Candy Hearts Blog

It's a sweet adventure full of gluten free goodies!

Candy Hearts Blog - It's a sweet adventure full of gluten free goodies!

Animas: Our Pump Choice (Updated!)

The Animas Ping.

Welp.

Here we are.

The end of 2014.

Which means we’re 4 years removed from the first time I wrote about why we’ve chosen the Animas Ping to keep the insulin flowing around here.

Sugar’s pump warranty expires this month – on December 27th, to be exact. As usual, this time always rolls around and I find myself sizing up all the pump options available.

Please Note: A lot has changed in the insulin pump industry in the past 4 years. I’m going to tell you why Animas is the right pump for us and the reasons we’ve ruled out other pumps. What’s important to me may not be important to you. Likewise, my reason for ruling out an option may seem ridiculous to you. In the end, we can only choose one. I have to rule them out somehow! I’m not here to list a comparison of every advantage and disadvantage of every pump on the market, but here’s a great overview and another great one if you’re looking for that.

**Animas — Winner Winner Chicken Dinner!  I’ll start with the obvious…

The Remote: Simply put – We love remote bolusing! I hate overnight corrections, but love that I can just push a few buttons and be done with it rather than having to dig out her pump to do it. I love sitting across the table at a restaurant, and zapping her with a pre-bolus while she’s still perusing the menu. I love that she can wear a dress and not have to worry about lifting her skirt to access the pump. I love that she can hang out with her pals at a party, doing whatever kids do, and I can bolus her from across the room without interrupting. I could paint a million pictures about why I love — and need — remote bolusing in my life. In fact, I love it so much that we haven’t been able to give up the remote in exchange for CGM integration now that the Animas Vibe is approved for kids.

The Pump Bolus: Yup. I love our remote (though I do feel it could use a makeover), but I love that we have the option to administer a bolus from her pump too. I can’t count the number of times the remote has accidentally been left at home, in a different bag, at school, at a friend’s house, etc, etc, etc. When you consider how long we’ve been using it, I suppose it really isn’t all THAT many times, but enough times to really appreciate the option of administering a bolus from the pump.

The Tubing: Yup. You heard that right. We *PREFER* having the pump – and the ability to perform all essential pump tasks – attached to her body.  Sugar has been pumping with tubing since she was 3 years old. It doesn’t get in her way…ever. Period. End of story. In eight years, the tubing has been the least of our concerns when managing type 1 diabetes. We also love that she can disconnect and reconnect easily whenever necessary.  Not to mention that she likes the camaraderie that comes with being spotted by (or when she spots) another pumper in the wild. At this phase in her life, she’s proud of her pump, and really doesn’t care who can see it – tubing and all.

0.025u Basal/0.05u Bolus: Using undiluted insulin, can you draw either of those doses up accurately in a syringe? No. You can’t. Even if you have a syringe with a half-unit marking, you’ll still be guessing. Over the years, we have come to depend on the precise micro-dosages that Animas offers for both basal settings and bolus delivery.

Insulin On Board (IOB): Keeping track of active insulin to avoid stacking is something I have always considered a key safety feature for any insulin pump. I refuse to attach my daughter to medical device that doesn’t keep track of the life-saving (and, potentially, life-threatening) hormone it is infusing into her body. Along those lines, I expect the pump which is infusing such an essential fluid to recognize when her BG is below target and adjust dosing to accommodate accordingly. Expect. Per-i-od. You’re automatically off the list if you don’t do both of these things.

Sites: Sugar uses the 6mm/23 inch tubing Insets. They’re easy to insert, easy to remove, and easy to disconnect in between. We rarely encounter a site issue. After 8 years, I have come to the conclusion that they work great for Sugar and any pump we use would have to be compatible with them. Because the Animas cartridge (which is super easy to fill without air bubbles, btw) has a luer lock, users have the ability to try sites from other companiesif they so desire. The tubing is not proprietary, and I really appreciate that. In the first 2 months of our pumping experience, we were trying to use a different infusion set and it was disastrous. We actually began using the Insets with a different pump…more on that later.

Waterproof: Sugar has been tubing on a lake, romping around waterparks, running through sprinklers, playing on splash pads, and caught in the rain with her pump on.  During the summer months, we usually disconnect the pump and store it in a cooler while at the pool, because her BG tends to drop during swimming. (There we go again with loving the ability to disconnect.) I keep it in a plastic bag and just toss it in with the drinks…there’s been a time or two that water has leaked into the bag.  Suffice to say that I was very glad her pump was waterproof during those times! (Sidenote: The Vibe offers waterproof CGM integration. Dude.  Like. That’s freaking awesome.)

There are a few more things we really like about Animas — like the fact that it uses a AA battery (preferably lithium, but a regular battery gets the job done too), and I can grab them while I’m at the grocery store. Or steal one from a TV remote in a pinch. Not that that has ever happened or anything — but those features are most important to us. So, let’s move on. Here are the reasons we ruled out the other options:

Asante Snap: Asante uses prefilled insulin cartridges to load the pump. While I think that’s pretty awesome, they don’t offer an Apidra cartridge and Sugar uses Apidra insulin.

Next.  {Asante has left the industry since I wrote this post.}

Insulet Omnipod:  The first thing you’ll notice about the pod is that it’s tubeless. That’s awesome…if you’re into that kind of thing. As noted above, we like having tubing, so there’s that. You can’t administer insulin from the pod itself, nor can you change settings, set temp basals, blah, blah, blah. If you misplace/forget/whatever the PDM, the basal rate will continue, so that’s good news. You won’t go into DKA, but you won’t eat without a shot either. Aside from those things, we prefer a smaller basal rate than the pod offers (0.05u) — and beyond that, the ability to program a temp basal for an even smaller amount. You can’t disconnect insulin delivery without removing the entire pod or change a pod for whatever reason without losing all the insulin it still holds inside.  You also have to change the pod when the pod decides. Sometimes Sugar’s sites slip into a 4th (or 5th) day…{don’t lecture me}…I don’t need the thing yelling at me because we’ve had such amazing numbers that I forgot about the site change until the pump reminds me that it’s out of insulin and needs to be refilled. The PDM remote often has to be directly next to the pod/practically touching the darn thing for successful insulin delivery (might as well just push the buttons on the pump, eh!?!), and static electricity interferes with pod function.

If all that weren’t enough reason for me, the Omnipod meter has a notorious reputation for inaccuracy. In fact, the integrated meter uses test strips that have been called into question for accuracy concerns since 2010. From late 2013 through early 2014, there was (finally) a big confused mess of a recall.  The strips were recalled because the Omnipod PDM was reading erroneously low glucose levels…unfortunately, the recall came too late for this young woman who died.

At any rate, as you can imagine, many users prefer to use a different meter…which means they lug around the PDM to operate the device and another meter to use for glucose testing. Blah.

The pod also involves more adhesive and more adhesive involves more potential for irritation, rashes, and skin breakdown. I’ve heard a plethora of stories about pods that malfunction (A LOT of stories about malfunctions, actually), pods that get knocked off, pods that leak, pods that just start screeching randomly at inconvenient times for no apparent reason…the pod just isn’t the right fit for us.

Next.

Roche Accu-check ComboI admit that I don’t know a lot about this pump. I do know that I’d have to use a specific meter to communicate with the pump in order to program a bolus, and there isn’t an option to manually enter the BG if I so desired. I’ve also heard both the set changes and bolus delivery rates take way.too.long. For now, that’s enough.

Next.

Tandem t:slim: I would say out of all the other options, this pump was probably the closest contender. Unfortunately, it doesn’t adjust insulin doses until the BG is under 70. Sugar’s target is 120. If she’s any number less than that, I want the pump to take it into consideration — along with IOB — and subtract insulin accordingly. Waiting until the BG is 70 just isn’t cool with me. You also can’t just deliver a straight-up bolus without associating it with a BG number or carb count…if I just programmed 1 unit for a cupcake and now she’s eating a second one, I just want to program 1 unit again. I don’t want to mess with the other stuff. There have been rumblings of concern about this pump administering incorrect basal delivery, and some folks feel the onscreen buttons are too small, causing frustration when it times out because your fat fingers didn’t seem to hit the right one after three tries. I’ve heard a couple complaints that it’s easy to accidentally enter a BG where you should be entering carbs — thereby potentially administering insulin for 500 carbs when you really just wanted a correction for a 500 BG. I guess there are also a zillion confirmation screens — that sounds as annoying to me as having to scroll up from 0.00u when programming a Ping bolus. I’m used to one annoyance, and don’t want to get used to a new one right now. Beyond those things, this post sums up a lot and I’ve heard a few other horror stories about using Apidra insulin in this pump. Not to mention concerns about (any) insulin overheating when charging this pump (it doesn’t use batteries). Then there’s that whole upgrade thing (or lack thereof) –> basically, Tandem refuses to upgrade current users as they develop and release new technology. When I talked to one rep, he described set changes as “I get it set up – go take a shower – then come back”, because, apparently, it takes a while to prime the tubing. Getting a complete set and site change done at 2 am in under 5 minutes with the Ping is frustrating enough. For now, my sanity couldn’t spend a second longer dealing with slow priming in the middle of the night — or any other time, for that matter.

Next.

Medtronic 530G with Enlite: Lucky for them, Medtronic ruled themselves out as a contender in our home when they sued Cozmo out of business in 2009 over a minute detail they considered to be a patent infringement. I mentioned briefly somewhere up there that Sugar started pumping with a different pump originally. It was a pump we really liked. Sadly, dealing with the mounting legal fees imposed by Medtronic, combined with the flailing economy was too much to recover from. Cozmo employees lost their jobs, and Cozmo pumpers everywhere were devastated — including our family. In true bully form, they’ve sued both Insulet and Animas over “patent infringements” in the time since as well. Interestingly, however, Medtronic had no problem infringing on patents involving transcatheter heart valves — and, hey…KARMA’S A BITCH. <— yeah, that says “ONE BILLION”.

I’ll probably hold this grudge forever, but generally don’t make a big deal about it, because we ended up switching to the Ping and have loved it ever since.  You keep loving your Medtronic pump, and I’ll keep loving you anyway 🙂

Rant aside, there are a couple things I don’t like about Medtronic’s insulin pump technology.  For starters, could the bolus be delivered any slower? Cripes. When I want to get a pre-bolus started, I want it started N-O-W. Not 5, 10, 15, 20, whatever minutes from now. They’ll say people have complained about Animas boluses stinging, because it delivers faster {about a minute}. 1) That has rarely/practically never been an issue for my kid, and 2) A shot delivers faster than any pump out there, so… Moving on, Medtronic pumps are also notorious for “motor errors”. Anyway, I’m not a fan of their proprietary-tubing-thing either. You have to use THEIR products, even if you find one elsewhere that works better for you. It’s not waterproof, and the screen contrast is rather poor in comparison to other pumps. Lastly, Dexcom consistently outperforms Medtronic’s CGM technology when it comes to accuracy and sensor comfort.

————————————————————————–

In the end, there is one other detail that influenced our decision to stay with Animas. Before I mentioned it, however, I wanted to demonstrate that Animas has earned our business based on their own merit and solid record of performance in our home.

Last month, Mr. Rose completed his Bachelor of Science in Information Technology/Information Management and graduated after 5 long years of schooling.  His shiny new degree comes with a career change…which means we’ll be facing some uncertainty about how our health insurance situation will be impacted.

animas supplies

Right now, we have everything we need to keep insulin pumping through an Animas device around here…and that security is priceless.

P.S. (There will be one big change with our next pump order. Sugar will be switching from pink to green 🙂 Awesome color options are another reason she loves her Ping!)

**DISCLAIMER: I HAVE AN EXISTING RELATIONSHIP WITH ANIMAS. HOWEVER, CANDYHEARTSBLOG.ORG IS SOLELY OWNED BY ME, MYSELF, AND I. ALL OPINIONS EXPRESSED HERE ARE FROM MY OWN (CANDY) HEART. I WAS NOT COMPENSATED IN ANY WAY TO SHARE THIS INFORMATION WITH YOU TODAY**

Pudding.

A few months ago, Sugar’s A1c shot up by half a percent.  It wasn’t the actual number that was so concerning…it was more the fact that she had lost some weight, in addition to seeing an A1c elevation.  Then, on the same day we had that endo visit, Sugar ended up needing to have a tooth pulled emergently.

It just wasn’t a good day.

We went back to the endo 2 months later instead of 3, mainly for a weight check.  At that point, we had managed to drop her A1c from 7.5% to 7.3%, and she gained three pounds.  Aside from the fact that her annual labs showed that one of her thyroid antibodies had turned positive, it appeared that we were back on track, and heading in the right direction again.

And then there was November.  November…when I hit a wall.  November…when I was in the THICK of a rut.  November when I made gluten-free sugar cookies to bring with me to the endo, because I was willing to do anything to soften the blow that I knew that was coming.  November…when her A1c was back up to 7.5%, and though she hadn’t lost weight, she hadn’t gained any weight either.

Yeah.  THAT November.

A few days after THAT November endo appointment (um, 2 days to be exact.), I had an out of body experience, and spontaneously decided to switch Sugar from Novolog to Apidra (on Thanksgiving night nonetheless).  I say that, because no sound, well-rested, rational mother would EVER decide to start her daughter on a brand new insulin after a day of feasting, right before bedtime, just because.  A sane person wouldn’t ever do such a thing.

Which may explain the mindset I was in, after weeks on end of nonsensical blood sugar mayhem.

(Just sayin’.)

After 24 hours, I noted that it did appear her blood sugars were staying in target range more often.  By the six week point, I was pretty certain that Apidra could be attributed to the improvement we were seeing in her numbers.

That being said, I have always maintained that the PROOF would be in the pudding…the A1c Pudding, that is.

We had her quarterly endo visit last Friday.

Seriously, we did.

The day before the appointment, she also had a dentist appointment….and the dentist gave us a high-five, awesome report card for her teeth.

Such a different experience than the day she needed to have a tooth pulled.

Whew!  Relief.

Oh yeah!

Back to the endo visit.

6.9%!

Looks like pudding will be on the menu for awhile.

More on our APIDRA experience…
The day we started.
The experience.
The trial end.
The 6 week review.
The verdict.

Update: The Apidra Experience.

Let’s be up front here.

You’re supposed to change out your insulin pump sites every 3 days.

Got it?

It’s just that one of the biggest concerns I had about Apidra had been the number of times I ran across the complaint that it didn’t seem to last well beyond the 48 hour mark in an insulin pump.  I’m just not interested in troubleshooting high blood sugars every other day, if I can avoid it.

Right now I’m just observing, that’s all.

Here’s the play by play of our initial experience with Apidra.  I checked in around the 24 hour mark, somewhere between 9 – 10 pm each evening…

(Keep in mind that LOW stretch at the beginning of Day 1 never really dropped below 78 by fingerprick. New Dex sensors take us about 6 hours before we begin to see consistently accurate readings.)

(Forgive the photo.  I was frazzled.)

If I had access to Xanax, I’m pretty sure I would have taken at least one on Day 2.

I hadn’t made any adjustments to her pump settings.  She spent the majority of her time above 200, and I was feeling pretty down about it.  I wanted so badly to see this experiment work, but also wanted to see if Apidra was even going to last in her pump.  I didn’t want to invest the brainpower into tweaking her pump settings if this insulin wasn’t going to work out.  I was afraid that we’d have the same 48 Hour FAIL experience that I had read about.

It took everything I had not to yank her site, and throw this idea out the window.  Keep in mind that, by now, seeing blood sugars over 250 had become commonplace for over 2 weeks.  I was feeling really bummed, and feared we’d never get out of this rut, but decided to see if things settled down after she fell asleep, and we could eliminate food from the picture.

When I saw that her numbers did, indeed, come back into range overnight, I went ahead and made some adjustments to her morning basal settings in anticipation of the infamous breakfast spike.

Apparently it worked.  The proof is in the pudding, my friends.  In this case, the last of a pumpkin cobbler and a bowl of strawberries.  I realize that’s not the most nutritious breakfast, but I was all about pushing Apidra’s limits while she was under my watchful eye, before returning to school after the long weekend.

Even without making afternoon adjustments, she still only made it to 250 once, and the lowest BG we saw was 78.  In fact, 78 by fingerprick has consistently been the lowest BG we’ve seen since this experiment started.  Day 3 was full of carbs…from pumpkin cobbler to pretzels to a hot fudge sundae, fruit, yogurt covered raisins, and hot chocolate with marshmallows.

I wanted to see this stuff work under pressure.

I just sent Sugar to school on her 4th day of Apidra in the same site we started with……..ummmm…….more than three days ago.

Every.  Three.  Days.  People.

Don’t go telling your endo that you read some sleep deprived mother’s blog who let her kid’s site go indefinitely.

I’m not creating a science experiment, trying to see if I can fester an infected site in her bum.

Promise.

I’m simply gathering data.  Changing the site changes a very relevant variable, and I want to see how things are going with as many stable variables as possible.

Well, except for food.  As far as food goes, I was practically throwing it at her to see how well Apidra could handle it.

I sent her back to school with a graph that looks like this…

I’m giving this experiment 1 more day.

Then I’m pretty sure I’ll be requesting a prescription change.

(And now’s a great time, because we qualify for FREE Apidra until April 2012.  I like FREE.)

More on our APIDRA experience…
The day we started.
The experience.
The trial end.
The 6 week review.
The verdict.

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