This information has been produced to help children and young people using the Medtronic Minimed^TM 780G system with SmartGuard^TM technology.

It has been designed to be read online so you can follow links however you can print if you prefer.

SmartGuard^TM technology

The Minimed ^TM 780G system with SmartGuard ^TM technology is a hybrid closed loop system. The SmartGuard ^TM technology uses the glucose readings from the Guardian ^TM sensor to make adjustments to insulin delivery.

A hybrid closed loop system still requires you to carbohydrate count your food and drink and deliver a bolus 10-15 minutes before eating.

SmartGuard^TM technology will aim to keep your glucose at your selected target glucose level; 5.5, 6.1 or 6.7mmol/L and will help you increase the time you spend in the target range (Time In Range or TIR) of 3.9 – 10mmol/L.
 

Getting the most from the Minimed^TM 780G system

• Let the system work. Be prepared to let the pump do the work. Don’t try to second guess the pump or interfere otherwise it will not work efficiently.
• Time in Range. You will not achieve 100% time in range. Anything over 70% is excellent. If you are spending more than 25% above range, consider; are you giving insulin at the correct time? Is your carbohydrate ratio correct? Are you forgetting to bolus for some carbohydrates?
• Remember to bolus. The system is very clever but you still need to remember to bolus for carbohydrates. Missed or delayed boluses can lead to several hours of above target glucose levels and/or delayed hypoglycaemia.
• Pre-bolus. Giving your bolus 10-15minutes before eating helps the system work most effectively. If you give a bolus 20 minutes or longer before eating, the resulting drop in glucose might trigger the Safe Bolus (resulting in higher glucose later)
• Hypo treatment. You may need less hypo treatment, maybe only 5-7g glucose. As your glucose level falls, the basal insulin will also fall. Large or several hypo treatments could lead to rebound hyperglycaemia and trigger autocorrections.
• Persistent hypoglycaemia. If you have persistent hypos which do not respond to treatment, then go back to manual mode by turning off SmartGuard^TM. You will need to be in manual mode for at least 48 hours, from midnight, to allow the pump to recalculate settings, before turning on SmartGuard^TM
• Cannula changes. Remember to change on time. If corrections are not working remember ABCC (Assess, Bolus, Check, Change) - it is still an insulin pump and the basic rules still apply! Auto corrections not working can be a sign of cannula failure.
• Temporary Target. This is fixed at 8.3mmol/L. You can set this whenever you want to avoid hypoglycaemia e.g., during physical activity or exercise, going shopping with friends or school trips. Set this 30minutes - 2 hours before you need it to reduce insulin on board during the activity, to prevent hypos. The pump will not deliver auto corrections when the temporary target is set.
• Using the Temporary Target for exercise. If exercise is after a meal, set the Temp Target before the meal. You can leave it on after the activity, if needed, to prevent post exercise hypos. If you remove your pump for sports, you may still need to use the Temp Target for 1-2 hours after you reattach the pump if you experience delayed hypoglycaemia. Remember to check what the system is doing before exercise; if the pump is already running with zero basal, setting the Temp Target will not have any effect
• Exercise and carbohydrate. Don’t consume lots of extra carbohydrate before an activity (if you are keeping the pump on), with or without insulin, as the rise in glucose will lead to increased basal insulin (and auto corrections if not using the temp target) which could cause hypos. It’s best to have smaller amounts of carbohydrate (5-7g) spread throughout the activity. If exercise is within 2 hours of a meal only make a small reduction in the mealtime bolus for hypoglycaemia prevention.
• Removing the pump. When you remove the pump for a shower or bath or for contact sports, remember to stop the pump. This stops the pump delivering insulin that you won’t get, which could prevent corrections later.
• Mealtime bolus. If you choose to split your bolus, give the second bolus within 1 hour of eating. If you wait longer, rising glucose will trigger auto corrections which could then result in hypoglycaemia. Remember that basal insulin will increase in response to increasing glucose levels so will help manage delayed post meal glucose rises for high fat and high protein meals.
• Managing illness. SmartGuard^TM might be able to deal with mild elevated glucose levels. If it does not manage glucose levels during periods of illness you should go back to manual mode by turning off SmartGuard^TM and remain in manual mode until you have recovered.
• Ketones. If you have high glucose levels then remember to use the ABCC rule and check for ketones if glucose is >13.9mmol/L. If you have high glucose and ketones >0.6 then use the sick day rules and remember to give the insulin correction by pen, rather than using the pump, and change the cannula.
• Pen corrections. If you need to give a pen correction, you must turn SmartGuard^TM off for the duration of the active insulin set in your pump.
• Allow the system time to adjust. When SmartGuard^TM is switched on, the only adjustable settings are the insulin to carbohydrate ratio and the active insulin time (AIT). When you make a change to any settings, you will need to give the system about 2 weeks to adjust (unless persistent hypoglycaemia).
• Active insulin time (AIT). A shorter AIT will result in more aggressive correction boluses. A longer AIT will result in less aggressive correction boluses. An AIT of 2-3 hours is recommended.
• Corrections. If you are above target you can give a manual correction, while SmartGuard^TM is on using the bolus calculator. The pump will consider any insulin on board from previous auto-corrections. Use ABCC.
• False carbs. Do not enter false carbohydrate to try and lower glucose levels. The system remembers all carb entries and the total insulin dose is used to recalculate the insulin delivery. False carbs can lead to prolonged hypoglycaemia which can take a long time to resolve.
• Keep settings up to date. In case you need to go back into manual mode it is important that your basal profile is up to date. We recommend that this is done every 3 months. You can discuss this in your medical appointments.
• Support. There are several ways you can access support from Medtronic. You can register at www.medtronic-diabetes.co.uk/minimedcare/.
• Uploading. If you use the CareLink app, pump data is uploaded automatically at midnight. If you are not using the app, please remember to upload regularly at home. This means you have a record of pump settings in the event of pump failure. It is also helpful to review your data to ensure you are getting the most from the technology.

Contact Details:

Emergency mobile: 07940 476811

Email: uclh.cdorange@nhs.net or uclh.cddietitians@nhs.net

Further information and fact sheets can be found on our Children and Young People’s Diabetes web page at www.uclh.nhs.uk/T1