“And then Marcus gave me a Valentine and it had SPIDERMAN STICKERS on it and I love Spiderman stickers so that was the best Valentine I got except the one from Maddie that had a pencil and that was ALSO THE BEST ONE,” yelled Birdzone from the backseat as I was buckling myself into the driver’s seat.
“Yeah? So Valentine’s Day at school was awesome?” I asked her, reaching over my left shoulder to grab the belt.
And then I felt that familiar, gentle * pop * of the infusion set coming loose from the back of my arm.
Rarely do I have the chance to use my emergency supplies (which is a plus because that means I rarely have emergencies), but I always carry them. Even though I wear an insulin pump, I keep a back-up pen of Humalog floating around in my purse. Sure, it will eventually expire and I’ll have to swap it out for a new one, but in a pinch, it’s enough.
And even though it’s a bulky little spaceship to keep on hand, I always have a back-up Inset for just-in-case moments, like when I accidentally rip out my infusion set in the parking lot of Birdy’s school.
It’s been several weeks since I’ve switched to the Animas Vibe insulin pump (with integrated CGM technology – doesn’t that sound like a rehearsed phrase? How about “insulin thing with CGM thing built in and have you seen my coffee, pleaseandthankyou.”), and I thought I’d take a crack at some second impressions, since the first impressions were only compiled after a few days.
Talking ‘Bout CGM: I am still into the concept and application of having one device that does the work of two. While the Vibe still requires that I wear an insulin pump infusion set and a CGM sensor as two separate insertions, it removes the need for an external CGM receiver. I wrote about this last time, but to reiterate: I am okay with not using the separate receiver. I’ve traveled a lot in the last few weeks and the first few trips, I brought along my CGM receiver so I could plug it into the SHARE port.
For the record, I still haven’t upgraded to the 505 software. Judge all you want. Which may explain my identical CGM graphs. (And, also for the record, I’m really, really excited to see the new Dexcom receiver. That may change how I feel about clouding, as it would be much simpler.)
But then Chris and I came to realize that we aren’t good at this whole “data sharing” thing. As much as it sounds like a good plan in theory, we aren’t good at the application of it. I think this becomes a patient-specific preference sort of thing, and for this PWD, I’m not a data-sharer. But as I mentioned with that previous dead horse that I keep flogging, I like options. Love them, actually. And anything that gives data options – LIFE options – to people touched by diabetes, I am all for it.
(That sentence was a grammatical nightmare. Ignore the sloppy parts and move on, yes?)
The data collection portion is cumbersome. I hate dongles and charging cords and all the extra beeps and wires required to make sense of diabetes data. (Which is why I’m such a fan of the Verio Sync idea, which uses bluetooth technology to automagically suck the results off my meter and spit them into my iPhone, but there are issues with that system, too, because it’s only iOS compatible. Pluses in one way, minuses in another. But see aforementioned “I love options” sentiment, because it still applies.) But I did download my pump data, which also downloaded my CGM data. And, because I was feeling ambitious, I uploaded my glucose meter, too.
So this was my first time looking at Diasend with information about my insulin doses, glucose meter results, and CGM results on the same screen. (No, I am not sharing my results. My numbers have been absolute shit lately and I’m not going to pepper my blog with confirmation that I have diabetes. I’ll let the c-peptide test that’s required by my insurance in order to cover my insulin pump serve as that confirmation. Yes, that’s a thing. Yes, more on that later.)
Diasend is good for granular information, but the information on the “compilation” tab was ace for me. Seeing my blood sugar averages based on time of day was powerful. (I have midnight to 11 am nailed and awesome. Everything not in that time frame needs a solid snuggle these days.) As a Mac user who hasn’t explored the new Dexcom/Mac Portrait (I’m woefully behind on everything that doesn’t involve Birdy these days), seeing my Dexcom data on my laptop is amazing. I’ll be exploring Portrait in the next few days but in the meantime, I’m happy that information can be siphoned over to Diasend. And it puts the constant flow of data into digestible context.
Pump Stuff. Since I was a Ping user before, using the Vibe feels familiar and easy. I’m still glad this sucker is waterproof and the button clicking process is familiar to me. All of that feels the same. One thing I have noticed is that the more my CGM needs attention, the faster the battery in my pump needs replacing. This is annoying, but makes sense despite the annoyance. For the first time ever, I’ve invested in lithium batteries for my pump and it seems to hold much better than the alkaline ones I have been using for the last … forever. But overall, the pump feels familiar and comfortable, and since I hate change, that familiarity is a plus for me.
Alarms, for whatever reason, remain easier to hear and feel when they are coming from the pump. This was a huge concern of mine because I thought the pump alarms would be muffled by clothes and bedding, making them hard to catch. But I actually respond to low and high alarms more readily on the Vibe. I am not sure why. Maybe because it’s attached to my hip and I feel the vibration?
What remains to be seen is how the changing state of Dexcom progress will affect my feelings about this pump. Right now, it’s the only one integrated with the CGM I already use, so that’s a huge plus. But I am concerned about the fact that the software in the Vibe is already behind on the current Dexcom system. I know the FDA process creates hurdles that are hard to clear, but since the Vibe has already cleared the Big One, can I expect that updates and upgrades will come fast and furious? As a PWD using the Animas product, I hope this is the case.
And lastly, I’m hoping to have this pump covered by my insurance company. I’m still trying to get a c-peptide test done (travel, snow, and issues with fasting) to fulfill the requirements issued by Blue Cross Blue Shield, so that journey remains ongoing.
Thankfully, I’m still pretty effing sure I have diabetes. So yay? Yay.
The lows that have been creeping in lately need to stop. They are inconvenient at best, completely debilitating at their worst and the in-between is a muddled mess of glucose tab dust and frustration. Yesterday I had a diabetes technology fail coupled with a highly symptomatic hypoglycemic event that occurred simultaneously with a phone call to the Joslin Clinic … which sent me over to Twitter with an agenda of rage.
First, it was my Dexcom receiver that went berserk on me, telling me on both my Animas Vibe and my G4 receiver that my blood sugar was 202 mg/dL with double arrows down but after my feet weren’t responding to the “MOVE!” commands from my brain, I grabbed my meter to double-check. And saw a blood sugar of 43 mg/dL.
202 with double arrows down (on both the pump and the external receiver) is not the same as a meter reading of 43 mg/dL. #diabetestechfail
I immediately went for the glucose tabs and housed several of them. The low symptoms were intense – confusion, anger, tears, and a hand too shaky to hold the jar of tabs properly, so I held it with two hands, like those stock photos of baby panda bears drinking from a baby bottle.
Then the phone rang, and I answered it because: 1. When I’m low, I make bad decisions, and 2. It was the Joslin Clinic calling and I always answer their calls because Joslin.
And why did I answer the phone while low? b/c it was my endo calling to schedule c-peptide labwork to confirm that, yes, I have T1D.
And then the anger/adrenaline surge subsided and I was in that “weak with post-hypo panic, stupid body, knew I’d be fine in a few minutes but what the fuck” sort of fallout.
@CureT1Diabetes Rant has subsided. Post-hypo crying session in full effect. Honestly, this disease is doable until it's a fucking shitshow.
Eventually, as it always does, my blood sugar came back up and my brain tuned back into things happening on the planet. My CGM/Vibe/meter were back in alignment, showing me in the 80′s and holding steady.
Blood sugar now 81 mg/dL & all of my CGM devices finally agree with my meter. Now I wait for Joslin to call back w/lab orders to prove T1D.
Yesterday I had a hovering sort of low before a conference call, a low that took its sweet time letting my brain check back into the conversation despite my blood sugar number coming up reasonably quickly.
This morning, my pre-conference call routine involved a quick site change at my desk because I ran my insulin reservoir down to the fumes.
Diabetes, I have another call this evening. I fully anticipate that you’ll dress up in a clown suit and come skipping through the Skype screen waving your arms and burping, subtle interrupter that you are.
When you wear something every, single day, you notice every, single bit of it. I’ve been wearing this pump for four years and I know the lines of it by heart. (I remember the day that I switched from Medtronic to Animas and even those similarly-structured insulin pumps felt entirely different to me in weight, curve, and especially clip. As I wrote in my Animas Vibe initial review, change can be awkward.)
Two weeks ago, I dropped my insulin pump on the bathroom floor. It survived the fall, but happened to fall just so and smashed the edge of the battery cap the teeniest bit. See? (Ignore the hard knocks look of my pump overall. I’m tough on this thing.)
Okay, so maybe it’s not obvious (I can barely see it myself, even when it’s pointed out to my eyeballs), but my hip knew instantly. The jagged catch on the battery cap bit into my skin all day long and drove me bananas. (The photo is not accurate as far as how the chip lined up with my skin. The battery cap pictured is not screwed tightly onto the pump. When it’s on right, the chip faces my body.)
“Do you feel this?” I asked Chris, running his finger over the edge of the battery cap. “That teeny chip? It’s making me crazy.”
The point of this post? To illustrate how fully integrated these devices become into our lives, where we notice even the most seemingly insignificant blip. And to also note how awesome it is when your local pump rep just happens to have a replacement battery cap in the trunk of her car.
Again, disclosure: I work with Animas and have a sponsorship contract. Here are more details on my disclosures. I link to my disclosures more than I link to cat .gifs, which is saying QUITE A BIT.
As I mentioned, I’m testing out the Animas Vibe. Here are my first, quick impressions after a few days using the Vibe. (What, you wanted some long, flowery introduction paragraph? I’m out of words.)
First things first. Change can be awkward and uncomfortable. When I switched from Medtronic to Animas back in 2010, I had trouble with the switch not because of the pumps themselves but because of the change, in general. Wearing an insulin pump means being connected to a small box and tubing 24 hours a day, so you really get to know that box/tubing combination. The curves and edges of the pump became something I knew by heart, and wearing a pump that was even half a millimeter different than whatever I was used to made me grouchy. It took me about three weeks to become used to wearing the Animas Ping pump, and about a month and a half to become entirely used to the differences in filling the reservoir, changing the infusion set, responding to alarms, etc. (I experienced this all over again when I took the t:slim pump for a spin over the end of the summer. The pump itself was fine but the different size/shape/process made me grumpy like this cookie and I was less accepting of the pump because it wasn’t what I was accustomed to. This isn’t a comment on which pump is superior, but a commentary on why the learning/acceptance curve, for me, is a true curve. It also illustrates my hate for change.)
I was set up on the Animas Vibe on 12/31, so I haven’t had this thing for more than a few days, but going from Ping to Vibe was simple in terms of learning curve because I’d already done that curve. I have worn an Animas Ping since 2010, so the routine is familiar. Keep that in mind as you read through my perceptions, as they are colored by familiarity. And coffee. (I had two cappuccinos with dinner. TWO!! Bees in fingers [h/t CSparl].)
CGM Integration. I was unsure how I’d feel about integration, to be honest. I like having my Dexcom separate sometimes, and things like CGM in the Cloud and Share are important to me because I most-often travel alone, so having my data streaming to the cloud is an important safety feature. But, on the whole, I don’t stream my data (with overnight exceptions as noted). Basically, I am the main person who needs access to my data.
However. (And this is a big however.) I like, and appreciate, options. I don’t have the option of ditching diabetes, but I do have options on the tools and technology I use to make sense of diabetes. I LOVE having the Dexcom data showing up on my pump screen. Love, love, love. Why? Because I always have my pump clipped to me. I didn’t realize, until a few days ago, how often I was keeping tabs on my external receiver, bringing it from room to room with me, and keeping it clipped to my purse while I was out of the house. I went for a run the day that I hooked up to the Vibe and it was exciting to bring only one device with me. With a tube of glucose tabs in my pocket and pump clipped to my hip, I was good to go. It felt liberating.
@grumpy_pumper I went for a run yesterday and it was excellent to only wrangle one device instead of two. That was a big plus.
The best part, for me, is that I can run my separate Dexcom receiver at the same time. Yes, they can run simultaneously. (No, I have no idea how that impacts the battery life of the transmitter. Nor am I certain this is a sound idea. But I’m doing it anyway.) Both the Vibe and the receiver need to be calibrated separately, but for the times when I’m away for work, I’m happy I can still make use of the Dexcom Share without getting all weird. Options where there once weren’t any at all; I’ll take it.
(And I haven’t had a chance to test the accuracy of the receiver vs. the Vibe, but since I haven’t yet upgraded my receiver to reflect the 505 algorithm [we don't have a PC], I don’t know if my comparisons would be best. Once I hijack someone’s PC and update my receiver, I’ll circle back on this.)
One concern I had about integration was whether or not I would hear the alarms on the pump. In setting up my pump, I customized my alarms to reflect a vibration for any low blood sugars and a beeping for any highs, thinking that a vibration would be good for middle-of-the-night low warnings. While I haven’t had much time to test the highs and lows (thankfully, numbers have been reasonable for the last few days), I did have one 2 am low blood sugar and the vibration woke me up. I’ll have to wait a few more weeks/months to truly test how responsive I will be to the alarms.
One other concern I have is about the color indications for the different numbers. I’m a creature of habit (see above bit about hating change) and I am used to the way that the Dexcom G4 receiver lays out blood sugars, in terms of color. Ketchup and mustard, you know? Highs are yellow, lows are red, and white means don’t touch anything because in range. However, since companies cannot sync up their shit in a way that makes things easiest for end users (aka the PWD), the CGM graph on the Vibe is entirely different than that of the G4. On the Vibe, highs are red, lows are blue, and in range is green. For me, this has been a weird change because I like at-a-glancing at my CGM throughout the day, and now I need to readjust my mindset for what “red” means.
Screen Resolution. This might seem ridiculous, but there’s a new feature on the Vibe that allows for the brightness to be turned up/down with a click. The button on the edge of the pump with the little lock (or lightbulb, or whatever that icon is) makes whatever screen you’re on brighter, or less bright, with a click. I like this more than I should, I think.
Food Database. I haven’t used the Ping meter in a few years (I switched to the Verio when it came out, and am now using the Sync), so I haven’t done much with the food database in the past. On the Vibe, the food database is built into the pump, so if I go in to give a bolus and use the EZCarb bolus, I can access a customizable database on the pump itself. I haven’t had much time to play around with this feature yet, but I plan to as I fiddle around with the pump. (One note: on the “snack” screen, the food options are all junk food. Chocolate cake, cannoli, donut holes, key lime pie, just to name a few. Who categorized these as “snacks” instead of “junk food”? Confused the small, rational part of my brain.)
To that same end about not using the Ping meter for a while now, it’s important to note that the loss of meter remote capability in the Vibe vs. the Ping did not matter to me at all. I haven’t used the meter remote option in ages, so not being able to use it with the Vibe made zero difference to me. Your preferences will vary, of course.
Wearability. For better or for worse, this pump does not feel different on my body because it is essentially the same physical pump shape/size on my body. Having worn the Ping now since switching to Animas, the Vibe feels the same. But, for the record, I did try a blue pump this time instead of my time worn silver one, which feels sassy. Also, not needing to carry the Dexcom receiver makes for a lighter purse. (And when my purse holds glucose tabs, my meter, an insulin pen, car keys, wallet, gum, Batman, and a deck of Crazy Mates on an average day, one less thing is awesome.)
Battery Concerns. Since it’s only been a few days, I don’t know how quickly running the CGM and the insulin pump will burn through the battery. As it stands now, my Ping went through about one battery per month (maybe every 5 weeks), and my concern is that the Vibe will require more battery change outs. Time, again, will tell.
Software Questions. I haven’t uploaded my data to Diasend yet, but I’m excited to see what the overlap looks like for my pump, CGM, and blood sugar data. My past experiences with Diasend have been good – I like the software – but I’m not the best at uploading data from my pump (read: I never, ever do it because the process is annoying). I’m hoping that future iterations of the upload process make it more plug-and-play instead of “hey, weird dongle.”
Overall, I’m excited about the Vibe. (And even if you aren’t, let me be excited, would you please? I’m appreciating the fact that this system has finally been approved in the US.) I like carrying one less device while still using the CGM and pump combination that I trust and prefer (bias, bias, remember).
I’m looking forward to sharing thoughts at the close of this trial period, and then moving forward with a Vibe of my own … even if the name of the product gives me a bit of a smirky smirk.
Which may explain my identical CGM graphs. (And, also for the record, I’m really, really excited to see 
