# New Medtronic Pump - MiniMed 640G



## everydayupsanddowns

Got invited to a TweetyBloggers meeting at Medtronic on Friday, where they were all excited about their new pump.

Takes 'low glucose suspend' waaaay further by pre-empting possible hypos. Research suggests up to 80% of potential hypoglycaemia might have been averted in trial patients.

Blog post here: http://www.everydayupsanddowns.co.uk/2015/01/medtronic-minimed-640g-smartguard-pump.html


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## HOBIE

Looks good Mike !  Love my veo & Medtronic gadgets


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## Pumper_Sue

Hi Mike, what a fantastic review. Thank you.
Do you know what the duration of insulin is for the new pump?


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## everydayupsanddowns

Ach! Sorry Sue, that wasn't something I checked. You might have to wait until Feb when the website launches I'm afraid. If it's the same as the Veo, the Duration of Insulin Action can be set anywhere from 2 to 8 hours in 1 hour increments. Would that support your animal insulin's activity profile?

I'll email Medtronic and see if I can get a range in the meantime.


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## Pumper_Sue

everydayupsanddowns said:


> Ach! Sorry Sue, that wasn't something I checked. You might have to wait until Feb when the website launches I'm afraid. If it's the same as the Veo, the Duration of Insulin Action can be set anywhere from 2 to 8 hours in 1 hour increments. Would that support your animal insulin's activity profile?
> 
> I'll email Medtronic and see if I can get a range in the meantime.



No problem Mike, it was just a half hope but it's not something most people take any notice of. 
6 - 6 1/2 hours suits me fine. Thanks for taking the trouble though it's much appreciated. 
Must admit my main interest is the CGM side of things esp the cost and accuracy of the sensors. I'm about to start week 5 with my present sensor


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## everydayupsanddowns

Pumper_Sue said:


> Must admit my main interest is the CGM side of things esp the cost and accuracy of the sensors. I'm about to start week 5 with my present sensor



The 640G still uses the 6-day enlites, and apparently (from people round the table, not Medtronic) would allow the current workaround to restart the sensor. I've not got any experience, but someone I know gets 'up to' 12 days.

I think restarting the sensor might increase the chances of getting a calibration error, and my understanding is that after two calibration errors the sensor cannot be used any more.

It looks very much like Dexcom would still allow more restarts and greater potential (off label) sensor stretching, but of course only the 640G has the ablity to act on the data on your behalf without you having to intervene.


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## Pumper_Sue

everydayupsanddowns said:


> It looks very much like Dexcom would still allow more restarts and greater potential (off label) sensor stretching, but of course only the 640G has the ablity to act on the data on your behalf without you having to intervene.



My worry is the accuracy of the sensors if they are used to make decisions which could be a life or death situation.
I love the Dexcom but would never rely on it to bolus for a meal or make a correction.


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## Riri

Great report thanks


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## everydayupsanddowns

Pumper_Sue said:


> My worry is the accuracy of the sensors if they are used to make decisions which could be a life or death situation.
> I love the Dexcom but would never rely on it to bolus for a meal or make a correction.



I'll be interested to see the MARD (and other data) on the new system once their new website is up and running. I got the impression they had improved, but they were not in a position to give numbers.

The Veo/Enlites have demonstrated that LGS can be used safely, and SmartGuard is just a significantly improved version of that for hypo-avoidance. Neither are suggesting that they would ever _positively_ dose insulin (that's a whole different can of worms, but surely the way the whole 'artificial pancreas' thing has to head eventually), SmartGuard/LGS only ever cancel basal when (or before) low glucose levels are detected. 

Interesting to hear from users though that the 640G performed well enough that it was able to build up trust during the trial period.


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## Pumper_Sue

everydayupsanddowns said:


> I'll be interested to see the MARD (and other data) on the new system once their new website is up and running. I got the impression they had improved, but they were not in a position to give numbers.
> 
> The Veo/Enlites have demonstrated that LGS can be used safely, and SmartGuard is just a significantly improved version of that for hypo-avoidance. Neither are suggesting that they would ever _positively_ dose insulin (that's a whole different can of worms, but surely the way the whole 'artificial pancreas' thing has to head eventually), SmartGuard/LGS only ever cancel basal when (or before) low glucose levels are detected.
> 
> Interesting to hear from users though that the 640G performed well enough that it was able to build up trust during the trial period.



I'm looking forward to seeing all of the reports, it must be a good thing though that users built up a trust during the trial.


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## Flower

Thanks for the great review Mike. 

My Veo is out of warranty in about 6 weeks and I have used Enlite sensors for the past 4 years - started with SofSens and changed to Enlite 2 years back. The idea of SmartGuard as an additional safety net to Low Glucose Suspend sounds great. Very encouraging that users were able to trust the system during the trial. That is what always worries me as I have no hypo awareness and whilst the sensors have been accurate and saved the day on many occasions there is always that slight, nagging doubt. I can't wait to have a look at the new Medtronic pump.


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## HOBIE

All positive stuff !


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## HOBIE

Am going to a talk about this new meter shortly. will post cos looks good


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## Flower

Good to hear Hobie  I heard I'm getting the 640g in March/April and am so excited. It looks excellent and hopefully will cut down the amount of time I spend hypo as I'm struggling even with CGM. Please update us after the talk


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## HOBIE

Hey well done you ! Will post Flower


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## Riri

Do we know costs of elite sensors? Never had CGM myself and certainly not funded by my LHB.


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## everydayupsanddowns

I am really hoping the cost of the sensors will come down as the 640G rolls out - or that there will be some sort of decent 'subscription deal' or bulk purchase available as the take-up increases.

Currently they are between £55 and £52.50 each (depending on how many you buy) . They are officially licensed for 6-day use, but I gather that many people successfully restart at least once, so 8-12 days is not unlikely from what I can tell. So approx £5 a day. Plus the cost of replacing the transmitter when that goes, of course.

As with all CGM sensors/systems - they always seem punishingly costly to me.


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## Trishm

Hi Mike
Yes they are frighteningly expensive especially when cgm seems to be a vital part of the system. I’m led to believe that the 640 suspends insulin delivery if your blood glucose is dropping but the pump needs the cgm to do this. Is it worth having the 640 if you don’t have the cgm


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## everydayupsanddowns

Trishm said:


> Hi Mike
> Yes they are frighteningly expensive especially when cgm seems to be a vital part of the system. I’m led to believe that the 640 suspends insulin delivery if your blood glucose is dropping but the pump needs the cgm to do this. Is it worth having the 640 if you don’t have the cgm



Hello @Trishm

Welcome to the forum!

You've resurrected rather an old thread here and a newer pump which offers predictive low glucose suspend, PLUS the addition of more basal in micro-doses to combat highs is now available (when used with the newer Guardian 3 sensors). Which makes the MM670G the first commercially available 'hybrid closed loop' on the market. Though arguably the open source #wearenotwaiting Loop / OpenAPS alternatives are some steps ahead in terms of flexibility.

I would say absolutely YES that the MM640G, or any pump,  is still worth having without the bells and whistles of an integrated CGM. Insulin pump therapy has really good clinical trial data to demonstrate its effectiveness and the MM640G is one of a number of options that offer those benefits (precise dosing, flexible basal patterns, temporary basal rate increase/decrease, bolus wizard etc etc). 

I was fortunate to be able to trial the MM640G in the Summer of 2015 and used it with and without sensors. I posted a roundup of my thoughts here: https://www.everydayupsanddowns.co.uk/2015/09/64-days-with-minimed-640g-ep-9-review.html


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