To decrease lows and highs, especially for my teenager.
- To remove some of the continuous management decision making away from us.
- To provide a sense of security for my daughter as she travels with her high school basketball team.
- To have adjustments being made in the background as we exercise and travel.
- To prevent dangerous overnight lows. Even manual mode has suspend on low and suspend approaching low features.
The Pluses:
- The sensors are much less intimidating to insert than a Dexcom sensor. My daughter finally said goodbye to lidocaine cream to numb her skin first.
- The inserter tucks everything inside and with the simultaneous press of 2 buttons, it’s in the skin.
- Dexcom only functions an alarm – one to be easily ignored by kids and teens. Having the sensor feedback to the pump is a huge safety mechanism and it takes some of the hard minute-to-minute work away from the user.
- You can sleep in! The auto basal adjustments work their best magic when there are no other variables like food, exercise or stress. No more pouring juice down my daughters throat on weekend mornings when she simply wants to sleep longer than usual.
- For chunks of time you can actually “forget” that you have diabetes. Yesterday I had a late start to the health club and errands, finding myself grocery shopping at 1:30 with no lunch after a workout. I would have gotten low without my 670G doing its behind the scenes work.
- You can really see what’s going on with the basal rate by scrolling through the graph screen. I’m amazed at how consistently it gives little/ differing amounts of basal insulin.
- The only things for us to tinker with are: Carb ratios and active insulin time. Many people report needing more insulin for carbs. I notice – especially with a busy day at the hospital – the pump hardly gives me any basal prior to lunch which stops me from going low, but then I approach lunch basal deficient, either going high after the meal or needing more insulin to cover the carbs in the meal.
- I like the profile of the sensor better than the large, boxy Dexcom. It feels comfortable on my stomach, I always wore the Dexcom on my arm because of its dimensions.
- You can temp basal for exercise it’s called a “temp target” where it tries to adjust blood sugars to 150, not 120.
The Minuses:
- There is only one size of the pump available to fit the large reservoir. The size is a bummer for kids and those of us using small amounts of insulin. It also uses a AA battery – both of which make this pump larger, not smaller like many of us wish for.
- Guardian 3 Sensors are a bit clunky and cumbersome to get from the package into the skin. For travel, you need the inserter, the charger and the large package the sensor is kept in.
- The sensor requires more tape than I typically use; it may be problematic for the tape-sensitive folks out there.
- I had 2 sensor failures in the first week following cycling, and my daughter had one following basketball practice.
- My daughters blood sugars correlated quite well with her CGM readings, but mine were off by 50 – 100 points from the get-go with the first sensor. The second and third sensors were closer in accuracy.
- Medtronic is very good about replacing the sensors that have issues and they do have replacements in stock – I’ve already received ours.
- There is no remote monitoring available, although the smart people at NightScout do have a fix.
- The pump has needs, and can have them often. It may ask for extra calibrations, blood sugars, bolus doses to fix a high, meal insulin, it will boot you out of auto mode into “safe basal” or manual mode if the sensor isn’t happy or you don’t complete the necessary tasks it asks of you.
- All the button pushing begins with the variating safety screen [picture below]. I’m like of the horizontal screen in models past better. This pump design always has me either: pulling it off my waist, craning my neck to see it correctly – or trying to read it upside down.
