After meeting with my Medtronic rep

Diabetes Technology Insulin Pumps
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As I’ve posted elsewhere I’m going through the Four Year Drama of choosing a new pump. Currently on an old pager-style Minimed and considering T:Slim and Animas as well as sticking with the-devil-you-know. I just met with a rep and had some hands-on time with a 630G, as well as discussing the 670 hybrid-loop. I have to say I was favorably impressed. The interface is bright and readable, and they’ve organized it well. The status information is on the home screen and there are a lot of improvements in how quickly you can access the most frequent features, settings and so forth. Couple of points I thought might be of general interest.

670G Upgrade: If I get a 630 now, I’ll get on a priority list for the 670 and will essentially get one when without delay when it’s released. Cost of upgrade is $299 which they waive if you agree to participate in a user study–basically letting them use your data and answer some questionnaires.

Are you stuck with that hardwired 120 BG target? Officially? Yes. But in fact there’s a pretty easy work-around he showed me. Right now my last two A1C’s were 6.1 and 6.0, so it’s not a big issue for me as for some of you hard-core flatliners.

Do I really care about hybrid closed-loop enough to switch to Medtronic CGM? This is probably the real crux for me. I’ve been using Dexcom CGM, not Enlights, and I’m not real eager to switch. But the new Guardian sensors are claimed to be within a whisker as accurate as G5, which they’d better be because this system is asking a lot of sensor tech. I guess part of my reluctance is that I’ve spent a lot of time learning the quirks and particulars of my G5 and I don’t want to go through that all with a different system. Not to mention that with the Guardians the 7-day limit is a 7-day limit. No screwing around with rolling it over another week. The transmitter has an extra chip in it that is continuously checking it’s accuracy and status and will warn you if it thinks it’s getting out of kilter. Which is a good thing, but… I also like having the G5 iPhone app and whereas M-t are working on one for their system it’s probably a year off at least (I’m guessing more).

Yes, but do I really not care about the hybrid-loop thing? Up until today I was a definite “Meh” on this. Skeptical, curmudgeonly, thinking of it mainly as another complex subsystem in a system that already has a lot of failure points. Well… they talk a pretty good game. Exercise lows are a big problem for me and I was skeptical that it could help with that, given the lag-time between the basal you’re getting right this second vs when it’s actually going to have an effect. Depending on various factors I have to zero my basal out like two hours or more before my bike ride–how’s this thing going to know to lower my rate in sufficient time for it to do any good? Not sure I totally understood the answer but they claim it can compensate for this kind of low (and the post-exercise bounce-back) and had charts to show it.

And speaking of charts–I haven’t been able to find these online, but the ones the rep showed me were probably the single most persuasive part of the demo. It’s a lot easier to show than tell but basically they were showing basal rate at the bottom and BG at the top. Normally what you’d see is a basal line comprising what, six or seven big square-wave like steps over 24 hours, depending on how many rates you’ve set, with a jagged BG line roller-coastering away up top, But these charts were the exact opposite of that. Basal line zeroing out, popping up, down, all over the place in teeny little increments to large spikes. BG line waaaay calmer up above. Over charts for four days, same patient, the basal completely differed one day to the next. All of 'em had a bit of a bump for DP but even those curves didn’t repeat.

This is huge. Anyone who’s spent time on a pump, let alone those of us who have been here from NPH days, has seen this evolution where the insulin effect graph has progressed from a great huge clunky unresponsive thing to something slightly less clunky and more shaped to what the human physiology actually does and needs. R/NPH gave us two or three mountains we had to climb and descend every day; basal-bolus MDI gave us a flat line with a lot more different shaped peaks and bumps we could more or less control our selves. Pumps gave us the more or less custom bolus peaks and bumps but also let us set those longer square-wave steps we could fit to our diurnal patterns. These graphs were showing me something different, something much more like a normal physiology where this whole granular process is going on in the background underneath, continuously making little micro-adjustments in a truly dynamic way and the result are much smoother, longer curves up above.

I mean, I knew this was the idea intellectually but seeing it… well I’m a fan of Edward Tufte for a reason I guess. I’m still going to go ahead and meet with my Tandem and Animas reps but I gotta say I left this demo feeling like “meh” had become something a lot closer to “I’d really like to try this thing.” Except I love my G5. Hm.

If anyone can find a link to those charts–they must be online somewhere but I can’t look right now–please post them.

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How loud are the alarms? I am dropping MiniMed due to the alarms not being audible, nor being logical; e.g., on Suspend, I didn’t hear the alarm, and I am sure that it never repeated itself. 4.5 hrs later and a BG of 497, I nearly threw it through a window.

In the 17 yrs I have used a pump, I’ve had two Minimeds (my first, then this one), a Deltec Cozmo that I’d give my right arm for, and an Animas.

The Animas has a defective blockage program that causes it to work less than it actually delivers, and the MiniMed seems more dangerous than going back to syringes.

So I am looking elsewhere. Another factor with Minimed is that I’ve made 7 or 8 calls to their pump sales group and waited in queue forever before being dumped into voice mail. I’m too busy to have to deal with a dysfunctional company like this.

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Since I’m using a variable basal rate hybrid Loop system, I’m impressed by the same observation. Until I used it, I would not have thought that varying basal rates would be that effective but they are. The controlling algorithm can look ahead and predict relatively well the anticipated BG 60-90 minutes out.

This is a screen shot that shows BG (on top) and the basal graph on the bottom. The reference or zero line on this graph represents the basal rate programmed into the pump. Deflections above the reference line add to the background basal rate and deflections below the reference line subtract from the programmed basal rate.

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Loop contains a feature that lets you engage an “exercise mode” that you can announce in advance. Then the system will use usually higher BG targets to discourage high-temping basals.

If I were in the market for another pump, I would be looking seriously at the Med-T offering since it gives a little bit of obsolescence protection. Plus, I’ve been impressed with the durability of a 12-year old Med-T pump I’m currently using.

Are you nearing retirement age or do you have a few new pump cycles left with your insurance? Being able to get a new pump in four years should serve you well. I think, however, that the technical leaps I see on the horizon will more than likely have your more excited in the next go-around. Good luck.

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What is the workaround?

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IIRC it was a matter of lowering the Suspend Before Low parameter.

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Guess it’s a YDMV situation. I’ve actually had very good experience with their tech support and sales support. Had a pump replaced due to malfunction last August, and they actually contacted me about replacing my current one. Rep offered to come to my house for the demo, though it was more convenient for me to meet at a place near my work. And the alarms on my current pump are loud enough for me, though I didn’t ask to hear them on the new devices–oversight on my part. My main complaints have been with the crappy, hard-to-read interface but that seems to have been much improved with the new screens.

That’s disturbing as I’m very interested in the Animas as well because of the Dexcom compatibility.

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So I finally got the 630G a couple months ago. I’ve been a long-term Paradigm and Revel pump user because I only had to have one unsightly, clunky device on my hip instead of 2. A few things I love, a couple I hate. Supposedly, I’ll be one of the first in line for the new 670G, but I sure ain’t holding my breath. Even if I don’t use the closed loop system (I’ll have to patiently try it and see if it helps or not) I’m sure going to enjoy the increased accuracy of the new CGM.

I’ve been chasing the “find the best basal rate” for several years. My basal rate changes slightly (sometimes dramatically) when I change infusion sets every other day. One of the many challenges of T1 for over 50 years.

I check the Medtronic site every week because for some stupid reason I find out the latest and greatest coming out from Medtronic from diabetic news sites like Tudiabetes rather then a friendly email when Medtronic has received an FDA approval.

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I’d love to hear specifics. Living with the the thing is SO different from just looking at it for an hour.

One thing I did notice is that there’s no “Quick bolus” anymore, which I use a lot with my current pump. The new Contour meter acts as a kinda-sorta remote–lets you bolus right from the meter. So that’s kind of a compensation I guess, though I frequently bolus without a finger stick if my CGM is being reliable and/or I know what I usually take for whatever I’m eating.

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I can’t wait to hear more!!! Could you please share the details?

I’ve been hoping for this to be the case, but my local rep didn’t know of one when I got my 630 in December and we talked about my plan to get the 670. I also haven’t been able to find any workarounds described on the various forums I usually read (but that might be because hardly anybody has gotten their hands on the 670G system yet).

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I am not sure I understand your comment here. Do you mean the reports from Carelink? Do you upload your pump and meter data to Carelink / have you done it in the past year? They changed the reporting views to what used to be views just in the Pro version and any Carelink user can now get these charts with their own results. (Apologies if I misunderstood what you meant though.)

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No, I mean the ones I was shown from the patient trials for the 670G.

ETA: but I’ll have another look at Carelink. Honestly that’s been one of the suckiest parts of Medtronic for me since the get go, partly b/c I’m a Mac user and M-t takes forever making the site compatible when there’s a new OS release.

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You can’t change the target setting itself lower than 120, but you get effectively the same result by setting a lower cut-off for Suspend Before Low, which is a parameter you can control. Basically the pump allows you to run lower before suspending, so your average BG will come down commensurately.

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I am also a Mac user and use a workaround for the lagged compatibility with Carelink software: in Safari, under the Developer menu, set User agent to Firefox Windows and also set your Java to run in unsafe mode (I know it sounds bizarre, but it’s for the carelink address only). Basically the best, most comprehensive set of instructions that helped me is here: http://support.tidepool.org/article/35-troubleshooting-carelink-issues-mac.

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Thanks for the follow-up – I truly hope it’s as easy as that! :slight_smile:

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Thanks–I know that trick but it’s worth repeating because others may not. I also use a Dexcom G5, not the Enlites, so my CGM data isn’t on carelink anyway.

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One point I’d like to add is to make sure you’re updating your Java version regularly. If the SW won’t run with the latest Java version, then you’re opening the door to some serious risk. (I own a IT security consulting firm.)

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There’s a manual bolus that works like the Quick Set and there’s even Preset bolus that you can set up for frequent bolus settings.

Things I love- the status bar, the bolus options, the preset boluses, the programmable preset basal. It’s finally waterproof! The inserter for the sensors is much improved. The battery in the transmitter is much better.

Things I hate- the site change alarm only resets when you replace both the cartridge and the infusion set. I change them at different times. It asks you if you want to calibrate the CGM after it starts the bolus, which I frequently forget about.

You can download the user manuals for the 630 from the Medtronic site which can give you all the details.

Hope that helps - best of luck

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Yes, I really liked that too. I have a couple of regular issues that I do temp basals for and having those already dialed in at a single click is nice.

ETA:

That concerns me. Just today I switched to a new infusion site because after a day the one I’d started with still hurt like the devil. Tons of insulin still in the reservoir so I just stuck another one in a new spot and switched the tube over to it, yanking the previous one. I probably have to do that every couple of months. If it insists you have to do a new reservoir as well every time–i.e., treat every bad site as requiring you to do the whole thing as a new infusion–that would be a major annoyance.

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You can turn off the alarm. Like @Jane_Vaugh, I was disappointed when I found out that reservoir change resets the site change alarm. I always forgot to change my cannula every three days and hoped the reminder would help me. Well, it didn’t take long before I found out that the reminder wasn’t linked to cannula fill. Now I use my phone to remind me.

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When I went to the 630G training and asked the question about the infusion set alarm reset, the Medtronic rep and the diabetes educators implied it was “unsafe” to attach a new infusion set to an old cartridge and tubing set. I’ve been doing exactly that for many years and never had a problem. So I too will rely on my phones calendar alarm.