# Combo vs Medtronic. Have I missed anything?



## Radders (May 30, 2018)

my second pump is almost due for replacement and for the first time I am being offered a choice. I have up to now used Accuchek: first the Spirit followed by the Combo. 
Now I have the choice of the Medtronic 640g. 
I’ve read all the bumpf and seen the pump itself and so far am not persuaded that the Medtronic offers me any advantages but thought I would check in case I have missed anything as I know it’s a popular pump. 
I know about the Smartguard feature but as I wouldn’t qualify for the sensors to be funded, and as I never suspend my pump in the case of hypos and have hypo awareness, that doesn’t really attract me.
I am not sure whether self funding the sensors would be cheaper than using the Libre which I currently use, any advice on this appreciated. 
I do like the compactness of the remote handset for the Medtronic, however the added weight of the pump itself is quite a big issue for me as I wear my pump on my waistband and fear it will be too heavy. 
I have also been told that the bolus calculator on the Accuchek pumps is superior to that on the Medtronic. I very rarely use this as my first pump was a Spirit and so 
I got used to doing the calculations myself anyway. I have tried using it but find the entering of carbs for every meal a major chore, especially as I tend to graze and split my meals up. 
Are there any other things that are better about the 640g which 
I have missed?


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## HOBIE (May 30, 2018)

I know which Company are "World Leaders"


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## Radders (May 30, 2018)

HOBIE said:


> I know which Company are "World Leaders"


I don’t: please could you elaborate? I would be interested to hear as well what difference this makes as well?


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## everydayupsanddowns (May 30, 2018)

Both. 

Roche and Medtronic have both been global leaders in Diabetes for years. 

Hobie particularly likes Medtronic, of course.


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## HOBIE (May 30, 2018)

Who is bring out the Artificial Pancreas ? I Know which company I would pick


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## Flower (May 30, 2018)

This is useful for a comparison in weight and size of available pumps. https://www.ipag.co.uk/wp-content/uploads/2016/07/Insulin-Pump-Comparison-Chart-UK-2016.pdf

There doesn't appear to be that much in it Combo v Medtronic weight wise.

I wear my Medtronic on my waistband and have used a Medtronic for about 12 years after swapping from Roche. If you have good hypo awareness and don't need alarms and insulin suspension them the Libre fits the bill. I don't miss a handset for insulin  delivery as I've never had one and just input carbs into the bolus Wizard on the pump which I find excellent. . You set the Wizard up with your ratios, correction factor etc and then input carbs to get the insulin dose, you can amend it or choose to input a bolus manually ignoring the suggested dose. I do love my 640g and the customer care and reps are fabulous. I'm sure you'll be very happy with the choice you make.


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## everydayupsanddowns (May 30, 2018)

Radders said:


> my second pump is almost due for replacement and for the first time I am being offered a choice. I have up to now used Accuchek: first the Spirit followed by the Combo.
> Now I have the choice of the Medtronic 640g.
> I’ve read all the bumpf and seen the pump itself and so far am not persuaded that the Medtronic offers me any advantages but thought I would check in case I have missed anything as I know it’s a popular pump.
> I know about the Smartguard feature but as I wouldn’t qualify for the sensors to be funded, and as I never suspend my pump in the case of hypos and have hypo awareness, that doesn’t really attract me.
> I am not sure whether self funding the sensors would be cheaper than using the Libre which I currently use, any advice on this appreciated.



Medtronic is more expensive. For starters you need the transmitter which is £500! The sensors are roughly the same cost (about £50 each) but officially the Medtronic sensors only last 6 days. Fortunately you can restart them, and mostly I get 10-12 days out of them (as opposed to 14 on Libre) so if you are not expecting to need Smartguard assistance (eg overnight) then Libre is quite a bit cheaper.



> I do like the compactness of the remote handset for the Medtronic, however the added weight of the pump itself is quite a big issue for me as I wear my pump on my waistband and fear it will be too heavy.



The clip on the MM640G is disappointingly flippy-floppy. It does work, but it isn’t strong enough to hold the weight of the pump unless there is an edge for it to grip onto eg a belt or waistband. The paired meter for Medtronic is awesome though. The most accurate I’ve ever used. And it has a (non-wizard) remote function that means you can use it a bit like the Combo handset, as long as you don’t need the full wizard, which it sounds like you may not?



> I have also been told that the bolus calculator on the Accuchek pumps is superior to that on the Medtronic. I very rarely use this as my first pump was a Spirit and so
> I got used to doing the calculations myself anyway. I have tried using it but find the entering of carbs for every meal a major chore, especially as I tend to graze and split my meals up.
> Are there any other things that are better about the 640g which
> I have missed?



Entering the carbs into Medtronic is much faster than I remember from the Accu-chek Expert, so it might be more usable than you have found it so far. Plus with Medtronic you can use BG from anywhere (another meter, even the Libre if you were brave enough!). You could use the wizard to calculate corrections, and bolus manually for food if that helps too. Having used both, there are differences between the options in the wizards but I’m not sure I felt one was significantly better than the other. 

MM640G allows you to have named bolus patterns eg weekday, day off, sickness which is handy to keep track. 

In short there’s a lot to love about both. I’m not sure what I would do in your shoes, though familiarity of ‘the devil you know’ is quite strong when choosing something you use so closely every day


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## Radders (May 30, 2018)

Flower said:


> This is useful for a comparison in weight and size of available pumps. https://www.ipag.co.uk/wp-content/uploads/2016/07/Insulin-Pump-Comparison-Chart-UK-2016.pdf
> 
> There doesn't appear to be that much in it Combo v Medtronic weight wise.
> 
> I wear my Medtronic on my waistband and have used a Medtronic for about 12 years after swapping from Roche. If you have good hypo awareness and don't need alarms and insulin suspension them the Libre fits the bill. I don't miss a handset for insulin  delivery as I've never had one and just input carbs into the bolus Wizard on the pump which I find excellent. . You set the Wizard up with your ratios, correction factor etc and then input carbs to get the insulin dose, you can amend it or choose to input a bolus manually ignoring the suggested dose. I do love my 640g and the customer care and reps are fabulous. I'm sure you'll be very happy with the choice you make.


Thanks Flower that’s very handy. It seems to give the weight including the handset for the Combo if I’m reading it correctly. Both I and the DSN thought the Medtronic pump was heavier even without insulin in it, which would make sense as the handset is very large whereas that for the Medtronic is quite small.


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## Radders (May 30, 2018)

everydayupsanddowns said:


> Medtronic is more expensive. For starters you need the transmitter which is £500! The sensors are roughly the same cost (about £50 each) but officially the Medtronic sensors only last 6 days. Fortunately you can restart them, and mostly I get 10-12 days out of them (as opposed to 14 on Libre) so if you are not expecting to need Smartguard assistance (eg overnight) then Libre is quite a bit cheaper.
> 
> 
> 
> ...



Thanks for that, lots to think about and it sounds as though the Libre is preferable cost wise. The aspect the DSN mentioned as being superior in the algorithm was that it works out corrections to the middle of the target range; she said that the MM640 corrects to the top of the range - is she right about that? 

The clip issues do sound like they would pose a bit of a problem as I very rarely have suitable pockets so I do depend on being able to clip the pump on my waistband.


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## Radders (May 30, 2018)

HOBIE said:


> Who is bring out the Artificial Pancreas ? I Know which company I would pick


In terms of daily use though how does this affect me?


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## everydayupsanddowns (May 30, 2018)

Radders said:


> Thanks for that, lots to think about and it sounds as though the Libre is preferable cost wise. The aspect the DSN mentioned as being superior in the algorithm was that it works out corrections to the middle of the target range; she said that the MM640 corrects to the top of the range - is she right about that?



Yes. But you can set the ‘range’ as 6.0-6.0 or whatever and it works the same. There’s no on-handset our chart on the pump for BG distribution (well there is with sensors, but not for Fingersticks) so the ‘range’ doesn’t need to be a range at all 



> The clip issues do sound like they would pose a bit of a problem as I very rarely have suitable pockets so I do depend on being able to clip the pump on my waistband.



On a waistband Is absolutely fine, but I used to clip my Veo to my t-shirt front just by clipping a bunch of fabric. You can’t do that on the MM640G.

There’s a bit in here that shows it: 



See approx 4mins 20s

Having said that I’ve work it on my belt with no problems for years now.


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## HOBIE (May 30, 2018)

The clip on the Medtronic has been tested at over many miles per hour by me on a 1200cc motorbike clipped on to my leathers.


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## everydayupsanddowns (May 30, 2018)

HOBIE said:


> The clip on the Medtronic has been tested at over many miles per hour by me on a 1200cc motorbike clipped on to my leathers.



It’s fine with ‘an edge’ isn’t it Hobie.


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