The MiniMed Paradigm Veo System

The MiniMed Paradigm Veo System

Australians with type 1 diabetes such as six year-old, Harper Climo, now have access to new technology which mimics some key elements of the human pancreas. This new device can automatically suspend insulin delivery to potentially reduce the severity of low blood sugar, a dangerous and frequent occurrence in diabetes management.

The MiniMed Paradigm™ Veo™ System from Medtronic combines insulin pump therapy and continuous glucose monitoring with a unique new capability to automatically suspend insulin delivery temporarily if glucose levels become too low. This helps to potentially prevent low blood sugar (also known as hypoglycaemia) when a person is asleep or unable to react.

If left untreated, hypoglycaemia can cause loss of consciousness, seizure, coma or even death. More than half (54%) of respondents to a survey conducted by the Juvenile Diabetes Research Foundation in 2006 had experienced a hypoglycaemic attack severe enough to require assistance. A total of 78% had experienced a nocturnal hypoglycaemic attack. Additionally, each year nearly one in 14 people with insulin-treated diabetes will experience one or more episodes of severe hypoglycaemia, which requires urgent treatment by healthcare professionals.

There are currently more than 140,000 people with diabetes in Australia with type 1 diabetes, which is thought to be increasing at a rate of 3% amongst Australian children. A third of type 1 diabetes patients suffer fromhypoglycaemia while asleep, which may impair their ability to recognise or act to prevent a serious episode.

The MiniMed Paradigm Veo System includes an insulin pump with continuous glucose monitoring (provided by means of a separate sensor and transmitter). The patient uses readings from the monitor in conjunction with occasional confirmatory fingerstick measurements to understand their current glucose level, and program the insulin pump to deliver the appropriate amount of insulin. However, if data transmitted from the sensor shows that the patient's glucose levels have dropped below a defined threshold, the insulin pump automatically suspends insulin delivery for up to two hours. This may help to protect against or reduce the severity of potentially dangerous hypoglycaemic events.

While some patients can experience 'warning signs' before a hypoglycaemic event (such as feeling shaky, sweating, tingling in the lips, going pale, heart pounding, confusion and irritability), others do not experience any warning signs at all.

"Hypoglycaemia, especially overnight is a major problem for children with diabetes," said Clinical Associate Professor Tim Jones, Head Department of Endocrinology, Princess Margaret Hospital for Children and TheInstitute for Child Health Research. "A pump that will suspend insulin delivery at the first sign of low blood glucose levels offers the potential to prevent severe events.
"Many children and adolescents have a reduced awareness of symptoms of hypoglycaemia, this puts them at increased risk of severe episodes, the new pump will help prevent these and may even help restore the symptoms," he said.

Commenting on the importance of this development, Mike Wilson, Chief Executive of the Juvenile Diabetes Research Foundation of Australia, the world's leading charitable funder of type 1 diabetes research said: "Research has shown that new technologies such as insulin pumps and continuous glucose monitors can dramatically cut the risk of both short and long-term health complications associated with diabetes."
"These technologies are an important step towards developing a completely automated diabetes management system - effectively an artificial pancreas. While this isn't a cure, it will help to significantly reduce serious diabetic health complications while reducing the burden on individuals and families that live with the constant fear of blood sugar fluctuations."

Eventually, Medtronic hopes to deliver a fully automatic product that will function exactly like a healthy pancreas - monitoring glucose levels and delivering the right amount of insulin without any user intervention whatsoever. With the MiniMed Paradigm Veo System we are another step closer to closing the loop. Paradigm Veo System is produced by Medtronic. More information is available at: www.medtronic-diabetes.com.au

Interview with Michele Skippen

Michele Skippen is Harper's mother as well as a credentialed Diabetes Educator.

How did you previously manage Harper's diabetes?

Michele Skippen: Going back years to when Harper was eleven months old and diagnosed she was on injections, that was four injections a day. I had to administrate the injections and she was having about 12, little blood tests, the finger pricks, a day. Harper was only on the injections for three months because it was a nightmare, it is really hard to manage a baby that is breastfed and it is very hard to tell a baby how much to eat and when to eat it.

At fourteen months old she went onto the Medtronic Insulin Pump and that changed our lives, it gave us so much more freedom and flexibility; Harper could sleep in, eat when she wanted, eat what she wanted. She didn't want any carbohydrates and that was okay, we could cope with that as well. The Medtronic Insulin Pump made life a lot easier and allowed us to travel to America, not long after she started the pump and that went really well.

The Medtronic Insulin Pump is a device Harper has to wear twenty four hours a day, but all you have to do, pretty much, is press a button. Whenever Harper eats carbohydrates you just press a button, if she doesn't want to eat all day, she just wants to have bacon and eggs for breakfast (which is protein, not carbohydrates) it's fine- you couldn't do that on injections, but you can do it on the Medtronic Insulin Pump. Harper can also sleep in which you couldn't do before on injections. Often at McDonalds when you ask for a Diet Coke in the Happy Meal, they forget, or make a mistake and give you a normal Coke which causes problems, but that is much easier to manage with the Medtronic Insulin Pump, you just have to press the button and she will receive more insulin to cover for it.


Question: Can you talk a little bit about the way the MiniMed Paradigm™ Veo™ System works for Harper?

Michele Skippen: In February of 2010 we started the newest pump, the Veo™. The MiniMed Paradigm™ Veo™ System comes with a continuous glucose monitoring system and this is another sensor that Harper wears as well, twenty four hours a day. The MiniMed Paradigm™ Veo™ System is even better again as it takes her glucose level every three minutes and we can see the result on the front of the screen of her pump. Again, we have even more control, freedom and flexibility as we know what her level is doing, all day. If you only do twelve tests, a day, it's only really twelve seconds of the day, you see what Harper's number is, but with the continuous glucose monitoring system you can basically see every three minutes, what her level is doing. It is easy to know if is she going down or if she going up, which allows you to react much quicker and deal with any issues if she is going too low or too high- we are able to deal with this straight away.


Question: Can you explain how you are alerted when Harper needs assistance due to her type 1 diabetes?

Michele Skippen: With the Medtronic Insulin Pump there is a feature called the Low Suspend and that is the only Pump even made that has this capability. You have to pick a low threshold number for Harper's blood glucose levels, which is generally around 3.8. If the glucose level hits that, the Pump will alarm. If I don't hear that alarm for some reason, if its night and I am deep asleep and Harper is at the other end of the house, also in deep sleep, the alarm will turn itself off for two hours, which is great, very smart and is a big safety feature, not only for kids, but people that live alone. The Pump will alarm before the patient even gets to the low blood glucose level set. You may never actually use that Low Suspend but if they ever did drop and you weren't around and something happened there is the added reassurance that I know, that for some reason if Harper does drop to that level and she doesn't wake up to react to it herself and have something to eat at least the Pump will turn itself off for two hours. After that two hours, it turns itself back on, if the level is still at the 3.8 or lower, it will alarm again and it keeps going in cycles and turning off for two hours at a time and a message will come up on the screen saying 'I am a diabetic, please call an ambulance', which helps if she is out somewhere and it happened and I wasn't around.


Question: Does the MiniMed Paradigm™ Veo™ allow Harper to have sleepovers or go on school camp?

Michele Skippen: Absolutely! The MiniMed Paradigm™ Veo™ takes all the guess work out of it. A parent or teacher might put her to bed and normally they would cross their fingers that everything would be fine, overnight, but at least with this new system, it will alarm as an alert which is great. It is different during the day, like most diabetics, Harper knows if her levels are low, she'll often say "I feel funny" or "I'm dizzy" and let me know that she is feeling low. It is much safer for sleepovers and school that the MiniMed Paradigm™ Veo™ alarms if assistance is required and parents and teachers don't have to panic and test every hour.


Question: Does the alarm feature ensure that Harper does not experience a hypoglycemic attack?

Michele Skippen: Yes! Harper may still have a hypoglycemic attack but the Pump will alert you to it and allow you to react to it, quicker. Some diabetics in the night may have a hypoglycaemic episode and sleep though it or stay in that state, the whole night. You can be a hypoglycemic low level and not have any symptoms, if you're not that low, say 4. If you are lower than 4, say in the 2's or even 1's then you have to react quickly or else diabetics can slip into a coma, quite quickly.


Question: If the alarm does go off in the MiniMed Paradigm™ Veo™ what treatment is needed?

Michele Skippen: Usually at that level the diabetic is awake or you can wake them and you have to give them sugar such as, jelly beans, lemonade, Coke or something very sweet, they have got to have that straight away. There are things beside Harper's bed, if ever we have needed them, which we haven't, thank goodness. Harper will come and grab a Pop Juice out of the fridge if she hears that alarm, as it alerts her before she gets to that stage. If her level goes too low and we don't react quick enough or the patient can't be woken then a special injection has to be given or an ambulance has to be called to administrate the injection.

Question: What does Harper think of the new technology?

Michele Skippen: She loves it, she is so used to having diabetes as she has had it from eleven months and she just turned seven, the biggest thing for her at the moment is that it is a cool colour, a pink pump with a Tinkerbell sticker. Harper has freedom and flexibility that allows her to be, just like her friends, which is great. At seven there are lots of birthday parties and sleepovers and she is able to do all of that, now. All her friends are quite good and they know what a low level is and what a high level is, they also understand that she has to test. Harper has never hidden that she has diabetes and with her school friends, that see her everyday, they know that she has a hypoglycemia kit at school which has juice and sugar packets, on the teacher's desk. Her school friends support her and stand up for her; she has really good support at school.

My niece is also diabetic, she just turned 18 and I have got to see her go through high school, which has helped. I am an educator at the hospital so we teach all the patients with diabetes that diabetes is nothing to be ashamed of and they shouldn't hide it or hold them back from sport, jobs or getting their licence. Diabetes used to affect lives, you couldn't join the police force, scuba dive and there were many restrictions; thank goodness we are moving with the times and the research.


Interview by Brooke Hunter