Before I start pumping...

[ultrafine]

I went for a pump seminar last week, and have decided to buy myself a pump. The speaker of the seminar was a rep. from Medtronic and introduced me to their Minimed Paradigm 522 and the REAL-time system. I was wondering if anyone could give me ANY info/advice, pros/cons on the REAL-time system. The pump itself will cost me $6800.00, and the REAL-time system will cost another $700.00. That is a lot of money and I would like to know more about it before I decide to purchase one. I'm reading about it in the brouchure they gave me but I would like to know first hand from someone who has or is wearing one. Thanks!

[Jan B]

Ultrafine,

I love my pump (purple 522). I may get the CGMS, but not for now . . . I've set several basal rates and am doing great. I hate that you would have to pay that price. My insurance company negotiated paying $2500 less that the stated price. But, money is a tool, and if you must spend it to get what you need . . . that's just how it goes. I just think maybe you could negotiate a better price. I'm using my second model of Medtronic's pump.

The Animas is another popular pump. And the Cozmo . . . and . . .

[lilysmom]

Love my animas 2020, but my insurance piad 100%, which when all was said and done was approx $8000, wow, huh? BUT, for me it was and is the best thing I have EVER done in relation to my diabetes. Best of luck, and keep us posted.

[Subby]

Can't comment on the real time system, but reecently on a 722 - and I am finding it very good, better than I expected pumping to be. Perhaps if you feel confident in the minimed pump, getting it and leaving the CGMS option open for later, as Jan has done (and I, in probably vain hope for now), may be a great move.

I think pumping is one particular thing you need to "jump in the deep end". It really is something you need experience with, and you just can't understand the reality of it or predict your issues until you are doing it for a while. It sounds like you have pressure to make this decision now: maybe they are offering a special. But I think it is the best move just to get your head wrapped around the pump first and get your footing. Unless you have the money to burn and it doesn't matter if you don't like or use the CGMS.

Hopefully someone with the CGMS will be along: I am interested to hear, too!

[fgummett]

I use a 712 Minimed Pump and am well pleased with the control and flexibility it gives me in my daily life. Compared to MDI I liken it to driving a truck down a rocky mountain road: with MDI you get to make only two three or four adjustments to the steering and acceleration/braking as the truck trundles down that mountain... the rest of the time it is hands off! With the pump it is more like your hands are on the wheel and feet on the pedals for the whole daily trip :top:

As for the Real Time or CGMS system it is expensive (even the disposable sensors are $50 each here) but my expectation would be that you would not use it all day, every day... maybe at first or during times of sickness or stress... but instead it would be used for three or four days maybe once a month just to keep an eye on how things are going. What I find most exciting about CGMS is its ability to not just how your current Blood Glucose but also whether it's on the way up or the way down!

If money was no object I would definitely have the latest pump and CGMS, but as already suggested you could get the CGMS system later... it is not a substitute for testing anyway.

[NoelD]

Love mine, don't want to be without it. It's very nice having CGMS. The combo has changed my life for the better. The CGMS was as big of a benefit as the pump to me.

[valc3]

MM 522-Love it. I've been pumping a little over a year and I wouldn't go back to MDI. I have different basals, I can set temporary basals. No more feeding insulin or correcting highs. It took awhile to figure out the basals, but once I got it, it's been smooth sailing. It has improved my quality of life. I don't have the CGMS.

Good luck to you.

[morrisma]

Been pumping with one minimed model or other for 6 years and fighting with insurance to get the cgms option covered. Love the control and flexibility.

Now the bad news: Those prices you quoted are just the tip of the iceberg. You will use an infusion set every 2-4 days and cgms supplies on top of that. The $7500 is a big number but over a few years, more gets spent on the disposables.

If you do not have insurance or it does not cover this stuff, talk to your endo to see if there's a way you can get a better price.
Mike

[pegasus]

I have a 522 without CGMS. I'm still adjusting to it, but I believe it will be helpful over the long run. My previous protocol was Lantus at night and novolog or humalog before eating. The thing that appeals to me is that I could never control the Lantus/basal activity, so if I wanted to, say, go swimming, I had to calculate the timing of meals, the schedule the pool has, the amount of carbs I needed before or after etc. etc. etc. With the pump I simply turn it off, because the swimming takes care of the carb metabolism.

Also, I find the 522 a very smart machine, with the range of life variations it offers adaptation to, the built-in warnings. Have you looked at Minimed's online pump school? If you check the website, you'll find it. It walks you through a lot.

My doc says that currently CGMS isn't reliable, so while I find it very appealing, I decided to wait. It's also a lot to adapt to the pump itself on startup, much less a whole 'nother new tech.

The cost is obscene, but that's what our health care system demands!

Good luck!

[fgummett]

<soapbox> Agreed it is an obscene amount of money but compared to the long term complications it must be seen as an ounce of prevention saving a pound of cure. Renal dialysis is at least $50,000 per person per year, a heart attack is around $100,000... it's about time our collective governments woke up to this fact and started giving us more tax breaks or funding this type of device.</soapbox>

[ultrafine]

Dear DF friends,

Thank you everybody for the very useful advice and info!
I'm not in a hurry to purchase the CGMS so I think it is best to get it later on. Unfortunately $6800.00 is the price I have to pay for the pump, if it is something that will improve my life, I guess I should not complain about the cost. :T
I am super excited about getting a pump! I don't know why I have not thought about getting one sooner. With everybody’s positive advice and info I feel a lot more comfortable about getting a pump. I will inform you all on my progress once I start pumping. I’m hoping to be on it by the end of this month. I’ve got a lot of learning to do and I hope you all can help and assist me later on too. I will have tons of questions to ask! :D Thanks again!

Chrissy.

[Subby]

ultrafine, sounds like you've got a handle on it. I wanted to mention the one thing important thing I wish the minimed did: more increments for Insulin to carb ratios. I'll briefly explain as this is something you or your educator may not realise til later.

Basically, if you require larger amounts of insulin, it can become a problem, or an issue. Insulin to carb ratios are the number of grams of carbs a unit of insulin will cover. For many people this seems to be 10 - 18 kind of numbers. Huge variation though. You put this number in the settings and it is one of the factors the pump uses to deduce a dosage for food.

For me it is currently 5. From experience it is probably something more like 4.5. BUT I can only go down by whole increments. At these low numbers the change between 5 and 4 is huge. Say I eat 60 grams during a meal:
- on I:C of 5 it works the dose to be 12u
- on I:C of 4 it works the dose to be 15u
Big jump eh!
At the moment I need to keep modifying my dosages on the fly which for me at least, is a royal pain.

I believe there are other pumps that have better increments. To tell if this might be a problem for you BEFORE you decide on a pump, consider your total daily insulin and carb intake. I use between 90 and 110 units a day (50/50 basal/bolus), and carbs between 150 - 250 g per day. If you use less substantially less insulin for your carb intake, I:C ratio will be higher and you won't have the increment problem.

Phew, that was a mouthful. Hope it makes sense. And mind you, I will put up with this problem to have a CGMS enabled pump.

[Gary_W]

ultrafine, sounds like you've got a handle on it. I wanted to mention the one thing important thing I wish the minimed did: more increments for Insulin to carb ratios. I'll briefly explain as this is something you or your educator may not realise til later.

Basically, if you require larger amounts of insulin, it can become a problem, or an issue. Insulin to carb ratios are the number of grams of carbs a unit of insulin will cover. For many people this seems to be 10 - 18 kind of numbers. Huge variation though. You put this number in the settings and it is one of the factors the pump uses to deduce a dosage for food.

For me it is currently 5. From experience it is probably something more like 4.5. BUT I can only go down by whole increments. At these low numbers the change between 5 and 4 is huge. Say I eat 60 grams during a meal:
- on I:C of 5 it works the dose to be 12u
- on I:C of 4 it works the dose to be 15u
Big jump eh!
At the moment I need to keep modifying my dosages on the fly which for me at least, is a royal pain.

I believe there are other pumps that have better increments. To tell if this might be a problem for you BEFORE you decide on a pump, consider your total daily insulin and carb intake. I use between 90 and 110 units a day (50/50 basal/bolus), and carbs between 150 - 250 g per day. If you use less substantially less insulin for your carb intake, I:C ratio will be higher and you won't have the increment problem.

Phew, that was a mouthful. Hope it makes sense. And mind you, I will put up with this problem to have a CGMS enabled pump.

Very interesting and something I had not considered was the huge jumps due to 1:5 ratios... Thanks for pointing it out.

I've monkeyed with my Lantus again and now the worst ratio I have is around 1:8 again in the mornings, though I had been down to 1:5 for that meal. So this could be a significant factor in a pump decision from a future proofing point of view; my evening ratio now seems to be up to around 1:11, but I know how much my ratios have varied over the last couple of months and, over the lifetime of a pump, you need to be aware of this limitation even if it doesn't affect you in the here and now.

Gary

[Funnygrl]

522 here. I have the CGMS, but I do not use it. Love pumping, hated CGMS'ing.

[solox316]

The best advancement I have moved to is the pump. Couldn't ever live without it.

Second, is the CGMS. I hated it at first, and now I cannot go without it. As for accuracy, this morning my fingerstick was 102, my CGM said 104. The arrows that show up/down, trends, etc. are priceless in my opinion.

Keep in mind, I am speaking from being 100% covered on both. I would have trouble deciding to pay out of pocket.

*quick correction, the sensors are not $50 a piece, more like $30 or $35.

[ultrafine]

Thanks again my DF friends for replying to my thread! :)

Today, I purchased a Minimed and a CGMS! I'm so excited! Its being sent, hopefully it will arrive in the mail on Tuesday, after the long weekend. What's going to happen is a nurse will be visiting me and monitoring me for a month in order to help me manage using my pump. After a month or so later she will be teaching me how to use the CGMS. I guess they don't want to over flow me with all this new stuff. :T
I am so ready for this and can't wait to start!

I have a question, i'm sure that my nurse will tell me all this but I will just ask:

When you enter the amount of carbs into your pump, do you have to enter in the carbs in fruits and vegetables? How about condiments, dairy...all that stuff?

I did buy myself a helpful book called "The complete book of food counts seventh edition" by Corinne T. Netzer. Wow, that is a lot of carbs in foods that I have to know!:eek:

[Rebecca]

I count EVERY carb, enter the amount of carbs that I ate (bolus AFTER I eat), and my pump will suggest amt of insulin to bolus. It will also decrease the amount if I am lower than what I have my average set at (different time of day, different average.. right now @11.54p it is 135, but at 11.45a it is 115, and so on).
I would also suggest buying the book called Pumping Insulin 4th edition by John Walsh PA-C, and Ruth Roberts MA. It is known as the pumpers bible. It will give you a assortment of suggestions, and know how on the pump, no matter what pump you are using. (I personally have 2nd and 3rd edition). John is also a pumper and Ruth is his wife, so they both deal with diabetes on a daily basis. He is a PA for a very busy endocrinology clinic outside of San Diego California, and she is a therapist dealing with diabetes and also teaches.

[Metermaid]

Just remember to factor in the monthly 'pump supply' costs...it will add up! Just like 'test strips'...
You will need at least 10 infusion sets, and insulin reservoirs per month....better to ask prices.
You know they will let you 'trial' the pump first and if you are not happy, you can give it back.
Anyway..."Buyer beware".
Good luck

[ultrafine]

So last week my Minimed 522 (clear) came in the mail! Super excited! :D
I did the pump school on-line, read the books and watched the CD Rom. I'm very ready to go! BUT unfortunately, I have to wait another half a month to see the nurse who will be training me. GRRR!

I have a Question:

I put a battery into the pump to turn it on to pratice the functions on it before my training. On one of the sheets Medtronic sent me it said not to remove the battery. Ooopsies, I kind of did that. Is that going to hurt my pump?

[Funnygrl]

Nah, you can remove the battery when not using it and be fine. You'll just have to set the time again when you put the battery in again.

Yes, carbs and condiments and veggies can have a significant amount of carbohydrate. They should be counted.

[notme]

You just want to put a brand new battery in again once your remove the old one.

Congrats!

[JadeMonkey]

Taking out the battery may also clear the "demo" mode that the pump comes in which allows you to simulate giving boluses and such. When you start it up again it might be back to normal operation. Not sure how you can set it back to demo mode again if that happens.

-Jade

[ultrafine]

You just want to put a brand new battery in again once your remove the old one.

Congrats!

Thanks! :D
It was a brand new battery. I was reading a thread about a faint lock mark on the cap/lid part of the battery. I was trying to look for it and I guess I kept twisitng it see if i could find that mark and by the time I noticed the battery came out. Haha, silly me.:T

Taking out the battery may also clear the "demo" mode that the pump comes in which allows you to simulate giving boluses and such. When you start it up again it might be back to normal operation. Not sure how you can set it back to demo mode again if that happens.

-Jade

Thanks Jade!
I'm scared to put the pump back on, so I will wait till the 14th when I see my nurse to begin pumping! :cool:

[JadeMonkey]

Thanks Jade!
I'm scared to put the pump back on, so I will wait till the 14th when I see my nurse to begin pumping! :cool:

No problem. Don't be scared to turn the pump back on, you won't damage it or cause any problems. You may have to clear out some info on it if you play around with it some more but no big deal. Better to have you familiar with it to get started as best you can than worry about it. You could always call Medtronic and ask them how to turn the demo mode back on if, in fact, it was turned off (which it might not have been and then this was all for nothing.). ;)

-Jade

[ultrafine]

Hello friends!
It's been 2 days since I started pumping. Things are looking GREAT! I LOVE the pump! I am always on target/goal and I have never felt this good! :D
The only thing that troubled me at first is when I poked the quickset in, it was stinging bad for a few hours but went away.
My I:C is 1:10, and my basal rate is at 0.90u/24Hrs. What is everyone elses I:C and basal rate like?

I have a question!

Say I inserted a quickset the day before and today I realized that the insulin in the reservoir was running low. I want to still use the quickset from yesterday and just want to add more insulin to the same reservoir. Do I need to do a fixed prime with yesterdays quickset still in?

[Alice]

Personally, I'd make that MiniMed rep earn his/her commission...see if they will negotiate a lower rate. They do it on most of their insurance pumps...why pay a higher rate? Make sure you let him/her know you are looking at other companies. Like anything else diabetic, they profit is all in the supplies down the line.

[ultrafine]

Hi friends!

I forgot to ask another question...

When I draw the insulin, I get rid of all the air bubbles and then prime. After a while (hours later) I notice air bubbles in the tubing and I don't know how it got there. Does anyone know why?

[xMenace]

Hi friends!

I forgot to ask another question...

When I draw the insulin, I get rid of all the air bubbles and then prime. After a while (hours later) I notice air bubbles in the tubing and I don't know how it got there. Does anyone know why?

I try to let mine sit a few minutes before priming. I also spend lots of time flicking the bubbles out, even when there don't seem to be.

[FatCatAnna]

Personally, I'd make that MiniMed rep earn his/her commission...see if they will negotiate a lower rate. They do it on most of their insurance pumps...why pay a higher rate? Make sure you let him/her know you are looking at other companies. Like anything else diabetic, they profit is all in the supplies down the line.

I did try that with both of the pump manufacturers that I was interested in purchasing from. They wouldn't budge. Perhaps it's because of us living here in Canada - not sure - since private insurance is something that we don't all have here due to the way our medical system is set up here up north of the border (correct me if I'm wrong anyone).

I did question why with our Canadian dollar being almost at par with US (for how long who knows) - why the prices for supplies differ so much between the 2 countires sharing North America. For example - with my Animas 2020 infusion set (Comfort - Sil with MM) - in the US a box of 10 costs $135 USD - here in Canada it's $185 CDN.

Anyway, glad to see you are happy with your pump Ultrafine! I'm a newbie too - and self taught to boot - but you've got a great group here to reach out to when you need a helping hand! I did try the same pump out as you for 3 months - didn't like the CGMS - then I gave the Animas 2020 a go - and ended up buying it instead. They are both great to use - I just found the Animas 2020 screen / menu better for my aging eyes:cool: .

[ultrafine]

Hi Anna!
I bought the CGMS but I still have not tried using it. My nurse wants me to get 100% comfortable with the pump before I start giving it a go! Aww, thanks for being happy for me! You are so sweet :T I'm not to sure about how to use the CGMS but all I know is that the sensors do cost alot! :eek:

For my Minimed Paradigm, the cost for the Quick-set=$196.50and for the Reservoir=$41.50 (This is without any coverage).:eek: :eek: :eek: :eek: :eek: :eek: :eek:



I did try that with both of the pump manufacturers that I was interested in purchasing from. They wouldn't budge. Perhaps it's because of us living here in Canada - not sure - since private insurance is something that we don't all have here due to the way our medical system is set up here up north of the border (correct me if I'm wrong anyone).

I did question why with our Canadian dollar being almost at par with US (for how long who knows) - why the prices for supplies differ so much between the 2 countires sharing North America. For example - with my Animas 2020 infusion set (Comfort - Sil with MM) - in the US a box of 10 costs $135 USD - here in Canada it's $185 CDN.

Anyway, glad to see you are happy with your pump Ultrafine! I'm a newbie too - and self taught to boot - but you've got a great group here to reach out to when you need a helping hand! I did try the same pump out as you for 3 months - didn't like the CGMS - then I gave the Animas 2020 a go - and ended up buying it instead. They are both great to use - I just found the Animas 2020 screen / menu better for my aging eyes:cool: .

[NoelD]

Hi friends!

I forgot to ask another question...

When I draw the insulin, I get rid of all the air bubbles and then prime. After a while (hours later) I notice air bubbles in the tubing and I don't know how it got there. Does anyone know why?

Try letting the bottle of insulin get to room temperature. About 15-20 minutes works well most of the time. That will prevent the bubbles that look like champagne in the reservoir. I hate those.

[ultrafine]

Try letting the bottle of insulin get to room temperature. About 15-20 minutes works well most of the time. That will prevent the bubbles that look like champagne in the reservoir. I hate those.

Hi Noel,
Thanks for the great advice! :)
I don't see any more air/champagne bubbles anymore. :D Only some (champagne bubbles) in the reservoire after a couple of days.

[judi t]

I really appreciate the analogy you've used to describe being on a pump as opposed to MDI. I'm about to go on a pump, I hope. Given how out of control my BG levels have been all day today - I've had 3 extra shots already and it's only 6 in the evening - the way you describe the pump makes me even more determined to give it a go.

[steamfan261]

MM 722 w/CGMS. Love both. The CGMS, like many other things, is what you make of it. If you understand how it works, are careful to calibrate in the way you're taught, it tends to be exceptionally useful. Would not want to do without it.