I run into this question just about every other day. It is, by far, THE most common inquiry I get from the diabetes social network realm (aka - Diabetes Online Community ... aka The DOC). Honestly, I don't mind answering over and over and over again! The problem I run into is that LIFE often prevents me from returning e-mails/FB messages as promptly as I'd like. For this reason, I think it would be helpful to have a link available to provide folks with a pre-written answer.
It's not that I don't ABSOLUTELY LOVE interacting with my readers (I DO!!! Feel free to say hello anytime!!), but I feel bad when it takes me a few days to get back to someone who has come to me with a question that is important to them RIGHT NOW. I remember the days of choosing a pump. I remember wanting as much information as I could find, reading forum after forum, and just wanting to get the decision made so we could move to the next step. It took me 15 months before I felt ready to tackle another learning curve...once I crossed that hurdle, I was ready to ROCK-N-ROLL and just wanted to DO IT!!!!!
I should note here that I'm going to share the things that are important **TO ME** when it comes to choosing technology to manage Sugar's diabetes. You may have a completely different set of preferences. And that's okay. Just because I value something you don't, doesn't make either of us wrong. We each know what our lives entail. We each know what our individual needs are. So take this information for what it's worth and delete it from the brain if you decide it's just taking up valuable space...deal?
By the way, I'm going to be mentioning the top 3 insulin delivery technology options available in the United States. This doesn't mean they will all be available in your area...nor does it mean there aren't other options out there.
By the way, I'm going to be mentioning the top 3 insulin delivery technology options available in the United States. This doesn't mean they will all be available in your area...nor does it mean there aren't other options out there.
Oh, and one more thing. I'm not a doctor. I'm not a CDE. I'm a mother doing the best she can to be a pancreas for her daughter. What works for my child may not work for you or your child. So don't misconstrue anything you read here as medical advice. It's just our experience....not advice about how to manage yours.
All of that being said, and without further ado, here are the reasons we've chosen to manage Sugar's T1D using the Animas Ping Insulin Pump.
1) Insulin On Board (IOB): (Also known as "Bolus on Board" - BOB) If you've been reading Candy Hearts for awhile, you probably already know the value I place on this feature for Sugar's safety. IOB (aka "Bolus on Board" {BOB}) keeps track of the unused/active insulin still circulating in the system. Animas technology keeps track of active insulin for BOTH corrective doses AND insulin given to cover carbs. This is something I consider essential, because Sugar does not necessarily need to be corrected everyday, but she DOES eat carbs everyday.
The Medtronic MiniMed insulin pump system offers a similar IOB feature.
The Insulet Omnipod offers an IOB feature for corrective boluses, but does not keep track of active insulin for boluses given to cover carbohydrates.
I should point out that, if you're on shots, the IOB is essentially the reason you probably do not correct more often than every 3 hours. You don't have the IOB information at your fingertips and have learned to manage T1D this far. Admittedly, IOB is something I've become dependent on. She eats randomly, more on some days, grazes on others....often I'm checking a blood sugar within a 2 hour window from her last dose -- without IOB, I would NOT correct at those times...in fact, she would probably need to stick to a more regimented eating schedule for her overall management. Having the security of IOB allows me to calculate a correction, regardless of why or when the previous dose of insulin was given. Then, based on her current blood sugar, the pump will let me know whether a correction is or is NOT advised. Being able to correct confidently sooner brings blood sugar spikes back to normal range more efficiently.
HERE is an excellent article about IOB written by Gary Scheiner, a renowned CDE and author of Think Like A Pancreas.
HERE is a brief overview and description of what IOB is from the CWD website.
HERE is another helpful article from DiabetesNet.com.
HERE is a post from a PWD with the same IOB concerns I have.
HERE is a recent example where the IOB feature of Sugar's pump saved the day....it occurred when Sugar was in the care of a **NEW** babysitter while her dad and I were about 30 minutes away, and clearly demonstrates why it is important that an insulin pump keep track of active insulin for carb boluses. It reiterates the reason I feel this type of IOB feature is an essential part of Sugar's overall safety and provides extra peace of mind when she is not in my immediate care -- whether that be at a playdate, church class, school, or just because she's in the other room trying to assert some independence without me standing over her shoulder.
2) 0.025u Dosage Increments/0 Basal Option: Let's face it. A little insulin goes a long way, especially in little people. Animas allows dosing increments to be programmed 0.025u at a time. Try as you might, you will never be able to draw that up in a syringe -- even if you're using a syringe with half unit markings. No matter how you look at it, you'll always be guessing....that's IF you can even get such a minute amount past the needle and into the syringe itself.
Additionally, I have found it necessary to program a ZERO basal from time to time to assist with managing a pattern of lows. This typically happens overnight, but has also been the case for regular daily physical activity -- for example, she had some post activity lows when she was taking swimming lessons every day for 8 weeks. I found it useful to keep her basal set at zero for an hour before the swim lessons and it helped. I suppose a temp basal would do the same thing, but then you'd have to remember to program it every day.
THIS POST demonstrates the power of one little drop of insulin.
The newest Medtronic MiniMed Revel pump also offers 0.025u dosing. You can also program a zero basal.
The Insulet Omnipod does not offer 0.0.25u dosages. The smallest unit of dosage available is 0.05u. Additionally, you CANNOT set a zero basal as part of the regular pattern.
3) The Remote: Simply put....I LOVE IT. The PING remote acts as both a blood sugar meter using One Touch strips and a remote insulin delivery device. I've bolused through the door while she's in the bathroom (Oh, yes, I have. Nothing is sacred when you need to get a pre-bolus working and dinner is about to hit the table), from the hallway outside her bedroom, while she's in the backseat of the car, and across the table in restaurants. I love the remote PERIOD. It provides detailed information about blood sugar history and averages, including graphs and charts that break everything down according to the section of the day.
I've heard that the Medtronic MiniMed also offers a remote feature, but have never met anyone who is actually using it. I've never seen it and do not know any specifics about it.
The Insulet Omnipod, uses a wireless PDM for managing all tasks.
4) Pump Bolus: Yes, I love the remote. BUT, I have been stuck without it. A time or two, it hasn't made the transition from the gym bag to the purse, it's been left on the countertop when loading the fam to the van in a hurry, once we accidentally left it in a doctor's office waiting room an hour from home...whatever.... We're not irresponsible people...but we have been caught without the remote unexpectedly from time to time. In these moments, I appreciate the ability to administer a bolus from the pump itself.
The Medtronic MiniMed does deliver boluses from the pump.
The Insulet Omnipod only delivers a bolus from the PDM. A carb/correction bolus cannot be administered if the PDM is not available. The basal insulin, however, will continue to infuse, regardless of how far away the PDM may be.
5) Sites: When we first began our pumping journey in 2007, Sugar wore a different insulin pump that has since stopped manufacturing. At that time, we were using the infusion sites that came from the same company as the pump. Well....they didn't work us. I couldn't get a site to last longer than 36 hours, no matter how meticulous I cared for it. After a few frustrating weeks, I started shopping around in search of other infusion sets. We found the Animas Inset (straight insertion) and have never gone back. I appreciate that there's a small amount of adhesive as, sometimes, Sugar's skin gets irritated and itchy -- I don't like risking infection from skin breakdown and dirty fingernails in precious real estate areas that are used for her infusion sites. The less adhesive with sturdy application, the better!
The Medtronic MiniMed offers a variety of infusion sets. However, they use a proprietary system, so you cannot try products from other companies. The amount of adhesive used is comparable to the Animas Insets. In fact, the new MiniMed MIO infusion sets are practically identical to the old Animas Insets that we've been using for years. I don't think this is by coincidence.
The Insulet Omnipod obviously uses only the pods themselves. The pods tend to be bulky and use a great deal of adhesive surface area. Currently, the entire pumping community is awaiting the release of smaller pods...which are expected to reduce in size by about 40%. Any day now???!!!???!!!
6) Waterproof: Sugar has been swimming, tubing on a lake, running through sprinklers, playing at splash parks, 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. I often 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!
(**NOTE** The remote is NOT waterproof)
Looking back, I'm not sure that allowing the pump into the lake was the smartest idea, and I'm thinking we probably won't do it again. If that sucker had fallen off....I shudder to think..... It's probably a better idea to take it off before next summer's run on the tube and taking a dive to swim with the fish. Even still, at the time her life jacket was covering the pump pack and....well....we were all just so excited to be out in the boat that we forgot about it. You heard that correctly. WE FORGOT ABOUT THE PUMP!!!!! Oh well. Hindsight is 20/20....all's well that ends well!!!!!
The Medtronic MiniMed is NOT waterproof.
The Insulet Omnipod is waterproof, but the PDM is NOT waterproof.
I guess those are the big reasons....there are other features that we like too -- combo boluses, temp basals, and other stuff like that -- but all of the pumps have these features, so it's really nothing that sets Animas apart. While I'm on the topic of technology options, I'll answer a few other questions too...
WHAT ABOUT CGM?
Medtronic MiniMed has a combined insulin/CGM pump -- there are still 2 sites, but only one device.
Both Animas and Insulet have contracts with Dexcom and combined pumps for both of these companies are expected soon. Well, you know....as SOON as SOON gets with this stuff.
***UPDATE 2/11*** Since writing this post, we have started using the Dexcom continuous glucose monitor. Most of the time we like it. Sometimes we don't. HERE is a review from our trial week, and HERE is a more comprehensive review after using it for 2 months.
WHAT ABOUT THE TUBING? Well....what about it? I suppose there have been times when the tubing is inconvenient, but it's really not in the way -- EVER. No more inconvenient than placing a bulky pod on a diaper wearing baby, keeping it from wobbling on a small arm, or accommodating it under a tight shirt. We can either be concerned with tubing that hardly ever causes an issue or worry about a pod getting bumped, deactivating, and having to waste excess insulin (which appears to be a pretty common issue that people get frustrated by...I could list example, after example, after another, and still more examples or 6 pages worth about the frustrating rate of pod failures, but I think you get the point.) Pick your poison, ya know? Now that we use the remote, Sugar can wear dresses without worrying about needing to access the pump (this was probably our biggest tubing inconvenience), and we've found some great pump packs that do a good job of keeping the tubing securely hidden. The tubing is simply a non-issue. It always has been. When we first began pumping in 2007, the tubeless Omnipod wasn't even an option. It was TUBING OR BUST, BABY! We've never looked back.
WHAT ABOUT SITE PROBLEMS? Honestly....they hardly ever happen for us. Site dilemmas are part of the journey. Not gonna lie. Don't want to sugarcoat it. You WILL have a site issue or 2 if you're a pumper/podder. It's just reality.
HOW DO I GET READY FOR THE PUMP? There are a few books that I've found quite helpful. They both contain WAY more information than what you need in the beginning, but the intro to pumping sections are good reads, and it's nice to have a reference handy as you become more comfortable.
Think Like A Pancreas
Smart Pumping
Pumping Insulin
WHAT IF I HAVE MORE QUESTIONS? Well, JUST ASK! You can either leave a comment here or drop me an e-mail (candyheartsblog@gmail.com). I'll get it answered as soon as I can. If you leave a comment, I will it answer it in a follow up comment, so be sure to check back....and, if you're reading this for the first time, you may want to peruse the comments for more information.
In the meantime, be sure to check out Meri's Pump Parade, where she features a link to users of each pump option I've mentioned here. The Pump Parade offers additional perspective, photos, and information regarding the 3 most popular insulin delivery technology options.
From My CANDY HEART to Yours,
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HIGH FIVE and a BELLY BUMP from your BETA BUDDY girl. We are Ping users and would NOT change a thing. It is the right choice for us. We have been using it for 3 1/2 years and we plan on sticking with it when our 4 year deadline with the insurance is up...we will continue with Animas. I also find the Dexcom CGM superior to the Minimed Guardian (or whatever the latest name is)...so the CGM option with the Minimed does not lure me at all. I would rather have a reliable CGM than have both devices married into one...if that makes any sense.
ReplyDeleteAgree and LOVE our PING!! Not so in love with Dex (cgm) but can't give up on him quite yet. Animas also has AMAZING customer service!!
ReplyDeleteWe chose Medtronic because the integrated CGM and ended up LOVING it anyway. We could TOTALLY use the .025...luckily we get a new pump in June and Revel has it! But, of course, we have learned to manage around it.....
ReplyDeleteAmazing how we become so passionate and in love with our plastic Pancreas!
I have a question that I have asked the endo and others but still don't feel like I have gotten a straight answer about. Maybe there is no straight answer. But here goes. It seems like those of you who are on pumps have a LOT more lows, I mean REAL lows, than we do. I don't know if that is because you are on the pump, or because you are farther along in the disease process. Is it because we are still honeymooning? Did you not have such low lows in the beginning? Does being off Lantus mean that you have less of a safety net? Are these 30s and 40s just inevitable in our future, or are they somehow a symptom of pumping? This is one of the things that is worrying me about going on the pump. Our lowest low so far has been 67. Why?
ReplyDeleteThis is one of the most well thought out pumps posts I have ever read.
ReplyDeleteWay to go Wendy!
And to Wendy P...we actually have had less lows on the pumps rather than MDI. Good luck on your journey!
Awesome post! Thank you for taking the time to put this all together...it really helps newbies like me. :)
ReplyDeleteThanks for the love, my friends!
ReplyDeleteWendyP....
The simple truth is that lows just happen. They're a frightening side effect to insulin therapy.
As you strive for tighter control, there's a delicate line between the comfortable low end of normal and too low. The pump doesn't know all of the outside variables, such as illness, physical activity, and carb miscalculations.
Lantus is a 24 hour injection that provides a steady amount of "background" insulin. However, the pancreas naturally releases different amounts of insulin at different times of the day, and that's what pump therapy is designed to mimic.
Unfortunately, our brains are brains and not the beta cells of a pancreas. Pumping involves ALOT of guessing to figure out the correct amount of basals, ratios, and correction factors at the correct times of the day...and it's all subject to change with growth spurts, stress, illness, whatever. When you factor in the outside variables, plus that fine line I mentioned earlier, it can set up the potential for lows.
However, there's no less risk of "bad lows" on MDI....because insulin is fickle. Period.
Sugar had HORRIBLE lows on shots. Passing out, combative, confused....they were HORRIBLE!!!! HORRIBLE I TELL YA!!!!! And guess what? They typically happened in the 60's. Sometimes the most symptomatic lows aren't REALLY all that low at all.
I'm pleased to report that, since she began pumping, those horrific lows have decreased dramatically -- I think we've only experienced them 2 or 3 times since she began wearing an insulin pump almost 4 years ago. Pre-pump, she passed out and hit her head at least once a week.
I hope this helps, but I know it's hard to wrap your brain around. Insulin just doesn't follow the rules....and, as parents, we're left to navigate a confusing maze in it's wake.
this is a great run-down!! when C began pumping 5 years ago, we weren't given a choice...minimed was it. it's been fine for us except for the water issue...that's when i think about exploring different options. this past summer, C's cute little pink pump took a swim...3 seconds, tops...i freaked...but everything was okay...whew!
ReplyDeleteFirst Id like to answer Wendy Ps question. Its actually found that pump therapy reduces lows compared to mdi. Lantus being a 24hr basal would not reduce lows but increase them. As it cannot be fined tuned or reduced at any given moment. The lantus provides a safety net for highs not lows. We did mdi for 2 yrs and we now have 70% less lows. LOVE Js Ping! IOB is so important and imo waterproof too. Who wants to tell a kid he cant shower or swim cause hes in the middle of a combo bolus or is high. LOVE THE PING!!!
ReplyDeleteSo would you all say that your lower lows came later on? After your honeymoons were over? Or are we just lucky that they haven't happened yet? I guess I am just wondering if, and fearing that, those 40's, 30's, and God forbid 20's, are inevitable and just around the corner or if I can somehow avoid them. Probably just hoping for the impossible huh?
ReplyDeleteOH, WendyP....I wish I could tell you that there was a magical way to prevent those low, low, low numbers.
ReplyDeleteI suppose the closest you'll get is with a CGM that you learn to trust. I haven't had that experience yet, but there are plenty of folks out there who have.
The lowest Sugar has been was 26 -- NO SYMPTOMS. NOTHING!!!!! You would NEVER have known. She was getting a routine check before lunch at school.
I think it helps knowing that, even with the most vigilant management, those LOW LOWS can still happen. If you prepare your mind for the possibility and think about how you'll respond ahead of time, it will help when you're in the moment.
For example, we never store juice boxes in the plastic wrap that keeps them together on the shelf at that store...we always take that off and put them individually in the pantry. When we see a 40 or below, the last thing I want to do is fight with plastic....it's just one little way I'm ready ahead of time.
I used expired Glucagon kits for practicing...and I keep an insulin syringe taped to the current one so that it's always available.
When I needed to give a mini-gluc a couple weeks ago, I felt prepared because I had reviewed it in my mind time and time again over the past 5 years. I remembered not to shake the vial -- instead to swirl to mix -- and then draw it up in the insulin syringe...1 unit per year of age for the mini-gluc dose. I remembered to focus on the fact that her symptoms were worsening instead of on the number I saw staring back at me when I tested. I questioned if I was doing the right thing, but felt I could proceed with confidence because I knew I had gone over the scenario time and time again in my mind.
You're doing a great job, WendyP. Just keep swimming....one number at a time and always remember you're NEVER alone.
This is a great post! Great, great post and I think it is awesome that so many people are able to benefit from your knowledge. I love reading the comments and seeing how much your blog is helping others. AWESOME job, friend!!
ReplyDeleteJo was here tonight and she mentioned how great this post was too! She thought it was very helpful and I totally agree!!!!
That was great Wendy! Nice thorough work. Thanks for sharing the site with me. I read with enthusiasm, though I think we still will wait awhile on an actual decision...Amy
ReplyDelete