This long-awaited Medtronic 780G is now FDA approved. It’s been out for two years in Europe and has features that are a bit different from other commercially available automated insulin delivery systems in the US, including a target range down to 100.
This week you'll hear from Heather Lackey, global medical education director for Medtronic Diabetes who also lives with type 1 and has used the 780G. We talk about what else this system can do – remember this is the one with the 7-day infusion set – and Stacey asks a lot of your questions.
This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.
More info here: https://diatribe.org/medtronic-minimed-780g-approved-fda
Lackey mentions a study where even with no meal boluses for three months, people stayed mostly in range. Here's that study: The Official Journal of ATTD Advanced Technologies & Treatments for Diabetes Conference Madrid, Spain—February 19–22, 2020. Diabetes Technology & Therapeutics. Feb 2020.A-1-A-250.http://doi.org/10.1089/dia.2020.2525.abstracts
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Rough Transcription:
Stacey Simms 0:00
Diabetes Connections is brought to you by The only Ultra rapid acting inhaled insulin by Omni pod five, the only tubeless pump that integrates with Dexcom G six mi Dexcom G seven powerful simple diabetes management.
This is Diabetes Connections with Stacey Simms.
This week, the long awaited Medtronic 780 G is now FDA approved. It's been out for two years in Europe and its features that are a bit different from other commercially available systems in the US, including a target range down to 100.
Heather Lackey 0:44
And it's just been proven to do so successfully without really increasing a lot of time below range. You know, what will the next system lead up? Will it be below 100? I don't know. But it's so nice to be waking up with glucose levels that are so much closer to someone without type 1 diabetes with this lower target.
Stacey Simms 1:05
That's Heather Lackey, global medical education director for Medtronic. She also lives with type one, we talk about what else the system can do remember if this is the one with the seven day infusion set, and I ask a lot of your questions. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.
Welcome to another week of the show. Always so glad to have you here. You know, we aim to educate and inspire about diabetes with a focus on people who use insulin. I'm your host, Stacey Simms, and we are getting some big FDA approvals. Along with the Medtronic 780 G, we got word that beta bionics islet will soon be commercially available. As I am recording this I do have an interview set up with the beta bionics CEO. If all goes to plan that will be our show next week. Real quick, while the original islet dual chambered pump was not what was in front of the FDA, the pump that has been approved has some really interesting features. It's unique in that there are no steps to the programming. When you get your pump, you're not putting in basal rates or insulin sensitivity factors or anything like that. All you do is put your weight in. But that is for next week. You can follow me on social media. We've already shared some information about the islet and I've done many episodes in the past if you want to listen to those to get an idea of what was approved, but this week, we're talking about the Medtronic 780 G, as you likely remember Medtronic at the very first of what we now call a ID systems automated insulin delivery systems with their mini med 670 G and that was approved in 2017. We've been hearing about the 780 G for a long time. It was submitted in 2021. I've talked a lot about the delays in the in the news episodes. It has been approved in Canada since last year. It was approved in Europe in 2020. We're gonna go through lots of features of the pump, but you should also know that the sensor used with this system The Guardian four is approved with no finger sticks for dosing, which to me is one of the most significant changes.
My guest to talk about all this is Heather lackey. She has been with Medtronic for more than 19 years. She delivers medical education strategy for insulin pump systems. She trains Medtronic education teams around the world. She lives with type one she was diagnosed at age 16. She was also a consultant on the movie Purple Hearts. She also popped up in a scene in that movie and yes, I asked her about that. Lots to get through.
But first Diabetes Connections is brought to you by Afrezza. Afrezza is the only FDA approved mealtime insulin that comes in a powder you inhale through your lungs. So why should you consider this unique alternative to mealtime injections. Afrezzais another option if you want to lower your use of needles or if you're experiencing skin reactions at your injection sites, and it is ultra rapid acting so you can take it right when your food arrives. Even unexpectedly. Find out more see if Afrezza is right for you go to diabetes dash connections.com and click on the Afrezza logo. Afrezza can cause serious side effects including sudden lung problems low potassium and it's not for patients with chronic lung disease such as asthma or COPD or for patients allergic to insulin. Tell your doctor if you ever smoked ever had kidney or liver problems history of lung cancer or if you're pregnant or breastfeeding. Most common side effects are low blood sugar cough and sore throat severe low blood sugar can be fatal. Do not replace long acting insulin with Afrezza, Afrezza is not for us to treat diabetic ketoacidosis please see full prescribing information including box warning medication guide and instructions for use on our frezza.com/safety.
Heather, thank you so much for joining me. I have a lot of questions for you about the new system but first welcome. I'm glad to have you here.
Heather Lackey 4:52
Oh thank you Stacey. It's my pleasure to be here and so nice to get to meet you. I listen to your podcast and just excited Good to be a part of this one.
Stacey Simms 5:00
Oh, well, I'm thrilled to have you. And I'm sure you don't mind if I say it has been a long time coming. Lots of people very excited about this improvement. Can we start by just talking about the seven EDG? What makes this different from the Medtronic pumps that have come before?
Heather Lackey 5:16
Yeah, well, the mini med seven add system is different in the fact of course, it let's say what it Phil has right still has automated basal insulin, and that insulin ID based on the sensor glucose values, but this system is set apart because it delivers does auto correction boluses, like every five minutes is needed. So we know that life with type 1 diabetes, as you well know, as a mom, someone with type one and be living with it, we know that life does not go as we expect all the time and as planned. And so many things affect our glucose outside of the three things that we've always tried to juggle for years, right? Food and insulin and exercise. But now that we really kind of identify that there's so many other things that are impacting our glucose, it really brings to light the fact that we don't get it right 100% of the time, when we dose insulin, we adjust food. And so that's where those auto corrections that are coming in real time, every five minutes, if needed, can really help. And what I love about the system is the auto corrections, you don't have to be sky high to get an auto correction. As a matter of fact, you don't even have to be high. before they begin. They're really kind of thinking like a pancreas than as soon as your glucose rises over 120 milligrams, as the basal is working as hard as it can and saying, Hey, I need help, then the auto corrections come into play. And they can start dosing a correction bolus every five minutes if needed.
Stacey Simms 6:59
So what is the difference between the auto basil and that bolus that you're talking about? Because you know, the automated systems that are out right now already adjusted basal every five minutes? What is actually happening when you say oh, and it's also giving a bolus?
Heather Lackey 7:14
Yeah, so the bolus happens every five minutes on top of the date. Right, facie, so let's say, again, the goal for many meds seven ad G, there were kind of two goals in play, right, we wanted to further improve time and range, you know, compared like with the mini med 670 G system without compromising any safety, because we all know we can drive down glucose, right, but you don't want to have a lot of lows. And we wanted to reduce the daily interactions with the system. And those daily interactions, right, the the alerts and the alarms and all of the safety pieces that were were added to mini med seven, add, those have all been now relaxed, and so less than erection and improvement in time and range without sacrificing hypoglycemia. So what's nice about the system is you not only are delivering the auto basil, like you said, right, we have auto basil and other systems that now if the auto basal cannot keep the glucose level in the target range, it predicts that the glucose level is going to go higher than it would like then that's when those auto corrections come. And they don't come once an hour, they come every five minutes. As soon as that since your glucose rises over 120 milligrams per deciliter. If the system says, Hey, I'm working as hard as I can with your basal, and I'm not able to keep your glucose at the target range that we want, right. And we'll talk about targets and here in just a minute, hopefully. But if we can keep your glucose at that target range, then I'm going to ask for some help. And that's where those auto corrections. And those are boluses. Right? boluses that happen every five minutes without the patient having to agree to them, or take any action on their part. They just happen automatically.
Stacey Simms 9:14
Alright, I have a few more questions about that. But I'll get back to that in a couple of minutes. Because I feel like most people will just see the results. And they they may not have too many questions about exactly what's going on there. But I want to get back to that bullets in a minute. But you mentioned range, and the seven EDG has a lower range than Tandem and Omnipod. Five have currently right it's correcting down to 100. Or that's a choice. You can adjust that.
Heather Lackey 9:37
Yeah, there's a couple of things that are different and new about this. And Minimates seven add definitely treats to a target, not a range. But you're right though the target is the lowest target at this moment that's available and so the auto basal target, you can set three settings Three different targets are available to where the person was diabetes , their healthcare provider can can really identify which target is best for them. But the three targets are 100 milligrams per deciliter, 110, and 120. Now 100 comes as kind of the default auto basal target. And that's because we know that this system was all of the copious data that we have. And all of the simulations that were done before this system was even launched, was using that 100 target. And that's what this system is built around to be the best target to you.
Stacey Simms 10:36
We should note that tide pool type pool loop, which was approved by the FDA a few months ago, can correct down to 87. But it is not available in any insulin pump, yet. It's a software program that was approved. So 100 for Medtronic is the lowest that you can actually use right now. But it's interesting, that's 101 10 and 120, where some other systems have, you know, an exercise mode that is a higher range, do you have any insight as to why those were chosen?
Heather Lackey 11:02
Well, those are that close to target to mirror a normal functioning, you know, system a system without diabetes . And the interesting thing is, is the 100 target is very much achievable without sacrificing time below range, right? So we're able to drive with the auto basal target being set at 100. And with having the auto corrections that are even delivering up to every five minutes, this is the system, you know, determined that those were needed. We have the algorithm that built to drive the system to 100. And it's just been proven to do so successfully without really increasing a lot of time below rage. You know, what will the next system lead us? Will it be below 100? I don't know. But it's so nice to be waking up with glucose levels that are so much closer to someone without type 1 diabetes. With this lower target.
Stacey Simms 12:03
Let's talk about the sensor because there are changes here too. Right. Tell me about the sensor that goes along with the 780G? Yeah, well,
Heather Lackey 12:10
the Guardian four sensor is the center that it works with the mini med 780G system. And the Guardian Force center was designed really to reduce the burden as daily finger sticks. That was the whole goal. Let's remove calibration from the system. And let's try to develop a system that doesn't require finger sticks. As we know, sometimes finger sticks still are needed with really with any of the systems and sensors. But the majority of the time when our patients are in the mark guard feature is they are using the SR glucose to bolus off that, you know, there's no real need for a fingerstick glucose. And interestingly enough, most patients bend upwards of you know, 95% or so in that smart guard feature. And so many patients will tell me, I am forgetting my glucose meter at home. And I had one patient that went on a trip, he went out of the country and he said, Look, I totally left insulin and glucose at home because I had kind of forgotten to take my meter bag with me. Wow, learning for sure.
Stacey Simms 13:27
Oh my gosh, yeah, my son goes without a meter quite often. Since you know his we use the Dexcom in the control IQ system from Tandem. But yeah, you don't want to forget your bag entire. That's not good
Heather Lackey 13:38
news. Okay, that's if that's now a burden that is taken off of you. And that's lovely. Yeah, no doubt. No need to be prepared, right?
Stacey Simms 13:47
Yep, absolutely. And I think it's worth pointing out that this is the only automated insulin system in the United States. That is one system, right? It's a glucose monitor infusions that insulin pump. That's all Medtronic and this system has that extended infusion set right so you're talking to sensor you were for seven days, and an infusion set for seven days, right. We'll get right back to my conversation with Heather but vs Diabetes Connections is brought to you by Omni pod. And when you're deciding that a random insulin pump, you got a lot to think about, especially if you've never used a pump before. It really can seem overwhelming. I remember that there are a lot of choices, and you want to make the right decision. And that's why I'm so excited to tell you about Omni pod five. Curious about trying an insulin pump or seeing what life without tubes is all about. Unlike traditional tube pumps, you can try Omni pod without being locked into a four year contract. You might even be eligible for a free trial, go to diabetes dash connections.com and click on the Omnipod logo for full safety risk information and free trial Terms and Conditions. Also visit omnipod.com/diabetes connections. Now back to Heather answering my question about this seven day infusion set
Heather Lackey 15:03
That's exactly right. One kind of new feature of the mini med seven add system is the extended infusion set. And that extended infusion set. It's been launched for a few months in a few different countries. But it comes now with de minimis 780G system, and really allowing people to just kind of have to think about changing a center and changing their infusions that just one day out of the week versus anymore. And so that system, you know, I have so many people that will go have our youth told us for years, you know, that we have to change our infusion set every three days. And why are we able to start to use that system now, and just been using that now for seven days. And the the, it's really simple to explain without getting into a lot of engineering details, but that infusions that is made with this advanced material. And what it does is it helps to reduce the insulin preservative, you know, kind of the loss that we would typically have, it helps to maintain the insulin flow. And it helps to maintain the stability of the unfolding. And so there's such a reduced risk of any kind of blockage or occlusions, with your infusion set whenever you use this new extended infusion set. And I always have to remind patients and people with that need us and their families, make sure you're only using the extended infusion set for seven days, and you're not using your current infusions that are that long, because the materials are different.
Stacey Simms 16:41
Yeah, good point. Can you use any insulin in those extended infusion sets?
Heather Lackey 16:47
So well, in the mini med 780G system, the insolence that are approved and on label are human log and Nova logs. So both of those are available to us with that set.
Stacey Simms 16:59
So no, Lusia if I ask, just checking, those are not approved at this time. Got it? Got it. I had a listener ask if the duration of insulin is adjustable, you know, is that a setting that people can kind of go in and tinker with?
Heather Lackey 17:13
Yeah, so active insulin kind of talks about the or is our duration and insulin kind of tuning knob that is in the programmable settings on the mini med 780G pump, the active insulin Time is of the two settings that are critical is one of the two, right the first setting is the auto label target, you know, looking at that 100 glucose target for most people with diabetes, but then also setting the active insulin time to two hours. And a lot of people will say, Look, I have never had active insulin or insulin on board. I've never thought that human log or Nova log was out of my body in just a couple of hours. And so it's interesting that Medtronic is recommending a two hour active insulin time. Why is that? And the real answer is this is what the algorithm was designed around, right, it's fine to have the ability to, you know, the algorithm is asking the patient, if you set the active insulin time to two hours, then that gives me the ability to calculate insulin, if I think it's needed, right, that doesn't always mean that you're just gonna get insulin stacked on top of, you know, each other dose on top of a dose every two hours. It just means that gives the algorithm the ability to give correction sooner. And whenever you're giving those auto correction. as frequently as every five minutes, it makes sense to be able to just kind of give the algorithm the freedom to make the decision if it's needed. And anytime I have someone that really wants to debate this, and understand how the algorithm works, I just always have to say, let's just look at the data. And you know, we're not stalking we're not having hypoglycemia in the 10s of 1000s of patients that we have data on.
Stacey Simms 19:06
Yeah, it's actually I wish I had a diabetes educator. Maybe this will be for another episode. You are obviously a diabetes educator. But it'd be fun to have somebody else from a different pump company because other pump companies will say no, no, no, exactly. As you're saying like you're stacking insulin. We set it this way for a reason. It's not adjustable for a reason. Is this two hour duration. A different setting from previous Medtronic pumps forgive me? I'm not as familiar with them.
Heather Lackey 19:29
You don't know. That's a great question. They see it the same accident one time. Honestly that has been a part of the bolus calculator settings, the bolus wizard and now the smartcard bolus feature that even since the paradigm days, right, when the bolus calculator was first presented, we're now looking at decades ago with the active insulin time. So it's the same setting we've had, but now it's kind of viewed in a different way than Then it has been in the past, right? In the past, it was very traditional, like you're saying and, and kind of how patients will think of it with, you know, whenever I'm in conversation with them, they're like, How can this be. And the simple fact is, with setting the accidents one time, as low as two hours, which is what we see the best control, the best time and range and the lowest time below range, right? So the fueler lows is actually set at two hours. And what that does is it just is a tuning algorithm knob. And it says, Hey, algorithm I'm going to allow you to give, if you determine that it's necessary, meet Insulet. And because you're looking at my rate of change, you're looking at how much insulin is on board, you know, how many grams of carbohydrate that I've entered, it takes all of this information into account and decide if action should be taken. And what lovely is the patient, the person with diabetes that mom, dad, the family, they don't have to make any of those decision, the system is doing it for them.
Stacey Simms 21:05
It should have probably started with this question. But what does the algorithm use as a starting base? You know, we're used to traditional insulin pumps where you sit with your educator or your doctor and you say, Here's my basal rate, here's my sensitivity factor or correction factor, or, as we're talking about here, duration, there is a pump in front of the FDA right now that just uses body weight. What is the 780? G use?
Heather Lackey 21:26
Yeah, that's a great question as well, algorithm really start with total daily dose of insulin, kind of as it is its starting point, right, the calculation. And that's why whenever you are new on the mini meds 780G system, people have to stay in manual mode. So the kind of the non auto basal in auto correction kind of piece of it. So they stay in manual mode for 224 hour days, right. So it's two days in manual mode. And then there's enough data as a starting point for this system to be able to, to say, Okay, this is a safe basal amount for you to begin with. In addition, if there's sensor glucose tracings, in that 48 hours of kind of that warmup period, to the smart guard feature, then those fasting sensor glucose level pump is looking to see like, how much insulin Do you require, whenever you're not announcing meals and, and so it see, okay, this is your center, glucose is in a fasting state. Now, how much auto Basil is being delivered. And that is kind of the two main pieces of information of how the system decides how much auto basil to begin with, and to deliver,
Stacey Simms 22:49
got it, can the user switch back to manual mode,
Heather Lackey 22:53
yet, they can, at any time, they can stop the smart guard feature, we know that the data is so overwhelmingly heavy weights heavy on the smart guard side. So we definitely see a major difference in time and range being improved. Whenever people are in this barcard feature versus in manual mode, right? They're always encouraged to say and
Stacey Simms 23:16
got it but the system doesn't like. And I hesitate to say it this way. But you'll know exactly what I mean, the system isn't kicking people out as much as one of the very early automated systems for Medtronic, right? That was a big complaint with the 670 was I got kicked out of auto mode.
Heather Lackey 23:30
That was a complaint. And we know that whenever the mini med six, seven ad system, the first hybrid closed loop system of its time was a pretty conservative algorithm, right? Because it was first of its kind, Medtronic really had to build on a number of safety precautions. And in many cases that led to those unwanted alerts and alarms and interactions with the pump to keep the system kind of in that auto mode, smart guard auto mode feature. And so with this, we the exits on mini med 780 G system. I mean, they're just not happening, right. And again, though, the number one of two goals of this system was to reduce the daily interactions with the system. So we can't have beats and alerts and alarms. And hey, you have to enter a BG all the time in order to stay in to the automation mode. This is a big difference that people especially those that have been on previous hybrid closed loop systems of all kinds, they're like this is really a pretty big change right? exits at night, exit in the daytime alerts at night. Those are some of the things that are really different from a user lens. Whenever I hear anyone asked my husband, you know, like what kind of from your standpoint In a view, what's the biggest change with you seeing your wife were the minimis 780G system for a while. And he just says, look, it just doesn't wake us up at night. And he just seems to be a little bit more pleased. A lot of surveys that have been conducted all throughout, you know, the countries where people are using and wearing many hats, 7080 G system, you know, it's like 94 95% of people are saying that they're satisfied with the impact on the their quality of life, they're happier with the quality sleep, that's one that's pretty high, ranked and desired by many. So for us to get a good night's rest and to feel confident to go to bed, lay our head down, not have lows or highs not have alerts and alarms. That's the system that we need. And that that's what people are enjoying.
Stacey Simms 25:54
One more question about manual mode, a listener had asked me is manual mode usable during the auto mode? In other words, if somebody really feels like they need to do an additional bolus, can they do it?
Heather Lackey 26:05
It can be done, but I would kind of ask why do they feel like it needs to be done? Right? Why would you need to go out to manual mode if you need to give an additional bolus. So carbs can be entered at any time that those are consumed? Right, we definitely want to announce our mills. And at any time in the smartguard feature, a patient can always look to see if if they what we kind of say a user initiated correction dose is needed. So you don't you know, I don't ever want people to feel like once I'm in the smart guard feature, guy can't take action. If I see glucose, where I don't want it to be or if I've eaten something that I didn't tell it, you know, go ahead and deliverable list, at least check to see if a bolus should be given. And maybe some of the feedback that patients had on mini med 670 G system where they felt like they had to enter in perhaps kind of ghost carbs or fake carbs when they weren't actually eating them to kind of trick the algorithm to giving more insulin, I think you'll find with now that control that we have able to control on this system like that active insulin times and the auto basal. I don't see that people at all are having to what we say automate the automation? Well,
Stacey Simms 27:27
yeah, we let me ask you a follow up on that. Because I don't know anybody who uses an AI D system who just puts in meal boluses and says, Great, I'm always in the range I want to be are you saying that's what's happening with the 780?
Heather Lackey 27:39
Well, I'm saying that anytime that you eat in any of the AIP systems, right, you can you can enter those grams of carbohydrate. But because many meds 780G system gives the autocorrection doses starting at anytime, and glucose is over 120 systems. If the auto basal can't handle that glucose response, then they're gonna get it. So because you start you intervene the system intervene early and intervene often, there's less of the need to take matters in your own hand. Right. So it's a different mindset. Really it?
Stacey Simms 28:18
Yeah, no, it's absolutely it sounds great. Well, we'll see. When you said meal announcements, to be clear, you're talking about carb counting and putting in the numbers of carbs you're eating, you're You're not just saying I am eating?
Heather Lackey 28:31
You're saying I Yes. You're you're entering grams of carbohydrate. Thank you for clarifying going
Stacey Simms 28:36
no, I'm just you know, I know it's coming. It's amazing to see how these things are changing. I just want to be clear as we go. Yeah. Well,
Heather Lackey 28:42
you know, that's kind of a segue Stacey to a lot of the different thoughts on do people have to now with autocorrection? Do people have to be so precise on the grams of carbohydrate that they're entering into those bits? Okay. Well,
Stacey Simms 28:59
let me give you Yeah, let me let's segue into that. Let me give you the best case use that I can make in my house or something like this. I have an 18 year old, he's a great kid. He's very responsible with diabetes. He is terrible about bowling before he eats. It's just it's just not happening. And so we have a lot of, you know, excursions that perhaps don't necessarily need to be happening. I would be thrilled at a more aggressive post meal bolused system. So talk me through what happens to scenarios for you. Somebody has an AD of just throw 85 carbs out there because this happened recently. So somebody has an 85 carb dinner, they bolus five minutes after they finish it. Or somebody has an 85 carb dinner and completely forgets to bolus how does the system handle those things? Oh, yeah.
Heather Lackey 29:45
Well, I'd love to show you my report. Because not only does it happen with an 18 year old, it happens with me more than I would like oh my goodness. I plan for 33 years. How am I forgetting to push the button,
Stacey Simms 30:01
I love it, you're human, you're human. I'm totally
Heather Lackey 30:04
human. So the 85 gram carb dinner, and they bill it five minutes later, right? We know that if you are not giving insulin before the meal, right, you're gonna have food most likely showing up to the party before the insulin arrives, right, so you're gonna have food, their glucose is gonna rise because of the food digest. And then here comes insulin. In that case, we would say, Look, if then, you know, if you're really bolusing, after the meal, you probably are going to need to reduce your meal Bolin, than we have some exact parameters for healthcare providers to kind of discuss with their patients. But you know, on average, it's like, look, probably just dose for, you know, maybe that path in your case, maybe it's not, because as you know, as those is that sensor, glucose starts to rise, the auto basal start to increase, it gets to the maximum, let's say, and then here comes the auto correction. And then you've got insulin, you know, from the bolus still showing up to the party at that point. So what's so great about this system is it knows like, okay, auto Basil is increasing, then there's some, you know, potential auto corrections, as soon as the bullet is given, the system goes, Okay, let's just, let's back off, right, let's see, what's gonna happen with the system before we really just push the pedal to the metal and start giving more correction. Right? So everything is done with the total safety in mind, right, which is something that's so great. Now for the 85 grams of carbohydrate, and they don't bolus at all, well, then that's really what are the auto corrections and the auto basil can shine, that's really where you're going to see sensor glucose is rising. And am I going to say they're never going to go high with an 85 gram carbon bill, I would say that wouldn't be, you know, really unlikely, depending on what what the nutrients are in that food, I would think it was going to be unlikely. And so glucose is going to rise, the system is going to to handle it as as well as it can. But what I can see time and time again, with when mills are skipped, that patients don't go as high and they don't say as high as long. But we have a study that actually support that patient who did zero pole was seeing for a period of time. So this is every single meal for this length of time. And I'd have to look at the report to know exactly the days, but their time and range was just right under that 70% of time and rain. Yeah. And so that's not at all what we are recommending, because we know that if you bolus and you're using the recommended settings, it doesn't matter if you're eight year old, or if you are a 18 year old, or if you're a 58 year old or if you're a 78 year old, we know that for everyone, you can have an upward time and range of 80% plus, right. So we know it's better. And we absolutely want to provide the charge that we should be announcing mil but it's so nice, whenever the occasional I forgot to bolus to you know,
Stacey Simms 33:29
sort of occasional
Unknown Speaker 33:32
got your back for some more than
Stacey Simms 33:36
excellent. I did get this question about the bolusing system, how much of a correction is given? Because on some of these other systems, it's a partial correction. I don't know if you can share that, you know, it's it may be part of the algorithm that you can't share. And then also, how does the system differentiate? Or does it between a missed meal and a random high? You know, a high that may come for another reason?
Heather Lackey 33:57
Yeah. Thank you good questions. Okay. So for the repeat the first one, if you don't mind, sure
Stacey Simms 34:03
how much of a correction is given, you know, like on the T slim, I think I may not be correct here, but it's something like, you know, once an hour can give 60% of the program to bolus. So is that something that the Medtronic keep some good and maybe proprietary? Well,
Heather Lackey 34:16
I can tell you this is the difference with the mini med 780G system is it gives a full correction, you know, if needed every five minutes and every correction bolus, right? It's like if you were giving a correction yourself with a pump, you're going to enter your glucose. The system does the same. It says look, this is where the glucose is. This is where I want it to be. And it's targeting 120 Whenever it's giving a correction dose of insulin, right. That's why after 120 it can start to deliver a correction dose and it looks at the difference and it sees how much insulin is going to be needed. And then it also applies other metrics as well like how much insulin is circulating in the body and And then it determine the safe amount that is going to be needed every five minutes. Got it?
Stacey Simms 35:06
Got it. Okay, great. And then the other question is about does the system differentiate between, you know, missing a meal or a high for another reason? And I could think of highs, you know, and teenagers for, you know, hormones or exercise, things like that, does the system differentiate? And I guess the follow up is, does it need to, or is a high, just a high,
Heather Lackey 35:24
you know, really high is the high and and that's what's so great about the the system anytime there is a rising rate of change, and you know, parameters are met, that the pump says, Wait a second, this is a rising rate. Oftentimes, it's a meal that's missed right? To meet the parameters. When the system sees that this is Matt, what it does is it allows a correction dose to be delivered even a little bit more aggressively. Right. So you know, it does have a mill detection module built in. It has mill detection technology built in, but it doesn't so much say, Oh, this is your sensor, glucose is rising now because of the meal. So I'm going to act this way. Versus your since your glucose is rising, because you have hormone releasing in the middle of the night and you're sleeping, right. Either way, this system is looking at the sensor glucose response. And if it's corrections need to be delivered in a more aggressive manner, or larger corrections need to be delivered either way, then the system is able to do that. You know,
Stacey Simms 36:40
we've mentioned several times that you live with type 1 diabetes. I mean, I know I can talk to you about the pump for probably another two hours. And I hope you'll come back on and we can talk more about it. But I want to ask you about your your journey. You were diagnosed as a teenager, what did you use what was the first diabetes technology, I assume it was a blood sugar meter. coming right back to Heather in just a second. But first Diabetes Connections is brought to you by Dexcom. And Benny has been using the Dexcom CGM for almost 10 years now, that first insertion was in 2013, just before he turned nine. I mean, it was great. Then if you've done finger sticks for a while you know how amazing it is to go from that to continuous glucose monitoring. But it is even better. Now. The Dexcom CGM systems just keep improving, continuing to get more and more accurate with no finger sticks or scanning required. The easy push button insertion has made it easy for Benny to do it himself. He has done every one since we switched to the GS six in 2018, which is really great for his independence back then, as a younger teen. Of course, we still love the alerts and alarms, and that we can set them how we want if your glucose alerts and readings for the G six do not match symptoms or expectations. Use a blood glucose meter to make diabetes treatment decisions. To learn more, go to diabetes connections.com and click on the Dexcom logo. Now back to Heather talking about what things were like she was diagnosed at age 16.
Heather Lackey 38:10
Yeah, you know, I was diagnosed in 1990. And of course, I had a meter. The old lancing device that I had was the one that you lay on the table and it's spring loaded and it like warm around like a hammerhead, and it would poke your finger. Right. So that was my first one. And you know, I was just on conventional insulin therapy, right, at least had disposable syringes. I wasn't sharpening a needle or have a glass of orange or anything like that. And you know, for me, Stacy, my parents were so great. My dad worked internationally. And they were just constantly talking to people like what, there's got to be something that right because I was doing everything I could, I mean, I really tried hard. And I have for, you know, three decades, tried hard to really kind of manage things. And they said, you know, there's got to be something better. And that was right at the end was actually before the end of the DCCT trial, when my parents were told, Hey, there's, we've got to get her on something better. We're starting to notice that these multiple daily injections are going to be a lot better. So went to went and started multiple daily injections. And at that point, this was in 1992. At that point, they they the healthcare team said you ought to consider a tump you're you're young your parents have insurance. You guys are certainly kind of wanting to have the best control you should consider a pump and Stacy for cash for seven years. The first seven years after I was diagnosed I did not want an insulin pump to save my life. I wouldn't even think about it until someone said hey, I had gained some weight in college, as many females and male do and I was trying to lose weight exercising to on the elliptical and or the treadmill, either one. And every time I would exercise, I would go low. And every time I would go low, I would have to have juice and peanut butter crackers, or whatever the case was, and I was having more calories than I had exercised off, you know, you can see the counter of your calories that you're burning. And I'm like, This is ridiculous, I'm going to continue to go low, and not be able to trim down my weight some, and I didn't have the right tools. And so that's the reason I started on a pump and then have been on a pump. For the last, I don't know, 2026 27 years, maybe when you
Stacey Simms 40:37
used to do a lot of patient training on insulin pumps, I know you still do some now, I'm even in your role here. What are their biggest concerns? You know, there's a lot of mechanical learning if you've never used an insulin pump before. But there's also as you mentioned, there's a reluctance sometimes. Can you share a little bit about what patients tell you?
Heather Lackey 40:54
I think the unknown is the biggest thing for patients, right? They don't know if it's surgical, they don't know if it how this goes in how you disconnect, how you're going to get live. The five emphases as I call it, you know, how do you sleep? How do you shower? How do you swim? How do you go in, you know, with exercise and do sports, what happens with intimacy and things like that, you know, those are unknown if you haven't met with a an educator or you haven't had a friend or even a health care provider that's kind of talked to you through that. So I think once people understand how insulin pumps and continuous glucose sensors kind of work inside of our life, and really how easy they are. The trainings are so much more simplified today, because the therapy is so much easier, right? And so I think once they start to see they're starting to put the pieces together, like the technology is working in the background, I don't have to work as hard. Here's the the, you know, two or three things that I have to do change my infusion set once a week, change the sensor once a week, and then I have to enter some grams of carbohydrate, however those grams of carbohydrate are calculated, then they start to understand this is not as big of a deal.
Stacey Simms 42:09
All right, I have to go back. You said the five S's and then I kind of heard you editing as you went, you can say six on this podcast. But what were the other ones we had sleep swim.
Heather Lackey 42:18
So fleet that were when boarding and zek?
Stacey Simms 42:22
That's great. I love that list. That's a great list. All right, before I let you go, I can't let you leave without talking about Purple Hearts, this Netflix movie that you were a consultant on, right? Tell me a little bit about what happened there. This is a character that has type one. And she marries a marine to get benefits health benefits. And it's a very romantic story. How did you come to be a consultant on that? And what was it like? Well, what was so interesting
Heather Lackey 42:46
about this, I mean, it was I mean, what a one and a life champ or V I mean, it was really great. The director, or producer, I think it was the director, she had reached out to Medtronic, specifically, because she was, you know, obviously going to be doing this movie, and the hurt. So her team had reached out to Medtronic. And she really wanted to one US product in the movie. But I guess her colleagues and friends and and others that he had talked to whenever she mentioned that this character was going to have type 1 diabetes. They were all like, Yeah, well, we, you know, we've learned that Medtronic pump for, you know, years and years. And so that's why she reached out, right, so reached out to our communications team and our marketing team. And those teams were so great to say, hey, look, they're going to be using a pump and sensor on the set, they might need to have some help. Just making sure that everything is used correctly. And you know, you're always in film, in movies, etc. Whenever I see things being used in an incorrect way. So yeah, so anyway, I was able to go out on the set. And then, you know, one thing just kind of led to another and they were like, well, you know, we're gonna need someone to train. You know, Sophia Carson is the actress. I mean, like, what an amazing thing to be able to beat her and all the other dudes amazing talent on that, that and they were like, Why don't you I mean that you do this? So why don't you just do this in the movie. And I was so happy that that tiny little piece was not cut it, it was such an important thing for my friends and family to be able to see so. And it really does kind of make people with type one I've heard over and over it was kind of cool for the film to kind of walk through people without type 1 diabetes. Like there's a trainee, you know, like, we have to get to understand how to use this equipment. And it's kind of the big day whenever you go on an insulin pump. The coolest thing about the scene that I was in with Sophia Carson, whenever she we finished the scene and she got on the system and we had everything is moving and working at and it was it was there. She was like, Heather, this is amazing that people go through this. And then she was like, gonna give you a hug like this is like I feel empowered having this system on me whenever I'm playing a character that has type 1 diabetes, so it was very organic and natural. And that wasn't anywhere in the script, you know. So it was just a true testament to how powerful technology is and people with diabetes. Five,
Stacey Simms 45:31
is there going to be a second one?
Heather Lackey 45:32
I have pushed. I have said, I hope that there is everybody wants to know what happened to those two characters. I don't know about it, but I would I would love to see a second movie as well.
Stacey Simms 45:45
That'd be great. Well, we will leave it there. Thank you so much for sharing so much of your time with me. I would love to have you back on to talk more about this system. We still have a lot of questions. I'm sure we just scratched the surface. But I really appreciate your time. Thanks so much for sharing so much information.
Unknown Speaker 45:59
Thank you Stacey. Have a great day.
Stacey Simms 46:05
You're listening to Diabetes Connections with Stacey Simms. Lutz where information with diabetes dash connections.com. I know we didn't get to all of your questions. I will definitely talk to the folks from Medtronic. Again, I thought Heather was really terrific. And she laid everything out. I loved her five S's. But you should also know that the 780 G she mentioned this. It's currently approved for users seven years old and above with type one, they have started taking pre orders that happened in the middle of May, and they will be shipping later this summer. throughout the US. If you have a 770 G, you will be eligible for a free upgrade through remote software. If you want to be notified more, you can go there's a link in the show notes and get their upgrade notification newsletter. So just go to diabetes connections.com Click on this episode's homepage. It'll give you all the information that you need. I'm taking a deep breath because as I have been telling you, my May was bananas. It was wonderful. It was busy and all the best ways. But I mean, I went to Ireland at the beginning of the month. Then I went to New Orleans for my daughter's graduation. Then we had a giant family reunion at my house. So hopefully as you're hearing this, nothing that busy has popped up for the month of June. What I do have on the calendar is the ADA Scientific Sessions conference toward the end of this month. I have never been to this. I've always tried to make it but it's never worked out. So I have immediate pass. I have my microphones packed Well, not yet, really. But I am going to be going and talking to all of these companies. I'll be putting stuff in the Facebook group. So please join Diabetes Connections, the group or sign up for our newsletter. And you can do that at diabetes dash connections.com Because I'm gonna be asking what you want here, who do you want me to talk to what questions you want me to ask. I'm going to try to do a whole bunch of interviews while I'm there and set up a whole bunch more. You can always email me Stacey at diabetes connections.com. I'm super excited about going to this event and really hoping to bring your questions to more of these folks. As I mentioned at the beginning of the show, I am scheduled to talk to beta bionics about the eyelet so that should be next week's episode. And of course we have in the news this Friday to fill you in if there are any more FDA approvals a there's more stuff in front of them. This has been a really interesting year so far, and we're not halfway through. Thank you to my editor John Buchanan, audio editing solutions. Thank you so much for listening. I'm Stacey Simms. I'll see you back here soon until the end. Be kind to yourself.
