MiniMed Guardian monitor



who the hell wants a cable attached to their ear??? isn't that kinda DORKY??

DAVE

Mark S. Davies wrote:

> On Sat, 14 Feb 2004 11:25:27 -0600, "William C Biggs MD" <[email protected]> wrote:
>
>
>>Mark,
>>
>>I haven't seen the actual unit in operation.
>>
>>If this device doesn't have the actual glucose on it's display, I will be really disappointed.
>>
>>In the past, warning devices used exclusively for detection of hypos have not done very well.
>>
>>The Teledyne Sleep Sentry works for some people, and has been available for many years. The cost
>>is a tiny fraction of a glucowatch or the MiniMed system. However it doesn't work for everybody,
>>and is virtually worthless during the day because of false alarms.
>>
>>I will need to see if the data is downloadable into a computer in real time. You might be able to
>>get a current reading that way.
>>
>>Otherwise, the number of people who would be interested in this device just dropped by about 99% .
>>
>>
>>Thanks for the correction.
>>
>>
>>WCB
>
> At this point, I'm hoping that the Sugar Trac will come out this year and work somewhere close to
> the current promotional statements.
>
> Non-invasive, much smaller, readout, and a pricing of $350 basic unit and $1 per day for the
> consumable (the earclip) vs. Invasive, 2 bigger pieces, no readout, and a pricing of $1000 and $12
> per day? Even if the Sugar Trac doesn't have alarms, the only real advantage of the Guardian
> doesn't come until it can be hooked to the pump to close the loop....
>
> Mark Davies
 
On Mon, 16 Feb 2004 16:30:05 GMT, Bay Area Dave <[email protected]> wrote:

>I disagree with you on the Guardian's usefulness. Alarming, especially during sleep is a big
>feature. I was a bit low all night (not dangerously) and woke with a headache. I'd have preferred
>to be awakened to slow down my pump or have a tiny snack. Then I'd wake up more refreshed.
>
>As far as "closing the loop", the loop is gonna have to be PERFECT for me to buy into the
>technology. Pumping is quite reliable; bg readings are NOT. Look at how the Guardian REQUIRES that
>you calibrate it as LEAST twice a day to another meter. That's not too reassuring, now is it??
>
>dave
>
Dave -

Starting off with some info so you know my point of view. I'm not diabetic (although I'm a good
candidate for syndrome x Type 2 in the near future). My 18 year old son has been Type 1 for 9 years,
and is going off to college this fall. He had the early Medtronic CGMS for a weekend trial about a
year or 2 ago, and found it very intrusive (and that was before the transmitter pod was part of the
system). The trial with the monitor showed that he's extremely brittle - it was common for his
glucose levels go up or down by 200 points in a half hour period, independent of any food or
insulin. At the time of the trial, he was on a MDI 4 shot a day schedule, using sliding scale of
Humalog. He's now on a 508 pump.

Given all the above, you can see how we'd love to have him hooked to something with an alarm,
especially given how my wife and I worry about him going off to college. But $350 a month in sensor
costs alone? I find that extremely hard to justify, especially if it turns out the Sugar Trac does
have an alarm. I know the Pendragon will have an alarm, if it ever makes it to the US.

As far as closing the loop - I'd be comfortable with the accuracy of the current day meters in
closing the loop. I'd want more proof of the Guardian under difficult conditions. Developing a
continuous monitoring system has obviously been difficult, but it also seems the tricky part of the
closed loop system is the software - it's too easy to get into a feedback loop that ends up
delivering too much insulin.

To respond to a follow up post about the wire to the ear appearing "dorky". No doubt, that's true.
But the saucer sized piece glued to your chest for the Guardian isn't very chic, either, and I think
you only need to clip the earpiece on to take a reading. If you want to leave it on all night (if
there's an alarm), that shouldn't become a fashion statement.

I'm angry at Medtronic, if the information we've seen is true. I just have a vision of a marketing
guy saying "We need to make as much money as we can before our competitor's devices come on to the
market. We can frighten enough parents into paying big bucks now, then we'll drop our prices once we
face competition...."

Mark Davies
 
Mark, thanks for the background info. Gotta agree that the sensor cost is outrageous and hopefully
if the unit turns out to be useful (in the true sense of the word), then insurance will pick up most
or all the tab for this additional bit of hardware for us DM's. I still wouldn't trust a closed loop
system unless the method of delivery/dissipation of the insulin is an order of magnitude faster. ie.
subcu delivery is NOT going to work with a closed loop system. you'd need an implantable pump to
pull that feat off. Have you read about the dynamics of a subcu pump vs implantable. Different
animal altogether. When they get THAT worked out then we are talking an "artificial pancreas" of
sorts. A Paradigm isn't gonna do for a "closed loop" pump/monitor. Insulin takes too long to become
active and lasts too long for closed loop operation.

Please note that the other infrared monitor didn't fare too well--it supposedly worked on the
fingertips. I'm the original doubting Thomas when it comes to bleeding edge technology. Look at
those silly overpriced plasma TV's. Not ONE of them has a decent black level; they all looked washed
out because they can't display an adequately dark "black". Doesn't matter if you pay 3K or 10K; the
technology isn't quite "there" yet.

For all our sakes I hope the medical equipment supply companies like Medtronic keep burning the
midnight oil to come up with the next "breakthrough" product to help us manage this disease. Right
now, we've got excellent meters and excellent pumps. Blending them together is a step in the right
direction. Expecting a subcutaneous delivered injection of Humalog to work in a closed loop system
is asking the impossible. Hope you understand what I'm getting at; I can't recall and recite all the
specifics about the subject, but I've read enough and understand enough about insulin injected just
under the skin, vs the "hockey puck" method to know only the puck can go closed loop some day.

dave

Mark S. Davies wrote:

> On Mon, 16 Feb 2004 16:30:05 GMT, Bay Area Dave <[email protected]> wrote:
>
>
>>I disagree with you on the Guardian's usefulness. Alarming, especially during sleep is a big
>>feature. I was a bit low all night (not dangerously) and woke with a headache. I'd have preferred
>>to be awakened to slow down my pump or have a tiny snack. Then I'd wake up more refreshed.
>>
>>As far as "closing the loop", the loop is gonna have to be PERFECT for me to buy into the
>>technology. Pumping is quite reliable; bg readings are NOT. Look at how the Guardian REQUIRES that
>>you calibrate it as LEAST twice a day to another meter. That's not too reassuring, now is it??
>>
>>dave
>>
>
> Dave -
>
> Starting off with some info so you know my point of view. I'm not diabetic (although I'm a good
> candidate for syndrome x Type 2 in the near future). My 18 year old son has been Type 1 for 9
> years, and is going off to college this fall. He had the early Medtronic CGMS for a weekend trial
> about a year or 2 ago, and found it very intrusive (and that was before the transmitter pod was
> part of the system). The trial with the monitor showed that he's extremely brittle - it was common
> for his glucose levels go up or down by 200 points in a half hour period, independent of any food
> or insulin. At the time of the trial, he was on a MDI 4 shot a day schedule, using sliding scale
> of Humalog. He's now on a 508 pump.
>
> Given all the above, you can see how we'd love to have him hooked to something with an alarm,
> especially given how my wife and I worry about him going off to college. But $350 a month in
> sensor costs alone? I find that extremely hard to justify, especially if it turns out the Sugar
> Trac does have an alarm. I know the Pendragon will have an alarm, if it ever makes it to the US.
>
> As far as closing the loop - I'd be comfortable with the accuracy of the current day meters in
> closing the loop. I'd want more proof of the Guardian under difficult conditions. Developing a
> continuous monitoring system has obviously been difficult, but it also seems the tricky part of
> the closed loop system is the software - it's too easy to get into a feedback loop that ends up
> delivering too much insulin.
>
> To respond to a follow up post about the wire to the ear appearing "dorky". No doubt, that's true.
> But the saucer sized piece glued to your chest for the Guardian isn't very chic, either, and I
> think you only need to clip the earpiece on to take a reading. If you want to leave it on all
> night (if there's an alarm), that shouldn't become a fashion statement.
>
> I'm angry at Medtronic, if the information we've seen is true. I just have a vision of a marketing
> guy saying "We need to make as much money as we can before our competitor's devices come on to the
> market. We can frighten enough parents into paying big bucks now, then we'll drop our prices once
> we face competition...."
>
> Mark Davies