Medtronic 780G - thoughts on the first 5 months

**UPDATE APRIL 2023: This post 👇 was written when I'd been using this system for 5 months at the end of 2021 - I've now been using it for 2 years and I've written an updated review here. Some of the things I talked about in the original post have been fixed since I wrote it, so please do read the latest review to get an accurate picture of what this system is like now.**

In May 2021 I started using the Medtronic 780G insulin pump with the Guardian 3 glucose sensor which operates as a hybrid closed loop system. I'm writing this to share how I have found the pump and sensor so far - the good and the bad. This is all from my own perspective so things that matter to me might not matter to other people and vice versa, but I hope that sharing this will be helpful information for people trying to decide what insulin pump to have next.

My history with insulin pumps

This is my fourth insulin pump so I have a bit of experience of using them and I know what I do and don't like. I first went on a pump in 2009 when I was pregnant, a few years after being diagnosed as an adult. I went on a Medtronic Minimed pump on the advice of my endocrinologist and stayed on this type of pump for 8 years. After that I had a Roche Insight pump which I finished up with earlier this year and I was using the Freestyle Libre (self-funded) at the same time. You can read about the Roche pump in another post here. I've been using the Medtronic 780G since May 2021.

Why I chose the 780G

I was a bit disappointed overall with the Roche pump so I knew I needed a change and I wanted a system where the continuous glucose monitor and pump would talk to each other and I didn't want to go down the DIY option using apps etc to make that happen. I had tried this before but with limited success and I found the whole thing quite frustrating. I spoke to my hospital team who gave me some options and this was the system that fit my criteria. I am self funding the sensors and the hospital is funding the pump. I knew that I was making some compromises in going for this system but I thought the trade off was worth it for the "looping" ability I was getting.

What's good about it

There are some big things in this list and also some that are pretty trivial in the scheme of things but still worth mentioning!

Getting started - the Medtronic team were brilliant with onboarding, getting my account set up, virtual training and check-in phone calls. They made it very easy to get started.

Managing overnight blood sugars - from using a Freestyle Libre I have known for a few years that my overnight blood sugars are quite variable and prone to being high on waking, despite changing my basal rates etc. When I am in "Smartguard" mode on the 780G, which is most of the time, I wake up with my BGs in the 6's and have a pretty flat line overnight. I can see that the pump has been active in managing it overnight and it's really nice to wake up without the slight sinking feeling from seeing a high BG reading. For me this is one of the biggest and most consistent benefits.

Managing non-food related highs - I find that my sugars move around a lot because of what I'm doing at work. I work in quite a full on role and I know that my blood sugars can spike when I am heading into important meetings or travelling. The pump just takes care of this by giving little corrections to counteract the highs and gently brings them back down again.

I can (mostly) ignore it - other than the twice daily calibration finger pricks, entering my carbs and changing the infusion sets every few days, I don't feel the need to look at the pump to know what my blood sugar level is at during the day. I used to look at my Freestyle Libre readings all the time so this feels completely different. I can just get on with what I am doing and know the pump is dealing with it.

It accepts BG readings from other devices -I didn't know this was a thing until my last pump didn't accept a manual BG entry. I found that really annoying and it's made me really appreciate that I can enter in a BG reading from anywhere on this pump. It accepts readings wirelessly from the meter I am using for calibrations, the tiny little Accu-Chek Guide Link (which incidentally is my favourite BG monitor since the Freestyle Lite back in the day).

The pump tells you if the insulin flow is blocked - this has meant that I have spotted kinked cannulas a lot earlier when they have happened. It has taken some of the guess work out of the "why are my blood sugars so randomly high" moments we all have from time to time.

Less variability in my blood sugars - I hardly ever have hypos now and the highest highs using this system are in the mid teens rather than the 20s and they are dealt with more quickly.

The sensor doesn't hurt going in - the insertion device is painless and easy to use.

The clips are small and sturdy - I've been wearing the pump in my bra or on my waistband using the clip it came with which you can also take off to double up as a battery cap remover. It's much more robust than any of the other clips I have used in the past.

What's bad about it

The sensor is a faff to put on - you need two hands, there's a bit of a process involved with taping down layers (see below). When I wear it on my upper arm I need to get my husband to help me put it on. Compared to the Freestyle Libre it's much more cumbersome.

The sensor looks very "medical" - I'm comparing this to the cute and neat Freestyle Libre which is a little white round button on the top of the arm. This sensor has a piece that is inserted under the skin that has to be taped down with transparent tape that is way bigger than the actual device and looks very "medical", then the transmitter is stuck on top, and you can add another layer of tape on top to keep the whole thing in place. I have been less willing to have this sensor "on show" than the Freestyle Libre. I know it's a small thing and it's not enough to put me off using it, but they don't seem to have been that bothered about making something that looks neat to wear.

The sensor is temperamental - I've not had a brilliant success rate with sensors lasting the full 7 days they are supposed to. When I have told Medtronic about it they have replaced them but it happened a lot over the summer - I need to follow up with Medtronic on troubleshooting as there might be something up with my transmitter.

The sensor sometimes wants calibrating every 6 hours, even at night - I have been frustrated many times by being woken in the night by a buzzing pump asking for a calibration at 4am when I did one that evening that was supposed to last 12 hours. If the sensor isn't calibrated it kicks you out of Smartguard mode and just goes back to giving you a pre-programmed basal rate like a normal pump. I lost patience with the night time calibration requests and try to remember to silence the alerts before I go to sleep (they still work for hypo warnings).

The app isn't compatible with my phone - I have an android phone and the app doesn't work so I don't use it. I don't think I am missing out on anything as it has very limited functionality from what I can see.

The pump has no remote control function - I miss this from my last pump (when it worked). To do anything on this pump you have to physically get it out from your clothing and press the buttons. It's frustrating that this pump can obviously receive data wirelessly but this function isn't built in. I used to wear my old pump with a body band under my clothes and control it through a handset but now I have to wear clothes that give me access to the pump. Wearing high neck dresses means a trip to the ladies is needed to bolus for lunch or cancel an alert.

Medtronic cannulas are less robust - I've had more kinked cannulas in the last 5 months than I did with 4 years on the Roche pump (their infusion sets are way better). Annoying but I don't think I can do much about it.

Managing exercise takes more thought and planning - I used to just pre-load carbs before going out for a walk and/or under bolus for food so I didn't have too much insulin on board during the exercise. If I pre-load carbs with this system then it will see my sugars going up and give me more insulin so it defeats the purpose. You can set a temporary target for exercise but you need to remember to do this in advance. I find I still go low if I rely on this alone and need to drip feed carbs throughout the activity to keep things level.

Manual reservoir filling - this is a feature of the Medtronic reservoirs / cannulas and is a mild faff but is easy and doesn't take too long. The Roche pump had pre-filled cartridges so that was a bit more convenient.

Results so far

I'm having pretty good results, particularly overnight and my time in range is consistently higher than it was before with my Roche pump / Freestyle Libre combo. I haven't had a HBA1C done yet since being on this pump but I am confident that it will be an improvement on my last one.

New sensor on the horizon?

I am aware that there is a new version of the sensor due out which doesn't need to be calibrated. I am signed up to get that when it is available but I have no idea of the timeline. Hopefully that will be an improvement on the current sensor - I will post an update if and when that happens. (**Update - I got it in May 2022 and you can read my thoughts on the Guardian 4 and how the 780G is going after 12 months here**)

Overall I'm happy with the 780G so far, despite the negatives. If anyone has any questions, feel free to ask!