May 31, 2016

The Best Insulin Pump - The One You Use

I wrote about the best Insulin Pump a few years back. My view hasn't changed much, so, Summer Rerun. 

So here what I said in 2012

The question which is the 'best' insulin pump floats up in diabetes conversation regularly. Best is a natural but probably the wrong question.

The quality of pumps and their ability to perform the basic insulin delivery functions is so good that these days users and their care teams have the potential to define the device and vendor that most appropriately fits a person's unique lifestyle. That is a real wordy way of saying, ‘there is no best pump.’

Happily one size does not fit all.

People with diabetes have different needs because their diabetes varies. So don't look for the absolute best pump but to the device that best accommodates your individual lifestyle. This dude may love his backpack,  but it may not be your best choice. (And what is in the giant bottle on the bottom of that thing anyway?)

Design and feature matter. For example the patch, folks seem to have a love/hate relationship with the OmniPod. That is great. If you are drawn to the patch pump, no tubing, PDA driven approach -great. If like my kids. You think it is too big and uncomfortable and tube are okay a more traditional pump may be better in your life. There are a lot of criteria individuals can consider. Remotes are really great for little kids. Lock the pump down and have mom or dad operate it with a remote control. How much insulin do you use and how much does it hold. Is it a color a young girl is comfortable wearing 24/7.

CGM may matter. If CGM integration is mission critical only Medtronic has int on the market in the USA. Animas, Roche, OmniPod, and Tandem are in the on-deck circle with Dexcom. Remember that deck circle is a baseball term. There is no clock in baseball and Animas, and Omni pod have been next in the line up for years waiting to come to bat. Some of the fans in the stands are getting rowdy and jeering the Ump wanting to see them come to bat. Food databases are touted as a key feature. If they are to your look carefully at the implementation and ease of building realistic meals. Can you customize the food database to your needs.

Service matters. Check it out by calling the service in the middle of the visit by the sales team. Like everything else service varies. We have had great service from Animas other say they have had issues. Read up on TuDiabetes and CWD and keep in mind that when the device is as integral a part of life as an insulin pump, individual service expectations will be very high.

Sets matter. People talk about pump features, but the set and how it feels going in are where the rubber meets the road. -  Well, the insulin meets the subcutaneous tissue. Try on sets as part of the sales process. Sets plural, not set.

Instead of which is best maybe the question should be what features best adapt to my lifestyle. That the art and science of insulin pumping have progressed from that backpack size prototype, in the black and white pictures above, to diverse, miniature devices is great.

What is best is we get to choose based on our individual preference.

Related posts from the YDMV archives:
Why Pump
What would be Really Cool.

Updated with some grammar & spelling fixed 5/31/16. Sure there are still a ton of errors. My Writing May Vary

May 5, 2016

You Diabetes May Vary So Access Matters (Wherein I borrow from Manny & Scott)

Diabetes is complex.

It is highly dependent on patient self-care actions that include daily self-monitoring of blood glucose, medication and dosing adjustments, diet measurement, carb management, physical activity, and logistic management of all the stuff needed to do all of the above. Diabetes has a well-documented comorbidity of clinical depression and a subclinical level emotional exhaustion from the burden of management. Diabetes is complex.

Whoever manages it, needs tools they can work with.

My dear friend Manny Hernandez has a spectacular visual representation of the time patients self-manage. A chart that shows the percentage of time people with diabetes self-manage vs the time we spend with our physicians, diabetes educators, and care teams. It is below.

See that little white line? That is time with the care team. BUT to make the little white sliver visible, Manny had to exaggerate its proportion of the graph. This is not to minimize the role of our professional care teams but to make it visible. Manny is not alone in making the point of the importance of patient self-care. Here is Manny’s chart, presented by renown endocrinologist Dr. David Marrero at the ADA Scientific Session in 2015. In the image, we see one diabetes doctor talking with a huge room full of other diabetes doctors making the point that respecting the role of patients is critical to success.

Image source Diabetes Mine - Twitter

Let just pause and think about what this image represents: a doctors and a patient collaborating to advance the art and science of diabetes care at the ADA Scientific Sessions.

I think that patients and doctors collaborating is a brilliant model. 

All the diabetes complexity outlined in the opening paragraph, along with all the associated variability is self-managed the vast majority of the time by patients guided with a small but critical sliver appointments with their health professionals. Somehow in that little white space, doctors and patients figure out jointly how to make the time represented by the blue space successful.

All this is a very long way of starting to making a case for asking, "Who knows best what will drive success in the all the blue time on Manny’s chart?"

To put it briefly, again, I turn to a friend:
"My initial reaction is that healthcare decisions, such as which insulin pump to use, should not be made outside of the doctor/patient relationship," - Scott Johnson
We have seen that disruption to access to testing supplies in an attempt to reduce supply costs, resulted in increased hospitalization, costs, and mortality.

Diabetes is complex. It is highly dependent on patient self-care.

There are 30 million or so people with diabetes in the US. It is a safe bet we have different approaches to succeeding in the blue space on Manny’s chart. Long-term diabetes costs are contained by what happens in that blue space. 

The best practice is individualized diabetes care programs. The appropriate device may vary.

You Diabetes May Vary - So Will Your Care Program and Your Diabetes Stuff. 

Access matters for long-term success.

Related (and ancient) YDMV  Content: