Goldie Locks and the Three Pumps…How She Found the One that was Just Right!

The Patient:

Goldie is a 54-year-old woman with type 1 diabetes, diagnosed at 29-years-old in 1999 when she presented with DKA. Goldie works as an elementary school teacher, is married and has two children (none of whom have T1D).

The Regimen:

When Goldie was first diagnosed with diabetes, she was put on an MDI regimen, and she stayed on it for about two years. Then she moved over to a Medtronic pump (the old MiniMed 508), which did not communicate with a CGM. All of her pump settings and insulin dosing were up to her, based on her glucose results. Her A1cs were typically in the 7.5-8%  range, and she was pretty happy with that range at the time.

About 12 years ago Goldie decided to try the Omnipod patch pump. She liked it even though it was still a “dumb” pump (meaning it had no communication to a CGM). She upgraded to the Omnipod 5 when it came out because it’s a hybrid closed-loop system that gives insulin according to the CGM. Her A1cs on the Omnipod 5 were in the upper 6% to mid-7% range. Better!

One thing Goldie was still especially concerned about was hypoglycemia. Before the Omnipod 5, about 5-8% of Goldie’s blood sugars were in the hypoglycemic range, and the goal is less than 4%. On the Omnipod 5, her hypos were in the 3% range. An improvement for sure.

No “Real”  Problem…But!

Goldie wanted to try the new Medtronic MiniMed 780G because she heard so many good things about it online and from her friends with T1D. She hoped the 780G would improve her time in range even more, with even fewer lows.

Experimenting with Medtronic’s MiniMed 780G

Goldie wanted to “test” the 780G for a few days and see how it would do without her bolusing. We don’t recommend this, but Goldie really wanted to see what the pump could do – and it makes her case an interesting one.

This first CGM download is from a 3-day period when she didn’t bolus or make meal announcements:

As you can see from the download:

• Her total daily dose per day was 22.2 units
• Her average SG (essentially average glucose) + SD (standard deviation) was 146+47 mg/dL
• Her time in range was 73%
• Her TBR Est S1c (time below range) was 0%

She did not announce her meals for this 3-day time period just to see if the system was as responsive as she’d want it to be, and it was! It should be noted that Goldie typically eats a low-ish carb diet, but she had pizza one night that week, and this trial period was also over Thanksgiving!!!!

This next download shows how she did when she did bolus/announce her meals:

As you can see from the download:

• Her total daily dose per day was 27.7 units
• Her average SG + SD was 147+42 mg/dL
• Her time in range was 84%
• Her TBR was 1%
• Her Est A1c was 6.6%
• Her total basal dose was 11.8U (43%)
• Her total bolus dose was 15.9U (57%)

Typically, the ratio of basal to bolus should be close to 50/50, and she’s in that range.

The Solution:

The improvements with the 780G were enough to win Goldie over. Her time in range improved and she spent less time hypoglycemic – exactly what she was hoping for. Another thing she loved about the 780G was the 7-day infusion tubing wear, because you can take everything off at the same time once a week. The insulin cartridge and sensor last for 7 days as well.

The Takeaway:

Although Goldie was doing fine on the Omnipod 5, she really liked the Medtronic MiniMed 780G as it helped her stay in range with very few lows. She loved knowing that if she forgot to bolus before a meal the algorithm would take care of her and keep her in range, even if she ate a fair amount of carbs. She realized the new 780G was for sure a huge step up from the older Medtronic and Minimed models. So, the moral of the story is… you are not married to your pump! Pumps often have trial periods, so you can “date” a pump for a while until you find the one that’s the right fit for you.