Medtronic Paradigm Veo - Beginner

[ClaireCissie]

Hello everyone!

I am 23 and was diagnosed with T1 10 years ago this February. I have been on a basal bolus regime for at least 7 years and feel quite confident with carb counting but unfortunately can't seem to get my diabetes under good control. My last HBA1C reading was at 8.5% (I think) and for this reason I have met requirement for pump therapy. I have just been offered the opportunity to move onto insulin pump with 3 other people which I am very grateful for. My "go-live" date is the 9th of February and I have technical training in 2 weeks time. I have chosen the Silver Medtronic Paradigm Veo and I am very excited to get started. I am looking for any information or advise from any pump users out there about what to expect? If there are any significant disadvantages from the off-set? How it will affect me when driving, out drinking etc.? Anything at all would be much appreciated!

Thanks
Claire

 

[shedges]

Hi Claire,

There is so much I could say I'd be here all day ... and never get back to work. So here are some of my thoughts...

It will take some time to get everything running smoothly, so whatever happens in the first few weeks, don't forget to come back here for advice, help or just some supportive words. Give it a fair chance, whatever happens at first.

Some things will feel strange... not having to worry about a snack between meals to keep your blood sugar levels up. Last week I fasted from when I woke up until 9pm and my levels remained fine. Being able to eat when you like and simply bolus for it using the bolus calculator. The wizard in the pump takes all the guess work out of insulin dosing. It's amazing, not having to get the needle out for every little thing.

It's really important to keep a diary so you can see how things affect you - i.e. different foods, exercise, stress, corrective doses. Make sure you write down every time you take a bg reading, and all the other things that your nurses tell you to.. it'll make all the little puzzles seem simpler.

Try to live as normally as possible when you go onto the pump. My mistake was to eliminate exercise to begin with. I thought I'd get things running smoothly, then introduce gym, running, swimming, etc back in. Unfortunately those things were part of the way my body functioned. Taking them out meant that my insulin requirements changed. The result was that for the first few weeks my levels were really high and I felt like giving up. And as soon as I started exercising again, my levels went back to acceptable. So change as little as possible.

Expect it to bother you a bit at first when getting dressed or in bed, etc. You soon get used to it though. If you need to take it off for sport (or any other physical exertions ) you'll be fine. I often take mine off for up to an hour without significant affect on my blood sugar levels.

Hope it goes well. I'm getting a new pump on March 2nd, so will be going through some of the same stuff as you, just a few weeks later.

Good luck!

Sam.

 

[novorapidboi26]

Hi,

I too am a Veo user.........

Its hard to give a pros and cons of the device nearly 2 years down the line as it has become just part of every day life, just as the diabetes became, as well as going form 2 injections to MDI......

The pump for me goes unnoticed during every day tasks, apart from bathing and showering, where it will need to be removed or un clipped....

The only thing that was a pain for me at the start was the significant increase in testing...........you will start off and a flat rate basal over a 24 hour period but you will need to do lots of basal testing to see what rates you need over the day and night.........this was a pain but its only required at the beginning, after that its just fine tuning.........

what is your daily diabetes management like?

MDI?

carb counting and self dose adjustment.....?

 

[ClaireCissie]

Thanks for your time getting back to me! @shedges I really appreciate hearing the reality of things! I practice ashtanga yoga twice a week which is quite demanding and I will aim to keep this up at least in the second of the 2 introductory weeks so I'm ready to integrate into "normal life". I have always found exercise to be more hassle than it was worth with my diabetes. If I exercised to vigorously I could end up with ketones after a 1 hour body attack class, then plummet into a hypo a couple of hours later, which resulted in binge eating and just a general frustration which followed exercising!! So I'll make sure not to cut out my yoga at first.

I look forward to being able to fast if I want to and not having my bg rocketing if I have to skip breakfast! So that's great to hear! Although being diabetic 10 years I've only recently been made aware of dawn phenomenon - which I definitely have, to the point if I hypo in the morning by standing up and walking about I can come out of pretty much straight away!? Not sure if that's good practice or not though

Thank you for replying @novorapidboi26 It's great to talk to someone who is using the Paradigm Veo too. Am I right in saying that the Veo has the facility to link up to a glucose sensor for cgm? If so have you used this and do you get the sensors on NHS prescription?

I'm currently on MDI I take lantus and novorapid. I carbohydrate count at every meal and am on a ratio of 1:5 for breakfast and 1:10 for lunch and dinner, which I expect will be even more fine tuned with a perfect basal set up

When you talk of self dose adjustment is that correction dosing? I take 1 unit to reduce my bg by 2 mmol.

With regards to my overall control I am considered as "poor" and my last HBA1c was sitting at 8.5% which converted to the old measurement is about 10-something. Despite trying hard with MDI and working with a dietician etc. my control hasn't improved and I believe this is why I've met criteria for pump therapy. There are only 4 of us going live on the 9th so I'm feeling very grateful and excited now!

I have never really spoken to other diabetics before and don't know why I've done this alone for the last 10 years?! It's great to know there's so many people happy to support each other in the diabetic community ! Ha

How do you both find changing the cannula? I imagine this could be just as daunting as injecting yourself for the first time. I've yet to get my technical training so have no idea how it goes!

 

[novorapidboi26]

The Veo can wirelessly link up with a CGM yes, I haven't had one or plan to...........

There are expensive unfortunately and for most don't come on the NHS.............I can see it being very useful for folk who need that level of information due to hard to control blood sugars..........I like most can manage without it though.....

I was asking about your level of carb counting experience but its sounds as though you know what your talking about and will manage just fine on the pump as the basics are the same, you use the same methods of evaluating and adjusting as you would on MDI.....

the cannula change is a new experience for sure but the main thing is it doesn't hurt when it goes in..........9 times out of 10.......

its just like a plaster coming off, best pulled in one go..........

you'll love it honestly.........

any questions after training you can get answered here...............

how much basal are you on.........?

 

[ClaireCissie]

21 units of lantus but apparently still "under-insulinised" (if that's even a thing!) In the past when I have tried to up my background as soon as I'm on 22 I awake in hypo most mornings if I've gone to bed with a good bg.

As much as I know what ratios I'm on etc. I have no idea and have never known how to adjust these. I was actually on 1:10 for all meals just up until last year when a little more attention got paid to my control by diabetes team. This would be good to learn though! Do you know how to make decisions on these kind of adjustments?

I've also never split bolus doses for things like rice before these are all new things that I've heard about recently! I suppose it's just all one huge learning curve!

How long have you been using the Veo? Were you on MDI like me beforehand? I know this is certainly not a priority but do you feel like you need to be more cautious drinking alcohol when on the pump?

 

[Flowerpot]

Hi Claire

I'm another silver Medtronic Veo user, I'm just coming up to 4 years on the Veo, 14 years on a pump

You'll get good training to deal with all the initial set up, basal rates,cannula insertion, reservoir filling etc. It is daunting at first but once you have done it a few times you get quicker at it plus it's usually only necessary to change the cannula every 3 days. The Medtronic staff are really helpful if you have a query and also the website has got videos on how to change/insert all the various infusion sets.

It does take a lot of tweaking and continued testing when you first start but little by little your control will start to improve and fall into place. It is a big change from MDI but gives you so much more flexibility and fine tuning. The Veo can link up to CGM although it is funded rarely on the NHS and mainly when you have lost hypo awareness. However, a lot of clinics do loan a CGM for a week to enable fine tuning of basal rates or to iron out any specific problems so well worth asking.

Using a pump will help a lot with exercise as you can set temporary basal rates, reducing the normal rate by a chosen percentage, likewise you can run an increased basal rate for dealing with illness etc. It is a lot of trial and error to get the right percentage change in basal rates but it's an invaluable tool to have.

I wish you good luck with your Veo pump, I'm sure in a few months time you will have got used to it all and hopefully see a reduction in your HbA1c through improved control. I hope it all goes well for you.

 

[ClaireCissie]

Thank you for your supportive words @Flowerpot!

I suppose it's good to know that the Veo has the cgm facility in the off-chance NHS do have excess funding for the sensors in the future. I have read though that as the cgm takes readings from tissue fluid as opposed to blood there is approximately a 10 minute delay compared with blood readings. So I'm sure it has disadvantages of it's own!

Hearing all of your positive experiences is really encouraging. I can't wait to be able to test and have normal bg readings! I feel like there hasn't been a day gone past where I haven't had at least 1 reading which has been over 13 at least. It's got to the point when my bg monitor prompts me to check for ketones I ignore it as this pattern is just normal for me

 

[dancer]

I tried to reply yesterday but it wouldn't go through.

I've been using the Veo for almost 5 years and think it's wonderful. Very good points have been made above so I'll just add something about driving. In the first week you'll probably be advised not to take alcohol because of the possible effects on blood sugar. After that it's just the same as before except that you have the option of using a reduced temporary basal instead of snacking before bed. It took me a long time to try that - it's the usual story, what works for one won't necessarily work for others. Good luck. It takes a lot of work but it's worth it

 

[ClaireCissie]

Hi @dancer thank you for your advice. I'm getting so excited about my go live date now

I can imagine it being a little scary going to bed after a night out without some greasy insulin-free snacking and instead a reduced basal! I don't know if this is or was normal pre-pump for any of you guys, but I normally let my bg run high (even up to 20s) whilst drinking and wake up with a normal reading. I understand this to be the case due to my lantus working well through the night as I take it in the evening and also due to the fact my liver is too busy filtering alcohol to release glucagon? I'm unsure if this theory is correct though.

I think I'll be searching for more advise from you all before having a drink as I can't imagine drinking while my bg control is tight as I'm so used to it running high!

I'm definitely prepared to give it my all and work hard since I've been given such a great opportunity -funding is so tight within nhs GGC. I didn't even think I would be in the first 4 of the year!

 

[himtoo]

21 units of lantus but apparently still "under-insulinised" (if that's even a thing!) In the past when I have tried to up my background as soon as I'm on 22 I awake in hypo most mornings if I've gone to bed with a good bg.

As much as I know what ratios I'm on etc. I have no idea and have never known how to adjust these. I was actually on 1:10 for all meals just up until last year when a little more attention got paid to my control by diabetes team. This would be good to learn though! Do you know how to make decisions on these kind of adjustments?

I've also never split bolus doses for things like rice before these are all new things that I've heard about recently! I suppose it's just all one huge learning curve!

How long have you been using the Veo? Were you on MDI like me beforehand? I know this is certainly not a priority but do you feel like you need to be more cautious drinking alcohol when on the pump?

Hi @ClaireCissie
i am awaiting to go on a pump right now too -- have just been passed by the dietician for carb counting -- so waiting appt with pump nurse.
the paradigm veo is on my list of choices but have not yet really decided.
the reason i have posted is your comments on ratio adjustments --i have found that by keeping thorough records you can definitely "see" historically exactly what your bloods do post meal with a ratio and if it not in range tweak the rate until it is
i will now bore ( or enlighten ) you with an example

meal as follows
chicken curry and rice with the following ingredients

chicken portion 150 grams ( 0 CHO ) mushrooms 75 grams cooked weight ( 2 CHO) onions 50 gram cooked( 7 CHO) cauliflower 55 grams cooked ( 2 CHO) sauce - bought from jar values 200grams ( 17.5 CHO) basmati rice 150 grams cooked ( 47.4 CHO)
total CHO = 75.9
so @ 1u per 10CHO this = 7.59 u if you had a 1/2 u pen 7.5 u
@ 1u per 15CHO this = 5.06u
@ 1u per 7.5CHO this = 10.12u
@1u per 5CHO this = 15.18u

as you eat this meal and test at 1 hour , 2 hour , 3 hour , 4 hour , and 5 hour post bolus you will see what your blood sugar does
through much trial and error over the years on MDI my ratios are about 2.4u per 10CHO in the morning , 2.5u per 10CHO at lunch , and 2.2u per 10CHO at tea time.

my lantus is 30u at 6:30 pm

hope this helps -- pm me if you want any help with sorting your ratios

 

[iHs]

I think the Medtronic 640G which according to EDUAD blogger, is meant to be available for the summer and will be worth waiting for as it will be able to anticipate drops in bg levels through its connection with cgm and adjust the flow of insulin before the hypo levels come.

 

[Poppy2]

Hello and welcome! I too am about to start on the Veo, my saline start is tomorrow and insulin from Monday! I am scared but prepared for the challenges that face me (having waited a year since referral!) I have been reading the forums and the website that has been a tremendous help it is great to be able to share experiences with other people who truly know what it's like to live with Diabetes. I hope to share my experiences too!. Best of luck as you prepare for your new adventure in the world of pumping

 

[ClaireCissie]

Hi @ClaireCissie
i am awaiting to go on a pump right now too -- have just been passed by the dietician for carb counting -- so waiting appt with pump nurse.
the paradigm veo is on my list of choices but have not yet really decided.
the reason i have posted is your comments on ratio adjustments --i have found that by keeping thorough records you can definitely "see" historically exactly what your bloods do post meal with a ratio and if it not in range tweak the rate until it is
i will now bore ( or enlighten ) you with an example

meal as follows
chicken curry and rice with the following ingredients

chicken portion 150 grams ( 0 CHO ) mushrooms 75 grams cooked weight ( 2 CHO) onions 50 gram cooked( 7 CHO) cauliflower 55 grams cooked ( 2 CHO) sauce - bought from jar values 200grams ( 17.5 CHO) basmati rice 150 grams cooked ( 47.4 CHO)
total CHO = 75.9
so @ 1u per 10CHO this = 7.59 u if you had a 1/2 u pen 7.5 u
@ 1u per 15CHO this = 5.06u
@ 1u per 7.5CHO this = 10.12u
@1u per 5CHO this = 15.18u

as you eat this meal and test at 1 hour , 2 hour , 3 hour , 4 hour , and 5 hour post bolus you will see what your blood sugar does
through much trial and error over the years on MDI my ratios are about 2.4u per 10CHO in the morning , 2.5u per 10CHO at lunch , and 2.2u per 10CHO at tea time.

my lantus is 30u at 6:30 pm

hope this helps -- pm me if you want any help with sorting your ratios

Wow @himtoo that's amazing just how fine tuned you have your ratios. Hopefully I will achieve this once I have a correct basal dose set up through the pump, and I may take you up on that offer for some help in the next month or so

@iHs Unfortunately I don't have the flexibility to wait or choose any particular pump model - but I did get to choose the colour! I believe the Veo also has the functionality to suspend basal dose when a hypo is detected, this is of course if the cgm sensor is being used. However, to my knowledge I do not get the sensors on NHS prescription and on researching I believe the cost £50 per month approx. to fund on your own! I'm sure such technologies will be available soon

Hi @Poppy2 it's so nice to be able to share this exciting time with other people! Please keep in touch and let me know how it all goes for you. Please excuse my naivety, but what does your saline start involve? I haven't been informed of this yet?

 

[himtoo]

no probs -- happy to help

don't want to steal poppy2's thunder but you start on saline to get used to using the pump before you "go live" with insulin

 

[ClaireCissie]

I see! Just not heard this from my diabetes nurse yet. My technical training is on Friday 30th of January so I'm sure they will explain the set up then! I'm getting very excited about it now looking forward to the challenge as geeky as that sounds haha

 

[himtoo]

I see! Just not heard this from my diabetes nurse yet. My technical training is on Friday 30th of January so I'm sure they will explain the set up then! I'm getting very excited about it now looking forward to the challenge as geeky as that sounds haha

I don't think it sounds geeky at all -- i don't even have a date yet and i am getting excited -- you must be thrilled at the prospect of lower A1c's and tighter control and no daily injecting

 

[ClaireCissie]

I definitely am and it's just all happened so quick! I feel very grateful to be one of only four people. When the pump was first mentioned to me about 3 years ago the estimated funding would be available in 2016 so we're running ahead of schedule! I haven't had the opportunity to attend diabetes education pre pump though but by the look of it there's plenty of support on here

 

[shedges]

Hi Claire - don't worry if your nurse hasn't mentioned the 'saline start' ... not all nurses start you off that way. I'm with North Hampshire hospital (Basingstoke) and they started us all off straight onto insulin. It's up to hospital policy, I guess.

 

[Flowerpot]

I was also launched out of the hospital with insulin in my pump and didn't go through a saline start.

It is good to hear how excited and keen you and others are at being given the opportunity to use a pump. It's easy to get a bit complacent and used to the monotony of controlling diabetes but reading these posts has really made me appreciate what a lucky girl I am to be able to use a pump.