Basal increments - medtronic and animas

Diabetes Technology Insulin Pumps
#1

Hello!
I am getting a new pump very soon. I will get either the new Medtronic pump (Veo, here in Canada) or the Animas Vibe.
The Veo now boasts that its basal increment is 0.025u/hr, the same as the Animas Vibe. This is good (IMO).
My understanding of Veo’s “smart scroll” for setting basal rates is that this small increment (0.025u/hr) stops once 1u/hr is reached; therefore, the Veo cannot be set to deliver a basal insulin, for example, of 1.025u/hr.
Is this correct?
Please pardon me if this question seems silly. I find the idea of losing a fine adjustment after hitting a certain point to be a strange design decision, since one goal of pumping insulin is to make use of very finely-tuned doses to facilitate tighter control.
I tend to have basal rates on either side of the 1u/hr mark, so having 0.025u/hr increments is often of benefit to me.
I have used the Animas 2020 and the Medtronic Paradigm 522 and have been pumping for 6 years.

Thanks!

(I have read that there is a workaround for people who need smaller basal increments - alternating basal rates on the half hour to get an average that is equivalent to the desired rate; I am not sure that I want to have to do this.)

#2

Yes, you are correct. The Veo (MMT-754), the 530G (MMT-751), and the Revel (MMT-723) all operate with the same scroll rates. The basal scroll rates are:
0.025 units in the range of 0.025 to 0.975
0.05 units in the range of 1.0 to 9.95
0.1 units in amounts over 10.0

#3

Thank you, Brian_J!

#4

Here’s how I tend to look at it. If use the Dexcom CGM then the Animas Vibe might be the way to go. But I can’t say much beyond that since I have no direct experience with either Dexcom or Animas.

On the Medtronic side, I would suggest avoiding the Medtronic Veo and waiting instead for the 640G. The 640G is just a better pump in terms of the options it offers. In my opinion, the one serious, non-tweaky major improvement the Veo offers is the ability to stop basal insulin if your SG (sensor glucose) drops below a selected point. Of course, to use this you also have to use Medtronic’s CGM.

I have no idea when the 640G might be available in Canada. All I can say is that it should be available there before it is available in the US and in the US the hand waving guesses are probably sometime in 2016. I also have never bothered to ask what the granularity of the basal rates is on the 640G. Perhaps if she has time now, @swisschocolate could take a quick look and tell us if it’s changed since the Veo.

#5

Thanks, irrational_John!

I agree with you that the 640G looks a lot better than the Veo/530g in many regards (better screen, better with water, more basal slots, and maybe also “SmartGuard,” etc.).

I am currently almost a year into a loaner pump from Medtronic, and am eligible for a replacement because it has now been 5 years since I got the 522. I have to choose by August 1st.

(Ontario’s Assistive Devices Program (ADP) covers a replacement pump every 5 years if your pump is not functioning after that period. The pump companies (who get paid by the ADP) seem to have all agreed to cover the 5th year with a loaner pump if there is a problem in that final, out-of-warrantee year - but the loaner pump does not count as a functional pump for the purposes of evaluating ADP eligibility.)

The threshold/low glucose suspend feature on the Veo/530g is definitely intriguing. I’m thinking about doing a trial with the Veo/530g to test the LGS for myself because I tend to sleep through my CGM alarms.

I think that the decision about the pump will be made on the pump-features I like and will give me the tightest control - a smaller basal increment in all ranges might just be the thing to tip the scales. Hence my quadruple checking the stuff about basal increments in the Veo/530g.

That said, I have found that using a CGM has been very helpful in anticipating lows (trend arrows, of course) and easing my anxiety about my anxiety - I can check and get an idea of whether my antsy-nervous feeling is just that or if it is likely the start of a low.
So I’m doing a side-by-side test with a borrowed Dexcom G4 standalone and my current Enhanced Enlite. So far I’m not convinced that the LGS is as great a thing as it could be, since the Enlite is less accurate in the low numbers than is the Dexcom. I will have a better idea of the reliability once I look at the data on Studio and CareLink.

#6

I have a Medtronic 523 and it has a “Max Basal Rate” setting. I have mine on 3.0U/ hour but it will go higher, for temp basal “fun”.

I also went through a phase where I had input the basals in 1/2 hour increments of .775U/ hour and .8U/ hour, to cobble up a .7875U/ hour setting. This was after I got the Enlite to go with it (necessitating a “letter of medical necessity” of course…) and I wasn’t scientific in my analysis but my A1C went down a couple of ticks. I’m recently trying to “iron out” the .775s to smooth things out, under the influence of having read “Sugar Surfing” but there’s a couple of times that I need a boosted basal and I may need to cut the late day back too however for now, I’m just snacking! LOL…

#7

John,

Just spent a week with the Vibe/Dexcomm, gave it back four days early.

The pump menu is pretty clunky, had to alter my basals as it doesn’t allow for anymore than 8 different basal types during 24 hours.

Screen is unreadible in sunlight. Just felt poorly designed and rushed.

The dexcomm (may be a faulty sensor) was always 2mmol out, it also missed a couple of lows, e.g reading at 5.4 when blood was 2.9mmol. This was despite regular calibration. Fourth day in I got an ERR1 error that could not be rectified through calibration, so I gave up and returned it.

Didn’t particulary enjoy having a sensor and an infusion site to fret about and look after either.

Placed my order for the 640G this morning, it’s the most feature rich and most attractive pump out of my current options. I don’t think I’ll cgm full time, so will accept some of the limitations of the enlites and use them now and then for basal tweaking, times of stress etc.

The abbot freestyle was bang on accurate in the two months I used it, was comfortable enough to bolus from it.

Part of me is now consideirng retruning to MDI and using the Freestyle Libe…

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Medtronic 640g - Offical Details and photos
#8

I find this really surprising - nearly all the Dexcom users rave about how good/accurate it is. . Personally I find the Dexcom sensors to be within 10% of a fingerstick 95% of the time - good enough to bolus or correct on (although this is strictly against the rules). I don’t know what an ERR1 message is. Did you call the Animas helpline? The sensors are warranteed for 7 days - if one fails prematurely they will replace it for free. I have had one bad sensor in nearly two years use. The replacement arrived within 24 hours.

Joel

#9

Hi Joel.

8 or 11. I still had to change my basal from the combo to the vibe. Combo can run 24 differing basals.

Didn’t contact the helpline. Didn’t feel it would be worth it. Material clearly states that an ERR01 is a failure for sensor calibration and that you’re to leave it an hour, enter a calibration and that if a CGM value is not present within 10 minutes you are to replace the sensor. I did this twice and waited and hour each time, not 10 minutes.

I’m not a registered customer so didn’t want the hassle of a phone call. They’d have no doubt replaced it but didn’t bother as I knew I didn’t want the system by the third day so didn’t want to waste Johnson and Johnsons time and money.

I know many have great accuracy with the dexcoms G4s and don’t expect enlites or the navigators to be any better.

Another issue for me is the vibe and G4 are essentially 7 year old tech. You can’t get the latest algorithm on the vibe, you can’t use the G5 sensor etc.

With the g5 synching with apple watches and smartphones I just thought it would be foolish to sign up for this system for four years as it already feels out of date.

I’d rather a standalone pump and G5 on a phone /smart watch if I was going down that route.

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#10

Yeah, the fact that the Vibe has been around that long was something of a surprise to me as it has only recently (earlier this year ??) become available in the US. If Animas hasn’t updated that sucker for 7 years, I’m not surprised that it might have sensor problems. It sounds as though the firmware could differ significantly enough from whatever Dexcom currently uses.

But, of course, who knows? :angry: It’s not as though the companies are going to actually share the details with us. :disappointed:

#11

0.025 is the smallest i can get.
the 640G also has like 8 possible basal profiles, which is way more than the Veo which had 3.

#12

The underlying pump is essentially the Animas 2020 with a few tweaks to the menu. It has been around for a good few years. Integration with the Dexcom is much more recent - Vibe was introduced in 2011. I believe that the firmware is equivalent to the one before the most recent (2015?) update. I haven’t had any problems whatsoever with accuracy or reliability.

The Vibe allows up to 12 different basal rates in a 24 h period. TBH I have never used more than 2 basal programs (weekday and weekend) which differ only in the morning rates. For activity or the like, I just use temporaries.

#13

IIRC, What the OP was wondering about is what is the setting granularity for basal rates > 1.0 U/hour. On my Paradigm 723 the basal rates also increment in steps of 0.025 U/hr when below 1.0 U/hour. Once you cross that boundary the increment becomes 0.05 U/hr. Does the 640G do the same thing?

I guess there may be some confusion in the terminology here. And, frankly I am no longer really sure what the original question was.

In the US documentation, Medtronic refers to a collection of basal rates for a single 24 hour period as a “pattern”, but “basal profile” also works fine for me. So there is the question of how many different 24 hour basal rate profiles can be created on a pump.

As Ms Swiss said, the previous Medtronic max was three basal profiles but it has been increased to 8 for the 640G. Note: Another common sense feature Medtronic finally added was that you can now create a new basal profile by copying an existing one and then tweaking it. I think of these as “Well, it’s about time!” features. :angry:

Then there is the question of how many different basal rates one can specify for a given 24 hour basal rate profile. On my Paradigm 723 you can set a basal rate every 1/2 hour for a total of 48 different rates for a given 24 hour basal rate profile. I doubt this has changed with the 640G, but I don’t really know.

Why Medtronic was extra thorough in this case and made sure you could have that much extra flexibility in setting the basal rates in a profile when usually they stop at half measures, I have no idea. All I know is that in this case they maxed it out. :astonished:

#14

Dang only 8…

#15

Ahhhhh cheers John.

I was talking about basal rates during a 24 hour period, I have about 16 different basal rates during a 24 hour period and I wasn’t able to get the same flexibility with the vibe, I had to use time blocks etc.

#16

Well, so long as you don’t need to change your basal rate more often than every 1/2 hour, I think you should be OK with the 640G. :smirk:

The 8 basal rate profiles are intended to allow you tailor your rates based on some recurring change such as one for an “active” day versus one where you sit on your butt all day long. While I, personally, have never been able to make effective use of them, I am still glad to have the potential extra flexibility. :smile:

#17

Yep, that is what I was wondering about.

As I think and read on it more what I really wonder about is why the increments would be set to change in that way, as opposed to letting the user change the scroll rate throughout their basal settings.

A user-set scroll rate is an interesting feature that I imagine many people would want. Setting the scroll rate at 0.05 or 0.1 could reduce button presses, save time, etc. when making basal rate changes, in the case that a change of 0.025 is too small to make much difference.

I definitely used the 0.025 increment on my 2020, even for rates above the 1 u/hr mark. It’s one of those things where I might not always need it - but when I do need it, I really need it.

For me, that’s fine - I really liked a lot of things about the 2020.
Incidentally, I got the chance to use the Medtronic 522 when I participated in a study about the effects of resistance exercise on A1C. The 522 was the only option for a CGM here, at the the time, and the study’s nurse and supervising doctor decided that I’d need it to help me avoid lows (I didn’t know about that when I signed up for the study, btw - I just thought it would be interesting to participate and that I’d learn a lot; it was and I did).

#18

i have been on the dexcom cgm for almost a year now. i have had problems w/ it the entire time; however, my main issue is that i am so lean (100 lbs and skinny) that i don’t have enough body fat to inject the sensor into. i most often hit a nerve, muscle, or blood vessel, and that cannot be calibrated properly. also, they guarantee that you can go swimming while wearing it, and i cannot even shower w/out it going bonkers. however, their tech support team is available 24/7 and they are great. you barely have to wait before a rep gets on the phone, they will answer any questions you have, and they will replace your sensor overnight by FedX no questions asked. recently i complained to my endo, and he told me to place the sensor practically anywhere on my body that i could pull up/pinch up some “fat”. so, contorting myself, i found a nice juicy piece of flesh around my back/hip area. The Dexcom has been working like a charm.

and i wouldn’t trade it for the world. it has helped me to fine tune and tweak my pumps basal rates, my A1c has gone from 8.9 to 6.5 in the time period that i have been using this amazing piece of equipment. very high tech. many errors, but not more so than not. and even when i was having all the challenges w/ it, i still wouldn’t have given up.