# Choices for next pump MM640G vs MM670G?



## SB2015 (Jun 12, 2019)

This is likely to be a recurring theme, as it is a decision I will have to stick with for four years!

The pumps that are available from our clinic are
ACCU CHEK: Combo and Insight
(These are out for me as I cannot manually enter BG taken from Libre and have to do a Bolus for each calculation)

DANA: DanaR and DanaRS
I have never heard of these before
*Has anyone had experience of these?
Does it Bluetooth from PDM to pump?
What is the support like?*

MEDTRONIC: 640 and 670G
I know quite a few on here use these and all seem positive about them as well as the support.


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## HOBIE (Jun 13, 2019)

If I was offered a 670 Medtronic I would take there arms off. I am not kidding


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## Pumper_Sue (Jun 13, 2019)

Here's the link for the DanaR https://advancedtherapeutics.org.uk/


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## SB2015 (Jun 14, 2019)

I think I am heading towards the Medtronic.  

Any users out there can you tell me whether I have picked up the right idea so far
- The 670 can only be used with sensors, so I would have to be able to afford those all the time
- The 640 can be used like a normal pump with a variety of profiles or in smartguard mode with sensors
  I could then use it as a normal pump or when I can use it with the sensors.
- the sensors only last 6/7 days but I think some have managed to restart them sometimes.
- I can manually enter info from the Libre into the Bolus wizard
- you can use a preset Bolus without accessing the pump,otherwise I would need to get the pump out each time

Any other info?


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## everydayupsanddowns (Jun 14, 2019)

SB2015 said:


> I think I am heading towards the Medtronic.
> 
> Any users out there can you tell me whether I have picked up the right idea so far
> - The 670 can only be used with sensors, so I would have to be able to afford those all the time


Not strictly true... but effectively true. For full 'auto mode' you would need sensors, but you can use it without sensors in manual mode (with basal profiles and insulin:carb ratios etc). I think you can also use it pretty much like the MM640G with sensors and predictive-low-suspend, but I'd need to ask users to confirm that.

However, as far as I'm aware, the MM670 is only being given to people who use or are funded for full time CGM, as the MM640G is still available and cheaper.



> - The 640 can be used like a normal pump with a variety of profiles or in smartguard mode with sensors
> I could then use it as a normal pump or when I can use it with the sensors.



Yes. The MM640G can be used with or without sensors. But you only get smartguard (predictive low suspend) with sensors, obviously!



> - the sensors only last 6/7 days but I think some have managed to restart them sometimes.



Correct. Officially compatible sensors last either 6 or 7 days (depending on which transmitter/sensors you have) but they can be disconnected from the transmitter, the transmitter can be recharged and they can be reconnected as if a fresh sensor either once or (more rarely) twice. I generally get 11-12 days from a sensor. My longest was 19.



> - I can manually enter info from the Libre into the Bolus wizard



Correct. BG can be input to the bolus wizard from any source.



> - you can use a preset Bolus without accessing the pump,otherwise I would need to get the pump out each time



From the paired (Contour Nextlink 2.4) meter, you can choose one of 5 preset boluses from a menu (including square and dual wave boluses) OR you can dial-up a manual bolus of any size in predefined increments (eg 0.1u). The preset boluses are more flexible in terms of delivery (eg pre-defined number of units, dual wave split and duration). The manual boluses are more flexible in terms of dose size (eg guesstimated food at a fancy do with several guessed doses delivered over the course of an evening)

Neither of these options involve the bolus wizard, but either can be used without getting the pump out. In order to use the full bolus wizard (including correction ratios, iob etc) you need to get access to the pump itself.

Hope that helps


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## Flower (Jun 14, 2019)

I got another Medtronic 640g pump yesterday for 4 more years and I'm more than happy with that. The last 4 years have shot by and the pump has been great apart from operator error and the odd niggle but by and large I'm very happy. I did ask about the 670g but was told my area aren't funding it and it is only being used in certain areas. I'm not worried, my main concern is coping with no hypo awareness so I use my pump with sensors and have found it a very reliable and effective system.

I do extend the sensor life where possible, the Enlites last for 6 days, the Guardian 3's for 7 days and after 6/7 you need to disconnect the transmitter and recharge then start again telling the pump it is a new sensor. As long as you tape the sensor and transmitter carefully you are able to remove the transmitter without dislodging the sensor, I was able to extend the life up to 12 days - I didn't try any further than that. I input glucose readings from my sensor when my graph line is stable say for a biscuit etc but always do a blood test for meals.

I know the 670g in auto mode corrects blood sugar to 6.7? or 6.5?- can't quite remember which- and you can't alter that target. That doesn't appeal to me neither can you use TBR's as the pump is doing it for you. Mike wrote a post a few months back about the launch with information on the 670g, I don't know if you saw it.  https://forum.diabetes.org.uk/boards/threads/european-launch-of-minimed-670g.75671/

The way tech is developing I'm sure the next few years will see more options available for a hybrid loop system. I'm glad I didn't have a choice at my clinic because it is hard to know what to do but I am a happy girl with a 640g and SmartGuard to head off hypos. The Medtronic reps are so helpful when they come to the clinic and I've found the support from the company excellent.  I hope that helps.


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## SB2015 (Jun 14, 2019)

Thank you @everydayupsanddowns and @Flower for your comprehensive replies.
It is good to hear that the support from Medtronic is so good.
I know my next change is not until the start of next year, but it is good to do the homework before.

The only issue I can see is the lack of Bluetooth to the pump from the handset.  I think I will put up with that for the advantage of manual entry of BG from Libre for the Bolus calculation.  For dresses with no current access I shall have to put a zip in the side seam where other access is not possible.the Medtronic person I spoke to was keen to point out that this is something queried often.  Who knows what might happen in the next few months.


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## SB2015 (Jun 14, 2019)

For my  Combo they advise that it should not go through X-ray at airport security.
What is the situation with the Medtronic?


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## everydayupsanddowns (Jun 14, 2019)

SB2015 said:


> For my  Combo they advise that it should not go through X-ray at airport security.
> What is the situation with the Medtronic?



Fine through a metal detector, but not advised for X-ray or full body scanner (though people so, and are fine - but I’ve never wanted to risk it!)

I go for a ‘pat down’ by default.


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## SB2015 (Jun 15, 2019)

And a few more Medtronic questions
*
Both 640 670*
- if a sensor bleeds on insertion (if this happens with Medtronic ones) does this effect the accuracy

- if a sensor is way out from BG what happens (a Libre is replaced but this has only happened for me twice in two years )

- my Libre sensor has to wait 1 hour once inserted before being activated.
Is this the case for the Medtronic ones?  If this is the case on the 670 what happens during that time?

*640*
- does smartguard just suspend when you go low or does it give an alarm
if it alarms is this constant or an intermittent one

- what percentage of time in target do people achieve using smartguard

- can the data (when not using sensor) be downloaded to Diasend or any app which will combine pump data and Libre 

*670*
- the adjustments that are applied on the 670, are these from a profile that you enter yourself, or is the profile set automatically from a flat delivery

- how do you deal with exercise?  Is it possible to set TBRs or are these not needed

- what percentage of time in target do people achieve with this?


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## HOBIE (Jun 15, 2019)

I very much like my Libre & also my Medtronic system. They both work fine


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## everydayupsanddowns (Jun 15, 2019)

SB2015 said:


> And a few more Medtronic questions
> *
> Both 640 670*
> - if a sensor bleeds on insertion (if this happens with Medtronic ones) does this effect the accuracy



Not had many bleeders. But the one or two I’ve had either worked, or didn’t. So I guess, frustratingly, ‘it depends’ 



> - if a sensor is way out from BG what happens (a Libre is replaced but this has only happened for me twice in two years )



If a sensor is misbehaving (either refusing to start, or giving results not accurate enough to be useful) I call Medtronic and they send a replacement. Of course this only counts within the official life of the sensor, so I wouldn’t call after 6 days for Enlites as that’s not fair. Medtronic have to be pretty hot on this because sensor values can directly affect insulin supply. One thing you get which you don’t with Libre is access to the ISIG value - the strength of the raw sensor signal. The pump uses this along with the BG calibrations to give you the sensor glucose value. And every time you recalibrate it rechecks with the ISIG for the new multiplication. There are two things about this... one is that calibration is best done when sensor glucose is fairly steady (so that interstitial lag doesn’t mangle the sums) and the other is that you can crudely check the sensor ‘health’. I’d generally expect an ISIG in the 20s and higher to give excellent accuracy. By the time it drops near 10 or below, the sensor is on its way out. 



> - my Libre sensor has to wait 1 hour once inserted before being activated.
> Is this the case for the Medtronic ones?  If this is the case on the 670 what happens during that time?


With recharging the transmitter (20-30 mins) and sensor warm up (1-3 hours) I can often be 3 hours without sensor information, which is a bit frustrating. Newer sensors may warm up faster I think?



> *640*
> - does smartguard just suspend when you go low or does it give an alarm
> if it alarms is this constant or an intermittent one


You choose. You can have suspends just happen silently, or you can set to be notified when you ‘suspend before low’. You can also set different alerts at different times of day (by the hour if you wish). You can also set how soon after an alert you want to be reminded if the condition still exists. I have 30 mins for lows and 1.5 hours for highs because I don’t want to be nagged while Novo-notvery-Rapid gradually gets going. Each alert needs to be acknowledged by 3 clicks. Turn on. Scroll down the screeds of text on the screen. Accept. If you miss an alert in a noisy environment it will gradually ramp up the intensity, including pump vibration. And eventually sirening. 

You can silence all alarms (eg in a meeting / at theatre / in choir performance) but you will still be alerted if you actually drop hypo. 



> - what percentage of time in target do people achieve using smartguard



I’ve run a couple of sensors over the last 4 weeks. These are not unusual stats for me when I’ve been able to run sensors concurrently. When I’m only using sensors ever other month I have to spend more time firefighting in the first week and generally have more lows and more like 70% in range. 

With Libre I’d expect more like 2-8% of time below 4. 





Sorry that the pie chart is a bit bleached out. But you should be able to read the numbers. 



> - can the data (when not using sensor) be downloaded to Diasend or any app which will combine pump data and Libre


No. Medtronic have their own system called Carelink. It’s just about OK, and slightly better now than when it was absolutely useless. 

Glooko/Diasend were promising Medtronic integration for a while, but it’s not happened yet AFAIK.


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## SB2015 (Jun 15, 2019)

everydayupsanddowns said:


> Not had many bleeders. But the one or two I’ve had either worked, or didn’t. So I guess, frustratingly, ‘it depends’
> 
> 
> 
> ...


Thanks Mike
Very comprehensive answers.
The % in range is impressive with the sensors.

I am glad that I have some thinking time.


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## everydayupsanddowns (Jun 16, 2019)

I asked some folks in the FB MM630/640/670 users group about the MM670G



SB2015 said:


> *670*
> - the adjustments that are applied on the 670, are these from a profile that you enter yourself, or is the profile set automatically from a flat delivery
> 
> - how do you deal with exercise?  Is it possible to set TBRs or are these not needed



Profile
You set a profile (basal/ratios etc) to begin with while the pump learns about you for at least 2 weeks. These then form your fallback position whenever you drop out of auto mode.

Once in auto mode the pump looks at insulin use sensor glucose history and multiple other factors and makes an adjustment every 24 hours. Your ‘basal profile’ is replaced by micro boluses that the pump adjusts automatically, increasing/decreasing general level and also as each day unfolds in reaction to rising/falling sensor glucose. The aim is always to return sensor glucose to 6.5mmol/L (and that midpoint target cannot be changed downwards). Auto mode Bolus ratios and correction factors are also automatically updated daily. I’m not sure if it is possible to see what factors are being used in order to periodically update your manual mode settings.

Exercise
You cannot set TBR in manual mode, but you can temporarily set an auto mode target of 8.5mmol/L to effectively reduce basal delivery. This is reported to be very successful when set an hour or so before exercise, and for some time after exercise.

TIR
Didn’t get a TIR suggestion, but some users have posted before saying they’ve had their best ever A1c for a young adult just gone away to university with all the challenges and chaos that involves!


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## SB2015 (Jun 16, 2019)

Thanks @everydayupsanddowns .  Really useful information.

I am going to try and change the title of this thread as Medtronic 640 vs 670 would be of more use to others.


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## SB2015 (Jun 16, 2019)

Failed, but that does not mean it is not possible.
If there is a way and you think that this would be useful @everydayupsanddowns please let me know.


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## everydayupsanddowns (Jun 16, 2019)

I’ve added the pump numbers in for you @SB2015


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## SB2015 (Jun 16, 2019)

everydayupsanddowns said:


> I’ve added the pump numbers in for you @SB2015


Thanks Mike
Is that something I could have done myself or is it a moderator thing?


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## everydayupsanddowns (Jun 16, 2019)

SB2015 said:


> Thanks Mike
> Is that something I could have done myself or is it a moderator thing?



I’m not sure! It may be restricted. I have a ‘thread tools’ menu on the right under the title.


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## SB2015 (Jun 16, 2019)

I have just found it. Thanks Mike.
Ready for next time so long as I remember!


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## spiritfree (Jun 17, 2019)

SB2015 said:


> This is likely to be a recurring theme, as it is a decision I will have to stick with for four years!
> 
> The pumps that are available from our clinic are
> ACCU CHEK: Combo and Insight
> ...


I have a 640. I was told the 670 is only being given out to people with little or no htpo/hyper. The 640 is a good pump.


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## SB2015 (Jun 17, 2019)

Thanks @spiritfree .  I suspect that the same restrictions will apply here, but they have not been mentioned.
The views of all that use the 640 seem very positive, and I like the idea of 
- being able to manually enter level from Libre at meals for Bolus advice
- the option of using sensors with it when possible


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## Pumper_Sue (Jun 17, 2019)

From reading the garb on Medtronic's site you can only have the 670 if you agree to use a years worth of sensors. So unless your CCG will fund them you will need a very deep pocket.

I'm having the 640 in August but going t use Dexcom with it as far cheaper.


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## SB2015 (Jun 17, 2019)

Pumper_Sue said:


> From reading the garb on Medtronic's site you can only have the 670 if you agree to use a years worth of sensors. So unless your CCG will fund them you will need a very deep pocket.
> 
> I'm having the 640 in August but going t use Dexcom with it as far cheaper.



Does the Dexcom link with the Medtronic pumps, or are you you using it independently from the pump.?


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## Pumper_Sue (Jun 17, 2019)

SB2015 said:


> Does the Dexcom link with the Medtronic pumps, or are you you using it independently from the pump.?


I'm going to use it independently, the G6 predicts lows of 3.1 half an hour before it's going to happen. Only thing it can't do is suspend the pump.


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## sofaraway (Jun 19, 2019)

Pumper_Sue said:


> From reading the garb on Medtronic's site you can only have the 670 if you agree to use a years worth of sensors. So unless your CCG will fund them you will need a very deep pocket.
> 
> I'm having the 640 in August but going t use Dexcom with it as far cheaper.



Could you ask for a tslim as that’s links with dexcom and will suspend the pump when that update is live, it may already be live actually


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## sofaraway (Jun 19, 2019)

The 670g in some areas can be ordered without CGM funding in place if so one wants to self fund, although my understanding intermittent sensor use is far less useful if you want to use the 670 in auto mode


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## Pumper_Sue (Jun 19, 2019)

sofaraway said:


> The 670g in some areas can be ordered without CGM funding in place if so one wants to self fund, although my understanding intermittent sensor use is far less useful if you want to use the 670 in auto mode


It states on the Medtronic site that unless you agree to the purchase/use of sensors for a year you can not have the pump.


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## SB2015 (Jun 20, 2019)

Recently checked and in our area we only have the option of: Insight, Combo, 640G or DANA DS

I have still not found anyone using DANA pump and emailed the company twice but had no reply, which doesn’t bode well for support level.  I definitely want to be able to manually enter G level taken from Libre, to reduce finger pricking, which is not possible on Combo or Insight, so that leaves Medtronic.

The dexcom sensors seem to only work with the t-slim (which is not available here) so I have the option of using those independently, which would not make sense against the Libre.  I can then use Medtronic ones intermittently when I want the alarms.

The DSN is sending me some cannulas to try, to check that I don’t react to them. 
There should be one that will work.

Or by February perhaps there will be a cure!!,


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## Pumper_Sue (Jun 20, 2019)

SB2015 said:


> have still not found anyone using DANA pump and emailed the company twice but had no reply, which doesn’t bode well for support level. I definitely want to be able to manually enter G level taken from Libre, to reduce finger pricking, which is not possible on Combo or Insight, so that leaves Medtronic.


I suspect there could be a problem with the email.
I used to be with Advanced T when I had the Cozmo pump and their support is fantastic. Give them a ring and find out about the email being received.


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## everydayupsanddowns (Jun 20, 2019)

I know a diabetes dad whose daughter specifically chose the Dana RS because of the ease of using it with open source APS. 

They have blogged about it here: http://circles-of-blue.winchcombe.org/index.php/2018/07/31/insulin-pump-trial-dana-rs/


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## SB2015 (Jun 20, 2019)

Just reread @Pumper_Sue ’s


Pumper_Sue said:


> I suspect there could be a problem with the email.
> I used to be with Advanced T when I had the Cozmo pump and their support is fantastic. Give them a ring and find out about the email being received.


Thanks Sue


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## SB2015 (Jun 20, 2019)

everydayupsanddowns said:


> I know a diabetes dad whose daughter specifically chose the Dana RS because of the ease of using it with open source APS.
> 
> They have blogged about it here: http://circles-of-blue.winchcombe.org/index.php/2018/07/31/insulin-pump-trial-dana-rs/


Thanks Mike
What is an open source APS?


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## everydayupsanddowns (Jun 20, 2019)

APS is Artificial Pancreas System. Sometimes called ‘looping’. There are a number of (unregulated) DIY options for integrating CGM data with suggestions that users need to implement (open loop) or using adapted pumps or sending info to the pumps via user-built components to ‘close the loop’ and automate delivery.

Started in the US but there are 100s now looping in the UK. There is also a company (Tidepool) which is working to get the open source algorithm approved by the FDA.

The systems are Loop OpenAPS and Android APS. Tim Street (occasional member here) blogs about this quite a bit. Eg https://www.diabettech.com/looping-a-guide/what-is-it/


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## Phil65 (Jul 22, 2019)

SB2015 said:


> Recently checked and in our area we only have the option of: Insight, Combo, 640G or DANA DS
> 
> I have still not found anyone using DANA pump and emailed the company twice but had no reply, which doesn’t bode well for support level.  I definitely want to be able to manually enter G level taken from Libre, to reduce finger pricking, which is not possible on Combo or Insight, so that leaves Medtronic.
> 
> ...



My insight pump ran out of warranty in April, my replacement pump options given to me were Insight, Combo! Ypsomed. I have been self funding Dexcom G6 since April and pushed for Tandem. I was told Tandem was not an option (risk attached, as the only item that the company has) so, I am due to start on a Medtronic 670g in September, I will have to self fund Guardian CGM. Dexcom estimates that my A1c will be 5.7, after 22 years of Type 1 I have never had an A1c in the 5s. CGM has certainly helped with highs and lows (cannula fails are a problem for me) and adjustments are implemented sooner, it has also highlighted basal adjustments that were needed and Insulin/Carb ratios that needed to be tweaked.


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## SB2015 (Jul 22, 2019)

Phil65 said:


> My insight pump ran out of warranty in April, my replacement pump options given to me were Insight, Combo! Ypsomed. I have been self funding Dexcom G6 since April and pushed for Tandem. I was told Tandem was not an option (risk attached, as the only item that the company has) so, I am due to start on a Medtronic 670g in September, I will have to self fund Guardian CGM. Dexcom estimates that my A1c will be 5.7, after 22 years of Type 1 I have never had an A1c in the 5s. CGM has certainly helped with highs and lows (cannula fails are a problem for me) and adjustments are implemented sooner, it has also highlighted basal adjustments that were needed and Insulin/Carb ratios that needed to be tweaked.


Sounds like you have got things sorted Phil. I look forward to hearing how you get on, and whether their prediction comes to fruition.

 I was amazed when I joined this forum and realised how often people needed to change their ratios.  I had thought it was just something you checked before the annual consultant appointment.


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