I used to a professional photographer. I was lucky enough to work with the best professional SLR cameras and lenses, and what I loved about using them was the control. Fuzz out the background or make it sharp as a tack with aperture adjustment. Freeze the motion or let it blur by changing shutter speed. My colleague used to call Auto Mode on the camera “Bonehead Mode”, professing that only amateurs and hacks used it. I wasn’t quite as adamant as him, as I saw the value of “Bonehead Mode” for certain situations, and I appreciated the sophisticated technology that made it work so well. But I didn’t use it either, preferring creative control over ease of use. So, my first months on the 670G were an exercise in letting go of control and trusting the machine.
It wasn’t without its hiccups.
The 670g slowly learns your needs, and once a week reevaluates the algorithms controlling basal insulin delivery. It does start out conservative for safety, so my first month I had quite a few highs. I went on vacation for a week during that month and found that eating at restaurants was quite alarming—no pun intended. Even using published carb counts, my blood sugar would spike and stay up. In some ways that was more of a learning experience for me, rather than my pump. Restaurant food is the bane of our existence. Maybe they lie about the nutrition info, maybe it’s just that the food is high GI, and of course the portions are too big, but whatever it is, that week was crazy.
But, what I’ve learned since then is that with the 670g I canwayoverestimate my carbs and still be safe. In fact, once my CDE and I evaluated my info, we lowered my carb ratio a lot, knowing that the pump would decrease or stop basal delivery after a meal to keep me from going low. This is basically the Superbolus concept which can be used with any pump: Give yourself a huge bolus to prevent the after meal spike, then lower or stop your basal delivery for a few hours afterwards. It took me a while to let go of the fear, but it works like a charm.
One thing that doesn’t work as advertised, at least for me, is Temp Target. In Auto Mode you can’t lower your basal rate, so what you’re supposed to do when exercising is set Temp Target. That changes the pump’s target blood sugar to 150 instead of 120. Fine in theory, but when I ‘exercise’—really my part-time housecleaning job—I drop like a rock, Temp Target or no. I experimented, setting the Temp Target a few hours earlier--no improvement. Setting it early and halving my carb count for the meal previous—slight improvement. Finally I found what worked for me was suspending delivery while I worked. I’m extremely sensitive in both directions—going way up and way down—and that was the only solution besides chugging apple juice the whole time I was working. Occasionally I still have to chug, but that would happen no matter what pump or shots I was on.
Then, I caught a cold. In Auto Mode, you can’t raise your basal rate either. I guess I could’ve chosen to go back into Manual Mode and increase my basal rate, but like I talked about in my last post, I’m trying to be honest with the pump so it can learn me accurately, so I stayed in Auto Mode. But there’s no way to tell it “I’m sick this week, so give me more insulin, but then next week don’t.” I had high blood sugars all week. Not only was I sick, I also didn’t work, so it was a double whammy. The pump reset itself to my “new” needs, and the next week when I wasn’t sick andwent back to work, I was crashing on a daily basis. Learning experience: next time I’m sick I’ll put the pump in Manual and increase my basal to avoid that problem.
I’ll write more about my wish list of improvements for this pump next time, since nothing’s perfect. But despite feeling whiny and hopeless at times, like all the alarms and scrolling through endless menus and requests for extra BGs weren’t worth the hassle, my A1C test result sure shut me up. After being on the pump for only two months, my A1C had dropped from 9.3 to 7.7. I was floored.
I’m using about the same Total Daily Dose, but it’s being applied more accurately. I have fewer lows, fewer highs. I stay low and steady overnight, and since sleep constitutes a third of your life, that makes a huge difference. Despite the daily struggles and setbacks, the long game is looking good. “Bonehead Mode” is doing a better job than I could do myself. Maybe it’s like a self-driving car. If you trust the technology, you can give up control and let it do the driving. 98% of the time it’ll be more skillful and efficient than you. But keep your eyes on the road and one hand on the wheel, just in case.