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RE: [IP] D vs. MM (long)

Sandi Pope <email @ redacted> wrote:

> 3  new pump due out this summer with MM 508 software
> (sans the problem) diff types of boluses, easier
> scrolling, etc

The MiniMed 508 problem was fixed last November.  The problem had no effect
on the safety or general reliability of the pump.  It was a nuisance only.
> 4  it is waterproof, even without the red tappet, no
> disconnecting for anything

Actually, the MiniMed 508 is also waterproof for the important parts.  The
drying precautions are just that -- precautions.
> 5  comes with back up pump, because that is the
> standard in Europe, D decided to keep the stds the
> same for the whole company, no reason to ever go back
> to shots

The D-tron will not have a second pump in the package.  The second pump
procedure came from Swiss law (D is a Swiss company) which requires a backup
system be constantly available in case of failure of any potentially life
saving equipment.  It never was for altruistic reasons.
> 6  D has developed and received approval in Europe for
> a closed loop system or artificial pancreas

MiniMed has been working on such a system for over a year.  Early tests with
dogs have shown a high level of success.  One person whose son works for a
medical research organization (I don't know which one) has told me that one
has been implanted in at least one human being.  Since I haven't been able
to substantiate this, it's best to consider it a rumor at this point.
> 2  not waterproof and must disconnect

Not entirely true.  While MiniMed *does* say that if the internal part gets
wet by dropping into a bathtub, for example, to remove the reservoir and dry
it out.  This is precautionary.  The internal circuitry, motor, etc., is all
inside a waterproof case.
> 3  only capable of .1 unit basals, so if a young child
> or active adult only wants say .4 unit basals per hour
> then the pump delivers .1 unit every 15 minutes, this
> is why MM is having a terrible time with occlusions, 
> just recently MM has bought Humalog crystals from
> Lilly to try to reformulate them so that their pumps
> won't clog

The MiniMed 508 allows a setting for more dilute insulin (e.g. 50 u per ml).
Lilly is working to develop a buffered Humalog specifically for use in
pumps.  Can you document the occlusion problems?  Why would MiniMed have
this problem with occlusion due to the Humalog while the Disetronic not?
This sounds more like an argument to use regular insulin instead of Humalog
than an issue of which pump to choose.

> 4  if there is a problem with your pump you must
> resort to shots for however long it takes the loaner
> to arrive

According to the MiniMed people here in Atlanta, one should arrive by the
earliest FedEx delivery available.
> 5  MM has developed a continuous glucose montoring
> system the only problem is that is measures
> interstitial fluid which is not accurate and it is
> very expensive for the doctors to purchase ($5,000)

The accuracy is approximately the same as for a blood glucose monitor --
that is it meets the criteria for waived laboratory tests under the Clinical
Laboratory Improvement Amendments of 1988 (CLIA 88) as do *all* commercially
available home test meters.  The difference is in the lag time between blood
glucose and interstitial fluid glucose, which is not yet well documented
(This lag time is the reason for the delays in the availability of the
GlucoWatch system which also measures interstitial cell glucose, not blood
glucose).  The $5000 price tag includes two CGMS units, the comm unit,
software, and support.  Sensors are $30 each.  The purpose of the CGMS is
*not* to replace regular testing but to better see the diurnal trends in
one's control.  Further, there is no way to get real time readings from the

> 6 half of MM profits come from the supplies, reps push
> that business, changing the insulin cartridge
> everytime time for example

Only half?  Are you suggesting that Disetronic doesn't do the same?
Actually, I get the reservoirs separately from the infusion kits.  I suppose
I could order half the number of reservoirs, etc.  I know the Silhouette
kits can be ordered as complete or what they call "combo" with twice the
number of cannulas as tubing sets.  Not much difference in price, though.
> the single biggest reason I chose D for my two kids is
> the basal delivery system that gives you 20 pulses per
> hour.

And that is probably the best reason to choose the Disetronic, particularly
for children (and others) who are very insulin sensitive.

> Now, I found out some VERY underhanded and illegal
> business practices MM uses to destroy D's reputation. 
> MM has been taked to court by D in FL for improper
> sales tactics and advertising, settled prior to trial.

How was it settled?  Was there any admission on MiniMed's part?  Why did
Disetronic drop the suit?  Without this information, your sentence is mostly
innuendo, and is quite defaming.
> There is much
> more and if you want email me privately.

I suggest that if there is substantiation of these allegations that they be
made public.  These are serious charges, and could impact many of us if they
are true.

The bottom line, IMHO, is that both pumps are useful devices, and the Animas
pump will be as well.  Most of the choice of one pump over the other comes
down to personal preference on someone's part.  There is no fundamental
difference in what they do -- deliver measured doses of insulin in a
reliable, programmable way.

Jim Handsfield
Centers for Disease Control and Prevention
mailto:email @ redacted OR
mailto:email @ redacted

The opinions expressed are my own and do not necessarily represent those of
the Centers for Disease Control and Prevention, the United States Public
Health Service or any other agency of the United States government.
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