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Post: Blog2_Post
  • Writer's pictureMichelle Law

Can the Medtronic 780G deal with it when you don't bolus?

Managing Type 1 diabetes during social events, especially those involving eating food, can be awkward. For whatever reason, pumping for food at the table or in the moment if you're standing around eating canapes can be tricky. Often I'm in this situation at a work event (I still don't love doing diabetes in front of people I don't know well) or I'm with friends/family and don't want to dig around in my clothes or go to press my pump button's in the toilets.

Well, now that I am three years into using the Medtronic 780G I've become quite comfortable with being hands off, not pumping at all for food at the table in certain situations and trusting that SmartGuard (the 780G algorithm) will pick up the slack.

Here's how the Medtronic 780G fared during a hands-off evening last week while I spent a lovely few days in Scotland at Glenmorangie House.

High necked dress + fine dining + Medtronic 780G + no bolus = 84% Time in Range

We arrived at Glenmorangie House on Monday, had a lovely dinner in the evening and then woke up to a full day ahead to explore and hang out. I bolused for breakfast, then set a temporary target for our walk later in the morning (I ate a few too many sweets along the way but SmartGuard autocorrected that as you can see from the chart below).

In the evening we had another fine dining experience but this time I decided to wear a long high necked dress that made it impossible to access my pump at the table. This is what happened:

What happened when I left SmartGuard to deal with my fancy dinner

I went totally hands off all evening. My phone doesn’t connect to the pump so I couldn’t watch my sugars during the dinner but it was OK – I trusted the pump to do its thing. It did a good job, auto-bolusing pretty furiously once I started eating and keeping me at 84% time in range for the day.

This is the report from Carelink that shows what happened on Tuesday.

Screenshot of Medtronic 780G Carelink report showing Time in Range

I think one of the key reasons why it works so well at formal dinners is that fine dining tends to be quite small portions and lowish carb, spread over quite a long time.

My experience of leaving Smartguard to it

Pushing it with the 780G

I have been experimenting with how far the 780G can be pushed when it comes to mealtimes since I went to the ADA2023 conference last year. I think all hybrid closed loop systems are now working on trying to "fully close" the loop so we won't have to bolus at all any more. You can read more about this in this post from Medtronic: How Far Can We Push Simplification?

One thing I learnt was there’s a trade off between precision bolusing and time in range (typically the more precise you are with carb counting, the higher the time in range) – but the trade off is less pronounced if the carb content of the meal isn’t that high (because the algorithm has less catching up to do). You can miss a bolus completely sometimes and it will auto-bolus a series of corrections to bring you back in range (you need to be patient though, it can take a while).

Another thing I heard about was a sort of half way house. This approach is delivering a fixed bolus for certain types of foods – e.g. a “snack” bolus of 15g, a “meal bolus” of say 40g and don’t bother refining the carb counts (the algorithm can pick up the slack). I didn’t use this strategy for last week’s dinner as my dress meant I was going to be totally hands off for the evening, but this can help ease the mental load a bit.

So, thanks to this technology - whether because of the circumstances at the mealtime or because I just need a mini break from micromanaging diabetes - it's nice to know I can step back a little and let SmartGuard do a bit more work. Disappearing to the toilets to inject insulin is now a distant memory. It's nice to just wear whatever I like, no matter how impractical it is for insulin pump access, enjoy the night and forget about diabetes for a while.

Has anyone else tried letting their pump take full control during a meal or event? How did it go?

Michelle Law in Scotland
Avoiding a hypo on a windy Scottish walk


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