**Disclaimer** This blog is about
methods that work for me and my diabetes, in my clinic setting, with the team
that provides my care. We all have very different care, funding, time,
management techniques, preferences etc, so this blog is from my personal
experience and musings.
I’m conscious that when I’m asked
to present at conferences, training sessions, lectures or write for journals
and other publications, many of the requests I receive are about what went
wrong with my diabetes and my care. When I deliver a presentation I always
ensure that whoever is listening understands that what happened was in my past
and is not my present or future. A great deal has changed in my T1D care over
the last 4 years and I have a lot to be thankful for... (cont)
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!!
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!
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!
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
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!
