So, I finally got a new insulin pump, the Minimed Paradigm 523, otherwise known as the Revel. I didn’t want to get it. I’ve been hoping that DexCom and Animas might finally get the FDA approval necessary to come out with an integrated system — you know, one where your blood sugar shows up on your pump itself so that you don’t have to carry around a meter. They’ve been trying to get approval for quite some time and I must say, I don’t see what the hold up is: everyone (I hope!) knows that CGM data is not reliable enough to bolus off of, so I would still be double-checking with finger pricks; I just wouldn’t have to carry around the DexCom receiver.
But the time had come. My Minimed pump was not only out of warranty by a year, but it had cracks all over its face. Not a good sign. Since I’ve maxed out my deductible for the year — and Animas/DexCom have not yet come out with anything — I decided to go for it. Several wonderfully hassle-free days later, I received my new pump in the mail.
Here’s where I have to pause to be positive: I love my Minimed pump. I’ve been wearing one for nearly 10 years and I’ve found the company’s reliability and customer service to be superb. I am very grateful for my Paradigm and would never, ever want to go back to pure injections.
But at the same time, I’m very frustrated. I just had my insurance company spend several thousand dollars (I don’t even know exactly how much yet because the claim hasn’t been processed) on a new pump that, for all intents and purposes, is exactly like my other pump. Unless I really kick and scream, they’re not going to cover a new one for at least four years, once this one’s out of warranty. And yet, as far as I can tell, the only differences between this pump and my last one are:
-more safety checks as you prime (which you can’t turn off and which, if you’ve been pumping for ten years, are annoying)
-the ability to adjust your basal by .025 of a unit instead of .05 (which I do not need), and similar refinements for boluses
-active insulin is displayed on the same screen as the bolus dose. This is a nice feature, as I used to have to scroll back through my history to try to figure out when my last bolus was. But since I don’t trust the active insulin feature to begin with, I don’t pay much attention to it.
-more flexible settings for the bolus wizard (which I also don’t often use since I’ve never found an insulin/carb ratio that works for me)
There are several other small differences between the two, but if you are not using the Minimed Guardian REAL-time continuous glucose monitoring system, they are really pretty much the same (you can read more from Karmel Allison on some of those other differences here). And I find that frustrating. I know, I know, it’s hard to get approval for new changes, no matter how logical or safe — consider low-glucose suspend. And also, other than say, wirelessly integrating with a phone display, it’s tough to think of how a pump could be improved on its own — most improvements I can imagine would also require use of the same company’s CGM. (It’d be great if Minimed pumps could pick up readings from Abbott meters, and even better if they would talk to other companies’ CGMs, though I know that’s very wishful thinking.) Nonetheless, every time a new iPhone comes out I can’t help but wish that pumps were updated with more regularity. And I also wish that Minimed made it more clear that most of the new features require you to be on the Minimed CGM system. As it is right now, the large “Revel” on the box makes it seem like it’s something very new and different — but the pump itself is a Paradigm 523, which is only one number up from the one I got nearly six years ago.
But enough whining. On a lighter note, I found a section from the User Guide that made me laugh.
“It is very important to look at your blood glucose readings as feedback regarding your diabetes management,” it says, “not as statements about you or your self-worth. Try not to have an emotional reaction to the numbers and do not judge them too harshly.”
Okay, so far, so good — decent advice, even if it’s nearly impossible to follow.
But then it says: “You will soon learn how to modify the numbers easily and precisely through insulin pump therapy.”
Again, I love my insulin pump. But “easily and precisely”? Now there’s some wishful thinking.