I've been on the hunt for the best automated insulin delivery (AID) system for a few years now. Along that journey, I've tried nearly every insulin pump that's currently available in Australia. Three years ago, I was using the Medtronic 670G (let's not talk about that), then I tried DIY looping for a year, then I spent a year using Ypsomed with the CamAPS algorithm, and now I'm using the Medtronic 780G. So far, this one is the winner. Here's why...
Some things I love about this pump
7-Day Infusion Sets
This has been an absolute game-changer. I used to feel like I'd only just put in a new infusion set and then it would be time to do it all over again. But a week between set changes makes it feel like diabetes is a lot less in my face.
Not only do I not have to change them as often, but the new sets are a lot less prone to kinks and occlusions. In the 5 months that I've been using them, I've had one set failure, and even that lasted longer than 3 days before it gave out. The new inserter works much like the firing mechanism for the Dexcom G6, in that it fires the needle in and withdraws it all in one motion. For me, this has meant less painful insertions, and less human error, which has meant less site failures.
A different pump would have to have some very shiny features indeed for me to say goodbye to these 7-day infusion sets. They've lifted a good amount of the mental load of diabetes off my shoulders.
Speaking of reducing the mental load...
Different people use different levers to lessen the burden of type 1. Some people choose to reduce the amount of carbs they eat, others stay on injections rather than pumps so they're not constantly reminded about diabetes by having more tech hanging off them. For me though, I go all in on the tech. I want the smartest, most powerful algorithm that will do as much of the thinking for me as possible so that I can eat whatever I want (within reason), whenever I want, and my algorithm will mop up the mess with minimal input from me. And of all the commercially-available algorithms available in Australia at the moment, this one seems to have the most horsepower.
Now I could go back to DIY looping, which has the potential to be even more aggressive, but this algorithm has given me good time in range for the amount of effort I have to put in. With this system, the only factors I control are active insulin time, carbohydrate ratios and my blood glucose target (you have the option of 5.5, 6.1 or 6.7; I've chosen 5.5). That means that I'm not having to constantly assess and modify my basal rates or my insulin sensitivity (correction) factors. These are two massive variables that the pump just takes care of, and hence I don't have to think about. And I love not having to think about them.
The algorithm
This algorithm isn't shy about correcting high blood sugars either. If your blood glucose goes above 6.7 and basal is already at maximum, it will give a full correction. And when the next CGM reading comes in, it will correct again if necessary... and keep correcting. In addition, it has a different algorithm that kicks in if it detects a rapid rise (usually the result of a missed meal bolus) which allows it to be even more aggressive until the rate of rise decreases.
Does this mean that I never go high? Of course not. But because I know that it’s calculating proper, full-strength corrections, I’m much less likely to rage bolus, and instead just let the pump handle it. Again, less time thinking about diabetes!
Compare this to the Tandem t:slim, which won't start correcting until you're predicted to reach 10mmol/L in the next 15-30 mins - and even then will only give you 60% of your programmed correction factor... once every hour! That means a lot more effort from the user if you want to stay in a tighter range.
Ypsomed's CamAPS algorithm is more aggressive than the t:slim, but it delivers that as a temp basal, which I found meant that I spent more time floating around 13 or 14 before it could pull me back into range.
For those who like the numbers, here are my time in range stats on the various algorithms:
Medtronic 780G SmartGuard: ~87%
Ypsomed with CamAPS: ~82%
DIY Loop for iOS: ~82%
Control IQ (Tandem t:slim): watch this space; I'm hoping to try it in early 2025.
The App
Now don't get too excited, you can't bolus from the phone app! However, you can see the last 24 hours of CGM data, and the interface is pretty good for checking what actions you and the pump have been taking. For example, looking back at how many carbs you bolused for, and when, is a lot easier on a big screen. You can also check how many units of insulin are in the reservoir, the battery status, and how many days are left on your CGM.
Another big advantage of the app is that it automatically uploads all of my pump data (CGM readings, bolus history, infusion set changes etc.) to Carelink, Medtronic's diabetes management platform. This means that I don't have to remember to upload my pump data before seeing my diabetes educator - it's just there!
Apart from the obvious wish of being able to bolus from the app, I do wish you could see more than 24 hours of CGM history. I often find that if I'm eating the same thing for lunch two days in a row, I want to go back and check how well my bolus worked yesterday so that I can modify it today. But often that piece of history is just over 24 hours old and so not available... and I'm not about to go and log in to Carelink just to look that up!
There's also an Apple Watch app, which is handy for checking where I'm out without pulling out my phone or pump. However, the number on the watch doesn't update very often; most of the time I have to tap the icon to force it to refresh. I'm pretty sure this is a power-saving "feature" imposed by Apple though, not Medtronic's fault, so I'm not sure when this will improve. I also wish that you could see the graph on the watch home screen, not just the number. To view it on the watch, you have to tap the widget to open the watch app, then swipe across to a second screen.
Some things I don't like
The size
Yep, this is usually what puts people off trying this pump in the first place. It's the chunkiest pump in Australia at the moment - the Ypsomed, Tandem t:slim and Omnipod are all smaller. And it is noticeable, particularly when it's floating around in the bed with me. When I rolled onto the Ypsomed in the middle of the night, I'd tend to keep sleeping. But I've found myself waking up every now and then with this one. I've gotten used to it (I think I just reposition it in my sleep now) but I do wish it was smaller.
As someone who wears jeans a lot, during the day I can clip it to my belt and that works pretty well. But for other types of clothing, you might have to get more creative...
It does also look like a pager from the 1980s... with a colour screen, granted, but still... I really wish Medtronic would hire one of Apple's designers (or maybe poach someone from Tandem?) so that it felt like I was carrying a device from the 2020s.
Slight distraction for a second though... Medtronic's new 8 Series pump is in the works, which is much smaller and looks a lot more space-age! It will also be fully controllable from a smartphone. So shiny things to come, but it's gonna be a few years before it's here...
The CGM
After nearly a year with this pump, the CGM doesn't bother me as much as it used to. But going from a 10-day Dexcom sensor to the 7-day Medtronic Guardian was a step back. Despite the advertising slogan of "zero calibrations", it's not quite true... If the pump ever exits Auto Mode, (this usually happens if I wait more than an hour to put on a new sensor after the last one expires) it requires a calibration before it will turn Auto Mode back on. And with Dexcom and Libre both being calibration free (and lasting 10 and 14 days respectively) this definitely feels like a step back.
Having to recharge the transmitter every time I change the sensor is also less convenient. It only takes 25 minutes to charge, but it means that you can't do a sensor change all in one go - you have to remove the old one, wait for the transmitter to charge, then put the new sensor in. There's also been a couple of times when I've remembered to pack a spare sensor, but forgotten to pack the transmitter charger...
All of that being said, the CGMs have been pretty reliable for me once they're up and running.
Medtronic do have some new CGMs in the works, but we don't have a timeline on that yet. Their new Simplera CGM is arriving in Australia early next year, but it's not the version that works with insulin pumps - that will arrive "shortly after" apparently. They've also announced a partnership with Abbott so that Medtronic users can use the Freestyle Libre CGMs, but that is a fairly recent announcement and doesn't even have a timeline for release in the USA yet. So we'll be waiting a while...
Final thoughts
As I said at the top, this is the pump that's allowed me to get good time in range with the least amount of effort. I really feel like I spend less time thinking about my own diabetes management, and I think that's really all any of us want, right?
As we like to say at the Centre "Your diabetes may vary". So while this is the best pump for me right now, it might not be the best fit for you. Have a chat with your diabetes educator; talk to them about your lifestyle and what's important to you. There's always some trade-offs, but you want to be choosing the right trade-offs.
After you've had all those discussions and you're considering this pump, you might like to know that there are ways to effectivcely get a trial of this pump before you commit to it for four years. Have a chat with your diabetes educator, who can reach out to the relevant Medtronic representative.
Right. I'm off to get fish and chips and see how my pump handles it. Catch me, algorithm!
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