Tips for success on Minimed 670G.
I LOVE my Minimed 670G system. I started this product in 2017 and it has literally changed my life. I have always had very tight control and with over 20 years of diabetes under my belt, I didn’t realize how much of my time and energy went into my DM management. That is, until I didn’t have to do it anymore.
Prior to being put on Minimed 670G, I tended to run my BGs between 80-120mg/dl ALL the time. I put a lot of effort into this and because I ran my blood sugars so tight, any change in my routine, exercise, or dietary habits would completely throw me off, usually causing me to have lows. STOP…test…treat….go…stop…test…treat…go. This was just my life. That is, until had my experience with auto mode.
I’ll admit; I struggled with the 120mg/dl target at first. I wanted my 80’s and 90’s back! But once I realized how much less I thought and worried about my diabetes; how much less I had to stop and treat lows; and how I could finally for the first time in 20 years sleep through the night…I was certainly okay with a 120mg/dl target. Did you know an average of 120mg/dl equates to a 5.7% A1c? Prior to my experience with Minimed 670G, I pretty consistently ran HbA1c’s less than 6.0% (with a lot of lows). After 3 years on 670G I have consistently ran between 6.0-6.5%, my time in range (70-180mg/dl) is dependably >70%, and time below range (<70mg/dl) <4%. I am HAPPY with that. Especially when I think about how much my quality of life has increased.
I know some people struggle to adjust to the Minimed 670G system so I would like to share some tips that I have learned both personally and professionally that may help.
There are three rules. In my experience, if these rules are followed, most if not all people are/can be successful on this system. I call them the 3 C’s.
Rule 1. CALIBRATE
You MUST calibrate every 12 hours (approximately 2-3x/day). I encourage people to set up calibration schedule. That way you are calibrating when it is convenient for you. This also helps avoid overnight alarm fatigue. It is best to calibrate when the glucose readings are stable to avoid extra calibrations. I calibrate first thing in the morning (before breakfast), before dinner, and ALWAYS before bed. This works for me, but I encourage you to come up with a calibration that is most convenient for you. I do recommend, however, that you always calibrate before bed to avoid alarms overnight.
Rule 2: COVER CARBS
Though auto mode can compensate small errors in carb counting, it cannot compensate for big discrepancies (maybe in later models?). Missed/late boluses are the second most common cause of auto mode exits (first, calibration errors). Carb coverage is therefore a must. I highly recommend blousing 15-20 min before meals. I’ve often found that people who are just starting on Minimed 670G have an issue with giving their boluses late; either right before meals, during meals, or even worse…after meals. Usually this is done out of fear of hypoglycemia or past experiences with post-meal lows.
When looking to avoid hypoglycemia it is essential to understand how the auto mode algorithm works. Bolusing late while in auto mode will not help you avoid hypoglycemia, and may increase your risk. Let me provide an example.
John has a very stressful and demanding job. He does everything he can to avoid lows while at work, including blousing late for his meals. He would rather be high than low. John has a big meeting after lunch and wishes to avoid hypos at all costs. He does not prebolus for his lunch and decides to bolus after instead. After about 15 min he gets an alert from his Minimed 670G reading “high sensor glucose”. He has hit the 180mg/dl mark. He then decides he is safe to bolus. He inputs his BG of 180mg/dl and the carbs that he has eaten for lunch. One hour later, his BG is 60mg/dl. Why?
The Minimed 670G system increases/decreases insulin depending on the sensor glucose reading which is provided every 5 minutes. If a bolus is given late, that means that the sensor glucose has been rising considerably for some time. Because of this, auto basal has been increasing in the background. By blousing late, John stacked his bolus on top of his increasing auto basal which led to a low. He stacked his insulin without even knowing it! He would’ve been much better off blousing early for his meal and avoiding his high to low entirely.
Here are the rules that I follow if I miss a bolus or bolus late. Remember, this is not nearly as effective as blousing early for meals, but it could help avoid lows if late boluses are given.
-If within 60 minutes of missed bolus, bolus for correction plus half the amount of carbs missed. Recheck in 2 hrs and give correction as recommended by bolus calculator.
-If more than 60 minutes since missed bolus. Give correction only. Recheck in 2 hrs and give correction as recommended by bolus calculator.
But seriously people…bolus 15-20 min early whenever possible. It will change your world!
Rule 3: CORRECT
This rule is simple. Set your CGM alarm at an appropriate number (I use 180mg/dl) and whenever you are alarmed for a high sensor glucose, input that number into your bolus calculator, and take a correction.
My experience with Minimed 670G has been incredible and many of my patients have had the same experiences. If you follow these rules, chances are that you can be successful too! Good luck!