My Heart Is Snapped In Two

1414426_86457786There are worse things happening in the world. There are always worse things.

On Friday, as I was making dinner, a friend texted me:

“Did you hear the horrible news?”

My heart skipped a beat. The diabetes community is vast and wide and filled with people I love. Who was suffering? Or worse…who had died?

I didn’t respond by text. I rang her up and asked: “What happened?”

“Asante closed their doors today. They shut down.”

If you use an insulin pump, you’ll quickly understand how I felt. Your insulin pump is like a member of your family (it’s there at every meal, every occasion, and sometimes you fight with it…) and I have quickly grown to love my Asante Snap pump. I loved it so much that I became a consultant for them, writing about my experience with their pump and insulin pumping in general. It was no secret that I felt my control had improved that it was going to be the last insulin pump I used before the Bionic Pancreas became commercially available.

I am mourning the loss of an innovative company that attempted to give their customers what they wanted: choice. Some of the features the Asante Snap pump has is not available with any other pump on the market, and we’ll be hard pressed to find them integrated into any future insulin pumps (although they should – site change reminder? Missed bolus? Small things that made a difference in my time in range and overall control.).

Because I consulted with them, I also knew the employees that were just as passionate about the Asante Snap pump as I was. They were caught unaware, as all of the customers were. They found out Friday, right before the rumors started to fly and the public announcement was published on the website.

Customize-your-snap-insulin-pump-2Simply put, funding didn’t happen. The company attempted to go public, but pulled their IPO at the end of March when investors and the stock market didn’t bite. (Another pump company attempted an IPO at the same time, without success, and two other pump companies’ stocks were not doing well during the IPO offering.) From what I was told, the CEO was working with a company for a partnership and at the last minute, the deal fell apart.

 

I’ll choose another pump. (Both Animas and Insulet are offering Asante Snap users offers to switch.) The talented employees will find other jobs.

But my heart right now is snapped in two.

Goodbye, Snap.

Snap Decision

You grab a pack of gum at the checkout counter. It’s an impulse purchase and you don’t think about it. It’s a snap decision, made right then and there.

Choosing an insulin pump is anything but a snap decision. You research all of your options, talk with other people who wear pumps, weigh the pros and cons of each pump, and of course, find out if insurance will cover your pump and supplies.

In my case, my insulin pump choice was a snap decision. With a capital S.

unnamed-3The Asante Snap pump. 

After my warranty expired on my previous pump (Of course, it was pining for the fjords five weeks later.) and an opportunity to try the next generation of that company’s pump, I recognized that I needed to do further investigating. I’d only worn two brands of insulin pumps in the over 15 years of pumping. I am still happy with the choices I made back then, but back then, I didn’t have a lot of choices.

I cheer the fact that we have more choices now when it comes to insulin pumps and continuous glucose monitoring devices. Each pump and CGM has its strengths and weaknesses, which of course, means that some people will choose them based on their own needs, wants, and desires.

Here’s why I chose the Asante Snap Insulin Pump.

I Am Ricardo Montalbán

You can’t “test drive” a piece of gum. You buy it and if that new flavor isn’t what you wanted, you throw it away or foist it off onto someone else. It’s gum, right? Costs a buck? Pshh. Get outta here.

But it’s rare (or in some cases, impossible) to test out an insulin pump. This device is going to be a part of your life for a hopefully good, happy, healthy long time. And it’s not cheap. You choose a pump based on what you think it will do for you, go through the hoops (and oh, are there big, flaming hoops!) to get approval from everyone involved, only to find that… you hate it. I know some individuals who have returned their insulin pumps before the “trial” period is over, but it’s a big, ugly hassle and insulin pump companies don’t make it easy.

Asante gets that you should be able to take a pump for a test drive. Feel the rich Corinthian leather seats. Determine if what you want is what you actually get. They offer everyone who is interested in trying the Asante Snap pump a four-week free trial, including supplies, training, and support. I got to sit in the driver’s seat and go for a long drive. I wish all pump companies would do the same.

No More Rebel Yell Time In Range!

The four-week free trial is one thing. It’s another thing entirely when you discover that by not changing a single basal rate or bolus factor, that your time in range with your blood sugar skyrockets. (And when I say skyrockets, I mean supersonic space age shiny skyrockets.) Having the luxury of a Dexcom CGM allows me to see how my blood sugars play nicely (or not nicely) during the day. I was doing a lot of Billy Idol hair spikes. Without changing my eating habits or dosing timing, I saw spikes turn into smoother lines and when I downloaded my Dexcom (Finally able to do it on my Mac!), I was shocked. 80% time in range (for me, range is 70 – 180, but I’m already tightening the higher end).

Less lows. Less highs. All of a sudden, I wasn’t exhausted at the end of the day, chasing the blood sugar dragon. My head was clearer. I had energy. I thought it was a fluke, but after almost 8 weeks on this pump, I’ve come to realize it’s two things: the Asante Snap pump algorithm and the pre filled glass cartridges making this happen. I can’t take any credit for better blood glucose levels.

 Heart of Glass

The pre-filled glass cartridges not only help the insulin not degrade and lose potency as quickly as the plastic cartridges I once had to fill; it also cuts down on the time I used to fiddle around with pump  set-up. Doesn’t seem like a big deal, right? It’s a big deal. You get that I’m a two-minute sort of woman when it comes to diabetes.

Instead of the elaborate ritual of drawing up the insulin into a plastic cartridge, checking for bubbles, filling the tubing, checking for bubbles, priming the pump, checking for bubbles, I drop the cartridge into the pump body and it auto primes. In two minutes, I can complete an insulin pump set up, including a new insertion set. All that extra time I have now? I can rock out. 

(And I don’t have to hunt for a battery in the bottom of my purse. The battery for this pump is built into the pump body. You replace the pump body with the changing of the cartridge. Easy.)

I’m not the only one who thinks this is a good thing. I join Scott Johnson of Scott’s Diabetes, Melissa Lee of Sweetly Voiced and others who have switched from other pumps to Asante. Here’s what some people had to say about how easy it is…

The Little Things Add Up to Awesome

It’s the little things. A customizable color screen. A built in flashlight on the pump for those early morning BG checks. A missed bolus calculation if you stop your pump for a shower. (I never realized how much insulin I had missed even disconnecting for 20 minutes.) The ability to set alarms to NOT go off at 3am to wake you up to remind you to change your cartridge.

Some people prefer an integrated CGM and insulin pump. I tried it.  I’ve come to realize that I’m a Dexcom chick, tried and true. The other pump company with an integrated system has not yet updated its algorithm for increased accuracy. Plus… here’s the thing: The Dexcom G5 screen will be accessible to view on my iPhone I won’t even need to look at my pump to see my CGM graph.

When I was at AADE last summer and saw a glimpse of the future with Asante Snap (I sat next to Wil and we got to ooh and ahh at the demonstration, they announced not only would they be partnering with Dexcom for future upgrades, but they were the first company hooked up with Tidepool. (And you know how much I love them!). And then they blew everyone’s socks off my demonstrating bolusing the Asante Snap from an iPhone. I’ve never had a remote bolus device. I am totally ready for this. And when it does happen, it won’t cost me an arm and a leg (or a pancreas) to upgrade, because upgrades are $99. Straight. No chaser. 

I got to design my Snap. (Well, I got to have input. The Kid actually decided on the colors.)

No Pump is Perfect

No insulin pump is 100% perfect. (If it was, it would be called a pancreas and this blog wouldn’t exist.) I do miss the vibrating alarm option I had on my previous pump. I am a little jealous of other pumps that do have remote bolusing devices. I am a lot jealous of the current integrated pumps and CGM systems that work well. And I can’t upload my data at home; Asante currently uses the clinic version of Diasend.

I’ve talked with the management team at Asante. I’ve asked questions about their future models. They listen (and they even have a patient advisory board so they can get feedback). I see the Asante Snap becoming more perfect soon.

IMG_5863Time. In. Range.

Oh… that time in range. That blissful time in range that makes me feel more rested, less stressed, and looking forward to getting my A1C done. That makes it all worth while.

My new time in range makes my diabetes management easier and less about diabetes and more about me. 

Best Snap decision I’ve ever made.

I talked to Asante so much and gushed about how much this pump has improved my life that I’ve agreed to enter into a consulting agreement with Asante Solutions to write about my experiences pumping on their website. Please check the updated About page  for disclosures. Remember: My thoughts are my own. No one can make me write what I don’t feel or believe in on this blog. In fact, I get zero compensation for this – or any – blog posts on this blog. This is MY blog. MY words. MY thoughts. You get to read the uncensored version – always. 

Medtronic CareLink and Browsers of Yesterday

516892_68656024On the FAQ pages of Carelink. it plainly states:

Which web browsers can be used to access CareLink Personal software?

The system is currently validated to work with Microsoft® Internet Explorer® version 7, 8 and 9, Internet Explorer 10 Desktop, Apple® Safari® 4, 5 and 6, and Mozilla® Firefox® 5.0.1. Other browsers might still work although Medtronic Diabetes is not able to guarantee proper operation of those browsers.

 

I use a Mac. (According to Dexcom, I’m already a complete loser, as their CGM software won’t even run on a Mac unless you use a PC emulator program.) I have two browsers downloaded on my system: Safari (which comes standard on most Macs) and Firefox (which is easily downloaded and what I use occasionally for some banking transactions that demand Firefox).

I know that CareLink works on a Mac, because I’ve uploaded my pump data before on this laptop. So, the other evening, when I needed to upload data so that my trainer and I could look at it together while talking on the phone to adjust settings, I thought it would be easy.

I got this screen when I went to Medtronic’s CareLink link on their website:

Screen Shot of Safari Browser

My Safari was “too up-to-date”, so I couldn’t access CareLink through that browser.

Well, shoot. OK. Fine. I’ll fire up the Firefox browser I have… Version 21. (Not Firefox 5.)

Too up-to-date.

And by the way, if I wanted to download Internet Explorer right now, it’s IE 10 – or 11. And wait, they don’t have a version for Mac.

Frustration

If I didn’t have an amazing husband who is a web developer and happened to be home and was willing to sacrifice a pocket protector to the Geek God, I would have been not been able to upload my data. (He somehow configured something and magically, I have a Firefox browser that is…workable.)

I was able to examine the data that I uploaded, but I can’t imagine how frustrating it must be for others who expect that along with the latest technology they get from Medtronic, they get an upload system that will only work with the browsers of yesterday.

Yes, I expressed my opinion to the support team at Medtronic. I was polite, but I did use the phrase: “Unacceptable.” People who know me smile, as that means I’m pretty angry.

Will they do anything? Time will tell, which is pretty much been my phrase about this experience. What I do know is that it takes just one web developer to fix it and make sure that it works with all systems when there is an upgrade… I’m sure they can spare someone in their IT department.

Like I told you before, Medtronic, while allowing me to trial the system and all that comes with it, does not expect that everything I say will be rainbows and glitter about my experience.

The diabetes community talks incessantly (and I believe, sometimes to the wall) about the crucial need for integrated technology to make our lives easier to manage our diabetes. The Medtronic MiniMed 530G with Enlite is an integrated pump and continuous glucose monitor (and that threshold suspend, which I’ll write about soon… promise), but it’s an utter fail if you can’t use the browser… or two browsers…. or system… that you have to review the data and reports. Fail. (It’s not just Medtronic… Dexcom has failed me, too.) What good is the data if you can’t get to it?

Parting Thought

Heads up, Medtronic IT department. Please update your CareLink application and browser compatibility. (I’m not going to even talk about Chrome, which you supposedly don’t support at all…)

P.S. I’ll write about the actual reports that CareLink provides in another post. They do deserve a post of their own. But jeez.

Come. On.

 

 

 

 

 

The Ca-Chunk Factor: MiniMed 530G with Enlite

The Enlite® serter, the device patients use to insert the Enlite® sensor beneath the skin, was designed with patient comfort in mind. With a simple insertion process, it inserts the sensor at a 90-degree angle using a completely hidden needle.  Courtesy Medtronic, Inc.
The Enlite® serter, the device patients use to insert the Enlite® sensor beneath the skin, was designed with patient comfort in mind. With a simple insertion process, it inserts the sensor at a 90-degree angle using a completely hidden needle.
Courtesy Medtronic, Inc.

Control. It’s a concept that people with diabetes wrestle with… control over what we eat, our blood sugars, our lives in general. When you’ve done everything in your power to keep this disease in check, and yet, you see a high (or low) blood sugar on the meter, it’s frustrating.

So, I take control whenever I can in my diabetes, which includes needle insertion. I’m not a huge fan of “auto-insertion” and never have been. From my very first injection in 1983, I would slowly insert the needle into my selected spot. If I was halfway in and it began to hurt or I felt a twinge, it wasn’t uncommon for me to pull the needle out and start in another spot. Quirky? Guilty as charged. There are times that I am jealous of those who jam a needle in and quickly inject and move on, but I prefer having control over at least, inserting the needle. I use a Silhouette insertion set for my insulin pump because I can insert it manually…under my control.

The Medtronic Enlite® Sensor uses a insertion device that doesn’t allow for the rate of needle insertion. (The Dexcom G4 sensor insertion device uses a plunger, so yes, I totally take my time pushing that plunger down.) I didn’t have a positive experience with the Sof-Serter sensor insertion and truth? Freaking out about putting in the Enlite®  on Friday was actually raising my blood sugar. I was… scared. What if it hurt just like the Sof-Serter? What if the needle hit a spot that was tender and it bled? What if it came time to put that inserter onto my skin and I chickened out.

The Ca-Chunk Factor

Then there’s the Ca-Chunk Factor. That sound that the inserter makes when the mechanics release and the spring load snaps and something happens. If you’ve had diabetes for a while, you’ll remember the “Ca-Chunk” sound with the Autolet lancet device (a.k.a The Guillotine). I dread that sound. Sends shivers up my spine. I sweat a little in anticipation.

I had my training session with the Medtronic trainer on Friday and after the polite introductions, I spilled my guts. “I’m scared about the insertion pain and the accuracy and the Ca-Chunk Factor, but right now, it’s the insertion pain. I’ve been told that it hurts much less than the Sof-Serter, but I have nightmares about those insertions, so…”

Lisa, the trainer, was incredibly cool about it all. (I think I may not have been the first to express these fears.) We talked about the difference in needle gauge sizes (the Enlite®  introducer needle is significantly smaller) and how many individuals had expressed surprise at how comfortable the sensor felt after insertion. She asked me to explain the Ca-Chunk Factor. She offered to have me practice using the inserter, but I took a deep breath and said: “Let’s just do this.”

Here’s how the insertion of my first Enlite® Sensor went for me.

Lisa: “You don’t need to pinch skin at all. Just place the inserter directly onto the skin and don’t press the inserter hard. Most people find it comfortable to stand up when they do the insertion.”

I nervously stand, whipping my shirt up and searching my abdomen for a spot that would have the least potential for an “OWW!”.

Me: “OK. Wait! Where should I have the green button?” (The green button is what you press and release to insert the Enlite Sensor.) I turn the inserter around on my abdomen, trying to find a comfortable way to hold it and the button and begin to feel that sweat beading on my forehead.)

Lisa: “When you’re ready, press the green button.”

Deep breath. Moment of truth. I push the green button.

I think to myself: ‘Wow. She was right! That didn’t hurt at all! Jeez, I have no idea why I was freaking out about this.’

Lisa: “Now, release the button.”

Me: “No problem.”

As I released the button, I heard…

“Ca-Chunk.”

I had been fooled by the Medtronic Enlite®  Sensor serter. It drives the needle in upon the release of the button, not the push. And because I was lulled into the concept that I had already done the hard part, it came as a surprise. What was more of a surprise was that it didn’t hurt when it really went in.

My first fear – squashed. Annihilated. (Next week when it’s time to put a new sensor in? I’ll have to trick myself, but I know it won’t be as painful as I thought it would be.)

After the insertion process was complete (There are more steps, including a complicated process of taping the sensor down onto your skin…), I told Lisa that I had been duped by the inserter. Happily duped.

Right now, a few days into this, if you asked me where the sensor was on my abdomen right now, I’d have to think hard. No pain. No twinges. (I’ll talk about the accuracy in another post.)

Control. I could give up a little for this…

 

Guinea Pig: MiniMed 530G Insulin Pump with Enlite

OLYMPUS DIGITAL CAMERAIn second grade, Mr. Harris introduced us to our class pet: a black, tan, and white guinea pig named Zipper. He (she?) squeaked quietly in a large cage filled with shavings in the back of the room while we learned about math and good citizenship. I got to bring him home for one of our breaks and loved on that little guinea pig while our cat shot daggers from her eyes. She was jealous.

Hi. Please call me Zipper for the next 90 days.

The MiniMed 530G with Enlite will become my insulin pump/sensor system, along with all that it entails over the next three months, thanks to a trial offered to me by Medtronic.

Here are the details of the trial, as I’m all into disclosure:

Medtronic is loaning me the entire system for the 90 day trial, including the 530G pump, CGM transmitter, Bayer Contour Next Link meter and test strips, Enlite sensors, reservoirs, and infusion sets. After the trial is complete, I will return all unused supplies as well as the pump, transmitter, and Bayer blood glucose meter.

I will be providing feedback to Medtronic through a survey and a one hour phone call after the trial is over. I will go through the entire set up as if I am a new pump user, including meeting with a Medtronic trainer and using their protocols and help desk. I will be changing my infusion sets every three days and my Enlite sensor every six days.

They won’t be putting words into my mouth (which is great, because it’s already full of my own) and I will share my honest opinion, my ups and downs, and what I think about the system. They know I’m not one to dance around the real issues, so you’ll get what you always get from me: unabashed and never whitewashed realism.

I’ve worn a Medtronic MiniMed pump for years and I’ve been happy with it. As I have said before, when I first started on a pump, there were only two companies in the game. As I was moving to Europe, I chose the “not Minimed” company, but when I returned to the U.S., Minimed had jumped so far ahead in technology, it was a no-brainer.

Time marches on and the market has expanded, not just with insulin pumps but with CGMs, and this is where my trepidation comes in. I had tried the Sof-Serter and abandoned it due to pain and accuracy issues. When I attended the Medtronic Advocacy Summit in January, I spoke with several Medtronic employees who assured me that the new CGM is less painful to insert and more accurate than before.  We. Shall. See.

Why I’m Trying The MiniMed 530G with Enlite

I’m curious. (Isn’t that enough?)

I love my Dexcom CGM. I love its accuracy, it’s ability to eek past the recommended seven day readings, and the fact that my husband can take it from me and still watch my numbers as I snuggle in the other room with The Kid. (And yes, he has brought me a juice box when I didn’t realize I was going low.) I love my MiniMed Revel 723. My fingers know the buttons in the dark. It’s been a part of me for so long. There are other insulin pumps out there and I’ve petted some of them, wondering if I would like them just as much if not more than what I currently have.

But this Threshold Suspend thing that will stop insulin delivery if it goes below a decided upon BG level? Totally looking forward to that if it does what it’s supposed to do. My overnight lows, even with the Dexcom, are still pretty rough. I’m sleeping through my alarms until I get to the 55 mg/dl or below “prisoners are escaping” blare. By then, I’m wobbly, cranky, and I eat until I stop panicking. Total barrel full of fun the next day. As the Threshold Suspend is unique to the Medtronic Minimed 530G, it’s a big deal for me. Will it be worth giving up my Dexcom? Would it be better for me than the upcoming but not yet released Animas Vibe? Can I get over the non-open standard nature of Medtronic data?  We. Shall. See.

We. Shall. See.

I keep saying: “We. Shall. See.” because you’re basically taking me home for 90 days. You get to watch me run around like Zipper and observe this experiment in ThePerfectD.com habitat. Fun photos! Great stories! An expletive or two! (O.K., I hope not…) Reality.

I would like a water bottle on the side of my cage, please. Maybe filled with caffeine? Can you do that for me?

My name is Zipper and I’ll be wearing the MiniMed 530G with Enlite for the next 90 days.

Squeak.