Category Archives: Pumps

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:

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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.
 
 
 

Reservoir Recall, and the FDA Gets Tough.

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This is an FYI post, in case you haven’t heard about it yet. If you’re a Medtronic pumper, you will hear about it because Medtronic is sending a letter and FAQ sheet to all their pump users.

Medtronic Diabetes is voluntarily recalling specific lots of reservoirs for Paradigm insulin pumps. Apparently, the affected reservoirs are at increased risk for leaking. The photo above is part of the FAQ sheet I received that lists the lot numbers that are being recalled.

Now, I know it’s easy to bash a company for making something that is eventually found to be faulty. But I will also give you some facts, according to the recall notice sent to me:

– First of all, this is a voluntary recall. No one made Medtronic recall these reservoirs. I don’t know if there was any kind of communication between them and the FDA, for example, that led to the voluntary recall before a mandatory one. But still, a voluntary recall always happens faster than a mandatory one.

– Medtronic conducted an investigation of the cause of this issue, and found that the reservoirs in question were all manufactured on a specific manufacturing tool that developed “abnormal wear”. They have corrected the issue and put additional testing and inspection in place.

– Med-T has a number to call if you have the recalled reservoirs and need new ones right away: 1-866-450-0890. They will ship the new ones free of charge to you.

Medtronic acknowledges a few cases of diabetic ketoacidosis requiring hospitalization that may have been caused by the faulty reservoirs. I don’t want to belittle these cases, or the patients and their loved ones involved. I also think it would have been nice if I’d have received an e-mail, or a tweet from @MDT_Diabetes. Other than that, what I am saying is that if a product I’m using does need to be recalled, I want the recall to be done like this.
 
 
Also, the FDA has cracked down on companies selling products that claim to help mitigate, treat, or cure diabetes, but as we know, they don’t. This includes “natural” treatments that have undeclared ingredients; dietary supplements that claim to treat, cure, or prevent diabetes; homeopathic over-the-counter meds that claim to help with peripheral neuropathy; and prescription drugs sold by pharmacies without a prescription.

Take a look at these products, and where they’re from. It proves that there are scam artists just about anywhere you go. These products are being pulled from the market by the FDA:

– Diexi by Amrutam Life Care Pvt. Ltd., Surat India.

– Anastasia Diapedic Foot & Leg Treatment by Anastasia Marie Laboratories Inc., Oklahoma City, Okla.

– Exermet GM, Galvus, Nuzide, Triexer and unapproved versions of Januvia, all from
bestcheapmedsonline.com.

– Diaberex by Enhance Nutraceutical.

– Zostrix Diabetic Foot Pain Relief Cream, Zostrix Diabetic Joint & Arthritis Pain Relief Cream and Diabeti-Derm Antifungal Cream, all from Health Care Products, Hi-Tech Pharmacal Co., Amityville, N.Y.

– Sugar Balancer by Health King Enterprises & Balanceuticals Group Inc., Chicago.

– Insupro Forte by INS Bioscience Berhad, HLS International Sdn. Bhd., Easy Pha-max, Selangor Darul Ehsan, Malaysia.

– Diabetic Neuropathy Foot Cream, Diabetic Foot Cream, and Diabetic Hand & Body Cream by The Magni Group, doing business as MagniLife, McKinney, Texas.

– Eradicator by Naturecast Products, Coral Springs, Fla.

– Diabetes Daily Care by Nature’s Health Supply Inc., College Park, Md.

– Glucocil by Neuliven Health, San Diego,Calif.

– Neuragen PN and Neuragen Cream by Origin BioMed Inc., Halifax, Novia Scotia, Canada.

– Nepretin by Nutrient Synergy, Longmont, Colo.

– ProBeta by PharmaTerra Inc., Bellevue, Wash.

For more information, and to stay up-to-date or report on Diabetes drugs or devices, visit FDA MedWatch at www.fda.gov/Safety/MedWatch/default.htm
 
 
Happy Wednesday… Stay safe!
 
 
 

Stay cool, my friends.

Okay, so obviously, I need to post this. If only to remind myself that insulin becomes useless once it reaches a certain temperature.

About a week and a half back, I had to toss out my reservoir with something like 65 units of insulin left. My site was working well for a few days; then allofasudden, my glucose kept climbing up. Over the 300 mg/dL mark. In the middle of the day, which is very odd for me. When I got home from work, I changed out my set, and wouldn’t you know it, before long, my BG came down into the upper 90s – low 100s.

This sequence of events didn’t surprise me too much: It is summer in Baltimore, and baby, does it ever get hot and humid here. Add to that the fact that our air conditioning unit finally gave out about a week earlier, and it’s no wonder I couldn’t keep the insulin in my reservoir cold.

Fast forward to this week. Again, I have a site that’s working very well, for about 5 days (yes, I often go longer than 3 days… so sue me). And we had a new A/C unit installed about a week ago. I go to bed overnight sitting at a pretty good 96, and I had a granola bar for a snack right before turning in, so I wasn’t worried about going low. I got up for a minute about two hours later, and a quick check of the Dexcom unit showed 124. About what I expected.

Then, about 3 a.m., the Dexcom starts beeping. That loud, “you’re high, you’re high” beep. Now it says 224 mg/dL. Great.

By morning, I was at 266 mg/dL. I took the reservoir out of the pump, and it certainly felt warm to me. I must have been sleeping right on it all night. Those reservoirs aren’t always the easiest things to look through, but what was inside didn’t look like normal insulin to me anymore. So I decided to throw out 70-plus units of insulin this time and change everything over. Today was a sensor change day too, so it was a double blessing while I was trying to get out the door to work.

Novolog, the insulin I’m using right now, has a tolerance up to 86 degrees farenheit (according to their website). By the way, Glucagon is only good up to 77 degrees farenheit. Above those temperatures, bacteria living in our insulin start to break down the protein inside our vials, insulin pens, and yes, pump reservoirs. Also, according to a Mayo Clinic blog post, “Heat can make proteins like insulin harden, which increases the potential for infusion set occlusions”. They also recommend tucking in the tubing instead of leaving it out and exposed to the heat (which is what I’ve been doing).

Man, I used to love summer. Now the hot weather gives me one more thing to consider. I know I will be much more careful through the next few months.
 
 
 

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