Final thoughts on the Medtronic MiniMed 640G with SmartGuard

Here are my final thoughts on the Medtronic MiniMed 640G insulin pump with EnLite sensors and SmartGuard low glucose suspend. Watch the video to see if I give it a thumbs up or thumbs down... It was a close call!!

Enjoy :)

Ninjabetic x

Nursing, Diabetes and Insulin Pumps

Here's a quick video about life as a student nurse with Type 1 diabetes and an insulin pump. 

Enjoy!!

Ninjabetic xx 

How To: Do a set change/cannula change and use an insulin pump

Here's a little video of me showing you how to do an insulin pump set/cannula change and how to use a pump for basal/bolus options.

Enjoy!!

Ninjabetic x 

Boyfriend vs Insulin Pump

This week I interviewed (grilled) my other half about what he thinks of my insulin pump. 

Ninjabetic x 

Video - The Diabetes UK Professional Conference 2015

In this week's video I'm at the Diabetes UK Professional Conference and I talk about my experience of using the MiniMed640G and how SmartGuard worked to prevent hypos! 

Ninjabetic x 

Video - Hypoglycaemia prevention

In this video I talk about my experience of using the MiniMed 640G pump from Medtronic and how it's working to prevent my hypos. 

Ninjabetic x 

64 days on MiniMed 640G: Managing my Type 1 Diabetes. Week 1

Some of you may know that I've been lucky enough to be offered a 64 day trial of the brand spanking new MiniMed 640G by Medtronic. Why 64 days? Because the number 64 is in the pumps name. Why not 640 days? Well, I asked (a few times), but sadly the answer was no. But hey-ho... I'm not complaining! 

So during the 64 days I'm going to be vlogging (it's like blogging but with videos - vlogging!) on youtube about my experiences with the 640G. You'll also find two other patients with Type 1 who are also using the 640G and will also be vlogging - Dave (@SowerBee) and John (@MM640G).

For those who haven't heard about this pump you can find more info on a previous blog that I wrote about it. It goes into a lot more detail about the technology and the aim of the new system,

What can I tell you so far about the pump?

Ok, I'm only a few days in so I want to start with the insulin pump. It's taking some getting used to as I've been using another pump by another company for 2 years now. I found it really helpful to sit down with a cuppa after my training and just have a look around the options and settings, just taking time to get used where everything is and how to access the options I'd be using. It's important to be comfortable with medical technology - There's no set time that you should be used to it and 'flying' through the options. Everyone learns at a different pace. Asking lots of questions helps! 

The pump itself - I love it! 

I'm not just saying that because I'm trialling it - but I really rate it (yes rate, not hate) and after a week of using it I would be more than happy to continue using it in place of my regular insulin pump. As a stand-alone pump (forget the CGM and SmartGuard for now), it's bloody impressive! I've never used a Medtronic product before so I have no idea how similar it is to other pumps they have, but personally I think it has set the standard in terms of what's on the market at the moment.

The pump provides a vast amount of options and functions, offering much more control (in terms of diabetes management) than I'm used to. For some I can imagine that may be slightly intimidating (I was a little overwhelmed during my training session) but don't let the amount the pump can offer put you off - as a patient you are in control. Now that I've had a few days to get used to the pump I can see just how beneficial it can be to my day-to-day diabetes management. In a strange way, as much as it gives me more control, I also feel it gives me more freedom through the choices I can make.

It's the little things that have impressed me...

For example - I can flag specific events that have affected my blood glucose (BG), so if I've had a mahoosive pizza and my BG has shot up I can flag that on the pump. Similarly if I've had a post running hypo, I can flag that too. Then in my appointments when my consultant says to me...

"What happened on this day 2 months ago?" 

my answer won't be... 

"2 months ago? I don't remember what happened 2 hours ago!"

... but it will be flagged in my data which will give us both more insight into what actually happened, rather than guessing. We all know how hard it is to remember every little detail! 


Other awesome pump things... (These aren't all of the options but they are a few of my favourites).

• It has a big colourful screen - this is a huge help to me as I have retinopathy
• Sexy design - It looks like an iPod and is very sleek and smooth (does that sound weird?)
• The belt clip is also the key that unscrews the battery cap! (No more 5p tricks!)
• It has a back button (this impressed me far too much)
• The menu is incredibly easy to navigate
• There are clear sections in the menu depending on which info you need - e.g. history which is broken down into sub-sections - alarm history, daily history, sensor glucose history etc. 
• The pump will remind you when you need to change your tubing and re-fill your reservoir (no more "when did I last do that?" moments
• It has a 'reminders' section which has sub-sections that can be personalised e.g. reminders to take other medications, check your BG, a 'missed meal' reminder etc. - I really like how personal I can make this pump!

It also has the regular functions that you would expect from an insulin pump, like bolus delivery options and temporary basal rates.

Are there any cons? 

One biggie that had me worried when I started using this pump was that the blood glucose meter that works with it doesn't have a bolus wizard, only the pump does.

A bolus wizard basically calculates the amount of insulin you need to take for a meal (or a correction dose) depending on your blood glucose levels, the carbohydrate content of your food (if applicable) and other factors such as exercise or illness. Now... my current BG meter has a bolus wizard which does all of this and then sends (via Bluetooth) the amount of insulin I need to my pump which then delivers it, meaning I don't need to fish around in my bra or pockets to find my pump and do this manually. 

Th Contour Next meter (the one working with the 640G) doesn't have that function, meaning trips to the bathroom or a different room to pull the pump out from wherever I've hidden it in order to use the bolus wizard. There is an option on the BG meter to deliver a pre-set dose of insulin from the meter straight to the pump (no fumbling) and also to give a dose of insulin that you've decided yourself straight to the pump (also, no fumbling). 

For some people this isn't a huge con, but I think it depends on how open you are about using your insulin pump - everyone is completely different. Personally, I don't mind people knowing that I have an insulin pump, however, depending on the situation (a meeting or a lecture for example) I would much prefer not to be fumbling around in my bra for my portable pancreas. 

Currently this is my only con and one that I was aware of before getting the pump. But who knows... at the end of the 64 days maybe this won't be such a big deal for me! At the moment the pros certainly outweigh the cons!



I'll blog about the CGM and SmartGuard soon... I promise! 

Ninjabetic x 

Helpful links

Medtronic

MiniMed 640G 

MiniMed Infusion Sets

MiniMed e-shop

Medtronic MiniMed 640G and SmartGuard Technology

Yesterday I went off to Medtronic’s UK head office expecting to continue with our usual blogger and patient advocacy meetings. What I didn’t know was that I was actually going to be given an exclusive preview and test run of the new Medtronic MiniMed 640G insulin pump and CGM system with new SmartGuard technology! Now that's what I call a good day! 

As a Medtronic patient advocate I have been working alongside them, with a group of other patients and carers, to help them move into the world of social media and digital health care, and to offer an insight into what patients really want from diabetes technology. This in itself bought me the opportunity to travel to Amsterdam last year to blog about their Diabetes Junior World Cup, and here I was again, with yet another opportunity!

I should explain something else… I’m not currently a Medtronic user, but what I really like about the company is that this doesn’t matter to them. I have diabetes, I live with it day in day out and I have views about it – the products that I do or don’t use (often this is out of my control anyway) doesn’t matter to them. This, of course, doesn’t mean that I won’t be a Medtronic user in the future and with the new and exciting MiniMed 640G technology, I could be easily persuaded.

So… enough about me… the 640G is what you need to know about!

The MiniMed 640G is a sensor augmented insulin pump. Medtronic has a vision and that is to create an artificial pancreas and their 640G is the next step towards achieving that vision. Their aim is to create technology that gives people more freedom, improved safety and better health when it comes to diabetes. We know that many companies have this same aim but this product (from what I saw) really does deliver those aims.  

The 640G uses a new technology called SmartGuard. SmartGuard is designed to give people advanced protection against hypoglycaemia and hyperglycaemia. The intelligent system has been based on the wants and needs of people who already use the Paradigm Veo insulin pump, providing better blood glucose control and safety, especially when it comes to nocturnal hypos – something that I think worries us all from time to time.

The system is similar to Medtronic’s Paradigm Veo but, as I said, it’s far more advanced. The Veo has a low glucose suspend function in which the pump will turn off insulin delivery for up to 2 hours if a person's blood glucose levels reaches a pre-set low glucose threshold. However, the new SmartGuard tech will turn off insulin delivery before a person's blood glucose hits the low glucose threshold, therefore avoiding hypoglycaemia. It does this by predicting a persons blood glucose levels 30 minutes before they are going to drop (providing they are also using an Enlite CGM - Continuous Glucose Monitor). The prediction is based on how quickly the person’s levels are dropping. The pump will alarm/vibrate to alert the person that the insulin delivery will then be turned off (for a minimum of 30 minutes) and will stay off until their blood glucose starts to rise again or until they feel better and manually override the system to turn their insulin delivery back on. 

When insulin delivery is turned off to avoid a hypo this means that all insulin is turned off - basal and any bolus programmes that are running - e.g. dual wave. If the person would prefer to eat/treat before the auto-suspend starts then they can stop the suspend function and treat the impending low like they usually would. The user is very much in control of how the system works. 

A high threshold can also be set, in which the pump will alarm/vibrate if a person is going to reach their high level, therefore allowing them to manage the impending high (correction, temp basal increase etc). The pump will not automatically deliver more insulin if a person is reaching their high threshold - This is what a closed loop system (artificial pancreas) is but the technology isn't quite there yet.

One important question that was asked by fellow blogger Mike (@everydayupsdwns) was; What happens if a person’s blood glucose drops below the pre-set low glucose threshold but does not rise again within the 2 hours that the insulin delivery has be turned off for? The answer is that the pump will only turn delivery back on after 2 hours if the person has physically interacted the pump e.g. pushed a button, therefore the pump is recognising that the person is aware of the hypo. If, for example, they are unconscious and do not press any buttons, the insulin delivery will be suspended for a further 2 hours, so 4 hours in total. After those 4 hours… well I just hope that the person would be found by then.

We joked that the pump could have technology like cars do which alerts the emergency services if it is involved in an accident and its location. I actually think this is a brilliant idea. Maybe something for the future, eh :) 

We were told that the algorithm that is used in the SmartGuard technology was the same that was used in the Pilgrim Study in which 80% of hypos were avoided during exercise. The remaining 20% were due to levels that were dropping at a very fast rate which resulted in the persons blood glucose levels hitting their low threshold marker. 

This brings me to alarms and vibrations. In the situation Mike mentioned above, alarms will be set off by the pump to alert a person that they are heading towards, or have reached, their low glucose threshold, therefore hopefully alerting someone else to the unconscious person. It’s a scary reality, but something that we do need to think about as people with diabetes.

The alarms can be turned off though! If you’re sitting in a meeting or your child is in assembly, or if you just want to sleep the whole night through (and you’re other half too!) the low and high threshold alarms can be turned off to avoid that beep beep beeping. The person using the 640G can turn the alarm off themselves, but this doesn’t mean that the low or high thresholds will be turned off. It just means that if a person is heading for a hypo then the pump will deal with it without alarming. If a person turns off the hyper alarm then the pump will not be able to do anything about the levels heading up. Sounds a little scary doesn’t it… Turning off the alerts and letting a device do its thing... but as @LwSweetpea88 pointed out – It’s hard to trust new technology, but you don’t know what it will be like until you’ve tried it.

A few quick bits about the MiniMed 640G

• It will be available in the UK, Sweden, Denmark and Australia – I believe it will be launched in early February (the 2nd)
• It’s licensed for use by children 
• It needs a calibration at least every 12 hours
• The sensor life is 6 days
• If a person decided to restart the sensor past the 6 days then it may well result in a calibration error – if the sensor has 2 calibration errors then it will stop working
• Low level auto-suspend had a minimum suspend time of 30 minutes
• Insulin delivery will only be turned back on when the trending arrows on the receiver are pointing up (meaning that glucose levels are rising sufficiently)
• There are a choice of high and low alarms
• There is an alarm if the user’s blood glucose levels do hit the low threshold (though the aim of SmartGuard is to avoid hitting this threshold)
• The user can choose to have no threshold at all
• The pump pairs (via radio frequency) with the contour next link USB blood glucose meter
• The pump has a bolus wizard, the blood glucose meter does not
• The blood glucose meter can tell the pump to deliver manual insulin doses (decided by the person using it) or pre-set doses - e.g. 2 or 4 units
• The pumps come in cool colours (and I think look a little like iPods)
• It’s not too big and not too small – comes with a clip and you can also buy Lenny the Lion rubber protective cases for it! 
• The pump has a colour display screen
• The display on the pump has colour coded icons which let the user know if they are running low – e.g. the battery will be green, amber or red depending on how much battery is left 
• The screen is a lovely size (really important for me as my retinopathy means I’m always squinting at my tiny pump screen)  
• Both pump and CGM are waterproof  
• The system uses the Enlite sensor & guardian link transmitter (the transmitter has been improved - so we were told)
• The pump has a 'back' navigation button! This may seem like a small detail but my current pump does not have this, meaning I have to scroll through all options if I miss the option that I want
• 5 basal settings can be used, temporary basal rates can be set and the pump has options for bolus doses to be delivered in different ways (e.g. dual wave)
• The pump does not need to be used with CGM - It can be used as a stand alone insulin pump (obviously this will leave the user without the option of the low and high thresholds, alerts and CGM trace etc)
• CGM data can be uploaded via Medtronic's software package, CareLink, and sent to your diabetes team
• People will be able to purchase supplies through Medtronic's e-shop

Something I haven't mentioned is price... and that's because I don't know it. I did ask the question and I was told that it wasn't a huge step away from the Veo and enlite sensors as a combination, but we will have to wait for more information on that one. 

That brings me to the end of the scribbled notes that I took during the meeting... I suppose the only question I need to ask myself based on what I saw and know is would I use it? 

My answer (if self-funding and CCGs didn't have any influence over my decision) is yes, without a doubt! I'm fed up of waking during the night with low glucose, worrying about what my levels are doing and if I'm going to need to treat a hypo during a meeting or whilst I'm on placement. I'm fed of of the growing fear that one day I might need an ambulance call out or that my driving licence might be taken away from me, that I might end up in a dangerous situation due to my diabetes. I'm also bloody fed up with my constant battle with hypos and exercise! But that's a whole other story.

I hope this blog has been useful to you... I'm aware that I have been using notes to write much of this blog but I hope what I have said is accurate. I'm sure Medtronic will be releasing more information soon, but until then please feel free to share this with anyone who might be interested!

Also - Here's a video with some nice visuals 

Ninjabetic x 

Diabetes - We speak the language

It’s bitter sweet, isn’t it? On one hand, no one wants Type 1 diabetes (or any type for that matter) to come knocking at their door. No one wants a life-time of insulin injections, pump set changes, finger pricks and carbohydrate counting. Within the diabetes online community, I often hear people being welcomed into ‘the group that no one wanted to join, but everyone is glad to be in.’

Why is that? Because on the other hand, the illness itself can be incredibly motivating and, for many, can provide a sense of empowerment. Those with diabetes develop will-power; they develop knowledge about the human body, they exercise their brain 24/7 by staying one step ahead and thinking like a pancreas, they exercise their bodies and treat them well, they become mini mathematicians through carb counting, measuring blood glucose levels, calculating correction and bolus doses… the list goes on and shows that, in fact, having Type 1 diabetes can make us incredibly determined, empathetic and bring purpose to our lives. Type 1 diabetes, through its bad points, allows us to create our own unique skill-set.

This brings me to talk about the incredible weekend that I’ve just spent with 132 youngsters, from 12 countries, who all have Type 1 diabetes. The cause… To provide them with the opportunity to meet other people with diabetes from all over the world, to share stories, experiences, expertise and to support each other throughout a Junior World Cup. The event was organised by Medtronic, showing that we all speak the universal language of diabetes. 

Looking at the players you wouldn't have a clue that they had diabetes and honestly, 99% of the time I forgot that they did! Leaving the airport with the Spanish team, the kids were beyond excited as they danced, laughed, showed off a few moves that they would be saving for the pitch the next day. It wasn't until I saw a tiny piece of pump tubing poking from underneath of one of their tracksuits that I remembered why I was actually there. Why we were all there. It was diabetes that had bought us all together, however, as someone who has diabetes herself, the best part was seeing them getting on with things and not letting their diabetes stop them. It really was hugely satisfying to see how little their diabetes bothered them and that the most important thing at that time was getting together with their new friends. 

This year's UK team were all insulin pump users. The aim of this was to raise awareness about insulin pump technology and what it can provide for young children and teens. It was interesting for me to watch the team, and their accompanying parents, throughout the weekend, noting that the kids were pretty much in control of their own pumps, their testing and treating highs and low. And rightly so! This technology (especially when linked with a CGM) should allow for parents to relax a little, give them the confidence they need when their kids are off doing their own thing and provide them with some comfort that the kids can safely manage the technology. Of course, the worry will always be there, but one of the aims of an insulin pump is to alleviate some of that. For the kids I could see that the pumps promoted independence with their diabetes, something that I imagine was very important for them as many were heading to secondary school within the next few weeks! 

Not only that but for growing guys and girls; flexibility seemed to be key in their lives!

"I can now eat what I want, when I want."

"I usually take it off for football matches and check at half time."

"The pump allows for my sugars to be better controlled before, during and immediately after sport."

"The CGM lets me watch my sugars closely before and after sport as well as when I am playing."

The bonds that were made looked tight. The team were just that - a team, and despite only meeting each other on the weekend they had a couple of things in common! Diabetes, football and instagram were the main topics of choice. I was even persuaded to re-start my instagram account as I wouldn't be "cool" unless I used it. It was evident that the team had two main goals that weekend, having fun and learning! That's what the event was all about and the UK team certainly did that from what I saw.  

Charging up and down the pitch, the kids took it all in their stride. Testing before the match, playing for 10 minutes, testing and treating a hypo (if necessary) during half time, then getting straight back to it. "I'm 8.8!" I heard someone shout, "Me too!" said someone else as they shared their blood glucose levels after a match. Looking around me other teams were doing the same. Some comparing pumps, pens, numbers, football boots, blood glucose meters... Though I couldn't understand what they were saying it didn't matter. I knew that when I saw someone handing their friend a bottle of juice it was because they were hypo. 

Diabetes and support doesn't always need to be heard to be understood, but it does needs to be seen. Parents will know, people with diabetes will know... Often you just have to look at someone with diabetes to know exactly what they need. I think that's a really important lesson when it comes to gaining more of an insight into our condition and definitely something that this event proved. Type 1 diabetes goes far beyond what has been written in a book or a leaflet, what is delivered in lectures or during sales pitches, and it goes far beyond the 15 minute appointments that we recieve. The condition is personal to each of us, to each of the kids that I saw on the weekend, and can't be treated with a 'one size fits all' approach. Flexibility and understanding are key in the self management of diabetes, whether that's gained through sharing experiences, tips, advice or just sitting back and listening to others. More importantly though, learning through real experiences, through seeing, not just hearing, is what it's all about and I believe this is what the event showed on the weekend, if that was the aim or not. 

So well done to the teams, you've taught me, you've taught your team mates and you've taught many people that diabetes is a language that can be understood by everyone. 

Ninjabetic x 

The UK team - Winners of the Fair Play award

For more information about Medtronic and the products the have please visit their website here - http://www.medtronic-diabetes.co.uk/ 

For information about how you can be a part of the Junior World Cup 2016 please 'like' the Junior Cup Diabetes facebook page or 'follow' them on twitter.

To view more pictures and videos of the event take a look at my facebook page, Ninjabetics, and twitter account @ninjabetic1

Medtronic

Yesterday I went to visit the lovely folks from Medtronic, with other diabetes bloggers and patient advocates, to give feedback that would help them identify areas they could improve on and how they can support the people who use (or are thinking of using) their products.

 

 

 

 

Having never used a Medtronic product in my life (sorry guys), I was a little nervous about what they would expect from me. How could I give feedback on products that I hadn't used? But there was the promise of a free lunch, and also the opportunity to share my ideas on what I thought could help to improve people's lives.

I couldn't turn down an opportunity like that!

So myself and fellow Portsmouth diabetes blogger, Anna (@Type1diabetesblog), battled the elements and made our way to Watford for the afternoon. The free lunch was good... but the focus group was even better :) I learnt a lot about the Minimed Veo (insulin pump) and how it works with their Enlite CGM sensors (continuous glucose monitor) to suspend a persons insulin for up to 2 hours when the CGM detects that they are heading towards a hypo. Something that was made clear from the word go is that the user can override this 2 hour period if they want to pump to carry on delivering insulin. *phew*



Other information that we were given is that the Minimed is now the only system clinically proven to significantly reduce hypoglycaemic events...

This has resulted in:

• 32% reduction in night time hypos
• 38% less severity and duration of night time hypos
• 40% less values in the hypo range at night
• 0 severe hypos

 

 

 

 

 

                                              

Next we moved on to Medtronic's Enlite CGMs, and the other patients in the room shared their experiences of using of them (or other brands). My ears pricked up when hearing stories about how much people's HbA1c has improved, hypos are caught much earlier, sleeping is made much easier and isn't interrupted unless necessary and their lives in general have been improved by the added information that CGMs give.

 

 

 

 

I had CGM jealousy. I stared at everyone's CGMs and wanted one for myself... I was the only person who didn't have one. If I could have found Medtronic's stash of Minimeds and CGMs the I probably would have raided it and filled my bag.

I have a current a1c of 9.9 and I wake up during the night to check my blood sugars and make sure I'm not heading towards a hypo. I'm working my bum off to get a lower a1c and it's exhausting at times. Another issue that I have is that I find it incredibly hard to predict where my blood sugars are heading just by seeing a number once every few hours. Is it going up? Going down? Staying where it is? I can't see what it's doing, so I just have to make the most educated guess I can... And as you can imagine, that isn't always right.

 

 

 

We were then told about a special promotion that Medtronic are offering to Minimed users who aren't currently using a CGM. I've popped some links at the bottom of the page if you wanted to take a look.

 

Finally (and the part that I could really contribute something to) we were asked about the best ways Medtronic could engage with patients. Obviously I boasted about the joys and benefits of social media, in particular twitter facebook YouTube and blogs, and hopefully something can come of that.

 

 

Ninjabetic x

 

 

Disclaimer: Medtronic haven't asked me to talk about their products in this blog post. Anything written in this blog post are my own thoughts and opinions and not those of Medtronic.

 

Enlite CGM Special Promotion - http://www.medtronic-diabetes.co.uk/patientstories/hypo-protection?utm_source=blogger&utm_medium=site&utm_campaign=hypo-reduction

 

 

Minimed Voe Insulin Pump - http://www.medtronic.co.uk/your-health/diabetes/device/insulin-pumps/paradigm-veo-pump/

 

Enlite CGM sensors - http://www.medtronic-diabetes.co.uk/patientstories/hypo-protection?utm_source=blogger&utm_medium=site&utm_campaign=hypo-reduction