Outside the Box: Silencing Tandem Dexcom Alarms

Posted on November 29, 2022 by Laddie

If you’re like me, sometimes you want to silence all Dexcom alarms.

Maybe you’re at church, a wedding, or a funeral. Possibly a job interview or an important meeting. Maybe you just want to sleep. Maybe it is the first 24 hours of a sensor with erratic readings and nosediving lows.

All Dexcom alerts except for the 55-Low alarm can be turned off on both your phone and Tandem pump. But you can’t turn off the 55-Low critical alarm or even pause it for a certain period of time. Some people think that is a great safety feature and have no problems with the limitation. Me, I struggle with it. Although Dexcom is a great tool and I appreciate that it regularly gives me notifications of highs and lows, I don’t believe that it saves my life every day. I am confident that if I can silence all Dexcom alarms at certain times, I am going to be okay. Sometimes my diabetes mental health requires that. I don’t want my medical device to siren at my niece’s wedding or during an important business meeting. (Actually I am retired and don’t have important business meetings. But you know what I mean.)

In August I wrote about my frustrations with Day 1 Dexcom sensors. Many or most of my sensors start at a number much lower than my actual meter-confirmed BG. While it is easy to turn off Control IQ on my Tandem pump until the sensor is reliable, the stress of repeating false 55-Low alarms on both my phone and pump is sometimes unbearable. I want to STFU those alarms! Not forever. Just for a couple of hours until the sensor stabilizes. Here is a reminder photo from that August blogpost.

When I am losing the battle with Dexcom false low alarms, I can turn off my phone for a while or overnight if I am not expecting important phone calls. But the pump is different. I can’t turn it off or bury it in my sock drawer because I need insulin delivery. I can’t pause or completely silence the sensor on the pump without stopping the sensor session. I am stuck.

It recently dawned on me that there is a way to silence the 55-Low alarm on my pump until the sensor is stable and reading accurately. I recently purchased a small Faraday bag which magically prevents Bluetooth and other electronic signals from communicating with whatever device I put in the bag. The Faraday pouch allows me to keep my pump running without turning off the active sensor session. But it stops the transmitter from sending false low numbers to the pump and prevents the incessant low-55 alarms. (FYI you must turn off the Out-of-Range alarm for the period that the pump is in the Faraday bag or you’ll get that alarm. Options/My CGM/CGM Alerts/Out of Range.) If I am concerned that I might have a real low, I use my meter. For something short like a funeral, a real low is an unlikely occurrence as long as my BG starts at a good number. For a sensor startup, I’ll probably use my meter several times whether or not my pump is in a Faraday bag.

If you don’t know about Faraday bags, you can do an internet search and learn about how they work. People use this technology to protect key fobs, credit cards, phones, and other electronic devices from remote hacking. Scientists have lots of exotic uses for Faraday cages that block all electromagnetic interference. Me, I just want it to temporarily isolate my pump from inaccurate sensor readings.

If you’re someone who doesn’t struggle with Dexcom inaccurate numbers and isn’t bothered by alarms, a Faraday pouch is probably not for you. But if you are like me and sometimes just want to be protected from alarms that are inaccurate and/or intrusive, you might want to give a Faraday bag a try. There are lots of choices online and I purchased this one for about $20 through Amazon. I wasn’t convinced that the Extra-Small size would work (although I think it would), so I bought Small. It is big enough for my phone and definitely roomy for the pump.

When you remove your pump from the Faraday bag, initially it will show the Out of Range symbol. It takes 5 minutes or less for the pump to reconnect to the Dexcom transmitter.

Some people will appreciate the ideas in this blogpost. Others, especially parents of young children and people not diagnosed in the dark ages, will be askance at the idea of blocking Dexcom signals.

But me, sometimes I need my diabetes tech to leave me alone. I am not a total rebel and mostly I do a good job of managing my blood sugar and staying safe. But sometimes I am just an imperfect human trying to deal with imperfect D-tech and I need a way to protect my mental health. The Faraday bag is a new tool in my arsenal.

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Note: The Faraday bag is not a solution for the siren of Tandem occlusion alarms. Fortunately with my recent pumps, I am rarely getting those alarms anymore. But I have memories of shrieking (false) alarms in yoga class and at the movies. So far none at a wedding or funeral….

A Review of the Tandem t:slim X2

Posted on February 21, 2017 by Laddie

I started using the Tandem t:slim X2 insulin pump on December 13 and this review is long overdue. After 2 months, I am mostly happy with the pump. I am comfortable navigating through the menus and have learned a few shortcuts. I like the touchscreen and the “modern” look of the pump. I like knowing that I will be able to add new features to my pump with software updates. At the same time I am annoyed with almost daily alerts about one thing or another. Most significantly, I am frustrated with occlusion alarms which I never experienced with previous pumps.

The Good Things

I like the touchscreen and being able to enter numbers for carbs and BG levels rather than scrolling up and down.

I like the looks and size of the X2.

I like the ability to turn off the screen to preserve battery life. I like the ability to go backwards through menus and tap the “T” to return to the home screen.

I like being able to fine tune settings. For example with Active Insulin Time, my early Medtronic pumps restricted changes to hours. 3 hours seemed too short; 4 hours seemed too long. Then with Animas, I could select 3-1/2 hours or 4 hours and neither seemed perfect. Now with Tandem, I am using 3-3/4 hours and could even select 3 hours and 39 minutes.

I like the ease of setting Site Reminders on my X2. This wasn’t a feature that I particularly missed on previous pumps, but now that I have it, I use it often.

I like that the reservoir icon remains red after I clear the customizable low reservoir alert.

I like that I can read the pump screen in bright sunlight when hiking. Sometimes I have to take off my sunglasses to read it, but it is much better than my Animas pump screens which were totally unreadable.

I like that Tandem has attempted to create a pump that is contemporary and has worked to creatively meet the needs of insulin users.

I like that I will be able to download software updates to add new features such as CGM integration to my X2 as they are released by Tandem. My fingers are crossed that these updates will be allowed under Medicare rules.

I really like this pump.

The Annoying Things

I find filling the reservoir to be an overly complex and time-consuming process. It is like a “black hole” because I can’t see the insulin in the reservoir or troubleshoot air bubbles. I dislike that the icon on the home screen does not give me a more exact estimate for the number of remaining units of insulin. I can start with a syringe of 250 units and the pump registers 180+ units. After delivering 10 units of insulin (that’s half a day for me), it displays units of insulin rounding to the nearest 5 units. Below 40 units it begins to show specific units. I seem to “lose” more than the 45 (!) units that Tandem indicates as normal.

There are alerts which interrupt me on almost a daily basis. I use temp basals of “0” often for 30-60 minutes when I am moderately low and don’t want to eat. Unfortunately the X2 alerts 2 minutes later to indicate that my basal rate is less than half of my normal basal rate. Well, duh! That’s what I programmed. I suspect the alert is actually a result of a sensor, but IMO software should dismiss the alert if the basal change had been programmed.

I dislike the pigtail connection between the cartridge and the tubing. It tends to stick out and cause tubing to hang out of my clothes.

The t:clip vertical case that accompanies the X2 is bulky and poorly balanced. My guess is that it was designed by men who wear it on a belt. When I clip it to my waistband, the pump is top-heavy and leans forward resulting in an odd bulge in my clothing. If I bend over, it frequently falls off. Rumor is that a new case will be released soon.

Things to Which I am Indifferent

I have never wanted a rechargeable pump but it doesn’t bother me. The X2 charges quickly and does not require a proprietary charger. I can even charge it in my car. So it’s fine.

A lot of people like the way that basal and bolus settings are programmed together in blocks of time on the t:slim. So far I don’t find much benefit doing it that way but I don’t care.

The X2 holds 300 units of insulin. I was fine with 180-200 unit reservoirs, but it’s easy to fill the cartridge partway.

User Error Problems

Some of my issues with the X2 have been due to “user error” and are resolving as I become used to the differences between the X2 and my previous pumps.

The most common error that I make is not resuming insulin after filling the cannula on new infusion sets. I can’t quite remember how it was handled with Animas, but I never had the problem of not resuming insulin. With the X2 I have to wade through a couple of screens like “Stopping Fill” and “Test BG in 1-2 hours” before I get to the option of “Resume Insulin.” Many times I have returned the pump to my pocket before those extra screens. Thankfully I always get an alarm that the pump is not delivering insulin and can fix the problem. I am getting better at slowing down and not forgetting to resume insulin, but occasionally I still mess up.

Another annoyance is if I accidentally touch Bolus on the home screen (and this is easy to do) and don’t clear it, I will get an alert for an incomplete bolus although I haven’t entered any data. The alert will not clear until I go back into the pump, clear the alert, and back out of the bolus feature. Once again this is happening less often as I become more focused when handling the pump with an active screen and being sure to push the top button to turn off the display.

I used Animas pumps for the last 4 years and bolus insulin is infused quickly and immediately. Tandem pumps use a patented “Micro-Delivery” process and can take a couple of minutes to infuse a bolus. More than once I have pulled the same trick that used to mess me up with Medtronic pumps. I bolus for my breakfast while getting dressed. Forgetting that I programmed a bolus a minute ago, I unhook my pump to thread the tubing through the hole in my pocket or even to take a shower. Meanwhile insulin is dripping out and I have no way of knowing how much of my bolus I missed. Once again I am working hard to break this habit.

Occlusion Alarms – The Elephant in the Room

I have used an insulin pump since 2005, first Medtronic and then Animas. In all of that time I had at most 2 or 3 occlusion alarms. If you want to add “loss of prime” alerts on my Animas Ping, maybe you could add 5 more alarms. In 12 years I estimate that I had a problem with insulin delivery 7-8 times. Less than once a year. I cracked pump cases more times than I can count, but I never had a pump replaced because it did not deliver insulin.

I have used the Tandem t:slim X2 for almost 10 weeks. In that time I have had 9 occlusion alarms resulting in an immediate stoppage of insulin delivery. The first couple of times I panicked at the shrieking pump alarm fearing that something was actually wrong. Nope. Not once has there been a problem that did not disappear by working my way through the menu screens and pressing “Resume Insulin.” The vast majority of these alarms have been while delivering meal boluses, but not all. fullsizeoutput_1c6b

Before I go any farther, I must admit that I do not change my cartridges every 3 days as recommended. (I do change infusion sets every 2-3 days.) My first occlusions happened when my cartridges had been in use for 8, 9, and 7 days. So I shortened my cartridge use and had occlusion alarms at cartridge ages of 2, 5, 7, and 1 day. I have only used one cartridge without an occlusion alarm. FYI my total daily insulin dose ranges from 13 units to 26 units and averages 18-20 units. I regularly used reservoirs for 8 days with both Medtronic and Animas and never had a problem.

I have been in contact with both people at Tandem and “experts” in the diabetes online community and have considered every suggestion. I have changed cartridges more frequently. I have used a Spibelt and a Flipbelt. I have used the awkward Tandem case because Tandem techs think it is a temperature issue. (I did learn that the case traps in heat and your insulin goes bad in about 5 days.) I have carried the pump in my pocket and worn it on my waistband. I am 100% convinced that my manually inserted Comfort Shorts (Silhouettes) are not the problem. The occlusion alarms have not correlated with site age and have randomly occurred at site ages of 1, 2, and 3 days. I have had no failed or kinked sites and have used these sets for 12 years with no issues. A Tandem tech assured me that the pigtail design of the cartridge/tubing is not at fault because an internal coil protects it from kinking.

Replacing the pump has not yet been requested by me or suggested by anyone at Tandem. I am currently wearing the pump on my waistband using a Nite Ize hip clip attached directly to the pump and I will see if I can make it 2 weeks without an occlusion alarm. (Thanks Sarah Sugabetic and Kerri Sparling.) My record is 13 days; so far I’m on Day 6.

One thing I must give kudos to Tandem on is that when I get an occlusion alarm during a bolus, it does let me know how much of the bolus was delivered so that I can reprogram the rest after clearing the alarm.

Everyone at Tandem has been respectful and concerned. I sit here in the middle of this experience wondering “What separates the many people who never have occlusion alarms from those of us who are plagued with them?” For me these alarms are #FakeNews and #AlternativeFacts and not once have I seen a kink in my tubing or needed to change out an infusion set or cartridge to resolve the issue.

Conclusion

I like my X2 and do not regret the purchase. I wrote extensively about why I chose this pump and I would not make a different decision today.

At the same time I am conflicted about wholeheartedly recommending this pump to others. How can I recommend a pump that averages a once-a-week stoppage of insulin for seemingly no reason? I admit that I don’t follow all of the rules, but in general I am a conscientious PWD and am doing nothing differently than I did with Medtronic and Animas. Because I have always heard the occlusion alarms, I have been able to restart insulin delivery immediately and have suffered no ill effects from these events.

I delayed writing this pump review because of the occlusion alarms. My hope has been that every “fix” would resolve the issue and I could write a glowingly positive review of the X2. I want to love this pump and I want Tandem to grow and be a successful pump company. As I said before, I really like this pump.

Maybe the hip clip will be the solution.

If not, I will probably argue for a replacement pump as the next step. At this point I am confident that I will not be abandoned by Tandem.

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Please note that this review only reflects my personal experiences. Many users do not experience occlusion alarms with the t:slim X2. Others had these problems with other brands of pumps and don’t with Tandem. Be sure to talk with your medical team, contact a Tandem representative, and read as many reviews as possible if you are in the market for a new insulin pump.

Insulin Pump Decision 2016

Posted on November 28, 2016 by Laddie

Laddie_Head Square And the choice is…

Next week I will be ordering a new pump or at least I hope I will. My decision could have been difficult, but because of the narrow time window for ordering my pump and looking at my future under Medicare, it was easy.

Timing:

As someone who uses a lot of technology to manage my diabetes, I satisfy my insurance deductible long before the end of the year. With my 2016 deductible satisfied, my pump will be covered at no cost to me—as long as it is shipped before the end of the year. I think I dawdled last time I purchased a pump and ended up with a warranty expiration date in December. Not great timing as I would feel more comfortable if I already had the pump in hand.

My timing is also affected by my move to Medicare in April 2017. I will have individual insurance for January-March, but it will have such a high deductible that a pump purchase would essentially be out-of-pocket. If for some reason I don’t get the new pump in December, I will wait until after April 1. It is not ideal to start Medicare needing a high-ticket item and I don’t know whether I would be forced to abide by the Medicare policy of a 5-year warranty on pumps. I don’t think so because Medicare did not purchase my current pump, but you never know.

Timing also affects what pump I will select. I would like the opportunity to try out the Medtronic 630G, but only if I would be eligible to upgrade to the 670G. Unfortunately I will be on Medicare by the time the 670G is released and Medicare beneficiaries are not allowed to participate in manufacturer upgrade programs. I have been told that this rule is part of anti-fraud regulations, but it truly makes no sense to me. It is not as though there is any cost to Medicare to allow me to upgrade if I pay the out-of-pocket cost (if any) and I don’t see how anything about it is fraudulent. But this is not a battle I can win and therefore I will not buy a Medtronic pump at this time. I don’t find the 630G sufficiently appealing to live with for 4 or 5 years especially since it uses the current generation of Enlite sensors and not the improved sensors that are part of the 670G system. I could wait until the 670G is released but there is no guarantee of Medicare coverage.

Pump Options:

Accu-Chek: I have never considered an Accu-Chek pump. I think some people are very happy with the Accu-Chek Combo, but there is little about it that excites me. I don’t want a meter-remote and given my recent experience with the Accu-Chek Connect meter, I don’t want to be tied to using Accu-Chek test strips. Just not a good fit for me.

Animas: I currently use an Animas Vibe and it is an okay pump although I do not use it as a Dexcom G4 receiver. I have a very difficult time reading the screen in bright sunlight and that has been a real problem when hiking. It has started to lose the date/time info when I change the battery and I would not trust it for very long as an out-of-warranty device. A new Animas pump with Dexcom G5 integration is on the horizon, but there is no timetable for its release. Four years ago I purchased an Animas Ping because the market release of the Vibe was expected to be any day. It was over two years later.

Insulet: I have never been interested in the Omnipod and do not mind pump tubing. Although some Medicare Advantage and Cost plans cover the Pod, basic Medicare does not. As someone moving on to Medicare in four months, there is no reason to fall in love with the Omnipod.

Medtronic: It is mostly a timing problem as described above. I won’t purchase the Minimed 630G because it is a Windows Millennium pump. If you don’t know what that means, you are lucky. We owned several Windows ME computers and they ended up being a very short-lived and poorly-supported generation of computers. If the 670G were available today, I would seriously consider it.

So what’s left???

Tandem: I have decided to go with the Tandem t:slim X2. I am excited to move to a touchscreen device and am especially excited about the integrated Bluetooth and Tandem Updater. Do you notice that I used the word “excited” twice? When I selected the Animas Ping four years ago, I considered the t:slim and passed on it because of the lack of an upgrade program and I didn’t want a rechargeable pump. I never liked my Ping and was jealous of those who “loved” and were “excited” about their t:slims.

A huge selling-point of the X2 is that it will allow users to update the software in the future to accommodate new features, the first being integration with the Dexcom G5 CGM. Automated insulin delivery algorithms are also on the horizon. I personally hope that the Bluetooth connectivity will allow Bluetooth BG meters to automatically populate BG numbers into the pump. Although Medicare does not allow participation in hardware tslim_x2_insulin_pump_front_view_rgb upgrade programs, my fingers are crossed that software updates will be allowed. I discussed the Medicare problem with my local Tandem Rep and he indicated that Tandem is aware of the issue and hopes to make Medicare recipients eligible for software updates. I know that nothing is guaranteed.

To tell the truth, I still do not want a rechargeable pump. I have always liked the confidence generated by a spare battery in my meter case. But I will adjust.

One Worry:

My individual insurance policy is being cancelled at the end of the year because BCBS of MN is leaving the individual insurance market except for one hugely expensive policy. When I ordered sensors 10 days ago, the supplier indicated that I needed an insurance pre-authorization which I had not needed in several years. I panicked thinking that the insurance company was implementing a year-end money-saving policy of denying DME. I had visions of a new pump being denied. Fortunately Tandem has reviewed my policy and indicated that they are confident the pump will be approved. But until it is safely in my hands, I will worry. (And I did receive the sensors.)

Final Thoughts:

In our family we keep cars a long time. Although my primary car is a 2012 model, I still drive a 1999 SUV several times a week. As I age, it is easy to wonder if my current or next car will be my “last car.” That makes me a little sad because I love the excitement of buying and driving a new car.

I am not yet at the point where I think that the pump I select today will be my “last pump.” But with Medicare’s pump 5-year warranty policy, I am certainly not looking at an unending stream of new insulin devices. At age 64 I hope to have many years of continued good health and many more pumps, but the future is unknown. Will I get the opportunity to use an artificial pancreas-enabled pump? Maybe. Will I quit pumping entirely? Maybe. Will I some day live with implanted beta cells? Doubtful. Will I be cured of diabetes? No. I am not worrying about any of this. It is all in the “I wonder” category.

Today I look forward to using a Tandem X2 pump. Unlike previous pump decisions where I had doubts about the “right” choice, I am confident about this decision. I don’t expect absolute perfection with the X2, but I hope for excitement and the opportunity to have pump hardware that can move into the future with software changes. Fingers crossed.

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Pump comparison charts quickly become out-of-date as new pumps and manufacturers enter and leave the market. If you’re considering an insulin pump purchase, a good place to begin is here and here along with technology articles at Diatribe and Diabetes Mine. Ultimately manufacturer websites and sales reps are an excellent (but biased?) source for current information. And don’t forget to ask your DOC friends for their experiences and opinions.

The Last D-Tech

Posted on August 16, 2016 by Laddie

The 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 Ultimate Pump!

Posted on November 21, 2013 by Laddie

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?