Met with Medtronic Rep: help me decide

Today, in the middle of the BEST sun-shower ever, we went to meet with the Medtronic insulin pump rep. She brought a bunch of demo pumps and a foam cushion covered in infusions sets.

The best parts:

I got to see and feel a lot of different infusion sets. And we talked about their various benefits and had a go at disconnecting/reconnecting them. I am quite interested in the lower-profile sets, and potentially the angled sets. The rep seemed very concerned about the amount of packaging that comes with the Mio sets, but I think that an all-in-one system is actually a very attractive prospect for a never-pumped diabetic!

She had both the Paradigm 522 and 722 demo pumps with her, plus the VEO which is the same size as the 722. Their main difference is resevoir size; I would only need the smaller size as I don't consume much insulin however the rep pointed out the insulin requirements increase dramatically during pregnancy (hello! That's what we want here!!). So I asked if, should I select the 522, could I get a 722 loaner pump during pregnancy and she said she could probably work something out for me.

Both the 522 and 722 work with the Medtronic CGM system. I do not really like the look of the Medtronic sensor or transmitter. It looks big and clunky compared to the Dexcom CGM. And it has masses of extra tape that goes with it. however, it IS rechargeable. The Dexcom rep confirmed that the Dex transmitters routinely last longer than 6 months, and even over 12 months before their battery goes flat. Humph: money.

The VEO is another kettle of fish all together. It looks just like the 722, but it offers a really advanced feature: low glucose suspend. This is where it shuts off all insulin delivery if you go too low and don't respond to the warning alarms. It's a very attractive proposition, as it would help to fix one of my primary problems: hypos. But it comes at a very high cost. The VEO is not govt funded in New Zealand. The rep said although it's not funded, if I paid $2000 then the balance would be funded. So, it's partially funded? It got confusing. Total price for this puppy? Hold your breath: $12,000.

And that doesn't include the cost of the CGM transmitter or sensors.

Ok, pick yourself up off the floor.

Back to the core decision. Should I get the Animas Vibe pump, or one of the Medtronic pumps?

Here are the main points as I see them:

Animas Vibe / Dexcom

• This is the pump I have been looking at getting for the longest time.
• It has combined pump and CGM.
• It uses Dexcom CGM which is the most accurate available in NZ at present. Animas and Dexcom are currently involved in The Artificial Pancreas Project.
• Waterproof.
• Larger, colour screen.
• Offers smallest increments for insulin delivery. I need this.
• Insulin pump (including CGM receiver) fully funded.
• Dexcom transmitter (approx $1000) and sensors (approx $125 each) are not funded.
• Dexcom sensors last up to 7 days.
• Fancy bolus, fancy basals yada yada yada...

Medtronic 522

• Combined pump and CGM.
• Uses the Medtronic (Enlite?) CGM, which is not as accurate as the Dexcom based on the research I have done. The brochure the rep gave me doesn't even state accuracy!
• Pump is funded.
• As with Dexcom, the Enlite CGM transmitter and sensors are not funded. The rep did not have a price-list with her and is yet to send these to me.
• Sensors last up to 6 days.
• Fancy bolus, fancy basals etc.
• Quite easy to navigate menus.
• Small grey screen.
• Has a back button.

Medtronic 722

• As per the 522, but has a larger reservoir which could come in mighty handy during a pregnancy.
• I am not considering this pump, rather if I went with the 522, I would ask for a 722 loaner during pregnancy.

Medtronic VEO

• As with the 722, but offers additional software that works with the CGM system. This Low Glucose Suspend stops insulin delivery when blood sugar drops and the diabetic doesn't respond to alarms. It has other specialised alerts as well, but the rep didn't explain those very well. She also didn't have a VEO brochure even though she knew I was interested in it. Overall it's a very attractive idea... having hypos prevented for me. Hell, I've had two hypos since going to this damn appointment.
• But it is very expensive and is not fully funded. I'm not even sure it's funded at all, since it doesn't appear on the Pharmac schedule. From the way the rep was talking it would seem that Pharmac is paying funding for a 722 and then the patient is actually getting the VEO. How that works through the machinery of Pharmac funding is beyond me.
• Still have to stump up the pennies for the CGM bits'n'bobs. Wow. This is sounding like it's getting to pricey.

That's all I can think if now. I am quite tired (big field trip with the students today, plus visit to the rep, plus went low twice, plus all the grocery and petrol shopping, plus cooked dinner!) and need a nap.

If you have advice or feedback on making this choice, chuck me a note in the comments :)

p.s. I got the results of my HbA1c back = 41 mmol/L = 5.9% = !!!!! This is the first time it's every been under 6% and I wasn't even trying to accomplish that! I was trying to make it go UP!