New Medtronic Revel Insulin Pump and Dexcom Continuous Glucose Monitoring System

Last week I was finally able to see my new endocrinologist in Florida. We decided that it was time to upgrade my insulin pump to the latest model and start using a continuous glucose monitoring system (CGM). My old endocrinologist wanted me to upgrade a couple years ago, but I was hesitant to do so because I was living in Costa Rica, and would have had to rely on my family to relay supplies through the mail. Most packages that leave the USA are subject to search and delays due to local customs policies. Therefore, I wanted to minimize my reliance on the mail as much as possible.

Now I’m in Florida and can personally arrange all my medical shipments and prescriptions. The mail is more reliable 🙂 . More importantly, each company – Medtronic Diabetes and Dexcom – will honor all their warranties and offer emergency shipments when necessary since I’m inside the continental United States. These companies could not make such promises while I was living in Costa Rica. In fact, neither of them would ship directly to Costa Rica since the insulin pump and CGM market there is non-existant. Most people with Type 1 Diabetes in Costa Rica are still on shots, something I stopped nearly 10 years ago. I actually hope these companies start marketing their products in other countries, because they do make a difference in the quality and consistency of one’s treatment.

The Medtronic Revel Insulin Pump is part of the “Paradigm” product line introduced about 10 years ago. My last upgrade was about 4-5 years ago, from the Minimed 508 to the Paradigm 712. The 508 was going the way of the dinosaur. Medtronic was slowly phasing out 508 supplies and almost exclusively offering Paradigm products only. I was forced to upgrade even though I didn’t want to, 😉 but it was for the best. The Paradigm pump offered enhanced features, a better motor, and convenient AAA battery power.

Like any other business, Medtronic needs to make money, and one way of doing that is upgrading people to the “latest” systems. If you have good health insurance, it makes sense to get the best technology available to treat your Type 1 Diabetes. Unfortunately, healthcare – like most things in life – is not free: each time I changed to a new pump model or infusion set supplies, I inevitably had to throw old items out and put new purchases on my credit card. Some of the outdated pump supplies were not fit for medical use and better sent to the dump, but probably had a retail value in excess of $2,000. Meanwhile, I was getting bills from MasterCard for $800 in new pump supplies. The waste and excess of the USA healthcare system is outrageous. Everyone – including those with limited financial resources – would be better served with a secondary market for older insulin pump models sold “as is” or factory refurbished.

The most dramatic change to my treatment regimen is the Dexcom G4 Platinum Continuous Glucose Monitoring system. I haven’t lived in the USA for 9 years, and even though I was aware of the rapidly changing glucose monitoring technologies, the thought of actually adding it into my treatment plan was daunting. My Florida doctor started talking about the Dexcom system as if I was knowledgeable about the topic, but after a few minutes I had to admit my ignorance and we started back at square one. I appreciated his patience and advised him that I tend to have OCD tendencies about my Type 1 treatment, and never really educated myself about continuous glucose monitoring because the thought of change was more terrifying than the potential benefit of using newer technology.

Medtronic DOES offer a continuous glucose monitoring system for its Revel pumps, but it’s accuracy after 6-7 days of use is not as reliable as the Dexcom system. Medtronic has a better system in the works, but is currently waiting for FDA approval before bringing it to market. If Medtronic’s new system is better than Dexcom’s, no doubt I’ll be switching over as fast as they can bill my health insurance. For now, it makes sense to use the more robust and accurate Dexcom CGM. We’ll see how it goes.

Psychologically, here’s where I’m at:

The Good News: My diabetes is under control, my A1C is nearly that of a non-diabetic, my weight is down, and my blood work showed no problems with cholesterol, kidney functions, or proteins (Ketones). My body is healthy and I’m not facing a health crisis.

The Bad News: CHANGE. All this new technology and tweaks to my insulin regimen will throw off my numbers for a few weeks until I get used to everything. During my appointment, I almost asked the doctor, “If it ain’t broke, why fix it?”, but that’s a cop-out that stubborn people like me use all the time. I’m settled in my new apartment and have some time to try new things. Why not get the best treatment alternatives available?

In the end, I’m afraid my numbers will suffer and my current positive outlook on my physical health will change to dismay and “What was I thinking?” self doubt interrogatives.

I need to put fear aside for a moment and take a risk that might yield a happier, more flexible lifestyle. Continuous glucose monitoring delivers sugar readings every 5 minutes, a huge improvement over my “old system” of sticking my arm 4-5 times a day. It just makes sense to upgrade my treatment and outlook.

Good luck to anyone else making changes in their healthcare. It’s scary but usually works out for the best! (Now, what to do about my BPD??? 🙂 ) – that’s for another post.