[Gary_W]

Evening all,

As stated in another thread, I'm hoping to get a trial of a pump soon (though soon varies hugely in its scope and definition). I'm jumping the gun here by a long, long way I suspect but I like to get things sorted so I'll be in a better position to do the right thing when the time comes. It was alluded that I may get a choice between an Accu-Check Spirit, a Minimed (not sure if it's 522 or 722 or if I understand the difference) and an Animas (I think 2020). It's pretty difficult trying to decide between things, but when you don't know all the facts it's harder still.

I've had a good look at all three in terms of the websites and am trying to work out what is going to be important to me in terms of features.

One feature that I really like the sound of is 'Insulin on Board'. However, the implementation of this looks very simplistic on both the Minimed and Animas and the Spirit doesn't do it. From what I can see on both the Minimed and Animas, you tell the pump how long you think a bolus is active for in the setup menu. If you tell it 4 hours, I take it that it does the maths based on using 25% of that insulin per hour? If that's the case, it's a pretty useless feature for me. I use Apidra, and (when it's working) I recon on 70% being gone after 2 hours, then 15% per hour after that so it's all gone after 4 but it's far from an even absorbtion. My correction shots based on this 35/35/15/15 have tended to come right... Would IoB on a pump think that it was 25/25/25/25, and if so is there a work-around?

The only website that has a decent interactive pump is the Animas one, though I've managed to find good info on the Minimed too. The Animas website has kind of put me off the Animas pump as it seems to involve a lot of button pushing to do a bolus. What I couldn't work out was that, when you use the bolus wizard and it calculates that you need, say, 7.2u of insulin, it still makes you dial that in rather than just asking you to press a button to confirm. The Minimed looks like it puts that amount straight in there. Can owners let me know if this is the case?

I don't think I'd use the food database on the Animas; one slice of my brown bread may not equal yours. If I'm at home, I weigh it on my Salter diet scales that do an outstanding job. They strike me as less fiddly than the interface on the pump. Also, it looks rather rife with US foods, so I doubt it would find use in my life. Anyone want to give me a good reason why I could use it?

The Spirit looks most flexible in terms of basal rates; you can set every hour individually from what I can see wheras the others do 4 or so different rates per day? Would anyone need more than 4 basal rates per day? My main reason for wanting to pump is problematic basal rate variations, though I'd be shocked if I couldn't get it right with 4 different basals in a day... It also looks like the software allows Accuchek meters and the pump to download to the same software for profiling which looks very useful. Does this software come with it, and is it any good? I currently use an Ultrasmart meter which I'm very happy with but this looks like one up for the Spirit in this department.

All seem to do several bolus types, and I guess you can do the 'super bolus' on all of them (which sounds good for a carby meal which I do occasionally do ) Any particular pros and cons of each?

Do any of the pumps alter the bolus ratio based upon time of day? I'm sure I'll find this out on the websites, but haven't seen it so far. I know the Spirit doesn't as there is no bolus wizard type thing.

If you made it this far, thanks for reading!

Gary

[Funnygrl]

IOB isn't quite as simplistic as you make it sound. They base the amount of insulin it uses on the curve of action of the insulin, not a simple 25% after each hour math.

I find IOB EXTREMELY helpful both in terms of knowing how much I need for a low and in terms of preventing stacking and correcting too soon.

The Spirit is NOT better at basals than the Paradigm or any other pump. On all the other pumps you set the time frame, and the rate for that time frame. You can set it by the half hour. The Cozmo and the Minimed allow up to 48 rates per profile. The Animas allows 12. So the Cozmo and the Minimed are both actually better with basal rates than the Spirit. And you don't have to set it by the hour- you set it by the time frame.

All the pumps allow you to download the pump and a meter.

None of the pumps technically have a super bolus as a feature, but all of them can do a super bolus.

Overall, the Spirit is WAY behind the Paradigm, Animas, or Cozmo in terms of features.

All of the pumps let you alter carb ratio, bg target, and ISF by time of day. The bolus calculators are actually VERY helpful.

[David]

Knowing the IOB is VERY important to me. While I usually use my pump's wizard, I sometimes want to overide it and knowing my IOB helps me make an informed decision.

David

edited to add, I tend to agree with FG about the Spirit

[Gary_W]

Funnygrl and David - thanks for your replies.

Funnygrl - please can you give a little more detail about the IoB feature? How does it know what the response of the insulin is, as you could potentially be pumping Humalog, NovoRapid or Apidra and they all differ. If and when this happens for me, it will be Apidra I would stay with (well, that's my current perception). I just don't see how the pump 'knows' the profile as the only bit I could see to fiddle with was 'how many hours does it last?'

It's good to know about the basal rate abilities of the pumps, and that you can do different ratios and ISF's per time of day. So far, the Spirit is certainly sounding like the most basic of the three though to be fair I'd be delighted by any one of them at the moment. Given the choice, my current one would be the MiniMed. As the MiniMed is the pump they give everyone at the moment, that might even make things easier as the trainer here will be most familiar with that. I don't perceive of any training issues (I was an engineer for 17 odd years before I started selling things) and if anything has buttons and menus I'm typically right at home.

Gary

[w5wjp]

You tell the pump how long the insulin will last. It is done this way because it is different for everyone.

[xMenace]

I think it's very valuable, but I don't use my pump's smarts. I do it all in my head. I suppose this helps me get into trouble, but there are times when IOB doesn't work. When I have a bad set, either the insulin doesn't work at all or it kicks in up to 8 hours later. 30+ years of scar tissue will do this to you.

[Subby]

Just a quick note for Paradigm users: you can get to an IOB reading of sorts this way:

Go into Bolus wizard, dial in any blood sugar and proceed to Estimate Details screen. If you scroll down you will see your current Active Insulin (this is IOB or BOB, to my understanding)

(note: not putting in a BG will give you an n/a)

I'm not sure if the IOB features on the other pumps give more information, but just this figure alone can be very helpful as has been mentioned. Why they couldn't put this very useful figure in the Status screen is absolutely beyond me.

[Funnygrl]

Originally Posted by Subby

Just a quick note for Paradigm users: you can get to an IOB reading of sorts this way:

Go into Bolus wizard, dial in any blood sugar and proceed to Estimate Details screen. If you scroll down you will see your current Active Insulin (this is IOB or BOB, to my understanding)

(note: not putting in a BG will give you an n/a)

I'm not sure if the IOB features on the other pumps give more information, but just this figure alone can be very helpful as has been mentioned. Why they couldn't put this very useful figure in the Status screen is absolutely beyond me.

Keep in mind though, if you use Carelink, putting in "any bg" will cause "any bg" to show up in Carelink, and will skew your averages in daily totals.

I really wish they would just put it on the status screen already!

[Subby]

Thanks for that info funnygrl, I haven't been using carelink. How about if you cancel the bolus right at that point? It still records the BG you put in?

[Funnygrl]

As soon as you hit "Act" after the bg, it's recorded. If I just tested, know I don't need a bolus, and don't care about knowing IOB at the moment, I pull a B, bg, act, esc manuever to get the bg in there quickly for future reference on Carelink.

[JJM335]

Originally Posted by Gary_W

Evening all,

As stated in another thread, I'm hoping to get a trial of a pump soon (though soon varies hugely in its scope and definition).
Gary

Gary:

This is a bit "off topic" but how did you go about getting on the list for a pump? I have always understood that to qualify you need to have shown that you cannot get acceptable control with MDI (i.e. A1c>7.5) or you have other issues (e.g. hypo unawareness + severe hypos).

Like you I am getting frustrated at the limitations of MDI, I can do the boluses fine, but my basal requirements seem to diverge between night and day. Basically, I can get the night-time Lantus perfect. However, I am then going consistently hypo during the day (26 readings of <3.0 in the last month is way too many). If I drop the Lantus even 2U I go sky high at night.

I know that you have decent A1c's and are not making constant trips to the ER so how did you persuade your clinic to let you trial a pump?

Joel

[HollyB]

I think John Walsh has a comparison somewhere of how the different pumps calculate IOB -- anyone got a link?

It's been extremely useful for us with the Animas, which I know calculates along a curve with a peak at 1-2 hours and then a small "tail" or residual effect for the last hour. That would be a better match for Novorapid or Humalog than Apidra, I think.

It gives me a lot of peace of mind, especially when Aaron is sleeping over somewhere, that he can take his BG before bedtime AND factor in how much insulin is still active in his system.

6.9 looks a lot different if you've got 3 units of insulin still working away!

[Gary_W]

HollyB - This might be the link; it's a web address written down on p 50 of 'Pumping Insulin' (4th edition). I've read it twice and still don't quite get it... It references a 'table 2' and seems to think that tells you how to set your own pump for this feature, but table 2 is missing from this page. Anyone help with that? Index of Diabetes Technology pages: Insulin Pumps, Insulin Pump Comparison, Blood Sugar Meters, continuous glucose monitoring devices, noninvasive monitoring, diabetes software.

Joel - I still don't know for certain if they will let me trial a pump. I'm just on the first rung of a ladder, and I'm not sure how tall that ladder is.

The way I got to this rung of said ladder was simply to ask. The most recent two British pumpers I've noticed around these parts have been Sharon (Shabbie) and Shane (Gobbly). At the time of getting the pump, neither had an HBA1c >6.5 (let alone what NICE says) and, if I understand it correctly, neither have disabling hypos. But both have pumps. Sharon and Shane - hope you don't mind me quoting your cases and apologies if I have hold of the wrong end of the stick.

So this said to me that the NICE guidelines have huge variants in how they are interpreted throughout the country, and as such the only way to find out locally is to ask. When I did so, the answer came back that it was possible, but what is 'required' around here is the say-so of the consultant and to have been on the DAPHNE course. You can then borrow a pump and potentially get one though I'm hazy on the details as to how...

I have not been on the DAPHNE course; I argued that I was assessed for DAPHNE last year and that the clinic stated my level of knowledge exceeds the DAPHNE course. For this reason, it would be a waste of my time and their money. For all I know, they could try and hold it up due to this local protocol. NICE says you must have been given education, my argument is that I educated myself here + reading plenty and that my education has lowered my HBA1c to <6 and lost me a whole bunch of weight whereas using their method I was sat firmly outside deaths door (slight exageration, but I generally keep a whole bunch better these days).

Anyway, until I get to see this consultant, all bets are off. Currently, this appointment is not scheduled until July. He may turn around and tell me I must do the DAPHNE course, for which there is now a 10 month wait. So I potentially have a long, long way to go.

The problem I have is that getting the pump is purely down to the LOCAL clinic's interpretation of the guidelines. If they choose to interpret them to the letter then I would have no chance, so I need these guys to be on my side. It is not something where jumping up and down looks like it will work, as it is their potential loosening of the guidelines that is giving me a chance in the first place. But it is incredibly frustrating and I don't really know what to do at the moment...

A little edit for those who don't know - DAPHNE (acronym is actually DAFNE) is Dose Adjustment for Normal Eating. It essentially teaches that 1 CHO is 10g of carbs or 5g of carbs or 15g of carbs (a very crude way of working out your ratio that counts in 5's) and is therefore (A) useless to me and backward compared with the way I do it and (B) completely useless for a pump when you can go in .1 u of insulin...

Gary

[xMenace]

Originally Posted by HollyB

I think John Walsh has a comparison somewhere of how the different pumps calculate IOB -- anyone got a link?

Index of Diabetes Technology pages: Insulin Pumps, Insulin Pump Comparison, Blood Sugar Meters, continuous glucose monitoring devices, noninvasive monitoring, diabetes software.

[Funnygrl]

Ok, I feel bad being the American correcting this, but it's DAFNE- dose adjustment for normal eating.