I’ve been working on this post for a few months, but other topics kept pushing themselves to the front of the line. On 11/7/13 @MHoskins2179, @txtngmypancreas, and @AMNimlos used Twitter to brainstorm the idea of having custom-made pumps. Argh! My idea was going mainstream! I immediately called my lawyer, filed my patents, and got back to work. A few weeks later I have gotten no indication that the interlopers have backed down and I guess we’re at an impasse. Consider Microsoft vs. Apple, Dell vs. Gateway, Best Buy vs. Circuit City, Target vs. WalMart and if you’re still interested, I have a bridge in Brooklyn I’d like to sell you.
I’ve decided to buy a custom-made pump. No pump on the market has all of the features I want and many of them have features that I definitely don’t want. So I’ve decided to do what we used to do for many of our family’s computers. I’m going to find a small, reliable company to assemble a pump with the hardware and software from various pump companies as specified by me. Working with the Comparison of Current Insulin Pumps at Diabetes Net, I’ll select components line by line. I’ll also include some features that are not available on current pumps, but should be. When I’m finished, I’ll look forward to having my ideal pump.
Size and Shape: Because I don’t mind tubing and prefer small infusion sets in contrast to the size of even the newest Omnipod, Insulet will end up having no presence on my custom pump. Although I like the idea of the smaller and lighter Asante Snap, I plan on having an integrated CGMS and will need a larger screen. So I choose the Tandem t:slim for its sleek modern look and the largest useable screen.
Reservoir Options: I have used both Medtronic and Animus pumps and have no preference for one reservoir system over the other. But since I am designing my dream pump, I will go with the pre-filled Asante reservoirs which in my ideal world will be available in multiple sizes with all insulin types and non-proprietary connection types. For me it will be a 200ml Novolog pre-filled reservoir. (Of course ideally I would have access to the next generation faster insulins, but let’s be realistic here….)
Touchscreen or Buttons: This is an easy choice. I will go with the Tandem touchscreen where I can enter numbers on a keypad rather than scrolling up-down-up-down and continually missing my target number. My Animas Ping requires even more scrolling than my Medtronic pumps did and has a bad habit of continuing to scroll after I release the button. Almost anything will be an improvement for me over the Ping.
Screen: I enjoy the readability of the black background with bright color screens of my Ping and Dexcom G4 and I will continue with color. The downside of these screens is the difficulty of seeing some of the colors in bright sunlight and Medtronic boring gray does have some merit. I don’t know how color is used on the t:slim, but I do like how the Ping uses white text with colors for highlighting. The white text is much easier to read in sunlight than colors such as red. Whoever chose red for the numbers and graphs depicting lows on the Dexcom did not do their homework. Check out my blog post from 8/29/13.
Basal and Bolus Increments: in most areas, I would be happy with the rates of Animas, Medtronic, or Tandem. I would definitely like the t:slim’s options for temporary basals because I am frustrated by the Ping which only allows 30 minute increments. Even 15 minute increments per the Asante Snap would be fine. I also like the Medtronic option of setting temporary basals as either an exact basal rate or a percentage.
Bolus Calculator Options: There is no pump that has exactly what I want. I want a straightforward and streamlined menu system where I can calculate and administer bolus insulin logically and quickly. According to Wil’s 7/22/13 post at LifeAfterDx, the Asante Snap requires only 6 steps versus the 14 steps of the Tandem t:slim to bolus for a meal. Tandem has fallen for the FDA-endorsed idea that users actually pay attention to the warning and “Are you sure?” screens that pop up on their pumps. If the FDA knew how little most users paid attention to safety screens and warnings, they probably wouldn’t allow any of us to use a pump. I was satisfied with Medtronic menu system and totally hate navigating through the Ping system. So I will check out the Asante menus and either select that or Medtronic.
Power source: For this line item I am definitely in the battery camp and have no interest in a rechargeable pump. I can’t count the times that I have been unable to use my Verio meter because I ignored the charging warning. Same with my battery powered toothbrush. Compared to the price of most of my diabetes supplies, a battery is a cheap power source. I have carried an extra pump battery in my meter case for years and I feel more confident in this back-up plan than the idea of finding a cord and power source to recharge my pump.
Motor and Memory: I don’t know enough about pump motors to have much preference. As far as memory, it looks as though the Tandem keeps the most info. So I’ll go that direction and try to convince myself to download my devices more often.
Software Download: I haven’t seen Tandem’s software, so I’ll be conservative and go with Carelink. The one requirement for my pump software is that it be compatible with all of my devices regardless of brand. And it should work like my Fitbit with all devices automatically downloading with Bluetooth.
Waterproof: I’m not sure that the Animas Ping is really more waterproof than other pumps, but I appreciate the fact that because they guarantee the replacement of my pump if I have water damage. So I’ll stick with Animas.
CGM: Although I know that Medtronic’s Enlite sensor is a huge improvement over the previous Sof-sensor, I am committed to a Dexcom CGM for my pump. But I want Medtronic software to integrate the CGM readings into my pump.. As much as I like Dexcom, I miss the information that is readily available on Medtronic pumps. I like that you can scroll backwards in time and see actual sensor values rather than just graphs. I like predictive alerts and missed those when I switched to Dexcom.
Blood Glucose Meter: In an ideal world, all brands of meters would be compatible with all brand of pumps and have universal connectivity. I find Freestyle to be the most accurate for me and I will stick with that.
Summary: The whole idea of a custom-designed pump is a pipe dream. We will never see online promises of build to order, unleash the power, get the best, the fastest and the ultimate pump. Because I have rarely had a computer work properly for four years, I know that I should appreciate the FDA review of our pumps. At the same time I am frustrated with the sub-optimal and old-fashioned devices that are compromises between safety and good design. But I can’t complain too much. I started my diabetes career thirty-seven years ago peeing on strips and taking insulin once a day. I am a happy camper with my Animas Ping, Dexcom CGM, and Freestyle meter. But a girl can dream, can’t she?