Monday, 19 January 2015

It's a System Not a Pump. Apparently!

No new blog for months then two in a week! I know, it doesn’t make any logical sense but enjoy it while you can!



On Friday I caught a ridiculously early train to visit Medtronic in Watford as a get-together for some bloggers and other more important people than me.

(I’ll be up-front and tell you they paid for my return train trip and lasagna and profiteroles for lunch. As the return train journey totalled seven and a half hours sitting in a variety of uncomfortable seats to a single destination with no detours I’ll leave it to you to decide whether I was ‘wined and dined’ to a level that might affect my impartiality!)

The purpose of the day from Medtronic’s side was to get feedback from various parts of the diabetes community without outside healthcare professionals to inhibit free speech – not that that is normally enough to make me bite my tongue!

The main subject of the day was their “biggest product launch for ten years”, the imminent arrival of the MiniMed 640G System. There were plenty of facts and as other people made more detailed notes than me, and manage to summarise details in a concise way I struggle with, I’ll point you to them rather than repeating stuff already said.

Go, please do. I won't be offended. But come back!

OK now you’ve read them welcome back and I’ll add bits I picked up.

System? I thought you were going to see a new pump?
I think brainwashed is the term. Just like I know all the words to Let It Go (it wouldn’t be one of my blogs without a Disney hyperlink!) because it’s been repeated so many times in my vicinity; Andy, Mike and the other Medtronic UK people were very well prepared in (nearly) always calling it a system not just a pump. The thinking is that the inbuilt technology is so integrated into their Enlite CGM that they are keen it’s not just a pump upgrade, it’s a new way to approach pump therapy.

Where did the name come from?
OK, I’ll admit it’s not the biggest question for most people but product naming always, worryingly, intrigues me. So here goes:
6 - Sixth variety of MiniMed pump from 1983 onwards.
4 - Fourth CGM algorithm since 1983.
0 - To allow incremental tweaks i.e. next could be 641G.
G – CGM enabled. Why not 640C or 640M? Shrug.
Having said that I like proper names. Veo has the ring of a space-related hero. Hey-ho; numbering it is.

How and when do I get one?
During the last year Medtronic have been testing them around the world and some people (this might be UK-only info) towards the end of last year who began pump therapy on the Veo were given the option to automatically upgrade to the 640G. These auto-upgrades (if eligible you’ll already know) will be started this week. The official worldwide launch begins on Monday 2nd February in four countries only; UK, Australia, Sweden and Denmark. Other countries will then be rolled out but this is subject to local medical approval and hoops to jump through.

Are they replacing existing Veos?
No. A juicy rumour I saw this weekend was that all existing Medtronic Veo users would get an automatic free upgrade. This is not true. Swaps will be down to your usual local pump replacement policy. Your local healthcare provider buying the new system from Medtronic will drive this and supplying you, as happens currently. Sorry.
Initially in the UK they’ll be provided in parallel to the Veo while local commissioning groups get their systems updated but within a short time (about 6 months) all new Medtronic pump supplies will be the 640G system.

Have sensors improved as historically they have a reputation for average performance?
This is an interesting one. The latest version of the Enlite CGM sensor (version 4) was built with this pump in mind. The improved algorithms in the 640G mean that CGM performance of the current Enlite sensor is noticeably improved when used with the Veo/530G.
Personally, as I’ve said previously, I’ve had an OK experience with the Enlite with a reasonable success rate. Others I know have fallen out with it so this improvement ‘might’ tempt them back.

Would I want one if no CGM?
Yes. This is because I’m a bit of a gadget geek and any extra features are always tempting. For me the key (non-CGM related features) are:
  • Waterproof – Splashing about by the pool on holiday with no stress about having to disconnect if popping in and out etc. Official rating of IPX8. This translates as "IPX-8 Protected against water submersion - The equipment is suitable for continual submersion in water under conditions which are identified by the manufacturer (typically 3m)." As a comparison the Libre is IPX7 which is up to 30 mins in up to 1m of water.
  • Battery back-up – The 640G has a built in rechargeable battery than can provide up to 8 hours of use if the replaceable AA (instead of the Veo's AAA) battery runs out. This is pretty cool, as currently my emergency kit bag has to contain a battery as the warning on the Veo can be as small as two hours. Also, a big plus, the type of AA battery used now includes rechargeable for the first time.
  • Set-change alerts – After mistakenly reaching five days on a set recently I love this development. The ability to set an alert automatically to come on at either 2 or 3 days after a set change is one of those features that’s so blooming obvious, yet simple!
  • Bolus from meter - The new Bayer Contour Link XT meter acts as a way to bolus without fishing out the pump from the pocket or dress (at the weekends). The bolus wizard isn't accessible but you can give normal, square or dual-wave boluses. The pump also acts as the USB transmitter for the (soon to be improved) CareLink software for downloading pump data for clinic appointments etc along with the blood glucose readings from the meter.  

Is SmartGuard helpful in real-life use?
We’ve all seen brochures and advertising and taken everything with a big pinch of salt. The promises offered by SmartGuard in reducing the number of hypos and providing a safety mechanism against severe ones sound fantastic. But will it work? For this we have to take the experiences of Sue from Dasang and Helen a person with T1 who also works for Medtronic. I can see the skeptics now saying we can’t trust Helen as she works for ‘them’ so she would say that wouldn’t she? Well, no. I don’t think she would. The official Medtronic peeps said that if Helen or us wanted they’d leave the room they would but no one felt any pressure so we carried on. Helen gave some real-life examples of where the SmartGuard kicked in without her realising and the insulin delivery had already been suspended before she realised there was a possibility she might be going low. The ability to turn the alarms off meant there were times when it stopped then restarted without her knowing at all!
But what about for me? Well this weekend I was doing my usual weekend tasks and junior football stuff and whilst I kept my BGs up by topping up with Fruit Pastilles. The value of something that would have kept me at a slightly higher level without having to stop and test would have been priceless. Yes, the Libre would also have been useful for easy tracking but the idea of the 640G system ‘managing’ me just blows my mind. Temporary basals, again could have been used but for some periods I wasn’t sure how much activity I was doing as it slowly increased until I started so by that stage it was too late.
Once again I’ll admit to being a bit of a techy geek and shiny new things always tempt me but I do believe that, for me, the 640G would be a good replacement for my current Veo. I’ll come back to this though.

I currently extend my life of Enlite (against Medtronic advice). Can I still so this?
A lot of “no comments” and “we do not recommend this” when this idea was suggested. Medtronic could only obviously discuss the 6-day use of the Enlite. If someone found a way to extend it and did so they would need to do this at their own risk. No change there then! 

Will Enlite sensor price be changing on launch of the 640G?
No. Despite other promotions elsewhere, Medtronic UK are not going to be changing the price of the Enlite sensors in the short to medium term. Parallel to this there is running a NICE consultation on the use of Sensor Augmented Pumps. Until this has been completed and published in around October Medtronic will have a limited understanding on potential future volumes and therefore possible mass production volume savings. This is a bit of a disappointment with other subscription promos around the world but this is where we are at the moment.
One slight change is that a MiniLink transmitter and one Enlite sensor will be provided with each 640G system. This removes the initial start-up barrier of the transmitter of £350 for new users.

I’ll admit to being smitten with the 640G system. It’s got a lot of new features that match the competitors’ offerings but I genuinely believe the SmartGuard sets it apart – if the sensor costs are affordable!

Roll on November when I hit 4 years with the Veo and then I wait patiently for Red, my Veo, to break outside its warranty! (Assuming other new technology doesn't cause me even more quandaries!)


Until the next time. Stay safe, enjoy life and try and stop humming LET IT GO!




Thursday, 15 January 2015

How Full is Your Glass?


or Type 1 Diabetes in 2015.....

I tend to spend a little bit of each day flying around Facebook, Twitter and too many blogs to name having a look at how people are feeling and looking for the killer tip to enable me to live a stress-free diabetes life. That tip will arrive I’m sure, next week. Hopefully. Until then I’m left with the rest of you and I’m happy with that.

But I sometimes have a problem that messes with my head a little. Admittedly it doesn’t take much to confuse me so you shouldn’t be too surprised I’m frowning again.

I’ve touched on this before but for me diabetes is part of my life but it’s not my focus. I realise I’ve got a 24/7 condition for the next ten years* but I also know in the tombola of medical conditions if I had to pick a ticket out of the bag I’ve not done too badly. We all know the negatives about dangerous hypos, long-term complications, etc etc but I can live a relatively normal active life and because I’ve been ‘fortunate’ enough to have it from a very young age it’s my ‘normal’. For others diagnosed much later I can understand the grief about memories of behaviour lost but for me it’s more about that’s just how it is.

Nearly two years ago I wrote about how useful and special the Diabetes Online Community is to me and I’m still there with that mindset. It’s a bottomless pit of resource that is there for you 24/7, just like your diabetes, to share and understand your 2am hypo that needs correcting before you can go back to sleep.

But within that community I sometimes feel a little bit down about how people are feeling and struggle to understand how people get so angry about stuff that’s, yes important at the time, but if thought about in the longer term,  will just fade away like the rest of life’s ‘big’ stresses.

So here’s my attempt to remind people how lucky we are to be a person (or parent of a person) with diabetes in 2015 instead of 1915 or even 1979.
  • Insulin - In my insulin delivery device I've got the magical clear liquid that if delivered under my skin enables my body to keep on living. The lab work of thousands of scientists enables me to take this medicine in tiny, tiny volumes help balance against the glucose in my blood to occasionally give me a magical 5.5 mmol/L (100 mg/dl) reading on my....
  • Modern blood glucose machine - back in the early years after diagnosis my parents had to keep my glucose control in balance using urine sugar testing. The test tubes enabled me to pretend I was a scientist by dropping fizzing tablets into my wee and waiting for a decent amount of time to see what colour the liquid turned. From memory blue was good (i.e. not high) but anything darker meant there was too much sugar in my urine. But it wasn't telling me I had too much sugar in my blood then, it was giving a measure of how I was doing two hours earlier. The progression from this were the urine test strips which were the same measure but slightly more refined and negotiating with parents as to where on the colour-coded scale the shade of green was had begun. The further left on the top line the better! After this, for me, came the first Reflolux blue meter using BM test strips that needed a huge amount of blood and a full two minutes to get a result. Again this was a huge progress and a massive step forward to make 1987 the best time ever to be a person with diabetes; up to the next development! Fast forward another 18 years and my sexy Contour Link XT needs a tiny amount of blood and 5 seconds to give me accurate up to the minute reading which it then bluetooths to my ....
  • Insulin delivery device - Yes I'm a pumper but the same rules apply for the MDI. The modern insulin delivery technology is just fantastic. I can deliver ridiculously small amounts of insulin after a few presses of a button (see photo below - that dot in the middle is 0.1 units). And using modern algorithms devices such as the Aviva Expert meter or my Medtronic pump's bolus wizard, after a suggest to me how much insulin to take. I don't even have to do the math! I just tell it how many carbs I'm eating and it calculates my dose. That's bonkers. Marty McFly can keep his hoverboard, I'm happy with my D-Tech! But if it does go wrong I get to have one of my favourite... 
                                               It's there!


  • Hypo treatments - Thankfully the days of white plain Dextrosol in blue packets have disappeared and now 3 grams of carbs comes in the nice circular form of a Rowntrees Fruit Pastille. Four of these and I'm away back up to where I should be. Occasionally my local supermarket has special offers on my 'medicine' and I' then able to share this news with other ... 
  • People With Diabetes - Do you remember going to the hospital before the Internet arrived? For me that mostly involved sitting in waiting rooms, with people of varying disability and a book full of recently hand-written numbers that would be found out by the blood test I'd taken two weeks earlier. There then followed the promises of blindness, amputation and kidney failure with the very large hint that everyone else could do it so why couldn't I? So in my head there were two camps; the failures with parts dropping off, and everyone else who never had a HI or LO reading on their meter. Nowadays I'm meeting new people every day online and face-to-face who 'get' what it's like and don't judge but understand. This is absolutely fantastic and again I feel lucky to be alive now. Just like any community there are a few nutters out there but that's like anywhere and a quick unfollow and move on solves that easy enough; that's not a hint by the way. Don't leave me behind! And like insulin and test strips for Type 1s in the UK discussion doesn't....
  • Cost - Living where I do I'm fortunate that healthcare is free at the point of use. Yes, it's paid for out of taxation but if I use more insulin than my mate down the road it doesn't cost me any more than him. New tech is arriving and it would be great to get this on the NHS too but, going back to an old article, would that be appropriate? Still not sure on this one over a year later and after I've spent a decent amount already on various continuous/flashy glucose monitors. I know I'm very lucky as in other countries the choice between buying insulin or food is a daily worry. Have a look at great work the Pendsey Trust do for more information on that here. Hopefully things will improve and they can also have a great ....
  • Future - The next few years look to be fantastically exciting with new tech being launched yearly and each step being a step closer to either a fully functioning artificial pancreas or even maybe that magical cure or vaccination. I'm still in the '10 years' school of thinking but for the first time in over thirty years it looks genuinely possible that 10 years may at some point start to reduce.
So there I have it. In summary I feel very lucky to be around now and yes there are challenges every day but these are small in the big scheme of things. In the words of Pumbaa - Hakuna Matata.

Remember that every day you go to bed, you can pat yourself on the back safe in the knowledge that you've won your diabetes battle today by still being here and you should be very proud of that!

Thanks for reading and now give yourself a pat on the back to celebrate getting to the end! :) 


Dave

* The cure is always going to be there in ten years: