Dear Dr. Beach:
I read your article last month about the advances in diabetes and was wondering if you could answer another similar question. The new pump you mentioned sounds very interesting. Do you have any other information about it? I have been on the pump for five years and was thinking about trying the new one so any further information about it would be very helpful.
Sincerely, M.M.
Dear M.M., It seems that the best way to answer questions in this column is through experience with some additional medical information. I have been wearing Medtronic's new Revel pump for the past three weeks. First and foremost, the new pump has some new features that enable significant fine tuning of insulin delivery. For any patient on a basal rate of less than 1.0 units per hour, the Revel is able to deliver in 0.025 increments. This is wonderful for me, as I find that overnight, 0.5 units per hour leads to low sugars and 0.45 results in morning high sugars. Now, I am able to deliver 0.475 units per hour, which seems perfect. Likewise, any patient with a carbohydrate ratio less than 10 can fine-tune the ratio to the 10th degree. In other words, for patients at 1 unit to 8 grams of carbohydrates, they can now change the ratio to 8.5 or 8.7. This makes the delivery of insulin for meals even more precise. Another nice safety feature on the new pump is the fact that the active insulin time is displayed more often. This provides safer delivery of insulin as the patient can identify any active insulin and avoid low blood sugars. One of my favorite new features is the missed bolus alert.
The Revel pump enables the patient to set certain time spans when they would normally bolus such that if the patient forgets to bolus, the pump will alarm. I find this very useful across the dinner hours as I often forget to bolus and a gentle reminder helps me avoid high sugars.
The true beauty of Medtronic's Revel pump is with the sensor alerts.
First, for those of you annoyed by sensor alarms all night or, more likely, your spouse is annoyed, the Revel allows you to set different parameters by time of day. So you may want sugars between 80 and 150 during the day, but perhaps 80 to 200 at night will result in better sleep. Secondly, the Revel has a rate-of-change alert. In the past, rapid changes in the sensor readings were only noted by an arrow or two if you happened to look at the pump screen at the right time. The Revel will alarm whenever the rate of change is significant and give you an opportunity to address this issue appropriately.
Lastly, my favorite of all features is the predictive alerts. The Revel pump will alert the patient that it is predicting sugar will be high or low in a set amount of time. In my case, I get an alarm predicting a high or low sugar 30 minutes before it happens! This feature is absolutely amazing.
This enables me to make efforts to stay within a normal sugar range and address issues before they occur. This feature alone has made my life much easier and prevented both high and low sugars.
Overall, the changes and features added to Medtronic's Revel are fantastic. In my opinion, this is the Cadillac of insulin pumps. Many of the benefits are associated with the continuous glucose monitoring system, and I would encourage any patient on the pump to try to obtain this system. If you have had a Medtronic pump for four or more years, you are due for an upgrade and should talk to your health-care provider. If you are on a Medtronic pump but it is not 4 years old, then you can pursue the Revel through a pathway program. This is how I was able to upgrade, and the process was fairly simple. Medtronic's Web site, www.medtronicminimed.com, has all of the information required, and I encourage all patients on pumps or interested in pumps to visit this Web site for further information.
Dr. Jonathan Beach, who has lived with diabetes himself since age 4, heads the Northeast Center for Diabetes Care and Education at Urgicare of the Northeast in Plattsburgh. Send questions to him for this column, which runs the second Tuesday of every month, to: The Northeast Center for Diabetes Care and Education, 79 Hammond Lane, Suite #2, Plattsburgh, NY 12901 or E-mail Dr. Beach at: diabetescenter@urgicarenortheast.com
