Tag Archives: insulin pumps

A Pump Vacation? More to it than you might think.

Yeah, about that 3-day pump vacation I had last week: To be honest, it was a little less “Pump Vacation” and a little more “Sudden MDI Freakout”. The reasons for that are ones you can probably think of, but since this was unplanned, I wasn’t really prepared. I was lucky to have done as well as I did, when you consider these factors:

To begin with, I started back on the Lantus for basal insulin. I was still using Novolog for boluses, just like I do in my pump. But it’s been quite a while since I’ve used Lantus, and it scared the crap out of me. Prior to pumping, I had some pretty horrific lows on Lantus, and that’s the first thing I thought of when I did my first basal injection. Here’s the biggie: If I’m injecting for my basal, I need to take exercise and what I’m eating into consideration. Too much (read: ANY) eating without a bolus injection means going high. Exercising without extra carbs or without previously altering the basal injection almost certainly means eating and drinking like a juice-addicted chow hound later on. There’s no such thing as “threshold suspend” when you’re injecting.

Oh, and injections. Part of the flexibility with pumping is the obvious freedom to bolus whenever you need to, without stopping what you’re doing and finding your insulin pen, getting a fresh needle out, and injecting. For everything you put into your mouth. When I had bloused for dinner, eaten, and then Maureen’s family decided to go to Dairy Queen or something for dessert, I had to decide whether I wanted to partake and inject again. I still had to decide whether I wanted to add to my carb count for the day. But part of my decision was based on whether I actually felt like doing another injection.

And the calculations. I’ll admit it… I’m a big user of my pump’s bolus wizard feature. The first time I needed to do a bolus injection, my BG came in at 78 mg/dL. You know what that means, right? Take the 22 mg/dL I was below 100 to figure how much to reduce my bolus so I wouldn’t go low overnight. To my surprise, I found that doing these calculations in my head was like riding a bicycle (in my head). The first calculation took a while, and I practically singed some brain circuitry, but the rest were really no trouble. Good to know I can still do simple math in my head.

But I also had to remember that I was in sunny, HOT Florida. When we went out with my pump on, the air conditioning in the car kept my pump cool, and then we’d quickly go into an air-conditioned building of some sort. But I needed to take the cooler along when I had the insulin pens, or leave them in my pocket the entire time. Which can be tough with a swimsuit on. In retrospect, I should have just kept them in my pocket anyway.

All of this is just a reminder that a pump vacation may seem like a fun idea when you first think of it. But if you don’t do some real planning, you may find yourself in sudden MDI freakout mode, just like me. Make sure you have your calculations down, you’re familiar with what your insulin of choice is capable of, and make sure your meal/carb intake is well planned as much in advance as possible. If you think of these things ahead of time, you can look at even the surprise pump issues with a little less freakout and a little more vacation in mind.
 
 
 

Decision 2014: What’s the Snap really like?

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It’s been two weeks for me on the Snap insulin pump from Asante. I’m wearing the Snap as part of a free trial offered by Asante to all prospective customers. They’ll give you four weeks on the pump, supplies included, along with a voucher for the insulin cartridges you’ll need during your trial. So far, this is the only company I’ve considered that offered a free trial. Anyway, since it’s been a two weeks, I thought it might be time to give a little more insight. Hopefully, this won’t be too long… but since I’ve been able to check this one out more than any of the others, I probably have a little more to say about it. Here goes:

Set changes: When you’re working with the Snap, you’re working with pre-filled 300 unit insulin cartridges. The infusion set is self-priming too. You don’t have to worry about reservoir fill-ups or air bubbles, and that means you wind up wasting a lot less insulin just hooking yourself up again. Definitely a plus. As a result, you’ll probably spend more time on each cartridge. For that, Asante plans for you to use one specific set (with the primer(?) connector) for your changes including insulin. Then they want you to use a different set (without the connector) after 72 hours if your cartridge isn’t running out of life juice. I’m not sure how all that works, because personally, I’m not about to do a set change after three days, then another one 48 hours later. I just kept the first set in for the normal 5 days (5 ½?) it takes me to go through 300 units. And unless I’m dealing with some serious heat, that doesn’t seem to be too much of a problem. I will add, also, that the simple time savings of having a pre-filled cartridge isn’t that big a deal for me, though it is nice.

Humalog Only Accepted Here: Also, let’s not forget that the cartridges come in Humalog only. I’ve been primarily a Novolog user up to now. This is only my experience, so take it with a grain of salt: In my 2-plus weeks on the Snap, I’ve found that Humalog brings me down from spikey highs, but it does so in a very slow, stairstep kind of way compared to Novolog. As a result, I’m learning to avoid things like potato chips and pizza. I am getting better at managing my diabetes with Humalog, so this isn’t necessarily a deal breaker. Though that’s a good thing, it’s crazy to think I’ll never eat those foods again. If I had a choice between the two, I’d stick with Novolog for now.

Striker! You’re coming in too low! (Bonus points if you know which movie that’s from) One of the issues I found (that I don’t remember being covered in training, but I may have missed it) is that when your BG comes in under 70 mg/dL at the moment you’re sitting down for a meal, you can’t use the smart bolus feature. This happened a couple of times during my trial. My pre-meal check came in at 64 or 60, and I couldn’t enter those numbers using the smart bolus feature. To get around this, I wound up entering my BG number for the smart bolus at 70, then dialing down the insulin amount slightly to get to where I think I would be okay, as long as I ate right away. Also: When you do treat before eating, you do have the ability to enter in the carbs you already had (First Carbs), then the carbs you’re about to eat on a separate screen. It will figure out your bolus accordingly.

As a (somewhat) veteran insulin pumper, this feature drives me crazy. But if I was new to pumping, or a CDE or doctor working with someone new to pumping, I might find this a great safety feature. Again, this isn’t a deal breaker or a deal maker for me. It’s just a quirk of using the Snap, and I thought you should know about it.

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I should also mention that the Snap will deliver boluses three different ways: The Now Bolus, Timed Bolus, and Combo Bolus. The Now Bolus is delivered right away. The Timed Bolus delivers your bolus at a specific amount of time (minimum 30 minutes). And the Combo Bolus is pretty much like the Dual Wave bolus on the Medtronic pumps… delivering a set amount now, and a set amount later, predetermined by the user (in 15 minute increments, which I like).

Beep volume: Love, love love the beep volume on this thing. I also love that it’s adjustable. This is such a simple feature. Why can’t other pumps incorporate this idea?

Additional features: The pump has a flashlight feature on it. That’s nice if you need a light and can’t find one anywhere else. Otherwise, turn the light on. If you’re low, your significant other will forgive you. Sorry… I don’t mean to make light of this feature… it shows that the manufacturer has added something that most People With Diabetes will find helpful.

The Snap also has the ability to create more than one basal profile. Again, I think all pumps should have this feature. When I do a long bike ride, I want to be able to change my basal profile for the entire day, not just perform a temp basal then forget about it once it’s complete.

Bolus delivery is pretty fast. Not sure how big a deal that may be for you (it is not a big deal to me), but I thought I would mention it. On the scale of bolus delivery speed, I’d put the Animas Ping at the top, then the Snap, then Medtronic, and t:slim far behind.

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Finding your daily totals and how they translate into 5 day, 10, day, or 14 day averages (14 days is the highest setting) via the Log Book menu item is pretty easy. This is another feature that I don’t remember covering, but it was easy for me to find. Again, I think new pumpers (and their medical teams) may find this helpful.

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Ease of use: The Snap is actually a pretty easy pump to use. Not a lot of clicks to get around to what you need. Menu descriptions make sense. If you like the pre-filled cartridge idea, and the self-priming, that’s an added bonus. I could imagine myself using this pump on a daily basis.

Here’s where I will also tell you that the local pump rep has been fantastic, answering questions and calling me a few days after I began to see if I had any follow-up questions or issues.

In a few days, I’ll be sending the pump back to Asante. Not because I’m not satisfied. Rather, because I want a little time to do some additional research and decide what is best for me from both a patient and an economic perspective.

I hope you’ve found this recap helpful. And if there’s anything else you’d like to know, be sure to ask.
 
 
Disclosure: I’ve been on a standard four week trial of the Asante Snap insulin pump. This is the same trial that is available to all users who are considering starting on insulin pump therapy, or are considering a pump change. I was not given anything by Asante, and I was not asked to write about my experiences. In fact, I did not tell them I’m a writer at all. All opinions, as always, are my own.
 
 
 

Hey! You look just like me!

A number of times, I’ve read blog posts from people who have seen someone wearing an insulin pump in public. In many of those instances, the writer can’t quite bring themselves to say something to the person wearing the pump. And I never understood why, until it happened to me too this past weekend.

I got up early Saturday morning to help my best friend get things set up for a flea market his group was sponsoring. It turned out they didn’t really need my help at all, so after 45 minutes or so I stated the obvious: “You don’t really need me now… I’m going to go home. I’ll call you later to see if you need me to help break things down when it’s over”.

I said my goodbyes, and as I walked out and toward my truck, I saw a guy, about my age, with exactly the same pump, in the same color, that I wear.

I stopped in my tracks as he walked by. I couldn’t believe it. I mean, yeah, nearly 30 million people in America live with diabetes. But I thought I was the only one in Baltimore. Okay, I knew I wasn’t the only one here, but sometimes it seems like it. Anyway, I thought hey, this is a perfect opportunity to meet someone else from the pancreatically-challenged part of the population. I should run and grab this guy by the arm and have a long conversation with him!

But before I could catch up with him, I noticed something else. He was enjoying himself. He was enjoying his day. I watched him from a distance, for about five minutes or so, and I realized this is the life that we had hoped for when insulin pumps were brought to market for the first time. Heck, this is what we want when artificial pancreas systems make their way to the market.

We just want to live our otherwise normal lives, in a normal fashion, just like people without diabetes do. Somehow, watching this fella enjoy the flea market, I was able to enjoy knowing he felt like the rest of the people around him.

In this case, I could really appreciate the fact that Diabetes Man, living his life, doing the same things as everyone else around him, was more important to me than getting to talk with someone locally who lives with diabetes 24/7 like I do.

It was a good indication that I need to remember to be grateful for the amazing advancements that have already made our lives better, even while we advocate for even better advancements for the future. As I headed home, my full heart and my big smile were indications that diabetes can and will be lived bigger and better every day by myself and Diabetes Man at the flea market. Nothing will stop us from enjoying life to its fullest.
 
 
 

Start of the Snap.

Before I begin today, please allow me to say Happy Anniversary to my wife of 21 years. No baseball games tonight Maureen… let’s celebrate!

Part of my day Wednesday was spent getting training and getting started on my four week trial of the Asante Snap insulin pump.

Asante is confident enough in their product to offer a free four week trial of the Snap pump to prospective customers, complete with a voucher to help pay for the Humalog cartridges required for the pump’s use (side note: Asante, you have no idea how much I appreciate the help). In the end, it’s not much different from Medtronic, who, after I would submit insurance paperwork and a prescription, would help me through the process of purchasing the 530g system, then allow me to return it within 30 days if I wasn’t satisfied. The biggest difference between the two (I had to submit the same type of paperwork for my Snap trial) is that for Asante, this is a trial, with the opportunity to go through the purchase process once it’s complete. If I decide not to keep the pump, I already have a postage-paid envelope to drop the pump into to send it back.

After just a couple of days, I can’t speak with much authority on the Snap. So I’ll just give some first impressions.

Maybe I’m a seasoned veteran after 4 ½ years of pumping (I doubt it), but training seemed a pretty easy thing with this pump. My local rep was knowledgeable and able to describe everything about every menu item on this device. Training was simple and straightforward, and the thing that took the longest was probably just inserting the cannula. Part of trying out a new pump also involves trying out a new infusion set. The one I’m using has extra long tubing, which can be a little tough at times. But the extra length really comes in handy when you have to put on a dress shirt for work.

I like that this pump has a volume setting. I cranked that sucker up, and I can actually hear beeps from my pump! I can also turn the volume way down for those times when I’m at a play or at the movies.

Programming a bolus is simple too, though I have one question of anyone using the Snap: After programming a bolus, have you accidentally hit the button to cancel that bolus when returning the pump to your pocket or belt clip? I haven’t done that yet, but it seems like it would be easy to do.

The display is nothing to write home about. Kind of like the Medtronic display (though brighter), I think of it as an MS-DOS screen, if you’re old enough to know what that means.

Taking the display a bit further, I should tell you that Asante is in the process of updating their screens to a color display, which should start happening in late November. Along with that, users will also have the opportunity to choose from a wide variety of pump color combinations. So my question was: If I purchased the pump now, would I be allowed to upgrade in November? The answer is… Yes. Anyone purchasing the Snap pump between now and November 15 will not only be able to upgrade their pump to a new color combo and a color display, they will also be allowed to keep their original version too. For someone new to pumping, this could be an easy way to get a backup pump for nothing extra.

I’m not a big fan of the belt clip. But honestly… Can you say you’re a fan of any of the belt clips from any manufacturer? I can’t think of a way to improve belt clips without invoking the phrase “putting lipstick on a pig”.

When my trial is finished, I’ll try to get a little more in depth with the Snap. In the meantime, if you have any questions, feel free to ask. If I don’t know the answer, I’ll try to reach out to my rep for the solution. Also, if you have experience with the Asante Snap pump, I’d love to hear some of your insights!

Disclosure: I’m beginning a standard four week trial of the Asante Snap insulin pump. This is the same trial that is available to all users who are considering starting on insulin pump therapy, or are considering a pump change. I was not given anything by Asante, and I was not asked to write about my experiences. In fact, I did not tell them I’m a writer at all. All opinions, as always, are my own.
 
 
 

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.
 
 
 

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