A year of Medtronic 780G

If you want the short version, after 15 years with #T1D, the Medtronic 780G hybrid closed loop system is giving me the "best" blood sugars with the least effort that I've ever experienced.

It's got even easier since I upgraded to the Guardian 4 sensor which doesn't need the 2 finger pricks every day for calibrations - this has reduced the amount of babysitting of the system, it's reduced the frequency of the alarms, it's improved my sleep and it's increased my time in Smartguard (which is when the algorithm does its thing). I am paying for the sensors right now and they are expensive but they improve my life so much I am willing to sacrifice whatever else I could be spending my money on.

Don't get me wrong, it's not hands off. Actually I put my hands on this pump A LOT.

What I like

The results! I typically get 70-80% TIR from week to week. On average for the last 3 months I've been at 75% and I've even managed a day of 100% (still going at the time of writing!)

Night time sugars are nailed. I can have late night snacks, hot chocolate before bed, not stress about eating pizza or curry for dinner - little things that improve quality of life - because I know that Smartguard will gently sort out my sugars while I sleep. THIS IS MAJOR! I've struggled to wake up in range in the past. Seeing the Libre line being all over the place when I used to scan on waking would be such a downer to start the day with. A little failure first thing in the morning every morning. NO MORE! It's also made me appreciate how much effort it takes to stay in range overnight as I can see how much the Smartguard has been fine tuning things.

It's easy to get started on this system. I had tried to make a DIY loop before but something always got in the way. I didn't want to do it myself. Everything with the 780G comes with instructions and training that are very easy to follow. The onboarding and follow up from my clinic and Medtronic was brilliant, all done remotely through COVID.

I don't have to intervene in my sugars unless I'm hypo. It's a huge weight off my mind. The Smartguard algorithm is dealing with my sugars, I have outsourced that job.

I don't finger prick any more. I enjoyed this with the Freestyle Libre as well and it's been one of the best improvements in my quality of life since being diagnosed in 2007.

The Carelink reports are helpful. It took a while to get them though as I couldn't reliably upload via my phone so I have to use the USB dongle on a desktop computer to do this. It does give me a little boost to see the charts and stats.

What I don't like

The pump shape. It's bulky and hard to hide under clothing. I had to accept this being more visible than my last pump and it has to be easily accessible.

The cannulas. I don't love the Quick sets (lots of kinked cannulas) or the Mios (I find them really annoying and fiddly to insert and I can't easily detach them with one hand). I'm waiting to try the Mio Advance next.

Inability to remote control. Needing to press buttons on the pump is a big negative for me. I've had to stop wearing some of my favourite things because I can't get the pump out in public without flashing. When it worked, this was one of the things I liked about my old Accu chek Insight pump.

The sensor is bulky and needs loads of tape. It doesn't look as neat as other sensors. Medtronic is working on a new sensor that's a bit like a square shaped Freestyle Libre that will last a week initially then work up to 2 weeks. That will be a lot better than the current sensor which is a faff to apply and doesn't look great in my opinion.

The sensor only lasts a week. Come on Medtronic, you're playing catch up here!

Still need to calibrate after 2 hour warm up. This means it's not practical to insert a new sensor before bed. For me, a night without Smartguard is a disaster compared to what the algorithm can do so I try to avoid going for nights without a sensor on.

Menstrual cycle is not factored in. I can't tell it where I am in the menstrual cycle so it deals with hormone related highs reactively (which is still helpful). Surely this variable could be built into the algorithm for this and other closed loop systems?

Slow corrections from highs. It doesn't feel aggressive enough when sugars are very high (I think it assumes static insulin sensitivity which doesn't seem very "real world")

Poor connectivity to my android phone. This seems to be a common thing from what I've seen online. I've given up using my phone to view my sugars.

What I still have to do

This pump can do a lot but it's important to remember that it doesn't remove the diabetes burden completely. Here's a list of everything I still have to do:

- count carbs and manually enter them into the pump

- remember to pre bolus

- plan and manage exercise (aka any sort of additional bodily movement eg housework)

- correct hypos

- change the cannula & reload insulin every 3 days

- change the sensor every week (charge transmitter for an hour and wait for 2 hour warm up time after insertion)

- manual data uploads onto a desktop computer

- order supplies

- pay for sensors

What would make this system even better

If anyone from Medtronic is reading this, here's my wish list! I know they are already working on some of this from watching Nerdabetic's latest video interview on YouTube.

1. Nicer pump design. I'd prefer it to be smaller and rounder

2. Remote bolusing / pump interaction

3. Smaller and neater sensor (in development)

4. Longer lasting sensor (in development)

5. Fully closed loop - eliminate need for carb counting (others working on)

6. Factor in the menstrual cycle

7. Longer wear cannulas (in development)

8. Less wastage from packaging

9. Better compatibility with wider range of phones

10. Price reduction to help facilitate wider access

If anyone has any questions I'll do my best to answer them!

Thanks for reading x