7 tips for success with SmartGuard Auto Mode
Thursday, August 5, 2021 - 16:07
The MiniMed 770G system^ and the MiniMed 670G system^ with SmartGuard Auto Mode are systems that automatically adjust basal insulin to keep you in range and help to prevent highs and lows*. When using Auto Mode, you might find there are changes in the way you manage your diabetes. To help you, we created a collection of top tips for the best experience:
^Components sold separately. *Refers to SmartGuard Auto Mode. Always Read the Instruction for Use. Medtronic’s (real-time) continuous glucose monitoring (CGM) products are indicated for use by people living with type one diabetes.
CONSIDER SENSOR PLACEMENT
To get things started, when you first insert your sensor, consider trying one of the areas shaded below to see what works best for you.
Making sure your sensor is taped down well is critical for sensor performance. If you have allergies to the tape or need extra tape based on activity levels or the climate you live in, work with your healthcare team (and/or your local Medtronic Clinical Specialist) to find the best solution for you.
KEEP 3.9 – 10 MMOL/L IN MIND
While SmartGuard™ Auto Mode uses a target of 6.7 mmol/L, its goal is to increase time spent between 3.9 and 10 mmol/L without increasing your lows. To do this, the Auto Mode feature reviews your total daily dose over the past 6 days of insulin usage and adapts every day at midnight. The algorithm then calculates some safeguards such as minimum and maximum hourly limits. If you exceed these limits all you need to do is a quick fingerstick reading to confirm you’re ok and you go straight back into Auto Mode!
The pump’s algorithm determines every 5 minutes how much insulin to give you by looking at your current sensor glucose, as well as where it has been and where it’s going. It also looks at how much insulin is still active in your body. Calibrating 3 to 4 times a day, spread throughout the day at stable times such as before your main meals and bedtime will help your pump have the most up to date information that it needs and help keep you in range. These few calibrations can help you to have confidence that that sensor is working correctly.
REVIEW YOUR HABITS TO TREAT LOWS
When it comes to lows, the usual recommendation is to treat using the 15‐15 rule. Take 15 grams of rapid acting carbohydrates if BG is below 3.9 mmol/L, check BG again in 15 minutes, and repeat if BG is still below 3.9 mmol/L. However, when using Auto Mode, we’ve seen that some people find that they need to reduce the amount of carbs they use to treat lows since the pump stops the background insulin as glucose levels go down. Make sure to follow your doctor’s treatment plan and consult with him or her before making any changes.
IT IS IMPORTANT TO PRE-BOLUS BEFORE A MEAL
By giving insulin before you eat, instead of when you begin eating the meal, you’ll give the insulin a head start to begin working. If you experience highs after eating, pre-bolusing could be a helpful habit to discuss with your healthcare team.
LOOK AT NEW THINGS THAT LEAD TO HIGHS
You might also need to give insulin for things you didn’t before using Auto Mode, like caffeine, protein, and fat. For example, if you wake up and have a cup of black coffee, which contains no carbs, you might still see a rise in glucose readings. In this case, consider a small bolus to cover the rise in glucose from the coffee. Check with your healthcare team to see if you need to dose differently for this. If you still see a pattern of highs after eating, speak with your doctor to see if your carb ratio needs to be adjusted.
TAKE NOTE OF WHAT AUTO MODE DOESN’T DO
Remember that Auto Mode does not dose off of “patterns.” Auto Mode adjusts based on what you need every 5 minutes and cannot correct for large dose mismatches. For example, Auto Mode doesn’t know what you eat for breakfast or if you go to Zumba class every Tuesday. This is why it’s important to continue to input information (like carbohydrate grams or using the Temp Target for activity).
TEMP TARGET MIGHT HELP
Remember, the standard Auto Mode target is 6.7 mmol/L, and you can temporarily change your target to 8.3 mmol/L for situations where you have a higher risk of hypoglycaemia, such as exercise. The Temp Target feature is designed for any time you want less background insulin. In addition to exercise, this may include garden work, times of high stress, exams, driving, or drinking alcohol. Every person is different, but in general you could start the Temp Target 1 to 2 hours before exercise and end it 1 to 2 hours after.
If you find you are still dropping low during exercise, you may need to consider a combination of suspending your pump and/or consuming carbs to avoid the low altogether.
These tips are recommendations only. Always read the Instruction for Use. You should consult your physician or other health care professional 1) before starting a new or changing your therapy plan and 2) before starting any exercise or nutrition program to determine if it is right for your needs.
The content of this article is for informational use and is not in any case should it replaces the consultation of the instructions for use of the device or the opinion, diagnosis or treatment prescribed by the doctor. Always consult with your doctor for diagnostic and treatment information and strictly follow your doctor's instructions. Medtronic cannot be held responsible in any way for any damage caused, or presumably caused, directly or indirectly, by the information contained in this article.
1. Iturralde E et al. Expectations and Attitudes of Individuals With Type 1 Diabetes After Using a Hybrid Closed Loop System.Diabetes Educ. 2017;43(2):223-232.