A First Hand Comparison: Minimed Paradigm vs. FreeStyle Navigator

Diabetes Technology Glucose Monitoring
1

I’m a relatively new user to this forum but have been reading the posts for some time now. I’ve been a pump user for more years than I can remember and jumped on the CGMS wagon when it first came out as a separate Guardian system.

Let me first discuss the Minimed Paradigm CGMS system a bit. When news first hit that Minimed had released a CGMS system in limited markets, I just simply had to jump on it for my own peace of mind. I live in the northeast and flew down to Houston to purchase (out of pocket) the Guardian system, which, at the time, was separated from the Minimed pump.

To be rather blunt, the Minimed CGMS hasn’t changed much since back then. The technology is essentially the same and the sensors (oh, the sensors) are just as troublesome. This post is not meant to look at every single component nor is it meant to be an instruction manual, so I will skip the small details.

The Minimed sensors contain a very long and thick needle (I cannot stress this enough). I am a rather athletic male and have very little fat anywhere on my body. The sensors are inserted through an insertion device, which, quite literally, springs the aforementioned long and thick needle right into your stomach. With my physique, the majority of insertions resulted in extreme pain and quite severe site bleeding (my pants sometimes got blood stains from the dripping blood). I also quickly found that when there was excessive site bleeding, the sensors were worthless - they would not get a good signal. This was especially disheartening, not only for the physical pain, but the pain this process was on my wallet. My insurance considered CGMS systems experimental and did not cover the cost, with each sensor resulting in a $35 out of pocket expense.

Assuming a successful sensor insertion, I waited out the calibration period and entered my BG reading. In a nutshell, I have had an awful experience with the Minimed CGMS’ ability to accurately display BG readings. It was a false sense of security knowing that I had a CGMS sensor on me but which did not reflect accurate results. For example, it would not be uncommon to be in the 200+ range, bolus, approach hypoglycemia about an hour later (~90-100) and have the CGMS still reflect the 200+ range. Worse yet, the results gained some accuracy around the third day of use, which is also the sensor’s expiration date (72 hours). Often times, the sensor would not have a good signal or would lose it after a day or two of use. This resulted in false low alarms, with the CGMS system advising me that I was low when I was perhaps 50+ units higher.

The nice feature about the Minimed CGMS system is that it is housed within the Paradigm pump and does not require carrying two separate devices. However, this feature was not strong enough to hold me as a customer once I found the FreeStyle Navigator.

I ordered the FreeStyle Navigator through one of the authorized resellers. The ordering process was long and drawn out because of the multiple hoops that the patient is required to jump through. My reseller, in particular, was horrible (and still is). After hours of phone conversations and numerous medical documents, my order went through and my insurance billed. I received the device and opted not to partake in the formal training given my long history with the systems and my technical knowledge.

Setup was a breeze. After configuring the device with the necessary options, I took out one of the sensors. The sensor and its support bracket are attached to the insertion device. To insert, you simply peel off the tape backing, apply it to the designated area, and press a button. I simply cannot compare the insertion discomfort between the FreeStyle Navigator and the Minimed CGMS system because, quite simply, the FreeStyle Navigator does not have any discomfort! Most times I barely feel anything, other times it may feel like the prick of a lancet device. I have not ever had any pain or site bleeding.

The calibration period with the FreeStyle Navigator is quite longer (10 hours), but the sensor itself lasts longer (5 days). Once calibrated, however, I was absolutely amazed as to how accurate the device is. I am not getting into the technical specifications between the two devices (ie. the data refresh rate, frequency of calibration, etc.), but in all of these categories the FreeStyle Navigator wins hands down. The pattern trends are accurate and the displayed BG level is usually no more than 10-15 points off from a fingerstick reading (sometimes it’s as close as 3-5 points off!). I have had a few times when the device was not properly calibrated and the readings were consistently approximately 30 points higher than my fingerstick, but this was quickly solved by manually requesting a BG calibration. The sensor really does last the full 5 days and the results are just as accurate on day 5 as they are on day 1.

Now the bad. I had a few sensors that didn’t work due to errors, but a brief call to technical support resulted in a new sensor being shipped to me within 2 days. The sensor’s adhesive is not as strong as I’d like and, even worse, leaves my skin extremely irritated. By day 2 or 3, my skin is itching, red, and bumpy. I recently started to use a prep pad which creates a thin film layer over the skin. This greatly reduces the irritation but it does not completely solve the problem. The FreeStyle Navigator designers can really improve on this area. Also, the Navigator requires an additional, albeit small, device to carry around. This will be solved with the future integration between the FreeStyle Navigator and the Omnipod.

In summary, below is a list of pros and cons of each system:

Minimed CGMS

Pros: Pump integration; small transmitter
Cons: Highly inaccurate results; extremely painful insertion; 3 day sensor life; 5 minute data refresh rate

FreeStyle Navigator

Pros: Highly accurate results; painless insertion; 1 minute data refresh; 5 day sensor life
Cons: No pump integration; larger transmitter; extreme skin irritation

Having said all of this, I am EXTREMELY happy with my selection of the FreeStyle Navigator. It has really given me piece of mind and valuable information which I use to manage treatment. My only regret is not having found the Navigator sooner!

If you have any questions about either system, please post a reply or PM me and I will get back to you with an answer!

2

I use the Minimed. I threw out the sen-serter, as I find manually inserting the sensors is easier and no bleeding. I ‘lie’ to the CGMS and get 9-16 days from one sensor. I find the first day of new sensor gives inaccurate readings. The second through to the last day of sensor life Where I can’t ‘lie’ to it anymore are actually pretty darn close.

Navigator and Dexcom have pluses, to be sure, but I prefer the all in one type of thing. I have the pump, an iPhone and that’s all I want on my ‘Utility belt’ (Batman I am not …LOL)

3

I “lied” to the device as well and opted to select that I inserted a new sensor when the same one was still inserted. However, even with the best sensor, the signal started to die around the 5th or 6th day. It amazes me that you’re able to get 9-16 days from one sensor!

As for manually inserting the sensors, I tried that too but with little success. I inserted the silhouettes manually, but I found that the sensor needle is much thicker and rougher than the infusion set, so it was difficult to make a smooth entry without hitting muscle or scar tissue.

4

I really think the CGMS, like infusion sets, will be a YMMV type thing. I have had great success with the Minimed - I find about 85% of my sensors are extremely accurate, even on the first day; I usually have no pain upon insertion (like this morning on my thigh - and no bleeding!); I get a full week out of each sensor (could get more, but choose not to); and best of all - my insurance covers the CGMS at 90%. When I decided on one, my insurance would not cover the Navigator, but they would the Minimed, so that was really what made my decision. It’s just icing on my cake that the transmitter is integrated into my pump.

I think Minimed is working on next gen sensors - I seem to recall reading that they acquired a company with a new type of CGMS - so that’s probably why they haven’t issued any updates to the current Guardian sensors. I’m hoping they’ll come out with their patch pump and new CGM system integrated into one PDA-style controller/receiver, about the time that my warranty is up on the 522. Wouldn’t that just be sweet?

5

The Minimed CGMS will save all the data in the pump. But how is the FreeStyle Navigator doing this? Is the device itself saving all the data? If this is the case is it possible to get the data as an XML or CSV file? This would be very interesting for our project Glucosurfer.org. We could develop an additional import filter for these files as we did for Minimed and Accu-Check files.

6

The FreeStyle Navigator does save all of the data in the device. Moreover, it can sync the data with a PC running the FreeStyle software wirelessly using Bluetooth. The software program can also receive the data from the Omnipod using Bluetooth and the two are integrated together. It’s actually a very nice software program with a lot of options and reports. You can export the data although I doubt XML/CSV are options.

7

Would you like to share an extract of your data for further analysis? You will find my e-mail address on the project page. As an alternate to e-mail you can create an account for the Glucosurfer project and upload the file on the page diary after login…

8

I feel much the same way about my Navigator (which currently reads 114 ->). Let’s see how it compares to my current blood sugar. I’m on Day 4 of this sensor (27 hours remaining), the adhesive is holding (though I agree, they can do better), and I can’t sense the sensor in my left arm. grabs strips Okay, BG = 115 mg/dL. Good boy, Navigator!

I tried out the Dexcom and an older diagnostic version of the MM device. For me, comfort, accuracy, and display features were everything and the Nav won on all counts. (At the time, the Dex didn’t have a model that allowed you to navigate menus on the device itself.)

Nice job expressing your views on the differences, B. I appreciate your perspective…and also happen to agree with you pretty strongly.

9

The Navigator does not communicate with any pump, though you could use it as your primary blood glucose meter (it has a strip port) and input those numbers directly into your bolus wizard manually. So, technically, you can use it with any pump, but it will not “send” any data to your pump.

Out of pocket, the Navigator sensors are about $60 per sensor, with 6 used per month. The start-up kit costs in the $900-1000 range (before insurance) for the handheld receiver and transmitter. My insurance covered their usual 90%, for which I was very thankful.

(Dark Cloud, it is hard to understand whether you are making statements or asking questions when you pretend to speak that way and use no punctuation. I also find it offensive, as I’m of Native American descent. My great-grandmother in Oklahoma did not speak this way and neither do the elders of any tribe I’ve ever met - even a dear family friend who was born in 1890 on the plains and who died when I was a child. I really wish we could convince you to go back to the way you used to speak here in the forums. It was conversational English and much more respectful of our heritage. This new voice is strange and difficult to understand.)

10

The Navigator gives an updated reading every 60 seconds, but you must still prick your finger and get a blood sugar value before taking insulin and to calibrate the sensor. The Nav has a built-in meter, so you don’t need a separate blood glucose meter.

11

I use the Minimed–insurance covers–and it talks to my pump (also minmed)

Don’t like the needle for sure–however, I only get an occaisional bleeder…and mine stays accurate unless my BG is swinging very wildly, then like alternate site testing can be off by 15 min from finger reading then. I also cannot get more than 3 days out of sensor–my body doesn’t like it after that (infusion sites either)

The best part of the CGM for me is low detection (why I have it-cause I can’t) and trending–like straight lines :slight_smile:

12

You calibrate the sensor by testing your blood sugar at 10, 12, 24, and 72 hours into wearing it. The Navigator matches your blood sugar to your CGM reading. Yes, it’s like 97% accurate or something, but with any CGM system, you have to understand the difference between interstitial tissue fluid monitoring (the fluid your blood cells travel through) and your blood glucose monitoring. The interstitial fluid can be behind your blood sugar level by 15-20 minutes perhaps and because insulin works slowly (comparatively), you should base all dosing decisions on a more current glucose reading.

You seem to have a lot of questions about using a cgms in general. I encourage you to read up in our continuous monitoring groups and forums for more info and to check out the nav website at http://www.continuousmonitor.com.

13

I have been using the new Dexcom Seven Plus for the last few months and all I can say is wow.
Over the first 10-days the accuracy is within 15-points of a finger stick, unless of course you are rising or falling fairly quickly and then this is more about the way CGMS measure blood sugars and nothing to do with the Dexcom.

The sensors are a dream to insert and a dream to wear. No irritation, discomfort in any way and to be honest, I forget I’m even wearing a sensor.

After inserting it, I cover the whole sensor with Tegaderm Polyskin to keep everything in place for as long as possible.
I have just gone into my 15th day and the sensor is now showing some signs of inaccuracy, so nearing the end of it’s life. I doubt the paper sticky tape that comes with the sensor would hold it in place for this long without additional support from the polyskin.

The sensor takes a reading every 5-minutes, which is fine especially when you consider that it takes 10 to 15-minutes for actual blood sugars to sweeten the interstitial fluid anyway and lets face it, how often do you need to know what your sugars are doing every minute?

I like the way that the Dexcom can be recharged without having to mess about with batteries.

I like the fact that it can be customised with various alert settings. I can set the high and low alerts to go off where I want or turn them off completely. One night I was hovering around 180 all night and each time it rose above 180, it woke me up. This happened 3 times that night and I was exhausted the following day. Now I set it to 210 at night and if it goes off at that level, I will treat myself to a drop of insulin (After finger stick testing of course) and then forget about things.

I like the fact that it only takes 2-hours to start a new sensor. The 10-hour start up time of the Navigator would drive me mad.

Cost wise is really good too. I pay for my own sensors as CGMS are not covered under the NHS in the UK. $275 for a pack of 4-sensors works out at $68.75 each or $9.82 a day if you only use each sensor for the official 7-days lifespan. That compares to $12 a day for the Navigator and it’s official 5-day lifespan.

Some would say it is a downside to not have an integrated finger stick blood test meter, but this doesn’t worry me at all. I get to use any meter I choose to use and just punch the results in when I’m done. I have a pen size meter that just clips in my shirt pocket and is no hassle to bring with me, but more importantly, the accuracy is really that good, I will generally trust the Dexcom within the first 10-days and treat using it’s readings, as long as it has been calibrated that day also.

The calibration tests are required every 12-hours. I usually calibrate it first thing in the morning, before breakfast and then again in the evening 12 hours later. That means if I forget to take a blood test meter with me, it’s no big deal. The Dexcom carries on working even if you pass the 12-hour point, so it’s not the end of the world if you end up doing it later. It just displays a blood drop in the right hand corner, reminding you to do a blood test at some point.
Unlike the Navigator, which knows when you first inserted the sensor and counts back from then, the Dexcom just has a rolling 12-hour clock. If it hasn’t had a blood test reading for 12-hours, it asks for one.
If I do a blood test before lunch just to check I really am a little high before treating, I will punch the readings into the Dexcom and the 12-hour clock starts all over again. I probably wouldn’t then calibrate it again until bedtime.

It also doesn’t matter when you calibrate. You don’t have to be between a certain sugar range to calibrate it. If I’m high or low, it doesn’t matter to the Dexcom. I understand that other CGMS require the user to be between a certain range when calibrating.

Build quality. It looks a feels good. A quality product I would say. I have heard that a number of people with Navigator’s have experienced cracked screens and the batteries tend to rattle in the transmitter case!
Out of interest, the Dexcom transmitter has a battery moulded inside that cannot be replaced. That means that you must throw away the transmitter once the battery inside is dead. I understand that the battery life is approximately 16-18 months. While this is another expense, the benefit is that the sensor & transmitter assembly can be kept small & light, which is a bonus for the person wearing it for a year and a half!

Keeping things in perspective, one small downside is the distance the transmitter and the receiver must remain at all times to maintain a signal. About 5-feet is the accepted rule. Anymore than this and no readings will be captured by the receiver.
It’s not really a big deal though. A few times I have gone to the Kitchen to get myself a drink, leaving the Dexcom in the living room.
When I return and realise that I had left it there, there might be a few missing dots on the screen and then it carries on again where it left off.

Finally, it comes with a cable to connect it to your PC and this allows you to download the captured data. You can then play about with this data in the software bundle that comes with it, displaying lots of graphs & pie charts etc.
You can even connect to Dexcom and download any new software updates for the receiver or send technical data from the receiver direct to Dexcom Technical Support.

All in all, this is an excellent bit of kit. Comfortable, accurate, reliable, user friendly, cost effective and well built.

I could have easily bought a Freestyle Navigator here in the UK that is already converted into mmol/l (Worldwide standard), but instead I jumped through many hoops and asked friends in the US to help obtain a Dexcom Seven Plus that is using ml/dl.(USA standard) Why? Because I was sure I was making the right choice and so far, I have not regretted my decision. :slight_smile:

14

I am totally new to this concept of CGM. I’m currently looking at pumps and thought - heck, why not get a CGM to go along with it? My BG is not in control, so the thought of a CGM to help me see what’s happening and pinpoint when to give additional insulin seems to make sense to me. I’ve been looking into the Minimed pump (which has the option to add on its CGM) and the Ping (which works with Dexcom). But, the first CGM I ran across was Navigator (which work with the Pod). So many choice and things to consider!

So, I appreciate each of your posts, as they have all given me a lot of information (and raised more questions). Correct me if I’m wrong, but it sounds like the Minimed pump will only work with their CGM (Guardian), right? Or is it only that using another CGM will not communicate with the pump?

Animas and Dexcom work together, but can you use the Animas with the Navigator? Since the Animas and Dexcom don’t communicate with each other, you should be able to use any CGM, right?

The same would hold true for the Pod and Navigator - since they don’t communicate with each other, right? You could use the Pod with Dexcom, right?

I recently had an iPro (through Minimed) for a few days to capture info for my endo. I was told that it was actually the same size and comfort level of the Guardian. The only difference being that the data wasn’t sent to a pump - instead it was kept in the receiver to be downloaded. It was a bit of jolt when it was inserted. And, there was some bleeding. I found it to be a little uncomfortable and was never able to forget that it was there. But, it wasn’t horrendous. I will say that it’s been out for the past day, and the insertion site is still sore and sensitive.

Is that common to all CGMs?

I was a little concerned also that the entire unit was tapped down using an extra layer of surgical tape. I’m wondering if that has to be done continuously with the Guardian (or any other CGM). Perhaps it was done so I wouldn’t have to take the data receiver off to shower? Is that also common to other CGMs - having to take off the sensor from the insertion portion to shower? Or does it stay on?

I want to thank all of you for the discussion. It’s great that I can hear so much “real information” (not that of company advertisement) about all of these products. Advertisements always sound SO great. But to hear about realities of the products from people who are, or who have, used them makes me a better consumer.

Before I forget, the 10 hour waiting period for the Navigator - does that mean that you have two sensors in during that time? One that’s actually running and that you’re entering BG reading into and another that’s just in limbo? Has anyone heard anything about the Solo (pump and CGM)? How does that compare with the rest?

15

I wear the MM Paradigm 522 with CGM. Regarding what I have just read, I must point out a few things. (1) I have heard that the Navigator is extremely accurate. I have also heard (as the poster mentioned) that it is extremely irritating to the skin. In defense of the MM, my trainer told me to always do a restart on Day 4, which allows me to wear MM sensors for 6 days. I also have very little body fat. Going against MM’s “rules” I have been manually inserting MM sensors in the upper buttocks for almost 2 years. I do a manual insertion and, indeed, the needle is long, but I have experienced no pain! I did wear the OmniPod for 1 solid year, before getting the MM pump. The “marriage” of the OmniPod and the Navigator scares me. Here’s why: Folks with low body fat (i.e. body fat ‘real estate’ issues) will be wearing the Navigator on their arms. Since the Pod is so large, and since traditionally people have been instructed to wear their Pods on their arms, there will be precious little area onto which to paste their Pods. If you re-use sites too many times, you end up with absorption problems. Furthermore, for anyone with sensitive skin (like yours truly) - I used to develop welts from the Pod adhesive - just think of the double whammy of a large Pod adhesive welt plus a large Navigator adhesive welt. UGH! I agree that the Navigator sounds like a dream, but I sure wish they’d fix the adhesive issue AND integrate with a traditional pump. I know I can’t speak for everyone. Folks with loads of body fat (not your Typical Type I’s) and non-sensitive skin may do well with the new system, integrating OmniPod and Navigator.

16

I am brand new to this forum but not new to diabetes. My son uses the Navigator and Cozmo pump. I just want to clarify that you can download the Navigator and the Cozmo pump into the same computer software called the CoPilot. The CoPilot will integrate both the CGMS and pump data all together, it’s wonderful. That’s doesn’t help people not on a Cozmo, but I did want to clarify that there is software out there for the Navigator and pump.

17

Brenda, the Omnipod pump uploads to CoPilot as well. I recently switched to Omnipod from Cozmo and use the Navigator, too.