mySentry Trial: CareLink Pro

Last posts in this series: mySentry Trial: Starting UpmySentry Trial: Wearing the Sensor, & mySentry Trial: The mySentry Unit

I’m still wearing my old Cozmo pump. It’s long past its warranty period. There are so many cracks in it that I keep it as far away from water as possible. The battery cap is a different color than the cartridge cap, and the cartridge cap is a different color than the pump. It looks more like Frankenstein each time I harvest a part off an old pump to repair this one. But it’s still going, and doing a fine job. But I recognize that the day is approaching where I have to decide what pump I’d like next.

What I’m about to say is going to surprise many of my friends and former co-workers from Smiths Medical. Y’all might want to sit down…

I’m seriously considering a Medtronic pump for my next purchase.

(thump, thump, thump thump, thump) 

That was the sound of at least five of my former Cozmo buddies fainting…

Their CareLink Pro software is amazing.

Medtronic has clearly invested a lot of resources into this software, and even more resources into educating doctors and HCP’s on how to interpret the reports and make therapy adjustments. I’d even wager on them working harder on the software than on the actual medication delivery aspect of the pump itself (which hasn’t changed much over the years).

Scott E. wrote that “The Hook” brings you back, and I have to agree. I really miss it.

Just before my first endo appointment after starting the trial I uploaded my information into the software. At the appointment my doctor spent about five minutes looking through the data and was able to make some very significant therapy adjustments. Basal rates, insulin to carb ratios, correction factors, all of it. I was floored by how quickly he could make sense from what he was seeing.

And it all helped.

But you know what really draws me back? I didn’t do any extra work to provide him with all of that information. I wore their pump, I tolerated their sensor, I used their glucose meter. I didn’t write anything down, I didn’t keep a logbook. I didn’t even think about preparing a report for my next appointment.

I just used their system.

What am I waiting for?

Their next generation sensor.

I had a lot of trouble wearing the current Medtronic CGM sensor. As you can imagine, that sensor is capable of sending a lot of information into CareLink. Without sensor data I’m not sure I’d feel so strongly about the benefits CareLink offers. If I can tolerate their next generation sensor, rumored to be coming soon, then I’ll switch without hesitation.

I hope my Cozmo can last that long.

Disclosure

I received all of the pump supplies, components, and training from Medtronic, free of charge.  I was not asked to write or say anything about my experience, I was not given any limits around anything I did write or say.  I did not receive any compensation other than the opportunity to try their products.

mySentry Trial: The mySentry Unit

Last posts in this series: mySentry Trial: Starting Up & mySentry Trial: Wearing the Sensor

mySentry

The mySentry device is a remote display station for the Metdronic Paradigm pumps.  Retail price is $3000, and I’m not sure whether people have had success getting their insurance to cover it or not.

I think it’s fair to say that the intended market for this is parents or caregivers who want to be better able to monitor blood sugars of a loved one.

This concept starts out as a really big deal for parents who’s child with diabetes sleeps in another room.  But it also proved to be a surprising convenience even for me, who sleeps only a torso away from my pump.

Initial Communication

6 feet

I had a lot of trouble getting reliable communication between the pump and mySentry.  I placed mySentry on a nightstand table next to my head.  Not even an arm length away, and maybe three feet away from my waistline where the pump was.

The first night I was plagued by communication problems.  mySentry couldn’t find the pump, and would display a message and sound an alert.

With all of the problems I had getting the pump and sensor to communicate it reinforced my perception that the overall communication of everything was under-powered.

Unable to find pump

The documentation says that if the pump is within six feet of mySentry the communication should work.  That was not my experience.

There is a component of the system called the “Outpost” which acts like an amplifier or repeater.  It plugs into an electrical outlet, collects the information from a pump that is within six feet, and zaps that info to the mySentry display.  According to the documentation, the mySentry and the Outpost can be up to fifty feet away or greater.

I plugged the Outpost in at the base of my nightstand table, but that didn’t resolve the communication issues.  I tried a few different locations, and eventually jerry-rigged an extension cord to give the Outpost a birds-eye view of me and my pump while I slept.

I spent a ridiculous amount of time on this little graphic.  Kim would be so proud of me.

 

Jerry-Rig

 

It seemed like flying from Minnesota to Iowa with a layover in New Mexico, but it solved the communication problems.  Unless I rolled over and was laying on the pump.

Now We’re Talking

Once I got most of the communication issues figured, I started to enjoy the convenience of having so much information available in the blink of an eye.  I could see my interstitial sugar, my pump battery level, insulin in the pump, when my next sensor calibration was, and how long I had left on the current sensor.

Information

 

It was a real surprise to me how much I valued seeing all of this in one glance, with visual representations and colors (I didn’t have to work to interpret numbers, etc.), and without having to pull my pump out and navigate through menu screens.

I liked this.

A lot.

Graph

 

Alarms, Alerts, Light

The alarms and alerts are plenty loud, even on the lowest volume setting.  When an alert or alarm went off, I still had to pull my pump out to acknowledge it.  I didn’t like that much, but can understand the safety concerns.  There have been days where I’ve pressed the snooze button on my alarm clock without knowing it.  Sleep is a powerful force.

The screen brightness can also be adjusted, but even on the lowest setting it felt pretty bright.  I’m a pretty easy sleeper, so it didn’t bother me much.  But if you are the sort that needs darkness to sleep, this might be an issue for you.

Overall?

It was a great convenience, as I mentioned above, to see all of that valuable information so quickly and easily.  In terms of blood sugar safety, it only works if I can tolerate wearing their sensor, which I couldn’t.  There is a lot of talk about their new sensor (Medtronic Enlite) being better and easier to wear, but it’s not available in the U.S. yet.  No current news about when we might see it here.  What’s that saying about the strength of a chain and its weakest link?

This experience did open my eyes to the value of having information available in multiple locations.   Thinking about my e-mail, contacts, and calendar, that information is available on whatever device I use.  It has me spoiled.   I want that same access in my diabetes devices.  I want them to talk and share information.

Would I Buy?

No.

But I’m not the target market for this device.  If my child had diabetes and wore a paradigm system with CGM, I would try really hard to make it happen.

Questions?

If you have any questions about my experience with mySentry, please don’t be shy.  Leave a comment, or contact me privately, and I’ll do my best to answer.

Next post in this series: mySentry Trial: CareLink Pro

Disclosure

I received all of the pump supplies, components, and training from Medtronic, free of charge.  I was not asked to write or say anything about my experience, I was not given any limits around anything I did write or say.  I did not receive any compensation other than the opportunity to try their products.

mySentry Trial: Wearing the Sensor

Last post in this series: mySentry Trial: Starting Up

I wore the pump for about a week before starting on a sensor.  That time was used to become familiar with the basics of delivering insulin with a pump that was brand new to me.  My sensor training went great, and without any trouble I was up and running.

I own a Dexcom SEVEN+ system (a different brand of CGM) and decided that I wanted to wear both devices to get a feel for how they compare.  I didn’t do any scientific comparisons, I didn’t keep any detailed records, nothing fancy.  Just anecdotal observations.

Medtronic and Dexcom CGM Transmitter

The transmitter from each system

The first low I had while wearing both systems just about rocked my socks off.  Lows are often unsettling, especially when right in the middle of something, and on top of that I had both devices buzzing and beeping at me.  It was completely overwhelming, and I questioned whether I’d continue to wear them both.

But I did continue, and I discovered something very interesting.  When one system was off (not matching up to actual blood sugar numbers), they were both off.  So maybe perceived inaccuracies between brands of CGM technology actually come right back to something weird happening in the wearer’s interstitial fluid rather than either of the devices being wrong.  That was a real eye-opener for me.

MedT Sensor Introducer needle and device

Huge needle

Inserting the Medtronic CGM sensor was surprisingly painless for me.   During the course of twenty-plus sensors, there wasn’t a single one that hurt.  This surprised me because the needle (and the sensor, for that matter) are pretty big.

Actually, the needle is huge.

In this picture, you see the sensor and needle loaded into the Sen-serter, a spring-loaded sensor insertion device.  For the record, I am a fan of spring-loaded insertion devices.  I like that they help me with a quick insertion, something I’ve always had trouble with doing manually.

Again, I want to say that, even though the needle is the largest I’ve seen/used, not a single insertion hurt.  Not even a little bit.  I had one that bled like crazy, but even that was pain-free.

The process after insertion was slightly confusing though.  There is a 5-minute “wetting” period after insertion.  What that means is that you have to wait for at least 5-minutes before plugging in the transmitter.   Once plugged in, the clamshell is supposed to show a green light (that part is kind of cool. It seems the light is buried way inside, but still shows through the clamshell skin).

There was a couple of times where I didn’t get the green light, and I wasn’t sure why.  I would disconnect the transmitter and try again, and then it seemed to work fine.

Calibration is also a bit harder (the system is less forgiving of blood sugar on the move).  Jeff talks a lot about calibrating in his CGM post (a wealth of tips and knowledge), and something that Wil talks often about too.  The post I’ve linked to for Wil is quite old, and many things have changed since, but still offers a lot of wisdom around calibration.

CGM Integration

The CGM integration into the Medtronic pump felt very sophisticated compared to what I was used to with the Dexcom system.  I could dig deeper into the historical data, I could see the amount of time left on the sensor, and I could see when the next calibration was due.

Queued data rocks.  If the clamshell transmitter loses connection to the pump, it can store up to 40-minutes of CGM information.  Once the communication is re-established, it back-fills all of that information into the pump.  This was great for when I was taking a shower, or just after basketball when my pump is in my locker and I’m cleaning up.  I had very few gaps in my CGM graphs.

Another thing I really enjoyed was the ability to silence alerts for a set period of time.  I used this when I knew my CGM wasn’t tracking very well and didn’t want to be pestered by any of the alerts.  I could tell it to be quiet for whatever period of time I wanted, and it left me completely alone.

Wearing the System

Physically wearing the system proved to be more troublesome.  Especially during basketball.  I made a little video to explain.

I’ve never used more extra tape and crazy solutions to keep a CGM sensor in place.  Ooh, wait.  That’s a lie. I once used toupee glue to keep my Navigator sensors on.  That probably deserves its own post…

These sensors are approved for three days, which feels really, really short.  That being said, there are times where my Dexcom sensor itches so bad by day 5 or 6 that I’m ready for it to be gone.

And yes, I know that people restart their sensors.  Officially I did no such thing.  Unofficially?  I couldn’t keep the damn things on long enough to do it.  One or two basketball sessions and they were toast (clamshell flop).

Another thing I had trouble with is the holes they left in me.  I don’t know if it’s due to the size of the sensor, or the clamshell flopping, or something else, but these things seemed to leave much bigger (and more irritated) holes in my stomach.  In fact, the holes took longer to heal than the three days each sensor is approved for use.   I know my stomach is no masterpiece, but it looked like it had been shot with a shotgun by the time I had used a couple months worth of sensors.

Last Two Small Irritations

I once got a CGM alert on the last screen of programming a meal bolus.  After confirming the CGM alert, I had to start the whole bolus programming sequence over again.  I know it’s not a big deal, but it bothered me enough to make a note of it.

In that same vein, when I got a CGM alert at night I would turn on the back-light to see what it was.  After acknowledging the alert, the back-light turns off.  I’d have to turn the backlight back on to program my correction bolus, or set a temporary rate, or whatever action needed doing.  Again, a very small thing in the big picture, but it bothered me.

Last Two Large Concerns

The CGM alarms on the pump are way too quiet.  Dangerously quiet.  Can’t hear them at night quiet.  This was one big concern that I heard from many readers.   I didn’t hook up the MySentry device for a few days after starting the CGM, and many (most?) of the pump alarms without MySentry watching over them went unnoticed.

The last concern I have is all about the weak signal.

Weak signal, weak signal, weak signal, weak signal.  All the time, weak signal.

With the transmitter on one side of my body, and the pump on the other side, weak signal.  Talk about feeling fat.  Holy crap.  Feeling fat AND having a device beep at you all day to remind you of how fat you are. I’m not a fan.

I have never had to adjust my life to a diabetes device more than when I was wearing this system.

In my years of pumping I have found a “sweet spot” on my belt for my insulin pump.  It’s become a part of my movements to keep that sweet spot out of harms way.  When I get in the car and put my seatbelt on, the sweet spot is safe.  When I am navigating tight spaces, I’m subconsciously aware of that sweet spot and keep it out of the way.

I had to change where I put my pump to accommodate the weak transmission of information between the transmitter and pump.  It caused major disruption for me.  Remember how I broke the belt clip in the last post?  I wasn’t wearing my pump in the sweet spot because the transmitter couldn’t talk to it.

I should not have to adjust my lifestyle to accommodate a diabetes device.

When I play basketball there is one place where I feel my pump is safe.  I wear it in a pouch on an elastic band that goes around my waist, and I position it specifically where I do because it is comfortable and safe. I got so many weak signal alarms during basketball that I had to use the “silence” feature I mentioned above.  Sometimes the pump would be less than 18-inches away from the transmitter and still couldn’t communicate.

It made me feel so fat.  Like I needed a satellite orbiting my stomach in order to relay information back and forth.

Final Thoughts & More to Come

I still have a lot more left to say on my trial.  This post is, by far, the most critical and complaint-filled section of my review as a whole.

It sounds like I hated the system.  Which I didn’t.  There were certain aspects of the system that gave me a lot of trouble, but overall, I still liked the system.  Stick with me, and I’ll cover those in detail in the next post or two.

Next post in this series: mySentry Trial: The mySentry Unit

Disclosure

I received all of the pump supplies, components, and training from Medtronic, free of charge.  I was not asked to write or say anything about my experience, I was not given any limits around anything I did write or say.  I did not receive any compensation other than the opportunity to try their products.

mySentry Trial: Starting Up

I recently had an opportunity to try the Medtronic mySentry product for a few months.

Because I wasn’t using one of their pumps, this trial meant I had the opportunity to experience the whole suite of their products.  A paradigm pump, their CGM transmitter and sensors, the One Touch UltraLink meter, the mySentry, and their CareLink reports.  I also had to be trained on all of that and spend some time getting used to how things are done.

The trainer I met with was fantastic (Medtronic, Courtney deserves a promotion and a raise).  I was up and running on the pump and a couple of weeks later we met again to add the CGM into the mix (more to come on that in later posts).

As I started this trial I had a clear bias against Medtronic stuff.  I think my time spent as an inside sales rep for Cozmo is responsible for that.  Having spent so many years on a Cozmo, it took me a few days to get used to how the Medtronic pump works. But after that initial break-in period I was pumping along as if nothing had changed.

Other than my unfortunate ceiling fan incident, I didn’t have any technical trouble with the pump during my trial.

Inconveniences

There were a few minor things I needed to adjust to.

Bolus Programming

The bolus process on a Medtronic pump takes longer to program than on my Cozmo.  There are more steps involved and some extra confirmation screens to jump through.   With the pump set to vibrate, it took forever to get through everything.  The pump would give a vibratory confirmation each time I jumped through a step in the process.  I prefer vibration for my pump alerts, but couldn’t stand how much it slowed everything down.  On the suggestion of the trainer, I changed to an audible signal which cut the programming time way down.

Double Correcting

I also got tired of “double correcting.” Cozmo has a feature that isn’t available on any other pump (yet?). You can set a series of thresholds for blood sugars that increase correction doses by a percentage the higher you get.  For example, if I’m over 250 mg/dl, my Cozmo is programmed to increase my correction dose by 5%.  If I’m over 300 mg/dl it will go up 10%.  And so on.  As my blood sugar gets higher I am less sensitive to the insulin, therefore I need more than just what the correction math says.

So on any other pump, it requires multiple correction doses.  I test, I’m high, I take the recommended correction bolus, then test again later, am less high, but still need another correction bolus.  I understand that as my sensitivity changes things get less and less exact as far as the math is concerned, but I quickly tired of the double corrections.

Maximum Bolus

The maximum amount of insulin this Medtronic pump would allow at any single time is 25 units.  That probably seems like a lot of insulin for many of you, but I’m a big guy and I need a lot of insulin.  I would often exceed that 25 unit maximum and have to deliver another manual bolus to get the total amount of insulin needed.

I know it doesn’t sound like a big deal, but think through the process.  I’d program all of my information, get a dose higher than 25 units, have to remember (or write down) how much over 25 units, deliver my 25 unit bolus, wait for that to complete, then go back in and manually program a bolus for the amount over 25 units.

Guess how many times I either forgot to do that, or just plain ignored it because it was such a pain in the ass?

A lot.

Guess what that did to my blood sugars?

No Backlight?

Speaking of blood sugars, the meter that talks with the pump doesn’t have a backlight.   What year is this?!  No backlight?  Really?

As of this writing, Medtronic has switched meters and this is probably not an issue.

The Clip

My only other gripe about the pumping side of things comes from the belt clip.  It lasted about three weeks.

 

Not a Bad Experience

 

I know the majority of this post sounds a little sassy and comes off as if I don’t like the Medtronic pump.  Which I do.  I do like it, minus the few inconveniences I mentioned above.

The next posts about this are going to dive into the sensor aspect of this system, along with the MySentry component, and then I’m going to talk about their secret weapon, the CareLink reports.

Overall my experience was definitely positive, and I’ll get into more of that in the coming posts.

Next post in this series: mySentry Trial: Wearing the Sensor

Disclosure

I received all of the pump supplies, components, and training from Medtronic, free of charge.  I was not asked to write or say anything about my experience, I was not given any limits around anything I did write or say.  I did not receive any compensation other than the opportunity to try their products.

Forgot My Meter

Cozmo pump with attached CoZmonitor

Cozmo pump with attached CoZmonitor

For the first time in about eight years I forgot to take my blood sugar meter with me today.  I have been wearing a Cozmo insulin pump for at least that long, and as such, I’ve had my meter connected to me, literally.

The Cozmo pump (discontinued in 2009) had a Freestyle glucose meter that actually clipped onto the back of the pump.  There was a slot for the test strip, and the results would be displayed right on the screen of the pump.

In a slightly over-sized belt pouch, I could carry days and days worth of insulin and everything I needed to test my blood sugar.

I haven’t had to carry one of those “meter pouches” for longer than I can remember.  Until now.

I was recently given an opportunity to try the Medtronic MySentry device for a few months.

The system only works with the Medtronic pump and sensors, so in order to try the system I have to also try the pump and sensor.  Which means I have to let go of my dear old Cozmo for a little while.

The biggest adjustment so far has been the need to remember to bring a glucose meter (and supplies) with me.

I can’t emphasize enough how big of a lifestyle change this is for me.  I knew it would be just a matter of time before I forgot it.  Sure enough, today at lunch.

So what did I do?  I did what any meterless PWD would do.  I bolused based on my CGM reading (though I’m not wearing the MedT CGM just yet – I get hooked up on Monday).

I know, I know!  We are never supposed to make such important treatment decisions based on CGM readings.

What would YOU have done?

2012 Medtronic Diabetes Advocates Forum

Group Photo from the 2012 Medtronic Diabetes Advocates Forum

Medtronic Diabetes hosted the second ‘Medtronic Diabetes Advocates Forum’ at their headquarters in Northridge, CA last week.  Myself and nearly thirty others involved in diabetes social media spent about a day and a half visiting with some of the brightest minds at Medtronic.

Picture of Lane, Cherise, George, and Scott

Lane with the DSMA Live Crew

I am always encouraged by the caliber of people that are involved in making life easier and safer for people with diabetes, and I’m not exaggerating when I say that Medtronic has some of the best.  Lane Desborough continues to be the shining beacon of brilliance to me.  No pressure Lane. :-)

We had an opportunity to meet most of Lane’s team, and there were more advanced degrees from many different disciplines than I can even understand.  I was so impressed with these guys and their resolve to design safe, easy to use, and most importantly, effective management tools.

A funny typo on the agenda had Lane WAY ahead of the game...

That was quick! The loop is closed! Hoorah! (NOTE: This is a TYPO!)

There is an area just outside of Lane’s office where they have daily stand-up meetings.  The walls are covered, floor to ceiling, with charts, principals, design goals, data, and more.  They were almost literally alive with information, but that isn’t what impressed me.  What impressed me was Lane and his team talking about certain projects, and that they knew which driving principals certain stages tied back into.  In other words, these are not just a bunch of words on a wall.  They are actually becoming reality through the work these guys are doing.

I heard the phrase “reducing on-body burden” many times, which helped me shift perspective a little bit to see exactly how burdensome all of these things can be just to wear.

Another thing that struck me was the foresight to build a “privacy” button on the MySentry device.  MySentry is a device that was born to show your CGM number to anyone who can see it.  That is great, and useful for almost all of us.

But what about those times where I’m in a funk with my diabetes?  What about those times where I need to put my head in the sand for a day in order to regain my sanity? On those days I do not want anyone else to see what my numbers are and bug me about them.  I know they’re a mess, and while it looks like I’m totally ignoring things, in reality I am taking a small step backward to gather myself again.  Hello privacy button!

Picture of Chuck's autograph in my copy of "The Book of Better"Better – Chuck Eichten!

Chuck Eichten was the guest speaker on Friday afternoon, and he was great.  Chuck has lived with type 1 diabetes for a very long time, and recently wrote a fantastic book about his outlook on life with the big D.  If you haven’t already check out “The Book of Better“, I highly recommend it.  You’ll enjoy it, and it will hopefully help bring your perspective to a place that’s a little bit better…

I had a chance to visit with Chuck a bit, and he’s a great guy.  I could chat with him for hours, and hope to have an opportunity to do so sometime.

Global Advocacy

Dr. Fran Kaufman shared an afternoon with us talking about the work she is doing around the globe.      It is eye-opening to see conditions around the world, diabetes or not.  To think that a diagnosis of type 1 diabetes is a death sentence in many areas is pretty heavy.

Dr. Kaufman and her family have made unbelievable sacrifices to try and make a dent in this problem, and for that she has my everlasting gratitude.

One of the key points that I’ll forever keep close is that we need to do more than just figure out how to get supplies and insulin to people.  Without education, all the supplies in the world are useless.

Thank you Dr. Kaufman.

Thoughts?

I always leave events like this inspired.  Sometimes that inspiration comes from the company or organization that brought us all together, but more often it comes from my friends and peers who are constantly looking for more ways to help people.

Here are a bunch of people who live well with diabetes, sometimes raise families, often hold full-time jobs, and somehow find the time and energy to dedicate their lives to helping others live better with diabetes.

The relationships that start, and build, at these events are more important than many people might realize.  Through these relationships we not only push each other by brainstorming and collaborating, but we also shine a light on personalities that don’t only exist behind a computer screen.

MySentry Trial?

In a surprise announcement, Medtronic offered to let all of us try a MySentry Remote Glucose Monitoring System for three months.  I haven’t decided yet how I’m going to respond to this, but wanted to disclose the offer and make sure everything is out in the open.  None of us knew about this offer prior to accepting the invitation to the meeting (words proudly borrowed from Kim).

I have mixed feelings about this.  On one hand I’m excited, and think I’d like to give it a try.  But on the other hand, I know there are always issues and questions around ethics and honesty when given an opportunity like this.

I’m currently wearing an old Cozmo pump, which is long past it’s warranty expiration date.  So this offer means I would not only be able to try the MySentry system, but that I would need to be set up with the whole family of Medtronic products.  I’m loyal to my Cozmo, almost to a fault.  I will continue to say that any pump on the market is a step backwards from Cozmo until there is a pump that offers better features.  But does that mean I shouldn’t try this?  I don’t know.

Are there ethical concerns that you have about this?  Would you be willing to share those concerns with me? I don’t want to make any missteps that would damage the trust I’ve worked hard to build over the years.  I’m worried that the temptation to try these new gadgets is clouding my judgement on this issue.

Medtronic hasn’t asked for any favors with this, and if their products stink I would say so.  However, I’m not a reporter.  Reviews and such are not my strength.  Would I be able to cover this well enough? It may also open up an opportunity to compare the Dexcom CGM with the Medtronic CGM component (if I can tolerate all of that ‘on-body burden’).

I don’t know what to do. Please help me.

Disclosure

Medtronic invited me to attend this event, paid for all travel expenses, lodging, and food for the duration of the event.  We have all been invited to try the MySentry CGM system for three months (details pending).  Medtronic did not ask me to comment or write about my experiences, nor have they asked to review or limit anything I might write.