The First 12 Hours - The Medtronic Minimed Paradigm REAL-time Continuous Glucose Monitor
It's finally here and I'm using it. The Continuous Glucose System that I blogged about six months ago arrived today. Yes, I tend to be an Early Adopter and I've gotten nailed in the past (the Glucowatch sucked) but this one may just be a winner.
It's called the MiniMed REAL-Time System. It is an add-on (D in the picture at right) that "sips" intersitial fluid and reports an estimate of my current blood sugar to a pump that is exactly the same form factor as my existing pump. In fact, it's the same housing. I swapped my existing Paradigm 512 Pump out for this one, the controls are identical.
(Check out my Diabetes Explanation: The Airplane Analogy if you're not familiar with how diabetes works IMHO)
Out of Box Experience
Note: You should talk to your Diabetes Doctor/Endocrinologist and take a training on how to use this device before jumping in or you could hurt yourself. I am NOT a doctor - this is just one guy's experience.
The package arrived at 10am this morning. The one containing the sensor tips said "perishable" and was packed with ice packs. I put it in the refrigerator immediately. Travelling with these will be a little tricky, as it's unclear how quickly they degrade. Presumably in about 72 hours.
I transfered my settings over from my existing pump manually. The pump, glucose meter (the finger stick device) and continuous meter/transmitter (the one taped to my belly) all have unique ids. You have to tell the pump the unique id of the transmitter, as well as the unique id of the finger stick meter.
After attaching the new transmitter (with a big ass needle/canula) I told the pump there was a new transmitter/sensor. It starts calibrating and says to wait for 2 hours and then it'll want a finger stick. This two hour warm up happens every time you put on a new sensor - about every 72 hours. At noon, it beeped, then I did a finger stick test. You want to put on a new sensor when your blood sugar is stable. I woke up at 110mg/dl and it stayed that way for the morning. I pushed lunch out a bit to make sure it stayed that way. After the first calibration I started getting updates every 5 minutes.
Aside: You truly can't conceive of what it's like to have this 6th sense, this 6th dimension where you need a number to really know how you're doing. It's like getting a GPS when you're lost. Like fixing a speedometer in a broken car.
My sense of how my blood sugar ebbs and flows was heightened and I literally had one of the best blood sugar days of my life (since I was diagnosed at 21). It enabled me to make better food decisions and even sneak in a short walk after lunch that had substantive benefits.
I'm loving this device. I'm sure there will be troubles and it'll be harder to get through airport security, but I suspect that this is going to change the way I manage my diabetes. There's a value called the hA1C, expressed as a percentage, that measures blood sugar control over the last 3 month period. Non-diabetics have a value between 4% and 6% indicating that their blood sugar was roughtly 100mg/dl over that period. Mine is currently between 6.3% and 6.5%, which is high normal. I believe this device, plus my use of Symlin, will get that number to the normal range, thereby limiting my chances of compliations like blindness.
I still will check my blood sugar via a finger stick between 4 and 10 times a day. The meter will wirelessly tell the pump that I checked. The fingerstick is considered more authoritative than the continuous meter. In fact, the continuous meter is calibrated by the fingerstick.
The continous transmitter's sensor last 72 hours then the tip needs to be replaced. The larger transmitter lasts at least six months, then it needs to be replaced. It has a sealed internal battery. Additionally, it's interesting to note that the transmitter has a version number. Mine is 1.6, which tells me that they can improve the transmitter at least every 6 months and I won't need to do anything to see improvements in accuracy. The pump holds all the data and history information and includes both a 3-hour and 24-hour graph view.
You shouldn't make insulin dosing decisions based on the continuous meter - it's just a trendline that gives you an idea of what happens the other 23.5 hours that you're not sticking your figer.
Scott's Diabetes FAQ
Everything You Always Wanted to Ask a Diabetic But Were Afraid to Ask
Q: When did you become diabetic? How did it happen?
A: I had the flu (or flu-like symptoms) in November of 1994. When it was over, I was peeing all day long, had lost 35 pounds (I was skin and bones) and my dad, a firefighter/paramedic said, you need to get to a doctor, ASAP. My blood sugar was clearly high and suddenly I was a Type 1 diabetic.
Q: So that's Juvenile Diabetes, right?
A: It's not called Juvenile Diabetes anymore, as it can happen to folks in their 30's and beyond. There are (basically) two types of Diabetics:
- Type I – used to be called Juvenile Diabetes or Youth-Onset or Insulin Dependant (IDDM). These folks nearly ALWAYS use Insulin. Typically these folks don’t produce any (or much) of their own insulin. If I don’t make it, I need to get it somewhere.
- Type II – also called Adult-Onset or Non-Insulin Dependant (NIDDM). They are so different, it’s a shame they are both called Diabetes. These folks typically have decreased responsiveness to their own insulin. If they aren’t using their own insulin well, they need to be made more sensitive to it.
"Worldwide, there are about 171 million diabetics, but only about 10 percent of those have Type 1 diabetes. The vast majority have Type 2 diabetes, which is linked to obesity. In the United States, about 900,000 to 1.8 million people have Type 1 diabetes, the American Diabetes Association says."
Q: The pump makes all the decisions for you?
A: No, the pump is just a delivery device. It pushes insulin through a tube into small plastic needle-thing called a canula that is 9mm into my belly. I move it every 72-96 hours. The pump has a screw-drive internally that pushes a head against a syringe's piston. It's got some wizards and calculators, but it never does anything automatically, other than deliver a small background (basal) dose that I have to set myself.
Q: Why not just stick with needles? My [uncle|sister|dad|butcher] does two shots a day and he's|she's all good...
A: Taking insulin twice a day is the equivalent of going for a flight but you're only allowed to touch the flight controls twice. Better make those two turns count. Same thing with checking your blood sugar. If you check it twice a day, imagine flying from LA to New York and only checking your altitude twice.
Q: What's so great about a pump?
A: I can make little adjustments on the order of a 1/10 of a Unit of insulin, while folks with needles can usually only managed 1/2 a Unit and they'd need to stick themselves each time!
Q: Do you sleep with the pump on? Shower? What about sex?
A: You can disconnect it for ~30-60mins without ill effects, but everyone is different. While it's not connected, it's not delivering, so you'll likely need to compensate. It's not waterproof. I sleep with it on and remove it at other times.
Q: Is it hereditary?
A: Some Type 1 diabetes is, and many Type 2's are, but it all depends. I'm the only Type 1 in my family going back many years, but I know a girl who's entire family, brothers and sisters are all Type 1. Z has a 2% chance of being a Type 1 Diabetic, which is roughly the chance anyone has with one Type 1 parent.
Q: Can you eat cake?
A: I can eat whatever I like, it's how long I want to chase my blood sugar afterwards that dictates what I eat. It's all about the Glycemic Index - the speed that the food hits you. For example, an apple with the skin on it will raise blood sugar slightly slower than an apple with the skin off. Brown rice is often slower than white. White bread is satan. Going back to the airplane analogy, a food with a high GI will "pull back harder on the stick, making it more difficult to steady the plane later."
Q: Does it suck?
A: Big time. But what other choice do I have?
Q: Will it kill you?
A: Very likely. Diabetic typically die of diabetes before other things. Disability insurance is hard to get, as is life insurance, although the latter is easier than the former. However, the key is maintaining as normal blood sugars as possible. I know diabetics who've been diabetic for 50 years, and they didn't have 1/10th the tools and knowledge we have today. I figure if I can stick it out another 10 years, maybe 20, there will be a cure.
Timeline of Diabetes Care
- Before 1922 - Certain Death. A childhood friend of my 90 year old grandmother was diabetic, was fed only lettuce and quickly died.
- 1944 - Insulin is derived from Beef and Pork. Standard insulin syrunge is developed. Folks boil and reuse their needles. Blood sugar is tested by peeing on a stick and matching colors. Accuracy is +/-100mg/dl.
- 1959 - Diabetes is divided into Type 1 and Type 2.
- 1974 - First Insulin Pump/Backpack
- 1983 - Biosynthetic Human Insulin is created. (Ya, seriously, this just happened in '83)
- 1990 - Digital Insulin Pumps the size of a pager, finger stick tests take 45 seconds.
- 2006 - Finger stick tests take 5 seconds, insulin pump communicates wirelessly with continuous meter.
- 2007 - ?
Soon I shall eat cake.
(If you have other questions, post them and I'll answer them in the comments)