Thinking about the Medtronic 780G — The Incredible Hulk?
“The strongest there is to crush after-meal highs!”
Want to listen to the podcast on this?
Episode 3: Mastering the Medtronic 780G – The Hulk of AID. We break down the Medtronic 780G, the most aggressive AID system for tackling high glucose levels. We explore how SmartGuard auto-corrections work, how to optimise settings, and how to manage exercise, high-fat meals, and hypoglycaemia prevention.
You can look forward to:
- The most aggressive system for tackling high glucose levels and optimising time in range (3.9–10.0 mmol/L or 70–180 mg/dL)
- Highly automated, requiring minimal user intervention
- Strong overnight glucose control
If you select the Medtronic 780G, here are the essentials:
- How the SmartGuard algorithm works
- Starting settings
- Tips and tricks
- Preventing and treating hypos
- High-fat meals
- Exercise
How the algorithm works
The Medtronic 780G system has three components:
- Medtronic 780G pump
- Guardian Sensor 3, Guardian 4, or Simplera
- The SmartGuard algorithm inside the pump
This graphic explains how the 780G algorithm works in a nutshell.
Take-homes
- The algorithm auto-calculates basal rates and correction factors.
- Basal insulin increases when glucose is rising.
- Auto-corrections are delivered aggressively every five minutes when glucose is rising quickly (above 6.7 mmol/L / 130 mg/dL) and basal increases are not enough.
- Basal insulin decreases and suspends if glucose is predicted to go low.
- The default target is 5.5 mmol/L (100 mg/dL), adjustable upwards to 6.1 or 6.7 mmol/L if needed.
Starting settings
The algorithm needs your weight, average total daily insulin dose, carbohydrate ratios, and active insulin time. SmartGuard then updates continually in the background.
You need to wear the system for 48 hours before SmartGuard can be turned on, so it can learn your insulin sensitivity.
Active insulin time (AIT) is the “aggressiveness switch” of SmartGuard — it governs how strongly it tackles after-meal spikes.
A simple guide:
2 hours = aggressive
2.5 hours = “normal”
3 hours = safer / slower
You can change the target level on the 780G, but for maximising time in range it is usually best left at 5.5 mmol/L (100 mg/dL).
Keep basal rates and correction factors updated in case you have to move into manual mode.
Once the above is set, the most common adjustment over time is carbohydrate ratios.
Starting an AID system can be broken down into two phases:
SURVIVE
THRIVE
You can download How to Survive and Thrive — 780G. A more comprehensive onboarding workbook is available: 780G Workbook.
Tips and tricks
If you want to reach 70% or more time in range, do not forget the basics:
- Three balanced meals
- Accurate carbohydrate counting
- Bolus insulin 10–20 minutes before eating
- Be active for 10–15 minutes after eating
- Rotate cannula sites
Follow the above and you may find: 99 Problems But Highs Ain’t One (download/use/share)
Other things to be aware of:
- Always suspend the pump when disconnecting (showers, sport, sex).
- Update manual mode settings in case SmartGuard stops:
- Basal rates
- Correction factors
- Target level
Preventing and treating hypos
It would be ideal if hypos were a thing of the past — but they will still happen.
The algorithm can prevent many overnight hypos.
However, if you take too much bolus insulin or exercise without planning, hypos will still occur.
You will often need less hypo treatment than before, because the algorithm will often have reduced or stopped insulin at least 30 minutes earlier.
You may also want to treat pre-emptively if glucose is 4.0–6.0 mmol/L (70–110 mg/dL) and trending down.
This chart is based on weight; the example shown is for a 30 kg person. Download How to Survive and Thrive — 780G and enter your weight at the top to generate a personalised version.
If you want this hypo guide, download it here.
High-fat meals
From the Mealtime Insulin Guide, we know that high-fat meals with carbohydrates (pizza, takeaways) need additional insulin.
If you set Active insulin time between 2–3 hours, SmartGuard will usually handle the delayed rise fairly well.
For example, you can enter all 100 g of carbohydrate for a pizza upfront and let SmartGuard do the rest.
If you still get a delayed rise, next time dial in 25–50% extra “fake carbs” about 90 minutes after eating (e.g. an extra 25–50 g in this example).
If you go hypo in the first 2–3 hours, next time only enter about 75% of the carbohydrates (e.g. 75 g instead of 100 g in this example).
Exercise
There is a quick method and a more comprehensive planned method.
The quick method
Turn on Exercise mode before starting — ideally 90 minutes before. Then take small carbohydrate top-ups every 20 minutes as required.
Avoid large carbohydrate loads all at once: glucose may spike and the algorithm may increase insulin, raising hypo risk.
How many grams every 20 minutes?
It depends on body weight. Here is an example for a 50 kg person. Download How to Survive and Thrive — 780G and enter your weight to generate your own chart.
You can download the exercise charts here: mmol/L and mg/dL.
The comprehensive planned method
To use this method, work through the Exercise Guide so you understand exercise types, bolus reductions, and how to adapt plans after trials.
Read it?
Great — you are up to speed with exercise management.
The T25/T25 table should now make sense. If not, read the article on the recent AID and Exercise Consensus Guideline — the infographic under the T25/T25 grid is especially helpful.
This downloadable exercise tool for the 780G makes creating and adapting exercise plans easier.
Go forth and conquer the 780G.
Check out the top ten tips to optimise time in range when using an AID system.
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