Saturday, 17 January 2015

Medtronic MiniMed 640G and SmartGuard Technology

Yesterday I went off to Medtronic’s UK head office expecting to continue with our usual blogger and patient advocacy meetings. What I didn’t know was that I was actually going to be given an exclusive preview and test run of the new Medtronic MiniMed 640G insulin pump and CGM system with new SmartGuard technology! Now that's what I call a good day! 

As a Medtronic patient advocate I have been working alongside them, with a group of other patients and carers, to help them move into the world of social media and digital health care, and to offer an insight into what patients really want from diabetes technology. This in itself bought me the opportunity to travel to Amsterdam last year to blog about their Diabetes Junior World Cup, and here I was again, with yet another opportunity!

I should explain something else… I’m not currently a Medtronic user, but what I really like about the company is that this doesn’t matter to them. I have diabetes, I live with it day in day out and I have views about it – the products that I do or don’t use (often this is out of my control anyway) doesn’t matter to them. This, of course, doesn’t mean that I won’t be a Medtronic user in the future and with the new and exciting MiniMed 640G technology, I could be easily persuaded.

So… enough about me… the 640G is what you need to know about!

The MiniMed 640G is a sensor augmented insulin pump. Medtronic has a vision and that is to create an artificial pancreas and their 640G is the next step towards achieving that vision. Their aim is to create technology that gives people more freedom, improved safety and better health when it comes to diabetes. We know that many companies have this same aim but this product (from what I saw) really does deliver those aims.  

The 640G uses a new technology called SmartGuard. SmartGuard is designed to give people advanced protection against hypoglycaemia and hyperglycaemia. The intelligent system has been based on the wants and needs of people who already use the Paradigm Veo insulin pump, providing better blood glucose control and safety, especially when it comes to nocturnal hypos – something that I think worries us all from time to time.

The system is similar to Medtronic’s Paradigm Veo but, as I said, it’s far more advanced. The Veo has a low glucose suspend function in which the pump will turn off insulin delivery for up to 2 hours if a person's blood glucose levels reaches a pre-set low glucose threshold. However, the new SmartGuard tech will turn off insulin delivery before a person's blood glucose hits the low glucose threshold, therefore avoiding hypoglycaemia. It does this by predicting a persons blood glucose levels 30 minutes before they are going to drop (providing they are also using an Enlite CGM - Continuous Glucose Monitor). The prediction is based on how quickly the person’s levels are dropping. The pump will alarm/vibrate to alert the person that the insulin delivery will then be turned off (for a minimum of 30 minutes) and will stay off until their blood glucose starts to rise again or until they feel better and manually override the system to turn their insulin delivery back on. 

When insulin delivery is turned off to avoid a hypo this means that all insulin is turned off - basal and any bolus programmes that are running - e.g. dual wave. If the person would prefer to eat/treat before the auto-suspend starts then they can stop the suspend function and treat the impending low like they usually would. The user is very much in control of how the system works. 

A high threshold can also be set, in which the pump will alarm/vibrate if a person is going to reach their high level, therefore allowing them to manage the impending high (correction, temp basal increase etc). The pump will not automatically deliver more insulin if a person is reaching their high threshold - This is what a closed loop system (artificial pancreas) is but the technology isn't quite there yet.

One important question that was asked by fellow blogger Mike (@everydayupsdwns) was; What happens if a person’s blood glucose drops below the pre-set low glucose threshold but does not rise again within the 2 hours that the insulin delivery has be turned off for? The answer is that the pump will only turn delivery back on after 2 hours if the person has physically interacted the pump e.g. pushed a button, therefore the pump is recognising that the person is aware of the hypo. If, for example, they are unconscious and do not press any buttons, the insulin delivery will be suspended for a further 2 hours, so 4 hours in total. After those 4 hours… well I just hope that the person would be found by then.

We joked that the pump could have technology like cars do which alerts the emergency services if it is involved in an accident and its location. I actually think this is a brilliant idea. Maybe something for the future, eh :) 

We were told that the algorithm that is used in the SmartGuard technology was the same that was used in the Pilgrim Study in which 80% of hypos were avoided during exercise. The remaining 20% were due to levels that were dropping at a very fast rate which resulted in the persons blood glucose levels hitting their low threshold marker. 

This brings me to alarms and vibrations. In the situation Mike mentioned above, alarms will be set off by the pump to alert a person that they are heading towards, or have reached, their low glucose threshold, therefore hopefully alerting someone else to the unconscious person. It’s a scary reality, but something that we do need to think about as people with diabetes.

The alarms can be turned off though! If you’re sitting in a meeting or your child is in assembly, or if you just want to sleep the whole night through (and you’re other half too!) the low and high threshold alarms can be turned off to avoid that beep beep beeping. The person using the 640G can turn the alarm off themselves, but this doesn’t mean that the low or high thresholds will be turned off. It just means that if a person is heading for a hypo then the pump will deal with it without alarming. If a person turns off the hyper alarm then the pump will not be able to do anything about the levels heading up. Sounds a little scary doesn’t it… Turning off the alerts and letting a device do its thing... but as @LwSweetpea88 pointed out – It’s hard to trust new technology, but you don’t know what it will be like until you’ve tried it.

A few quick bits about the MiniMed 640G

  • It will be available in the UK, Sweden, Denmark and Australia – I believe it will be launched in early February (the 2nd)
  • It’s licensed for use by children 
  • It needs a calibration at least every 12 hours
  • The sensor life is 6 days
  • If a person decided to restart the sensor past the 6 days then it may well result in a calibration error – if the sensor has 2 calibration errors then it will stop working
  • Low level auto-suspend had a minimum suspend time of 30 minutes
  • Insulin delivery will only be turned back on when the trending arrows on the receiver are pointing up (meaning that glucose levels are rising sufficiently)
  • There are a choice of high and low alarms
  • There is an alarm if the user’s blood glucose levels do hit the low threshold (though the aim of SmartGuard is to avoid hitting this threshold)
  • The user can choose to have no threshold at all
  • The pump pairs (via radio frequency) with the contour next link USB blood glucose meter
  • The pump has a bolus wizard, the blood glucose meter does not
  • The blood glucose meter can tell the pump to deliver manual insulin doses (decided by the person using it) or pre-set doses - e.g. 2 or 4 units
  • The pumps come in cool colours (and I think look a little like iPods)
  • It’s not too big and not too small – comes with a clip and you can also buy Lenny the Lion rubber protective cases for it! 
  • The pump has a colour display screen
  • The display on the pump has colour coded icons which let the user know if they are running low – e.g. the battery will be green, amber or red depending on how much battery is left 
  • The screen is a lovely size (really important for me as my retinopathy means I’m always squinting at my tiny pump screen)  
  • Both pump and CGM are waterproof  
  • The system uses the Enlite sensor & guardian link transmitter (the transmitter has been improved - so we were told)
  • The pump has a 'back' navigation button! This may seem like a small detail but my current pump does not have this, meaning I have to scroll through all options if I miss the option that I want
  • 5 basal settings can be used, temporary basal rates can be set and the pump has options for bolus doses to be delivered in different ways (e.g. dual wave)
  • The pump does not need to be used with CGM - It can be used as a stand alone insulin pump (obviously this will leave the user without the option of the low and high thresholds, alerts and CGM trace etc)
  • CGM data can be uploaded via Medtronic's software package, CareLink, and sent to your diabetes team
  • People will be able to purchase supplies through Medtronic's e-shop

Something I haven't mentioned is price... and that's because I don't know it. I did ask the question and I was told that it wasn't a huge step away from the Veo and enlite sensors as a combination, but we will have to wait for more information on that one. 

That brings me to the end of the scribbled notes that I took during the meeting... I suppose the only question I need to ask myself based on what I saw and know is would I use it? 

My answer (if self-funding and CCGs didn't have any influence over my decision) is yes, without a doubt! I'm fed up of waking during the night with low glucose, worrying about what my levels are doing and if I'm going to need to treat a hypo during a meeting or whilst I'm on placement. I'm fed of of the growing fear that one day I might need an ambulance call out or that my driving licence might be taken away from me, that I might end up in a dangerous situation due to my diabetes. I'm also bloody fed up with my constant battle with hypos and exercise! But that's a whole other story.

I hope this blog has been useful to you... I'm aware that I have been using notes to write much of this blog but I hope what I have said is accurate. I'm sure Medtronic will be releasing more information soon, but until then please feel free to share this with anyone who might be interested!

Also - Here's a video with some nice visuals 

Ninjabetic x 

© Ninjabetic

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