Minimed 522/722 & RealTime CGMS

[MamaCat]

I'm thinking of upgrading my Minimed Paradigm 512 to the 522 so I can get their new RealTime CGMS.

I know my 512 is not compatible with the system, and I need to upgrade before my warranty runs out anyway. (1) Have any of you used their "Pathway" program to upgrade, or will some insurance companies pay for an upgrade? (2) Do you like the changes made in the 522/722? (3) Are there any shortcomings to the 522/722 or changes you wish they had made but didn't?

My endo gave me a 3-day run on a clinical Minimed CGMS in January, and the info. we got was a real eye-opener. I found I have a small rise in my bGs starting around midnight, then the so-called Dawn Phenomenon really kicks in for me about 2:00am. (4) If you have the CGMS, are you finding it reliable? (5) Are the sets similar to those of the pump, and what's it like to now have TWO things attached to you 24/7?
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sorry, just found JRCSKB's thread from 8/17. Is it okay for this new thread?

[spike]

I'm thinking of upgrading my Minimed Paradigm 512 to the 522 so I can get their new RealTime CGMS.

I know my 512 is not compatible with the system, and I need to upgrade before my warranty runs out anyway. (1) Have any of you used their "Pathway" program to upgrade, or will some insurance companies pay for an upgrade? (2) Do you like the changes made in the 522/722? (3) Are there any shortcomings to the 522/722 or changes you wish they had made but didn't?

My endo gave me a 3-day run on a clinical Minimed CGMS in January, and the info. we got was a real eye-opener. I found I have a small rise in my bGs starting around midnight, then the so-called Dawn Phenomenon really kicks in for me about 2:00am. (4) If you have the CGMS, are you finding it reliable? (5) Are the sets similar to those of the pump, and what's it like to now have TWO things attached to you 24/7?
_____

sorry, just found JRCSKB's thread from 8/17. Is it okay for this new thread?
Heck, IF it was reliable, and the sensors didn't have to be refrigerated, and the thing didn't cost a fortune, and the Freestyle navigator doesn't have better features, SURE I'd get a CGMS from MM.

[notme]

From what I have been told, none of the insurance companies will for the CGMS sensors and they are expensive. I don't think I would even consider it until you check with your insurance company to see if they will cover sensors.

[butterflykisses]

It's doubtful your insurance company will pay for the upgraded pump, and Minimed says no insurance companies will pay for the CGMS. You can still upgrade the pump, decide later if you want to use the CGMS part. It's an additional $1000 out of pocket for the starting kit. I can't remember how much the sensors are, but very expensive. I've read that some people are leaving the sensors in longer than the 3 days, getting more time out of them. The transmitter itself has a battery that can not be replaced, so when they goes out, MM says about 9 months, you have to purchase a new transmitter. I don't know how much that will cost, but considering the starter kit is $1000 I'm sure it's not cheap. Just make sure you understand the costs before diving in. good luck.

[Zapatka]

yeah no kidding, a 10 pack of sensors will run you about 400 dollars. I believe the final cost came to about $11.40 a day for the CGMS. I'm sure, however, that insurance will cover all of it in the future.

[JediSkipdogg]

I know my 512 is not compatible with the system, and I need to upgrade before my warranty runs out anyway. (1) Have any of you used their "Pathway" program to upgrade, or will some insurance companies pay for an upgrade?

Insurance companies do not pay for Pathway upgrades. Also, keep in mind to make a wise decision when doing a Pathway upgrade. If say your current pump is 3 years old today and you upgrade through the Pathway, your new pump will only have a 1 year warranty on it. And I doubt Minimed will be making a new pump for another 2-3 years, so you'd be stuck with a warrantless pump which could be dangerous if something happens. Remember, with the Pathway program your warranty starts with the first pump and lasts 4 years from that start date. If you do a Pathway upgrade the day before that pump warranty is up, you have a 1 day warranty on the new pump.

Insurance companies will generally buy one a new pump every 4 years just because they know how expensive warranty repairs on a pump are. So check with your insurance on that.

Also, insurance WILL NOT pay for the CGMS half of the pump, that is the transmitter and sensors. The transmitter must also be replaced every 12 months at about $500 since the battery can't be changed in it. You can try to appeal your insurance, and it may work, but an appeal is a lengthy and annoying process. So for that it may be wait the 1-2 years for insurance to cover it.

(2) Do you like the changes made in the 522/722?

I don't have a 522/722 so I can't compare that to a 512. The 522 is exactly like the 515 with CGMS capability, so if you compare the 512 to the 515 you'll find out the differences minus CGMS.

(3) Are there any shortcomings to the 522/722 or changes you wish they had made but didn't?

There are some and this is another reason to wait. They are doing a software update on the 522/722 but not until December or the first of next year. The software will show the user history on the CGMS back a few days. It will also allow more functions in the CGMS area in terms of trends and assisting with pump info.

(4) If you have the CGMS, are you finding it reliable?

A CGMS unit is currently only about 40% reliable. Readings have been as much as 40 mg/dl off on people in normal range. Also, there is a 10-15 minutes delay (they say 8, but a CGMS only reads every 5 minutes, so 10 minute minimum) between what your BG is and what the CGMS shows since it is reading interstitual fluid and not blood.

The other problem is if one is in a rabid rise or drop. A CGMS unit can't keep up with that. Therefore during that stage it may be a bit before the CGMS says you are in a rapid drop. My fear is also people will rely on the CGMS more and trust it and not do fingersticks for corrections. Before administering ANY insulin, one is SUPPOSE to do a fingerstick even on a CGMS. However, I know people get lazy at times, and I know even I would do this, I would make corrections based on the CGMS.

Currently a CGMS is ONLY useful for monitoring trends that one may have. But are you willing to outlay that expense for that? And if one things they can use it sparingly...wrong...The sensors come in packs of 10, must be refrigerated, and I believe expire in 6 months. Then you have the transmitter battery half. Over time that will expire, so doyou want to pay $500 for a new transmitter when you only used the last one ten times or so?

(5) Are the sets similar to those of the pump, and what's it like to now have TWO things attached to you 24/7?

The sets are 100% similar to a pump. The sensor is just like a Comfort infusion set (angled, about 15 mm long.) The major problem with havingt the two things attached is they need to be far enough away that insulin pooling in the area won't mess up the readings. That generally is only about 2-3 inches. But keep in mind you will now have 50% less infusion sites for the pump. And for some people that can be extremely difficult. The good part about the CGMS though is it's wireless. So you don't have to worry about two cables being attached and getting tangled.

The other disadvantage is it's not as easy to just disconnect. With a pump you can disconnect for an hour after a bolus and think nothing of it. With a CGMS, when you disconnect and get out of the transmitter range, which isn't much, maybe 5 feet, then you have to recalibrate on reconnecting and it can take a few hours for you to get an accurate reading again. If doing the love making thing at night, that means you could have an unpleasant time afterwards reconnecting and waking up to recalibrate it and if it gives you a false high or low till it gets back on track.




I'm not persuading you to not go with it. Just giving you all the facts and research that Minimed seems to leave out or only mention if you ask them about it.

[MamaCat]

Gee, y'all, I'm SO glad I asked! I thought I had researched it all and, quite frankly, was ready to get both as soon as I could afford it. I had NO idea that the Pathway program just continued on the current warranty, nor that the insurance company would pay for a new pump in time. Yes, I was concerned about getting a pump just before new improvements would be available. As for the CGMS, I did NOT know that basically the transmitter is a disposable unit. :dontknow: Oh, well, guess I'll just have to be patient a little longer. :whistling Some of the things you shared were not forthcoming from the manufacturer. Thank you all SO MUCH for the info! :adore: The last thing I need to do is flush a thousand bucks down the drain! :shot:

[Dewey]

As I mentioned to Spike, I was unaware that the CGMS sensors had to be refrigerated. To me, this seems quite odd in that once a sensor is out of the fridge & placed on the body, it's no longer cool. Wouldn't it lose "potency," once it's no longer cool? (At least that's my hypothesis on it..). Don't know if this holds any truth to it or not, but I just find it odd that they have to be refrigerated prior to usage. Does anyone else know (or has anyone asked MiniMed) why there's a need to refrigerate sensors prior to use??

[MamaCat]

As I mentioned to Spike, I was unaware that the CGMS sensors had to be refrigerated.

I had never heard that either. But then, I didn't know about the non-replaceable battery in the transmitter...

[JediSkipdogg]

Does anyone else know (or has anyone asked MiniMed) why there's a need to refrigerate sensors prior to use??

From http://www.minimed.com/products/insulinpumps/faq.html

"Do I need to refrigerate my glucose sensors?

Glucose sensors are shipped in a protective foam container containing chilled gel packs designed to protect glucose sensors from temperature changes during shipment.

You should immediately refrigerate your glucose sensors upon receipt. Keep in mind that even though we recommend keeping glucose sensors in the refrigerator, glucose sensors can survive at various temperature ranges. Glucose sensors must also not be frozen.

Prior to inserting a glucose sensor, allow it to warm up to room temperature (may take approximately 15 minutes).
top
What happens if the glucose sensor is left out of the refrigerator?

A glucose sensor can be left out of the refrigerator at room temperature for up to one week and it would still be acceptable to use the glucose sensor. Do not use the glucose sensor if it has been left in the sun (or extreme heat) or conversely if it has been exposed to extreme cold."

[Dewey]

Thanks for the info., Jedi. Seems to me that they're still unstable, at best (at least for the time being). Hopefully something better will come along very soon, or perhaps MiniMed will revamp their sensors...One can only hope (and wait. :().

[JediSkipdogg]

Thanks for the info., Jedi. Seems to me that they're still unstable, at best (at least for the time being). Hopefully something better will come along very soon, or perhaps MiniMed will revamp their sensors...One can only hope (and wait. :().

The part I find odd is that while I agree with their reasoning, why is Minimed the ONLY one that requires that? Both the Dexcom and Navigator don't mention any thing about refrigeration. Yet Minimed, which has had a CGMS for 7 years, still requires refrigeration. Sounds kinda stupid to me.

[MamaCat]

Thanks, Jedi... Research is supposed to make our lives simpler... The CGMS thing eventually is going to be good, but I think from what I've learned it's not quite there yet. I'M not going to be one of their beta testers (unless it's free, of course...).

[Dewey]

Thanks, Jedi... Research is supposed to make our lives simpler... The CGMS thing eventually is going to be good, but I think from what I've learned it's not quite there yet. I'M not going to be one of their beta testers (unless it's free, of course...).
I was involved in a trial of the CGMS, so was able to try it out. It seemed to work ok for me during the time I wore it (after having to replace the initial sensor while getting hooked up), but that was several years ago. Personally, I'm in agreement that it has a ways to go to become "fabulous." I recently found my graphs, so I'll scan & post them when I get the chance. :)

[jrcskb]

Hey everyone. I have worn the sensors since 8/15. I will share my own thoughts, but I am still looking at the best way to share my data.

1. The refrigeration thing is not a big deal. As was said, they can last up to a week without refrigeration. You are only supposed to wear them for 3 days (although rumor has it they do last a bit longer). Plus, 10 sensors fits in the "butter drawer" of a fridge with enough room for butter!

2. Problem: My biggest issue with the sensors is that they are very sensitive and require as close to "ideal" situations as possible to calibrate effectively. When starting a new sensor, it is suggested to be done when levels are not changing very much (usually before meals or at wake). I have found this hard to "schedule". One sensor was started about 3 hours after a meal and the values for the first 12 hours were not good. A couple that have calibrated well from the beginning have been very good.

3. Accuracy: Overall I am pleased, but not ecstatic. The accuracy is the best within I would guess 60ish to 150ish. So, for those who gain or have optimal control, the data will be very accurate. I have had "false" lows - readings in the 40s when my meter said 75. A high came in on the sensor at 240's and I think I was actually 275 on the meter. However, the point to remember is that the meters and the sensors have the same accuracy built in. In other words- if the meter reads 100 the range of the "lab" value should be between 80-120. So, if the meter reads 70 and the sensor is at 56 (or up to 84) it is likely perfectly "accurate". Without a sensor, a test of 70 only really tells you that you are in that range anyway. If the sensor gives me a low and I dont feel low, I don't correct by eating (as I would not with a low meter reading that I questioned).

4. Trends: The data is really incredible to see (like the graphs from the "Gold" cgms 3 day test). I now have about 8 full days to see trends at meals, overnight, etc. and will adjust my rates accordingly. Fingerstick snapshots don't provide this much data.

I think the biggest issue is making the calibration easier to establish so the readings are converted into better data earlier when starting the sensor. I have found that I can live with the accuracy (or inaccuracy as some will say!) once the calibration is set up well enough.

Please, let's keep this cordial :shakehand If you have any questions, let them rip and I will do my best - but I am new to this as well!

[spike]

Hey everyone. I have worn the sensors since 8/15. I will share my own thoughts, but I am still looking at the best way to share my data.

1. The refrigeration thing is not a big deal. As was said, they can last up to a week without refrigeration. You are only supposed to wear them for 3 days (although rumor has it they do last a bit longer). Plus, 10 sensors fits in the "butter drawer" of a fridge with enough room for butter!

2. Problem: My biggest issue with the sensors is that they are very sensitive and require as close to "ideal" situations as possible to calibrate effectively. When starting a new sensor, it is suggested to be done when levels are not changing very much (usually before meals or at wake). I have found this hard to "schedule". One sensor was started about 3 hours after a meal and the values for the first 12 hours were not good. A couple that have calibrated well from the beginning have been very good.

3. Accuracy: Overall I am pleased, but not ecstatic. The accuracy is the best within I would guess 60ish to 150ish. So, for those who gain or have optimal control, the data will be very accurate. I have had "false" lows - readings in the 40s when my meter said 75. A high came in on the sensor at 240's and I think I was actually 275 on the meter. However, the point to remember is that the meters and the sensors have the same accuracy built in. In other words- if the meter reads 100 the range of the "lab" value should be between 80-120. So, if the meter reads 70 and the sensor is at 56 (or up to 84) it is likely perfectly "accurate". Without a sensor, a test of 70 only really tells you that you are in that range anyway. If the sensor gives me a low and I dont feel low, I don't correct by eating (as I would not with a low meter reading that I questioned).

4. Trends: The data is really incredible to see (like the graphs from the "Gold" cgms 3 day test). I now have about 8 full days to see trends at meals, overnight, etc. and will adjust my rates accordingly. Fingerstick snapshots don't provide this much data.

I think the biggest issue is making the calibration easier to establish so the readings are converted into better data earlier when starting the sensor. I have found that I can live with the accuracy (or inaccuracy as some will say!) once the calibration is set up well enough.

Please, let's keep this cordial :shakehand If you have any questions, let them rip and I will do my best - but I am new to this as well!

How comfortable were the sensors, as compared to a set (what type sets do you wear?).

The accuracy being "ok" for 60-150 isn't much help for those who would most benefit from a CGMS--those who's bg's range from the 30's to 300+. I had another bad experience with a Compact reading too high last night and that got me down to 43 in a matter of minutes. I think I'm going to curtail my use of the Compact Plus and stick with my trusty LifeScan meters, even if they read a wee bit low at the high end. Darn it! The "all in one" feature of the Compact Plus is hard to give up!!!

[jrcskb]

Comfort: Truly, once the sensor is in, you only notice the weight of the transmitter (which is attached to the part that goes into the body by a small wire). You can tape the transmitter, but I find it easier to tuck in my waistband/belt to avoid the tape (which is incredibly sticky and allergenic I am sure!). I am thin, so the area of skin is an issue, because the sensor and transmitter do take up a decent amount of space. Putting the sensor in is a little more "invasive" than the quick sets I use - you have to hold it at a angle that basically is sending it perpendicular to your skin and directly in.

Accuracy: I agree that the more variable your readings are the less accurate the sensors would be for you. I have some variability myself. I guess the first point is that the trending that it does catch can help to avoid the variability by adjusting your insulin. Also, it does read the right direction of the extremes (in my experience). For example, when I was in the 40s on the sensor I was in the 70s on my meter (so at least "headed" low it appeared). When I was high on the sensors my meter was consistent (although a bit too far from each other). Although no real science to back my point, I do feel that meters have more variability from lab values than advertised (most likely especially in the extremes as well). Often I get a high (275) on my meter and recheck and get a number up/down by 25 or more.

Alarms: The thing I forgot. You can set high and low alarms. So, if you are 50 on the sensor and the alarm is set for 70 it will alarm every time it makes a reading (5 minutes) until back at or above 70 (same for highs). I was sleeping and it had me low - it woke me up and I corrected (a good thing), but then it took probably 35 minutes (7 alarms) to get me back above 70 (bad thing!).

[spike]

Comfort: Truly, once the sensor is in, you only notice the weight of the transmitter (which is attached to the part that goes into the body by a small wire). You can tape the transmitter, but I find it easier to tuck in my waistband/belt to avoid the tape (which is incredibly sticky and allergenic I am sure!). I am thin, so the area of skin is an issue, because the sensor and transmitter do take up a decent amount of space. Putting the sensor in is a little more "invasive" than the quick sets I use - you have to hold it at a angle that basically is sending it perpendicular to your skin and directly in.

Accuracy: I agree that the more variable your readings are the less accurate the sensors would be for you. I have some variability myself. I guess the first point is that the trending that it does catch can help to avoid the variability by adjusting your insulin. Also, it does read the right direction of the extremes (in my experience). For example, when I was in the 40s on the sensor I was in the 70s on my meter (so at least "headed" low it appeared). When I was high on the sensors my meter was consistent (although a bit too far from each other). Although no real science to back my point, I do feel that meters have more variability from lab values than advertised (most likely especially in the extremes as well). Often I get a high (275) on my meter and recheck and get a number up/down by 25 or more.

Alarms: The thing I forgot. You can set high and low alarms. So, if you are 50 on the sensor and the alarm is set for 70 it will alarm every time it makes a reading (5 minutes) until back at or above 70 (same for highs). I was sleeping and it had me low - it woke me up and I corrected (a good thing), but then it took probably 35 minutes (7 alarms) to get me back above 70 (bad thing!).


Thanks for the detailed info! I agree on the meter variability--last night was the final straw for false high readings on my Compact Pluses. I'm back (actually, I'm lying--I took a Plus with me on a bike ride today) to the UltraSmart/Ultra II meters. I'm sick of doing a correction bolus when none is needed because the Compact is either 30-40 points too high, or comes up with too many readings that are more than 100 points too high (I've had about 6-8 of those recently). aaargh!!