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Assessing the MiniLink.

No More Medtronic MiniLink for me these days.The MiniLink trial has ended.  And I have plenty to say. 

The Good:  First off, Medtronic's level of customer service was unprecedented, which isn't unique for this CGM experience, but for my past four+ years with Medtronic on the whole.  My representative was attentive and drove all the way frickin' down to me from Boston, spending several hours explaining the ins and outs of this technology.  After I was hooked up, a local rep contacted me and offered to walk me through any issues.  Also, my contacts at Joslin were quick to touch base and see if I needed a hand with the insurance hurdles.  Overall, everyone on Medtronic's team made navigating this system as easy as they could.

The MiniLink CGM is smaller than it's predecessor and that shows me the kind of technological progression I need to see in order to become vested in a product.  The shape of the transmitter is rounded and aerodynamic, helping it to lie flat against the skin and remain pretty incognito.  And I didn't need to sport one of those wacky shower patched when I bathed, which was a definite plus.

On the second through the fifth days of a sensor, the numbers were within 50 points of my meter and I saw trends in my afternoons that I had no clue were happening.  Thanks to the CGM technology, I was able to isolate a basal issue and tweak accordingly.  And I loved - LOVED - looking at the graphs and seeing where I had pockets of lows or highs.  Useful information, when it was providing the right data.  

The Bad: 
The CGM has the best intentions, but only when calibrated in ideal circumstances, and my schedule lately hasn't provided many moments of plateau.  The results aren't too shabby when I'm calibrating at the right times, but it missed three bad lows on my overnights - 43, 39, and 34 mg/dl, respectively.  (And when alarms did go off, I couldn't hear them with the pump against my waist and buried underneath the winter blankets.  With the alarm set at 70 mg/dl and not being on the sensor's first day, it should not have missed three of these.)  That's the whole point of the damn thing - to protect me.  It did respond more accurately when I was edging towards a high, which was helpful.
 
But wearing it?  I'm not sure how you do it and not go nuts.  I'm going to work and going to the gym every week day and the sensor did not make dressing for either event very easy.  When I wore it on my arm, I bonked it against door frames and snagged it on sweatshirts.  When I wore it on my thigh, it ached against my muscle tissue.  And the three times I wore it on my abdomen, it was disagreeable because I do not like wearing anything device-esque on my stomach and it felt intrusive to me.   The transmitter doesn't lay flat and seems flop around unless I tape it down with an inordinate amount of medical tape.  And when I didn't have it taped down solidly, it shifted around a bit and tugged the needle out of place, which I found to be very painful.  I do not want any more pain than is necessary, and bloody, botched sites do not bring me any peace.

The Honest: 
  Unfortunately, MiniLink and I did not see eye to eye this round.  I'm not comfortable making any efforts to have my insurance company pay for something that I found to be frustrating, and I definitely am not in a position to pay out-of-pocket just to have one to play with.  I'm not comfortable using the MiniLink for my own diabetes management, but I don't plan on discouraging anyone from using it in theirs.   
 
BUT - and this is huge - I am an adult.  I can test my own blood sugar, dose my own insulin, and communicate how I feel.  I can completely see how a CGM can help a parent of a diabetic child feel like they have a "translator" for their kid's diabetes.  I've rec'd several emails from people on the Children With Diabetes board who asked me about the MiniLink and I recommended it, and other CGMs, to them for that reason.  I can also see how people who have more time to commit to learning this device and spending several weeks making it work in their lifestyle could benefit from the technology.  Maybe now isn't the right time for me to be wrangling in a device that requires plenty of fine-tuning and patience.  But if not now, when?

I hope to retry the Dexcom 7 and see if there have been improvements made from the 3 series I tried last July.  I know that different companies keep coming out with new versions of the continuous glucose monitoring systems, but I just want one that I can rely on, to a certain extent.  Bells and whistles and colors and shapes don't mean as much to me as accurate numbers. 

Comments

An upside--I've heard you don't need shower patches with the Dexcom 7. :)

Thank you for the honest opinion Kerri.

i kind of view the CGMS as WindowsME, it kinda worked, but not really, and not for everyone.

Hmm. I was waiting for this post. I was almost onboard with the MiniLink but I really trust your opinion and am looking at no insurance coverage. I liked my Dex sample last year but it is a big leap. It gives me a lot to think about and it is what has been holding up my 522 arrival.

Great write up - good to read. I've been wearing the sensor on my thigh, and mitigate any flopping by using one 3x 5x ish piece of white Walgreens tape. It works - although the packaging and promo material would lead you to believe it looks a lot sleeker and sexier.

My complaint has been the lag time, and failure to reach highs as quickly as they come - which initially resulted in some overcorrections (both ways.) Based on that I know when it's creeping up I might already be high - and know to stomp those out.

But - I just took a week off without it - simply because I didn't see myself doing anything different or special last week that I'd really USE the numbers and not test. I saved a sensor - and feel that barring the bizzare or weird days of (stress?) highs and lows I think those of us who have a daily routine already know what to expect - so for those paying for a CGM sans insurance or wanting to conserve them I'd recommend using it as backup when doing out of the ordinary activity.

I think wearing a "part time CGM" would be an excellent alternative. Just keep them and use during crazy weeks - and think of it as additional tool in your arsenal.

I'm going overseas for two weeks in March - and bringing a few sensors with me. Long plane flights, long nights, jet lag, and different foods are where the Guardian can show it's mettle. Hopefully...

As always, I appreciate your candor.

Thanks Kerri for your review. I am on the fence on whether I should persue a CGMS. I have been dealing with diabetes for 35 years and have had A1c's in the upper 5 lower 6 range for as long as I can remember. Right now I just think it has too many bugs to be worked out. I think I'll wait until at least the next generation comes out.

thanks for this review, kerri.. it really helps!

I'm not in any rush to get Brendon on the CGM until it's all tweaked and streamlined. Maybe in a few or more years.

It's still in it's buggy, and physically awkward stage right now.

After a few weeks of hard thinking (though no trial run) I just decided against getting a MM522/Minilink for all the same reasons as you list here (most of all THE ACCURACY.) These posts of yours were incredibly helpful as I made my decision. Thank you for all your great writing.

Having a CGM is like having your first baby: there's never really a "good time" to start, you really never can afford it, it takes an incredible amount of work and patience, and you have to catch it when it first messes up to keep it on track. But once you've had it a while it really grows on you and you wonder how you ever got along without it to begin with.

i agree wholeheartedly with nick that having a cgm is like having your first baby (or puppy in my case). i have had mine for almost a year now and the sensor technology has improved so much since then that many of my frustrations with inconsistent readings have been alleviated. i also give much credit to the wonderful minimed reps who have given me so much support and guidance -- much more than my doctor has been capable of providing. i have found that one major benefit of having a cgm is the ability to know why i sometimes wake up feeling hung over in the mornings; i am now able to see where my glucose levels are in the middle of the night and adjust my basals accordingly. as for the fashion issues, well, thank goodness that empire waists are in style now.

Nick, that is such a brilliant description of what its like to live with CGM.

I've been using the Minilink for 12 months now and would hate to be without it. I think it probably took me about 3 months to get to the point where I was 100% comfortable with it.

I find its accurate most of the time, the only time it isn't is when I'm falling or rising really fast. But, and this is the important bit for me, the trends are always spot on. So, if it says I'm rocketing up and am currently 200, I'll generally do a blood test to check as I know I'll probably be higher than that. Before the CGM I wouldn't have even known I was rising so could have been high for a good few hours before I knew.

I tend to wear my Minilink on my back because then I can't see it and its out the way. I don't think I'd last a day with it in my arm!

Thanks for the very valuable review. I think it's a pass for us for now.

Great write up!

We tested the minilink on our 1 month old daughter last week and got 2.5 days out of a sensor. It bled, it was painful (even with Emla), and the accuracy was not too bad but questionable, especially in low and high ranges. We laughed about our excitement when the CGMS number was actually close to our meter. What's the point in having the number on the screen if it is only good for trending? I LOVED the trending arrows however.

We are now on day 4 of the Dexcom 7. I have to say the accuracy is quite a bit better. Very rapid changes in glucose levels tend to be off (as to be expected) but the system from an accuracy perspective is better IMHO, strange readings are corrected or caught up to quickly. The sensor was also easier to insert, no pain, no blood, and our daughter is completely unbothered by it. Now if Dexcom could do an extremely simple programming change and put some trend arrows on it, there wouldn't even be a debate as to which one we would use. Especially since they are getting rid of the tethered calibration, etc.

You should give the dexcom 7 a shot, from what I hear it is improved from the STS by a wide margin.

Your review is spot on! For me, one of the unexpected benefits of childbearing is a nice layer of fat on my hips, so that is where my sensor goes. I tape over it with one IV300 (a nice light square-ish type tape) and it stays put for usually 6 days and I don't even notice it.

I have been using my Minilink for 2 months now and have a love/hate relationship with it; exhausted of it "bugging" me all the time I took it off for a while. But I guess I am hooked because my break only lasted half a day before I couldn't help myself and a new sensor went in. Like someone above said, the numbers are usually off but the trends are right on.

I'm finding it hard not to over correct though. I don't think my overall numbers have been this bad for years!

Kerri,
I tried this CGM around the same time as you and had similar results. Have you tried it again since then? The minimed rep I have dealt with acknowledged it did not work well during the initial phases and that they have made many updates since then. I am going to give it another try very soon, but wanted to see if you had any words of wisdom or experiences to share on this.
Thanks for doing all you do.

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