Category Archives: Pumps

Not exactly MacGyver, but good enough.

Tuesday, I was able to overcome a potentially panic-enducing episode of my own doing. I’m not the most handy guy in the world, so getting over this was a big deal for me, even though it’s probably not to you. Let me explain:

I walked out the door and headed to work without checking the status on my insulin pump. That means I left for work without noticing that I had about 7 units of insulin left in my reservoir. Not nearly enough to last through the day until I got home.

I don’t generally keep extra insulin lying around my desk at work, so I had to come up with something, or inconvenience The Great Spousal Unit and ask her to make a special trip downtown, which is way out of her way. To make matters worse, my Animas pump has one feature that I absolutely detest: when the pump says zero units left, it stops pumping.

The problem is, when the pump says it’s at zero units, there are still about 20 units of insulin left in my reservoir. Now that’s enough to last me through the day at work. What to do?
Reservoir
Well, I don’t recommend that anyone do this on a regular basis. It is far from an exact science. But it beats wasting insulin, or potentially going a few hours without any. Here’s what I did: once my pump went to zero units and gave me a no delivery alarm, I pulled the reservoir out, and every hour, carefully pumped more insulin in using the plunger underneath the reservoir. You know… syringe style. Once the plunger reached a certain point, I had to use a pencil to push it further and continue to pump insulin.

Like I said, this is not an exact way of delivering insulin, and I do not recommend it if you can avoid it. In addition to regular hourly bolus amounts, I checked my glucose levels about every hour and a half to make sure I wasn’t too high or too low. But in this case, this practice solved two problems for me: I did not need extra insulin or to leave work early to get extra insulin, and I did not waste 20 units (or more) of perfectly good Novolog.

My old insulin pump had a 300 unit reservoir. My new pump has only a 200 unit reservoir. This isn’t a huge concern for me. I can manage with either. However, one of the features of my previous pump that I took for granted (and wish I had back) was the fact that I could fill the reservoir, prime the pump, go until the pump said zero units left, and still keep pumping for hours, because it kept pumping until the insulin was gone, not until the display said zero. The “Load Cartridge” feature on my new insulin pump already takes about fifteen units away from a full reservoir, and I take about ten more to prime (it’s long tubing). Then the pump quits when it says zero units, even though there are always 20 units or more left in the reservoir.

All’s well that ends well. When I got home from work, my pre-dinner BG check resulted in a reasonable 115 mg/dL.

I must say, I find it annoying at best, wasteful at worst for my pump manufacturer to stop my pump entirely when I have insulin left in the reservoir. So Animas, if I work on checking my pump status more often, can you work on that delivery of all the insulin in my reservoir? My solution was not exactly MacGyver-esque, but it was useful anyway. Let’s hope I don’t have to employ similar tactics in the future.
 

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Decision 2014… 2015… 2016? Finally!

Remember that whole “Decision 2014” thing I had going on during the year that my Medtronic Revel pump warranty expired? Should I go with a new pump? What am I looking for anyway? What should I do?

Well, Decision 2014 became Decision 2015, which finally became Decision 2016:
MyVibe
Stop staring at my late afternoon basal rate.

Okay, so I chose the Animas Vibe as my new insulin pump. I think I’m way past the point of detailing why I didn’t pick another pump, and besides, those companies have lots of employees who have families with mouths to feed, and some of them I know and like and admire, so I’m not going to go into that. If you really want to know, send me an e-mail and I’ll tell you, but I’m not blasting it over the internet for everyone to see.

Instead, I’ll talk about me specifically with the Vibe.

First, even though this pump is generally marketed as a pump with a CGM integration, I chose to only do the pump purchase right now. Why? Because the CGM that’s integrated with the Vibe is the Dexcom G4, which is really good, accurate, and already one generation behind the current model. In the next few weeks I’ll be submitting paperwork to try to get the Dexcom G5. I’m hoping that if the G6 makes its way to the masses sometime in the next year, I’ll be able to upgrade to that. I just didn’t want to be two generations (or more) behind before my insurance would pay for a new CGM.

As far as the pump is concerned, it’s working pretty well so far. Oh, and no, I haven’t been through training with the pump yet. I had it programmed, on, and working within 45 minutes of cracking the box open. I do not necessarily recommend this practice to everyone.

Anyway, the pump is working well. My insulin needs seem to be less than they were with the Medtronic pump over the last year, when it seemed like I was having to bolus extra for every meal just to keep my BGs in a decent range. As with many things diabetes, there may be truth in the fact that the old pump was fighting to keep up, and there may not be any truth to that at all. Let’s see how the next few months go.

I’m getting used to the ezCarb bolus feature, which is pretty simple to work out once you get used to it. I’m doing my best to keep my fingers off of the instant bolus button (my terminology) on the side of the pump. Why I can use this to bolus by the unit without any calculation, but I have to perform several clicks to get to the bolus calculator in the pump is beyond me. I can see a less determined person guessing and instant bolusing all day. And possibly paying the price for it later, if a calculated guess is wrong.

I really like the button on the top of the pump, which gives me an instant insulin on board reading, though I wonder if I can get that to display on the main home page of the pump. I don’t think so, but I haven’t read everything in the pump manual yet.

This pump also has a smaller reservoir than most pumps on the market. Just 200 units, rather than the 300 units offered by Medtronic and the t:slim (they also offer even larger capacity options). I thought that would bother me a lot, but so far, it hasn’t been a big deal at all.

I like having a metal belt clip. I don’t know if it will get bent out of shape eventually and not work as well over time, but if not, I’ll be happy to not have to order a new plastic one every five or six months.

One other thing: This is my choice. This decision was made after careful consideration, and I’ve chosen something that works for me and my diabetes, and how I want to manage said diabetes. Your diabetes may be different, so your decisions may be different, and that’s okay. It’s why we need more choices.

To sum up, I like what I’m experiencing with my new pump to this point. It’s not everything I wanted, but no pump on the market has everything I want right now anyway. In the end, I have something I can live with for four years, after which time, an artificial pancreas solution may be available. So while I’m sad that there aren’t better options for insulin pumpers right now, I’m excited to see just what the next few years brings.
 

Decision 2014: Pump update.

So… A quick update on my pump search. As I mentioned back in May, the warranty has expired on my Minimed Revel pump. I still have a fair amount of supplies on hand, so I’m taking a little while to learn more about other pumps out there on the market. You never know… I might re-up with Medtronic. But I don’t want to do so until I’ve had a chance to see what else is out there.
 
 
I may or may not have mentioned this, but I did get the chance to check out the Animas One Touch® Ping® during my last clinical trial. It seemed to work pretty well. I like that it’s waterproof. I also like that insulin bolus delivery is exceptionally fast compared to Medtronic. To be honest, that’s not a deal breaker or a deal maker for me, but it’s something I noticed. Another thing I noticed was how much there is on all of the menus on this pump. Just to prime and begin insulin delivery using this pump requires a lot of button pushing. Again, not a deal breaker, but if all things were equal, that’s something that could sway me toward a different pump. Overall: Good experience.
 
 
That brings me to Tandem®’s t:slim®. I met last week with one of the local reps for this product. Like the other pumps I’ve inquired about, Tandem is not going to let me do a test drive on their model. But I feel like I got the next best thing when meeting with this rep. We spent over an hour talking about everything t:slim. This was pretty unscripted, though I suppose a couple of his answers were because they had to be. The best part was, I was able to handle the pump (which I had not been able to do up to that point).

I practiced filling the cartridge, priming, setting basal rates, programming a bolus. Our conversation was all over the place, which in this case, was good for me. He showed me how specific things worked, and if I had a question out of left field, I was able to ask it and get it answered before we resumed what we were originally doing. It wasn’t a power point presentation; it was two people talking about an insulin pump.

The other thing I liked about this rep was that he didn’t shy away from the difficult issues. Let’s face it: There isn’t a pump on the market that doesn’t have something less than wow about it. But when we talked about those things, I got honest answers. Which is both refreshing, and the decent thing to do.

I liked a couple of additional things related to this pump. I like the bolus reminder. Set your bolus reminder and it will alarm you if you forget. I also like the temperature gauge that can tell you whether you might be in danger of skunking your insulin due to extreme cold or heat. Again, not deal breakers or deal makers, but nice features nonetheless.

I also like that the battery charges like a phone or tablet, rather than requiring the replacement of a AAA battery every month, which I’m doing now. You might not think that’s a huge deal, but it’s at least a minor deal to me. Changing a battery every month isn’t that difficult. But in the time I’ve had my current pump, I’ve gone through 50 or 51 of them. Multiply that by who-knows-how-many insulin pumpers out there, and you get an idea of how much we’re filling our landfills with dead batteries that we don’t need to use anymore.

Bottom line: I like the t:slim, for the obvious sexy reasons. I’m not in love with the cartridge fill, so I’d have to convince myself it’s not a big deal. And Maureen thinks that sliding the cartridge into place in the way the pump works would drive me crazy. She cites my issues with the battery and SIM card on my cell phone as an example. Any honest answers from current t:slim users would be helpful and very much appreciated.
 
 
Next up: I’m looking into the Asante Snap. According to their website, I might actually get to try one out! More to come as I continue to explore the world of insulin pumps.
 
 
 

Beginning a year (or less) of discovery.

That noise you hear is the sound of my pump warranty expiring. Didn’t think it sounded like that, did you?

My insulin pump is the Medtronic Minimed Paradigm® Revel 723 pump. It’s the only pump I’ve ever worn. It’s still going strong, pretty much like it was back in August of 2012 when I wrote this post. I’ve been more than satisfied with its performance.

That’s why I plan on keeping it for a while. Probably about a year. There are a few reasons why:

First, I have about a year’s worth of infusion sets and reservoirs to use up. I should have stopped that automatic 90 day refill of supplies, but I didn’t until now. Even if I go to Med-Ts newest offering, the 530g with Enlite, and I can use the same stuff (I think I can use the same stuff… anyone? Bueller?), I would like to start over with a clean slate of durable medical supplies. And if I don’t move to the latest Minimed product, I would hate to waste all of those reservoirs and sets. I don’t think that would be fair to my insurance plan, my employer (who pays most of the cost for that plan), or the larger cost of care for a chronic condition in America.

Which brings me to my second reason: Unlike the last time I chose a pump, I’d really like to do some shopping around to see if there’s a better option for me. Maybe the new Medtronic pump/CGM/With the Threshold Suspend Feature is just what I need. But I won’t know unless I try out other pumps too. If I give myself six to nine months to do some deep dives into functionality, ease of use, etc., I think I should be able to cover everything the market has to offer (and has available in the USA) right now.

Third reason: Giving myself that long to make a decision also gives me a little more time to get feedback on more recent entries into the market. Hopefully, several more months of reports and anecdotal evidence from my DOC peeps will help me make a more informed choice. You can’t always time these things out perfectly (where are you, Animas Vibe?), but if I see someone who’s recently chosen a product talking about how things are better or worse for them than when they started on said product, I’ll feel better about my choice.

The sales effort has already started with my current pump maker. I received a call from Leslie from Medtronic on Tuesday. She reminded me that the 530g “is the first pump moving toward the artificial pancreas with the threshold suspend feature”.
I thought I heard back in January that Medtronic heard the Diabetes Community when they expressed concern that the term Artificial Pancreas was a bridge too far. My conversation with Leslie (where I heard that phrase twice), a check to their website twice (in December and this week), and a call to their main diabetes line (1-800-Minimed) twice tells me there is still a disconnect. Not a good start.

Despite that, I haven’t made up my mind yet. I’m still listening.

Ideally, I’d like to actually try out each pump for a couple of days. My guess is that’s not possible. I was told by Leslie from Medtronic that I can’t do that, but if I want to have them submit the paperwork to my insurance, they can help me get the 530g system, and if I don’t like it, I can always send it back within 30 days. Sorry, but paying people to do lots of paperwork, get a prescription from my endocrinologist, package the goods, send it to me, and possibly pay to have me send it back is too much money just for one person to try it out.

Again, I would feel incredibly guilty about that. I just want to try it out for a few days before I make a commitment.

I’m hoping to try out everyone. Medtronic, Asante, Animas, Tandem, the whole works. Don’t worry, I’ll be reaching out to you. I don’t expect special consideration. According to The Great Spousal Unit, I have a highly-placed sense of fairness that I don’t relinquish easily. I suspect you’ll say I can’t try it out without a lot of money being spent either by you, or me, or my insurance, or all three. But understand this too:

I will not make my next insulin pump choice without at least seeing it in person. I want to touch it, see how the bolus feature works, see how the basal feature functions, how the reservoirs are filled, and what the infusion sets are like. I want to examine the cost, investigate the customer service, government recent recall notices, and anticipated FDA approvals.

And I want to read and hear present, and future feedback from my fellow members of the Diabetes Community.

The clock begins now. It ends when I make a decision.
 
 
 

It happens to all of us.

If you’re a pumper, chances are you’ve seen something like this before:

DSC01146

The story: I changed my set on Friday night, about 2 hours before bed. When I woke up in the morning, my #BGNow was 174 mg/dL. Higher than I would like, but I can deal with 174. I had a smaller-than-normal breakfast, and a fair amount of both coffee and water throughout the morning.

When I checked just before lunch, I was at 286 mg/dL. I was meeting a friend for lunch, and I just dealt with it… sometimes, new infusion sets just don’t seem to take right away. I had a very small lunch, enjoyed my time with my friend, and headed home.

Just before dinner, my BG test resulted in a 266 mg/dL. Okay, I’m getting some insulin, but something is clearly wrong at this point. What to do? Do an injection and wait it out some more? Or make the decision to change my set and start over?

I opted for changing my set, but not changing my tubing. If it was a bad cannula (pictured here) or a bad site, the tubing wouldn’t matter. If it was bad tubing, then a site change wouldn’t change anything, if you know what I mean. I’m the kind of guy who likes to know the cause of something, so I didn’t change the tubing, knowing I could do it later if I had to. As you can see in the photo, there was no need to because somehow the cannula got kinked. Which almost never happens to me, which is probably why I waited almost a day to change out the set.

After making the change, I did a correction bolus and ate a nearly carb-less meal. When I checked almost three hours later, I was at 84 mg/dL. Problem solved.

Just another annoying, stupid thing. Freakin’ diabetes.
 
 
 

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