MiniMed 780G Insulin Pump System
How’s It Going?

The MiniMed™ 780G Insulin Pump System with Guardian 4 continuous glucose monitor (CGM) hit the US airwaves in July 2023 to lots of fanfare. With promises of improved control, reduced finger sticks, and less alerts and alarms, demand and expectations were high. Southside Diabetes was lucky to be part of an early access program in which our patients were able to upgrade beginning in June 2023. So with almost 90 days into the new 780G system, how’s it been going?

Dr. Stallings here, and I don’t mind saying I had HIGH expectations for this new system. I am a Medtronic purist. I believe in the company, the algorithm, and the products – even through the annoying sensor(s), because of the great algorithm. (An algorithm is the software inside of the insulin pump that manages your insulin delivery with glucose data from the CGM.) Even in the challenging times, my patients and I were rewarded with excellent outcomes on 630G, 670G, and 770G. But, admittedly, it took extra effort from us all. So … enough is enough, and it’s time for great outcomes with less work – for patients AND their healthcare providers.

Enter 780G. The system experienced multiple FDA delays but finally made it. Medtronic was prepared for high demand – but Medtronic will also be the first to tell you that the demand exceeded their expectations. This has lead to some frustrating delays in existing Medtronic pump patients receiving their upgraded sensors and 780G software, but once the smoke cleared and patients were up and running on their new 780G systems with Guardian 4, they’ve all expressed the same opinion: it was worth the wait.

Here is what we are hearing from patients:

• I love the new sensor! No more fingersticks!
• I am sleeping through the night. No alarms!
• My blood sugars are better controlled. Less up and down.
• I’ve never seen my sensor glucose so flat.
• Better mealtime forgiveness if I forget to enter carbs or just guesstimate.
• I love the 7-day sets! It’s nice to change my sensor and my set on the same day.

As clinicians, here is what we are experiencing:

• Fewer phone calls and portal messages about sensor failures and alarms
• Improved patient experiences and feedback
• Happy patients that don’t have to fingerstick
• Improved glucose and A1C control
• Improved time in range and reduced hypoglycemia (sugars <70) **
• More time in automated insulin delivery (SmartGuard)
• Less patient input into the system – just enter carbs
• Improved carb guesstimated forgiveness
• Less anxiety surrounding carb entry

Overall, the experience has been nothing short of amazing. That’s not to say it’s all been rainbows and unicorns. Some of our challenges have included:

• Confusing information to existing 770G patients about upgrading to 780G
• Low blood sugars after meals, especially patients coming from 770G
• Low blood sugars during the day and overnight for patients who didn’t have low sugars before
• Delays in shipping Guardian 4 sensors, or sending Guardian 3 sensors
• Especially for patients receiving their sensors from a third party company other than Medtronic

Thankfully we’ve been able to mitigate almost all these issues with a bit of creativity, and patients are skipping off into the sunset and singing the praises of 780G. Okay, maybe that’s a little dramatic – but not much, honestly.

Here are our most frequently asked questions and answers:

1. My 770G is working fine. Should I upgrade?
   • The 780G algorithm is better and who doesn’t want fewer fingersticks? Read the SSD 780G info page here: 780G – Southside Diabetes (southsidediabetesva.com)
2. Can I use my Guardian 3 sensor with 780G?
   • Many patients want to use up their sensors since they can be pricey, and this is fine. Keep in mind that Medtronic will send you up to 2 free boxes of Guardian 4 to replace your Guardian 3 sensors depending on your insurance approval/shipping date.
   • You WILL still require fingersticks on Guardian 3, even if using with 780G. The Guardian 3 sensor requires calibration whereas Guardian 4 does not. Hang in there.
   • Do NOT cross over your Guardian 3 and Guardian 4 supplies. In other words, do not use your Guardian 4 transmitter with your Guardian 3 sensors, and vice versa. Keep them each fully segregated or you are likely to experience inaccurate sensor glucose readings and premature failure of your sensor after 2-3 days.
3. Do I get a new 780G insulin pump?
   • Yes and no.
   • No if you still have a 770G insulin pump that remains in warranty. You will need to complete the software download to update your pump to 780G.
   • Yes if your insulin pump is out of warranty. They will ship you a brand new 780G.
4. Why are my blood sugars dropping on 780G?
   • Long story short, the algorithm needs to learn you. Our patients changing from 770G to 780G are having more low sugars after meals as the algorithm learns how much insulin you’re using every day and where. Sometimes the algorithm can get a little overzealous and use more insulin for auto corrections than it needs. For example, you were using 75 units a day on 770G, but it was only broken down into basal and bolus amounts. (Basal is background delivery; bolus covers meals and high sugars.) But on 780G, the total daily amount of insulin is being broken into basal, bolus, auto correction, and Meal Detection Technology. So 780G is basically trying to tease out what insulin goes where – and this takes time.
   • If you keep having issues with low sugars, talk to your healthcare provider about temporarily adjusting your settings, such as active insulin time or your SmartGuard glucose target.
5. Why do I keep having to calibrate or do a finger stick glucose?
   • My guess is you’re not entering your carbs before you eat. This not only permits the system to give you a meal bolus (extra insulin for your meal), but it also acts as a meal announcement to activate Meal Detection Technology. Enter your carbs!
   • Make sure you haven’t crossed your Guardian 3 and Guardian 4 supplies. Don’t try to use the Guardian 4 transmitter with Guardian 3 sensors, and vice versa. Crossing the streams can cause weird readings and make the sensor stop working faster.

Overall, I’ve been very impressed with 780G and will continue to recommend it – and Medtronic – to my patients. As with any insulin pump or diabetes treatment plan, you need a strong partner in healthcare! If you have questions about your insulin pump, or diabetes in general, call Southside Diabetes to make your appointment today. We look forward to working with you!

Sample Type 2 Diabetic, 1 week on 780G: