New pump and CGM! :D

Just in time for 2014, I got the new 530G Medtronic pump and Enlite sensor (for continuous glucose monitoring). It is always fun to get new things and see all the new features available on such a piece of technology. Unfortunately, now that I have the pump and I've done all the reading and training to use it, I don't know if I will actually be able to use all of the new features. So what do I have? A fancy, upgraded (*and purple!) version of what I had before. Don't get me wrong. As a tool for my diabetes and getting closer to my A1c (average glucose) goals this should be beneficial and I'm glad I got it. I'm just not as excited to have it as I was anticipating receiving it. It is supposed to be more accurate and at least I don't need to pull out the user manual and I can clear an alarm without looking, but I feel like that is part of what makes new things fun.
In contrast, I got a FitBit for Christmas and I am constantly looking up tips and hints on their Help site! The new pump just went in my TummieTote (which is my favorite pump accessory by far!) and I more or less forgot about it. Not one part of the dimensions, buttons or general appearance has changed.

Let's break down the good, bad and things I'm indifferent about.
 Pros:

• I can dial in basal rates and boluses in much smaller amounts with up to 3 decimal places (which I might not necessarily need, but my doctor wants me to try).
• I can flag events under "Capture Event" such as exercise, food (without bolus), and meter BG (without bolus or calibration) so it will show on the pump software reports my doctor sees instead of having to match up a separate record. That is, as long as I remember to "Capture" at the time the event is occurring. (If only it had NFC capabilities...)
• Threshold Suspend - this is the most hyped feature of this pump, which Medtronic chose to title an "Artificial Pancreas" feature. When turned on, the pump will suspend all insulin delivery for 2 hours if I do not respond to a Low Glucose Alert. This is only beneficial if the CGM is accurately calibrated, i.e. I truly have low blood sugar when the sensor indicates. Also this will have a loud, obnoxious, continual alarm during the entire time the pump is suspended. If I am unconscious then hopefully this will mean that someone (probably my husband or a coworker) will come to my aid. When not properly calibrated (which could happen in random situations), this could mean a lot of disturbed sleep.
• Overall accuracy of the sensor should be improved.
• Size of sensor electrode is smaller in length and gauge. It is much less painful on insertion too. I was shocked by how little I felt (I inserted my first Enlite sensor on Jan 7, 2014 at a pump training session so will be doing my second insertion by myself, probably tomorrow!). I also don't have to pinch or look for fattier areas to insert the sensor or worry about significant bleeding which I think will improve accuracy. I can put it in less fatty areas with less scar tissue and better circulation (of glucose to interstitial fluid from the bloodstream and vice versa). Hopefully insertion will continue to be easy, since I have read reviews saying otherwise.
• Sensor has been approved (and will continue to work without the 3 hour restart period) for use for 6 days. Since I used the old sensors for as long as possible (despite them only being approved for 3 days) and on average got about 8 or 9 days out of them, this is not exceptional for me. With the minimal taping advised and my fear that the sensor will pop out, especially with summer activities, I really hope the majority of sensors last for 6 days.

Day 2 (Jan 8, 2014)

Day 5 (Jan 12, 2014) Surprised the sensor is still in

Day 5 (Jan 12, 2014) There is no way to replace this wider tape, and it is all I can use to hold the sensor half of the CGM down. Water freely flows under parts of it (what will happen if I go swimming?) and last night my pump tubing got caught under the transmitter side (which hurt!).

 Good things (Beneficial, but not fantastic):

• The reservoirs, infusion sets and overall set up, buttons to press, etc are the same.
• Menu is much more user-friendly. It uses titles like "Reservoir + Set" and "Fill Cannula" instead of the more general term "Prime". Once an Alarm is cleared, the pump displays the part of a menu that would come in use for that alarm.
• Low and high prediction Alert.
• Trending high or low Alert. This would be extremely irritating if there is no significance to the increase. For instance, if I increase from 130 to 100 over 10 minutes, it doesn't matter to me as much as a situation where I go from 100 to 70 in 10 minutes. However this feature does not discriminate between the two situations.
• Missed bolus reminder for those who forget to bolus during a certain time period. This is useful but it requires a person to eat at the same times each day. I love the flexibility of having a pump because I tend to have a different schedule on any given day. I will soon get "alarm insensitivity" if I used features like this. It would also be a hindrance if I am speaking with a client at work and my pump keeps vibrating. I also hate having to explain these sorts of things to strangers.

 Cons (mostly my concerns):

• When I have the option for Low Alerts turned on, I also have to have the High Alerts turned on. It might not be intuitive, but I don't really mind having high glucose. I usually test my glucose every 5 or 6 hours or look at the number on my pump. At minimum I test before each meal and/or snack. If I have high glucose, my basal rate will take care of it or I will catch it in plenty of time to compensate. Luckily, I can set the high alert to alarm every 3 hours instead of every 20 to 30 minutes as I usually set the Low Alert. Low glucose, especially when I am having a "good BG day" is much more important to catch asap.
• The instructions in this pdf document are the only backup I have for preventing moisture (sweat, shower, pool water, etc) from getting under the adhesive holding the sensor in place. I do not feel confident about this staying in place during a day at the waterpark or just a day outside in humidity of a Virginia summer. My pump trainer said that if we use the entire IV3000 transparent dressing over the sensor and transmitter together (which I found worked the majority of the time with the old sensors) it will buckle and cause the sensor electrode to pop out. This is unfortunate because she also claimed that most insurance will not cover extra sensors. Meaning: I'm probably going to be wearing the sensors for more than 6 days to compensate for those I might lose. I'd say that I would minimize the number of showers per week or the amount of activity I do in my pool or outdoors during the summer, but that's not going to happen!
• This pump only works in mg/dL and my brain works in mmol/L. I didn't even ask about that because my old pump had both units (apparently people are bad at selecting units and picked the wrong one and messed everything up...argh...FDA..). So after nearly 25 years (in March 2014) of using mmol/L from living in Canada, I have to adapt to new units. And after probably 15 years of One Touch meters, it looks like I'm going to be switching to Contour (since the Contour Next syncs with the pump, which is pretty cool). I have already made the mistake of overcompensating insulin correction instead of letting the Bolus Wizard take care of it.

 To anyone considering upgrading: if insurance will cover it, I highly recommend doing it. I don't know how this pump will be for me over the next 4 years, but I figure the more up-to-date I can be, and call me crazy, the closer I will be to having the correct calibrations and preparations for the true Artificial Pancreas that is on the horizon!

Most recently: HbA1c: 7.4%, 140.5 lbs; left ankle mild peroneal and Achilles tendinitis, calf cramping. Have not worked for 5 weeks and doing physical therapy twice a week. Exercise: stationary bike, stretches. Calorie counting with FitBit.