The time has come. It’s hard to believe but its four years since I got my pump and its warranty is nearing an end so it needs to be replaced. On one hand, I can’t believe four years have passed since I stepped into a brave new world and felt a bit like I was having to learn everything I ever knew about diabetes all over again. On the other, I can’t imagine life without my pump and CGM any more.
Anyway, don’t tell the pump (because I need its loyalty for a few more months yet and it has a tendency to get stroppy), but the end is nigh and I’m on the hunt for a replacement. A quick survey of the pump marketplace shows that things don’t seem to have moved on a great deal since I last looked at the pump market in 2009, but there have been some developments so what are my choices?
Omnipod now sell their tubeless pump in the UK which is real progress. Last time I thought the egg sized pod was too big to have attached to me for 3 days without being able to take it off and the lack of tubing left me in fear of leaving the remote behind as I dashed out the door. Having poked around at the Omipod at an exhibition I’m afraid that’s still my view. For me the pod needs to be much smaller and I need some way of convincing myself I won’t forget to pick up the remote before I’m up for that.
The Accu-Chek combo is still a tempting offer with its fully functioning remote control that also acts as a blood glucose meter. This means I can hide my pump in my bra and then use the remote to do a blood test, calculate how much insulin I need with the built in bolus wizard and then instruct the pump to deliver the insulin, all without having to delve into my bra in public. This is very tempting. Where the Omnipod fails me is that if I don’t have the remote I can’t bolus. With this, I can bolus with the pump (which is attached to me via tube so I’m going to have to try hard to leave it somewhere) or with the remote. The cynic in me does wonder though whether this is just a smart new remote to tart up a pretty old pump model.
Non-pumpers, if you’ve glazed over at the thought of all this tech, Accu-Chek seem to have done something clever by taking the intelligence behind pump bolus wizards and making it available to those on MDI. Nice idea. The Accu-Chek Aviva Expert is on their website but info is pretty sparse. There is a pretty detailed review by Mike over at EveryDayUpsAndDowns if you want to know more.
The Animas 2020 seems to be big on looks and personalisation. It has a huge screen compared to the others so you can see a lot of data without flipping through menus. And their bolus wizard is customisable so you can input your favourite foods. It gets a big plus for having tiny 0.025U/hr basal increments meaning you can really tailor your basal rates to the nth degree.
Finally, we get to the incumbent. I’ve had a Medtronic pump for four years and I’m happy with it. Their latest, the Metronic Paradigm Veo is an updated version of my current pump. This is where the whole reviewing the market process falls apart. The big screens, sexy remotes and customisable bolus wizards are nice to have but they can’t compete with the one killer app offered by this pump – integrated CGM. I will sacrifice virtually anything for that. Speaking to an Animas rep 18 months ago they were very hopeful of offering a pump with Dexcom CGM integrated by 2010 but I’ve seen no sign of that. I’m not willing to wear a pump and carry a separate receiver for the CGM when an integrated version is available so it means my only choice is the Paradigm Veo.
This is no great hardship. Like the Aminas, it too has the tiny 0.025U/hr basal increments which will be an improvement on the 0.05 setting I currently have. The bolus wizard works well and I’m so used to it I find it really intuitive. I can’t fault the service I’ve had from Medtronic over the last four years. My problems have been minor, evenso they were fixed fast. The CGM functionality has been improved so I can now set it to alarm if I’m rising or falling quickly (great for anticipating highs and lows and taking early action) and it has the reassuring safety feature of if the CGM detects I am low and I don’t respond to the numerous alarms, it’ll suspend insulin delivery for up to 2 hours. Interesting.
So, just like four years ago, my choice is simple. Integrated CGM is top of my list; therefore it has to be the Paradigm Veo. If pumps were like Mr PotatoHead and I could customise to my heart’s content, I would add in a fully functioning remote that displayed my blood sugar from the CGM and allowed me to dose remotely. Until the PotatoHead pump is available though, it looks like I’m sticking with Medtronic.