Auto Mode Questions :: 670G

(Dave) #1

Hello everyone,

Not new to the pump world, but new to the Auto Mode stuff.

I was really excited to get the auto mode stuff… as my numbers are very easy to jump up and down … so I thought this would help… but I’ve not been using auto mode at all because of a couple of issues…

The first few weeks were nice… but then I got into a odd funk, that landed me in the ER.

So my normal sensitivity is 50… so say for 260 I should take about 2.2 units of insulin… which seems normal… or let’s use a more recent issue… 360, normal bolus wizard told me I should use: 4.2u however, if I turn auto mode on and let it do it’s thing, it wants me to take 7 units… which makes me not want to trust it at all… What sent me to the hospital was it should have only given me 5 units, and auto mode pushed over 10… so I needed to get to the ER and get some D50 as rapid acting glucose was not helping…

This makes me not want to use auto mode, but I think auto mode would work well for me … suspending and the micro boluses…

Has anyone had this sort of problem?

(Madalyn) #2

Hi Dave,

I’ve only been on the 670G pump since about mid-February, but I’ve been on some pump or another for about 14 years. I gave up on automode after the first frustrating week and half of struggling with it. I was skeptical that it would work well for me to begin with, but I feel like I did give it a fair try. I was already in-range like 80% of the time when I was in manual mode and using the CGM, so I’m back to doing that now.

So I don’t have much experience with using automode myself, but I will say that your complaint of the automode OVERcorrecting sounds rather unusual. Most of the complaints I’ve read about and experienced myself relate to the automode UNDERcorrecting for high BGs. The idea is that the automode will mostly bring you back down into range on its own with a steady stream of microboluses. (It may take like 8-12 hours of feeling like poop for you to come back down, but – in theory – it will happen.) So when you go to correct a high BG, automode should typically give you less than the normal correction bolus you would take in manual mode.

The fact that the automode so severely overcorrected for your high BG sounds suspicious to me. I would contact either your pump trainer or the Medtronic 24-hour support line to report your problem. To my understanding, the major focus of the automode algorithm was to avoid putting users in danger of going low like that. I wonder if you’re not having a software issue.

Please keep us updated on how your problem resolves!

Best wishes,
Madalyn

(Dave) #3

Madalyn,

All very good points… I’m supposed to meet with a minimed person in town… sometime… I need to double check when that is… I just think if I could “restart” the learning mode… it would be better… but … Thanks for the info!

(Ryan) #4

Dave, I agree with Madalyn that the overcorrection problem is unusual. I also agree that calling Medtronic to report this problem is necessary. You may have some kind of error.

The good news is that you can reset auto mode’s algorithm by staying in manual mode. The 670g uses your carb ratio, active insulin time, and data from your past 6 days of pump history to create your secret/personal auto mode settings. You can check with your doctor/trainer to make sure the carb ratio and active insulin settings are correct. When you are confident that you have 6 good days of data from manual mode, you could try auto mode again from scratch.

(Dave) #5

@rpm3313 Ryan, When I run out of auto mode, everything is kosher and good … I am not afraid to give myself insulin, but when running in auto mode, I’m very trigger shy of using the suggested dosages…

I’ll make sure to get ahold of someone here soon…

Do you know how to reset the auto mode, so I can start back at scratch… I’d love to try that first.

(Ryan) #6

Dave, sorry if I wasn’t clear. The only way to reset auto mode is to stay in manual for six full days in a row.

(Dave) #7

Got it! But I’m not sure that’s true… because I’ve been in “regular mode” with low detection for the last 6 months… this week was the first time I tried to turn auto mode back on.

Course I could be wrong… if by manual mode you mean no high/low detection and no sensor… I could probably swing that too :slight_smile:

(Madalyn) #8

“Manual mode” means that the automode is turned off. You can still use the sensor and set the various choice functions of alert on high/low, suspend on/before low, etc when you use the pump in manual mode with the sensor. The big difference between manual mode + sensor vs automode is that you have to set your basal rates for manual mode. Automode does not use your basal rates in any way whatsoever – it runs completely off what the sensor tells it. It detects your sensor glucose and then delivers microboluses to keep your sensor glucose around 120.

(Elizabeth) #9

Yikes…sounds like youve had a horrible experience in auto mode. Have you been calibrating 3-4 times a day? This is critical so your SG and BS are closer, but don’t over calibrate either. I’ve had a multitude of issues with kinks in my cannulas, faulty sensors and transmitter issues. Auto mode has been working (so far). I’ve called Medtronic so many times that they probably have memorized my number. I would strongly recommend you contacting them. There are some great technical people at Medtronic and most are very willing to help you figure out your issues. One of them told me that it takes 3 sensor changes for your algorithm to reset itself if you’ve had a lot of issues with bg/sg.

(Virginia) #10

Continuing the discussion from Auto Mode Questions :: 670G:

Sounds like your Medtronic rep or endo to review your reports, adjust some settings and possibly more training. The 24 hour reps are good at tips. I’ve been on automode for about 2 years and really like it. Learning curve was frustrating, and still have issues with sensor sometimes, but overall a lot easier than manual.

(Jon) #11

Hi Dave,

Like others have suggested, definitely contact the Medtronic 24 hour Helpline if you have not already. I would also recommend (as I believe someone else recommended) talking with your doctor/Medtronic to ensure the correct configuration for you has been accurately entered into your pump. What you described definitely does not seem right! As others have said, overall the reps. on the HelpLine are excellent. As Elizabeth mentioned, calibrating 3-4 times per day is critical in the Automode. Medtronic recommends first thing in the morning, before meals and before bedtime. They also recommend that you do not calibrate if your BG is less than 70 or greater than 250 or whatever you have your limits set at. Although I have many frustrations with the 670G CGM, it does work! In addition, the base pump is fabulous in my opinion.
In November 2018 when not using the CGM, my A1C was 6.9 and March 2019 while using it was 6.4. I primarily use the Automode to see how I am trending as when I was not using it, I was having some dangerous lows. In the Automode, I do not like the TempTarget, when I am active, as it does not back off my basal insulin enough and I go too low. I really like the Temp Basal which you can unfortunately only use in the Manual Mode. When I am very active, and in the Automode, I have started suspending delivery which has helped lows that the TempTarget has been unable to. I also like that when I do this in the AutoMode, I can continue to monitor how my Sensor Glucose is trending. The risk of this is forgetting to resume normal delivery and then going high. However, because I check my BG 7-10 times a day, it isn’t a huge risk. It would be nice if we could suspend delivery for a specific period of time such as 30 minutes, which delivery would then automatically resume when the 30 minutes expires. One last thing, I recently received a new transmitter which has tremendously improved many things and primarily the never ending Check BG alerts. I hope these comments help some! Good luck! Jon