# Closed loop and exercise



## SB2015 (Mar 12, 2021)

I am now using a 780G pump and benefitting from it constantly adjusting my background insulin.
The only bit that still foxes the pump is if we go for a long walk, where I will hypo towards the end.
I use a temporary target, set before I eat breakfast so that it corrects me to the higher target.  In manual mode I would normally trickle in glucose throughout our walk (Wurther’s originals) to avoid hypos.  We are advised not to eat carbs without telling the pump when in auto mode.

I am interested to know how others manage exercise when using a closed loop system.


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## everydayupsanddowns (Mar 12, 2021)

I find that sometimes the tslim works really well, and other times it acts hopelessly late.

The tslim has a very different set-up to the MM780 of course. The adjustments it makes are based on the profile you currently have set (including basal and correction factors etc)... so if ‘exercise mode’ stops working well for me, I think it can be an indication that my basal pattern needs tweaking. Additionally... I can set a specific (very low basal) pattern and turn that on during, or even slightly before starting exercise to force the issue.

I’m still feeling my way with it a little. Initially I had a ‘dog walk’ virtually zero basal that I activated alongside setting exercise mode,  then I had a period where just setting exercise mode was enough.

Often with added carbs... sometimes without!


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## JohnWhi (Mar 12, 2021)

SB2015 said:


> We are advised not to eat carbs without telling the pump when in auto mode.


I was certainly not told this by either the Specialist Nurse or the Medtronic representative, and I have a problem with the logic thereof. Although my experience of the 780G with SmartGuard is briefer than yours, one thing I have found is that, if you are going low and basal has been shut off, there is little more that SmartGuard can do to solve the problem. Fast-acting carbs are needed. So far as I can see, entering additional carbs when you are low would present the possible danger of a small insulin input. Discussing settings with Medtronic + DSN, I suggested that cautious use of "Suspend All Delivery" worked for me as an Exercise Mode, and they did not disagree with that.


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## SB2015 (Mar 12, 2021)

JohnWhi said:


> I was certainly not told this by either the Specialist Nurse or the Medtronic representative, and I have a problem with the logic thereof. Although my experience of the 780G with SmartGuard is briefer than yours, one thing I have found is that, if you are going low and basal has been shut off, there is little more that SmartGuard can do to solve the problem. Fast-acting carbs are needed. So far as I can see, entering additional carbs when you are low would present the possible danger of a small insulin input. Discussing settings with Medtronic + DSN, I suggested that cautious use of "Suspend All Delivery" worked for me as an Exercise Mode, and they did not disagree with that.


Now that makes more sense to me as it would stop any Bolus for the carbs.  Otherwise there was no way of lifting levels up to the temporary target.  Thanks for that @JohnWhi .
I have a meeting with Medtronic on Monday.  I will raise this then.


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## SB2015 (Mar 12, 2021)

everydayupsanddowns said:


> I find that sometimes the tslim works really well, and other times it acts hopelessly late.
> 
> The tslim has a very different set-up to the MM780 of course. The adjustments it makes are based on the profile you currently have set (including basal and correction factors etc)... so if ‘exercise mode’ stops working well for me, I think it can be an indication that my basal pattern needs tweaking. Additionally... I can set a specific (very low basal) pattern and turn that on during, or even slightly before starting exercise to force the issue.
> 
> ...


Thanks for that @everydayupsanddowns .
What I had picked up defied logic, and my experience supported logic.  @JohnWhi ’s experience supports my thoughts too.  I think I have a plan to try before my appointment with Medtronic and DSN on Monday.  Thanks both.


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## Maco (Mar 13, 2021)

Hey @SB2015, think we’ve spoke about this before but I’ll give my input again.

Medtronic advises me to set the temp target 2hrs before exercise, then the amount of time you’ll exercise plus another two hours. The 2hrs before let the pump & your BG adjust, then obviously the temp target while you exercise then the 2hrs post workout is to stop you dropping. At the minute I’m stilling training twice a day, one session weights one session cardio. No temp target needed for the weights but definitely needed for the cardio, but like I think you’ve previously mentioned it’s quite easy to simply forget or spontaneously decide to go for a walk etc.

My cardio only consists of two things, treadmill or cross trainer & never longer than 50 minutes. For me it doesn’t matter if I’ve set my temp target or completely forgot my BG was always drop. As John has said at this point there’s nothing the pump can do, it’s just like if you give too much bolus for a meal. Your going to go low & you’ll need carbs.

I always exercise with a packet of Orange glucose tablets in my pocket, 2 tablets is enough for a full on hypo so if I get down to the low 5’s or high 4’s I’ll have one tablet. Continue to drop i take another. Works every time


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## SB2015 (Mar 14, 2021)

Maco said:


> Hey @SB2015, think we’ve spoke about this before but I’ll give my input again.
> 
> Medtronic advises me to set the temp target 2hrs before exercise, then the amount of time you’ll exercise plus another two hours. The 2hrs before let the pump & your BG adjust, then obviously the temp target while you exercise then the 2hrs post workout is to stop you dropping. At the minute I’m stilling training twice a day, one session weights one session cardio. No temp target needed for the weights but definitely needed for the cardio, but like I think you’ve previously mentioned it’s quite easy to simply forget or spontaneously decide to go for a walk etc.
> 
> ...


Thanks Maco.  Glad to say that apart from this issue things are working well.  I was just unfortunate at the start with dodgy sensors, illness, ..., but now happily sitting with a TIR in the high 90s most of the time.  
Thanks for the tips.  It is interesting how different the advice is from the trainers, but ultimately we have to find the practical solutions between us.


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