What advice should I give to a 30-year-old female patient with type 1 diabetes mellitus (T1DM), diagnosed at 29, with a current glycated hemoglobin (HbA1c) level of 8.2%, on basal insulin Tresiba (degludec) 26 units and Novorapid (insulin aspart) 8-8-7 units, with normal urine ketones, elevated blood glucose, normal estimated glomerular filtration rate (eGFR), normal liver function tests (LFT), and absent C-peptide, regarding transitioning to the Medtronic 780G insulin pump?

Transitioning to MiniMed 780G Advanced Hybrid Closed-Loop System

Your patient is an excellent candidate for the MiniMed 780G system, and you should strongly recommend proceeding with this transition given her suboptimal glycemic control (GMI 8.2%) despite appropriate MDI therapy, confirmed autoimmune type 1 diabetes, and preserved renal/hepatic function. 1

Why This Patient Qualifies

Automated insulin delivery (AID) systems are now preferred over non-automated pumps and MDI in people with type 1 diabetes, and your patient meets clear criteria for advanced technology 1:

• HbA1c/GMI >8.0% despite appropriate analogue insulin therapy (Tresiba + Novorapid) 1
• Confirmed autoimmune T1D (GAD antibody positive, absent C-peptide) 2
• Young adult with recent diagnosis—ideal demographic for technology adoption 3, 2
• Normal renal and hepatic function—no contraindications 1

Pre-Transition Calculations and Planning

Calculate Her Current Total Daily Dose (TDD)

• Current basal: 26 units Tresiba
• Current bolus: 8 + 8 + 7 = 23 units Novorapid
• Total TDD = 49 units/day 4

Initial Pump Programming Parameters

Set the following parameters for pump initiation 4, 5:

• Total basal dose: 0.48 × 49 = 23.5 units/day (program as hourly rate: 23.5 ÷ 24 = 0.98 units/hour baseline)
• Insulin sensitivity factor (ISF): 1700 ÷ 49 = 35 mg/dL per unit (or approximately 1.9 mmol/L per unit)
• Insulin-to-carbohydrate ratio (ICR): Start with 500 ÷ 49 = 1:10 (1 unit per 10g carbohydrate) 4

MiniMed 780G-Specific Settings

Program these advanced features 3, 6:

• Glucose target: Set to 100 mg/dL (5.6 mmol/L) for optimal outcomes—studies show this achieves 80% time in range 6
• Active insulin time: Set to 2 hours initially 6
• Auto-correction boluses: Will be automatically delivered by the system (typically represents 29% of total bolus insulin) 6

Critical Pre-Transition Education Points

Insulin Supply Requirements

Order rapid-acting insulin appropriately 4, 5:

• Only rapid-acting analogues (Novorapid/Humalog/Apidra) are used in pumps—no basal insulin 4, 5
• At 49 units/day, one 10mL vial (1000 units) provides 20 days of therapy 4
• Order 2-3 vials initially to ensure adequate supply during dose titration 4
• Never dilute or mix insulin when loading pump reservoirs 4

Site Management Education

Emphasize infusion set care 5, 3:

• Change infusion sites every 2-3 days 5
• Less frequent site changes correlate with higher GMI and lower time in range—this is a critical compliance issue 3
• Rotate sites to prevent lipohypertrophy

Transition Protocol

Day of Transition

Follow this specific sequence 7:

1. Continue Tresiba on the morning of pump start (do NOT stop abruptly)
2. Initiate pump therapy with calculated basal rate
3. Discontinue Tresiba 12-24 hours later (after confirming pump is functioning properly and glucose is stable)
4. This overlap prevents insulin deficiency gaps 7

Intensive Monitoring Phase (First 48-72 Hours)

Check blood glucose every 2-4 hours during the first 24-48 hours 4:

• If hypoglycemia occurs: Reduce basal rates by 10-20% 4
• If fasting glucose remains elevated: Increase basal by 0.1-0.2 units/hour 4
• Monitor for hyperglycemia >14 mmol/L (252 mg/dL): Check pump/infusion set and test for ketones 5

Expected Outcomes Based on Real-World Evidence

Glycemic Improvements

The MiniMed 780G achieves superior outcomes in real-world use 2, 6:

• Time in range increases from ~67% to 74-80% within 3-6 months 2, 6
• HbA1c reduction of 0.6-0.7% (from 7.9% to 7.2% in similar populations) 8, 2
• Time >180 mg/dL decreases significantly (from 29% to 17-22%) 3, 2
• Hypoglycemia remains minimal (<1% time <70 mg/dL) 6

System Usage Metrics

Expect high engagement with proper training 6:

• Auto-mode usage: 94% of time 6
• Sensor usage: 90% of time 6
• Auto-correction boluses handle approximately 29% of insulin delivery automatically 6

Critical Pitfalls to Avoid

Risk of Diabetic Ketoacidosis

Warn about pump-specific DKA risk 1, 5:

• Pump uses only rapid-acting insulin—disconnection causes relative insulin deficiency within 1 hour, absolute deficiency within 4 hours 1, 5
• If pump disconnects or malfunctions: Check blood glucose immediately, test for ketones if >14 mmol/L 5
• Always have backup insulin pens available 7

Compliance Factors Affecting Success

Address these predictors of suboptimal outcomes 3:

• Infrequent site changes strongly correlate with worse glycemic control 3
• Longer diabetes duration may require more intensive support 3
• Schedule follow-up every 3-7 days initially, then every 3-6 months for parameter adjustments 4, 1

Follow-Up Schedule

Short-Term Monitoring

Reassess pump settings every 3-7 days until glycemic targets achieved 4:

• Review downloaded pump/sensor data
• Adjust basal rates, ICR, and ISF as needed
• Confirm adequate site rotation

Long-Term Management

Schedule specialized pump clinic visits every 3-6 months 1:

• Review all parameters (basal rates, ICR, ISF) 1
• Adjust for physiological changes (weight, exercise, menstruation) 1
• Download and analyze time in range, auto-mode usage, and sensor adherence 6

Quality of Life Benefits

Emphasize these patient-centered outcomes 6:

• Significant reduction in fear of hypoglycemia 6
• Improved diabetes quality of life scores 6
• Better sleep quality 6
• Increased treatment satisfaction 6
• Greater flexibility for meals and activities 5

Special Considerations for This Patient

Young Adult with Recent Diagnosis

This demographic shows excellent outcomes 3, 2:

• Not yet in "honeymoon phase" (diagnosed at 29, now 30) so insulin requirements are stable 4
• Shorter diabetes duration predicts better improvement in glycemic metrics 3
• Higher education/socioeconomic status (implied by access to advanced technology) correlates with better outcomes 3

Medtronic Team Coordination

Your role as treating physician 1:

• Provide medical clearance and confirm no contraindications 1
• Calculate and prescribe initial pump parameters (as outlined above) 4
• Sign consent for perioperative/hospital pump continuation if needed 1
• Maintain oversight of glycemic targets and parameter adjustments 4
• The Medtronic team handles technical training, but you remain responsible for medical management and dose adjustments 1