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Insulin pump and CGM

M

Minnie_19

Well-Known Member
Messages
75
Location
Devon
Type of diabetes
Type 1
Treatment type
Pump
Hi

Just wanted a bit of info on Continous blood glucose monitoring and insulin pumps.

I'm currently using the Medtronic minimed paradigm but I'm due to go into clinic in the next few weeks to take a look at some new pumps as I'm due an upgrade. I'm not yet sure which pumps will be available to me, which is a shame.

I've been thinking for sometime about CBGM, particularly because I have had in the past night time hypos which I've needed assistance to treat. This hasn't happened for sometime but it would be nice to have the reassurance that I would be woken if my levels began to drop.

It would also be helpful from a work point of view to have better tabs on my glucoses levels when I'm not able to test.

So I know I'm after a CGM that will alarm when my levels are going out of range, but other than that I'm not sure. It would make sense if my new pump had the ability to do this also.

Has anyone got any recommendations? I've read a little about the Animas pump and the Dexcom, what do people think of this system?

Thanks
 
You can contact your regional hospital board and ask them what pumps they currently offer. That information will either be relayed to you informally or through the freedom of information act. That will give you time to research the different pumps available to you and what will suit your needs best.
 
I'm going for a pump today. I know the Medtronic closed-loop system has been approved in the US but not here yet
http://www.wsj.com/articles/fda-approves-medtronics-new-automated-insulin-pump-1475093556
To me it provides the best answer so far - a CBGM that tells the pump what to do.
I've asked Medtronic about costs and self-funding but I haven't got an answer. All they say is it isn't approved here and to go for the 640g.
As far as I know the NHS isn't yet funding closed loop CBGM pumps yet but I may be wrong (I hope so).
I'll push for one today but let me know how you get on. It might be different in different commissioning group areas.
In the meantime, have you looked at the Freestyle Libre system? It won't wake you at night (I have it and I also had night-time hypos). What it does do is tell you what's happening during the night when you're asleep. So you can see when your levels drop and act accordingly. I've found my levels go below 3.0 almost every night when I exercised that day. No I haven't stopped exercising but I have adjusted my Levemir dose.
As an aside it is also revealing a very acute dawn phenomenon with me, which before I would have tried to tackle with even more Levemir, which would have caused even more acute night time hypos...
The system's also great at work, as you don't need to finger prick in meetings or difficult times, just hold the scanner to your arm. If you're going low it will tell you with a big fat downwards arrow. Have a sip of Lucozade and all's well again. No-one even notices. I've even done this on stage in front of 100s of people, they just think you're having a sip of drink.
The problem of course is it costs £100 a month!
Hope this helps
good luck!
 
What about Dexcom G4, G5 or Medtronic's enlite system? You seem to have got yourself tied up with closed loop systems here for some reason? And by the way, Dexcom 670G closed loop systems will not be in the UK till early 2017; at the earliest.
 


I tried to offset DP by injecting more basal but eating a carb snack before going to bed to try to prevent the hypo about 2-3am from occurring.
 
@Minnie_19 - all the available CGMs (Dexcom and Medtronic) can be set to alarm when low, when going low, when high and when going high, plus when the rate of change is rapid.

Two current UK pumps include CGM as part of the pump. The Animas Vibe and the Medtronic 640G. On the Vibe it is purely CGM and uses Dexcom G4 kit. On the Medtronic, it is integral to the pump Smartguard function, where, once the pump predicts that you may go low, it will suspend your basal insulin. I@ve written quite a lot about it here.

Dexcom kit through Animas is cheaper than the Medtronic CGM kit, which is something to take into account when you are self funding. Dexcom sensors cost around £40 each but some people manage to extend their life up to 6 weeks. I've only ever managed 29 days. The Medtronic Enlite sensors also cost £40 each but the longest I've got out of one is 12 days.

Some people complain about the accuracy of the Enlites vs Dexcom, but my experience is that the current generation of Medtronic Enlites with the Guardian 2 transmitter is that it is more accurate than the Dexcom G4 and equally as accurate as the Dexcom G5.

Medtronic have also made some interesting noises with regard to replacing the 640G with the 670G when the 670 becomes available.

Whatever you end up doing, you are likely to be self funding so cost will play a part. For me, it's a no brainer to go with the Medtronic Smartguard as it's by far the best way of using CGM with a pump. You may find that cost plays a bigger part in your decision.
 
I have an Animas Vibe but not the Dexcom yet (can't afford it at the moment) I was torn between that and the Medtronic system but what finally decided me was the concern about Enlite accuracy that Tim mentions above, but also things related to the pump. I preferred the look/design of the Vibe, and I liked the fact it took Luer sets so I had a bigger choice of sets. I was also concerned about practical things, having read that the Medtronic pump clip was weak. That would have been no good for me at all.

The choice is an individual one, but do think about the pump as well as the CGM. I'm very pleased with my Vibe and feel I made the right choice for me. My tip is to write down all the factors, including cost, and then go for what suits you and your lifestyle.
 
Thank you all for your replies. Its all been really useful. Today I've spoken to my diabetes nurse specialist who advised me which pumps would be available to me, which are:

- Medtronic 640g CGM
- Animas (no handset) CGM
- Roche Combo
- Roche insight

Having had a read into it a bit today I think i've narrowed it down to either the Medtronic 640g or the Animas vibe. I really like that the Medtronic 640g has smartguard technology and will suspend basal rates to avoid a hypo. I know this is something which could be achieved with the vibe and CGM by looking at the information provided but it seems like such fantastic technology to have.

I guess now it will come down to cost and unfortunately it looks like the Medtronic (which I feel i'm leaning to more) will be more expensive. I'm waiting for the Animas Rep to contact me with some more information, so you never know he may change my mind!
 
Minnie_19 said:
I know this is something which could be achieved with the vibe and CGM by looking at the information provided
Click to expand...
Not really. The only way for this to work on the Vibe is if you set a "going low" alarm then turn off your basal yourself. There is no interaction between the CGM and the pump.
 
I've been using the Medtronic system for 18 months and I concur with every thing tim2000s has said,when I had no hypo awareness the system was a life saver for me,but the choice is yours,so I would advise plenty of research.Good luck.
 
tim2000s said:
Not really. The only way for this to work on the Vibe is if you set a "going low" alarm then turn off your basal yourself. There is no interaction between the CGM and the pump.
Click to expand...
Yes sorry I didn't explain myself very well there!
 
The Combo is old now and was upgraded to the Insight. However the Insight has problems with the steel cannulas being withdrawn so they have to still offer the combo as a choice for people wanting steel cannulas. I've had 640, combo and insight. Insight was my favourite but useless to me without steel cannulas. I have a CGM being funded currently arranged for 3 months by my CCG but still waiting upon the MDT team decision as to which pump/CGM they recommend for me...I still have the choice to make for myself but there is no pump that ticks every box for me...

Its a tough decision to make.
 
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