# New Medtronic 640g pump



## Flower (May 21, 2015)

I've been at the hospital all afternoon being shown how to use my new 640g pump. Oh my word, it's so clever. I've already tested out the Smartguard feature that suspends basal insulin to prevent a hypo, I only got as low as 3.2 because it suspended basal at 4.5mmol. The Smartguard technology kicks in at 1.1mmol above the normal sensor basal suspend level in the hope of stopping serious hypos.

It is an amazing piece of technology and I'm slightly unnerved as it is quite different in many ways to my Veo. I had a 2 hour bus journey home after and I was dreading any alarms going off as I'll need a few days to get used to the menus and controls. For any partially sighted pump users it has a really good contrast on the screen, black background with white/yellow text and a control to adjust brightness of the text.

I'm up and running and feel like a new girl at the start of term, not quite sure what to expect even after 16 years of using a pump and hoping for a quiet time.

The advancement in technology since my first pump in 1999 is amazing, it gives me great hope for the future and what will be available in another 16 years. We also had an interesting chat about developing the closed loop and the challenges involved.

Right, I'm off to read all the manuals I got given and watch the sensor screen update


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## Northerner (May 21, 2015)

Terrific Flower! Good luck with it!


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## HOBIE (Jun 3, 2015)

That is on my shopping list !  Pleased you have one Flower


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## Pumper_Sue (Jun 3, 2015)

Just seen this post, how's it going Flower?


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## everydayupsanddowns (Jun 3, 2015)

Hope it's going well Flower 

I'm having a 2 month trial starting mid-June. Really looking forward to it!


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## Flower (Jun 4, 2015)

It's going really well thanks. 

Different menus to navigate but pretty self explanatory and I'm getting used to it. The screen is so much easier for me to read with just some central vision as it has a black background with white text and a brightness contrast. The alarms have better volume control so I can hear them more easily. All the pump icons are in colour and change from green to amber to red as battery life/insulin reservoir etc runs down.

The best part I've found is the Smartguard feature on the CGM which cuts in 30 mins in advance of predicting I'm going to hit my low glucose setting - mine is set at 3.4. It can cut in up to 3.9 above the low glucose suspend if bg levels are plummeting so for me that's a maximum of 7.3mmol. It is slightly odd to have basal insulin suspended in the 6's and low 7's but it has averted hypos and because it only suspends until bg levels stop falling I haven't had rebound spikes.

The sensors have been really accurate which gives me confidence as I have no hypo awareness and am reliant on it to do the right thing!

The screen locks after a short time and highlights which arrow you need to press to get back into the menus which is a simple way to prevent hitting the controls accidentally. 

So thumbs up for the 640g, all good so far  I hope your trial goes well Mike and I hope you can soon get a 640g on your shopping list Hobie


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## heasandford (Jun 11, 2015)

How brilliant that sounds! So glad that you've got it, you must keep us up to date with your progress. It has made me think about plummeting levels - almost 4 above low glucose sounds ridiculous, but perhaps that's necessary; I've been having lows I couldn't stop, perhaps I should turn off the insulin at a higher point. 

I'd also be interested to hear what happens a couple of hours after the suspend, doesn't your BG go up then? 

Great to hear such success and positive response!


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## HOBIE (Jun 26, 2015)

Sounds good Flower. Keep us informed


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## Simbul (Jun 26, 2015)

Always good to hear people who're happy about their pump 

Were you already using sensors before? What's your experience with them?
I spent some months with Medtronic sensors and was not impressed: they were bulky, painful to insert and woefully inaccurate. That was 2010 though so I expect things will have moved on since then.

Also, ignore me if my question is too prying, but are these sensors covered by the NHS or do you buy them yourself?


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## trophywench (Jun 26, 2015)

Simbul - the NHS doesn't cover them automatically - to fund them, they have to be persuaded you are a special case, and apply for funding on your behalf.

If you were hypo unaware - and none of the normal redies for re-establishing awareness worked - that might be a case where you might be able to get one.

Quite a number of people pay for them - and the CGMS itself - themselves.

This leads to some folk only using it full time eg whilst pregnant or during other significant life events - depends what they can afford.


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## Pumper_Sue (Jun 27, 2015)

I have managed to find an organisation who are funding my sensors for me as the NHS wont.


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## Flower (Jun 27, 2015)

Hi Simbul

I've used Medtronic sensors for 4 1/2 years now and the accuracy for me hasn't ever been an issue. The newer Enlite sensors- introduced about 2 years- back are smaller and I don't find them painful to insert. The new Guardian transmitter with the 640g pump has given me excellent accuracy and tracking. 

I do get funding from my CCG for the sensors as I have no hypo awareness and was going unconscious too often without warning and damaging myself when falling down. I've got bones that break very easily and I was causing myself extra problems when collapsing and having fits. My consultant told me he would get them for me as my life was at risk. I know I am exceedingly lucky to be able to use them.

I've only had 2 really low hypos since using the Smartguard with the sensors and 640g which is a big improvement, I have found the Smartguard brilliant at preventing me from falling much beyond about 3.4.


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## Simbul (Jun 27, 2015)

Thanks for the info 

The sensors are £525 for a pack of 10 on the Medtronic online shop (plus £490 for the transmitter) so I understand why the NHS doesn't cover them by default 

Hypo unawareness sounds pretty serious: in that case CGM makes total sense. I'm lucky enough to be able to feel my hypos reasonably well, so for me it would be more about finding out about my glycaemic profile. I suspect there are swings I'm not quite catching with my normal tests.

Flower: as I recall, quite often when I was calibrating the sensor with a fingerprick reading I was finding a big discrepancy between the CGM value and the BS value. Something between 2 and 3 mmol/l. It was almost as if CGM was flattening out the extremes, or just not catching up with my actual BS fast enough.
I assume that's not what you're seeing, then?


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## Flower (Jun 27, 2015)

i don't get big discrepancies like that, often spot on if my bg is stable at the most about 0.2 mmol/l.

I have been very impressed with the new transmitter and the changes made to the algorithms on the sensor and 640g system. If it wasn't reliable I'd ask to change to something else as without hypo awareness I am putting a lot of trust in it!

Have you looked at the Abbotts Libre sensor which you swipe to get glucose readings? If you don't need hypo alarms it might be worth a look.


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## trophywench (Jun 27, 2015)

Well blood and interstitial fluid don't read the same do they?


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## Simbul (Jul 4, 2015)

My understanding was that interstitial fluid reflects blood sugar changes with a slight delay, though I wouldn't know exactly how long.

Flower, it's good to know things got better since I tried it. Maybe it's time to have another look


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## everydayupsanddowns (Jul 4, 2015)

Interstitial fluid is usually said to reflect blood glucose with something like 5-15 minute delay (depending on the person, the device and the algorithm it uses). Of course we don't really measure blood glucose in any case any more. Meters these days are calibrated to reflect 'plasma glucose' so there's some interpretation going on even with fingersticks (haematocrit values anyone?).

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 smartguard 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.

I've started to post some video blogs about my 64 days with the MiniMed 640G here: https://www.youtube.com/channel/UCW6fYkYKSJy-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


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## Pumper_Sue (Jul 4, 2015)

Simbul said:


> My understanding was that interstitial fluid reflects blood sugar changes with a slight delay, though I wouldn't know exactly how long.
> 
> Flower, it's good to know things got better since I tried it. Maybe it's time to have another look



Dexcom has roughly 20 mins delay


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## heasandford (Jul 4, 2015)

everydayupsanddowns said:


> I've started to post some video blogs about my 64 days with the MiniMed 640G here: https://www.youtube.com/channel/UCW6fYkYKSJy-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



This is good Mike, are you going to put it up separately on this Pumping section?

I am starting to recognise that a 'low BG' alarm would be really useful; while I love the Libre (and feel that I don't ever want to live without some form of continuous glucose monitoring) it has proved that my results are so erratic and rapid that I often miss the hypos before they happen. My excellent improvement in HbA1c when I started with it were really due to too many hypos attempting to achieve perfection (I know, not what anyone wants to hear, but I do seem to be the worst case scenario)

Sorry if I've hijacked the post!


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## trophywench (Jul 4, 2015)

I wouldn't mind having the info from any of these devices, but I have concluded at this stage in my life that the lack of decent sites already for cannulas, more or less rules out using one - anywhere - for a CGMS cannula - I might NEED that place for a pump one.  I've always said, I'm used to my face and I still rather like my legs - so I'd rather like a torso transplant.  However - with the problems some other people have with their innards - that I don't have - perhaps I better keep them too.

Dermis transplant anyone?  LOL


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## heasandford (Jul 4, 2015)

Think we need a 'like' button, TW! (although not much else from FB, i'm not much of a fan!)


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## Simbul (Jul 6, 2015)

everydayupsanddowns said:


> I've started to post some video blogs about my 64 days with the MiniMed 640G here: https://www.youtube.com/channel/UCW6fYkYKSJy-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



Nice bit of video blogging Mike! I can totally see how those extra keypresses could drive someone mad


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## HOBIE (Jul 8, 2015)

Looks a good bit of kit Mike, Thanks for sharing


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