Jason Gensler, person with type 1 diabetes, is the founder of the Foundation for Type One Diabetes and the creator of the synergistic philanthropy model. He’s an out of the box thinker, beer aficionado, coffee connoisseur, and bacon fanatic. He proudly dedicates his life to social entrepreneurship on behalf of the global type 1 diabetes community.
Jason is one of the first users of the Medtronic 670G hybrid closed loop insulin pump system, sometimes referred to as an artificial pancreas. He’s been wearing the pump for the last 23 months and is planning to help test the next iteration of Medtronic’s technology. He answered some questions for us about what it’s like to live with this promising new device.
Tell us a bit about yourself and your experience with diabetes. How old were you when you were diagnosed with type 1 diabetes, and how did you manage your blood sugars before you started the 670G?
I was diagnosed with T1D two weeks after my 16th birthday. My 17 year Dia-versary is on May 10th 2017. Prior to the 670G I was wearing the T-slim pump and using the Dexcom G4 CGM. I managed my BGs as best I could prior to the trial and although I could maintain about a 7.0% – 8.0% A1C it felt like a ton of work.
What inspired you to sign up to try the 670G?
I have participated in many trials over the last 5 years at the Barbara Davis Center, and have witnessed the progress being made in our industry. I went into the 670G pivotal trial with huge expectations, knowing what was on the line for the diabetes industry, our T1D community, and knowing how many companies are pursuing their own version of an artificial pancreas or ‘automated system’.
I applaud Medtronic for their efforts to blaze the trail for the industry. In my opinion, they learned a great deal from the 530G launch, and how the system was not quite what it was cracked up to be. But this time, it’s completely different. All the data is based on real people’s results, over the last two years.
What differences have you noticed between the 670G and your previous pump/methods of controlling your blood sugar?
Now that my sensor glucose value is being used to determine how much insulin the pump will administer on my behalf without any input from me, I have made calibrating my pump a top priority. I’ve developed some simple habits to optimize my outcomes. Calibrating three times each day – immediately after waking up, about three hours after lunch, and at bedtime. I chose these approximate times because there are no outside variables (like active insulin on board or food) impacting my blood sugars, which means my meter and sensor are more likely to be accurate. This also enables me to stay in Auto-Mode without worrying that the pump will force me out and revert to Manual Mode, due to missing a required calibration. I am experiencing very impressive results yet I’m only testing 4-5 times per day and calibrating three times.
What’s been the most challenging part of learning to use the 670G?
The biggest challenge for me happened at the beginning. I’ve been in about 14 clinical trials and had never been afraid of being the “guinea pig” during the first phase, until this one. It took about six months to finally use the system as a tool, the way it was intended. At first, we were manipulating settings that had nothing to do with what we were trying to impact. Since there was zero human experience, we had nothing to reference. It was extremely difficult even for someone who works in diabetes research. However, that is exactly the point of phase one trials, and I’m very proud to say that our learnings have been implemented in Medtronic’s training protocol and I’m thrilled that the rest of the T1D community will be able to benefit from our experience.
Which aspects of the 670G work the best, and which aspects do you think could be improved? (I mean this both in terms of the devices themselves and which situations/times of day it works best in terms of managing your blood sugar for you.)
I’d say the best aspect is that the system itself is so intuitive and user-friendly. It’s always one step ahead, and the sensor is incredibly accurate. Having the availability of so much information at your fingertips on a color screen is very valuable. But, sleeping through the night and waking up with blood sugars in the sweet spot every day is life changing! Also, the suspend before low in manual mode is unbelievably precise and effective. It’s very encouraging to see that Medtronic implemented as many new features as they could in one device, and they all work extremely well.
Something that can be improved, and is being worked on for the next iteration, is the algorithm. It needs to be more robust because trying to use Auto-Mode with high fat / high protein meals is not as effective as it needs to be. Although it does reduce spikes, I still sometimes end up manually bolusing as if it were a dual-wave bolus… but since dual-wave is not available in Auto-Mode, I’ve learned to set an alarm about an hour after my initial bolus to deliver the second bolus for the high protein / fat.
What has it been like emotionally to transfer much of your blood sugar management over to a closed loop system?
Simple. It’s a relief! The day that it sinks in, when you realize that you’ve relinquished a majority of the control to the pump, is the day you begin to experience the freedom that so many of us haven’t had since the day we were diagnosed. I will say though, that it takes time to familiarize yourself with the system, it’s capabilities, the functionality, and how you can maximize its effectiveness. It’s not easy, but it’s very much worth the initial effort and responsibility.
What, if anything, has surprised you?
The one surprise I had is that this pump is by far the most capable technology that anyone can leverage for optimal control. Based on my personal experience with the 530G, I didn’t trust that this 670G was going to be such a life-changer. This experience has gone beyond my expectations. It blows my 530g experience out of the water. Medtronic is light years ahead of where we were just three years ago, thanks to this revolutionary technology. Because of this, I thank Medtronic for recognizing that our patients and our community deserved so much better than what we had.
The idea of a closed loop system is enormously exciting to many people with diabetes. Based on your experience so far, do you think this excitement is warranted?
Absolutely! It’s the first device that has been approved by the FDA to deliver a potentially deadly hormone with precision, without user input. Is it a cure for diabetes in a box? No, but it sets a new precedent for our industry. It’s forcing all competitors to develop more advanced technology and better algorithms to diminish the overwhelming mental burden of type 1 diabetes.
Some say 120 is too high of a target BG. While I agree that it would be much better to have BGs in the 80-95 range, this is still a huge step forward. Having an average sensor glucose value of 130, like I do right now, is not all about the A1C. It’s more about the freedom, and the fact that I’m now enjoying my life much more than I ever have before. Today, I’m able to pursue what lights me up and I’m so much more productive because I’m no longer unintentionally allocating a ton of mental capacity to diabetes. I get to think about all the things that matter and make me happy.
As of today, May 7th 2017, I’ve been in range (70-180mg/dl) 86% of the time over the last 30-days. I’ve been on the 670g for almost two years, and I’ve realized that sleeping through the night, waking up with a normal BG, and being in range most of the time has become an “expectation” for me. It’s an awesome realization knowing that our entire T1D community may soon develop this same expectation, and will demand similar yet improved systems from the industry moving forward. That is exactly why I am so confident when I tell people that the 670G is going to transform the type 1 diabetes industry over the next 18 months.
If you could talk directly to the designers and engineers of the 670G system, what feedback would you give them?
Thankfully, I already do. A big concern for me was that the pump wasn’t as effective as I was hoping it would be in Auto-Mode when eating extremely low carb, under 30grams per day. I brought that up to the VP of R&D at Medtronic, and not only did he assure me that it was a valid concern, but also that they were already working on a potential solution. He flew out to our clinical site and spoke with many of the patients in the clinical trial and the doctors to discuss our experiences and ask for our insights and potential solutions. It’s great to see Medtronic putting patients’ needs first.
On a scale of one to ten (where 1 is very little and 10 is a huge amount) how much thought/effort would you say you are devoting to your blood sugar management now (on the 670G) compared to your previous method of blood sugar management?
On a scale of on to ten, I’d say a 2.5. I think about diabetes about 75% less than before since the 670g allows the user to be “Proactive vs Reactive”. This pump interaction is slightly more frequent than other pumps, but it does so much work on your behalf that it’s very well justified.
I assure you, T1D’s would much rather interact with their pump if it’s preventing them from going too low or warning them of a potential high, versus reacting after they’ve tanked way too low or they are already super high.
Would you want to continue using the 670G system once your trial period is over?
Absolutely! That’s why 100+ others and I wrote the letters to the FDA. There is no way I would ever go back to any system that isn’t dictating my blood sugars for me. It would be like going back to having a horse and carriage when you could drive a car. I’m very happy to see that Medtronic is continuing to support its users, and allowing us as the pivotal trial participants to stay on their system.
Is there anything else you’d like to share with our readers?
- I started a Facebook group exclusively for 670G users to help each other, and catalyze new users straight to success. With this FB group, we can also figure out what gaps exist in the current Medtronic Training Protocol. When Medtronic officially releases the 670G system commercially in June, over 25,000 people will be upgraded from the 630G. We plan to leverage this group as much as possible to benefit the entire T1D community by allowing Medtronic access to our findings and enabling them to include the information in their training tools.
If anyone already has their 670G pump, please request to join us.
- My website was designed to give the type 1 community an up-close look at what it’s like to wear this life-changing system. Choosing a pump is a four-year commitment, and I want everyone to feel like they have all the information they need to be confident in making that big decision. On the website, you can easily sign up for zoom video chats with me once a week to answer any questions for anyone considering the 670G pump.
There is also a daily calibrations section. I know families lost trust in Medtronic when we were disappointed by the 530G and the original Enlite sensors, but this system truly does work. So, I’m uploading my data to the website at least three times a day to showcase the accuracy and hopefully allow users who were disappointed with the Enlite sensors to recognize how amazing this system really is. Comparing the Guardian Sensor 3 and the original enlite is like comparing the Samsung Galaxy S8 to the original Samsung GT-I7500 (the first Samsung Smartphone).
Living with T1D is hard, and staying positive can be even harder, but I’d like to remind everyone to appreciate just how far our industry has come. The technology that has been developed in the last few years is unbelievable! Let’s all be grateful that we live in a time where technology can help us lead normal lives, and that we can’t have unrealistic expectations and find a cure yesterday. Instead let’s leverage the great tools provided to us to live life as comfortably as possible, and allow these advancements to continue chipping away at the overwhelming burden of T1D. In only a matter of years, we will all be able to look back on the 670G approval as a pivotal moment for our industry.