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Wednesday, 17 April 2013

Double Trouble

For the past week Lewis has been angrily beeping at me from deep within my underwear drawer (buried in between my bras and socks, hoping to muffle the noise). As my Private Health Insurance is just about to kick in, I was given the opportunity to trial an Animas Vibe pump (Whom I nicknamed Bastille; a name that I have decided to call my future obese cat) and the new Dexcom CGM before making my final decision.
Lewis & Bastille
For starters, I think its necessary to point out that I am on an older version of a Medtronic pump. The new one has features on which I cannot yet comment, like the capture event menu, which I did add to my list of pros for Medtronic anyway, because it sounds awesome. Similarly Animas have the Diasend food database which I didn't use whilst trialing, and it sounds awesome as I can never ever ever remember the carb counts to anything, even foods I eat everyday. Except kit Kat Chunky's. Those are worth 36gm or 44gm carb for the king size ones. Guess who eats too many Kit Kat Chunky's?

I also think its necessary to disclaim that I was only given the loaner pumps for the purposes of seeing which one I want for realsies now my PHI can't money-suck aimlessly anymore; not for rambling reviews. Which I will do anyway.

Be warned, this is a large slice of blog-pie. You can find the fat-free (condensed) comparison list below:
Pros and Conning it!
The short version of my comparison - because the long version really is long

I have lived with a Medtronic pump for the last 8 months. It would be an understatement to say I was a little bit emotionally attached to Lewis. So bear with me as I try to see clearly through my rose-tinted glasses. Originally as I was trying to decide on my loaner pump it all ended up coming down to 1 major point for each - Animas was waterproof. Medtronic wasn't. Medtronic had CGM. Animas didn't. CGM won because I was more interested in getting a better HbA1c than going swimming with my pump.

I also thought the Medtronic pump was just that little bit easier on the eyes. In saying that, now that I've had the Animas for a week I'm beginning to think its rather a little cutie, and am confused at my earlier thoughts that it was an uggasauras. Although I have got the plain black one, and I do still think the green version of Animas is reminiscent of one of the many cane toads that used to inhabit the toilet at our farmhouse when I was younger.

I'm already set up for Enlite CGM with Medtronic, having taken advantage of their recent 'Oh-crap-animashavecgmnow-eeeep-competitors' promotion. My 1st experience with Medtronic was more than disappointing, with the ISIG dropping out completely after only 4 hours of use.  Medtronic CGM drops out a lot. Maybe its to do with the extra-long showers that I intend to indulge in, but I am forever having to 'Find Lost Sensor'. The Animas Dexcom on the other hand hasn't dropped out at all. Of the 2 Animas Dexcom is easiest to insert, with a simple push down, click, pull up inserting mechanism. I think the insertion mechanism might be the reason why I had a bent cannula with my 1st Medtronic Enlite sensor, it is much more complex to use and can only be done on a super flat surface or it fails miserably. The graphs for both CGM's are much of a muchness; Medtronic wins me over by the smallest fraction, as you can scan backwards through your graph to see the exact readings every 5 minutes, whilst Animas only shows the overall graphs. Neither CGM stands up well for night-time tracking and I fought hard to try to calibrate both for correct night-time readings to no avail. CGM are really only good for trend tracking, not spot-on readings. I found with the Enlite CGM that the less calibrations I did, the more accurate it was. For the Dexcom I need to do more calibrations to keep it accurate.

CGM costs a pretty penny either way, but Medtronic wins hands down in the price department, especially if you take part in the current $375 starter kit option. Basically you get 5 sensors, serter, transmitter & charger for the price of only 5 sensors, but I don't know how long it is running for. Replacement sensors cost $375 for a box of 5. Animas costings are at $440 for a box of ?5, and you have to buy start up for setting up cost of approx $1000. They are also doing deals at the moment, but I'm not positive on what they are.

About 75% of the time that I am actually using my pump (i.e, the hands on part) is when I am bolusing. Medtronic has the quick bolus button that incorporates their bolus wizard. You can basically access it in 1 click. For me this is definitely a big consideration. I'm lazy. To bolus with the Animas Vibe you have to go in through the main menu and it is a little bit harder to navigate. For example the 2 hour post-meal BGL reminder for the Medtronic is selected before you confirm bolus, whereas with Animas you bolus 1st and then select to give the 2 hour reminder, which so far means I am accidentally putting my pump away during bolus delivery and then having to bring it out again to remember to say yes to reminder. Animas pumps bolus faster than Medtronic, which seems to mean more efficient insulin use via absorption. The other day I successfully ate a piece of banana bread and ended up on 7.5, which I have never been able to do with my Medtronic. Supposedly this faster bolus delivery can 'sting' (They have an option to change it to a slower speed to combat this) but I haven't felt any pain so far. I generally don't bolus more than 6u at a time. Animas have the quick option to cancel a bolus in progress, which is a feature I love. There have been a few instances where I have realised that I have overbolused, and being unable to cancel, have had to deal with the resulting hypo. Its a very 'safe' feature.

In the past week I have seen 2 movies in theaters (Warm Bodies, which I recommend and Oblivion, which I don't recommend) and the bright, colourful screen of the Animas pump was very apparent in this situation. I was able to illuminate and read the carb count off my chip packet using the light cast off from the pump screen. Medtronic has a green back light with black writing. In terms of screens I love the Animas. So pretty to look at and much bigger writing for those with sight difficulties.

Reservoir sizes don't make much of a difference to me as I use a max of 40u total per day.Medtronic have 2 reservoir sizes at 180 or 300 units which could cater to people with more insulin resistance (or those who shovel down the carbs by the bucketful). Animas have a happy medium at 200. The Animas reservoirs are a little poorly designed in that the needle used to take insulin from your cartridge is too long, and you are unable to get the last 5 or so units into the reservoir without a lot of fiddling about. On the other hand they seem to allow less air bubbles into the reservoir.

Both pumps are amazing and I have enjoyed them both immensely. I will be happy with whichever I choose in the end (oh damn, decision time!). They each have individual characteristics for different people and everyone's individual needs and wants. 

If I had to sum them up in 1 sentence each:

Medtronic is easier to navigate and very user friendly, with a more cost effective CGM and possibly aimed at lazier of the Type 1 species.

Animas has lots of safety features (such as waterproof, cancel bolus, and you have to confirm everything you do) and would suit younger children and those who are very visual in their methods.
I took Bastille into the shower. And went low. So my guess is I probably dont need it in the shower then anyway.

Saturday, 6 April 2013

Have Sugar, Will Devour

"Hi Chris, I'm low, I need sugar".

Today my partner, Hugh, and I collected his father from the Brisbane airport. Fresh off the plane from England. We had asked him to meet us at arrivals 5 min parking pick-up. His plane got in a little later than we expected and we ended up having to do a loop (Which at Brisbane domestics is no easy feat. It's a fair few km for the loop). As we drove through the 2nd time looking for a spot to park in, among all the chaos of dodging attempted ram raids by elderly and foreign drivers, we spotted him in the distance, walking in the opposite direction. Being the passenger it was decided I would get out and wait with Chris so he didn't wander too far away looking for us. We were caught behind a man very slowly trying to manouvre his way into a reverse park position.

So I get out of the car and leg it towards Chris, whilst Hugh drove off to do another lap as we had by this stage reached the end of the 5 min parking area. First words out of my mouth once I had caught up with Chris weren't "hello, how was your long haul flight?" or any other pleasantries. They were "I'm low, I need sugar". I didn't realise it until I had gotten up, but once I was up and standing, I felt it. My badly blurred vision and inability to answer Chris' following questions suggested that I was probably in the mid 2's at best. I felt like I wanted to fall down and die.

I didn't have sugar or my meter on me. They were in the car. I didn't have my phone on me. It was in the car. And I didn't have my wallet on me. That was in the car as well. Chris' plan was to urgently call Hugh to tell him to high-tail it back as fast as possible whilst he apparently scanned the crowds for anyone eating a chocolate bar that he could steal. My plan wasn't anything. It was to go ballistic in my head at myself for being so stupid as to not grab my jellybeans on my way out of the car.

I think Hugh may have sped as he reached us in record time, just as I was preparing to make the dash of my life back into the airport terminus (which was a good few hundred meters away) and beg a sugar sachet from security. At least I was wearing my medical ID to corroborate my story that I needed sugar.

Never have I been more relieved to see car juice before. I call it car juice because I keep juice boxes in my car for hypo's. Said juice boxes have all been sitting in my car for many many months and have heated up the point where they have probably fermented. They're probably alcoholic by now.

This whole episode ruined my day and I spent the car ride home having an internal screaming match with Morty. Just one of those days when the little things about D tick you off. Today it was the fact that I despise having to take a pharmacy with me everywhere I go, just in case, even for 5 minutes. Tomorrow I'll be careful and carry pocketfuls of jellybeans with me around the house. Just in case.