Tag Archives: insulin pumps

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?

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This is my diabetes.


This is my insulin pump. It is my lifeline of sorts, in that it allows a steady rate of insulin to be infused into my body throughout the day. Also, it lets me add extra insulin to cover the carbohydrates I eat, and to correct any high blood sugar numbers that might happen from time to time.

If you’ve never lived with diabetes… imagine this external device as part of your life 24 hours a day, seven days a week, forever. The only time it comes off is when you swim or take a shower. It can also add a level of concern about what might happen in the future, should something break, or should insurance stop covering some or all aspects of this therapy.

It will also be the subject of additional scrutiny from TSA agents when you go through security screening at the airport. As I’ve found out firsthand, that’s including when you go through the TSA Pre-Check line.

This is my diabetes.

Here’s a Dexcom Clarity report. It gives me valuable information on glucose trending for the past seven days. Among other things, it helps me to know if I need to consider changes to the basal rates on my insulin pump.

If you’ve never lived with diabetes… imagine an extra level of concern about what might happen in the future, should the report not be as well as expected. Imagine living with concern over just the anticipation of a report or a simple lab test. Concern about the future is something I try to put in a box, safely stored away until the time when I might have to address it.

Frankly, I don’t know if I could handle it if I started to worry about potential complications all the time.

This is my diabetes.

I have a quarterly appointment with my endocrinologist next month. I have a meeting with my primary physician a month after that. I’ve already been to the ophthalmologist this year. And I have to schedule time with a podiatrist and my dermatologist too.

Meanwhile, there are prescriptions to fill. I have a couple of everyday medications that are refilled every 90 days. Add in the insulin I need, which I need to have refilled every 90 days too. Then there are strips for my glucose meter, sensors for my CGM, infusion sets and reservoirs for my insulin pump.

My out of pocket expense for all of this, the amount that insurance does not cover, has passed $3,500 per year.

If you’ve never lived with diabetes… imagine spending the price of a European or a Caribbean vacation every year just to stay healthy. Think about not finishing college, just so you can afford your medication and supplies.

And that’s not counting the cost of the time it takes for all of those things mentioned above.

This is my diabetes.

If we handle all of this well (and who can do that all the time?), we’re considered obsessive about our disease, making it a bigger part of life than it should be. If we don’t handle it well, we’re considered “non-compliant”, or worse. And that’s without any outside influences like stress at home or in our careers.

In addition to a constantly vacationing pancreas, we go through these internal struggles too, all the time, every day.

This is my diabetes.

This is my diabetes.



This is the most recent infusion set I used to pump insulin into my body. You know, the thing I need to do 24 hours a day, every day, or else I die.

When you inject insulin, either by syringe or by insulin pump, you run the risk of drawing some blood out at the same time. It’s just part of the landscape. You learn to live with the possibility of blood coming out while you’re trying to get insulin into your body.

If you’ve never lived with diabetes… imagine pulling an infusion set from your body and small (and sometimes, large) amounts of blood comes from the site. Imagine having to pull a set early because you can see that blood is on the outer portion of the adhesive used to hold the cannula (the small plastic tube that winds up inside your body, through which insulin is pumped) in place.

Then imagine the idea that this will happen many times if you’re lucky enough to live many years with this condition.

This is my diabetes.


This is the site on my leg where that infusion set was placed. I took this photo within five minutes after pulling the set. My leg will look like this for a couple of days, at least. I need to be careful not to use that site again for as long as I can, because the scarring that has gone on under the skin could keep me from being able to pump insulin through that spot for some time. If I overuse that site, repeated scarring could make it impossible to pump insulin through there permanently.

If you’ve never lived with diabetes… imagine looking at a site like that after three days (or less). Imagine knowing you’ll have another site just like it to look at in three more days (or less). Do the math and imagine how many of these wounds you’d willingly give yourself over the years just to keep from dying.


This is my Dexcom sensor site after two weeks. The sensor sits under the skin and measures glucose in the interstitial fluid between your skin and your blood vessels.

After about a week or so, the adhesive around the sensor starts to pull away from the skin. To continue to hold the sensor in place, I add something called KT tape. It’s the tape you see beach volleyball players wear. It’s flexible and stays in place and is fairly water resistant.

Using the tape allows me to get an extra week or two worth of wear from a sensor. Sensors are expensive, and they’re just one of the many things we’re required to purchase if we want to manage our diabetes as well as possible.

If you’ve never lived with diabetes… imagine getting out the tape every couple of weeks and carefully cutting a hole (hopefully better than the one above) and even more carefully placing the tape over the sensor, placing it so it will hold the sensor and surrounding adhesive in place for a little while longer, so you can afford to purchase something else you really need.

This is my diabetes.

The crazy thing about all of this is that I’m one of the lucky ones living with this disease. I actually have access to an insulin pump and supplies, a continuous glucose monitor, and other tools of diabetes management.

But I’ll never outlive the scars. I’ll never get a chance to rest. There will always be one more thing that needs attention. Every day of my life. It is never ending.

This is my diabetes.

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.
 

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.
 
 
 

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