Category Archives: Pumps

Diabetes Delay

Here’s something you probably know, or maybe you should remember if you forgot. Because we see, we read about people all the time who seem to be better at handling their diabetes than we are. They’re in magazines, with big glossy photos, and stories recounting all of the fabulous things they’ve accomplished while living with this condition.

But there’s something not written in there. It’s something that you and I and those “Diabetes Superstars of 2019” have in common, in addition to our failed pancreases.

Trust me when I say this: absolutely no one is living a perfect life with diabetes.

We all have a weakness. Whether it’s the late night carbs we squirrel away when no one’s looking, or it’s burnout that shows up when we least expect it, or it’s an A1c we’re uncomfortable with, everyone has something they would not like to show the public.

I’m no exception. My weaknesses include extra carbs when traveling, probably due to stress and a fear of going low at night. I don’t experience depression, but I have my moments of melancholy now and then. And there’s one other thing.

I have to be the lousiest refiller of prescriptions and supplies in the history of the planet.

I sit here this morning, looking at the cabinets where I store my pump infusion sets, reservoirs, and CGM sensors, and I realize that the sensors are the only thing I have enough of right now. The infusion sets and reservoirs will run out within two weeks if I don’t refill them. And I feel stupid.

I feel stupid because Medtronic will stop supplying the infusion sets and reservoirs for my Animas Vibe pump in September. That means, when the supplies run out after that, I need a new pump, or I need to stop pumping altogether.

I’ve been good at stretching supplies… wearing infusion sets a day or two longer, reusing reservoirs, all with the idea that I could build up a good supply and go a few more months, maybe into 2020, before having to start on a new pump.

Now, with my current supplies running out, I have to start over, and if I’m lucky, I’ll get an extra few weeks beyond September before switching. I’d be lying if I said I wasn’t mad at myself right now.

Now, I could get mad at Medtronic, because they don’t have to stop supplying me in September. But even if Animas still had a presence in the market, they would eventually stop supplying my pump, so the onus is really on me with this one.

So what can I do? I can be mad at myself, but I also must go forward, recognize that I have to get my supplies refilled, and do that. Today. Maybe I can set a reminder to refill my supplies every three months, though I suspect my delay with this part of my diabetes is really just that I hate to go through the motions of ordering supplies on a regular basis.

There you have it. I’m not perfect. I’m never going to be in a magazine either, but you get my drift, right? Don’t ever look at someone and think they have every part of their diabetes figured out. We all have something we wish we were doing better. But we also have resilience, and that keeps us doing what we need to do, even if sometimes, we don’t want to do it.

Note: I did order reservoirs and infusion sets today… maybe I needed to get this out of my head and just do it.

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Choices, and the Fear Of Missing Out

It’s funny… I’ve been asked more lately about why I haven’t moved away from my Animas Vibe insulin pump than I’ve been asked why I have remained on this pump.

For the benefit of someone who might be in a similar situation, or just for the few of you who might actually be interested in my opinion, here’s my thinking on the subject today:

First of all, I don’t have to hurry to another pump. My Animas warranty is still good until January 2020. That’s nearly a year and a half. For starters, let’s go with that.

I will admit that I’m not particularly fond of my Animas pump. I don’t hate it either. In all honesty, I’m agnostic when it comes to this device. But it works, and there’s something to be said for reliability. For the record, I use Medtronic MiniMed Quick Set infusion sets, which I’ve used even before starting on Animas. They seem to work best for me.

I have a few choices when considering what to do…

Thanks to Medtronic, which took over customer care from Animas, I can go right now from my current pump to the Medtronic 670g. The appeal of that is obvious, owing to the hybrid closed loop nature of the system. Also, I have friends and acquaintances using the 670g, and all of them either like it or love it.

The biggest issue for me in this case is that the Medtronic CGM still does not lay flat on the skin. If I have to tape it down to keep it on, that’s a deal breaker for me. If they re-engineer the CGM so it will lay flat without taping it down? Medtronic is definitely in consideration.

One of the other intriguing ideas available to me is to create my own DIY closed loop system. I’m already using the Dexcom G5, and I have an old Medtronic pump (my first pump), which might be compatible with one or more of the systems out there.

The idea of doing that really appeals to me. On top of the appeal of a functional artificial pancreas system, there’s also the appeal that on top of my other pumping possibilities, I would always have this option in my back pocket just in case nothing else seems to be as good.

But more than anything else, when I think about why I don’t make a choice at this time, it comes down to one overriding issue: FOMO, or Fear Of Missing Out.

I’ve got nearly a year and a half to go on my current pump’s warranty. My biggest regret in making a change would be if I went to another pump and then, let’s say six months later, something new and wonderful was approved by the FDA that I would love to be using. Only by that time, I would be just six months into a four-year pump commitment that I couldn’t get out of.

I had kind of the reverse happen when Animas decided to close up about two years into my commitment with them. I’m not unhappy with my choice, but I’m unhappy that the company I chose to make the commitment with could no longer uphold their end of the bargain.

Anyway, with all this time left on my warranty, I’ve decided to wait a while and see what happens. I have no idea what’s coming in the next 17 or 18 months. I’m just grateful to have options.

Choice matters for People With Diabetes. Let me ask you:

How would you feel if you were in my position? Would you wait? Or would you make a change?

You do NOT want to see this message…

This is not something you want to see displayed on your insulin pump:

This is what popped up on my Animas Vibe pump about a week ago. Immediately, a number of thoughts (all bad) came to mind…

– Does this mean the pump has failed?

– Can I fix it and start pumping again?

– Animas is out of business in the USA… If it’s broken beyond repair, what then?

– What about backups? Do I have enough basal insulin, and syringes or pen needles, to get me through until I get another pump?

I’ll be honest, I thought immediately that the pump was toast, and that I was too, because I knew that Animas is no longer selling insulin pumps in my country. I thought that a failed pump meant I needed to find a new insulin pump manufacturer, and probably, a fight with insurance for replacing my pump before the warranty was out.

Like a complete novice, I called the number on the back of my pump. As I expected, the old Animas number rolled over to Medtronic customer service. We went through some initial getting-to-know-you items, like name, contact number, and the serial number from the back of my pump.

Then I was asked to describe my issue. I covered the error message you see above, and after an extended silence, I was told that indeed, my pump was kaput.

But… good news! Medtronic was able to send a new Animas pump my way in about 36 hours. But… bad news! That meant a full day and a half on MDI, or multiple daily injections.

Ordinarily, this wouldn’t concern me. But when I go the MDI route, it involves a certain amount of longer acting insulin, injected to replace my pump’s basal rate. In my pump, it’s fast acting insulin (Novolog) all the time.

In this case, my basal insulin was Lantus. While using Lantus prior to starting on my insulin pump eight years ago, I encountered some of the worst, the scariest lows I’ve ever had in my life.

So I kept a close watch on my Dexcom CGM, and I did have a couple of lows that, while not super scary, occurred at times when I typically wouldn’t encounter a low just using my fast-acting insulin of choice. In this scenario, I was glad to have access to a tool like my CGM, to give me near-real time numbers and trend data. It helped me ensure that I wasn’t flying blind with my blood sugar numbers. I was far less likely to be surprised.

Nevertheless, I was thrilled to come off the Lantus and start pumping again. Same model pump, same color. There are two important things to note here, especially since I haven’t mentioned these two yet:

1. Make sure you have backups in case of pump failure. I started to run really low on pen needles. I needed to reuse a couple of them, and that’s not always a safe practice (and in case I really have to tell you, never reuse someone else’s pen needle or syringe).

2. Make sure you note your pump settings (basal rates, insulin/carb ratio, correction factor, etc.). Hey, my pump was broken. How could I get all of the settings that have been in there for two years? I had them on my iPad at home. I carry the iPad whenever I travel too, for this reason as much as any other. When it was time to set up the new pump, I was all set to go with the information I needed.

The moral of the story here is that shtuff happens. How we deal with it is sometimes scary, but dealing with unexpected things is kind of what we’re good at. After all, our lives depend on it.

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.
 

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.
 

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