This is the wrap and is based on three things:
1. Comparing the 64 days on the MiniMed 640G (Feb to April 2015) with 64 days on the VEO from (October to December 2014 ) In terms of; HbA1c, number of hypos, alarms, time managing diabetes
2. A summary of The Good, The Bad & The Ugly of the MiniMed 640G and how to manage expectations. Plus a surprise about the #DOC
3. Final bit of frivolity and stupidity by me!
For those finding this VLOG for the first time you can see on the history bar on the right hand side a chronological list of the VLOGS to find more info on:
1. Why doing this 64 days - episode 1
2. The MiniMed 640G, how to set up, the features etc - episodes 2 - 8
3. What is CGM, SmartGuard, Setting for SmartGuard - episodes 5-8
4. First two weeks and SmartGuard in action - episodes 9 - 18
5. Adapting SmartGuard settings for day, night and post-meals - episode 18
6. 7 top tips to get best Enlite Performance, mine improved from 13% MARD to 10% - episode 16
7. How Alcohol interacts with diabetes and managing a stag do and recovery - episodes 17, 19 - 20
8. How exercise changes glucose levels and how you can manage - episodes 21 - 22
9. See more on the MM640G at:
- MiniMed 640G System : Medtronic Web-site
- Tangerine Diabetic 64 days MiniMed 640G - Dave Sowerby VLOG
- Ninjabetic 64 days on MiniMed 640G - Ninjabetic VLOG
Comparing 64 days on MiniMed 640G with VEO:
Important point to note that 3 hypos per week is normal for people with type 1 diabetes achieving good control HbA1c <7.5% (58mmom/mol). People having 0 hypos per week are invariably running their blood glucose high due to fear of hypos or because they plain don't like them and they have 4+ hypos per week when try to run tight control. This is the paradox of diabetes management hypos are inevitable if you are going to run tight control, the trick to try to minimise them!
| VEO 64 days | MM640G 64 days | |
| Weight (kg) | 95kg | 95kg |
| BG number in 64 days | 554 | 495 |
| BG Average per day | 8.6 | 7.8 |
| BG Average (mmol/l) | 7.1 | 7.1 |
| BG Standard deviation (mmol/l) | 2.8 | 2.7 |
| AUC <3.5 | 0.03 | 0.01 |
| AUC <9.0 | 0.19 | 0.36 |
| SG Average (mmol/l) | 8.3 | 7.3 |
| SG SD (mmol/l) | 2.1 | 2.3 |
| Average carbs | 326 | 295 |
| Insulin units Average | 36.3 | 35.3 |
| Basal % | 40% | 37 |
| Bolus % | 60% | 63% |
| U/kg | 0.38 | 0.36 |
| Clinical Measurements | ||
| HbA1c % | 6.1 | 5.8 |
| HbA1c (mmol.mol) | 43.0 | 40.0 |
| Hypos <3.5mmol/l in 64 days | 30 | 28 |
| Hypos <3.0 in 64 days | 15 | 14 |
| high alarms per day | 0.8 | 0.9 |
| Low alarms per day | 11.8 | 0.8 |
| Suspends duaration per day (hrs min) | 0 mins | 2hrs 8 min per day |
| Number of suspends per day | 0 | 2.1 |
The table shows clearly the same clinical results can be obtained form the VEO when compared with the MiniMed 640G, however, what the table also clearly shows is that to obtain the same results I had to respond to the VEO low alarms 12 times per day which means:
- 90-120 minutes per day managing low alarms with extra carbs, temp basals and increased surveillance. 10 -15 extra hours per week!
- 8 hours lost sleep managing low alarms
Graph 2 backs up what I have been saying in the VLOG that SmartGuard works at its best overnight when there is only basal insulin causing hypos! A massive difference being full nights sleep and hardly any biscuits during the night (keeping my waistline in check!)
Graph 1: VEO three month sensor overlay
- Graph 2: MM640G three month sensor overlay
Amazing results can be achieved with the Veo and Real-time CGM BUT not many people, are prepared to do this because:
- They have lives outside of Diabetes
- They have not been taught the skills and solutions on how to manage the alarms well
- It's a hell of a lot of work
- They are not a diabetes nerd like me!
The MiniMed 640G allowed me to have the same control with only 1 low alarm per day due the Smart Guard protection from hypos and safety, which meant I got 10-12 hours per week back, 8 hours more sleep and a significantly lower risk of diabetes burn out!
This was achieved by the MiniMed 640G suspending and re-starting the basal on average 2.1 times per day for a total of 2hrs 8minutes (Smart Guard) without any alarms! The crazy thing is looking back at my download there was no patterns to say I needed to reduce basal at a certain time of day or change carb ratio. It was just natural daily variation of activity, food intake and mood that meant Smart Guard has become invaluable in keeping good control, preventing hypos and keeping my sanity! I think people with diabetes and Clinicians alike will have to learn two suspends per day is completely normal and healthy if good control and low number of hypos is going to be achieved!
I am prepared to manage all the alarms with the VEO but a for a lot of people with diabetes the alarm fatigue is too much (the same for any CGM system be it Dexcom, Animas Vibe, Abbott Navigator). Its my opinion that this is the first real step towards the closed loop allowing semi-automation of hypo management and will mean more people will be able to manage CGM without diabetes burn out! but this in only my opinion!
I know for me I think much less about my diabetes and more about living life!
If you want the download pdf's email me at jspfree2@gmail.com and I will send them. This BLOG will not allow me to upload PDF's. Key pages are at the bottom of this BLOG
MiniMed 640G: The Good, The Bad and the Ugly
As a stand alone pump it has almost everything you would want. The Good
- Very easy to use, navigate and easy to follow instructions
- Waterproof
- Colour screen that's adjusts to light
- Alternate basal profiles
- Remote bolus with also pre-set bolus option
- Sex appeal, no longer a an 80's pager, but now a 90's IPOD!
- The safest Bolus Wizard technology that takes into account both bolus and correction insulin for active insulin (IOB, BOB) for safety, unlike some other pumps that only take into account correction insulin.
The bad:
- No bolus wizard in remote bolus
- Change sensor alarms - listen to VLOG for full explanation
- Still has a tube, however due to the recently published accuracy difference between tubed (95% accurate) and patch pumps (66% accurate), I will take a tube pump any day!
- J Diabetes Sci Technol 2013;7(4):1011–1020
- Me in the shower showing the waterproof off!
One thing to consider when choosing a pump is do you think you may use or need CGM as an option in the next 4 years due to:
- Issues with hypos like me
- Funding becomes more readily available by the NHS or your funding provider, country dependent (there are international viewers don't you know! Ha)
- The companies make the sensors cheaper and therefore more affordable for self-funders
- You become pregnant and need very tight control
- You have erratic control due to hectic lifestyle
Its a wrap
I have a new found love for the #DOC (Diabetes Online Community for the internet virgins, which was me until 64 days ago!) who are a very knowledgeable and helpful bunch of ego maniacs (me included), gentle helpful soles and philosophers! Peer support from PWD (People With Diabetes, everyone loves an acronym, especially the NHS) is key with diabetes and I know believe online really offers this!
Technology is great but by far the most important aspect of diabetes management is the person/families education, knowledge, management strategies, positive attitude towards a condition that does not let you have a day off from constant blood glucose checks, planning, review and modification. My strongest advice is to educated your self by:
- Attending a structured education programme such as DAFNE or local equivalent.
- Read key books by great diabetes authors such as:
- Gary Schiener - Think like a pancreas
- John Walsh - Pumping insulin or Using Insulin
- Get good at carb counting - even as a Registered Dietitian I still have a lot to learn (Thanks Andy Sherwood @colonelblighty) that's why I love the #DOC
- Adhere to the 7 P's: Prior Planning and Preparation Prevents Piss Poor Performance
- My Uni Lecturer Dr. Ian Kenvyn taught me that and it invaluable
- Myself and best mate Phil Hayes CEO of Kloodle follow this religiously
- Finally the 3 P's, diabetes is a life long fight that never gives an inch but by realising you cannot win every battle but you can win the war, you can prevail:
- Positive
- People
- Prevail
Thanks for watching! over 10,000 page views since I started and I have hopefully educated, entertained and for sure made you cringe!
I may do some VLOG's after the cricket season on carb counting and other aspects of diabetes management. If you would like me to do some more let me know in the comments below or at @MM640G
Thanks again for viewing
AND CUT (Martha, stole your line!)
Cheers
John
See the download pics below first from the MM640G and then the VEO. What amazed me was the reduction in time spent hypo overnight!
Download pics from MiniMed 640G
Download pics from VEO
(1. sensor overview 2. meter bg over view 3. day by day)
