670G Suggestions for Improvement


(Paul Burger) #1

I started another thread on this site with some issues I had with one problem with the Medtronic 670G pump (BG/Calibrate Loop). There has been a lot of discussion on that thread from several users, and many other “issues” were mentioned there. I thought I would try to compile everything I have personally experienced, as well as other contributions I have gathered from other threads, and start this new thread.
I am not wanting this to be a complaint session. Rather, I am hopeful that we can all gather together our suggestions for improvement. I then plan to pass along the suggestions to my Medtronic Reps, and hopefully others will do the same for your reps, and then hopefully we can be heard. I would like to think that they would take these as suggestions for product/software improvement for the next release of the pump.

Please add on to my list below and let’s get a consolidated list of suggestions for improvement together.

  1. Releasing pump from belt clip is next to impossible.
  2. Belt clip is plastic, and damages easily. Animas had a very sturdy metal clip, that was very easy to disconnect the pump from the belt clip.
  3. Screen orientation is not right - should be sideways - or with tubing down. When I take the pump off my belt, I have to turn it around in order for the screen to be oriented now. I end up looking at the screen upside down almost all the time. Suggest the screen orients automatically based on how the person is holding it – like my iPhone.
  4. Way too may alarms, and no way to clear the alarms unless you physically look at the screen. In my old Animas pump, I could interact with the pump about 80% of the time without actually looking at the screen (muscle memory one user referred to this as). This pump requires you to look at it – clearing alarms is a different set of keystrokes depending on the alarm
  5. Why is the unlock key always rotating? Very user unfriendly. What purpose does it serve??
  6. Why is the bolus confirmation on a separate screen? I have missed actually delivering a bolus several times by not confirming the bolus.
  7. Calibration takes forever - why?
  8. If I do not respond immediately to the “Calibration Needed” alarm, it goes to a delay calibration screen. No way to get off this screen, unless I delay. No way to reduce delay time to 0 - no way off the screen. Poor software design here - should have a way to simply back off the screen. Now I test, and then hit delay for 5 minutes, and the pump immediately picks up the calibration. Just a silly thing that you can’t get off the screen
  9. Need a way to control the pump and sensor from my iPhone. One huge advantage is I can at least release my iPhone from its case easily and get to it - (see point #1 above)
  10. Procedures/ training needs to be updated on steps to re-enter Auto Mode on sensor change. After calibrating there is a 15 minute delay, then a BG required to enter Auto Mode. Why is the 2nd BG needed - why can’t the calibration take care of the auto mode step? If that is not possible, then at least let new users know there will be 2 BGs required (one Calibration, and one BG) with a 15 minute delay between them. This was very confusing when I first started on the pump, and was not spelled out in any of the training materials
  11. Sometimes you calibrate - sometimes you check BG but don’t calibrate. When do you do which? Why can’t you just hit calibrate every time you stick your finger and have the pump decide what to do with it?
  12. Pump goes into a loop of Calibration/ BG required. Round and round and never goes back into Auto mode. (See other thread on this site for much discussion on this topic)
  13. Sensor accuracy - it is advertised that the new Guardian sensor is more accurate than previous sensors, but I still have wide swings between BG and SG readings. (MUCH less accurate than my previous Dexcom sensor). Accuracy does seem to improve on day 2, then degrade again on day 6
  14. Pump will not accept a new BG, and immediately prompts for a new BG. Seems to happen when the Sensor Glucose it has on file and the BG being entered are too far apart from each other. Why does the pump simply not accept that it is wrong, and accept the new BG? Am being told the system needs to “catch up” when it gets readings it is not expecting and “rest” a bit to correct this.
  15. Exit Auto Mode when the pump has been at min or max delivery for 2 hours – I’m sure this is some kind of safety thing, but I find that since I have been on the pump for almost a year now, my old basal rates that are programmed in there are simply no longer accurate. When the pump exits out of auto mode and goes back to these old basal settings, if I do not immediately test (like in the middle of the night) and it uses these old basal rates, it is really bad – I go either way high or way low. To me it would be much safer to remain in auto mode even if it has been at min or max delivery for a long time.
  16. Pump will sometimes not do a correction bolus – even when by BG is above 150. Correction boluses are much different in Auto mode from the old days of an insulin pump. I know it will only correct to 150, and will often times not correct if there is any active insulin on board. But I have it happen fairly often that there is no active insulin going, and BG above 150, and it still will not create a correction bolus. I know I should not say that I have eaten any carbs, but often times create carbs, just so I can get a correction bolus. Seems a quirky software thing.

(iloveautumn) #2

Hi,
What a great start! I can ditto everything you said… very comprehensive listing!
Me: T1D x 33 yrs, almost 20 on pump. Always Medtronic.
Ironically, my belt clip just broke (again!) this morning!
-One thing to add please… the number of button presses just to bolus sometimes! I’ll have to do an actual count sometime, but i swear it’s like 7 or 8 at times! (I miss the simple arrow quick bolus!) Not convenient like when in a meeting at work. Definitely don’t want to attempt when driving.

  • I definitely agree with the frustrating looping/calibration/enter BG thing
  • I also definitely agree with the screen orientation. Would be nice to tilt the pump upwards to see screen (and it not be upside down)
  • I would love to have a feature to be able to give a mini bolus in auto mode, like before removing pump for showering, or when getting up in the morning to deal with an anticipated rise in sugar. I usually end up having to pretend I’m bolusing for some carbs when I’m not eating anything at all.
    Thanks again.
    Im looking forward to seeing what others have experienced and how Medtronic can continue to improve upon their technology!

(iloveautumn) #3

Another thing i miss when in auto mode… the square wave bolus feature, like for pizza or snacking throughout a longer period of time


(Kathy) #4

It would also be nice if Carelink joined the 21st century. I’d like to be able to upload via my phone (like I could with Glooko, even with a dongle), and actually look at the data on my phone (via an app). It would also be nice if the product worked with MS Edge and the current versions (and stayed current) of Chrome, Firefox, etc.


(Dennis J. Dacey, PwD) #5

I presume that all “Carelink” users have seen the app that is now required to upload data? It took about a minute to install it on my Windows; it appears to replace the former stuff that I no longer see on the screen.


(Kathy) #6

A couple of other things that would be useful (and make things a little safer).

Right now they have only one set of carb ratios and one active insulin time. We really need the ability to have at least one set of carb ratios for manual and one for auto (I’d prefer the ability to have at least 4 so we can easily deal with activity styles that vary based on “at work or school” and “not at work or school” - I get way more active when not at work). Also need to have an auto active insulin setting and a manual setting. The active time, for many of us is set in the 2 - 3 hour range for auto and 4 - 5 hour range for manual. This is important for people who have difficulty getting the sensors settled down and need to stay in manual for several hours while this happens.

As for @Dennis 's comment on Carelink - the new uploader works okay but seems to be quite a bit slower to get the upload done.

To add to my carelink wish list, it would also be nice if it would work with IPads, etc.


(Dennis J. Dacey, PwD) #7

Hi Kathy @kkavolinas is it slower, I thought it was my imagination because I was in a hurry.

As for your suggestions for a pump, maybe you should contact the pump manufacturers and get in on the design planning.


(Ryan) #8

Great list and additions! Another point about exiting automode after max delivery for four hours: it boots you into safe mode. So your BS is high, automode isn’t doing it’s job, and then it gives up and dispenses even less insulin until manual mode begins. This happens at night, so safemode has no chance of dealing with predawn phenomenon.

I think I have counted at least 20 button presses to turn automode on, clear the first “not ready” notification, make my way back to the home screen, then clear the second (and totally ^&*%$ redundant) “BG required for automode” notification. It feels like a safety feature gone totally awry, combined with really awkward programming and a bad user interface.


(Richard) #9

I’ve used the 670G for about 6 months now. I’ve reviewed this list and also the 48 entries on the “looping” problem. I’ll add a couple of concerns the the 16 listed:

I frequently note a major discrepancy between sensor values and my BG values within 30 minutes of getting out of bed in the morning-- always with the sensor value much higher, sometimes by 100mg% or more, even though I calibrate first thing when out of bed… This is concerning because of potential overdelivery of insulin while in auto mode. Anyone else experiene this?

The looping problem is driving me crazy-- at least when it occurs, which is not all the time. “ignoring” it for a few hours can work, but then there are the annoying alarms to put up with.

A big issue regarding the looping for me-- I’m on medicare, CGM is not covered for the 670, and the sensors are VERY expensive-- not to mention the big number of BG strips. I’m thinking of a switch to Dexcom, because I’m expecting the looping issue to go away with a different system, and medicare will cover the Dexcom CGM.

Overall I find hypoglycemia is less prevalent with the 670 but the hassle and expense are major unfavorable factors.


#10

If Medtronic actually takes these suggestions to heart that would be great! Aside from the ones listed above I would add:

  1. Make the BG target in Auto-Mode adjustable. - According to Medtronic via my Endo the target of 120 was set because they wanted it to be approved for use in children too and 120 was what made that possible. If that’s the case I’d prefer to have two 670G models, 670GA and 670GK, one with a locked BG target in Auto Mode for kids, but with the adult version editable. I’m betting FDA hoops make this financially infeasible, but this is a “wishlist” after all.

  2. This might be duplicating #4 in the main list, but please change it so that alerts that actually fit into one screen don’t need to have me press down and then press OK. There are already enough button pushes on this pump.

  3. More control via the accompanying Contour Next Link BG meter. Compared to my old Animas Ping the “control” from the meter is severely limited. On the Ping you could do pretty much all daily functions from the meter remote. It actually had a two-way link with the pump and would show you the calculated boluses on the meter.

  4. Move the “Reservoir and Tubing” option to the first menu screen. There’s a lot of button pushing to get to a feature we use frequently.

I think everything else was covered in the main list. Here’s hoping Medtronic is able to listen and make the changes their users want.


(JL) #11

I agree with all of these suggestions. At this point I rarely use auto mode or a sensor because of these types of issues with the 670G, but primarily because there’s no way to disable alarms and alerts and especially sirens, and secondly because there’s no iPhone app for communicating with the pump.

Medtronic tells me the alarms are a safety feature. This doesn’t seem logical since the only option to avoid alarms is to be on manual mode without a sensor, which is not what Medtronic advocates for safety.

I had an old Medtronic pump long ago that had a remote bolus key fob that I carried on my key ring. This made it easy to bolus at restaurants and other public places. The 670G has no remote or iPhone app so the pump or glucose meter must be physically handled to bolus. This is not at all “automatic” even on auto mode.

So my expensive 670G isn’t doing any more for me than my old 630G and it’s less user friendly with more attention and button pushes required. The 670G might be more welcome to people who like constant interaction with their pump and don’t mind wearing it for the world to see. I wear mine so it’s not visible, which makes it harder to respond to all the alarms. I was hoping it’d be truly automatic as advertised.


(Sandra) #12

I agree. Endo sold me on this pump since you pretty much wouldn’t have to think anymore except for food intake and boluses for high sugars. The app was another selling point to this which I came to find out doesn’t even exist yet. This is my first pump ever. I have been on it for three weeks. In that time if become seriously disappointed with it. It has fallen short of all the selling points.
Enough complaining. To add to your list, which is my biggest complaint, the sensors. They “can” be 20 to 30 points different from the BG reading and are suppose to last 7 days. Mine only last 5 days or less and are 50 to 100 points different. How am I suppose to calibrate anything in any mode (auto OR manual) with that kind of difference. That’s enough to either do insulin or eat some sugar. Why FDA EVER approved this is absolutely beyond me. Why am I going thru the pain of inserting this sensor when it doesn’t even work properly. Sad that these machines are a Type 1 diabetics lifeline and the bottom line is I REFUSE to use auto mode, so I don’t have to think anymore, and am having to out think it. What the heck am I doing all this for??


(Guy) #13

It would be great if Medtronic put more effort towards getting Medicare coverage for the CGMs. Many of us old time Metronic users who were able to obtain the 670g pump and have been forced to use the Dexcom 5 CGM because it is covered by Medicare. I have not heard anything from Medtronic that they are working with much effort to get Medicare coverage for the Guardian 3 sensors.


(Dennis J. Dacey, PwD) #14

I hear you frustration Guy @gsmalley. Now that FDA has finally March 12, 2018] agree that that Medtronic system is safe for use, I expect that the findings and application have been submitted to CMS.


(Guy) #15

Dennis, If you or anyone else gets any updates on this, please don’t hesitate to share it. Many thanks, Guy


#16

Thought of one other things I’d like. It would be nice if they would put a numerical amount of insulin left in the reservoir instead of just the little icon on the main screen. I count 8 button presses to get to the status screen to see how much insulin is left. Would be nice to be able to just look at the screen without actually having to unlock it and see how much insulin the pump thinks I have left so I know if I’m good for my next bolus. TSlim and Animas both do/did this. Not sure about older Medtronic pumps since this is my first Medtronic, but it seems basic information like this should be front and center. There’s definitely space for it on the screen.

I also find it odd that even if the pump believes there’s not enough insulin left in the reservoir it’ll still act like it’s delivering the whole bolus. Just as an example, the pump thinks I have 5 units left and I tell it I want to bolus 9 units it still goes through the motions like it’s giving me 9 units. Am I actually getting my full 9 units? I don’t think I’ve ever gone over more than a few units so I’ve never been in a situation where it thinks I have 1 unit, but I’m asking for 10 or whatever, but it does make me wonder. The Animas Ping wouldn’t bolus more than what it thought it had in it, so when it read 0 you were only getting another bolus from it by changing the reservoir. Granted on both pumps there always seems to be a little left in the reservoir when changing and it seems like Medtronic is counting on that making up any “overage” you ask for. For all the alarms on this thing I’ve never gotten one telling me there’s not enough insulin left for the bolus I asked for even when the status shows that to be the case.

Sadly, even if Medtronic were to take all our suggestions to heart and make our requested changes I don’t think we’ll ever see them on the 670G. I believe only the T-Slim X2 has the approval for software updates which means we’ll all have to upgrade for whatever “nominal” fee to Medtronic’s next pump iteration.


(Dennis J. Dacey, PwD) #17

Hi @awg0681, thfirst statement will be said with a big smile and wink: oh for the good old, very simple days [mid 1950’s] of diabetes management when tools were simple and did exactly what they were intended to do - just boil a glass syringe and stainless spike called a needle, occasionally put a few drops of urine in a test tube and maybe once a year have a blood sugar test that took three days to develop. Oh yeah, and wonderfully refined insulin drawn out of pigs and cows and a vile of U-40 NPH only cost $1,77. :grinning:

Now to answer your question: my three “older” Medtronic miniMed pumps, currently an MM#523, all very easily display the amount of insulin remaining in the reservoir - and I dan program the pump to notify me with sound and text when the volume of insulin reaches two thresholds.
I have also found that when the pump reservoir reads " -.- units left", i.e., empty there remains at least 5 units in the reservoir - I’ve pushed that amount out of an “empty” infusion set and attempted to measure. Kind of a good hidden safety feature that has saved me a couple of times when I detoured on the way home and met someone for dinner.
My pump warranty expired last month [Medicare insists that I wait another year before replacing] and you guys are helping me decide which pump I’ll next use - to date, I’ve only used MiniMed - do you have any feedback from Medtronic that the problems addressed here are being “corrected”?


(Sal) #18

If you are going to wait a year anyway, I would wait and see what’s available then.

Here is what Medtronic has in their pipeline:

The smaller, no calibration disposable sensors are very intriguing to me as well as the auto-bolusing feature. I think most of the complaints about the 670 calibration problems will soon be resolved.


(JL) #19

Continuing the discussion from 670G Suggestions for Improvement:

Hi Skitter. When I wear the sensor on my thigh, it is much more reliable and the readings are very close to glucometer numbers. Wearing sensors where instructed (abdomen) was very unreliable and frequently lost connection. In case you haven’t tried different locations for your sensor, it might be worth trying.