Medtronic pumps available in Canada include the 630G and the 670G Hybrid Closed-Loop insulin pump. Below is an image of the 670G (it is essentially the 630G pump with increased capabilities including an updated transmitter for glucose sensor).
The Auto Mode feature of the Medtronic 670G pump automatically adjusts basal insulin every 5 minutes. "Setting" basal insulin profiles by missing meals is not required because:
- Auto Mode feature functions like a “dimmer switch”. It turns basal insulin up, down or off to attempt to maintain a target of 6.7 mmol/L (before and after meals). A temporary target of 8.3 mmol/L may be programmed by the pump user.
- Medtronic's proprietary (and unseen) algorithm uses recent and past glucose readings to determine basal insulin needs.
- The basal insulin provided is different every day. There will be times the patient receives no (zero) basal insulin. See here.
The Auto Mode feature makes suggestions for correction insulin and meal bolus insulin. Patients must still accurately count carbohydrate and program into the pump. The pump's bolus advice for meals and corrections can be accepted or declined by the paitent. However, it cannot be modified.
In Auto Mode, patients will only be able to control the:
- Active insulin time
- Carbohydrate ratio.
The following are NOT available for use when the 670G is in Auto Mode (they are available in Manual Mode):
- Temporary basal
- Insulin sensitivity factor - ISF (The algorithm determines a correction dose based on recent insulin delivery, not on ISF. The patient may accept or decline the dose.)
- Dual or square wave bolus
- Pre-set boluses
- Easy bolus
- Manual bolus
- Remote bolus
Additional Auto Mode information:
- Auto Mode requires regular blood glucose calibrations of CGM and additional blood glucose tests when the pump requests.
- The pump can exit out of Auto Mode under certain conditions. In this case, the pump will use "Safe Basal."
- Safe Basal is an automatic function. It is a constant basal rate based on recent insulin delivery history. No automatic adjustment of basal rates is done in Safe Basal and the sensor glucose data is not used. Safe Basal allows the user time to take the actions needed to resume Auto Mode (eg. input a blood glucose reading). If actions aren't taken to resume Auto Mode, then after 90 minutes of Safe Basal the pump will return to Manual Mode (e.g. it will function like a normal pump using programmed pump basal settings).
- Although Auto Mode delivers a different amount of basal insulin each day, periodically the manual basal rates should be updated to reflect the overall pattern of recent Auto Mode basal insulin delivery as seen in Carelink reports.
- 670G Menu Map
- Frequent Programming Needs:
- All insulin settings under Options > Delivery Settings e.g. Options > Delivery Settings> Bolus Estimate Setup > Carb Ratio
- Options > Smart Guard > High and Low setup.
- Alert Silence found from the Main Menu > Audio Options > Alert Silence (user can specify duration of time; hardwired alert of 2.8 mmol will still activate)
- Protocol for Hybrid Closed Loop Technology(pdf) with 670G (Medtronic)
- Auto Mode Patient Handout (AHS)
- U.S. Minimed 670 Support Page is comprehensive
- YouTube Quick Access Videos on Programming
- Display options
- Setting up Carelink
- Clear alert or alarm
- Basal rate
- Insulin to carb ratio (ICR) in Auto Mode
- Active insulin time
- Bolus with no glucose data
- CGM automatically connect transmitter
- CGM manually connect transmitter
- CGM inserting sensor
- CGM home screen
- CGM personalized alerts/alarms (15 min)