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Review: Experiences with MiniMed Paradigm
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Dear reading beings,
After 4.5 happy years with MiniMed 508, I applied to my health insurance company for its successor, MiniMed Paradigm 512. My 508 simply wasn’t up to date anymore, and I wanted to use the many new features of No. 512. Now you, dear pump-users and non-pump-users, diabetics and interested non-diabetics, can read how I like my 512, that I tenderly call “Salusina Adelgundis von Maubeuge” (i.e. Salusina derives from Salus, the patron saint of health; Adelgundis von Maubeuge was the patroness of many little ailments. :o) )
♥ Why use a pump? ♥
An insulin pump is part of the therapy for insulin-dependent diabetes (Type I), formerly known as juvenile-onset diabetes. (Those who are interested in further details are heartily welcome to read my diabetes report.)
Pump therapy is the latest and most progressive form of insulin therapy. The insulin isn’t injected anymore, but emitted into the body by a small pump. The pump is worn attached to the body all the time; while an injection needle supplies insulin. The insulin is in an vial or in a reservoir in the pump. The catheter consists of a 6 to 12 mm long needle made of steel or Teflon and of a plaster for fixing it. Via this aditus insulin is emitted into the subcutaneous fatty tissue. The concept consists of a basal rate covering the amount of insulin that is generally required and of several bolus rates regulating the rising blood glucose after meals and correcting blood glucose values. The pump contains only one type of insulin, either normal insulin with a short effect or an insulin analog. Pump therapy is the best insulin therapy because it imitates the pancreas of a non-diabetic. A patient using pump therapy, consequently, can lead an almost ordinary life. You can dose the insulin more precise, and the dosage can be adapted to specific requirements; thus, blood glucose values are more stable. Pump therapy, in most cases, makes hemoglobin HbA1c decrease and diminishes the risk of subsequent damages.
♥ Appearance ♥
To my mind, the Paradigm is a very good-looking pump. It is very small (7.6 x 5.1 x 2.0cm) and light (100g, as much as a bar of Ritter Sport chocolate), and it doesn’t look “medical” at all. People who don’t know that I have diabetes think that it is a pager or an mp3-player. It is available in four different colours: transparent, blue, smoke, and purple. All colours are semi-transparent (see photos). I chose the purple one, by the way. Although purple, the colour is very dark and discreet, but still a bit more interesting than dark grey, and it goes well with many of my clothes. If you still need greater choice, you can decorate the pump with adhesive Paradigm skins. They are part of every reservoir pack; and there are many different types ranging from leopard pattern over football-team logos to floral designs – everything is available. You can see my pump with a rose skin on the picture below. ;-)
♥ MiniMed Paradigm – Overview of Functions ♥
Minimed Paradigm is distributed by the company Medtronic. It has been on the market since 2002, at that time with No. 511. Today, there is already No. 522, that can be integrated in the so-called Real-Time-System with continuous blood glucose monitoring and automatic insulin correction. Paradigm 712 is equipped with the same functions, by the way, but it has a larger reservoir (3 ml). No. 512 only has got a 1.8 ml reservoir. Hence, it might be the best choice for people who don’t need a large amount of insulin and prefer a small pump. Its navigation of menu is logical and handling it is easy, even for kids and elderly people. It is excellently manufactured. I haven’t noticed any flaws yet, and its display doesn’t get scratches as easily as the 508 did.
Paradigm Link:
No. 512 doesn’t have Real-Time-Function yet, but a Paradigm-Link Function, i.e. it can communicate with the accessory measuring device Ascensia Contour II. It calculates a correction for the bolus according to your blood glucose values. I don’t need this function because I don’t like Contour II very much. I’m using another monitor and enter my blood glucose values manually. A Contour II-user still may find this very useful.
Bolus Wizard:
To my mind, this is the best new function of the Paradigm pump. According to your blood glucose value and the amount of carbohydrates you want to eat, the pump calculates the adequate bolus. It determines, for instance, the bolus dose for 3 BU with the value of 7.8 mmol/l at 6 pm. Furthermore, it considers how much insulin from the last bolus is still active, so there is no interference that might lead to hypoglycaemia. The pump makes a suggestion first, and if you don’t agree, you can correct it. In addition, when using the Bolus Wizard, you can check how much insulin is still active. I always use the Wizard because, to my mind, it is just extremely useful. You don’t need to calculate in your head and, as long as the factors for calculating the bolus rate are correct, you will have reliably good values after a meal, thanks to Bolus Wizard.
Remote control:
Like No. 508, the Paradigm 512, too, comes with a remote control. I hardly ever use it, but when wearing long dresses or other “difficult” clothes, it might make sense to use the remote instead of rummaging around for the pump. In this case, the pump uses vibration or sound signals, so nothing can go wrong with the bolus. :-)
In addition, the remote only works properly with the respective pump.
Bolus options:
There are three different bolus options: normal, dual, and extended bolus. Normal bolus emits all the insulin directly; extended bolus spreads it over several hours; and dual bolus subdivides it all. Dual bolus and extended bolus are useful when blood glucose is only rising slowly after a very rich meal. However, up to now I have only used the normal bolus because, generally, my blood glucose values rise quickly after a meal; and I hardly ever have rich meals. By the way, users of other pumps produced by competing companies criticise that the Paradigm emits the bolus very slowly, that is 0.1 IU per second. However, I am satisfied with this speed, I got used to even slower emission using the 508 (0.1 IU per 4 seconds). It even hurts me if too much insulin is pumped in little time. For this reason, I am fine with it. Admittedly, people who need much insulin and often have a bolus of 20 to 30 units will have to be patient till it has run through.
Basal rate options:
Like for the 508, there are 3 basal rate profiles (e.g. every day, weekend, workday). One can enter 48 basal rates, i.e. programme a new amount of insulin for every half hour of the day. This works in measures of 0.05 units which supports a very precise dosage. This is very useful, particularly for babies and little children, because 0.1 units may be too much for them already. I don’t necessarily need such an accurate dosage, but for children it is absolutely convenient. A function I am constantly using, on the other hand, is the lowering or the raise of my basal rate. Exercise, stress and illness also change blood glucose values, so you have to be able to react quickly by lowering or raising your basal rate. You can do this either by units or by percentage (a great advantage compared to the MiniMed 508 which couldn’t do it by percentage).
Reminder:
Another brilliant function, that is very useful is the reminder. It helps you remind yourself of checking blood glucose values at a particular time. It is particularly useful for children who can’t tell the time yet or who are likely to forget monitoring their values, but also for me. The pump can be used as alarm clock, for instance. I use this function to remind me of taking the pill because I always have the pump with me, unlike my mobile phone. By regulating the volume, one can decide how discreet the reminder will be.
Memory:
The pump’s memory saves every “event” of the last 90 days; i.e. which bolus was emitted when at which value, when the pump was filled, if there was an alarm, etc. It is a great advantage in comparison to No. 508, which only saved 25 events.
Catheter-refill-programme:
In contrast to No. 508, I don’t need to fill the catheter manually anymore. I still have to fill the reservoirs, i.e. the small insulin containers in the pump, by hand, but I don’t mind because I’m using an insulin analog which isn’t available in pre-filled vials anyway. The pump has got a thread inside with a plug that can be rewound electronically. Then you can insert the reservoir and fill the catheter with the help of the refill-programme until insulin leaks in front. This is super convenient. It is unbelievable how long I had to wait when I used the 508. because I had to do everything manually and it worked very slowly. Lighting: the display has got a greenish grey backlighting, so you can use the pump even in the dark (at night or at the cinema). It provides enough light to recognise where the buttons are, but a separate lighting for the buttons would have been useful because you can’t read the writing on the buttons, even with the light on.
♥ Compatibility ♥
Infusion-sets:
The paradigms have their very own connection-system, i.e. there are special Paradigm reservoirs and compatible catheters; in particular, the Easy-Set made of steel with an insertion angle of 90°, the Quick-Set made of Teflon with a 90° insertion angle, the Sof-Set made of Teflon with a 90° insertion angle but without plaster, and the Silhouette-Set made of Teflon with a variable insertion angle. Unfortunately, I can’t handle the Teflon-catheters produced by MiniMed, although I would like to use Teflon. Hence, I changed to other catheters with a classic Luer-Lock connector. The compatible reservoirs with Luer-Lock for Paradigm are offered by Wellion. The company Medtronic suggests not to use these ones (it is obvious why ;-) ), so their warranty won’t cover it if anything goes wrong. On the other hand, during the six years of my experience, I only once had a broken reservoir, and that one was produced by Medtronic. So no worries; use Wellion reservoirs if you want to apply your preferred catheters.
Batteries:
Paradigms work with ordinary AAA batteries, a great advantage in comparison to other pumps which need special batteries that are expensive and difficult to find. Depending on usage (i.e. vibration alarm, lighting, etc.), batteries last 1 to 2 months. Cheap batteries don’t work, though, because the pump simply won’t accept them. To be sure, it should be a quality brand like Energizer.
♥ Accessories ♥
A belt clip and a black leather case come with the pump. However, there are many different cases (e.g. nylon, neoprene, leather, waterproof Activity-guards, bra-cases etc.) and belts (for your back, belly, legs etc.) available. As far as I know, insurance companies will pay for one case of your choice.
♥ Availability ♥
The final question is, of course, where to get the pump if you want one. A pump costs about 4000 to 4500 Euro. Applying for a pump becomes increasingly difficult because of the complicated financial situation of our health care system. My own application was already approved in 2002, when I got my MiniMed 508. A little later the Paradigm 512 was advertised and I wanted to change as soon as possible. But it took four and a half years until I got it. My health insurance company weren’t convinced of the advantages of the new pump before my doctor, my mother and I pushed them to process my application until it was accepted. Not every insurance company will cover pump therapy and they won’t pay for every pump. This means you have to be persistent and may not give up. And when you have the pump: Do your best to keep your values up or to even improve them. Otherwise the insurance company might very quickly take the pump away again for the reason that the therapy didn’t show any effect. There is a clear disadvantage of MiniMed insulin pumps: Despite their 4-years-warranty, you don’t automatically get a new pump when it has expired (like from Accu Chek), but you have to submit a new application which will only be approved in exceptional cases.
♥ Conclusion ♥
I am completely satisfied with Paradigm 512 and recommend it to all potential pump-users. It looks good, is small, light and provides many useful functions. It is ideal for children because of very precise dosage, and it has never let me down. I don’t miss anything except for the Real-Time-System of No. 522. However, that one is only accepted by insurance companies in exceptional cases anyway. Disadvantages: no Luer-Lock connection on the company reservoirs, no warranty for other reservoirs, it doesn’t work with cheap batteries, you don’t automatically get a new pump after four years. To my mind, and in the opinion of many other Paradigm users, the advantages still outnumber the disadvantages. 5 stars!!!
By Lithium (translated by Yvonne Balzer)
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