Posted by on Tuesday 19 June 2012

Dear Medtronic...

Apologies in advance for this really very dull, slightly ranty post on the intricacies of the user-interface on the Medtronic Veo.

I've been having a fairly turbulent time with the old 'goalpost chasing' diabetes game recently. For a month or two my BG averages were climbing... then I hit a patch of a few more lows than usual. At the same time I was in the run-up to my first ever Pump Clinic (which is tomorrow, more on that later) so I was preparing with a few basal tests. These confirmed what I knew already. My basal requirements had shifted. Again. Actually it seems they had shifted several times in opposite directions, and I was still playing catch-up.

This is nothing new of course, it happened to me all the time on MDI too. Before I came across the technique of 'basal testing' I would have attributed these chaotic readings as 'diabetes randomness'. These days, when meal doses and corrections start misbehaving for no apparent reason, a basal test is often my first port of call. With Artoo by my side I have the wonderful ability to quickly try a general raising or lowering of basal even before I have the opportunity to run a proper, detailed basal test. Illness is another time when these Temporary Basal Rates (TBRs) really earn their stripes. For a period of a few days, you might need 10%, 20% or 30% more basal than 'normal'.

For a period of a few days.

I'm not sure what the fine folks at Medtronic think people will use a TBR for, but it doesn't seem that they have considered that option. Well some of them clearly have, because you can set a TBR for up to 24 hours on the Veo. But... Inexplicably, someone decided that the pump should 'warble' at you every hour, day and night, that a TBR is set. If you set it to vibrate it makes several long buzzes. If you set it to short bleeps it's a series of three little 'pips'. Day and night. 24 hours a day. To tell me something that I already know. I have taken to wrapping Artoo in bubblewrap overnight to try to save Jane's sleep (I can sleep through anything, Jane is not so lucky).

It gets worse.

That pip-pip-pip is the only warning sound I get. If I glance at the pump screen there is a hollow circle too (I'll come back to that), but after, say 12-48 hours of illness/TBR you phase out the hourly pip-pip-pip during the day. If during that time you got a 'no delivery', 'low reservoir' or other alarm you would not even think to check what it was because your pump is just intermittently bleeping through the day anyway.

Now continuing with illness as an example... during that time you might generally need more basal, so you set a TBR at 120% for 24 hours. Then you do some activity (gardening? alligator wrestling? route march?) which in your experience usually needs a basal reduction. So now you want set a different (lower) temporary rate for a few hours, then return to your 120% TBR for illness (are you still with me at the back?). What you really want, is to be told when the TBR finishes, so that you can take action then and readjust. But your TBR will end with not so much as a bleep or warble. Nothing. The only time I want Artoo to tell me about a TBR (preferably with a different sound to the more 'serious' alerts) and he stays entirely silent.

The TBR chime is SO unhelpful. It contributes absolutely nothing to the pump user, and actually can potentially obscure/conceal a 'real' alert. I have no idea what is it doing there.

To add insult to injury, however loud those TBR warblings seem to be at 3am, they are pitifully quiet during the day. As a back-up notification on the Veo, there is a hollow circle at the top of the screen that tells you that an 'alert' condition exists. If it's very serious (eg the pump is in Suspend and no insulin is being delivered) this circle is filled with black. This means that at a glance you can see if there is any kind of problem with pump delivery. Very useful you would think... Sadly, again the overlap between 'alert' and 'condition' lets Artoo down. I can choose between up to three basal patterns. Currently I have them set for 'weekend' (waking later) and also for roughly 120% of normal which seemed to be where I settled during the holidays when gym visits fell away. When I'm on 'normal' I can check for the end of a TBR (or another alert for that matter) by looking for the cicle. But... the hollow circle is also used to show 'different basal pattern'. So basically during any weekend or holiday period the circle shows all the time on Artoo. And is therefore useless.

Now don't get me wrong. I think the Veo is a brilliant piece of kit. It is very easy to use and superbly intuitive. Oddly that makes these very strange/illogical/unhelpful UI decisions even more irritating.

So please, please, PLEASE! Medtronic, when you revisit the next version of the Veo: No pointless hourly TBR twittering (or at the very least make it optional so users can turn it off overnight). A different alert sound to identify the end of a TBR. A tiny 'A' and 'B' in a corner of the screen to denote alternate basal patterns. Oh, and the option to increase the volume of alerts so that they can be heard outside of a monastery/library setting would be very helpful too.

Tch! Some people are just never happy :)


  1. Gosh how annoying to have that beeping going on all night - dont think they've thought this through have they? Just to say Animas TBRs run completely silently, for which I am grateful, but must admit a little (optional) alert would be good for when they finish, so I could do a check and assess whether I want to put on another one.

  2. I used to hate that when I was on the Medtronic - my first pump. Both the Animas Ping and OmniPod have that as well but they are options you can turn off. Yes please! Even better, the OmniPod does exactly what you would like - it alerts you when the temp basal is done. Sometimes I forget & wonder why my pod is beeping out of nowhere lol. I don't quite understand why one would need an hourly reminder that the basal has been temporarily adjusted either.

  3. Thanks for the comments! Yes I know I'm not the only one to find these chimes annoying. And I have not found anyone who finds them useful. At all!

  4. I hear you about the need for an "end of temporary basal" alarm. I often set my temp basal lower when I'm doing some physically demanding job, and inevitably I underestimate how long the job will take, so my basal increases without warning and I get socked with a low later.

    I also used to have two basal patterns I used regularly, and got so accustomed to seeing that hollow circle that I'd forget that I'm running around with a low-reservoir or something more attention-needing. A little "A" or "B" at the top sure would be nice! I wonder what the FDA approval process would be for that (then again, if you use the Veo, you're out of the U.S. FDA jurisdiction, so those rules are likely different)

  5. Yes! This pisses me off too! I always get a TBR vibrate just as a) I'm drifting off to sleep b) the pump is underneath my pillow directly below my ear. I suddenly wake thinking I'm being attacked by giant bees!

  6. @Scott Yup! We don't have to jump through FDA hoops here (and have low-suspend to prove it). Sadly though our FDA-a-like body NICE (the national institute for clinical excellence/cost effectiveness depending on how cynical you are!) don't recognise CGMs as a valid treatment option, so for adult pumpers in the UK they are still incredibly rare.

    @Tim What if you *were* being attacked by giant bees as you slept?! Chances are you would leave yourself wide open to attack assuming it was just Englebert wittering away!

  7. We don't have the Veo here yet, but the Medtronic Revel has the same issues.

  8. Just as Cara said, the Revel does do the same thing. And while it is a pain in the butt, have you set a separate "sick" basal and separate "active" basal? They would be your usual percentage higher or lower to account for your needs, and just switch over to that program for however long you need it. That would save on the hourly temp basal sound at least? I have one for PMS. I have to have it for a week, so I just have a separate basal for that week. Seems to help me.

  9. Thanks Sarah, Good thought! Yes I do use one of the basal patterns for illness/lengthy periods of inactivity. Maybe it's just me, but I find illnesses don't just switch on and off though. I might have a week of going up 5% every day or two. Then a few more days at 'illness' level. Then a week or few days coming back down to more like normal.

    TBRs are my friend. I use them *all* the time :)

  10. Great post Mike. Although I can't contribute anything technical especially given TBR's I applaude you for taking the time to put your thoughts out there for all to share.

    If we as the patient/customer won't provide feedback then how can we expect the products to improve. Let's hope that it gets back to the relevant people who can hopefully address that issue!

    Preferably before I get onto #teampump :)

  11. Totally agree with your post. I understand their desire for a large icon to demonstrate many things at once. Seems like MedT thinks numbers and half circles are too complicated for indicating errors, TBRs, and different basal patterns.

  12. Accutrend's Spirit has a number to indicate which basal you are on (out of 5!) and an alarm when your TBR finishes that you have to physically shut off, so in that respect it's better. But it still beeps every hour to let you know you're on a temp. I KNOW! I SET IT!

  13. So this is what I have to look forward to!!
    Seriously though, surely the companies do look at such well written and sensible blogs like this (no false modesty Mike!) to give them the commercial edge they are all looking for. And it does remind me how much of a sense of humour I have to retain......

  14. Thanks heasandford. In truth it's a very *tiny* thing, but surprising how irritating it can become after a few days :)

  15. This drives me mad too. If I want to make significant changes, I set up a second basal profile to mess around with as I can't bear having the hourly TBR alarm. So irritating.