Medtronic Insulin Pump

What users like and dislike about the Paradigm pumps

The Medtronic insulin pump has the ability to work with the company's continuous glucose monitor. Models include the Minimed Paradigm 522, 722, Veo and Revel. Here are some of the primary features and what users both like and dislike about these pumps.

Continuous blood glucose sensor: Some live by this feature and others find their first introductions to be frustrating. Certainly there is more research coming out regarding all the continuous blood glucose devices and their benefits in type 1 diabetes. Medtronic is, to date (this is 2009) the only pump company to integrate the continuous glucose monitor so that it reads directly on the pump and alarms on the pump. Alarms for the MiniLink Real Time monitor are also individualized on the pump -eg. people can set the pump to alarm if the glucose monitor senses a reading less than whatever value the user programs: eg. 5 mmol or 90 mg/dL or 4 mmol / 72 mg/dL or likewise if above a certain target. Integrating it with the pump means that two devices do not need to be carried. Just a warning, you need to really know what the benefits are of this device and not assume it will give you readings that are bang on all the time. The most beneficial aspect of any continuous glucose monitor is to use it to look for trends. As an example, happy users have found it priceless for finding overnight glucose trends. Another example, a reading of 5.0 mmol or 90 mg means a lot more to you if you know you have recently dropped and are continuing to drop - meaning you're likely to get low if you do nothing, rather than if you are 5.0 mmol and are quickly rising or 5.0 mmol and stable for the past hour or more. Head up - glucose sensors must be purchased. One sensor is about $50 (this is 2009 in Canada) and last about 6 days if using the Medtronic Veo pump (only programmed to last 3 days in the older Paradigm pumps). Some can reset the sensor and additional days out of one. Not all insurance companies cover the cost of sensors.

Carelink USB: Carelink is an online software program stored on the Medtronic server. It allows people to confidentially and wirelessly download the information on their pumps from any Windows computer to view in various report formats. A USB device (looks like a thumb drive) is inserted into the computer and the pump wirelessly communicates its data to download. It also allows glucose readings from most meters to download into the program even if the meter doesn't "link" automatically to the pump. Some people use the reports to help track their progress or to help them identify problem areas. They can also be used for continuous blood glucose (CBGM) records as the 522 and 722 Medtronic insulin pump models can work with MiniLink CBGM. The data is stored securely online and only accessed by a personal username and password.

Intuitive menu: Many users of Medtronic insulin pumps learn to use the screen intuitively. For example, everything to do with 'basal insulin' is under the menu heading 'basal'; likewise for bolus etc. However, users of other pumps could easily say the same and once you've got a pump, you quickly learn where most features are hiding.

Reservoir sizes: Medtronic Minimed insulin pumps offer models with 300 unit or 180 unit reservoirs. For people using over 50 units of insulin a day, the 300 unit option means less filling. As a comparison, Animas pumps after priming are about 180-200 units. The option of a Medtronic insulin pump model with bigger reservoir may not be of use to those who need smaller total daily doses of insulin.

Screen size: Some find the Medtronic insulin pump screen size too small. If vision is an issue, be sure to see the pump in person to determine if it's a concern or not for you. If it is, Animas has a bigger screen. But alas, Animas it does not have the built in continuous glucose monitoring option. In the Medtronic insulin pumps you can turn the backlight on with one button to make reading easier on the smaller screen.

Color and skins: Personally, color would not the be deciding factor for me when purchasing a pump. However, I met a young person recently who put color right up there as deciding factor. Medtronic insulin pumps, like the Animas ones, come in various colors now-a-days including pink. The Medtronic ones also have an eye-boggling selection of skins available. That includes uploading your own photo to make a personalized skin. I saw quite a show-stopping one the other day. If you're interested, you can check here: http://medtronic.skinit.com.

Water resistant not waterproof: Obviously some people prefer the latter, so this is a personal choice dependent on lifestyle. But...here comes the educator...given that there were some unfortunate events some years ago with Disetronic pumps that were waterproof, many educators in the know will advise all clients to take off the pump even if waterproof. The issues arose after a few waterproof from the factory Disetronic Htron pumps were submerged but unbeknownst to the users had cracks after having hit something or being dropped. All pumpers will have their pumps slip, swing or drop at some time so given that you cannot always tell if there are microfractures in the shell for water to make its way into the electronics, you may wish to consider with your educator the safer route of taking the pump off for the duration of the swim if it is less than an hour. If not, carefully inspect your "waterproof" pump (all pumps really) or arrange with your educator for how you should supplement your insulin if you plan to scuba dive all day.

Programmable alarms: The use of this is more popular recently given the importance of 2 hr pc readings. The BG reminder alarm can be set to alarm the pump 2 hour after each bolus to remind the user to test glucose and see effectiveness of the bolus. Other alarms can be set to go off at specific times each day to either remind people to eat or simply to use as an alarm clock. Models other than the Medtronic insulin pump come with some types of alarms as well, although not necessarily the 2 hr pc one. Of note, this can be an annoyance if you are a nibbler though or eat a late snack at night and thankfully can be turned off when not needed.

Paradigm Veo and Revel: These newer Medtronic insulin pump models offer advanced features if using their continuous glucose monitor sensors with them. The Veo and Revel are almost the same with the exception that the Revel (available in the U.S.) does not have the "Low Glucose Suspend" feature that the Veo does (available in Canada, Europe and elsewhere). The "Low glucose suspend" feature allows the insulin pump to automatically suspend insulin infusion if a low is sensed and the user does not respond to the alarm. The pump suspends insulin infusion for a few hours or until the user manually responds and cancels the suspend. People with hypoglycemia awareness and parents can be are particularly comforted by the idea of the suspend option. Others, notably those who have never had a concern with hypo unawareness, disable this feature on the pump.

Both the Veo and the Revel have "rate of change alerts" to notify the user of quickly changing glucose levels. People who are aiming for tighter control are drawn these alerts eg: if blood sugar is dropping or rising too quick an alarm sounds.

Both of these Medtronic insulin pump models have "predictive" alerts eg: alarm goes when pump determines you'll be below your target in 20 minutes (timing can be individualized). This theoretically allows a person to act before they get hypoglycemia. For those with diabetes and tight glucose control who have set tight glucose targets in the pump, the predictive alerts are constantly going. However, alerts can all be individualized or individually turned off.

Obviously the use of its these unique features come from pairing it with their continuous glucose monitoring system. One big downside many clients complain of is cost of those sensors as not all insurance companies cover them, and many people on pumps have no insurance. Another downside for some clients is the annoyance of frequent alarms. However some see this as a positive as leads to more blood sugar awareness as intended. Although these new features seem tempting, be sure to discuss with your health educator the appropriate use of them in your diabetes management.

Bolus Wizard: Most pumps have built in calculators. Having seen Medtronic insulin pump and Cozmo wizards, I prefer Medtronic as it clearly lists how the pump comes to it's decision and can be overridden manually at every step of the way if need be. Having said that, Cozmo no longer sells pumps. So... be sure to review the wizard or calculator screens of the potential pumps to see if there is adequate information posted including...current bg, grams carb, recommended bolus for carb, recommended bolus for correction, insulin still on board and subtracted hopefully just from the correction dose. Wizards must be set up and individualized with your insulin-to-carb ratios, correction factors and target glucose ranges so are not working when the pump is first received, but must be programmed in by you.

Proprietary infusion sets: When the Medtronic Minimed Paradigm pumps first arrived on the scene, competitors made a big deal of the fact that luer lock infusion sets could not be used on this Medtronic insulin pump. It only uses Paradigm infusion sets. However, over time this has not been such an issue, if any, for most people. Medtronic offers 30 and 90 degree sets like the luer lock sets with comparable prices. Also, Thinset reservoirs can be purchased for the Paradigm that allow it to use luer lock sets (but not through Medtronic of course!). See http://www.autocontrol.com/diabetes_products/thinset.htm

Largest company; faster advances: Some people have purchased a Medtronic insulin pump because the company is one of, if not, the world's largest medical technology company with pumps that come out with newer technologies faster than other companies. If you believe a new model pump to be coming though (eg. the Paradigm Veo) be sure to check on timelines and the cost of any upgrade packages to see if you can benefit or not. Try to base your choice of insulin pump on your current and foreseeable needs and the current products available for purchase in your country, not unknowns with unknown price-tags.

Customer Service: Like ALL pump manufacturers I have heard both good and bad stories here, with he good predominating (like all pump companies). I do know of two people who chose their second pumps from competing companies because of being upset from customer service. In each case, both were disappointed because they didn't get the key working features of the insulin pump they wanted or needed most (one needed continuous glucose monitoring, the other needed a bigger screen). Yes, customer services is important but if the companies were all equal, which pump would you choose to best meet your needs?

Good luck with your decision. In the end, if you work carefully with your medical team I'm sure you'll both benefit and enjoy pumping regardless of whether you use a Medtronic insulin pump or other brand. Be sure to discuss the decision to start pump therapy with your physician, educator and your insurance company.

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