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Our Decision to Switch to Medtronic Minimed 630G Insulin Pump – Part 2

This part may be a bit long, so go get some coffee and settle in. There is a lot to cover here ūüôā

Ahhhh….coffeeeeeee…. (Pixabay)

I started on the Medtronic 630G pump on 5/1/17 – the day I received it. This is a bonus of having a small endo office – they can pretty much work you in at any time for device training.

So, in the boxes were the pump box, sensor box, and meter box. Along with lots of papers and training books. I had also already watched the training videos and played with a demo too, so I had a general idea of what to expect.

Using the pump wasn’t my concern at all since it worked pretty similar to other pumps — it delivers insulin based on your settings. Okay, no biggie. The biggie for me was whether I could trust the CGM or not. This is a big question for many, especially if you are die-hard dedicated Dexcom user as well.

See, I had the 530G before with Enlite. I did not have good success at all. It was rarely correct, and I was going through sensors every 3 or so days. It wasn’t worth the hassle it was giving me. But, I had been keeping my eye on the 630G since it was available, and I wanted to see what other’s were experiencing. The consensus was that the 630G was much better somehow. I believe they updated the algorithm a bit, and it was supposed to be a vast improvement.

The game-changer that helped the transition:

I made the decision that others had (CarolCluka and CoolReeRee ) to keep my Dexcom sensor attached until I was fully comfortable. This lasted about 3 weeks. I kept my Dexcom connected to my Glooko account because I can connect Glooko to Medtronic Carelink, and I could see how they both compared. I was pleasantly surprised, to say the least:

Of course, there are times when the sensors didn’t line up perfectly, but as you can see, they’re pretty on-point with each other.

I’ve had pretty good success, and so much that I disconnected from my Dexcom after 3 weeks and felt completely comfortable doing so.

The good, the bad, and the tips…

Now, let me tell you… it hasn’t been all cupcakes and rainbows for the last almost-two-months. I did go through about a week or so of wildly inaccurate¬†readings. So much that I reconnected my Dexcom. See, the problem is that you cannot jump into the Medtronic system with the experience of Dexcom. You have to wipe that mindset out and start over.

First and foremost, you have to calibrate at least twice a day, but it is recommended to be 3 times at a minimum, and 4 max. So, I’ve developed a routine – I calibrate when I wake up, again before lunch, and before bed. The system stays pretty accurate if I do that, which is no problem really, because it’s not hard to do. I’ve never been one to feel comfortable enough to dose off of my Dexcom, so I always test before eating. All it takes is a click to calibrate, and then a click to go to the bolus wizard. No big deal at all.

Second, there are rules:¬†(I’m sure they could apply to Dexcom too to help make it be more accurate, but these are sort of a must-follow in my opinion if you are on Medtronic’s system)

  1. Follow the “B” rule when learning your own calibration schedule: Before breakfast, before lunch, before supper, before bed. Find three of those that fit YOUR schedule and when you know you’ll be least likely to be trending wildly (aka – no arrows)
  2. Do NOT calibrate if you have bolused in the last 2 hours. The sensor is less likely to be as accurate since you have bolused in that time, and a calibration could confuse the sensor.
  3. If the sensor is “off”, especially when waking up first thing in the morning, try drinking some water and walk around a bit. This gets the interstitial fluid moving around the sensor again. It will likely re-align itself within 30 minutes or so.
  4. Be patient. I cannot stress this enough. If coming from Dexcom, you may be used to the instantaneous calibrations.¬†The sensor can take 10-15 minutes to accept a calibration, especially if the values are very different (up to 60mg/dL). If it is above 60mg/dL, try the drinking and walking bit. If it doesn’t realign, call tech support for help or a new sensor. They can help you upload your pump and look for specific things that could be interfering with the sensor communication.
  5. When inserting the sensor and taping, BE GENTLE! Taping the sensor head down too hard or pulling the transmitter tape flap too hard and tight on top of the transmitter can cause the sensor to pull out just a bit from the skin, which can cause big trouble. If you set it up softly, it will be nice to you.

After I called tech support, I found that I was being too rough with taping, and not being patient with the calibrations. Since then, I’ve been able to go back to Enlight sensor values only, and it’s been just as good as it was when I first started. Heck, it’s even caught real, legit lows that the Dexcom didn’t.

In the past couple of months, I have been greatly impressed with the CGM of the Medtronic 630G pump. I’ve caught myself at times in awe of it, really.

Why the 630G now and not wait for the 670G?

One question I was asked already on Facebook was “why not wait until the 670G?” The reason is that I wasn’t sure I could trust the sensor to make the call to give me insulin if I were going above range. Cutting off my basal for a couple of hours is one thing — giving me insulin when I don’t need it is a whole other realm, and I wanted to be sure I could trust the system. I am on the list for the 670G, and I should be able to get it next month once my sensor order is due (that’s how they time when you get it if you’re on the pathway program).

I am on the list for the 670G, and I should be able to get it next month once my sensor order is due (that’s how they time when you get it if you’re on the pathway program). I can use the pump similar to how the 630G works now when I get it, and then wait to be trained on “auto-mode” later. I am cautiously excited to see how it works, but I’m also not going to be entirely upset if it doesn’t live up to the hype I’ve seen. Mostly, because I know the experience is going to be different for everyone, and I know it can be a learning curve even if you’re coming over from the 630G.

And, to be completely honest, it would be the same hesitancy whether it was the Medtronic system or one that incorporated Dexcom. Anything that augments how my insulin is delivered, I’m going to be very hesitant about. I guess I’m just old-fashioned and have been burned by eagerness one too many times.

Where to view more if you’re interested:

I’ve been trying to keep this to myself and a few close friends in the beginning just in case this new experience caused me to be upset and disappointed. I prepared myself for the worst, thinking it would be no different than the 530G. Maybe that’s why I’m so much more surprised than I thought I would be.

So, instead of blowing up their phones with text or Facebook messages, I decided to revive my Sugar and Sites domain for Instagram and Tumblr, and get my thoughts out there.

You can click on the image and it will take you to the Instagram page I’ve been using. Let me know in the comments what you think, and if you have any other questions. From those, I’ll make a Part 3.

Which brings me to my next thought: I may begin transitioning from Sugabetic to Sugar and Sites overtime. I’ll still keep Sugabetic alive, but maybe on a free WordPress site. I’ll handle the transition as smoothly as possible, but there may be a few days that things will be down. Until then, feel free to follow me on IG for updates about the pump experience ūüôā¬†

 

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Our Decision to Switch to Medtronic Minimed 630G Insulin Pump – Part 1

A few months ago, I was at home with the kids, and didn’t feel quite right. After a quick fingerstick, I saw that I was in the 20’s. In a panic, I couldn’t get anyone on the phone to talk with me until my sugars came up. I began to “eat the kitchen”, as it were. I finally reached my sister-in-law, who came to sit with the kids until I could get back to myself again.

After that day, I was scared out of my mind to go below 100 if I was at home with the kids by myself. So, I started running my numbers higher — much higher than I’m comfortable with, and I knew I would be risking damage doing so.

That’s when I realized, Dexcom Share wasn’t enough. It’s great to be able to Share and have people call to check on you… but what if they can’t actually reach you? My son and daughter can’t use my iPhone just yet (he can’t remember my unlock code), and neither¬†know how to use a glucagon kit.

I looked into the Loop system, but honestly, while I love that everyone is so willing to jump on board, I’m not.¬†I’m not confident in my own abilities to make this thing happen since it’s something done from home. I don’t mind tinkering and playing with Nightscout because it’s not directly affecting my insulin dosing, whereas the Loop system does. That’s a-okay if you’re on it – I’m not trying to down the system or anything. I’m just not comfortable with the idea of using it myself.

So, we looked into Medtronic. I know. It’s known as the big evil empire of the insulin pump world. And, while I am interested in the 670G, I was more interested it the 630G since it suspends insulin if the user is low. I know this is the exact same technology as 530G, but somewhere along the way, they’ve improved the CGM technology. I kept reading about how sucky the 530G was but that the 630G was much better on different sites, like Instagram and TuDiabetes, and a few others. People who had absolutely zero success on the 530G were being impressed and excited about the 630G.

After a lot of debate and hemming and hawing about it, I decided to take the plunge. I was going to trade in my Tandem using the Switch-to-System program, but I couldn’t afford the $1249 out of pocket to do the switch. So, on a whim and a prayer, we submitted for insurance coverage. Backed with letters from myself and my doctor, along with pages of blood sugars showing the amount and severity of the lows I had been having, we held our breath and waited.

On the evening of 4/28/2017 just after 5pm, we got the approval from my insurance. And, on 5/1/2017, I began as a Medtronic pumper again.

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Coordinating Devices with PumpPeelz

One little thing I like to do is design graphics. I piddle with it, mostly, so it’s not a big thing, but it gets my creative juices flowing and takes my mind off of other things that may be stressing me out.

So, I wanted to make a design to get a custom PumpPeelz made so that my Dexcom and Medtronic pump matched and looked cute. Crazy, I know, but that little bit of color and art makes having the devices not so mundane. So, I set out to make a design using a blank canvas in Photoshop and some “brushes” (some of them are more like stamps, like the ones I used). I also used color inspiration from my niece’s favorite show, Strawberry Shortcake. My favorite character is Cherry Jam because, well, she sings and her colors are pink (like, fuchsia pink), a purpley-tinged pink, white and purple. This is where I LOVE Adobe Color because I can pull the exact colors from the photo and use them in my design work in Photoshop. (okay, okay, enough about my geekiness…)

Scott was able to take my image that I sent him:

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And with it, he was able to make my matching skins:

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I love them. ¬†And the purple almost matches the color of the pump too. And, since I really don’t like the pink that the Medtronic pumps come in (someone likened it to a naked mole rat once, so now that’s all I see with it!! hahaha!), this gives me a perfect mix of purple AND pink… a pink that I like.

Is this post about diabetes? Not necessarily. But I do believe that things that make us happy and creative around diabetes helps us to do better and be more encouraged to take better control of ourselves. And if a silly pump skin or Dexcom skin helps do that and also gives me a means to display my artwork, then hey, it’s all good. ūüôā

So go and get creative. If we have to use these things to help us be healthy, why not get creative with them? No use in being drab all of the time, I say. (Unless that’s your thing… if so, go for it.)

 

If you like this design too and would like to have one like it, feel free to email me and I can let Scott know that you would like to purchase one. I don’t charge for the designs, so it would be the cost of a custom designed skin from PumpPeelz.

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Conflicted

I am one of MANY people who choose to use the Medtronic pump system with the the Dexcom CGM system. Since¬†my endo took me off of my t:slim, the biggest thing I have been irritated by is how I cannot get all of my information into one report. I was finally SO happy to have that ability with Diasend for the t:slim and the Dexcom, and now I don’t. I know Medtronic has their own CGM system and I do have the 530G that will work with the Enlite sensors, but I had a bad run of luck (about 3 months worth) with it when I used it last year and I am hesitant to go down that path again, especially right now.

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Plus, now that Dexcom has Share built into the receiver, it has been SUCH a valuable tool for me and my family. I even contemplated using my old, out of warranty Animas Ping system so I could have all of my data in one place, but after one day of all of the irritating quick-scrolling and constantly missing my intended mark, I got irritated and used my Medtronic pump again. Not to mention, logging everything into the Medtronic through the Capture option so I could keep complete records was just irritating in itself (not that anyone else should have to do that, but I was just for my own sanity’s sake).

It really baffles me how Medtronic, being the big business that it is, and knowing that not everyone can wear their sensor, wouldn’t work with Dexcom to have a Dexcom version of their pump. Of course, I don’t know if maybe the feeling is mutual between companies and they just don’t want to be friends or what, but it would seem that if a company wanted to reach a HUGE customer base for their combination product, it would offer options that would fit almost everyone’s needs.

Anyway, that’s where I am right now. I have had a good experience over the past month and a half with my Medtronic pump and it’s made handling diabetes with pregnancy since switching a lot easier. I just wish I could have my reports all in one place, instead of two. It helps me make better decisions about my care. Sort of like what having access to Medtronic Pro reports would probably do too, but that’s another beef I have with them ( I mean, seriously?? Why can’t we have access to the more comprehensive stuff if our endo’s trust our judgement? And why have TWO systems anyway – other companies don’t [I don’t think, anyway].)

Bottom line is I know Dexcom works very well for me. I know that I like the Medtronic pump. I just want my world to be perfect and have the option of having those two combined.

*clicking my ruby slippers*

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Studying and Tuning

Usually, about once a month, I study my Dexcom trends and make minor adjustments here and there in my insulin needs (with permission from my endocrinologist, of course). This ritual then becomes a weekly thing during pregnancy, and this time is no different. And, later in the pregnancy, I tend to do this every couple of days or so due to all of the increased resistance and stuff.

Since I switched back to my Medtronic pump after issues with the t:slim last week, I wanted to get a good few days of data before making any changes since typically you do have to make some adjustments between insulin pumps. Not all of them deliver in the same manner (though relatively the same, but juuuuuuust enough to possibly need minor changes in insulin dosing). Here’s what I mean:

6 days on tslim 2

6 days on the t:slim I had been using during the first part of my pregnancy…

6 days on the *replacement* tslim... NO changes in rates as they're the same brand of pump so it shouldn't have made a difference...

6 days on the *replacement* tslim… NO changes in rates as they’re the same brand of pump so it shouldn’t have made a difference…

...and the last 6 days since being on MedT with practically the same rates.

…and the last 6 days since being on MedT with practically the same rates.

If you compare the first and the last picture, you can see that there’s not entirely too much difference, and the average BG between the two was only a few mg/dL off from each other. The replacement, however, was whacko.

Either way, I’m doing a lot better on the MedT and will probably stay on it. And since I have made that decision, it’s time to get down to fine tuning things. I’m dropping every night around midnight, and it’s taking longer to treat them, thus I over treat and go high. BUT, the thing is, I’ve not corrected those highs. I’ve been trending back down on my own. So that tells me I have some work to do between supper, bedtime, and overnight basals and other factors.

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I usually look at my trends on the computer and try to identify things. If I think I see something or have a hunch, I’ll print out the Daily Trends report so that I can see the days individually and not as an average, and I’ll write my basal rates below it. This time (for example), I noticed that I dropped an average of 57mg/dL from my highest average to my evened out number when I wake up, which, ironically, is close to my insulin sensitivity factor (55mg/dL currently). So, I took the 1u and divided it by the number of hours it had been dropping ¬†before leveling out, which was 7hours, and it came to 0.14, which I interpret that to be a needed basal rate change of 0.15u per hour less than what I have it set at now. ¬†It all may not be exactly right, as most of what I think I’ve figured out is simply a hunch that I try out and see if it works. If not, I have record of my information pre-changes and I go switch everything back to what I had before.

This the stuff that goes through my head while I’m examining my data. This is why having as much of my data in one place is as crucial as air to me, especially while pregnant. It’s such a pain in the butt to have to look at multiple reports and have to spend more time organizing it than actually analyzing it. So, I’ve also resolved to leave my beloved Verio IQ and use the Contour Next Link meter that works with the pump, so that all of my data from the pump and meter at least are in the same place. That, and since using the CNL meter, my Dexcom data more closely matches it whereas it hardly ever matched my Verio. I’ve done a lot of research over the past couple of days, and it seems that maybe the CNL meter is a bit more accurate than the Verio, and with the Dexcom using the more accurate 505 software, maybe the two are just meant to be… Or I could just be completely off my rocker. ūüėČ

So, I’m off to my endo tomorrow for my monthly checkup and to share my observations and changes with him.

(What I do and write here are in no way medical advice that you should ever take as such. I have worked very closely with my endocrinologist over the years and he has helped me learn how to do these things. If you want to learn how to manage and fine tune, please speak with your health care professional, as I am not one.)

 

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Changes At The Half-Way

Typically, when one such as myself who is a device hoarder and who likes change becomes in a medical state where circumstances would favor more stable device use and more concentration on what is actually going on, one would stick to those devices no matter what and create a harmonious data record flow throughout the medical state.

My said state is, of course, pregnancy. A highly regulated and controlled medical state in those who are diabetic because both high blood sugars and wide variations in blood sugar control can cause damage to the developing baby. So, when I found out about this one, I resolved to stay on my t:slim pump, Dexcom CGM and Verio IQ meter – both because I was happy with my t:slim finally after having used it for almost a year without issue and for the sake of keeping consistent records. I had no concrete reason to switch back to another pump other than for my own sanity as I still didn’t 100% have faith in it. In all honestly, even though I had used it for the entire year without issues, I still -in the back of my mind- wondered when the issues would arise again. I held my breath with each cartridge change and said a prayer that it would work just fine. And it did… until earlier this month.

Granted, I know that being in the second trimester that insulin resistance would start to kick in, but there was a HUGE difference in my control after I had received my last replacement from Tandem on the 6th of this month. I was right back to fighting wild, crazy numbers from all ends of the spectrum without any rhyme or reason to them – and the only thing that had changed was the pump. And while I could call Tandem about it and have them replace my pump again, I just don’t have the mental energy to go through it again when even this last time was a bit challenging to get it replaced because the error I was getting was not a known problem and the pump had passed all other safety tests. I’m sure for other people, Tandem is a great company. I think they have a good product on their hands, but for some reason I just seem to not have luck with it for long.

Last week, when I had finally hit my breaking point – literally, I was sobbing Wednesday while contacting my Endo and letting him know I would be faxing records to him for help – I decided to go ahead and use my Medtronic pump. Crazy thing is, just for my own security of mind, I had just had it switched out from the 5 series (the 180u pump) for the 7 series (300u pump) to have as a “just in case” for the end of the pregnancy when insulin needs were going to be much higher. One of the issues with the t:slim seemed to be when I filled it up to 280, it would screw with the load sequence – thus the reason I had it replaced.¬†Within a day, my BG’s became predictable again. I could bolus without skyrocketing and plummeting later – as if the insulin wasn’t being delivered. I could pre-bolus on a predictable schedule before eating again. And while I don’t like that now I can’t upload my pump and meter together so all of my data is messed up, I’m more at ease about my glucose levels overall. All from switching a pump.

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Saturday, I put my t:slim into sleep mode and packed it up and away. I do not plan to use it for the rest of my pregnancy, and even after that, I’m not sure if I’ll use it again. I’m absolutely torn about it because it was the first pump since my Disetronic way back in the day that I truly loved to use. But it’s like I’ve heard many other veteran pumpers say – I don’t care how fancy you make your pump, I just want it to deliver my insulin and work like it should. Especially right now.

Of course, this all is not to say you shouldn’t get the t:slim if you want it – there have been plenty of people who have used this pump since it came out without issue. I seem to be one of the lucky few who has had problems with it. Not every pump works for everyone, and you can’t go off of one person’s experience to assume what yours will be.¬†

And I know this is already a long post, but I want to give a shout-out to my Medtronic rep if he’s reading. He’s been so supportive of me through the past 4 years – no matter how many times I would switch pumps and go back to my Medtronic one, he was always there to help with¬†whatever I needed. I can honestly say that I have never had a rep from any company be as good to me as he has, and I really appreciate that. So, a huge “Thank you” to Travis, especially this time for taking out a few moments on your day off (and on your way hunting, no less!!) to bring me a few sets that I needed until my order comes – you’re an awesome guy.

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3 Weeks

Three weeks ago, I began what I thought would be just a break from my Minimed pump / CGM combo. I was constantly getting frustrated with CGM sensors not lasting the full 6 days (usually only about 4 days) and knowing that my records were going to be all messed up. I have to hand it to Medtronic though, they stuck it out with me the entire time and without hassle replaced boxes of sensors and even my serter. But with all of the trying and trying and trying, I just couldn’t get them to work. So, I wanted to take a break. Being overwhelmed with that and just everything else, I just didn’t feel like I could troubleshoot anymore. Now, I’m not saying their product isn’t good, because I know a LOT of people who use it and have had a lot of success too, but I’ve learned one thing – there is a lot of truth in the fact that not every device “fits” everyone, and no, they don’t all work the same. Thus, my theory that everyone should get to “date” pump systems before locking in needs to be a must. And I don’t mean just over the weekend. I mean like, for a whole month or two. ¬†I just think with all the scar tissue I have and the sensitivity to the tape the Enlite has, it’s just not worth trying to make it work right now. So yes, in essence, it’s me, not them.

When I got frustrated, I switched back to using my Dexcom. Granted, it’s a pain in the butt to keep up with, but for me? The accuracy over the duration of wear time is much better. It wasn’t until everything happened with my eye that I realized just how important it was. I’m not saying it is super accurate, but I’ve been able to depend on it more than the pump CGM, and right now that matters a heck of a lot more than whether it’s integrated or not. Plus, I have no tape rashes or burns from the Dexcom, so that’s a huge plus for me.

IMG_5503Also, at the time, I had a fling.¬†No, not that kind of fling… a pump fling. Knowing how I am about wanting to switch up pumps between the Medtronic and my t:slim, I had actually planned on going through maybe two cartridges in my t:slim pump at the end of March. I don’t know if the battery works the same as most computer batteries, but with those, if you don’t use them, the batteries mess up, so every now and then I wanted to be able to use it so that just the lack of use didn’t mess up the battery. So, when the eye thing happened, I was on the t:slim. I was not having any issue at all with the pump like I had before, so I am not attributing what happened to that, but I am telling you that because when I spoke with my endo, he told me to “keep everything to the same” until I went for my appointment… which will be next week. So, for 3 weeks now, I’ve been using my t:slim pump. Much longer than I expected, but I have to say, I haven’t had the issues with random, uncontrollable highs that I did before. In fact, it’s been quite the opposite. My control has improved. I still wonder if the cartridges I had were affected by the recall, but that the lot numbers were too “young” to be considered in it (my lot numbers were in the 300’s, the recalls started in the 800’s). I’m not going to lie, I’m sort of hopeful that maybe that was the case and now the pump will work just fine.

And, as an update to the whole eye thing, I have good days and bad ones. For the most part, if I can keep my blood sugar as steady as possible and without any major swings (like, no arrows on the dex, and no BG’s above 180-200 for a period of time), my vision is pretty well clear. But if I have a period of time were my BG has run high for a while or if I have major swings (like when I went from 220’s to 70’s within an hour and a half), my eye is pretty well good for nothing for a while. It’s amazing me how things work and affect us all. If anything, this has taught me, as I said before, it’s not about¬†what you use to control your diabetes, as long as you’re using it the best you can and¬†doing the best you can.

Anyway, that’s sort of a rundown of what’s been going on. I know it’s probably confusing when I just throw stuff out there at random without any true point or purpose other than to just get stuff out of my head, but that’s sorta what I started blogging for anyway.

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