I was previously seeing a pediatrician who was great, but when I turned 18, he refused to see me as a diabetic patient anymore and referred me to an endocrinologist. Well, I made it almost 2 years without an endocrinologist until finally I no longer had anyone willing to write my prescriptions. I called up the practice I was referred to by my pediatrician and scheduled an appointment. It was a terrible experience. For a doctor known as one of the best (according to D-magazine), the guy could have given a [expletive removed] about providing quality care. Yeah, his nurse even told me he’s gone for a few months every year to go skiing. I was notified at the end of the appointment that I would receive my a1c result in a week. WHAT?? What kind of top rated endocrinologist doesn’t have an in-office a1c machine (i.e. a Bayer DCA2000)? Anyway, it didn’t take me long to decide I would not be coming back. Oh wait, maybe I had made up my mind when  I found out that they “didn’t receive” the insurance information I faxed them and that they didn’t know how to authorize a pump supplies refill with Medtronic. I should also note that two doctors from this practice made it into the endocrinology section of “D Best”.

My search for a new endocrinologist began. I searched Google for a while until I found someone who had a pretty impressive background. His website noted that he has started more people on pumps than any other doctor in Texas. Wow! Turns out I was very lucky. I can’t say enough good things about the guy. I went to the appointment, he sat down with me for almost 1.5 hours and explained new treatments I could try along with recent developments in the diabetes world. Being a professor at UT Southwestern, he was very connected with current research. I left here with a Symlin pen, my a1c (which by the way was 6.0–only time will tell if the Symlin gets me back to the 5.5 I once had), and lots of new knowledge about current diabetes research.

Why am I posting this? Well I would have liked to find an article like this one when I searched Google for diabetes endocrinologist dallas. If you would like names of any of the people I have mentioned in this article, post a comment with a valid email. Put your email address in the “email” field (so that it won’t be published) and in the comment section just say you’d like the names of people mentioned here.

A couple issues I have with the Quickset having come from the all-mighty Insets.

Quickserter

Insertion – The Quickserter is not quite the tool it seems when watching video demos on Minimed’s website. It took me up to 5 minutes each site change just to get the thing loaded properly. Nothing like the Insets which come attached to a nice disposable plastic insertion device. My frustration with the Quickserter grew so I decided to try inserting a Quickset manually. The first time was slightly nerve racking (I hadn’t inserted a set manually in years), but with a firm quick wrist movement, I managed to insert a Quickset twice just as painlessly as the Quickserter had done. Huge time saver. Conclusion: Quickserter is worthless; insertion is painless when done manually

Quickset connector

Connector – With the name “Quickset” you would think it would be very simple to disconnect and reconnect the tubing. Personally, I find the connector a little more complicated than it needs to be. Again, I love the Inset’s design in this area. In order to disconnect a Quickset, you have to squeeze the tabs and twist. Seem simple enough? It is, unless you are trying to disconnect through your clothing, something I do frequently. Reconnecting is where I came across more problems. To reconnect the tubing, a donut-like circle must be placed over  the infusion part of the set, lined up with the arrows and twisted. This becomes difficult when you place a set in a hard to reach area (i.e. your bottom) and can’t see the arrow–you have to play with it until it locks in place. Since I started using the Quickset, I have also had 2 instances where I absolutely could not reconnect the tubing (it wouldn’t fit onto the infusion piece) and had to resorted to inserting a new set. To be fair, I could have done something wrong, but as far as I am aware, I did everything properly. Conclusion: the connector could use a redesign

Other than the issues I outlined above, the Quicksets have been good. At the moment, I believe them to be my best option. That is, until a Minimed compatible Inset becomes available.

Minimed Guardian RT (left) and Dexcom Seven Plus (right)

Sensor Insertion
The Minimed’s insertion is simpler and and more straight forward, but I like the Dexcom insertion better. First of all, the way the Dexcom’s inserter is designed, it is much more difficult to mess up with the angle and the insertion needle is more likely to enter the skin fully. With the Guardian, if I was at all hesitant when pressing the trigger, it wasn’t uncommon for the insertion needle to only make it half way in. Overall, the Dexcom may be a little less painful, but they are quite similar in that respect. It is much more difficult to remove the insertion device and connect the transmitter on the Dexcom, so this may make it less favorable for those wanting to place the sensor in harder to reach areas.

Transmitter/Sensor design
As far as the design of the transmitter and sensor go, both systems have advantages and disadvantages. The Dexcom adhesive patch is much better than the Guardian. So far, it has been totally unnecessary to use any type of dressing that was necessary to make the Guardian transmitter/sensor stay on. The Dexcom’s adhesive patch is larger overall, but worth the size in my opinion given that it is much more secure. Plus, once you put Tegaderm or IV3000 over the Guardian’s sensor, it’s going to cover a larger area. As far as I can tell, the Dexcom’s transmitter doesn’t have a battery. My assumption here is that there is a small battery attached to the sensor…? To me this is an advantage because it takes off an extra 30 minutes of waiting every time the sensor is changed. Major drawback on the Dexcom is the the transmitter has no memory. This is something I didn’t consider before purchasing the device. If the receiver is not in range, quite simply, you are losing precious data. On the other hand, the Guardian’s transmitter stores 45 minutes of data, so you don’t lose anything as long as you get back in range of the receiver within 45 minutes. As far as range, the signal strength is about the same on both devices.

Receiver design

The Guardian is a clear winner for me as far as the receiver goes, however, both leave much to be desired. The larger screen on the Dexcom may be attractive to some, and the larger case unattractive. Unfortunately, to me, it seems that the larger screen is there for no reason. That is, they aren’t making good use of it. The graph on the Dexcom shows a range of 40-400 on the y-axis, so even if all of your readings are between 80 and 120, you’re stuck looking at a graph with a vertical scale of 40-400. A waste of screen space? Tell me about it. So if your eyes are bad, don’t let the larger screen lure you in. Additionally, on the Dexcom, there is no way to view specific data points on the graph. The Guardian has a cursor that allows you to scroll through the data points on the graph. Lastly, the Dexcom receiver also needs a 3 hour charge every 3 days. Now why in the world they would do this is beyond me. Perhaps they picked the wrong area to go green. I tried letting it charge overnight, but the transmitter signal didn’t make it to my night stand which cost me a whole night of data.

Sensor Wear Length
Dexcom advertises a 7 day sensor wear that I have decided is bogus. In reality, Dexcom sensors don’t last any longer than the Minimed sensors. What does this mean for the user? It means that you are paying more for a sensor that is going to last the same amount of time. As far as I can tell, these are essentially the same sensors Dexcom was selling when they only had an indication for 3 day wear.

Accuracy
To be honest, I don’t have much to say here. From what I can tell, accuracy of the two devices is very similar. With the Dexcom, I sometimes get one data point that’s way off of the others (ie noise), but that’s rare enough for me to ignore. For both devices, accuracy is highly dependent on where and how the sensor is placed, but personally, I have found the Guardian to be a bit more reliable.

Calibration
Dexcom is the winner here. It doesn’t just stop giving you data if you don’t calibrate within a 12 hour period. Just a notification that it needs to be calibrated. The Guardian forces you to calibrate at 12 hours which is a nuisance especially if it happens to be at a time that isn’t ideal for calibration, such as during a high or a period of rapid blood glucose movement.

Software
Carelink (Minimed’s web based software) is easier to use and can be accessed from any computer. Dexcom’s DM3 provides slightly more analysis capability, including graphs annotated with food, insulin and exercise data, but for me this doesn’t make up for the fact that it isn’t web based.

Conclusion
Both devices are good, but I prefer the Guardian (I’m now using the Minimed 722 w/CGMS) over the Dexcom. Minimed has given me better reliability and the sensors aren’t nearly as expensive when you consider that the price difference is simply because of the wear indication.

A new Fifty50 reservoir

It’s a great concept, but the reservoirs leave much to be desired as far as removing air bubbles. I never had problems with air bubbles when using my Animas pump, so I had no idea what I was in for. The plunger lacks the pointed tip that is found on the Animas cartridges so there is nothing to push air out of the connector portion of the reservoir. This means that in order to expel the bubbles, the bubbles must be positioned perfectly under the luer lock connector. Once I had a clean reservoir with no bubbles, priming the pump was another challenge. When priming, bubbles tended to get stuck in the area circled in the image below. I’m not sure what is different about the Fifty50 reservoirs that caused this, but it happened very consistently and took lots of patience and insulin to overcome.

Animas reservoir's pointed plunger tip

Bubbles tend to get stuck in the circled area when the tubing is attached.

Once I managed to get rid of all bubbles (took around 15 minutes for each fill), I had no problems with the reservoir. While I don’t recommend these reservoirs to someone new to a Minimed pump like me, they may be an OK alternative for someone with patience and extra luer lock infusion sets. They do work, and they do give consumers more choice, so despite some flaws, credit must be given to the company that created and manufactures these.