Asante Snap Trial, Week One

I caught the Asante Snap video-chat here on TUD a year or so back and was very interested. I was only about a year into switching from MDI to a (Medtronic) pump and had a lot of frustrations. It was too soon for my insurance to cover changing to another device, also I use Novolog not Humalog, so I put my interest on a back burner. But I saw the promo for doing a trial a few weeks back and decided to go for it. I started on it last Tuesday, 1/13/15 and it occurs to me some people also thinking about a switch might be interested in how it's going so far.

Initial concerns:

  • Novolog vs Humalog: problem? No. Some people say they've had issues switching but I see no difference whatsoever
  • Insurance coverage: will they pay for the switch? Dunno yet, but IIRC the controller itself is about $250 if I have to pay out of pocket, which is pretty manageable.

Things I don't like:

  • Infusion set tubes only come in 23" and 42". I have the 23" which seems a little short, whereas 42" seems like I'd always be getting tangled up in it. I'm used to Mio 32", and that seems just about right
  • Glass insulin reservoirs have key advantages but are more shock-sensitive. My first day, the pump slid off my lap and clunked on the floor, setting off a howling alarm that required me to swap out the reservoir/pump body and replace it--bit of a waste given that these things are supposed to go 6 days. In the trial situation Asante just said they would send me a new one but I don't know if my insurance company would be quite so nice, so this could be a significant downside. Gotta be more careful anyway!

Things I like. A LOT:

  • Pre-filled reservoirs. NO MORE TAPPING BUBBLES, and no more voids that cause BG spikes when you don't get all of 'em
  • Pre-filled reservoirs. NO More waiting for the insulin to warm up before changing sets. This is one of the biggest single annoyances of pump life. Anyone else suddenly remember today's the day they have to change their infusion set NOW, only you've gotta leave in 5 minutes or you'll be late for work? Or your alert goes off a minute after switching the light off at bed time and now you've not only got to get up and go through the whole rigmarole of changing it but also you can't start until your insulin bottle has had 20 minutes to get up to room temp after being in the fridge so it won't be full of bubbles.
  • Pre-filled reservoirs. They're made of glass, which means the insulin stays good for much longer, meaning...
  • 6 Days between reservoir replacements!!! You still have to change your infusion site every 3 days because the site gets saturated like with any other system, but it's MUCH simpler not to have to go through the whole infusion set changing process (which is simpler with this system to begin with b/c pre-filled reservoirs)
  • Programming niceties. Get this: you can tell the thing NOT TO ALERT you about a low reservoir in the middle of the effing night, if there's a reasonable amount of insulin still in there. I LOVE this. My damn Medtronic always decides to wake me up at 3 a.m. to let me know I'm going to run out of insulin around freakin' lunchtime. This message couldn't wait??? Well, yes it could, and now it does.
  • Programming niceties: when you pause the pump during your morning shower or whatever, the pump tells you how much insulin you missed when you start it again. Really handy to have that info--especially nice when you've paused it for exercise: now you know how much insulin you just didn't have to take because you were out there virtuously burning BG by physical exertion.
  • Readability: the've really done a great job with making the screens easier to read and interpret, using contrasting backgrounds, large type san-serif faces, etc.
  • Built-in flashlight. Well, that's self-explanatory isnt it? Very handy!

Things in Medtronic's favor

  • Carelink. For all it's retro Java clunkiness, I really like being able to upload my data to the cloud directly from my BG tester and be able to track it, send it to my endo etc. Asante says they're working on something similar, but it's not available yet.
  • BG tester talks to pump. I like having the tester automatically send my number to my pump before bolusing. It's less streamlined having to do it manually and easier to enter a wrong number by mistake.

Hope this is of use to anyone else considering a Snap. I'm happy to answer any questions if I can or compare experiences with others who are trying it out.

Thanks for posting this DrBB,

It sounds like it has a lot of positives. Somehow I was under the misconception that all the pumps were like this, just pop your insulin and go, which would be nice, but I use less insulin than most so it would also be a waste. It is a pain for sure to do all of this, dealing with air bubbles etc. But if you are putting a pump-fill in don't you still have to take it out to let it cool?

I'm using penfills used for my novopen junior now and I let them sit for an hour or more to warm up. I like that it tells you how much you have missed.. I'm not sure if the tandem t slim does this or not- I haven't figured it out yet if it does. 6 day changes sounds great. Is there more danger of scar tissue developing if you have the inset in longer?

I was always told that you have to let the insulin vial warm up for at least 15 min to try to minimize the amount of bubbles, no other reason. So no, you don't have to let the sealed ones warm up, just plug and go. I haven't used penfills, so I don't know if that's comparable, but with the Medtronic it's pretty much the same as filling a syringe back in the ancient past when I was on NPH/R (now THAT was the bad old days).

Re the inset, I met not have been clear: you still have to move it every 3 days, but you don't have to change the insulin reservoir, which is good for 6. So it comes with two different types of insets, some with tubing and some without for when you just have to move your site. You just stick one of those on, clip the tube from the old one into it, pull off the old one and you're done.

I've been using Snap for about 14 months and am so pleased with it, overall. I have the new customizable MySnap pump in my favorite color (blue) and they've updated some of the things I initially didn't like about Snap (the low res screen, for one).

Carelink is definitely better than nothing - which is about all we have with Snap so far. I did get it uploaded to DiaSend at my CDE's and it was lovely to see the data, but I want software I can use at home. Until they make a patient-side upload cable, we're s.o.l.

Ok, so the sealed one is protected from the cold? How do you keep it cool when you store it in the fridge? I see about the insets.. still 6 days for the reservoir is good. I wonder all the insets come with just the inset in case your tubing is ok but you have a cannula problem, I'm going to ask.

You store them in the fridge but they can go straight into the pumping body without warming. Bubbles aren't an issue because you're not transferring the insulin from one container to another (insulin vial to pump reservoir) as with the Medtronic.

Sounds great, lucky you!

Thanks for the post! I'm a newbie here--40 years old and diagnosed type 1 (probably LADA?) on 9/30/14. I'm currently on Lantus and Humalog, but I am seriously considering switching to a pump, and the Snap is the one that appeals to me the most.

My main question is this: how long does the Humalog cartridge last (as in days of quality)? I am currently taking pretty low amounts of insulin, my TDD is in the neighborhood of 16-18 units. That would mean a 300 unit cartridge would last a couple of weeks, but it sounds like it is set up such that you have to change out the cartridge every 6 days?

What I was told by my Asante trainer was that because the insulin vials are sealed glass, the insulin doesn't degrade appreciably. Apparently it's the plastic that most pump reservoirs are made of that actually breaks down the preservative in the insulin, but glass doesn't do that.

My TDD is such that at six days I'm down to under 20 units. The way the infusion sets are sold a six day limit seems to be assumed: they come in pairs, one with tubing and the connector to attach it to the pump body, and one with just the infusion canula for the day when you are just relocating your site and using the tubing already connected.

But I'm not sure if that's an absolute limit--seems like you'd be wasting a lot of insulin at your TDD. I'd contact Asante with that question.

I think I will go ahead and do that. I'm being treated by an internist, not an endo, and he's great, but he doesn't specialize in diabetes so I have been getting much of my information from online sources instead of from him. One thing I read in one of Gary Scheiner's books was that he recommended LADAs wait until they are out of the honeymoon phase to start pump therapy, as then your doses get more regular, I guess? I'm sure I'm still honeymooning, I have gotten down to 6 U Lantus at night, though I think I may need to bump that back up to 7 U.

How are you liking pumping in general as compared to MDI? I'm a reformed needle phobic so the shots don't bother me too much, but it definitely seems appealing to reduce the poking to once every three days instead of 4 times a day minimum.

Does the Asante Snap require a proprietary insertion set or can any you use any leur lock set?

Re the "honeymoon" phase. I think the idea is that the auto-immune reaction is still going on and breaking down your insulin-producing cells for a while, so maybe best to wait until all that stabilizes. That's the lore I remember from when I was diagnosed 31 years ago, so for whatever it's worth....

For me the HUGE difference was actually going onto MDI from having been on the old R/NPH regime, or as I fondly refer to it, the Eat Now Or Die regime we all used to be on. If you don't know, don't worry--you don't want to. :-)

Suffice to say that switching to the pump two years ago wasn't nearly as momentous for me, and the MDI regime pretty well grounds you in 95% of what you need to know for using a pump--carb counting & bolus injections etc. You get a lot more flexibility in programming the thing to different sensitivities at different times of day, compensating for the "dawn phenomenon" with less risk of waking up hypo in the middle of the night and so on. It's definitely a good thing.

I went for a LONG time--far TOO long--assuming that my non-specialist GP knew everything necessary about managing this disease. I had actually asked about switching from R/NPH to MDI for a couple of years and he said "You're doing alright, why mess with it." When I finally switched health plans and saw a specialist at Joslin, the first thing he said was "You're not doing too bad considering that the method you're using makes no f***ing sense whatsoever," and switched me to MDI. Finally! I could cite other examples over the years of incidents where I discovered that not only the general public is ill-informed about this disease, particularly Type 1, but a lot of medical professionals are surprisingly ignorant as well. I would STRONGLY recommend that you ask your GP to get you a referral to a specialist ASAP. I got a lot of resistance to it and didn't push as hard as I probably should have, and as a result spent a much longer time than I should have in a treatment regime that was antiquated and dangerous and a much bigger burden on my quality of life that it needed to be.

The connector from the tubing to the pump body is definitely proprietary, so I think that's a yes. They do offer different options such as angled canulas and stainless steel inserts so there may be more to it than I know about. My biggest complaint is that they only offer tube lengths in 23" and 43" inches, i.e., too short and too long. I'm hoping that's a false economy that they'll correct at some point going forward. But for my purposes it's more than offset by the other advantages.

@Melisa Lee - Sorry I couldn't reply directly to your comment but I'm using an old computer while my laptop is in the shop. Either my software or perhaps Ning is not cooperating.

I noticed that Diasend listed Snap pumps as compatible with their system. I use Diasend regularly and consider home-use essential, but I'm interested in the other aspects of the Snap. It will probably be on my short list next time. I love your comprehensive pump review that you did recently!