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Unique to Medtronic Pump


Please note that this article contains affiliate links.

Despite their many similarities, each of the insulin pumps currently available in Canada offers its own distinct features. Therefore, each insulin pump fills a unique need in the type 1 diabetes community. The key to success in choosing an insulin pump is determining which one has the features that meets YOUR family’s needs. Here are the
unique features that set Medtronic apart from all the rest.



Medtronic - Minimed™ 630G Insulin Pump / CGM System (released in Canada in April, 2017)   Medtronic Paradigm Insulin Pump

(*not to be confused with the 670G Hybrid Closed-Loop pump, currently available in the US, but not in Canada. We hope to be able to access closed-loop technology in Canada soon!)

  • The 630G continues the legacy of earlier Medtronic pump models with the inclusion of an integrated Continuous Glucose Monitor (CGM), the first one approved for distribution in Canada, and one of only two integrated pump/CGM systems currently available here.
  • This integrated insulin pump/CGM system contains Medtronic’s SmartGuardTM technology, the set of all the features and functions of the 630G. This includes CGM alerts for both:

    the occurrence of low (or high) glucose; this feature is called Alert on Low (or Alert on High). You can set the high glucose limit between 5.6 and 22.2mmol/L, and the low glucose limit between 3.2 and 5.0mmol/L);

    PLUS

    the prediction that glucose will go low (or high) within the next 30 minutes, based on the current glucose reading and trend; this feature is called Alert Before Low (or Alert Before High). For example, if you set your low threshold at 4.0 mmol/L, Alert Before Low will notify you when the algorithm predicts that in 30 minutes your glucose will be 4.0.

    Those familiar with the Veo may recognize this feature as the former “Predictive Alerts”, however there are a few key differences: Predictive Alerts allowed you to program in an alert for 5- 30 minutes before your chosen low glucose threshold; the current Alert Before Low is hard-wired to alarm 30 minutes before low glucose is predicted to occur.

    Medtronic’s system is the only one with the ability to set 2 separate alerts – one for a low and one for a predicted low (plus one for a high glucose and one for a predicted high).

    Note that Low Alerts exist in all CGM systems, and you can program those alerts for whatever level you want, including setting it high enough above your actual low threshold to alert you of a pending low before you actually get there. However, with those systems, you cannot program in a second alert for when your glucose actually crosses the low threshold. (Exception: Dexcom’s hard-wired, non-programmable, non-adjustable Low Alarm).

  • Suspend on Low (previously known as Low Glucose Suspend) is another SmartGuardTM feature that applies to the pump portion of the system. It collaborates with the integrated Continuous Glucose Monitor to stop basal insulin delivery if the user does not respond to a low glucose alert (i.e. does not acknowledge the alert with a button-press). So when a user is experiencing a debilitating low (which may include confusion, or loss of consciousness) they will not continue to receive insulin which would continue to contribute to the low. When this feature kicks in, the delivery of basal insulin will resume after 2 hours. This feature is part of a wider set of features included in Medtronic’s SmartGuard Technology, new in the Minimed 630G. The ASPIRE In-Home Study published in the New England Journal of Medicine2 demonstrated that SmartGuard technology not only reduces the number of low events per week by 30 percent but also shortens the length/intensity of those events at night by 37.5 % without increasing A1C. Very encouraging!
(Note: Under usual circumstances, it is not recommended to stop basal insulin delivery during a low blood glucose episode, as the interruption may result in high blood glucose a few hours later. However, in the case of the Suspend on Low feature, the pump puts priority on recovery from the low when a user may not otherwise be able to help him/herself; that is, it stops insulin delivery precisely when the pump-user needs it to do so, such as during sleep.)
  • The Minimed 630G system includes a linked Contour® Next Link blood glucose meter, which sends glucose readings wirelessly to the insulin pump, saving time and effort, as well as eliminating manual data entry errors.  New to the 630G, the meter can also be used as a remote to deliver a manual bolus, or one out of 8 preset bolus amounts (in units of insulin). So if your child has the same snack at school every day, she can simply select that preset program to deliver the correct amount of insulin for that snack. Or if you’re in the drive-through at Tim Horton’s with your child strapped in the car seat in the back, you can use the remote from the front seat to deliver the preset amount that corresponds to a Vanilla Dip. (It may be helpful to know, however, that the meter remote cannot be used to deliver a bolus using Bolus Wizard; this feature can only be accessed on the pump itself). 
  • The 630G pump is now fully water-proof, with the highest IPX8 rating (waterproof when submerged up to 3.6m (12 ft.) for up to 24 hours). This is an increase in waterproof rating from the IPX7 rating of the Veo. This new waterproof rating means that the pump will be replaced under warranty if it sustains water-damage; however, it’s still a good idea to check regularly for cracks in the pump casing… the fact that it will be covered under warranty is small consolation if your swim at the lake renders your pump useless for the rest of your summer vacation!

While most current insulin pumps are now waterproof, the Medtronic system is unique in that you don’t have to change battery caps to maintain its waterproof functioning. 

The CGM transmitter, while waterproof, has a different rating than the pump body/CGM receiver; it’s waterproof up to 2.4 meters (8 feet) for up to 30 minutes. The Medtronic Diabetes Canada website recommends that users see product user guide for care instructions to help maintain protection from water for all components.

  • The 630G insulin pump has the lowest bolus increment available on a pump in Canada at 0.025 units of insulin, half of the smallest bolus possible with other pumps.

    Tips from the Trenches:
    Although this may not seem like a big deal to many readers, it really is for those who are extremely insulin sensitive, and for very small bodies. I remember the days when we diluted insulin with a carrier so that we could deliver doses as small as a quarter unit for our infant son – and even that packed a huge punch for such a teeny body. The ability to deliver very small doses of insulin was critical to being able to correct high blood glucose without tanking it. -Michelle


    Those familiar with the previous Minimed model, the Veo, know that it also allowed you to deliver this small of a bolus, however, it only did so for doses under 1U; what’s unique to the 630G is that this teeny tiny bolus is available for all bolus sizes, including those greater than 1 unit. Also, this 0.025U dose is standard in most insulin pump models in terms of basal insulin, but in terms of bolus insulin, it is unique to Medtronic.

  • One (large) size of reservoir that holds up to 300 units of insulin.  
tips from the trenches of type 1 diabetesWhen purchasing a pump for a 10 year old you cannot imagine needing more than 180 units over three days but by the time the warranty is up on the pump your 10-year-old is now 14, the size of a grown man and in the throes of puberty, using 100+ units of insulin a day.  The 300 unit reservoir was invaluable for our family when our son’s insulin needs increased dramatically!  Even before this happens, you do not have to fill the reservoirs – just put enough insulin in for three days and enough extra for priming out any air bubbles.
-Jacky, mom of a 13-year-old boy with type 1 diabetes

  • Insulin pump is fully operational on its own via buttons on the pump body itself. This means if you misplace or forget your linked meter, you can still access all the functions of the pump and CGM. This also means that you have the flexibility to use not just the linked Contour any other blood glucose meter, if you want. (However, as with all linked systems, you will lose the communication between the meter and the insulin pump/CGM.)
  • As is common in CGM systems, the 630G provides glucose trend information: up or down arrows tell you if your child’s glucose is rising or falling, and how fast; horizontal arrows tell you that glucose is steady (not changing significantly). The 630G is unique in that it displays three levels of glucose rate of change arrows, compared to two levels in the previous model:

↓      Single arrow down means that glucose is falling at a rate of 1-2 mmol/L over 20 mins

↓↓    Double arrow down means that glucose is falling at a rate of 2-3 mmol/L over 20 mins

↓↓↓  Triple arrow down means that glucose is falling at a rate of over 3 mmol/L over 20 mins

(The same three levels of up-arrows exist to show rising glucose.)

This glucose trend information allows you take action based on how your child’s glucose is changing – and how fast it’s changing. After all, 7.0 mmol/L with ↓ is quite different from 7.0 mmol/L with ↓↓↓!

  • The 630G uses a new “Guardian” CGM transmitter, which is the same size as the MiniLink Transmitter used previously in the Veo, but which now has the algorithm right in the transmitter. This means that when updates are made to this software, you don’t need to upgrade the whole system; you’ll get the updates the next time you purchase a new transmitter (which could be only a few months, or up to a year if you just replaced the transmitter before the updates. But even that is not nearly as long as the 4-year life of the whole CGM system!)
The best part of this new transmitter however, is the internal data storage: the transmitter itself stores up to 10 hours of glucose data. What this means for real life is that if you disconnect from your pump to go swimming, or you leave the pump in the locker room for an hour while you work out, or you take a 9-hour flight across the Atlantic and put the pump in airplane mode for the entire flight… at end of the swim, workout or flight, all of the data is transferred from the transmitter to the receiver, without a gap in data. Awesome! (Note that the transmitter and receiver will automatically reconnect if disconnected for less than 6 hours.)
  • The CGM uses the enhanced Second Generation Enlite® Sensor (as the Veo did) to detect the glucose levels in the interstitial fluid at the sensor site. The company reports an overall Mean Relative Difference (MARD) of 13.0%1 (data obtained with the 630G) and a Hypo Detection Rate of up to 96%2 (data obtained with the Veo). Each sensor is approved for up to 6 consecutive days of use. Fingerstick calibration twice each day is recommended.

MARD is the Mean Absolute Relative Difference, or the % average error of the sensor versus the reference value, across all glucose levels from 2.2 to 22.2 mmol/L. MARD represents the difference between the patient’s CGM reference values, and those obtained from a lab analyzer – a lower value means user values are closer to the lab reference values; i.e. the sensor is more accurate.

  • At this time (July of 2017) there is not yet a way to remotely view CGM data with the 630G (like there was with the Veo, and there is currently for the Dexcom G5), although approval of an app for the 630G is pending. Check with Medtronic Canada for the current status of this feature.
  • Alert-Directed Navigation directs you to appropriate menus following an alert, for convenience and ease of use. 

    In addition, in the 630G the navigation is simplified and more intuitive when compared to the Veo. When it comes to the repetitive tasks of diabetes care, a few less button presses could really add up.

  • Because of the venting mechanism, tubing-to-reservoir connections are proprietary – if you have a Medtronic pump, you must use Medtronic infusion sets. Venting is used to maintain the proper pressurized environment for the internal and external mechanisms of the insulin pump. This venting mechanism is built directly into the infusion set connection, so new venting is provided with each set change to help maintain the reliability of insulin delivery.
  • The pump/CGM has a high-definition colour screen – sleek, modern, vertical-orientation, easy to read.

  • Carelink web-based software available from the pump company which allows users to store, review, and print their insulin pump and continuous glucose monitor data, for trend detection and glucose management decisions. We have heard many families talk about the exceptional user interface and data analysis options of Carelink.
  • Free Vacation loaner program provides a back-up insulin pump for you to bring with you on vacation (peace of mind just in case something happens with the usual insulin pump while you are away).
  • 4 year warranty period on the insulin pump/CGM receiver (plus up to 1 additional year under Medtronic’s Continuation of Therapy program, if insurance coverage will not allow you to replace the pump at 4 years - contact Medtronic for details)5-year warranty for pumps obtained through the Alberta Insulin Pump Therapy (IPT) funding program. 1 year warranty on the CGM transmitter.


For an overview of all features of each pump, please see the Insulin Pump Comparison Chart.

For an overview of all features of each CGM, please see the CGM Comparison Chart (coming soon!).


Any comments? Feel free to Contact Us.



References:

1. Veeze HJ. et al Poster 136 ISPAD 2014 : Real-life performance evaluation of the New Generation Enlite™ glucose sensor in patients with Diabetes Mellitus.

2. Enlite™ Sensor Performance Addendum, Paradigm® Veo™ Algorithm, True Alert Rate for Predicative and Threshold for 3.89 mmol/L @ 30 minutes; CLSI Guidelines, Method 2.





The above information was reviewed for content accuracy by representatives of Medtronic, Canada.


This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.


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