Minimed 530G with Enlite Sensor Trial, Day 1

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When Medtronic recently offered me the opportunity to do a free trial of the Minimed 530G with Enlite Sensor, their new pump and continuous glucose monitoring system, I jumped at the chance. (Disclosure: I have to give it back at the end of the trial period, and they have no say over what I write. Right now I wear the Medtronic Paradigm Revel 523, and the Dexcom Platinum G4 CGM.) Not only am I a diabetes dork and self-experimentation enthusiast, but I genuinely am interested in whether I might eventually be interested in switching over. 

I’m planning on writing a series of blog posts about the experience — so let’s start with the basics.

After an initial call last week from Sheryl, my StartRight program contact (StartRight is Medtronic’s new six-month support program for new customers or people upgrading their systems, and seems pretty awesome), I met my trainer, Lindsay, at a coffee shop this morning to get started with the system. 

I’d already checked out some of the gear myself — or, I should say, the packaging, which Medtronic recently redesigned to provide users with a less overwhelming and intimidating initial experience. (Some people had been so overwhelmed when they opened the box that they sent the pump back without even trying it.) So now the pump and CGM come in a special suitcase that you can bring with you to your training session, without having to worry about whether you’ve got what you need. In addition, the boxes themselves have been redesigned to look more like an Apple product than a medical device. For example: 

Is it a pump? Or is it an iPad?

 

The pump itself doesn’t look that different from the Paradigm Revel. 

 

It’s a good idea, especially when you imagine what it’s like to initially consider going from this:

 

 

to this:

 The first important thing to know about the Minimed 530G with Enlite is that it’s an entire integrated system — so that’s what I’ll devote the rest of this post to describing.

One part is the Minimed pump, which is what actually delivers the insulin. (As pumpers know, the pump is not “smart” — it can’t decide dosing itself — but it makes it much easier to customize your basal rates and make precise adjustments.) And the Minimed 530G is also the first insulin pump approved in the US that has “threshold suspend.” I’ll write more about this feature later, but the basic idea is that once you reach a predetermined number — say, 60 mg/dl — the pump will sound an alarm to make sure that you are alert and conscious (in which case you simply clear the alarm). If you do not respond to its alarm, then it will make a very loud noise, and go into “threshold suspend” mode, which means that it will halt the delivery of basal insulin for 2 hours or until you clear the alarm, whichever occurs first. The idea, of course, is to prevent making a low blood sugar worse by pumping in additional insulin. Again, more on this later.

The Minimed 530G Insulin Pump

The next part of the system is the Enlite continuous glucose monitoring system, which reads your interstitial glucose levels and transmits them wirelessly to the pump, which will then alarm if you go too high or too low. (As a side note, some insurance providers — hello, CMS! — don’t believe in the value of CGMs because you’re not supposed to actually dose insulin off them. To which I would like to point out an alternate definition of them, provided courtesy of StripSafely.com‘s Bennet Dunlap: by alerting you to severe hypos, they actually can be considered “death avoiders” — which seems to me like a pretty important purpose, and one which Medicare JUST MIGHT WANT TO COVER.) 

Enlite sensor

Enlite sensor and transmitter — this is the part of the CGM that you wear on your body

But I digress. The third part of the system is Bayer’s Contour Next Link blood glucose meter. This is the blood glucose meter that the FDA has specifically approved as part of the Medtronic system, and it’s pretty cool: when you test your blood sugar on the meter, it automatically logs the number, asks you if it’s before or after a meal (or neither) and sends the information to your pump. The pump then asks you if you would like to use that number to calibrate your continuous monitor (eliminating the need for manual entry) and also puts that number automatically into your “bolus wizard calculator,” which is a tool built into the pump that helps you calculate a proper insulin dose. 

Bayer Contour Next Link Blood Glucose Meter

What’s more, one side of the Next Link is actually a USB dongle — which gets me to the fourth part of the system: the CareLink Personal Management Therapy Software. Once you’ve created a CareLink account, you can plug in your dongle (heh), and the software is able to input all the info from not just the blood glucose meter, but from your pump and the continuous glucose monitor as well. You can then view this combined data on a variety of different graphs and overlays (I will write more about it once I’ve played around), and you can share it with your doctor or diabetes educator or anyone else you think might be interested. What’s more, since CareLink is based in the cloud, you can use it on either PCs or Macs (hallelujah!), and it automatically synchs between your devices. 

***An important coverage note: if you are on the Medtronic system and your insurance company says that it will not cover the Bayer strips, talk to your doctor about writing a letter of medical necessity saying that you require those particular strips. If that doesn’t work, contact Medtronic directly and ask them for help/guidance — if you’re on the 530G with Enlite system, there should be a way to get an authorization to get these specific strips. This is also true for people on mail order — if your mail order supplier tries to switch you to a different meter, PLEASE contact Medtronic or your StartRight representative and ask for help. The mail order supplier is supposed to be getting you these particular strips. (With that said, if you don’t want to use the Bayer meter you also can pick a different one and manually input blood glucose values; you just need to get a CareLink dongle, available from Medtronic, to get the data from the pump into your computer.)***

So that’s the basic overview of how the system works. It’s the first — and only — system in the US in which a CGM and pump communicate with each other directly. (Johnson & Johnson has submitted an integrated Animas Vibe pump/Dexcom CGM system to the FDA, but it has not yet been approved, and while Tandem and Dexcom have a similar plan, it’s not yet been submitted.) It’s also the first system in the US to have low threshold suspend. And it’s also the first system where the data from all three components — pump, CGM and blood glucose meter — can be easily displayed in one software management system. And I have to say, as someone who’s spent the past five years or so on a Dexcom CGM, Medtronic pump, and Abbott blood glucose meter, this smooth integration is really, really nice. 

For my next post, I’ll talk about getting started on the system. If you have any specific questions you’d like me to try to answer during the course of this trial, please leave them in the comment section.

Comments (7)

  1. Matt M. at

    I’ve been using the Enllte system for about 4 months now. It was the first CGM I’ve used, and while it’s got it’s frustrations (and I have actually been thinking of giving Dexcom a try), it’s been a definite improvement. I’m interested to hear your thoughts.

    I just wanted to add one note about using the Carelink software: even if you do not use the Carelink meter for regular blood testing, you do not need to buy a separate dongle to get the CGM info into your computer (yes, even a Mac like mine!). The Carelink meter (which I believe comes standard with a new Enlite system, or at least mine did) functions as a dongle by itself, even if you never use it to test BG.  

  2. Katie H at

    We just started our son on this pump, and our medical insurance covered the pump package, but then our perscription insurance would not cover the Bayer Contour test strips.  After filing an appeal and being rejected, we ended up getting our medical plan to cover the strips as a medical device and did not go through our perscription plan.  However, now we have to meet our deductable before the plan will pay 80%.  
    We also had issues connecting to CareLink through our Mac computer.  Otherwise we are very happy with the pump so far!  

  3. June S. at

    Thank you for sharing all this useful information with us! I am about to switch to the 530 G (as an upgrade.) I am extremely concerned about where I am going to place the Enlite sensors. I’ve gotten pretty good accuracy (though not perfect) with the SofSensors, which I’ve always worn in the upper buttocks (against the wishes of the FDA and Medtronic.) I also wear infusion sets, and I place them in my abdomen. Do you wear both your Enlites and your infusion sets in your abdomen? Scar tissue can often be a problem for those of us who do not have a lot of ‘body fat real estate.’

  4. June S. at

    Thank you for sharing all this useful information with us! I am about to switch to the 530 G (as an upgrade.) I am extremely concerned about where I am going to place the Enlite sensors. I’ve gotten pretty good accuracy (though not perfect) with the SofSensors, which I’ve always worn in the upper buttocks (against the wishes of the FDA and Medtronic.) I also wear infusion sets, and I place them in my abdomen. Do you wear both your Enlites and your infusion sets in your abdomen? Scar tissue can often be a problem for those of us who do not have a lot of ‘body fat real estate.’

  5. Hi all — thanks for the comments. Matt, that’s a great clarification: the Bayer meter can act as a dongle even if you don’t use it as your actual blood glucose meter. Correct me if I’m wrong, but I believe that if you did use a different meter (one that could not communicate wirelessly with the pump), you would need to enter your BG manually into the pump each time you tested. Then the value would be stored on your pump. When you plugged the Bayer meter into your computer, it would then be able to pull those manually entered BG values into Carelink along with bolus/basal delivery information. A bit of a pain, since it requires manual entry, but still a good alternative. 

    Katie, that sucks that you’ve had such a hard time getting coverage. If you’re not satisfied with your current work-around, you might want to contact Medtronic’s customer care line directly. I don’t know for sure, but I would think that they’d be pretty invested in getting customers to actually use those strips, since they’re the ones that the FDA approved to go with the meter. So they might be able to help you get your insurance company to pay.

    And June, I have problems with scar tissue, too. Right now I’ve taken to wearing my pump on my upper buttocks, because I’ve found that my hips and abdomen don’t work too well any more for insulin absorption (plus insulin causes fat deposits, and I’d prefer not to get lumpy!). I wear my CGM on my abdomen. That system works well for me. Also, while Medtronic recommends putting a ton of extra adhesive around the CGM sensor to make sure it doesn’t fall off, I’m wearing one right now just with the adhesive of the transmitter itself (i.e. nothing extra covering it). That takes a LOT less real estate, and so far it’s sticking fine, even through several workouts and showers.

    Hope that helps! 

  6. Tara Nettles at

    Hi, I’ve just started the 530G pump & CGM a few months ago, my insurance was paying 100%—but now it’s changed & I have to meet a high deductible. I can hardly afford to live, so if I want to continue I have to pay for the supplies myself. Could you let me know if there’s any free trials
    I can get into?  I would be so grateful to you. thanks so much,
    tara n

  7. Tara, I’d suggest contacting Medtronic directly, since I’m sure they want you to stay on the pump. Try calling the customer service line on the back of your pump and explaining the problem. Or, if you’re on Twitter, send a tweet to @MDT_diabetes  -they monitor their feed and will probably respond to you that way. I’m sorry to hear about the difficulties you’re having. 

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