To Pump Or Not To Pump…

46475171-0441-786E-F433F1BBB058B155_1For the past few weeks, I have been giving serious thought to returning to Pumpland. For a long time I was pretty committed to MDIs, and had only a vague interest in returning to the pump when / if I decide it’s time to have a baby. I know that maintaining a healthy pregnancy is easiest on the pump, and that’s what I was prepared to do.

This is not a segue-way into announcing I’m pregnant (not even close), but there are a few other things that have happened to make me reconsider.

10,000 Steps in Four Hours Flat

At the end of March, I started working a retail job. It requires being on my feet and walking (!) for four hours. I work about 3-4 days a week, and my CGM has proven time and again how difficult of a time I have managing my diabetes with this activity. If I were on a pump, it would be easy to switch on a temp basal that wouldn’t affect the rest of my day, but at best I can only manage the heavy activity with extra food (lowering my Lantus would affect the entire day). Extra food + no insulin = starting each day at 250+ and hopefully not crashing into the ground, although that still happens. Or I just spend the entire afternoon in the 200s which is also not so hot.

It’s True, Virginia, There Is a Dawn Phenomenon!

I used to think I didn’t have the dawn phenomenon. I was convinced, actually. HA! When I went on the Dexcom continuous glucose monitor I was in for quite a shock as my blood sugars made a swift turn upwards precisely at a 4am. Every. Single. Morning. You could set your watch to it. Again, one of the major flaws of Lantus (or perks depending on who you are) is that there are no changes in basal rates. It is what it is what it is. I’d heard of folks using NPH to counteract the dawn phenomenon on Lantus, and in fact, this is what my CDE, Gary Scheiner, also recommended when I met with him. (More on that in a sec.) It could work, but I don’t see that as keeping me in the MDI family.

Bruises, Bleeders and the Ouch Factor

It’s strange because taking shots didn’t hurt for the longest time. But lately they have really started to hurt. And bleed. And then bruise. It’s not like I’m suddenly not changing my syringes as often. I do it with same once-a-day frequency as always. But the needles hurt and even the injections — of Humalog! — are starting to sting with disturbing regularity. Not cool, my friends, not cool at all.

~*~

All this being said, I decided it was time to investigate my pumping options. As PWDs, we are “lucky” in that we have a wide variety of options, but that also means we have to decide what we actually like. And “liking” anything diabetes-related is an oxymoron if I ever heard one. Not to mention it always seems like two or three or four companies all have things that I like but they all come in separate pumps. Can’t someone make a “Build Your Own Pump” a la Build a Bear? No? Damn.

On Friday, I drove down to Philadelphia to meet with Gary Scheiner, whom most of you know as the author of Think Like a Pancreas. Gary and I have known each other for more than 10 years, and although I don’t pay him anymore, I still call him my CDE. He’s more like an adviser at this point, though.

We sat down and took a gander at all the different insulin pumps. The Accu-Chek Combo. The Asante Snap. The Tandem t:slim. The Animas Ping. The Insulet Omnipod. And the Medtronic Paradigm.

First things first: Medtronic is off the table. I used Medtronic’s insulin pumps for 12 years and you know what? It is basically the same insulin pump as when I started pumping in 2000. The only upgrades are the bolus wizard calculator (which everyone has now) and the CGM integrated system. Except their CGM sucks — at least for me, plus I’m allergic to the sensor! No dice on the Medtronic.

Next!

The Tandem t:slim is the insulin pump I really, really want to like. God, I want to love this pump. I was so excited when it was coming out and I couldn’t wait to try it at Friends for Life. Except then I saw it in person and I hated it. For one reason and one reason only. The screen flickers. When you press a button, it flickers as it changes to the next screen. I hate it. I feel like I’m going to have a seizure. Everything else about it seems ideal. All the customization, the beautiful colors, the slim profile. I don’t even think I’d mind the hideously long priming time because that’s only once every few days (and Gary suggests using that time to do your set change). Plus, I don’t use Apidra, so no qualms there.

The Accu-Chek Combo is the ugliest pump I’ve ever seen in my life. But it has a snazzy little remote meter that does pretty much everything. Not only can you bolus from it, but you can program all of your settings from it too. It also has one of the most accurate meters on the market, which is really important, as we all know. Right now I’m using an Ultra 2 and apparently, it’s one of the worst! Yikes. If you were the kind of person who always wanted the pump hidden, this would be ideal. However, I have my pump out at least some of the time and like I said, the Accu-Chek Combo has to be the ugliest pump I’ve ever seen.

The Asante Snap is the new kid on the block. Gary is an adviser to the company, and so he’s obviously a big fan. It’s a nice pump. I can’t think of anything terribly special about it, although it does have a reminder for bolusing later. Which is cool, except it’s just a reminder. It won’t actually give you a bolus down the road (say at 2 a.m. for that pizza you know will kick in), which is a feature I’m dying for someone to add. The Snap pump is somewhat like the Omnipod in that it has a “brain” and a “body.” The body is what houses the cartridge of insulin (just like a cartridge for a pen), which you then snap (get it?) into the pump brain. The brain is reusable, the body is not. You always throw the body away because there’s no way to get the cartridge back out again. The pump is also much longer and narrower than the other pumps, so it’s an odd shape for most of us. Not exactly ideal for bra-wearing either. I tried it out and you could definitely see the outline hanging out over my sternum.

The Animas Ping was one of my main contenders going into the meeting with Gary. And I still think it’s a pretty good option. The pump isn’t quite as icky looking as the Accu-Chek, but it’s not that attractive either. Personally, I think the menu is weird, but I’m also coming off of 12 years on Medtronic. Pretty much anything is weird at this point. However, when we tried out the remote bolus feature of the meter, you could tell just how slow it was. Each command needed to be communicated back and forth between the pump and the meter. Lots of “please wait” moments. Not awful, but not quite as speedy as I’m used to. I’m not sure how often I would use the meter as a remote, though. Maybe a lot? Maybe a little?

So the last pump on the docket is the Insulet Omnipod. Our lonely little pod. I tried out the demo pod of the new smaller, thinner pods a few weeks ago and you know what? It didn’t suck. I mean, I didn’t love it. I wasn’t jumping on couches or anything. But it was okay. I could see why people like the pod. I think part of it was that I’m on the Dexcom now, so I’m used to something lumpy hanging out on me and I’m used to carrying around a receiver. But. You can’t move it around, unlike a tubed pump so you’e stuck with it in one spot for three days. Also: you have to change it every 3 days. No eeking out a fourth day. Plus, Dexcom and Insulet are no longer playing together, so that’s something to consider. In fact, Gary told me that Insulet is working with a European sensor company (didn’t say which one) and that they are developing a pod that would have both the insulin and the sensor. Which is cool, until you realize the Omnipod has a 3 day lifespan. That’s just when the sensors start working! Luckily, Gary said this is years away from happening, so I’m not going to let that affect my decision.

~*~

Obviously this is not a comprehensive review of all the pumps. I’m sure I’m leaving a lot out, but these were my initial impressions of the insulin pumps that I saw. After going over all the options for pumps, I had to sit down and actually decide whether or not this was something I wanted to pursue. As you can see, there were a couple of pump contenders, but overall, I was sort of “meh” about the whole thing. I didn’t really feel like anything spoke to me, and considering this is something that is going to be attached me more-or-less permanently, I felt like I needed to make this decision slowly. There was always the option of going on NPH. Perhaps that was the better answer?

~*~

Okay, so you’re probably all dying to know whether or not I’ve decided to join the pumping ranks again. And the answer is…

I have.

And this morning I put in a call to the pump rep at…

Insulet.

I’ve chosen Omnipod as my insulin pump of choice, a decision I’ll talk about more tomorrow (because this post is hella long already). I’m very excited to share my newest adventure on Omnipod and I can’t wait to learn the tips and tricks from all of you!

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9 Responses to To Pump Or Not To Pump…

  1. surfacefine1 says:

    Congrats Allison! Excited for you.

  2. jessica says:

    Awesome! It has its ups and downs, but hope you love it as much as I do!

  3. Yay! I just switched to omnipod a few months ago, and I love it, love it , love it! So much more than my MM pump! I hope that you love it too! :)

  4. Scott E says:

    I’ve been contemplating switching pumps — the Medtronic I’ve been using does nearly everything I want: it talks to the meter (a Bayer NextLink, which I’d continue to use even if I switched), includes a CGM display, and is smaller than any of the others – except for maybe the Snap. But I’ve had some “technical difficulties” – as well as CGM pains and inaccuracies which are hard to overcome. If the Vibe makes it to market before the Veo, I just might go to it.

    Honestly, those are the only two pumps I’d consider. The others tubed pumps have nothing special to offer, and I’m not quite sold on the Omnipod. Meanwhile, the Medtronic talks to both a meter or CGM, the Animas only talks to one (Ping) or the other (Vibe). And from what I’ve seen of the Vibe, it’s got some features I’d miss that are unique to Medtronic. So, despite the MedT looking the same as it did a decade ago, it’s still got some pretty special features.

    We’ll see what happens. But for me, the race is on — and I have a sneaky suspicion that Vibe will come to market first.

    • I’d be curious to hear what you think the special features are that are on the Medtronic pump. I don’t really think there’s that much going for it. I was not talking about how the pump looks. I was talking about how the Medtronic pump functions. The only things it has added since the 508 I started with is the bolus wizard calculator, the CGM and the meter transmission (I’d forgotten about that). But it’s no comparison to having a meter *remote* and I can’t figure out why Medtronic hasn’t made one of those yet. It seems solely focused on the CGM component, and yet they can’t even get it approved. I don’t really want to keep investing in a company that isn’t going anywhere.

      • Scott E says:

        I know you weren’t talking about the appearance, but I just think that’s a big strike against it — it seems to suggest a reluctance to change and innovate.

        But as for what it does: as I understand it (keep in mind I haven’t used other pumps), the bolus wizard still exceeds the others — it begins with the “suggested” amount rather than making you manually dial it in. I like the way it handles IOB. I like the way a fingerstick can be used both for bolus purposes AND for CGM calibration without entering it twice (or even once, with the connecting meter). I like how the CGM graph shows tick-marks at each bolus, which helps put the trend-lines in context. And also on CGM, I like how you can have different low/high ranges throughout the day (i.e. my “high” threshold is lower overnight when I don’t need to worry about postprandial spikes). Medtronic has the little blue collar for filling a new reservoir which, I understand, makes it easier than the others (again, haven’t tried the others). Priming is rather quick and easy. AAA batteries are available practically everywhere. Customer service is great – any time of day or week, and even if I call at 10pm, they’ll have a replacement pump to me by the next morning. But biggest of all is Carelink. Since the pump knows every BG reading, every bolus (and the carbs associated with it), every CGM measurement, every correction — it can generate some really spiffy reports which are unparalleled, as far as what I’ve seen.

        Admittedly, the Medtronic is not perfect. I can give you a laundry list of things I *don’t* like about it, but you didn’t ask for it — and I don’t think anyone wants to hear it anyway.

        As far as a meter-remote, well I think Animas holds the prize on that because both the meter and the pump are made by J&J Subsidiaries. As a recent D’Mine article describes, Medtronic has had to scramble at times to partner with meter-manufacturers. Personally, I have no need for a meter-remote, but that’s just me and I know others feel differently.

      • I agree that the suggested amount is great, as opposed to scrolling. One thing I don’t like about other pumps. But the other pros you mentioned either aren’t much to write home about for me (again, YDMV) or not relevant to me (CGM + Carelink, which I can’t use as I have a Mac).

        It’s funny that you high threshold is lower overnight. Mine is actually higher because I don’t want to be woken up!

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