Friday, 10 April 2015

Episode 23: 64 days on MiniMed 640G System: The Wrap - Managing My Type 1 Diabetes

Welcome to my final VLOG!

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:

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
The two graphs below show the significant reduction in nocturnal hypoglycaemia (hypos during the night) achieved by SmatGuard. Graph 1 shows the three month sensor overlay from the VEO where the concentration of the red (hypo) is overnight and this meant lots of alarms, biscuits and lost sleep.
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
The Ugly:
  • 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
If the answer to any of the above is yes it would be advisable to choose a pump with CGM capability and as I have discussed above in my opinion the MiniMed 640G is the first real step towards closing the loop. There are lots of good CGM systems out there (Dexcom, Abbott Navigator, Animas Vibe) which work very well and by reading lots of BLOGS and VLOGS it seems with the Dexcom Sensor, you can get extra sensor life which is great for self-funders but you have to be prepared for the alarms and extra 10-15 hours per week managing and some sleepless nights. If like me you would prefer to have semi-automation the MiniMed 640G would be my choice but everyone has different priorities and as the NHS funds my CGM due to previous severe hypoglycaemia, it's hard for me to be fully balanced n this point. Oh and did I mention I work for Medtronic, well maybe once or twice!


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:

  1. Attending a structured education programme such as DAFNE or local equivalent.
  2. Read key books by great diabetes authors such as:
    1. Gary Schiener - Think like a pancreas
    2. John Walsh - Pumping insulin or Using Insulin
  3. 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
  4. Adhere to the 7 P's: Prior Planning and Preparation Prevents Piss Poor Performance
    1. My Uni Lecturer Dr. Ian Kenvyn taught me that and it invaluable
    2. Myself and best mate Phil Hayes CEO of Kloodle follow this religiously
  5. 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:
    1. Positive
    2. People
    3. 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
 (1. sensor overview 2. meter bg over view 3. day by day - See the blue snippets of basal suspend to view the frequency and help of SMART GUARD)



Download pics from VEO
 (1. sensor overview 2. meter bg over view 3. day by day)





Wednesday, 1 April 2015

Episode 22: 64 days on MiniMed 640G System: Exercise week - Managing My Type 1 Diabetes

Welcome back!

This VLOG is an exercise frenzy showing the effect of exercise in Diabetes Control. Key aspects being the difference between:
1. Exercising with active insulin board and not
2. Endurance exercise vs. Resistance exercise
3. Planning for before, during and after exercise

Other Highlights include:
1. Seeing Danielle's Yoga Moves
2. Seeing Becky and Lucy take on the old man (me) at Functional Fitness
3. Me overdosing on chocolate before exercise - Nightmare

To get the full exercise story please see:
1. Episode 21 for the full explanation of diabetes and exercise and planning

2. Episode 14 for resistance exercise and diabetes



An example of the Yoga that was missing!



Excellent Web-Sites that have really good Exercise and Diabetes information:
Excarbs - By Diabetes and Exercise Gurus: David Kerr, Helen Partridge, Michale Riddell
Diabetes Motion - Sheri Colberg - leading Diabetes and Exercise Expert


A good recent blog done by Dave Sowerby - http://www.thetangerinediabetic.blogspot.co.uk/

A Massive thanks the Sam Smith, owner of RIGS FITNESS for allowing me to film some of the sessions and generally owning the best gym! Check it out at the below sites

RIGS FITNESS: https://www.facebook.com/ElitePerformanceCentre?fref=ts
RIGS FITNESS Videos: https://www.facebook.com/ElitePerformanceCentre/app_212104595551052


Massive Thanks to Danielle for being a wicked Yoga Instructor.


Danielle Yoga Instructor: https://m.youtube.com/watch?feature=youtu.be&v=2ZSOoqo8N0s

 
Thanks to Becky and Lucy for being great sports and all round future fitness superstars!



Becky Hayes: https://instagram.com/beckyhayes1992/   Twitter: https://twitter.com/beckylhayes
Lucy Turnbull: https://instagram.com/lucyturnbull1/    Twitter https://twitter.com/LucyTurnbull1


Well I hope this helps and also provides a little inspiration that with a little planning people with type 1 diabetes can do whatever they want! Well apart from overdosing on chocolate!

Trying to make a decision on the next VLOG, options are:
1. Carb counting
2. Sensor performance, expectations and how MARD gets better after day one of insertion, false suspends and how to manage
3. Review of SMART GUARD and where works its best and where it does not
4. Open to ideas if you want something specific

Let me know what you would prefer by comment below or on Twitter @MM640G

Until next time! Oh and don't overdose on Chocolate! It's only Easter after all1

John

Episode 21: 64 days on MiniMed 640G System: 24 hours Charity Cycle - Managing My Type 1 Diabetes

Hello and welcome back,

Please find below my VLOG all about the 24 hour Charity Bike Ride I took part in on the 20th to 21st of March.




Highlights for diabetes management include:
1. What happens in the body during exercise and what are the risks for people with type 1 diabetes
2. How I plan my exercise management to prevent hypos
3. CareLink analysis of how my plan worked

Highlights for fun and charity:
1. we have raised 3,000 for Bury Hospice, if you would to donate please go to:
2. See the article in the Bury Times: http://www.burytimes.co.uk/news/12585368.Cricketers_cycle_the_equivalent_distance_of_Bury_to_Russia_during_24_hour_charity_ride/?ref=twtrec

3. See me in a pink leotard and Rio Parrott suit whilst cycling
4. See my mate Jamie's Rock dance to Jimmy Eats World "In the Middle"
5. See mine a Phil's battle to see who can cycle the furthest
6. See a preview of next weeks exercise VLOG that includes the lovely ladies below:

Becky Hayes: https://instagram.com/beckyhayes1992/   Twitter: https://twitter.com/beckylhayes
Lucy Turnbull: https://instagram.com/lucyturnbull1/    Twitter https://twitter.com/LucyTurnbull1


Danielle Yoga Instructor at RIGS FITNESS:
Danielle in action:
RIGS FITNESS: https://www.facebook.com/ElitePerformanceCentre?fref=ts
RIGS FITNESS Videos: https://www.facebook.com/ElitePerformanceCentre/app_212104595551052


 
 
Well thanks for watching and reading and I look forward to sharing my exercise VLOG next week!
 

 
All in aid of great cause!
 
Out for now
 
John