In Part 1 of this series, I discussed how the Animas Vibe performs poorly as a system in real time. Although the pump and continuous glucose monitor (CGM) are housed in the same hardware, the menu system often strands the user in no-man’s land where it is cumbersome to switch between CGM and insulin delivery functions. The CGM works as advertised but just not as well as the actual Dexcom receiver. The pump does its job of delivering insulin safely and reliably but doesn’t interact with the CGM except through annoying calibration alerts. It’s all okay; it’s just not great and the CGM and pump don’t add much value to each other. Today’s post is my impressions of the Vibe as a CGM.
For the first month after I received my Animas Vibe, I used it exclusively as my CGM. The pump/CGM combo had some definite benefits, but the shortcomings drove me crazy and I went back to using my Dexcom receiver in Week 5. Rather than write a totally grouchy post, I will highlight some of the positives of the Vibe followed by my reality with those features.
The Positive: The Vibe is the first insulin pump to be paired with the Dexcom G4 Platinum CGM.
The Reality: My transmitter communicates well with the Vibe which is a reliable CGM receiver. Unfortunately by the time the Vibe was FDA-approved in November 2014, Dexcom had already released the 505 software update which will not be available to Vibe users. Looking at hardware, the Vibe was approved and ships with the 1st generation G4 transmitter despite the fact that the new low-profile transmitter is compatible. The highly anticipated G5 transmitter which will send data directly to a cell phone will not be compatible with the Vibe.
The Positive: I like having one less device in my pocket when I leave the Dexcom receiver at home.
The Reality: The software/hardware weaknesses of the Vibe result in a CGM device that is inferior to the Dexcom receiver. Some of the problems that I will discuss are small screen size, sluggish population of BG graphs, and multiple menus to navigate when shifting from CGM to pump functions.
The Positive: I appreciate one-button access to the Data Screen which displays my BG number, the directional arrow, and my insulin-on-board (IOB) number.
The Reality: The button is not a dedicated CGM button. When I am in the pump or CGM menus, it changes function and adjusts the brightness of the display. I hardly ever change the screen contrast and would prefer the ability to return to the CGM at any time with a one-button push.
The Positive: The Vibe has a color, easy-to-read display.
The Reality: I like the color display of the Vibe and have no problems with it indoors. Outdoors is another matter. I hike a lot in Arizona and shade is at a premium on the trail. I find that both the Vibe and the Dex receiver are unreadable in bright sunlight. This is a serious problem in my opinion and both Animas and Dexcom need to address the issue. One reason I should upgrade to the Dex Share receiver is that my iPhone is easy to read in any light conditions. (*2016 edit: Please note that the Dexcom G5 receiver has corrected the sunlight problems of the G4.)
The Positive: The Vibe is waterproof and has been a rugged device for me as was my Animas Ping.
The Reality: That is my reality and kudos to Animas. Although I have not been using the Vibe CGM concurrently with my Dex receiver, I did so last week in anticipation of a Friday hike with numerous water crossings. It was a relief to leave the non-waterproof and more fragile Dexcom receiver at home. Although the transmitter signal is not necessarily reliable while swimming, it is a great option to have the ability to monitor your BG when in and out of the water.
The Positive: The Vibe has customizable alarms for low and high blood sugars.
The Reality: Some people prefer the Vibe alerts. Others prefer the Dex alerts. Some like having both devices active, especially at night. I don’t have a preference and miss very few alerts on either device.
The Positive: You can download the Vibe to Diasend and see your pump and CGM data in compilation reports.
The Reality: The reports are great and contain the same CGM data that a download of the Dexcom receiver provides. Unfortunately It is incredibly slow to download the Vibe. You need to unhook and suspend the pump and then use the awkward dongle device to send data to Diasend. I have an old Windows computer and the Animas download rarely works quickly for me. It usually takes five to seven minutes for a successful download. In comparison I can reliably download my Dex receiver to Diasend in 45 seconds.
My Main Gripes:
**** The CGM graphs are very slow to populate. Rather than pop up immediately, each graph appears as though someone is drawing it. After viewing the Data Screen as my starting screen, I like to see the 3-hour graph. I have to watch the 1-hour screen populate and then wait for the 3-hour graph to draw. The next time I push the CGM button with the pump in sleep mode, it will start with the screen I left off on during my previous session. So if I want to start my next session with the Data Screen, I have to go through the complete cycle of graphs (1-, 3-, 6-, 12-, 24-hour) or go back the way I came (1-, 3-, 1-hr) to return to that screen before the pump times out. Because of the tedious refreshing of the screens, I tend to stop looking at the graphs on the Vibe and stick with the Data Screen. Essentially I start using my CGM in static mode. I see the BG number and directional arrow but have none of the historical context provided by the graphs.
**** A second problem with the Vibe CGM is that the display is small. The Dexcom receiver has a landscape rectangle screen. The black window of the Vibe appears to be a landscape rectangle until you see that the active part of the screen is square and actually a bit taller than wide. When you combine the small size of the graphs with the fact that the hatch marks have no time labels (for example 10AM, 8AM), it is difficult to interpret the graphs. The length of the BG tracing (not including the graph axis) on the Dex receiver is 1.5 inches. The length of the same line on the Vibe is .8125 inches which is just slightly more than half (54%) the width of the Dex.
**** A third problem with the CGM functions of the Vibe is that when I wake my pump through the CGM button, I am then in “no man’s land” in relation to the rest of my pump functions. From the Data Screen, I can either use directional arrows to see CGM graphs or press the OK button which takes me to the CGM menu. If I want to get to the Main Screen of the pump to bolus or adjust basal, I need to scroll down through the entire CGM menu before I can select the Main Menu.
Below you will find a video (my first ever!) showing the button-pushes to navigate through the Vibe menus. (Please ignore the gaps in the tracings which are primarily due to a new sensor start-up.)
**** A final problem is that the navigation of the CGM functions seems to ignore which features are more important and used most often. When I get an alert for a low or high blood sugar, it doesn’t display the number. I need to push OK to acknowledge the alert and that sends me to the CGM menu. It then highlights the top line which is BG Calibration. I then scroll down and select Trend Graphs to view my BG number. What is a one-button push on the Dex receiver is now a 3-button push. When you’re low, bg calibration is low priority!
**** One Vibe alert that I hate and am not able to silence is the calibration prompt. When the CGM is active and I input a blood glucose reading as part of a bolus calculation, it asks if I want to use the reading to calibrate. Although I can ignore the alert and it will time out, it always beeps. Originally I had my “Other” alerts set on vibrate, and this screen resulted in a series of four(!) vibrations. Since it is only one beep when I have it set on low, I don’t quite understand the four vibrations. Although a twice daily calibration is important for accurate CGM performance, the Vibe seems to give it unwarranted attention by placing it at the top of the CGM menu and then not allowing the elimination of the audio/vibration alarm.
At the moment I expect that I will continue to use the Dexcom receiver and leave the CGM turned off on the Vibe. At the same time I appreciate the option to use the Vibe as a CGM and will occasionally use it for vacations, water activities, or when I want one less thing to carry. Maybe over time I will change my mind. If you are considering the Vibe, a great blogpost to read is by a Canadian T1 athlete who did change his mind and is now using the Vibe exclusively.
As much as I believe that Animas should have gone back to the drawing board before releasing a pump/CGM combo in the USA, it is still good to have another tech option for people with diabetes. Stay tuned for Part 3 of this series where I evaluate the Vibe as a standalone pump and discuss how it differs from its predecessor, the Animas Ping.