The Last D-Tech

Laddie_Head SquareThe last CGM.

The last pump.

The last D-tech before going on Medicare.

In early September I will purchase my last CGM system before going on Medicare in the spring. That will be followed by my final pump selection in early December. Rather than view these decisions with my usual excitement, I sit here with a stomachache of dread, frustration, and uncertainty. I tend to be naive and think that there is a “correct” decision when it comes to things like this, but there is enough going on in both the reimbursement and technology landscapes that I am faced with a lot of doubt.

First the CGM. It will be Dexcom for sure, but I am torn between staying with the G5 or going back to G4 platform. Although Dexcom is primarily marketing the G5, I use an Animas Vibe and have the option of staying with the G4 for the foreseeable future. (Please ignore the fact that I rarely use my pump as the CGM receiver. Click here for an explanation.) Currently Medicare does not cover continuous glucose monitoring for seniors with Type 1 diabetes. Many individuals and organizations are working hard for a policy change, but I am discouraged and convinced that I will have to self-fund my CGM starting at age 65.

Dexcom has made and continues to make decisions that make self-funding a CGM increasingly expensive. Looking at transmitters, G4 transmitters had a 6-month warranty but many of us experienced a much longer life than that. My most recent G4 transmitter lasted a year. G5 transmitters place a higher demand on batteries, but also have a software-mandated drop-dead date of about 100 days. Thus for someone who self-pays, transmitter costs have almost doubled from G4 to G5.

As yet no changes have been made that impact the cost of sensors. Unfortunately as reported at Diabetes Mine last week, the Dexcom CEO brought up the idea of Sensor Auto Shut-off during the latest quarterly earnings call. This was presented as a safety consideration and my initial snarky response was tweeted by Diabetes Hands Foundation: “So we can kill ourselves on Day 1 of a sensor when Dex is at its most inaccurate, but not on Day 11″ bit.ly/2b4fmjx @MNAZLaddie.” In Dexcom’s defense, no one can ignore the financial repercussions to Dexcom of customers using sensors for 2-3 times as long as warrantied.spiral with words_2016

I currently use most of my sensors for about 2-1/2 weeks. I have full insurance coverage for sensors, but experience better accuracy the second week than the first. I often finally change out a sensor for scheduling reasons or because it falls off despite SkinTac and additional tape. Very rarely is it because of performance problems. I doubt that there will be sensor auto shut-off until the G6, but it is another change that will greatly impact those who self-pay.

I think it makes sense for me to return to G4 for now, especially since I can use the Share feature to see data on my phone. Going back to carrying a receiver won’t bother me much, especially because I like the alarm profiles of the receiver much better than my phone. I am also tired of keeping my phone with me all of the time.

The CGM decision is tangled in my thoughts about a new pump. I am not in love with the Vibe and it doesn’t make sense to buy another one. Tandem is close to retiring the t:slim G4 and I know that if I go with Tandem, I would prefer to buy the t:slim X2 to be released in the fall. The last time I selected a pump for CGM reasons was the Ping in 2012 and it wasn’t a good choice for me. I’ll be writing more about pump musings in the fall, but as with previous pump decisions, it will be complicated by insurance considerations and the uncertain release date of new technology. Medicare rules will also come into play.

One undiscussed topic in today’s post is: If the cost of using a Dexcom continues to spiral upwards and there is no Medicare coverage, at what point will I choose to live without a CGM? Going back to the second paragraph of this blogpost, that is the sort of decision that fills me with “dread, frustration, and uncertainty.”

And fear.

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I sometimes conclude technology posts with the admission that my concerns are a #firstworldproblem. I am a privileged patient when it comes to diabetes and I am grateful.

The Vibe After Two Months:  Part 3 — Pump Performance

Two and a half weeks ago I surprised myself. I was standing in the pool dodging grandchildren with noodles, inner tubes, and water cannons. Out of nowhere I began to envision the possibility that I might choose to stay with the Animas Vibe when I select my next insulin pump in late 2016. You’re probably thinking “Where in the heck did that come from?” Part 1 of this series was highly critical of the Vibe as a pump/CGM system. Part 2 detailed my frustrations with the klutzy hardware and software integration of the Dexcom G4 into the pump. So how in the world did I get to the point that not only do I not hate the Vibe, I am relatively happy with it.

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Laddie_Head SquareI’ll start with a little history. In late 2012 I left Medtronic for Animas because I wanted upgrade access to the first pump to be released in the USA with a Dexcom integration. I had read a lot about the convoluted menus of the Animas Ping but figured that I would get used to them. Very quickly I figured out that I had greatly underestimated how much I would hate these menus. Over a year later I was still grouchy with my pump decision and frustrated with the constant scrolling, the need to populate each recommended bolus from zero, and the lack of a Back button.

One day a couple months ago it dawned on me that I had become so adept at scrolling and button-pushing on the Ping that I didn’t hate it anymore. I still wondered what the Animas designers had been smoking when they designed the software system…. But I didn’t fight it anymore.

When I received the Vibe in mid-February, it didn’t take long for me to form negative opinions on the CGM integration into the device. At the same time the insulin-delivery functions of the pump were mostly fine and I daily appreciated the jump-to-bolus feature. In mid-March I quit using the Vibe as my CGM and went back to the Dexcom G4 receiver. This simplified my interactions with the Vibe and my satisfaction with the device increased quite a bit. Very importantly, it eliminated the nagging BG calibration alert. No more beeping after every bolus containing a BG number! I no longer had the frustration of the slow-refreshing graphs and I could mostly stay out of the no-man’s-land CGM menu. I began to concentrate on what I liked about the pump rather than my dislikes. At this point I was content that the Vibe was my pump until late 2016.

Let’s go back to the swimming pool. When you have diabetes, going swimming can entail a bunch of complex, usually no-win decisions. Should I risk wearing my pump until I jump in the water and what if I forget to take it off? Should I take some of my basal ahead of time? How long can I go without my pump and how much basal did I miss? What if someone knocks my pump off the table or steals it out of my tote bag? Using the Vibe allowed me to just keep using the pump in the water and not worry about diabetes issues. I could wear my swimsuit for several hours and be as relaxed as everyone else. (Although the Ping was also waterproof, I didn’t spend as much time in the pool as I do now and anticipate doing in future years.)

So all of a sudden I was standing in the pool and thinking that not only was I content with the Vibe now, I could see selecting it for my next pump in late 2016. Do I think it is the best pump ever? Absolutely not. But the menus are adequate, the pump is sturdy, and I really pump_animas_vibelike the fact that it is waterproof. Although I might not choose to use my CGM very often with the Vibe, it is a nice back-up option for times when I don’t want to carry the Dexcom receiver. (This point will be moot once the Dex G5 is released because a receiver won’t be required and it won’t be compatible with the Vibe.)

Would I sign a contract now for the Vibe in 2016? No. But because I will be a few months shy of Medicare when I make my next pump decision, the Omnipod and Snap will be off the table unless Medicare coverage changes. It is unlikely that I will leave Dexcom for the Medtronic CGM, so that essentially takes the newer Medtronic pumps out of contention. (At the same time I was super impressed when a got a chance to see the Medtronic 640G at the UnConference in March.) Accu-Chek is not a good fit for me and I refuse to use a tubed pump that requires a remote controller. So it will be the Animas Vibe versus Tandem (and maybe Medtronic?). Let the battles begin!

One thing that I have not talked much about in this post is the decision to leave the Ping to upgrade to the Vibe. Many Animas pumpers (or parents of pumpers) rely on the meter remote of the Ping and the lack of one becomes a deal breaker for the Vibe. I hated the remote and it was relegated to a dark closet several years ago. In my book everything about the Vibe is equal to or better than the Ping.

At the bottom of the post, I have attached a link to a sheet that I received from Animas highlighting the differences between the Vibe and the Ping. A lot of the changes relate to the addition of the CGM functions. The biggie for me is the one-button bolus population. I also like the ability to see my IOB with one button push. There are other menu changes that aren’t important to me and I still goof up with some of the new navigation arrows in the Setup, Status, and History menus. I have no interest in the Food list which is now in the pump, but others might like that feature.

In summary, I am mostly happy with the Vibe. For me it is a sturdy, reliable, waterproof pump that is not overly aggravating when I don’t activate the CGM functions. At the same time I believe that Animas missed the opportunity to design and release a  pump which could have hit a home run in the diabetes tech world. I have no idea if there are new pumps in the pipeline at Animas, but I hope so. As we see feature-rich pumps such as the Medtronic 640G and offerings from Tandem, Assante, and Omnipod hit the market, it is my opinion that the Vibe longterm will have a shrinking share of the insulin pump market.

Click this link to see a PDF scan of the Animas Vibe Features Guide In comparison to the OneTouch Ping insulin pump: Animas Vibe_Ping

The Vibe After Two Months:  Part 2 – CGM Integration

Laddie_Head SquareIn 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.

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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 editPlease 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.

Summary:

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.

The Vibe After Two Months:  Part 1 – Report Card

Laddie_Head SquareI have been using the Animas Vibe for two months. I believe that the decision to upgrade from my two-year old Ping was a good one and I am content that this will be my pump until the warranty expires in November 2016. The basis of this satisfaction surprises me because the reasons I like the pump have little to do with why I thought I wanted it.

I am writing a 3-part series about my experience. Today will be an overall report card for the Vibe, primarily discussing whether it makes the grade as a pump/CGM system. Part 2 will be an evaluation of how the Vibe performs as a CGM receiver. Part 3 will be an evaluation of the Vibe as a stand-alone pump.

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In November 2012 I made the decision to purchase the Animas Ping because it was in line to be the first pump integrated with a Dexcom CGM. Despite poor results with the Medtronic SofSensors, I had really liked the integration of CGM data into my Revel pump. After using a Medtronic pump along with a Dexcom CGM for several years, I strongly believed that I wanted a single device merging my insulin pump and CGM.

When the Vibe was finally released in January 2015, I began to question the wisdom of following through with the upgrade. I was concerned that the CGM software was already out-of-date, that future Dexcom transmitters would lack compatibility with the Vibe, and that I might have insurance problems getting a new CGM system because the Vibe functions as a CGM receiver. After meeting with an Animas Rep in early February, I made the decision to follow through with the upgrade. You can read about that decision and my early impressions of the pump here.

After two months, I am happy with the Vibe as a pump, but I am back to using the Dexcom receiver full-time. In my opinion, the Vibe gets a poor grade as a SYSTEM in real time and earns a good grade in reviewal made. To clarify, the integration of the CGM into what is essentially an Animas Ping pump is clumsy and occasionally nonsensical when it comes to the decisions/actions that I make with my pump and CGM on a daily basis. It is difficult to move from the CGM functions of the device to the insulin pump functions. Unlike the Medtronic “system”, there is no meter that sends BG numbers automatically to the pump. At the same time because I can download the Vibe to Diasend along with my BG meters, Dexcom receiver, and now even my Fitbit (!), I have a great platform for merging and reviewing my diabetes and health data.

In a January review of the Vibe, Mike Hoskins of Diabetes Mine mentioned that his Animas trainer talked about the Vibe “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 is a great image, but I take it even further to say that the Vibe is a duplex with the pump in one unit and the CGM in the other. They are adjacent to each other, but they have separate entrances and there are no adjoining doors. To get from one device to the other, you must go outside and walk down the sidewalk to the other side of the building. Rather than adding value to each other, I find that the CGM part of the Vibe makes the pump functions more cumbersome than they are when the CGM is disabled.

Duplex Vibe

The only time that the Vibe works well as a system is when all of my devices have been downloaded to Diasend. In reviewal mode, it is a success because I can see reports merging  pump and meter data with my CGM. Unfortunately it is time-consuming to download everything (especially the Vibe) to Diasend, so it is unlikely that I will do this frequently. I am starting to get a little cyborg excitement envisioning an Apple watch showing real-time Dex tracings, Fitbit steps, and insulin pump data. A brave new world for sure and definitely not what the Vibe delivers.

In the next post in this series, I will write about how the Vibe functions as a CGM device and talk about what I consider some of the shortcomings of the Dexcom integration. Part 3 of the series will highlight my views on the Vibe as a stand-alone pump.

As a hint of what is to come, I like the Vibe as a pump. At the same time, I have become comfortable with the idea that longterm my CGM data is going to end up on my phone, Apple/Pebble watch, or some other device. Unless the CGM integration improves the function of the pump and does more than be a poor replacement for a Dex receiver in my pocket, a pump/CGM combo doesn’t seem to add much value to my diabetes life.

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.

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

Two Life Hacks and a Story

Laddie_Head SquareGoing Home with an Animas Ping/Vibe:  I have been using an Animas Ping pump for over two years and still go crazy with the convoluted menu system. One of the most frustrating things is the lack of an Escape or Back button and I have b*tched about that more than once, twice, ten times, a hundred times. Many bloggers reviewing the just-released Animas Vibe complained about the same thing.

in the Animas Users Group at TuDiabetes, a Norwegian Vibe user with the screen name of Siri (not my iPhone Siri) told me about a shortcut to escape the endless menus of Animas pumps and return to the home screen. Just press the Audio Bolus button on the right side of the pump. Then press the OK button or any key on the front of the pump. You will be returned to the home screen. Siri learned this from her Animas Rep.

With this trick, I will probably save an inconsequential 5 minutes a year, but I will save myself oodles of frustration. Honestly I have to admit that in the last couple of months, I have become so adept with my Ping that I really don’t hate it anymore…. I am definitely looking forward to receiving my Vibe:-)

iPhone trick:  Younger readers of this blog who have grown up texting probably know about keyboard shortcuts. Even I knew about them and had seen the “omg” already programmed into my iPhone and iPad. Because I text like an “old person” and type out exactly what I want to say, I never bothered using shortcuts and never programmed any into my phone. A couple months ago after being annoyed about having to type my email address into so many online forms, it dawned on me that I could use a keyboard shortcut for my email address. Therefore I programmed “mgm” into my phone as a keyboard shortcut for my gmail account.  I set up “mcm” for an alternative Comcast email account. “tgg” enters my blog web address. These shortcuts work on most websites and blogs and save me a lot of error-filled typing.

To set up a keyboard shortcut, go to Settings/General/Keyboard/Shortcuts. Click on the + in the upper right hand corner. Enter your email address as the phrase and a series of letters for your shortcut. One glitch is that a space is automatically entered after your email address when you press the space bar to use your shortcut. That is great for emails and texts, but most website forms interpret this space as meaningful and will reject your address. So after the email populates itself, you may have to backspace before entering your password. Keyboard shortcuts entered on one device automatically show up on your other Apple devices.

If you decide to give this a try and like it, just remember that you learned this from a 62-year old woman. It is never too late for this old dog to learn new tricks!

A Story:  Last Wednesday I hiked in the morning with a group of friends. I came home, cleaned up a bit, and had lunch. The refrigerator was empty so I went to “town” to shop. In the winter I live in the boondocks of Arizona and have a 20+ minute drive to the grocery store. Although I had drunk a lot of water on my hike, I was still thirsty and grabbed a can of carbonated water for the road.

I went to the hardware store, took Abby the Black Lab to the dog park for tennis ball retrieving on grass, and went to Safeway to buy food (low carb of course!). I was still thirsty so stopped by the adjacent convenience store to buy an unsweetened iced tea to carry me through the afternoon.Bud Light Box I grabbed the almost empty can of carbonated water to throw away and gasped as I saw it was a can of Bud Light! I had been driving around town drinking beer. Arizona has no-tolerance laws for alcohol and driving and I think that I would have been thrown in jail had a policeman seen me chugging beer as I completed my errands.

Bud Light in cans is not our beer of choice. I think this can was 3-4 years old and a remnant of the last time my husband entertained Minnesota golfing buddies in our winter paradise. Because I try to avoid Diet Coke, I drink enough weirdly-flavored carbonated water and iced tea drinks that a flat, tasteless beer didn’t register as something I shouldn’t be drinking.

I’ve told this story to many of my local friends. Everyone proclaimed that I was the last person that they would have envisioned drinking and driving at lunchtime. They also swore that they would have visited me in jail. It is a funny story that is actually quite terrifying.

When I got home, I checked my refrigerator’s “canned water” bin and there were no other cans of beer. I wish that I had checked the date on the beer can to see how old it was. At the same time I am glad that this is just a funny story told from the safety of my living room. Because I was totally unaware of what was going on, I have no idea how I would have tried to explain this to a policeman.

Summary: One diabetes hint, one iPhone hint, and a story about drinking and driving. Sounds like a great blogpost to me:-)

The Vibe is Approved!

Laddie_Head SquareThe Vibe is approved.

I say “Finally!” but I say that with excitement not grouchiness.

Kerri of Six Until Me has a sponsorship relationship with Animas and shared the news this morning on Facebook. Rather than have me repeat her words, check out her blogpost here.

I will definitely upgrade to the Vibe once I learn the details of the ezAccess Upgrade Program. When I purchased my Ping two years ago, I was guaranteed a $99 upgrade fee to the Vibe when it was released. I didn’t think that this pump/Dexcom combo would take so long to come to market and I might have purchased a different pump had I known the wait was going to be so long. On the other hand, I don’t know what pump I would have purchased instead and I am glad today to have the option of ordering the Vibe.

Although I am not as excited about the Vibe release as I would have been a year ago, there is no risk for me to upgrade. I previously wrote that the Vibe will not have the recent Dexcom software upgrade. I have also worried that the small Dexcom screen might not be big enough to  show my Dexcom graph clearly and I am concerned about the difficulty of seeing the Vibe screen in the sunlight. The Dex receiver doesn’t perform well in the sunlight either, so that is probably a toss-up. If I don’t like how the Vibe works with my Dexcom, I can just disable it on the pump and go back to using my receiver. Or my understanding is that I can use both devices simultaneously. So no risk.

The Vibe will also get rid of my biggest dislike of the Ping because the recommended bolus will self-populate rather than make me scroll up to it from zero. Huge improvement!  People who use the remote meter with their Ping may have to thing twice about upgrading to the Vibe because my understanding is that the new pump will not have this feature. I do not use the remote so that is a non-issue for me.

As you know, I have been one of many people working to have Medicare approve CGMS for seniors. If that does not happen by the time I get to Medicare, the Vibe eliminates the need for a CGM receiver and that will save me money. However, I don’t think it is known whether the Vibe will be covered by Medicare and the ezAccess Upgrade Program brochure states that “Medicare patients are not eligible for ezAccess.” Because I am still using private insurance and my Ping is in warranty, I am eligible at this time and I can wait to see how it plays out with Medicare.Vibe Upgrade

So this is an exciting day and I look forward to my upgrade to the Animas Vibe.  Although I struggled with the Medtronic Sofsensors, I really liked my years of having my CGM integrated with my pump. I like having one less thing to carry.  And I like having my CGM attached to me with the tubing of my pump. I have never permanently lost my Dex receiver, but I always worry about it. I also like that my cgm receiver will be integrated in a waterproof pump.

Click here to read the news release.  It indicates that the pump will start shipping in January 2015. Once again, thanks to Kerri for sharing this link on Facebook:-)

I was able to order my Vibe this morning by calling the Animas
number 1-877-937-7867 and pressing Option 3. I spoke briefly 
with one agent and was then transferred to another representative
who helped me with the upgrade. Just so you know, I will actually
be charged $799 for the upgrade and receive a $700 credit when
my Ping is returned. So the final cost of the upgrade is $99. For
fun and excitement, I ordered my Vibe in blue.

The Grouch Addresses D-Tech

Laddie_Head SquareI am a tech-happy Type 1 diabetic. A new diabetes device gets my heart racing and I treasure my D-devices almost as much as my iPhone and iPad. Maybe more? Nah…. Until there is an iPump, I will love my iPhone and iPad more. But my life is immeasurably better because of my insulin pump, continuous glucose monitor, and even blood glucose meters.

I have come to terms with riffraff hanging off my body and filling up my pockets. I don’t mind the daily minutiae of using these devices and I take things like changing infusion sets and poking my fingers in stride. I’m old enough that I don’t wear cute dresses any more and don’t have to worry about accessing a pump tucked in my underwear. I don’t care about black dots on my fingers and the red spots and occasional bruises that tattoo my body. I am not burdened by my diabetes devices.

At the same time I am very frustrated with my D-devices.

I have been using an Animas Ping since 2012 and am still irked by its menu system. Two years ago I made the decision to purchase this pump despite its shortcomings because I thought the release of the combo Ping/Dexcom device was just around the corner. My Bad. It’s now November 2014 and the rumor these days is that the Vibe release is just around the corner….

Some of my frustration for this delay is directed at Johnson & Johnson which didn’t submit the pump to the FDA until April, 2013 after several years of hinting that the submission would be in the near future. The Vibe was released in Europe in June, 2011 and I sit here 3-1/2 years later hoping to upgrade to one. The fact of the matter is that when the Vibe is finally released in the USA, it will be a 4-year-old pump. In some ways it will be little different than the Animas Ping as it was approved by the FDA on July 1, 2008.  So you could argue that Grouch D-Techthe Vibe is really a 6-1/2 year old pump. My understanding is that the G4 software update just released by Dexcom will not be included in the Vibe. Therefore the Vibe will be an old pump integrated with an out-of-date Dexcom receiver.

In general I am incredibly frustrated with the whole FDA process. I don’t understand why it takes a couple of years to review something that has been in use in Europe for several years. I don’t understand why if Dexcom has been given FDA approval for its latest update that neither Animas or Tandem will be able to include that update in their pumps that integrate with the Dex G4. In my opinion the lengthy FDA approval process punishes innovation and motivates manufacturers to stay with old devices superficially decorated with trivial new bells and whistles. Many or most diabetes tech devices are developed by US companies and we see the overseas market getting access to them years before we do. It’s cheaper and faster for manufacturers to get approval in Europe.

Are users of diabetes tech safer in the USA than in Europe? I’ve never seen proof of that.

The iPhone 4 was released in April, 2011. Some of you might be using it happily: unless you want to use IOS 8 / unless you have a new iPad which can’t use iCloud optimally unless all of your devices are using IOS 8 / unless you don’t mind your phone freezing up on multiple websites and apps / unless you want a beautiful, new sleek device. What if you had to purchase an iPhone 4 today and pay the same price as an iPhone 6?  Yeah, that’s the same excitement (not!) that I feel about the Vibe when and if it is ever released.

Yes, the FDA is trying to keep me safe. Please don’t tell them that the most dangerous thing I can do is go back to injections and accidentally substitute my fast-acting Novolog for my Lantus shot. Or carelessly give my basal insulin twice because I couldn’t remember if I had already given the injection. Insulin is a dangerous drug and everyone with Type 1 diabetes knows that we occasionally play Russian Roulette with our lives.

I recently read Cell by Robin Cook where a smartphone app called iDoc became an integral part of the medical care for test subjects. People with diabetes were implanted with an internal insulin pump that was controlled by iDoc.  iDoc was a master of blood glucose control until the patient got another medical condition (cancer, heart disease, etc.) that threatened to make their health care costs skyrocket. At that point, iDoc programmed a lethal dose of insulin for the diabetic patient. Dead as a door nail. Maybe I would like some FDA oversight on iDoc….

Continuing my frustrations with D-Tech, last Thursday I read reports of the new software release for the G4 by Dexcom. I quickly tried to update, but the Dexcom website was having problems. Kind of like the FDA crash on Monday, Nov. 3 at the #DOCasksFDA event. Don’t these people know that the DOC doesn’t fool around when it comes to sharing information? We arrive quickly and in large numbers and don’t fool around. There is no such thing as a trickle down release of information in the DOC.

Fortunately the Dexcom website was back working in an hour or two and I successfully updated my Dexcom receiver. Because my current sensor was almost two weeks old, I started a new sensor to inaugurate the new software. It ended up being the worst sensor start that I have ever had in my two years of using the G4. Within a few hours, I had Dex results that were a hundred points too high. A recalibration resulted in Dex results that were 80 points too low. Two days later the results were still not in line. Argh!

I hate D-Tech.

My Dexcom debacle has a happy ending (I hope!) and several of my last sensors are being replaced. I had been having problems before the update and I think the rotten sensor start was just an unhappy coincidence. I have had superb customer service from Dexcom in the last couple of days. The jury is still out on whether my problems have been sensor related or equipment related, but I am hopeful that I am back on the right track.

Totally unrelated to my rants in this post, my pump case cracked yesterday when I inserted a new battery. I called Animas and only had to wait 2-3 minutes before talking with a Pump Rep. A new Ping will arrive on my doorstep tomorrow.

Okay, maybe I love D-Tech.