The new 640G system from Medtronic

The new 640G system from Medtronic. We had trialled the 620G around a year and a half ago and I took a couple of thoughts away from that (1) the next 640G was going to be amazing but (2) it was bigger. Well seeing it today alleviated my worry about being too big. It isn’t really. It is a few mm’s bigger. There is an AA battery in it rather than the usual AAA so it is a tad fatter. The AA battery is necessary as it needs to power the Smart Guard technology and everything else it does. I deliberately took photos with my thumb in the photo so you can see the size.

You have to forget about the paradigm pumps from Medtronic that you are used to. All the previous pumps are paradigm pumps, from the first to the VEO. They all look the same and each pump had one or two extra facilities with each upgrade. It is an old system now.

The 640G is a totally new platform. The concept is obviously the same, it’s a pump giving insulin which is part of a bigger system. The reason it is called the 640G is because:

6: this is the 6th version of a pump from early 80’s to now. 4: this is the 4th version of CGM 0: this is so they can add extras and make other versions ie 641G, 642G G: this just means it is CGM compatible ie for Glucose maybe (not sure)

The whole thing is easier to use, the way the facilities are ordered makes it an easier to reach system ie you get to the bolus and basal menus from the front screen. The stuff you need most you can get to from the front screen. You can highlight the very top bar (with the lit up icons) and go to notifications etc.

On the VEO in the history you cannot see if temps had been set, you can on this pump, sorry system?

With this system you get a new transmitter. It looks the same as the current transmitter but it’s very different. We used it when we trialled the 620G and even with the old enlite (ie before this new version which came out February last year) it was so much more accurate so with these current enlites they will be even better. The current transmitter does not hold its own algorithm (how it works) inside, the pump (the veo) houses the transmitter’s algorithm. The current transmitter loses data after 40 minutes. So if like us you want all data, at a swimming pool I used to make Jessica get out the water after about 30 mins to stand next to the pump so it could update to the pump. This new transmitter with the 640G has all the algorithm within the transmitter which has real bonuses. If Medtronic want to update the transmitter which is planned over the years then they can just give people the new transmitter with the updated stuff inside. If it had been housed in the pump then you were stuffed until your 4 years is up for a new pump. The new transmitter also holds 10 hours of data rather than 40 minutes. Mind blowing. This brings me on to ……..

Airplane mode: marvellous feature. You aren’t supposed to use sensors on flights. You can turn the 640G onto Airplane mode so that the data is no longer transmitting the pump. However after your flight you can turn airplane mode off and your data for the last however many hours (up to 10 hours) just uploads to the pump. Fantastic.

The internal battery. I had forgotten about this. The veo has an internal battery which is I think is less than an hour (can’t quite remember), where it will hold the basal/bolus programmed settings. The 640G has an 8 hour internal battery. So if your battery stops you can continue using the pump for 8 hours, hopefully you won’t need that feature to test it!!!

You can use any battery you want now. They will recommend Lithium but you can use lithium, alkaline and rechargeable. They will still provide the batteries but due to sending batteries by post they can only provide the alkaline ones which work fine. Obviously the better the battery the longer it will last. The pump I was shown today had a cheap B&Q battery in it and had been going for around 2 weeks so far.

The screen is so clear and the letters easy to read and it is now colour. The children will like the fact (well so did I) that in each different menu there is a tiny colour picture in the top right. So in Reminders there is a picture of an alarm clock, the one that I like is in the Bolus wizard screen there is a wizard hat Genius

There is a small one and a large one like the VEO. The small one is the same 1.8 ml reservoir and the larger one is the 3 ml reservoir. The launch date is 2 February and the black one is coming first. In the photos you can see there is a silver bit, you can get that in black and different colours, purple, blue and pink I think.

The glucometer (test kit). You get a new Contour Link USB meter. It looks the same as the current link one but has added extras. Firstly it is the usb stick that you use for uploading your pump ‘system’ to carelink. You don’t need any cables or the current usb stick anymore, you just use the link meter. Paediatrics get two meters so you have a spare. Adults don’t

It also allows you to bolus from the meter with a standard, dual wave or square wave. It is not a wizard but actually sounds great. It’s called a remote bolus.

Remote bolus. This is not a full bolus wizard. For example (the example I was given). A lady has a latte every morning at roughly the same time. She should bolus for a latte, she doesn’t as she can’t be bothered so runs a bit high all day than she would like. She knows that if she carb counted and bolused she would get say 2 units of novo. She can set a ‘preset bolus’ for 2 units on the pump itself and call it 1 or 2 or snack or something, I think there are around 4 ish ie snack 1, snack 2 etc of these maybe plus breakfast, dinner and tea (not sure on the wording and may have the amount wrong, doing all this from memory and was told a lot). On the glucometer (test kit) you can go to present bolus and click snack 1 knowing that it is the 2 units she needs for the latte. It then delivers it without the need to get the pump out.

Jessica has the same breakfast amount of carbs (except during this experiment we are doing) of 30 carbs each day. We can look on the pump and see how much insulin it is going to give at that time of day for those 30 carbs. We can set up a preset bolus called maybe breakfast and for say 6 units (that is roughly what she may have then) and then instead of in her rush not bolusing at all or doing it late she can just bolus via her meter instead with a couple of buttons. This will only work if you know the insulin units you normally have at that time. You can do it using a dual wave or a square wave. So if you have fish and chip Friday (I think that is what used to happen or was it Monday) and consistently you have the same and use the same dual wave and you know the insulin units (ie work it out on the wizard first and then create a present bolus) you can then use the remote to bolus that.

If your child has the same snack at break time and has the same bolus then you set up snack 1 or whatever and that can be done every break time from the glucometer.

I think this is great and a step on from the ridiculous teeny weeny without a screen thingy that never actually came out of our pump boxes.

I did ask why Medtronic didn’t do a meter with full wizard and the answer is quite simple really. It is to do with the fact they use an outside company for the link meter and they haven’t created one yet. It will come but actually after hearing about the smart guard I don’t care

Preset temp: You can programme present temporary basal rates called different names, there are a few you can preset, ie sick, work day (or similar – can’t remember). So if you normally put on 125% for a sick day you can have this set up always and just turn it on. For us though this will be good for food!! I think you can have Temp 1 and Temp 2 etc but not sure how many. So for example fish and chips (we don’t actually have a lot of this but it’s a good example) we have to give a full up front bolus, all the insulin. However about an hour or two later we have to put on a 160% for around 3 hours (or more). We can present temp 1 to be 160% for 3 hours. We just turn it on and it does its stuff. Makes it all just a bit easier.

SmartGuard: So Medtronic already have Low Glucose Suspend (LGS). Now they have SmartGuard. These both work with the use of sensors only. I was shown graphs to describe this so will do my best. I asked lots of what turned out to be silly questions up front, should have just listened, not always my forte when excited!! One question was can I use both LGS and SmartGuard. The answer was there is no need to which I didn’t get until it was all explained to me.

There are numbers involved here and I probably won’t remember them all correctly ok. So you set your low level ie 3.4 mmol. Normally on the VEO with enlites you set a LGS level.

The SmartGuard will predict that you will be 1.1 mmol above 3.4 in 30 mins time as you are dropping quickly. It will suspend the insulin delivery. Whilst it is suspended it will carry on monitoring you. It will stop for a minimum of 30 minutes. If at 30 mins or longer it can tell that you are rising it will restart the pump. There is a bit more to it than that but that is it in basic terms (as that is what I like to understand). Essentially it is stopping a hypo from happening. With the LGS it is already happening, SmartGuard wants to not get that far.

If however you are dropping and dropping and no amount of suspending the pump will stop it and you end up down at that 3.4 then the pump will suspend for the 2 hours that the LGS does.

With the SmartGuard you can choose your alarms. This has been trialled in a small group of adults. You can turn all alarms and vibrations off for the SmartGuard. Some people found that when they looked back on their pump they found they had been suspended for 30 mins and then restarted and they never knew and were just going about their daily business. Some like the alarms but allowed it to do its stuff. A few found that rather than stuffing carbs before a walk or sport, as usual, they didn’t and instead allowed SmartGuard to keep them up and safe. Even if you have the alarms off if levels did fall to 3.4 then it would absolutely alarm anyway. I think this will take some experimenting and getting used to. I think it is amazing and getting closer to the closed loop all the time. There was a lot more to it than that but that is SmartGuard in a nutshell.

Volume: this is a biggie for parents and teens maybe (definitely my daughter who sleeps through everything). There is a volume button. It goes up to number 5. The number 2 setting is the current volume of the VEO so it gets quite a bit louder. Yippeeeee.

Insulin: all the insulin settings, anything to do with insulin are all housed under one roof now called insulin settings.

Most of the information you will need is found on the front screen. If using sensors the graph can be seen on the front screen. You can click on the graph which will take you to a bigger graph.

There are some great blogs, I haven’t read them all yet, but here are some links:

Overall opinion: this is my personal opinion. I think everyone loves their own pump and we all have our own opinions on all of them. Any pump is better than no pump. I think this new insulin delivery system (as it’s not just a pump, it’s a pump, meter, CGM, carelink thingy, SmartGuard technology piece of kit) is amazing. If I compare when Jessica was born and had her first insulin injection aged around 8 or 9 weeks old nearly 15 years ago to now, to a machine full of technology which can turn insulin on and off on its own to save her life, her brain, give her a quality of life we didn’t expect way back then (gosh have tears in my eyes) then wow times have changed. This system, in my view, knocks all other pumps/systems out of the park in terms of the latest technology on the market, there is nothing else like it, nothing even close actually. I wish there was as competition is healthy I think. Again this last bit is all just my view, I’m not paid by Medtronic (which was asked earlier ) I would happily jump ship to another company if they brought out something that would benefit my daughter more than this will.

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