# 64 Days with the MiniMed 640G



## everydayupsanddowns (Jul 4, 2015)

Heasandford suggested I posted this as a separate thread in case people were interested...



> I've been wearing sensors with a 640G for a few weeks now and I have been really VERY impressed, both with the accuracy of the sensors themselves and the Smartguard itself. Personally I love the fact that I can tailor when I want Smartguard to be active (and when I don't) and that I do not have to have any audible alerts at all - I can just let the 640G get on with things without pestering me with alarm fatigue and safe in the knowledge that if I DO hit my 'low limit' it will always alarm to warn me.
> 
> I've started to post some video blogs about my 64 days with the MiniMed 640G here: https://www.youtube.com/channel/UCW6...Jy-rl09wpV0wyA and will be updating with more details about Smartguard and how well it is working (and when it isn't!) in the coming weeks



I'm also planning posts with suggestions for improving sensor accuracy, sports/exercise, infusion set changes, whether (or not!) my levels and number of hypos seem to be improving and all sorts of other bits and bobs.


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## heasandford (Jul 4, 2015)

Great Mike!

Just one thought, do the Medtronic pumps not have separate meters that can remotely control them? I think it's the one thing I wouldn't give up with mine now - something to do with not having to fiddle around on my person....?!


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## everydayupsanddowns (Jul 4, 2015)

The 640G has a partial remote, but I think really it is only suitable for occasional use, like a posh frock party where you wanted to bury the pump and not fish it out.

The Bluetooth connected meter allows a 'normal' bolus of any amount of units, or one of up to five preset 'fancy' boluses (dual wave or square wave). The bolus wizard is not available from the meter. But for an occasional day, (or if you don't generally use the bolus wizard) I think you could make it work


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## heasandford (Jul 5, 2015)

I wonder what makes each maker of pumps decide what's important? 

I note your conversion to the 640G on the basis of beeps, or lack of them! The Accuchek combo beeps at the end of a TBR and requires an acknowledgement, so if it finishes at 3.40am (for instance!) I have to press the correct button TWICE! 

No-one picks up on all these things before getting a pump, and while most things are liveable with, some do become more irritating than others, don't they?


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## trophywench (Jul 5, 2015)

LOL Heasandford! - the beeps that annoy me most of all about the Combo are the low BG reminder - it's just TOO SOON after the first one.  I've been known to feel low and need the loo at the same time - so I go in the loo and test whilst I'm sat there.  depending on WHY I needed the loo it can be a few minutes before I can possibly treat the hypo - I mean if I was 1.8 or something silly like that, I'd call Pete to bring the Lucozade - but when it's like 3.5 - it can actually wait a bit longer, can't it?  LOL

Needs another few minutes IMHO.


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## Sally71 (Jul 5, 2015)

trophywench said:


> LOL Heasandford! - the beeps that annoy me most of all about the Combo are the low BG reminder - it's just TOO SOON after the first one.  I've been known to feel low and need the loo at the same time - so I go in the loo and test whilst I'm sat there.  depending on WHY I needed the loo it can be a few minutes before I can possibly treat the hypo - I mean if I was 1.8 or something silly like that, I'd call Pete to bring the Lucozade - but when it's like 3.5 - it can actually wait a bit longer, can't it?  LOL
> 
> Needs another few minutes IMHO.



You can change that in the settings - up to max 30 mins I think.  I've set ours to 20 because I found 15 too little and the extra 5 mins means daughter is more likely to have got back up to normal range, which means we then don't need a second dose of glucose which would probably cause a high later on.

Or the other option is to just ignore it...


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## trophywench (Jul 5, 2015)

Well I've been doing the other option, because I can't see HOW you can change it?  Could you explain where you do that please Sally?

In settings, you can only choose On or Off.  Well - that's the only choices I have anyway.


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## Sally71 (Jul 5, 2015)

On the handset go to Settings - Reminders - bG Test Reminders and then select After Low BG.  It only shows On or Off on the first screen but if you actually highlight and select it you then get choices of on/off, BG threshold (at what level it actually decides you are hypo) and Remind After, which you can set anywhere between 5 and 30 minutes in 5 min increments.  Don't forget to save the changes!


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## heasandford (Jul 6, 2015)

Brill! I had forgotten all about this option, thanks


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## Flower (Jul 9, 2015)

A good comparison between the Veo and 640g Mike  

I agree that the screen lock button which I thought at first was a good idea does annoy me a bit and I wish there was some way to turn it off. Only a minor niggle because I am finding the Smartguard great and have had a lot less hypos in the past few months. On my 30 day history, Smartguard has on average suspended my basal insulin for 2.15 hours per day and has cut in 2.8 times but there doesn't seem much of a pattern to when it's happening so I'm in basal tweaking mode at the moment to try and sort it out.


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## everydayupsanddowns (Jul 9, 2015)

Flower said:


> A good comparison between the Veo and 640g Mike
> 
> I agree that the screen lock button which I thought at first was a good idea does annoy me a bit and I wish there was some way to turn it off. Only a minor niggle because I am finding the Smartguard great and have had a lot less hypos in the past few months. On my 30 day history, Smartguard has on average suspended my basal insulin for 2.15 hours per day and has cut in 2.8 times but there doesn't seem much of a pattern to when it's happening so I'm in basal tweaking mode at the moment to try and sort it out.



My first 28 days have been ridiculous (in a good way). Like you say Flower, I like the way that Smartguard gives you breathing room while tweaking basals so that you can wait and see if a pattern develops or a tweak works.

First 28 days: https://www.youtube.com/watch?v=qiWetzr4t2A


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## heasandford (Jul 9, 2015)

Oh wow Mike!

SD 1.5, what joy! I have NEVER been below 2.5 and am more frequently in the upper 3s. 

The other thing this indicates is that suspending insulin works quickly, which I was struggling to get to grips with. I was confused because when you set basals the rule is that it affects results in 2 hours - this indicates that results are immediate. 

I am more and more learning that momentum and inertia (learnt from another clever T1) has a much greater effect on BG results.


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## everydayupsanddowns (Jul 11, 2015)

Well, not immediate, but the way SmartGuard is set up means that it kicks in perhaps 45mins to an hour before it is needed which gives the basal time to take effect. There are times when it cannot do enough, of course - especially where there is a lot of insulin on board, and sometimes it hangs in a little long and causes a slight rebound - but for me it works really really well in catching those *very* hard to spot lows that just gently drift below 4 when you aren't looking. 

Overnight hypoglycaemia has been transformed.


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## m1dnc (Jul 11, 2015)

Thanks for your reviews and I look forward to seeing how your trial progresses. This pump and the SmartGuard feature is really impressing me. I'm at the point of reviewing pumps as mine is coming up for renewal and I need to make a decision soon to start the CCG funding process.

I've been using the quasi-CGM Libre for the last 6 months or so and this has really helped me to hone my basals and get tighter control - to the extent that my HBA1c is down to 6.1% at my last review. The consultant suggested that I take a look at the 640G (and Animas Vibe) to take this a step further with proper CGM. The cost of the sensors is an issue with the 640G, as I will be self-funding and the Enlite sensors are effectively twice as expensive as the Libre and Dexcom ones.

I think Medtronic really need to look at the costs in this respect, as I would have thought that if they lowered the cost there would be greater uptake. On the other hand I guess they may be holding out for the NHS to fund more CGM, but I don't see that happening with the state of the national purse. It's a big factor though in my pump decision.


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## everydayupsanddowns (Jul 11, 2015)

m1dnc said:


> I think Medtronic really need to look at the costs in this respect, as I would have thought that if they lowered the cost there would be greater uptake. On the other hand I guess they may be holding out for the NHS to fund more CGM, but I don't see that happening with the state of the national purse. It's a big factor though in my pump decision.




I agree entirely, though I'm afraid I'm not *massively* hopeful of any significant movement on cost any tome soon.

Crazy really. If Abbott's experience with the Libre shows anything it is that there is a REAL hunger for these devices when they are priced in a more affordable way. Abbott simply could not make enough.

Because of the terms of the trial I am not allowed to blog/experiment with extending the life of Enlite sensors. The main cost benefit self-funders usually claim with Dexcom only really happens when the sensor is restarted for at least 14 day life (which is off label and not 'allowed' by Dexcom). With the MM640G actively intervening with insulin I can see why there is nervousness on Medtronic's part over the issue, especially since sensor accuracy tends to reduce the longer you push the sensor (some Dexcom users only ever push to 14 days even though longer life is technically possible to avoid decreased performance).

However I do know several people who extended life on sensors when self-funding CGM for Veo with some success.


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## m1dnc (Jul 12, 2015)

everydayupsanddowns said:


> However I do know several people who extended life on sensors when self-funding CGM for Veo with some success.



Yes, I've seen that mentioned, but I see your point that it might be a bit of a risk if the Smartguard is running. Can you turn off Smartguard and just run the CGM without it?

It did occur to me that the Enlite sensors might be cheaper if they are sourced from the US, but I've just checked and they're even more expensive there. It seems that they're often covered by health insurance there.


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## everydayupsanddowns (Jul 12, 2015)

m1dnc said:


> Yes, I've seen that mentioned, but I see your point that it might be a bit of a risk if the Smartguard is running. Can you turn off Smartguard and just run the CGM without it?



Yes absolutely! One of the very user-focussed things about SmartGuard is the way you can set up a profile, much like a basal pattern for how you want it to act and which (if any) alerts you want to receive before you hit your low limit. The pump will always alert when you reach the low limit you set, but it can also alert beforehand if you want. You can change your low (and high) limits, customise the alerts, switch SmartGuard and/or low glucose suspend on or off during different times of the day to really fine-tune how it works for you.

Really helps in reducing alarm fatigue!

I guess if I was self funding sensors I would have to experiment with restarts to see how long I could reasonably expect reliable data. Others' experiences that I've seen for Veo sensors suggests 10-12 days would be a reasonable expectation, but I'm just guessing really.


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## everydayupsanddowns (Jul 20, 2015)

In case anyone is confused by and/or interested in the whole 'SmartGuard' thing on the MiniMed 640G I have put together a little animation that explains how it works and what numbers/timings it uses to try to avoid hypoglycaemia.

Here it is: http://www.everydayupsanddowns.co.uk/2015/07/64-days-with-minimed-640g-ep-3-what-is.html


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## Flower (Jul 21, 2015)

Good stuff Mike, thanks for your latest episode 

2.5 months of my 640g and I love SmartGuard, it has limited my hypos massively and I've only been down to 2.5 in the past month. It is keeping my blood sugar chugging along so much more safely than relying on the Veo Low Suspend. 

I have been restarting my sensors to prolong their use and am getting between 8-11 days before they fail with very accurate readings. The main downside is not knowing when the sensor will fail, so far it hasn't failed in the night when I'm most prone to go hypo but I know it is a risk. I realise this is not encouraged for the fact the system suspends and restarts basal but for now I'm happy with the accuracy  I'm getting.


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## m1dnc (Jul 22, 2015)

Thanks Mike. Just to clarify: that 3.9 upper limit? Does that mean that Smartguard will not be triggered in any circumstance (i.e. whatever the apparent rate of BG fall) if you're above 7.9?

And Flower, good to hear that you're getting those extra days from the sensor. Still a bit to go though before competing with the Libre or Dexcom sensors.


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## everydayupsanddowns (Jul 22, 2015)

m1dnc said:


> Thanks Mike. Just to clarify: that 3.9 upper limit? Does that mean that Smartguard will not be triggered in any circumstance (i.e. whatever the apparent rate of BG fall) if you're above 7.9?
> 
> And Flower, good to hear that you're getting those extra days from the sensor. Still a bit to go though before competing with the Libre or Dexcom sensors.



Yes, that is my understanding. And of course it depends on where you set your 'low limit'. If you set at 3.0 then it would only intervene when sensor glucose below 6.9 and if dropping rapidly enough to drop you below 4.1 within 30 minutes (1.1 above low limit). Whereas if you set low limit to 5.0 then anything below 8.9 would be being monitored.

And you could set different low limits (or disable entirely) at different times of the day for greater/lesser SmartGuarding.


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## HOBIE (Aug 7, 2015)

Sounds good to me. Will try to get one nxt time


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