Anyone got experience of Medtronic CGMs?

[RuthW]

Anyone who has read my comments will know that I don't live in the UK right now so i don't have exactly the same choice of medical equipment. In Turkey we can't get Freestyle Libre (but then you guys are still queueing for it, I know). We can get Dexcom or Medtronic CGMs. I have a Medtronic pump 9though we are a generation behind you) but theirs is horribly expensive so I hesitate to commit. The other choice here is Dexcom. Anyone have any experience of using these devices together/separately? Any preferences, comments or recommendations?

 

[iHs]

I used the Enlite sensor as a blind 7 day cgm a while ago (meaning the data was only visable to the HPs at my clinic but not to me) The sensor was easy to insert with an insertion device and Medtronic supplied ready cut sensor tape to keep the sensor stuck down ok. As sensors go, I was a bit worried that the tiny plug in the side transmitter would come off but the sensor was inserted low down on my tummy so wasn't visable. The sensor's data was only a tiny bit out from my finger stick tests so on the whole, it's fairly good.

I'm now using the dexcom G4 with my Vibe pump and the sensor accuracy is a bit out on the first few days but gets much better by day 4 and at times the sensor data is the same as the bg meter data and at other times its about 0.4 to 0.7mmol out but nothing mega. On average I am getting about 25 days of good readings and can just press a button on my Vibe and up comes the bg cgm display. The downside is the expense and the low bg warning which will buzz or vibrate but even when some hypo remedy is swallowed, the cgm will still buzz to alert low bg so pressing the OK button will silence it for 10mins or so and will stop after about 20mins when bg starts to rise. I usually do a finger prick test to see how high my bg will have risen and then re calibrate the cgm because of the time lag. Other than that, for now it's very good and it's lovely to walk about and just quickly glance at the cgm screen to see what my bg is.

 

[irrationalJohn]

I have only used Medtronic's CGMs, both the Sof-Sensor (aka "the Harpoon") and its replacement, the Enlite. I am in the US so I only have experience with the first version of the Enlite, not the slightly "enhanced" version used outside the US.

Based on what I have read, most people prefer the Dexcom CGM for various reasons. Some focus on the accuracy, others on the ability to extend use of a sensor for up to two or, in some cases, three weeks. For others it is a cost issue.

While Medtronic CGM can and does work, it tends to be more finicky. My personal guess is that this is a consequence of the physical design of the Enlite. If one does not get the insertion & overtaping of the Enlite done right, then the sensor probe can be jostled which in turn leads to horrible inaccuracies. All of which are then blamed on the innate capabilities of the system, which I think is often a mistake. But ... whatever.

The bottom line is that based on what you said about Medtronic being "horribly expensive" you probably want to go with Dexcom if the cost is lower for you. If you were already using a Medtronic pump then perhaps that might be an incentive to also add on their CGM. That's how it worked for me. But if you don't currently have a compelling reason to go with Medtronic, then I'd say look at Dexcom and see how that might work for you.

 

[DunePlodder]

I've been using the Dexcom G4 for 18 months & wouldn't be without it. It's very expensive but gives me peace of mind.

It also gives you access to the wonderful Nightscout Project where lots of wonderful work is being done especially for parents/carers. http://www.nightscout.info

 

[RuthW]

Thanks everyone. Useful info. I am thinking that since people seem to like the Dexcom better and it seems to be cheaper to run, if I go for a CGM, I may get the Dexcom, even though theoretically it doesn't "go with" my Medtronic pump. (Of course, this is Turkey, so if I can prove Dexcom is cheaper I may be able to bargain Medtronic down). I am going to talk to my consultant in a coupe of weeks and see what he thinks.

 

[Flowerpot]

I've used Medtronic cgm for 5 years now, first with the Veo and for the last 6 months with the 640g. The 640g and Enlite combination is fantastic as I don't have hypo awareness. It uses SmartGuard to predict when my bg will reach a pre set low limit and suspend basal up to 30 mins in advance of me potentially reaching my low limit and only restart basal once my bg is rising. This has proved very efficient at reducing the number of hypos I have. On the Veo, basal was only suspended once I had reached my low level and remained suspended for 2 hours unless I over rode the suspension, this still proved a good way to avoid serious lows. I haven't had any issues with accuracy and tracking from the Enlites and extend the sensor length up to about 11 days on average without a fall off in accuracy.

It is more expensive than the Dexcom as the sensor length cannot match the number of days/weeks Dexcom users get. The transmitter for Medtronic is detachable and needs to be charged up after 6 days use whether I am restarting an old sensor or connecting a new one. My last transmitter lasted 3.5 years of constant use.

I've found the Medtronic combination both with the Veo and 640g very efficient but have never tried Dexcom for comparison.

 

[RuthW]

In Turkey they offer the Guardian real-time monitoring system:
http://www.medtronicdiabetes.com/products/guardian-real-time-cgm-system
I'm wondering if it's the same as the Enlite, or how far behind it is.

 

[irrationalJohn]

In Turkey they offer the Guardian real-time monitoring system

My understanding of the Guardian is that it is simply a stand-alone monitor intended for those who want to use Medtronic's CGM with MDI or non-Medtronic pump. At least that was what it was initially. I'm not sure of it's current status in reference to the newer Guardian Link 2 transmitter used with the 640G pump.

If you are going with a separate monitor I'd recommend seeing how much Dexcom would cost you. I feel the most compelling reason at this time for using Medtronic's CGM is if you use it in conjunction with one of their pumps, especially the 640G.

I'd also be careful of ending up with "older" technology. As I said, I'm not sure if the Guardian monitor has been updated to work with Medtronic's most recent CGM transmitter.

 

[RuthW]

My understanding of the Guardian is that it is simply a stand-alone monitor intended for those who want to use Medtronic's CGM with MDI or non-Medtronic pump. At least that was what it was initially. I'm not sure of it's current status in reference to the newer Guardian Link 2 transmitter used with the 640G pump.

If you are going with a separate monitor I'd recommend seeing how much Dexcom would cost you. I feel the most compelling reason at this time for using Medtronic's CGM is if you use it in conjunction with one of their pumps, especially the 640G.

I'd also be careful of ending up with "older" technology. As I said, I'm not sure if the Guardian monitor has been updated to work with Medtronic's most recent CGM transmitter.

Yes, it's really not clear from the website because it looks like the pump, so I am wondering if I will be carrying round two pump-size things, or if the Guardian is just the actual software and the sensor thingy will interact with my pump. The thing is that as far as I see we are actually TWO generations behind here in Turkey. My pump is the Paradigm 713, which is not even listed on the website, but seems to precede the Veo even. I mean these companies shift their excess stock in the developing world when they develop new models, so it's hard to find out what I'm buying. Their Turkish website doesn't give the info. It just gives a link which doesn't work!

 

[Flowerpot]

The Guardian Real Time is a stand alone CGM so you would need both your Medtronic pump and a separate receiver. It does say it appears bulky in comparison to Dexcom.

http://www.diabetes.co.uk/cgm/medtronic-guardian-real-time.html

It does look like a generation behind the integrated Veo and 640g but I presume it would use the Enlite sensors and possibly the earlier Mini Link transmitter. Hope that helps.

 

[yingtong]

I am getting regularly 20 days out of a enlite 2 sensor by recharging the sender after 6 days and restarting the sensor as a new one,it's a bit fiddly but I've mastered it now.Hope this is helpful to you.

 

[irrationalJohn]

My pump is the Paradigm 713, which is not even listed on the website, but seems to precede the Veo even

A 713? Wow. Below is a timeline of MiniMed pumps copied from the Wikipedia Paradigm pump article. I believe the dates cited are the date the pump was introduced in the U.S. The 713 is not listed. Sure it's not either a 712 or 715? Or maybe a 723?

• 1983 – 1st Pump MiniMed 502 (Eli Lilly makes synthetic insulin)
• 1985 – MiniMed 504 Insulin Pump
• 1992 – Launch Of MiniMed 506 Insulin Pump
• 1996 – Introduction of MiniMed 507 Pump
• 1999 – Launch of the Model 507C
• 1999 – Introduction of MiniMed 508 Insulin Pump
• 2002 – Inauguration of the MiniMed Paradigm 511
• 2003 – 1st Wireless MiniMed Paradigm 512/712 (followed by 515/715)
• 2006 – MiniMed Paradigm REAL-Time 522/722
• 2010 – MiniMed Paradigm REAL-Time Revel 523/723

The last two pumps in the list, the x22 and x23, and the Veo will work with the MiniLink transmitter and thus can also work with the Enlite, Medtronic's current CGM sensor. Their newest/most recent CGM transmitter, the Guardian Link 2, also works with their Enlite sensor. However, the Guardian Link 2 transmitter will only work with their newest pump, the 640G.

I find it hard to believe that there is any cost effective way to use a Guardian monitor in conjunction with a Medtronic pump. If you were to go with Medtronic CGM I would think the best route to take is to migrate to either the Paradigm x23 pump or the Veo or the 640G. If you want to go with a stand-alone CGM which does not integrate with a Medtronic pump, Dexcom is probably the best path.

Another factor to consider with the Enlite is that the monitor must be within a meter (usually less) of the CGM transmitter to work. If it is much further the monitor/pump will not be able to receive data from the transmitter. By comparison, Dexcom uses a stronger lithium battery powered transmitter with a range closer to 6 meters. I think for this reason Medtronic has pretty much stopped pursuing the stand-alone monitor niche in CGM and chosen to focus on pump and CGM integration. Yes, they apparently still sell the Guardian monitor. But it strikes me as very much of a "meh" product.

Notes:

1. There are also non-Medtronic pumps which integrate with the Dexcom G4. I, personally, am not impressed by them yet, but that may change.
2. The difference between the 500 and 700 model pumps is the size of the insulin reservoir the pump uses. The 700 model reservoirs, like yours, hold 3.0 ml or 300 units of U100 insulin. The 500 uses 1.8 ml (180 units) reservoirs.
3. Apropos of nothing, my first pump was MiniMed 507 back in 1996. I currently use a Paradigm 723 with MiniLink transmitter and (first generation) Enlites. I'm tentatively planning to upgrade to 640G in 2017 when my warranty expires. But that depends on what's available at that time.

 

[RuthW]

Thank you very, very much. That was very helpful. As I said, I am using the latest pump available in Turkey. Manufacturers do not generally distribute their latest models in developing countries. Beggars can't be choosers, as they say! So, looking at the info you have given I may start looking more seriously at the Dexcom - though of course I might then find that they too are distributing something terribly antiquated here!

 

[irrationalJohn]

I am using the latest pump available in Turkey.

It very well might be a 723 then. I was told by a rep I spoke with that Medtronic still sells the 723, even in the U.S., though I am not sure how one would buy one in the U.S. Instead of a refurbished unit, Medtronic sent me a new, unopened 723 when I asked to replace my previous one under a recall program, so they apparently still have boxes of the 723 in stock even though they are currently pushing the 530G (aka Veo) in the U.S.

If you have a 723 then if you press the middle "Esc" button while on the main screen you should see the "Status" screen. If you scroll to the bottom of the status screen you should see the pump model and serial number.

 

[RuthW]

Yes, Paradigm 715. I think multinationals often assign different product numbers to different regions.