Advice please! Should we go for the Combo or the Veo?

[Susie-Q]

Hi,
We are trying to choose an insulin pump for our three year old son (diagnosed Nov 2011 aged 2 years and 2 months) and I'd be really grateful for advice or opinions from any existing pump users. We can't decide between the Accu-chek Combo and the Medtronic Paradigm Veo, so I'd be particularly interested in hearing from users of either of those pumps. They both appeal to us for different reasons - the Accu-chek because you can do everything through the handheld remote control, so I'd be able to leave my son in peace (which I know he'd welcome!) and manage his diabetes discreetly at parties etc rather than fiddling with his pump everytime I give him a bolus. However, one disadvantage of the Combo is that it itsn't CGM ready, and as we have to commit to whichever pump we choose for four years, that rules out getting a CGM in the near future (which is something we are also interested in). Our diabetes nurse told us that you can get a remote control for the Veo as well, which goes with the Bayer Contour Link, enabling you to administer a bolus without touching the pump...however, it still didn't look as sophisticated as the handheld device with the Combo. Does anyone use a remote with their Veo, and if so how often do you find you need to look at the actual pump? I'd also love to hear from anyone using a CGM with their Veo and how they find it. I'd love to hear from any parents using the Combo to manage their child's diabetes, and how they find the pump in general. Many thanks!

 

[CarbsRok]

Hiya,
easiest thing to do is ask both reps to come visit you and let you handle the pumps.
For a very small child like your son then I would be inclined to go for the veo soley for the reason it gives a lot smaller basal increases. Even as an adult the combo is to much for me.
Yes you have the handset with the combo but that's all, if it goes t*ts up there are no brains/wizzard in the actual pump. So if you don't do maths then you have had it until a replacement arrives.
The remote that comes with the veo is fine for parties etc as all you need do is bolus and sort out later most of the time.
There's a medtronic pump school on line so have a look and see how it goes.
There is also the Animas vibe that is CGM ready. This is an extremely expensive option though. I was shocked at the cost of the stuff needed for the vibe :shock:
You can also get stand alone CGM devices if that helps.

Edited to add link of all pumps available in the UK http://www.input.me.uk/alt-insulin-pump ... suppliers/

 

[Cheryl]

Hi there,

I have recently changed from an old Accu Chek Spirit to the Veo. I would have liked a Veo-Chek! There is no pump out there that does everything that I wanted and I had to give up a "must have" for any of them.

There are two CGM pumps, the Veo & the Animas Vibe. I chose the Veo as it has the remote control. I discounted the Combo as it did not have CGM and that was more important for me in the end, though I would have loved a full scale remote.

The Veo (in common with most pumps now I think, but not with my old Spirit) was a Bolus Wizard, where you input the BG reading (the Contour meter uploads it to the Veo automatically), the amount of carb in the meal & according to your previously input settings, the pump suggests the bolus amount basedon the BG reading, the amount of insulin that may be left over from any previous bolus & the insulin/carb ratio that you have set. You can set multiple insulin/carb ratios for different times of day as well.

I never had any of that on my old spirit, so have found it makes life very easy, but it also makes the remote control less useful as you can't do any of that on the remote, it has to be done on the pump. I believe that the Combo has a bolus wizard that does the same/similar thing, but all can be done frmo the remote control.

The remote on the Veo is like a car key fob. It can deliver only a basic bolus. Set it up so that each key press delivers 1/2 or 1 unit (maybe more options, I'm not sure as it's all very new), press the button that many times, it beeps/vibrates the number of presses back to you, you confirm and it delivers that amount of insulin.

Now, having tried the bolus wizard, I have only used ther emote twice since I got the pump two weeks ago as the bolus wizard is so useful. I found the remote absolutely indispensible when I was wearing a dress at new year & had the pump strapped to my inner thigh. It would have been embarrasing to grapple up my dress as each course of my dinner arrived & I decided how much insulin I needed to have with it. Having the remote meant that I could bolus discreetly & easily. I also used it at a party when I didn't want to be dragging the pump off my waistband every five minutes when I went back to the buffet for more nibbles.

CGM-wise, I am coming to the end of my first sensor & have found it very useful. However, it is very expensive & I have had to self fund the CGM element, so I won't be able to use it all the time, I have some issues which I hope a sustained period of sensor use will address, then I have the option of using it intermittently when I think it will help some more.

It is very difficult to get CGM funding on the NHS & my clinic wouldn't even consider it for me, despite having two others on their books who are NHS funded. I accepted it without a fight as my old pump still had three years to run & I was happy that they accepted my argument that I needed a more flexible pump than I already had.

Costs are as follows:
Transmitter & 5 sensors (starter kit) £687 reduced to £585 if ordered with the pump. My DSNs were able to get this starter pack thrown in for free with the pump, so that saved me a lot of money.
Additional sensors are £275 for 5 and £525 for 10. Each lasts six days. They expire after six months, so you can't buy a load & store them for ages. The transmitter is in warranty for 12 months, though the rep told me that many are still going after 3+ years.

I totally understand your dilemma, I like to wear my pump in my boot during the winter & if I am going out, hide it in a bra pouch or thigh pouch, so a fully functional remote control would be wonderful. But, on balance, I decided that CGM was more important. The Veo is more complicated to use than my old Spirit, more button presses etc. but it does have a lot more features; I have got used to it very quickly & so far am happy with it.

I think that my DSN would have preferred me to have a Vibe (but this may be due to the fact that they use Animas & Accu Chek far more often than Medtronic so are more comfortable with advising patients on those pumps), but that has no remote at all so I discounted it early. It does have a colour screen (as does the Combo I think), the Veo is just black/grey LCD. You can upload the Veo data to the web with a usb which comes with it & use Medtronic software to analyse the pump data. Apparently you can give your HCPs access to this data online too, though i've not considered that as yet.

I have a very low basal requirement (only about 14u a day) & the ability to change my basal by 0.025 has already made a difference. One of my problems is maintaining a steady fasting basal & all the basal testing in the world with my old pump never sorted it out, if I changed down by 0.1 my BG would rise, up by 0.1 I would be hypo. I now have four times the flexibility. Using the CGM (and skipping a lot of meals at the moment) is really helping me to understand what goes on.

I hope that this rather long reply is helpful;. If I can assist any more PM me.

Cheryl

 

[Susie-Q]

Thank you both so much, that's been really really helpful. It's really useful to hear from people who are actually using pumps at the moment to get a feel for what features are important to them and what's not. Our DSN did arrange for us to see both pumps (along with the Animas as well) and that was useful but I think the problem is - like Cheryl - really I would like some kind of Veo Chek! I guess you can't have everything with any one pump (or not at the moment at least) and as you say, it comes down to what is more important to us - having the bolus wizard on the remote control, or having a CGM linked to the pump. I think at the moment, given that he is only three, its probably having the bolus wizard on the remote. I'm really keen to have a CGM for him but I think realistically, persuading him to wear another thing as well as the pump, will have to wait for a year or so anyway.
Thanks again
Susie

 

[smaynard]

Hi Susie,

I am Mum to a 6 year old who has been using the Veo for over 2 years with the CGMS (we use CGMS 24 /7). I don't have any experience of other pumps (the Veo was the only option our PCT offers). I don't use the remote function on it either, so I can't help there.

However, I do wholeheartedly agree with Cheryl's point that the Veo's ability to deliver very small increments of insulin is absolutely critical for low insulin requirements. It's truly amazing the difference even 0.025 increments on basal can make to my daughter. So, if your son currently has small insulin requirements I don't recommend you underestimate the value of this feature.

For us the CGMS is also invaluable and has enabled us to vastly increase both overall control and stability. The CGMS does not just display current blood glucose it tells you how quickly levels are moving and in which direction. You can program it to give you predictive alerts too, so if your son's blood sugars are heading for either hypo or hyper it will warn you in advance giving you the opportunity to take preventative steps.

With regard to your concerns getting your son to wear another device....I fully emphasis with your concern. However, please let me reassure you that my daughter completely forgets that she's wearing it....it causes her no discomfort. Bathing is also no issue, it tolerates water just fine (even several hours in the swimming pool on holiday did not cause problems).

We're actually just back from my daughter's quarterly review and the consultant was very impressed with the tightness of control we are achieving. 98% of the time our daughter's levels are between 4 and 10 mmol and her Hba1C is 6.4.....I'm certain I could not achieve this without the CGMS....my daughter's insulin requirements vary considerably...1 week she may be averaging 4-5 units of insulin.....the following it might be 8-10 units. Without the CGMS her control would be horrible...I just couldn't adjust quickly enough to the shifting trends without the visibility CGMS affords.

We have the CGMS fully funded by the NHS.

Best of luck with the transition to the pump. It's a lot of work in the early days and a very steep learning curve, but in my experience, the benefits have been tremendous.

 

[sub]

You are very lucky if your PCT funds CGM. Mine doesn't and it would cost £70 a week for me to fund it myself.
I have attended an open everning for the Medtronic pump and they advised that the CGM is something worth doing every 6 months, but not every day.

My daughter is 3 and was diagnosed diabetic just over a year ago. We are in the process of going onto a pump and have opted for the Accu Chek - it gives a dose of insulin every 3 minutes compared to every 20 for the Veo.
We've been using a dummy pump for the last week and have been very impressed - There are plus points to both systems, but the combo seems to work for us.
We've had a go with some canulas and my daughter has been swimming with one in. She loves the idea of the pump and tells anyone that will listen about the needle in her belly and the "magic" machine that makes her well!
Your diabetes team should have some dummy pumps for you to have a play with at home and see what suits you best. It's the only way you'll know for sure - they cost the NHS £3000 to set up too so you don't want to get it wrong and be stuck for 3 years with one you don't like!

Regarding the dosing on the accu chek - my daughter averages 8-10u of insulin by injection a day and the accu chek pump will easily manage her small quantities.

 

[smaynard]

I agree, we are 'lucky' to have funded sensors....it is not easy to get funding and in my experience you need to present a very strong and detailed case. I am aware that no other child under our consultants care has successfully obtained funding, so clearly it is considered individual by individual even within the same PCT. Maybe for some using a sensor sporadically to check basal rates are working well and make minor tweaks is sufficient. For us, that's simply not the case. My daughter's body responds very differently from one day to the next....even though she was diagnosed 3 years ago she is still producing some insulin naturally, but the amount varies and is in no way predictable. Also, growth spurts appear to affect her night time requirements considerably, I need to frequently modify her night time basal rates and the low predict alarm and automatic pump suspension if her levels drop too low has kept her safe on countless occasions.