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The Dialogues – Episode 3 – Medtronic CGM Guardian and all things CGM

Welcome to episode three of The Dialogues, where we have over Nicola – T1D and Medtronic CGM advocate. This episode is dedicated to the Medtronic family! Tune in to find out how Nicola’s life has changed after starting using the pump, and to learn how to make the most of your reads. 

Watch the entire episode here:

How are you? I’m excited to have you because the last two episodes were a bit general in the diabetes world. And in terms of focusing on CGM’s, we had Jane last week, and she gave a broad and insightful overview of diabetes and CGM’s.  


Tell us a little bit about your diabetes history. How long you’ve had it? And tell us about the fun and exciting things that come along with it. 

You could say I was diagnosed a little bit in the mature age group. I was 23, so I wasn’t really young when I was diagnosed, and I went through the typical process. You can just think of the needle sticks and pain injections, etc., and I’ve always been on Medtronic. 


In the beginning, I didn’t have private health insurance, and they very kindly loaned me a pump until I got that sorted, so for that reason, I have always been a Medtronic supporter. You know, there came a tipping point that made me think that I needed something better, or I needed to make a change like for me, that was wanting to be a mom. So I wanted to have babies. To do that, I had to have really good control. Although I had control, I just knew that it could be better. Thankfully, I had good terms with my Medtronic representative at the time, and I started talking to her, And then I changed my mind. I kind of went back and forward for ages, as people do with diabetes, trying to decide, to make a change. Then eventually, I just thought that it’s gonna be the best thing. So because I didn’t have private health insurance, they loaned one, which is what they do. That was a fantastic thing. I felt really more comfortable going with that. 


Yeah. And how is that impacted your diabetes management in life, in general? So how long have you been on it?  

Yeah, probably I have been on it for about 15 years. The thing is that I’ve never changed it. Like looking back, I would never have it any other way. You know it was a big move at that time, and I had to think about it. And all the things I was worried about back then just seemed so silly after I went on a pump.  You know, I like wearing something constantly on. I always worried about that. And then after a month or so into it, I forgot that I even had it all. I believe that we forget these things so quickly. I guess it’s just that fear of the unknown. And then you just very quickly adjust, and you just move on. You know, I wish I had never left it so long. I wouldn’t have any other way. I just couldn’t. Now I constantly wear a libre, and I try to avoid any period I don’t have one on my arm anymore. Because I like the availability of information that it feels much more secure. 


I find it interesting that people talk about having breaks from CGM on social media because it somehow causes them to have an overload of information and causes them to have anxiety, or they feel like they need to distance themselves a bit from it. I hear about people out there in the community doing that. Have you come across it?

Yes, I’ve had those conversations too. A lot of people have pump holidays. I’ve had a time where I’ve had to be off-pump for a couple of days, and it was terrible. It was really hard to bear that, and It’s hard to manage your diabetes, especially when you don’t have the reassurance in the gadgetry and all of the information that’s going back and forward between the pump and the CGM. These pumps and technologies keep you just so much more stable, whereas going back to injections. 


Do you want to talk a little bit about almost from the beginning of the set up that you’ve got for the pump and the CGM, some of the technical basics, and how you manage it all?

I am on a Medtronic Pump, it is the latest pump called the 670g, and it works in three different modes. So essentially, I could wear the pump just as a pump-only without CGM. I can wear it with CGM and just have that ‘suspend before low’ feature, which I had for a long time before the 670g was available. So, that was kind of my old pump. And then my latest pump I can wear in auto mode. So with that, I have a CGM, which talks to the pump and sends my CGM number (reading) every five minutes to the pump and then uses the algorithm to decide based on my current levels. It has a target in it where it’s trying to consistently keep me at 6.7, and it automatically adjusts my levels; for example, if I am on the lower side, it might not give me anything at all.  


Is the pump loaded with glucose of some sort? 

This is something that might be in the research. It works like it might not deliver anything at all if I have levels lower than the target. So, it will not deliver any insulin. And then if I have started to recover and travel back up, It might start up again.  As far as eating is concerned, It does the same work that the pump has always done. You tell it what your blood glucose level is and how much you are eating, and then it does the maths to decide on managing it through the amount of insulin it needs to deliver. 


So you still give a certain number of units when you have to bolus with food again, don’t you? And how frequently do you get into hypos?

Rarely I do that, and to be honest, the only time I will have a hypo is if I don’t have a CGM. That’s because everything goes back to the old way of doing it. That’s exactly why auto mode on the 670g came about because no two days are the same. And your insulin levels change every five minutes, just like your blood glucose levels. So, hypos only happen when I am off-CGM. 


You never get your bolus right to a point where you like; for example, if I have a bowl of Pasta, then I will give myself Novorapid, and occasionally I give myself a unit too much that will lead to a hypo event. Is that still a problem for you? 

Well, no, not so much, because, with the pump, it’s unlike what you can manage with pens. It’s working out how much insulin you still got on board that is still working. So it’s taking a bit away; thus, you’re less susceptible to encounter hypo. So, literally, we’ll pick it up really quickly and stop delivering the microdoses frequently; in this way, you avoid that.


The key benefit to pumps, particularly Medtronic pumps, is their ability to quickly adapt when you’re going lower and is it what the key selling messages with it? 

Absolutely, most definitely, because you could say the worst thing about diabetes is hypos, however, there’s other bad things about diabetes too, but I think it’s probably the worst. So we face a lot of trouble trying to avoid what is seen to be our biggest bugbears, and for ages now, Medtronic as it has the feature of suspend before low that makes it amazing. In fact,  it is getting better. 


What is ‘suspend before low’?

The suspend before low is where it used to predict that you were going to have a hypo. It would know where you are, and it would know where you’re headed and how quickly you were dropping, so the pump would suspend basal insulin, and It would switch off the background. This has worked well. Hypos are probably the issue if you over bolus, in case if you  miscalculate carbs and you give yourself too much, then you will eventually drop your sugars down, 


it sounds like; probably, we need to take a greater room for error. For example, as I just said that if I take one unit too much with the bowl of Pasta, I’ll have a hypo,  so it sounds like, with this setup, you may need to take two units additional in order to hit that hypo. So there will be more room for error?


Yeah, you’d have to probably miscalculate a fair bit because It’s knowing where you are all the time, and it knows when to switch on and switch off. So I guess it’s just a little bit more aware of what’s happening with you. Whereas without a pump, you inject it, and that’s it. You cannot take it back.


Do you know about the other CGM pump setups that have the same corrective ability?

No, Medtronic is the only one of this kind in the market at the moment. Some pumps do similar things but not to that extent. Oh! That’s my pump beeping, it’s saying I am hgh. Now I will intervene to correct it. That’s the other easy thing. So what I’m gonna do is I’m going to put that number in, as I’m not gonna eat any carbs, so I am just doing a correction, and I am bypassing the carb,  then it’s just going to give me an extra two units. 


And what is that thing that you’ve got on board?

It only ever takes rapid-acting insulin, but you can choose what you want to put in there.

I use Novo rapid, so that’s the only insulin that goes into the pump. You don’t need Levemir, Lantus, or other forms anymore; you just need one insulin.


What about the downside of it? Do you ever get annoyed with it like going swimming or sport or any other things like that?

Yeah, I guess the downside would be the alarms. I try to change the way I think about alarms if they’re annoying me. I know that the alarms are not telling me bad things; they indicate the things I need to do. And that’s a good thing. 


What is a good day or a bad day for you with pumps and CGMs?

For example, today, that was the first alarm I got. I mean, one a day is a good day for me. That’s easy, and having said that, some days, I might get four-five probably the most.


Do the alarms wake you up? 

Yes and no. There are various alarms conveyed a day. Like you can get an alarm to tell you when you are high or low, you could get alarms to ask you to do a blood glucose level, you get an alarm to say your battery needs to be changed or change the reservoir, which is cool. Because it tells you every three days when it’s time to change your reservoir, that’s quite helpful. They’re not bad alarms. You often get annoyed with them if you are having a bad day, so I try to look at them as a good thing rather than a bad thing because it helps me get worse outcomes.


I’m curious about getting to know what’s next? Like all of the CGMs and medical device companies are making their products to improve our lives. Are you aware of the technology improvements or changes that are about to come? I mean, devices are getting smaller and smaller. Do you know much about the future of these technologies and in terms of Medtronic? 

You’re right. Companies are always working on trying to make things smaller and sexier because wearing a black box is not particularly sexy. 


Do you wear a black box that clips onto your belt or something?

Yeah, here it is! This is 670g. Here is the insulin reservoir that sits inside it, and It talks to a little sensor and transmitter every five minutes, so that’s all you wear. Then there is a blood glucose meter that also talks to the pump, and that is all downloaded into a software package to help you read your reports or link them to your doctor. Like I do with my doctor, and we’ve even zoomed so she can have my reports, we can talk about it. I think it is really amazing the companies have really worked harder on their pumps. they’ve always tried to be at the forefront of technology. The next thing would be to make them smaller. Currently, the 670g is pretty ahead of the game. 


What are some of the main pros and cons of using pumps and CGMs? Like the alerts help you avoid hypo events, etc.?

I was quite resistant to using a pump, but you should know that you have to be ready. You have to decide it, and I sometimes wonder whether or not there is a tipping point where you make that decision, and  I guess the biggest reason is that you don’t wear all that gadgetry unless you’re going to get something out of it. The best part is that I have to think a lot less about day to day stuff by wearing a pump and CGM (Dexcom G6, Freestyle Libre and Medtronic CGM) because I feel confident that it’s doing what it needs to do. I don’t have to worry so much about it because I’ve found that with pens and no CGM you just don’t know where you’re at, that left me feeling really unsure and it kind of messed with my confidence especially at my job when I had to drive a lot, and I had to do presentations. I felt really busy, and I used to worry about everything and feel guilty about it. I think that is the biggest thing for me that I don’t feel that anymore. I feel confident that I’m not gonna have a hypo talking to you now like before. I would have been stressed about that, and I would have eaten 50 million jelly beans before we got to talk because I wouldn’t want to go low. So Yes, confidence is a big thing for me. Control and no hypos are  probably the other big things, 


So now we are getting close to wrapping up. I would like to ask you one thing,  given that you’ve gotta work around the diabetes space for a little while, are there any interesting patient scenarios that pop up to your mind? Any kind of interesting experiences that you have seen with other patients with pumps and CGM? Like I was thinking about an example that we had last week on a particular patient who went on to a pump very late in life and had great results. 

Yeah, I’ve never known anybody to regret it. There are funny stories like when you talk amongst your mates like when you get your pump cords stuck around your steering or gear stick or when you walk past a cupboard, you pull yourself back to the cupboard. So these are some stories from our daily lives. One thing is that you do have to think about what you’re going to put things in the summers and winters. These sorts of funny stories and things people share, but I’ve never known anyone to regret it. 


Thank you so much for giving us your time. Listening to you, I am also looking to have a pump, and I’m sure I’ll get there, and I am also sure it will probably be a Medtronic pump. 

 Well, it would be awesome to see you joining the club.