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Pump Criteria and Choice

Discussion in 'Insulin Pump Forum' started by paulpapa, Dec 14, 2016.

  1. paulpapa

    paulpapa Type 1 · Well-Known Member

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    Hi all,

    I had a pre-pump assessment this week that went well. I had my HbA1c result the same day which was 7.8 (which shocked me, I thought it'd be higher!), which I'm really pleased with considering it was 10.something a year ago and the lowest I've had in years. The nurse said its nearly a 3% drop in that time. Whoop!

    Now that my HbA1c is in a better place, the nurse said she'd have to make a case for me to go on pump therapy.

    I was just wondering if people have been successful in being approved with an HbA1c of under 8.5 as the NICE guideline says (I think)? Also, we went through other reasons I'm suitable - blunted hypo awareness (great stuff!), a lot of hypos, foot tingling (continued wonderfulness), and an intensive injection program with 100u per day. So, here's hoping I can get one!

    I'm swaying more towards the Medtronic 640G pump as it has CGM built in and looks easy to use. If the NHS one day allows funding for CGM, I'll be good to go. I use the Libre at the moment, but I can dream! Maybe one of them will be funded in the future.

    Just wanted to hear from people with the 640G or the Animus Vibe as they are the options presented. The nurse said they won't likely be using the AccuCheck Insight in the future as people have had issues with it and its slow to operate.

    Thank you.

    P
     
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  2. Type1Bri

    Type1Bri Type 1 · Well-Known Member

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    Hi Paul
    Glad your assesment went well, I know from meeting you at the T1D London meetups Xmas drinks the other week that this will help you hugely.
    My hba1c was 6.3% when I got my funding. I was funded on the grounds of Dawn Phenomenon, waking rises, problematic hypos and too many injections to gain good control. The main thing I think is being in a pro pump clinic, if the team are 100% behind you it really helps
    The 640g is great, does everything I need it to. If you are at the next meetup you can have a look at mine and get a feel for the menus etc.
     
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  3. rockape37

    rockape37 Type 1 · Well-Known Member

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    The 640G is a good pump though i have to say its the only one that i have had.

    I need to correct you though, it doesnt have a CGM built in but it is CGM ready in otherwords it will work with a CGM.

    Your quite right this pump is eady to operate and navigate around. I can safely say thst if you do get a choice that this pump would be a good choice.

    Regards

    Martin
     
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  4. GrantGam

    GrantGam Type 1 · Well-Known Member

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    Although I cannot vouch for either pumps as I'm not a pump user. The Vibe doubles up as a Dexcom receiver so it is also "CGM ready".

    The 640G has a pretty amazing feature that allows insulin delivery to be suspended when your BG is heading low, that could literally prove life saving in some cases. The only issue with this system is the fairly hefy cost of the Enlite sensors that make up the 640G's CGM system. They have a pretty short lifespan and I don't think they can be made to last as long as Dexcom's G4 sensors. Many people can stretch a Dexcom sensor over 3 weeks, so that combined with the Vibe would "probably" be the cheaper option if the cheapest pump/CGM setup is one of your main priorities.

    Tbh, from what I can see - you won't really go wrong with either pump, they're both pretty cool bits of kit!
     
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  5. azure

    azure Type 1 · Expert

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    I chose the Vibe and don't regret my choice at all :) I can't afford the Dexcom yet but I like having that as an option, and, after a lot of research I would prefer that over the Enlite, etc.

    The Medtronic does not have CGM with it - you have to buy the sensors as mentioned above, just like with the Vibe.

    I like the Vibe because it's tough, robust, waterproof and intuitive to use. I also like the wide choice of sets and the fact they're Luer sets (ie not brand specific).
     
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  6. Snapsy

    Snapsy Type 1 · Well-Known Member

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    Hi @paulpapa , that sounds like a great improvement - well done!

    My pre-pump HbA1c was 44 in 'new money', which is 6.2% in 'old money'. It went down to 42 (or 6%) after three months of pumping, and then more recently 46, which is 6.4%. I was approved for pump therapy because I was only able to achieve that level by compromising my quality of life (obsessive testing, limiting the things I was doing purely because of how I felt it might affect my control, lots of hypos and associated fear of hypos). I'm sure your team will be able to put forward a good case on your behalf.

    I have been using a pump since October last year - I have an Accuchek Insight and am so in love with it! Have never looked back.

    :)
     
  7. endocrinegremlin

    endocrinegremlin Type 1 · Well-Known Member

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    Yes my hbaic was around 7% average for 4 years before I got my pump. At the end oft he day the hba1c means half a result. You can get a perfect average from 2 and 20.....not those numbers but you understand. Its about the overall pictures. You just need to keep records and show it when the time comes.
     
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  8. Type1Bri

    Type1Bri Type 1 · Well-Known Member

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    • Useful Useful x 1
  9. catapillar

    catapillar Type 1 · Well-Known Member

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  10. tim2000s

    tim2000s Type 1 · Expert
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    Having used SmartGuard to great effect and having used both Dexcom G4 and G5 as part of my ongoing artificial pancreas experiments, let me give you a few thoughts on the two systems and the use of Smartguard.

    1. "Accuracy" of the CGM - the Enlites on the 640G are more accurate than the Dexcom G4, but not as good as the Dexcom G5. I was happy to bolus from them.

    2. Sensor lifespan - the Dexcom G4 sensors definitely last a lot longer than the Enlites. With G4 you can typically get 21 days out of a sensor. With Enlite, the best I achieved was 12 days.

    3. Price - If you sign up to the "Loyalty programme" that Medtronic runs, then you get each sensor for £40 at best. I believe this is about the same as the deal via Animas for the Dexcom sensors. The start up pack for the Medtronic is more expensive than that for the Dexcom though.

    4. Product support - I've never had any issues when dealing with Medtronic or Dexcom in terms of getting faulty sensors replaced, new orders, etc. Both have been great, but I can't speak for Animas, through whom you would be sourcing for the Vibe.

    5. Cannulas - both the Vibe and 640G have a wide range of native cannula options, some of which are made by the same manufacturer for both companies. The new BD cannula will first be available on Medtronic devices, while the Vibe uses a Luer Lock which allows you to use Roche cannulas as well as the Animas ones.

    6. Functionality - The Vibe is simply a CGM receiver. The 640G is much more. Smartguard is life-changing and is as commercially close to an artificial pancreas as you'll get right now. Using Smartguard, I was able to take my time in a glucose level below 3.8 to 1% of my total time wearing the sensors because the system has quite an aggressive algorithm for predicting lows and stopping them.

    If you can live with the cost limitations that come with the Enlites, then for me there is no comparison in terms of "living with Diabetes" overhead. The introduction of the 640G with SmartGuard is truly life changing. If you can try it before you make a decision, I'd strongly recommend it.
     
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  11. paulpapa

    paulpapa Type 1 · Well-Known Member

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    Thank you everyone. I'll do some more research on this and get back to you all. Very helpful responses though!
     
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