Where I'm At With This…

img-530pumpIt’s been almost two months since I began the trial with the Medtronic MiniMed 530G System with Enlite. I’d like to tell you where I’m at with this…

Truth?

I don’t know where I’m at with this.

The Medtronic customer service is phenomenal. Mostly phenomenal.* The Medtronic trainer has followed up with me and checked out my Carelink updates, giving me suggestions to improve my experience. The StartRight representative has been helpful.

My graphs and reports are, frankly, abysmal. My weight is up three pounds (and as an individual with food/weight issues, you know that doesn’t make me happy) and my A1C rose 0.2%, which may not be much, but I wanted it to go in the other direction. My CDE’s comment to me when she walked into my appointment was: “What is going on? These can’t be your numbers!”

Threshold Suspend

Here’s the thing I like about the Medtronic MiniMed 530G system with Enlite: Threshold Suspend. It does work.

Except when it doesn’t for me.

There have been nights that the Threshold Suspend feature is activated. My blood sugar is 104 mg/dl when I check. I shut off the suspension and restart my basal. It alarms again. By this time, I’m up, out of bed, trying not to wake John, and angry that the pump is waking me up for no reason.

Twice in the past month, it has legitimately suspended and I’ve treated, thankful that it woke me. I’ve yet to sleep through an alarm. (Man, that alarm is loud.)

But I’m finding, for me, that the noise from the alarms compete with the noise in my head over my blood sugars. I’m questioning constantly whether the numbers I see on my MiniMed 530G insulin pump are accurate. When they are, I breathe a sigh of relief. When they’re not, I breathe a sigh of frustration.

That’s a lot of sighs.

I love my Medtronic MiniMed Revel. I’ve said that before. Medtronic has been very responsive with every issue I’ve had with the Medtronic 530G with Enlite system. (The CareLink issue? That’s another story. Quick side note: I’m hearing from others that I’m not alone in my frustration with CareLink.)

My goal with diabetes management is to keep blood glucose levels within my prescribed range while minimizing the intrusion of diabetes into my daily life. (It’s a Hurculean task some days, but others…) The technology I choose to use is meant to help minimize the intrusion.

The Medtronic 530G with Enlite is designed to help minimize the severe hypoglycemic episodes with Threshold Suspend – and it does when the accuracy of the Enlite sensor is working correctly. I’ve had meter readings of 45 and my Enlite sensor is telling my 530G pump that I’m 82 (and the arrow is not trending down). I’ve had meter readings of 64 and my Enlite sensor is telling my 530G that I’m 64.

It’s Me. But is it?

The rise in my A1C is because I’m over treating when I go low. I know this now. I didn’t over treat quite as frequently before I began the trial, because I could see the fall easily on the CGM transmitter of my Dexcom. It’s not as easy to see that on the screen of the 530G pump.

I’ve had to turn off the predictor high and low alarms and the high and low range limit alarms for my sanity. That, for me, lessens the ability of this technology to minimize the intrusion of diabetes into my daily life.

Others are not having these issues and perhaps it’s because their diabetes management is better controlled or their own diabetes is not marred by delayed gastric emptying or quirky days. I’m still not giving up on getting this MiniMed 530G with Enlite system to work for me.

Anyone have suggestions?

*The customer service issue I had? I called in on a weekend to get a few sensors replaced due to sensor errors. I spoke with technical support, who made some less than supportive remarks regarding how I was trained by my trainer. Not cool.

I was also told that when the pump tells me to “BG NOW” to calibrate, I should wait 10 minutes if I’m not stable… which to me says that the pump shouldn’t say “BG NOW”… and if you’re not trained properly or don’t know better, your readings are going to be inaccurate. But when you get a BG NOW for the first time during the wetting period, after two hours, if your blood sugars are fluctuating slightly up or down, how are you to know? These questions have me up at night…

 

The Ca-Chunk Factor: MiniMed 530G with Enlite

The Enlite® serter, the device patients use to insert the Enlite® sensor beneath the skin, was designed with patient comfort in mind. With a simple insertion process, it inserts the sensor at a 90-degree angle using a completely hidden needle.  Courtesy Medtronic, Inc.
The Enlite® serter, the device patients use to insert the Enlite® sensor beneath the skin, was designed with patient comfort in mind. With a simple insertion process, it inserts the sensor at a 90-degree angle using a completely hidden needle.
Courtesy Medtronic, Inc.

Control. It’s a concept that people with diabetes wrestle with… control over what we eat, our blood sugars, our lives in general. When you’ve done everything in your power to keep this disease in check, and yet, you see a high (or low) blood sugar on the meter, it’s frustrating.

So, I take control whenever I can in my diabetes, which includes needle insertion. I’m not a huge fan of “auto-insertion” and never have been. From my very first injection in 1983, I would slowly insert the needle into my selected spot. If I was halfway in and it began to hurt or I felt a twinge, it wasn’t uncommon for me to pull the needle out and start in another spot. Quirky? Guilty as charged. There are times that I am jealous of those who jam a needle in and quickly inject and move on, but I prefer having control over at least, inserting the needle. I use a Silhouette insertion set for my insulin pump because I can insert it manually…under my control.

The Medtronic Enlite® Sensor uses a insertion device that doesn’t allow for the rate of needle insertion. (The Dexcom G4 sensor insertion device uses a plunger, so yes, I totally take my time pushing that plunger down.) I didn’t have a positive experience with the Sof-Serter sensor insertion and truth? Freaking out about putting in the Enlite®  on Friday was actually raising my blood sugar. I was… scared. What if it hurt just like the Sof-Serter? What if the needle hit a spot that was tender and it bled? What if it came time to put that inserter onto my skin and I chickened out.

The Ca-Chunk Factor

Then there’s the Ca-Chunk Factor. That sound that the inserter makes when the mechanics release and the spring load snaps and something happens. If you’ve had diabetes for a while, you’ll remember the “Ca-Chunk” sound with the Autolet lancet device (a.k.a The Guillotine). I dread that sound. Sends shivers up my spine. I sweat a little in anticipation.

I had my training session with the Medtronic trainer on Friday and after the polite introductions, I spilled my guts. “I’m scared about the insertion pain and the accuracy and the Ca-Chunk Factor, but right now, it’s the insertion pain. I’ve been told that it hurts much less than the Sof-Serter, but I have nightmares about those insertions, so…”

Lisa, the trainer, was incredibly cool about it all. (I think I may not have been the first to express these fears.) We talked about the difference in needle gauge sizes (the Enlite®  introducer needle is significantly smaller) and how many individuals had expressed surprise at how comfortable the sensor felt after insertion. She asked me to explain the Ca-Chunk Factor. She offered to have me practice using the inserter, but I took a deep breath and said: “Let’s just do this.”

Here’s how the insertion of my first Enlite® Sensor went for me.

Lisa: “You don’t need to pinch skin at all. Just place the inserter directly onto the skin and don’t press the inserter hard. Most people find it comfortable to stand up when they do the insertion.”

I nervously stand, whipping my shirt up and searching my abdomen for a spot that would have the least potential for an “OWW!”.

Me: “OK. Wait! Where should I have the green button?” (The green button is what you press and release to insert the Enlite Sensor.) I turn the inserter around on my abdomen, trying to find a comfortable way to hold it and the button and begin to feel that sweat beading on my forehead.)

Lisa: “When you’re ready, press the green button.”

Deep breath. Moment of truth. I push the green button.

I think to myself: ‘Wow. She was right! That didn’t hurt at all! Jeez, I have no idea why I was freaking out about this.’

Lisa: “Now, release the button.”

Me: “No problem.”

As I released the button, I heard…

“Ca-Chunk.”

I had been fooled by the Medtronic Enlite®  Sensor serter. It drives the needle in upon the release of the button, not the push. And because I was lulled into the concept that I had already done the hard part, it came as a surprise. What was more of a surprise was that it didn’t hurt when it really went in.

My first fear – squashed. Annihilated. (Next week when it’s time to put a new sensor in? I’ll have to trick myself, but I know it won’t be as painful as I thought it would be.)

After the insertion process was complete (There are more steps, including a complicated process of taping the sensor down onto your skin…), I told Lisa that I had been duped by the inserter. Happily duped.

Right now, a few days into this, if you asked me where the sensor was on my abdomen right now, I’d have to think hard. No pain. No twinges. (I’ll talk about the accuracy in another post.)

Control. I could give up a little for this…