[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

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.
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! 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]

Originally Posted by 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.

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.