Yet another which pump should I get question

Diabetes Technology Insulin Pumps
1

I know there is a boatload of discussion on this topic so I'm going to see if I can get some clarification on a couple questions I have.

Background: I've been on MDI for 20 years and in the process right now of getting on a pump. I've just met with 3 of the 4 reps for pumps that are available in Ontario (Minimed Veo, Animas Ping, Accu Chek Combo and I'm meeting Omnipod next week)

My questions are mostly about how people use the pump and imagining how I would use it:
1. Why does everyone (the Animas rep included) seem to downplay the value of a food database? I would have assumed that it would be valuable. I'm just relearning to carb count, so maybe that's it (I did count 20 years ago but now I just eyeball everything and go by gut feel)

2. I'm leaning toward the Ping or the Accu Chek because I believe that the powerful remote is a good thing. Can anyone explain why I might prefer to do things directly on the Minimed pump? Currently, I often just carry my pen when I go out and don't bother testing at those times. Maybe not being forced to carry a remote would be good (by all accounts the accu chek meter is awesome but the pump is a little feature poor)....

3. The Dexcom is currently not available in Canada. I'm a data junkie and CGM really appeals to me, but I hear so much that dexcom is better than minimed and that I should wait either for the Animas vibe (which I could upgrade to if I got the ping (but then lose the remote (see #2)) or wait until a stand alone comes which could then be used with the Spirit Combo (Animas rep said it should be here "soon" which is the only time I've ever heard that a stand alone dexcom is coming to Canada). Is there that big of a difference?

4. My computer runs Linux. All of the software seems to be Windows and sometimes Mac. Any experience here?

Any input on anything above (or that I might be overlooking) would make me happy

Thanks,
Jeremy.

2

I’ve been pumping with Medtronic pumps for 8 years. I was using carb counting before I started pumping. I have never missed a food data base on my pump for several reasons. Once you’ve been carb counting for a while, you learn the carb counts for the foods you normally eat. Secondly, IMO carb counting is most accurate when you weigh your food rather than just measure or eyeball. When I’m home and weighing food, I have a list of carb factors on the inside of one of my cupboards and that is faster to use than looking it up on my pump remote. Third, when I’m out and about, I can use my cell phone if I need to access Calorie King or some other program to know carb counts. Finally, there is a lot SWAG (scientific wild ass guessing) even when you carb count at restaurants or at home. How big is your portion? Is the banana ripe or green? My chili at Wendy’s has more beans than yesterday’s portion.

I have never missed a remote and really don’t want to bother with one. If I wore a lot of dresses, maybe I’d feel differently so I could hide my pump in non-accessible locations. My pump is in my pocket and I have easy access to do everything I want to do. I use the Link meters with my pump, so all of my testing info is automatically sent to my pump. I keep my meters in my purse and bathroom drawer. I don’t want a third device to carry on my body. Already have pump and Dexcom receiver.

I have a lot of experience on both the Medtronic and Dexcom CGMS. For me the Dex is a million times better than the Medtronic system: lots more accurate and almost no pain and bruising. You can read my post in this forum about my pump warranty almost being up and considering whether I should try the Animas pump because of the Dex/animas combo coming out hopefully within the next year.

With Linux, I say you probably haven’t got a chance in the world of getting a pump/CGMS program to work.

Good luck as you make your decision.

3

Hi Badger,

All very good questions. Personally, I have an Animas Ping and I like it more and more each day. I have been hoked up for nearly a year, and have had great control, as opposed to MDI, for every day that I have been hooked up.

First, I use the food catalog rarely, but when I do use it, it is of a great help. The food catalog can be customized in your meter to help with the foods that you like to eat. I think once I memorized the carbs of the foods I eat regularly, I use it less, but it is very handy when I need it. It has saved a lot of highs and lows.

Second, with a pump, no matter who's pump, you need to test, test, test. I like the remote features fo the Animas and that is a partial reason that I bought it. I also like the colour screen for my old eyes, and the software that goes with the machine. This is not to say that MiniMed's software is bad, but I just liked the Diasend better.

Third, I'd like to have a Dexcom, but my insurance doesn't cover it. I guess that is about the same as being unavailable. Many will agree with your statement that Dexcom is the best one out there, but sorry, I have no experience with either Dexcom or Medrtonics. I can't really say anything bad about a Medtronic pump. They are a good pump. I didn't care at all for their sales rep or their pushy telemarketers; but that is me.

Four. I run Linux too. You will need Windows for the Diasend and Animas tracking software. These are separate programs, and the Diasend is internet based, so that you can share information with whomever you choose. The Animas software tracks your pump and meter data too, but does contained on your hard drive. I am not so sure of compatibility to Windows 8, but I am sure the software engineers will address this. It may be available for MAC as well, but I have no experience with MAC software or hardware.

I hope this helps. All the best with your choice.

Brian Wittman

4

I’ve been very happy with my Minimed revel. Get your hands on the pumps, play around with them, and consider all features. For example, I didn’t think the Carelink software that comes with Minimed pumps would be so helpful, but I love it! It has really helped me fine tune my basal rates. For carb counting, I find weighing or using an app on my iPhone (CarbFinder) to be perfect.

5

I suspect that pumps can't keep up with other types of technology due to the lengthy FDA approval process...

6

Thanks for the input.

I'm still not sure if my insurance will cover CGM (I've gotten a couple responses, neither were satisfactory) but I would consider doing it out of pocket if it's not covered. One thing at a time though... first I need a pump then (assuming I don't get the minimed) we need to get a CGMS in this country.

I can no longer remember why I discounted the minimed in my search and just started focusing on Animas and Accu Chek -- it might have been as simple as the colour screen. hmmm... time for more reading.

One more question:
My current TDD is about 60U. With the pump discount that puts me at a guess of 45ish when I start pumping. Will that be pushing the 200U reservoir in the Animas?

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Not everyone ends up using less insulin on the pump. So if I were you, I would make my pump decision based on the amount of insulin you’re using currently.

I don’t know about the other pumps, but with my Medtronic pump, I always show about 160 units in my reservoir immediately after filling it. My reservoir size is 180. About 8 units are used in priming the tubing. Rumor is that the rest is actually there, but it’s almost like a hidden cache so you don’t run completely out.

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Badger,
About the reservoir size. If your current TDD is 60, you will be getting between 2 and 2.5 days between changes is my guess. Reason: on the pump, there is no standard TDD for many people. It depends on your bg and what kinds and amounts of food you eat. My current tdd ranges from 45 to 65. You could have a range of 45 to 70, again depending on carbs. And you will have wastage of insulin. Let's say that your pump will run out at 3 AM. Are you going to wake up then and change it or go ahead and change it before bedtime and waste the leftover insulin? My pump is demonic in that it's reservoir always manages to last until out after midnight, regardless of how I may try to schedule it to run out in the daytime. So I usually waste a few units or more by changing it early. You also do not use the last units in the tubing because it is not possible for the plunger to push it into your tissue (you will understand when you start).
This is a long way to tell you to think about whether you want the smaller reservoir or not. If your insurance pays for as many reservoirs, tubing, etc as you need then it may not matter to you. On the other hand, it is nice to be able to go a full three days or 3.5 without having to deal with it.
Over the 4 year warranty, your TDD could either increase or decrease. No way to predict. But if it increases, then you can't change to a larger reservoir until the warranty is up. Unless you want pay for a new pump out of pocket.
This may be garbled but hope you get the point. I think neither decision (smaller vs larger reservoir) is a bad one. Just think about your lifestyle and preferences.

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This is good. I like having my options narrowed down for me. I will strike the Animas and its 200U reservoir from my search.

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I don't think 45-50 units each day pushes anything on a pump. that is about what I use and sometimes I wonder too. I change sites about every three to three and one half days, whenever the pump is out if insulin. I change the infusion set and the reservoir at the same time. It takes about ten minutes to do, and is not difficult.

I don't think that is an excessive amount of insulin, and usage is the least of your concerns.

Be well.

Brian Wittman

11

To me, if the units are a question, that would be important. Part of the bonus of a pump is doing less work but the site changes are a bit of a chore so I'd want to do them at least every third day, rather than every two days so I'd go with one that will more comfortably cover your doses. If your dose goes down that'd be great. I got the big Medtronic one when I started and switched to the smaller on the warranty change.

12

It would be objectionable by just about any moral standards. I think we need to be a little careful when talking about experimenting on people or when talking about rushing clinical trials.

Maybe by placing a very high entrance cost on tests and instead of experimenting on the vulnerable, we could do it on the very rich and powerful?