Market forces in the insulin pump space.

It’s no secret that the number of people diagnosed with diabetes is growing, here in the United States and elsewhere. Yet, with the end of the Snap insulin pump last Friday, insulin pump options just got smaller. Does that mean we’ll start to see less innovation in pumping? Less options to upgrade? Possibly a higher cost?

I fear the answer may be Yes.

It’s all tied to a little thing I don’t like to call supply and demand. But I guess I have to.

There are roughly 300,000 insulin pumpers in the USA, give or take 50,000, depending on who you get your data from. As of this time last week, there were six insulin pump options available. That’s about 50,000 pumpers per maker, though obviously, some companies have more market share than others. Today, there are five pumps available to People With Diabetes in this country. If we divide the math evenly, that’s immediately 10,000 more users per pump.

Of course, if you’re a maker of one of these (still available) pumps, you might want to make a deal with previous Snap users to get them under your umbrella before another company does. That’s also supply and demand. So Insulet, makers of the OmniPod, and Animas, makers of the Vibe, are offering deals for Snap pumpers to move to their respective offerings.

Once this transition is complete (I’m guessing in about four months or so), the offers will probably end. At that point, who knows? Well, we do know this: With fewer competitors, pump makers will be less inclined to compete for our business. They will all see a spike in their revenue as a result of Asante’s demise, and they will all believe they have the best pump on the market. So if they don’t want to offer an upgrade pathway for existing users (as Tandem’s t:slim has declined to do recently), they won’t. Especially if you’ve still got some time under warranty left.

And what about price? The retail cost of an insulin pump has been right around $5,000 to $6,500 per unit for some years now. We know that the cost of everything goes up at some point, but that’s especially troubling when it comes to our diabetes, which costs a great deal of my disposable income already, even though I have good insurance coverage. The thought of having to pay even more for something I rely on so heavily is scary indeed. If I finally decide on a new pump in six months, will I have to pay a higher price?

Will I be paying a higher price for what is essentially the same pump? I’m thrilled that Medtronic has their threshold suspend technology, and I’ve seen and heard lots of positive news about the Vibe, but… the pumps themselves, on the outside, appear to be pretty much the same pumps as the previous generation from these companies. At this point, manufacturing these for a number of years (remember, only the software is different) should make the cost to the manufacturer far less than it was at the beginning of their run. But will it still be the same cost? Without any significant innovation other than software, which should also get less expensive over time?

I wish I had we had the chance to try out every pump on the market. Then I’d we’d be able to decide for ourselves if there is something special about a pump that is worth paying the same, or an extra, price for. Or something about a pump that makes it not worth paying the same, or an extra, price for.

Not that we’d be allowed to do that.

More choice, at least steady improvement, and a chance to upgrade for a fair price. Is that all we get, if we’re lucky? How about more innovation, more choices, and less cost as a product gets older? They even do that with mobile phones, for heaven’s sake. Is someone saying we’re not as worthy of innovation, choice, and affordability as the average cell phone user?

That’s the message I’m hearing, and I fear we may not be at the end of this cycle yet.

And then there’s the real world.

With the excitement over Diabetes Blog Week, I was brought right back down to earth again with two important pieces of news.

One of these stories you probably know already, and one you may not know about at all:

Asante Solutions, makers of the Snap insulin pump (I did the 30 day trial of the Snap last summer), has closed up shop. They left a message on their website Friday saying that they were no longer in business.

This comes as a shock to many, including me. I was so happy with my trial of the Snap last year that I was ready to sign up with Asante the very minute they were approved to use Novolog cartridges (their product only used cartridges filled with Humalog). It was an easy pump to use, it had all of the regular features you’d expect on a pump, plus a couple of extras including its own flashlight, and those glass-filled cartridges filled with Humalog. No more filling reservoirs doesn’t seem like that big of a deal until you actually don’t have to do it anymore. Now, with such a unique feature, Snap users can only use the pump as long as the insulin they have on hand lasts. Unless someone figures out how to refill the used cartridges, which, I don’t even want to think about right now.

It was a big deal last August when Asante announced a partnership of sorts with Dexcom to integrate the Dex mobile app into the Snap architecture. Now that is all for naught, many previously happy pump users have to go searching again, and through the insurance paperwork gauntlet again, and over 100 employees are out of a job.

If you’re a Snap user, you do have an option to transition to the Animas Vibe system. According to Asante’s going out of business announcement, “Animas is graciously offering a limited time offer to all existing Snap users to transition to the Animas Vibe pump.”

No word yet on what that offer might be. To get on your local rep’s call sheet with Animas, call 877-937-7867, extension 1562.


Let’s talk about something better: The U.S. Food and Drug Administration is seeking our input again!

The FDA has prepared draft guidance on collecting and submitting patient preference information, so FDA can consider the benefit-risk thinking of patients using medical devices like insulin pumps and CGMs.

From the introduction of this document, in FDA’s own words:
”FDA believes that patients can and should bring their own experiences to bear in helping the Agency to evaluate the risk-benefit profile of certain devices.”
I’m all for that. Once the draft is finalized, it will become the new standard for how FDA thinks about patient preferences when reviewing the devices we use to help us live better lives.

One thing the draft guidance won’t do: It won’t change review standards for safety and effectiveness, and it won’t create extra burden on sponsors of premarket submissions of devices to FDA.

Still, pretty exciting that we’re being asked for our feedback, that our input will result in edits to existing benefit-risk guidance already in place, and that FDA plans to take it seriously during reviews.

We have until August 17 to leave comments on this guidance, and I, along with some others, are still going over this to try and better understand it (it’s 35 pages long). Hopefully, more information will be forthcoming (he said all officially-sounding).

To get a look at the draft guidance and leave a comment, CLICK HERE.

When was the last time anyone ever asked you to talk about what you like or don’t like about your devices? Asked you what you can live with, and what you can’t? Here’s your chance.

Expect to hear more about this soon.

#DBlogWeek Day 7: Continuing Connections.

This is the sixth year of Diabetes Blog Week, started by Karen over at Bitter~Sweet Diabetes. All of us diabetes bloggers are given a subject to write about each day during this week, and after we publish each day’s installment, we’ll go back and link our posts on her site. Want to know more? CLICK HERE.
Here we are.. the final day of Diabetes Blog Week 2015. Thank you Karen for this fantastic idea, and for all of the hard work you put in every year to make this a really great week.

This is the conclusion of my fourth year of participation in #DBlogWeek, and it’s the first year that I’ve written on all of the topics. I usually use one or two of the wildcard topics, but this year, all of the topics just spoke to me.

Including today’s topic: Continuing Connections.

“The very first inspiration for Diabetes Blog Week was to help connect our blogging community, and that continues to be the most important reason it’s held every year. So let’s help foster and continue those connections as we wrap up another Dblog Week. Share a link to a new blog you’ve found or a new friend you’ve made. Or pick a random blog off of the Participant’s List, check it out and share it with us. Let’s take some time today to make new friends.”
This is a reaaalllly difficult topic. Please understand that when I give you links to two of the posts that I really liked this week, they are not the only posts I found interesting or inspiring. They are two among the many, many blog posts I read, commented on, got misty over, and thought about during this time. I love reading new and old blogs, and finding out about how people go through their daily lives with diabetes along for the ride.

Okay, with that disclaimer out of the way, here we go:
First, a blog that’s been around for a while. Alanna Swartz writes Life on T1, about her experiences in Nova Scotia, working for JDRF, and getting ready to get married. Oh, and about diabetes too. She is a super-duper advocate.

On Day 3 of Diabetes Blog Week (Clean it Out), she opened up to talk about body image issues, how people perceive them, how hard she works every day, and why she just is so done with worrying about it anymore. It was an incredibly brave post, and it made me want to hug her and tell her that I am in her corner no matter what. Check this out.
This next blog is one that has been around a while, but one that I have just found this week. Steve writes at a blog called Without Envy, where he writes about life as a parent of a girl with Type 1 Diabetes. On Day 4 (Changes), he talked about Empathy and Effort, in a well-written post entitled A New Utopia. Seriously, this guy is a good writer.
Bonus: I know I said I had two links to share, but I have a bonus for you too. Molly Schreiber lives in Baltimore like me, and on her blog called And Then You’re At Jax she had a rant on Day 4 that says exactly how we all feel sometimes when it comes to people who think they know what to tell us about our diabetes. It’s definitely worth a bonus read.
I have so enjoyed reading new and existing blogs this week! I hope you’ve enjoyed Diabetes Blog Week as much as I have. But check back again soon. There are some new things coming to this space very soon. In the meantime, enjoy your Sunday.

#DBlogWeek Day 6: Favorites and Motivation.

This is the sixth year of Diabetes Blog Week, started by Karen over at Bitter~Sweet Diabetes. All of us diabetes bloggers are given a subject to write about each day during this week, and after we publish each day’s installment, we’ll go back and link our posts on her site. Want to know more? CLICK HERE.
Welcome to the weekend. It’s a lovely Day 6 of Diabetes Blog Week, and it’s Preakness Day in Baltimore. Those two don’t have any correlation other than the date, but I live about ten minutes from Pimlico, so I just thought I’d throw it in.

Our topic today: Favorites and Motivation.

If you have been blogging for a while, what is your favorite sentence or blogpost that you have ever written? Is it diabetes related or just life related? If you are a new blogger and don’t have a favorite yet, tell us what motivated you to start sharing your story by writing a blog? (Thank you Laddie of Test Guess and Go for suggesting this topic.)
To be honest, I’m looking forward to reading my fellow blogger’s thoughts on this subject more than I’m looking forward to writing about myself. Or my writing. But, I’ll try to give you a few favorites of mine over the past three years.

The blog post that seemed to resonate the most with readers was something I wrote on #DBlogCheck Day 2013. In that post, I wrote about how important it is to add your voice to the ever-growing Diabetes Community. Nearly two years later, this still remains the most read thing I’ve ever written. I love supporting people. There’s nothing that I stand to gain as a blogger that I wouldn’t give to another writer when they really need it. This post was a way for me to say this community is big enough for all of us. Let’s all help more people get the love, support, and acceptance we’ve all experienced. I think the way I wrapped up that post said it all:

Your story is the most important one in the world to the person moved by it. Don’t let down the one person who needs to hear you.”
Personally, the one thing I wrote that means a lot to me was about Interoperability Awareness. I wrote it in anticipation of speaking during the comments portion of a public workshop at the U.S. Food and Drug Administration. When I did get up and speak, I delivered this text almost verbatim. It was the first time I felt like I had learned something from my fellow Diabetes Advocates and put it to good use. I was grateful, humbled, and swept up in a wave of emotion all at the same time.

“To talk about the proprietary nature of software that a company has developed just doesn’t hold water anymore. The software that comes with your device doesn’t have a separate line item on the invoice. It’s baked into the price. Protecting “intellectual property rights”, in this case, is a 20th Century complaint for a 21st Century world. And it’s an 18th Century argument when it comes to what is best for the patient. I’ve said it before, and I mean it: Patient trumps Proprietary.”
Finally, a phrase. It’s become kind of a mantra around here. I want you to know that it’s not a throwaway line… I really mean this with all my heart. I first wrote it in a letter to myself five years earlier (you have to read it to understand what that means). I wanted myself to understand then, and I want others to understand now, that there are not limits on my support of your hopes and dreams. I will leave this with you now. And please, feel free to steal it and use it yourself.

I support you… no conditions.

Happy Saturday!

#DBlogWeek Day 5: Let’s check out the menu.

This is the sixth year of Diabetes Blog Week, started by Karen over at Bitter~Sweet Diabetes. All of us diabetes bloggers are given a subject to write about each day during this week, and after we publish each day’s installment, we’ll go back and link our posts on her site. Want to know more? CLICK HERE.
It’s Frrriiiidaaaay! Today’s topic is all about what we’re eating:

Taking a cue from Adam Brown’s recent post, write a post documenting what you eat in a day! Feel free to add links to recommended recipes/shops/whatever. Make it an ideal day or a come-as-you-are day – no judgments either way. (Thank you, Katy of Bigfoot Child Have Diabetes for this topic.)

Today is a super busy day for me, so I must confess… I have to punt on this one.

Instead of talking about what I’m eating (this morning it was toast and coffeee… boring!), I’m going to go back and give you three of my favorite recipes I’ve posted here at Happy-Medium. You can use one for breakfast, one for lunch, and one for dinner. Or, as my grandparents used to say, one for breakfast, one for dinner, and one for supper.

First, my recipe for salmon cured with tequila, among other things. This is a great brunch food, actually.

This isn’t a Kosher-exclusive dish, to be sure, but had I not been exposed to the influences I’ve been exposed to here in Baltimore, I probably never would have tried this. And I love it! You’re going to find this is a very easy recipe, and one you can vary according to what’s on hand in your pantry and what you really like. If you close it up tightly after it’s cured, you can probably keep it in the fridge for four or five days.


I started with a ¾ pound filet. What you see was labeled as steelhead trout, but you might also see it as freshwater salmon in places. You’ll also need a deep dish, and a brick or something weighty to place on top of the fish while it cures. For my recipe, I included:

½ cup of kosher salt

1 tablespoon celery salt

1 tablespoon brown sugar

1 tablespoon dill (fresh is best, but I used dried because that’s what I had)

1 tablespoon McCormick’s® Grill Mates® mesquite seasoning

1 tablespoon extra virgin olive oil


Basically, you mix all of the dry ingredients, then add the olive oil and tequila until you have what seems like a dry paste. If you think your mixture is too wet, just add some more dry ingredients.


Now it’s time to get your hands dirty. Put your fish in your deep dish… this is where it will sit for a couple of days. Take your mixture and rub it over your fish. Make sure the mixture covers every single inch of the surface of the fish. If you don’t have enough to cover the fish, make more.


Once the fish is covered in your seasonings, wrap everything up. First in plastic, then in foil. Again, make sure the entire surface of the fish is covered. Place the fish in your refrigerator, and then place your “something weighty” on top. We used a brick from our landscaping outside, and wrapped it in foil. This helps your spices to really get into your fish, and it helps with the curing process too.


Then the hard part starts. Because you have to wait 48 hours to unwrap everything and dig in. Don’t be surprised if some of the liquid drains from the fish during this time. That’s normal, and it’s why you have it in a deep dish.

Once your 48 hours are up, get the dish out of the refrigerator and uncover everything. If you have to, use a paper towel to remove any leftover moisture.


Here’s what the finished product looks like on a cracker with cheese and some tomato. Salty, a little smoky, and melt in your mouth good.

Fish isn’t your thing? Have no fear. From Diabetes Blog Week 2012, the lunch menu includes a grilled pork salad:

Grilled Pork Salad

Grilled Pork Salad

This is just an awesome salad, not only because it’s (mostly) healthy, but also because it includes grilled pork. Of course, if you keep Kosher, you’re Muslim, vegetarian, vegan, etc., substitute something that works for you. You can probably still use this marinade:

3 tablespoons red wine vinegar
1/4 cup of olive oil
1 teaspoon salt (or seasoning salt, if you like)
1 teaspoon cayenne pepper
2 cloves of garlic, minced
1 or 2 tablespoons of fresh sage, chopped (or use dried sage, what do I care?)
2 or 3 tablespoons of good mustard (your choice here; I used the spicy brown stuff)

Mix all of these ingredients together in a bowl. Then, get 1 to 1 1/2 pounds of pork. I used a pork tenderloin from the local Trader Joe’s. Then, slice or dice it how you want. You want to make strips? Go ahead. Slice it like steak? Okay. I cut it up into bite sized portions (that’s how it was going to go onto the plate anyway). Then dump it all into the marinade for about 30 minutes. It will look like this:


While the pork is swimming around in all that mustardy-sagey goodness, get to work on the salad. Everybody has their own way to do a salad, so I’m not going to give a recipe. Okay, I am, but it’s really more of a description of the salad I made. So that’s not a recipe, is it?

1 head of Romaine lettuce
1/2 of a Radicchio
1 cup of broccoli slaw (about a handful or two)
1/2 cup of chopped carrots
1 or 2 large green onions (also known as scallions; but I grew up eating these things, and they were never called scallions then, so I can’t bring myself to call them that now)
1/2 cup of sunflower seeds
1/2 cup of dried cranberries

Mix it all together in a bowl, and set it aside. When you’re finished grilling the pork (USDA recommends that the pork be cooked to an internal temperature of 145 degrees), let it rest for at least 5 minutes before slicing, if you have to do that. As stated above, I had mine in bite-sized portions already, and cooked them in one of those cage-like things people grill their vegetables in.

This is great for lunch or dinner. Trust me… you will love it.

Finally, from last October, a flatbread pizza. We cooked it in the oven then, but we recently prepared this on the grill outside and it was amazing. Sorry if it looks like there’s advertising here; I’m just noting what I used, and I wasn’t compensated in any way for using these products.

Preheat your oven to 400 degrees fahrenheit. I’m still working on this; you can probably cook these a little lower, say around 350. The idea is to get all the ingredients cooked through while crisping up the flatbread, but not burning it. A little finesse is required. We’ve also done this on the grill, which requires a very low flame so you don’t burn the flatbread. Regardless, watch it like a hawk the first time.


I started with flatbread from Flatout Bread. Good size, easy to use, fits on a cookie sheet. 16 grams of carbohydrates per flatbread. They come in a variety of options, including Garden Spinach and Sundried Tomato. I used the Italian Herb. FYI: Their website contains great recipes from other bloggers.

I like to put a very thin layer of olive oil on the bottom of my cookie sheet, along with some garlic powder or celery salt, to give the crust a little zing. Then I went to the refrigerator.


I just looked for anything that might taste good on a pizza. I found turkey deli meat (for Maureen), salami deli meat (for me), green onions, baby portabella mushrooms, and green olives. I also had some cherry tomatoes left from my garden.

We began the pizza build with Classico Fire Roasted Pizza Sauce. The nutrition label says that ¼ cup carries about 6 grams of carbohydrates, and that’s about the amount we used on each pizza. I’m also a big fan of basil on my pizza; we didn’t have fresh basil, but I sprinkled some dried basil flakes on top of the pizza sauce to give it an extra layer of flavor.

Then we just started piling on ingredients! One thing about the tomatoes: A lot of flavor is in the juice of tomatoes, but that extra liquid can really make your pizza soggy if you’re not careful. These cherry tomatoes worked fine, but we made sure to put them on top of the other ingredients. If you’re using something like a Roma tomato, slice it really thin and place each slice on a paper towel first. It won’t drain all of the liquid from the tomato, but keeping the slices thin will keep from weighing everything down, while still giving you that tomato boost. Yes, I’m a fresh tomato addict.

Once we finished with our ingredients, all we needed was a little mozzarella cheese on top. Here’s a look at one pizza before the cheese and one after the cheese. Looks good, right?

Well, they were even better when we took them out of the oven. Cook your pizza at 400 degrees for 5 to 5 ½ minutes. In our case, thanks to our 50 year old oven (literally), we needed to finish it off for 30 seconds or so under the broiler to brown the top a little bit.

Well, I hope you made it to the end, and I hope you enjoy one or more of these recipes soon! To find more recipes, just click on the Recipes! category link on the left.


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