My Vibe Decision

Laddie_Head SquareA photo is worth a thousand words and the photo below shares that I decided to upgrade to the Vibe.

After I published  “The Vibe: Should I Upgrade?” on Feb. 5, a lot of things happened in the next 24 hours. As I mentioned in the blogpost, I was scheduled to meet with an Animas rep that afternoon to see the pump live.

The Animas rep was very nice and professional as she showed me the Vibe and allowed IMG_1118me to push buttons. I was immediately surprised that I did not dislike the pump and thought I could live with the CGM graphs on the small screen. Although I am still convinced that the design of all/almost all insulin pumps leaves a lot to be desired, I left the meeting with an incredible result: I didn’t hate the Vibe. I liked it enough that I decided on the spot that I would upgrade.

Amazingly, the next morning someone from Animas called to confirm my color selection for the Vibe (Blue!) and to indicate that she was ready to process the order. The pump was scheduled to be delivered on the next Thursday. At this point things became complicated as she called back to say that there was a problem with the credit card on file. After she couldn’t get three different credit cards to work, I started to wonder if I was on the Animas Sh*t List because of numerous negative comments about the Ping and Vibe on my blog.

The problem was finally resolved on Tuesday and despite the delay, I was promised a Thursday delivery. In fact Thursday morning at 9:00AM my Animas contact promised that the pump would be delivered that day. I didn’t believe her because UPS hadn’t even activated the tracking number yet. Of course the pump was not delivered on Thursday and I was frustrated because of the many things I had cancelled to stay home. At the same time the day was not a total waste because I cleaned most of the house and finished a couple of chores I had been avoiding. Finally UPS activated the tracking number and showed a Friday delivery.

I have now been using the Vibe for 4 days. Do I love it? No. Do I think the upgrade was the right decision? Yes, for several reasons.

  1. I was content with the Dexcom G4 and wasn’t convinced that I was having better results with the recent software upgrade. Therefore I have decided not to stress over the lack of the G4AP (Artificial Pancreas algorithm) software update in the Vibe.
  2. I am very happy to have less one medical device in my pockets.
  3. I have a history of losing my Dexcom receiver in bed at night. Now all I have to do is find the pump tubing and reel in the CGM like a 5-pound walleye.
  4. There are some improvements in the menu system, although not as many as I think are needed.
  5. This decision is only binding for 21 months and then I will select my last pump before Medicare. My choice now was to stay with the Ping or upgrade to the Vibe. The Snap, the t:slim, the Medtronic 530G, and other pumps were not part of the decision. It was Ping vs. Vibe and nothing else.
  6. Because I got the pump directly from Animas, I am going to optimistically assume that there will be no insurance ramifications when it is time to get a new Dexcom receiver. Maybe I will be so happy with the Vibe that I won’t even bother with another receiver.

Right now I am stumbling through the Vibe menus primarily because I was so adept at the Ping. One important feature of the Vibe is the ability to populate the recommended bolus by pressing the Up arrow. Unfortunately I am still Pinging and start to scroll before I remember to simply press the Up button. I will adjust and I – just – need – to – slow – down.

My biggest frustration is how many button pushes it takes to get from the CGM screens to the bolus menu. It is five/six button pushes to move from the CGM screen to the Bolus ezCarb/ezBG menu. The lack of an Esc or Back button on Animas pumps is a major design flaw IMO. In his review of the Vibe, Mike Hoskins of Diabetes Mine talked about the pump and the CGM living in the same house but being different rooms:

You can think of this system in terms of a dwelling — the two components used to be separate housing units, but now they co-exist under the same roof and are more like different rooms within one big home.

That’s my biggest takeaway. I have a pump. I have a CGM. They are in the same piece of hardware, but they are totally separate. In fact it seems that Animas forgot to even build a door between the two rooms.

With the Vibe I am finding that I am using the CGM in “static mode.” I push the button to see the CGM Data Screen showing my BG number, the trend arrow, and the insulin on board (IOB). Because it takes so long to change screens to the 1-hour, 3-hour, and other CGM trend screens, I usually don’t bother. I like the 3-hour screen and wish that I could just push the Up button twice to get there. But no, I have to wait for the 1-hour graph to load before I can push the button again to move to the 3-hour screen.

When I began using the Vibe, I made the decision to go all-in and not continue to use my Dexcom receiver. I can always go back to using the Dex receiver at any time and be no worse off than before the upgrade, but I hope to ultimately be happy using one integrated device. So far I believe that the pump functions of the Vibe are an improvement over the Ping, but for me the CGM part is a definite downgrade from the Dex receiver. Chances are that I will get used to it and be fine.

In my previous Vibe blogpost I provided links to other reviews of the Vibe. Since then I have read a couple others that you might be interested in.

Active Diabetic is a young Canadian who is an incredible athlete. His bio minimizes his achievements:  “I’m a cyclist, runner, climber, backpacker and oh yeah, I’m an insulin dependent diabetic too!” I “met” him last year during Diabetes Blog Week and was very inspired by his accomplishments and attitude. In May he published a blogpost that indicated that he would use the Dex receiver rather than deal with the Vibe for his CGM. But 10 days ago he wrote a follow-up post and shared that he is totally on board with the Vibe. Both posts are well-written and super informative, so check them out.

Kerri of Six Until Me wrote a post last week sharing her thoughts on the Vibe after using it for a couple of weeks. As always, you’ll find some helpful information.

Tarra who uses a Dexcom in tandem with Duchess, her diabetes alert dog, is mostly happy with her Vibe. Check out her post from yesterday.

Sara of Moments of Wonderful has just started the Vibe and today posted a video highlighting a few of the Vibe features.

I’m okay with my Vibe but not in love. It is definitely a #firstworldproblem that I can complain about a pump/CGM combo. As life goes, it’s pretty insignificant that the color screens are slow and I have to wait a few seconds for the graphs to populate. But children dying because they lack access to insulin. That’s important. If you haven’t donated to Spare a Rose, Save a Child, it is not too late. Click here and donate. No donation is too small and every gift makes a difference.

Spare a Rose, Save a Child 2015

Spare a Rose 728x90tag

Laddie_Head SquareAll of my 2015 blogposts have been about #firstworldproblems such as the Animas Vibe, my Dexcom G4, an iPhone trick, and a recent experiment of using long-acting insulin along with my pump.

But children in developing nations are dying because they have no access to insulin of any type.

I can be a grouch when diabetes technology does not live up to my expectations. My biggest problem these days is whether I should keep my current insulin pump or upgrade to the newest model. I joke about the excitement of switching from a hot pink continuous glucose monitor to a blue one.

But children in developing nations are dying because they have no access to insulin of any type.

I am 62 years old and have lived with Type 1 diabetes since I was 24 years old. Last week my Fitbit says that I walked 105,292 steps or almost seven miles a day. I went out to lunch three days in a row. I have very few complications of diabetes. I am indeed blessed.

But children in developing nations are dying because they have no access to insulin of any type.

I am writing this blogpost on my laptop computer at my kitchen table with an iPhone and iPad sitting next to me. My refrigerator is full of food and most importantly, there is a 3-month supply of insulin in the deli drawer.

But children in developing nations are dying because they have no access to insulin of any type.

What if there was something that you could do to make a difference for these children? There is and you can by supporting the Spare a Rose, Save a Child campaign sponsored by the Diabetes Online Community.

The message is simple, but powerful. Buy one less rose this Valentine’s Day and donate that $5 to the Life for a Child program sponsored by the International Diabetes Federation (IDF). Your gift of $5 will provide a month of insulin and diabetes supplies for a child in parts of the world where these life-saving medications and supplies are desperately needed. Consider donating $60, the equivalent of a dozen roses, and giving a year of life to a child with diabetes. Even more generously, make a pledge for a continuing monthly gift.

If you need motivation to donate, please watch this short vlog by my online friend Kelly Kunik at her blog Diabetesaliciousness©.  (To my contemporaries who might not be as hip as I am, a vlog is a video blogpost. I am trendy enough to know what a vlog is, but not so cool that I have ever done one….)

As we approach Valentine’s Day 2015, let us be generous in sharing our bounty with children all over the world. To us, a rose is small. To a child with diabetes, that rose represents another day, another month, another year of life.

I made a donation today and hope that you will too. To donate using PayPal, click here.

To Donate, Click on the Image

To Donate, Click on the Image

The Vibe: Should I Upgrade?

Laddie_Head SquareAfter eight years of using Medtronic pumps, I switched to the Animas Ping in 2012 to be eligible for the $99 upgrade to the highly anticipated Animas Vibe. I am totally committed to Dexcom and the Vibe was in line to be the first pump released in the US with Dexcom integration. Two-plus years later the Vibe has finally been approved by the FDA and is actively shipping.

I ordered my upgrade before noon on the first day that Animas accepted orders. Many people are getting delivery of their pumps, but I haven’t heard a peep. Did everyone order before me or is it because my Ping was supplied through Edgepark rather than directly from Animas? I have no idea how Animas is determining shipping order, but I hope that I have not been lost in their system. “Call Animas” is on my To Do list.

Last week I picked up the phone to contact Animas and then stopped. Do I really want the Vibe?

The Vibe (as will the t:slim/Dex integrated pump) is based on the Dexcom G4. The recent G4AP (Artificial Pancreas algorithm) software update will not be included nor will any future improvements in the Dexcom platform.

Unfortunately when a pump/CGM combo is approved by the FDA, the device is “frozen” in time with the hardware configuration as approved. I don’t know how software updates are handled by the FDA, but one source told me that the Vibe as configured will not allow software changes. Now that Dexcom has multiple hardware and software upgrades in the pipeline, a 4-year (or for me a 2-year) commitment to an older version of the Dex might be a bad decision. In the short run I can keep using my Dex receiver to access the new software. The just-released Share receiver will also be an option because it is compatible with the current generation of transmitters.

Now a word on the “current generation of transmitters.” Vibe purchasers new to CGM are being sent the high-profile Dex transmitters that were replaced by smaller transmitters a few months ago. I assume that the Vibe was submitted to the FDA with the old transmitter and wonder if it will take another FDA submission to change that. Fortunately the only difference between the transmitters is size although I personally can’t wait to get the small transmitter when my warranty expires in February. The new transmitter is compatible with the Vibe.

Dexcom is already talking about the next generation G5 transmitter that will have the ability to communicate directly with cell phones without the use of a receiver. The G5 mobile system transmitter will not be compatible with the Vibe.

pump_animas_vibeMy Animas warranty expires in December 2016 and I should probably just get the Vibe. The fact that it will populate the recommended bolus rather than scrolling up from zero is a huge improvement. Because I will pay the upgrade fee out-of-pocket, technically my insurance company shouldn’t know that I have the Vibe and then potentially refuse reimbursement for a Dexcom receiver when that warranty expires in August.

Unfortunately it seems that nothing is private when it comes to medical things. My doctor has to write orders for the Vibe and I wonder if Edgepark will be the shipper rather than Animas. Somehow I believe my insurance company will end up knowing about the switch. Maybe I am just being paranoid. Everyone else has been assuming that they will have no problems continuing to use the Dex receiver if that is their choice. But I think that many of us will see the day when insurance companies refuse to cover the cost of CGM receivers because we have pumps functioning as receivers.

I have not yet read one review of the Vibe that is overwhelmingly positive and I know of one person who has already returned it. Kerri Sparling’s preliminary review was the closest to being positive because she didn’t address any of the negatives. She promised a more complete review later and I will be interested to see what she writes. She is upfront about her sponsorship relationship with Animas and you can trust her when she says that her opinions are not for sale. Another Ping user, Sara at Moments of Wonderful also wrote about looking forward to receiving her Vibe. In my opinion anyone who has been using the Ping (except for fans of the Ping meter/remote) will most likely see the Vibe in a more positive light than users of other pumps. There is a definite learning curve to adjusting to the idiosyncrasies of Animas pumps.

Most non-Ping reviewers of the Vibe have been highly critical of the poor menu system, the low resolution color screen, the lag time of button pushes, and other negatives. I believe that Johnson & Johnson missed the boat by not starting from scratch when designing this pump. IMO Mike Hoskins of Diabetes Mine summed it up best:

my honest final verdict is this: the Vibe feels like an outdated, counter-intuitive medical device that seems like it would have been more relevant if released several years ago as promised. Today, it doesn’t feel innovative, but rather like a device that’s filling a market need for choice only because it promised that a long time ago, and it’s “better late than never.”

When I purchased the Ping, I underestimated how much I would hate the menu system and how long I would regret the decision. Because I have no option to change pumps until 2016, my feelings about the Ping are inconsequential as I make my upgrade decision. Frankly two years after the purchase, I have to admit that I have become a whiz at moving through the menus; the scrolling and button pushes have become second nature and I rarely think about them anymore. But it took a long time. The Ping has been a workhorse for me with no technical problems in two years. (I had my pump replaced once due to cracking of the battery compartment, but it was a quick process with good customer service.) Another important feature of the Ping is the waterproof guarantee. With the Vibe I like the idea of having a waterproof CGM receiver.

So what am I going to do? Today I am meeting with an Animas rep to get a hands-on look at the Vibe. Some early reviews have criticized how many button pushes it takes to access the CGM info and how slow the pump moves from screen to screen. The display is small and a different shape than the Dexcom receiver. If I upgrade, will I even use the CGM part of the pump except on an occasional basis? Is it worth $99 to populate the bolus recommendation with the push of one button? Will I be able to see the Vibe CGM in the sunlight because I find it impossible to see my Ping screen when hiking? (The Dexcom is bad in the sun; the Ping is worse.) Is there a risk that when my Dexcom receiver goes out of warranty that my insurance will not approve a new one because the Vibe functions as a receiver?

Had Animas contacted me about shipping the Vibe a few weeks ago, I would have jumped on board immediately. Now I am not so sure.

I’ll keep you updated on what I decide. I wish that I felt excited about getting the Vibe and maybe I will be once I make the decision. At some point I need to contact Animas. Or maybe they will get in touch with me….

If you’d like to read recent reviews of the Vibe, here are some to check out:

Kerri Sparling at Six Until Me

Melissa Lee at A Sweet Life

Adam Brown at Diatribe

Mike Hoskins at Diabetes Mine

Manny Hernandez at Ask Manny

Sara Nicastro at Moments of Wonderful

Midnight Two and Five

Laddie_Head SquareThe big thing around the DOC these days is the NY Times Op-Docs feature titled “Midnight Three & Six.” This twelve minute video was filmed by Joe Callander and funded by the Sundance Institute. In remarks accompanying the film, Callander begins the story as follows:

For the past eight years, the Chamberlain family in Fort Worth, Tex., has been coping with a nightmare all parents fear: In 2006, their daughter, Grace, was given a diagnosis of a life-threatening disease. Grace has Type 1 diabetes, for which there is no cure. Now 15 years old, she has endured approximately 34,000 blood tests, 5,550 shots and 1,660 medical tubing injections to keep her alive.

Later he writes:

But I was most struck by the realities of the family’s daily routine. Grace’s mother …. told me about nights punctuated by alarms to get up and check her daughter’s blood sugar, at “midnight, 3 and 6.” That timetable became my structuring device for making this film.

By Sunday afternoon there were 165 comments on the documentary. Some claimed that the Chamberlain’s family mirrored their life perfectly. Others labeled it as an overly melodramatic depiction of Type 1 diabetes and criticized the parents for how they care for their daughter. My guess is that all of the comments have some merit and mirror fragments of life with Type 1. To put it all in perspective, you should read the comment by Grace’s father who defends/explains his family’s experience and concludes that the film is an artistic peek at one family’s life with diabetes, not a factual textbook. He writes:

finally, please remember that a very talented, creative film maker asked us for a behind the scenes look at our family situation with T1D; then , he crafted a 12 minute film to encapsulate his subject matter in an artistic way. The film is getting a huge response, and we are happy about that…including the disagreements!

If you haven’t seen the film, watch it here. Be prepared to be disturbed whether or not you agree with the depiction of Type 1 diabetes. If you have time, read the comments.

The purpose of this blogpost is not to give my views of the documentary, but rather to use the title “Midnight Three & Six” as a starting point to discuss how often Type 1 diabetes and a good night’s sleep are incompatible.

I have had Type 1 since 1976—diagnosed at age 24. Parents were never involved in my T1 life and no alarms were ever set to test my blood sugar. Of course I had many years of diabetes before I even had a home BG meter. I also lived with diabetes before the Internet and as a somewhat ignorant young adult never considered that I might not wake up in the morning.

Although they were not an every night occurrence, I have vivd memories of horrific lows in the middle of the night. Waking up sweaty, shaky, and disoriented. Staggering downstairs for orange juice followed by multiple bowls of Frosted Flakes and milk. When I was lucky, I was able to find a dry nightgown before returning to bed, but it was always a struggle to avoid the sweat-drenched tangle of sheets where I had previously slept. I remember the freezing cold that permeated my bones and the inability to get warm even with the electric blanket on high. I can still appreciate the buzz as sugar raced through my body reviving my numb limbs, lips and brain. Although I probably woke the next morning with crazy high numbers, I have no memories of that.

As I aged, it became rare to sleep through the night without at least one trip to the bathroom. I began testing my BG when I got up. If it was low, I’d go back to bed with a couple of Werther’s candies in my mouth. It was many years before it became part of my Sleepy Dwarfwheelhouse to take an injection to bring down a high. I never woke at night without diabetes being the first thing on my mind.

I now live with a CGM. You would think that this watchdog would enable me to sleep soundly, but sometimes I think it is the exact opposite. There are many nights that the Dexcom is on the Midnight 3 & 6 schedule along with Grace’s parents, or more accurately for me, the Midnight 2 & 5 shift. I struggle with eating too many snacks through the evening. Sometimes it’s junk food. Other times by trying to avoid carbs, I eat things like nuts and cheese. It doesn’t matter which. The pattern is to go low early in the night from too much insulin and then go high at 2:00AM. Although I try to be conservative with corrections, usually the highs are followed by lows in the predawn hours. My G4 definitely earns it keep by alerting me to each one of these out-of-range numbers. Since I am confessing my sins, I might as well admit that I eat glucose tabs and dose insulin based on Dex numbers all night long.

On Friday after being frustrated with the current sensor, I ripped it off at bedtime and decided to splurge with an uninterrupted night of sleep. I had eaten nothing since an early supper, had no IOB, and felt confident that nothing too disastrous would happen. I think that it was the first night in two years that I had gone to bed without a functioning CGM (except for a few times when my transmitter died and I had to wait for a replacement).

I slept marvelously. No, I slept marvelously until 5:56AM when my Animas Ping starting singing Für Elise signaling a pump alarm. It turned out that I had not pushed any buttons for 12 hours and had triggered the Auto Off safety feature. A button push or two and insulin delivery resumed. Back to sleep. Back to sleep until 6:12AM when a twinkle alert indicated that my pump had lost prime. (Losing prime is an extremely annoying problem with Animas pumps and requires that you unhook your infusion set and prime a few units of insulin to restore pressure in the insulin delivery system.) A trip to the bathroom, bright lights, my infusion set reattached, and I was awake for the day.

Although my diabetes control is “good,” the fact that I rarely have a night without Dexcom alarms would indicate that I have problems that need to be addressed. I have a list of things that could be improved. In the meantime, if there are any parents who would like to take the Midnight 2 & 5 shift and start testing my BG, dosing insulin and giving juice as needed, I’m taking applications….