Thursday, August 22, 2013

Met with Medtronic Rep: help me decide

Today, in the middle of the BEST sun-shower ever, we went to meet with the Medtronic insulin pump rep. She brought a bunch of demo pumps and a foam cushion covered in infusions sets.

The best parts:

I got to see and feel a lot of different infusion sets. And we talked about their various benefits and had a go at disconnecting/reconnecting them. I am quite interested in the lower-profile sets, and potentially the angled sets. The rep seemed very concerned about the amount of packaging that comes with the Mio sets, but I think that an all-in-one system is actually a very attractive prospect for a never-pumped diabetic!

She had both the Paradigm 522 and 722 demo pumps with her, plus the VEO which is the same size as the 722. Their main difference is resevoir size; I would only need the smaller size as I don't consume much insulin however the rep pointed out the insulin requirements increase dramatically during pregnancy (hello! That's what we want here!!). So I asked if, should I select the 522, could I get a 722 loaner pump during pregnancy and she said she could probably work something out for me.

Both the 522 and 722 work with the Medtronic CGM system. I do not really like the look of the Medtronic sensor or transmitter. It looks big and clunky compared to the Dexcom CGM. And it has masses of extra tape that goes with it. however, it IS rechargeable. The Dexcom rep confirmed that the Dex transmitters routinely last longer than 6 months, and even over 12 months before their battery goes flat. Humph: money.

The VEO is another kettle of fish all together. It looks just like the 722, but it offers a really advanced feature: low glucose suspend. This is where it shuts off all insulin delivery if you go too low and don't respond to the warning alarms. It's a very attractive proposition, as it would help to fix one of my primary problems: hypos. But it comes at a very high cost. The VEO is not govt funded in New Zealand. The rep said although it's not funded, if I paid $2000 then the balance would be funded. So, it's partially funded? It got confusing. Total price for this puppy? Hold your breath: $12,000.

And that doesn't include the cost of the CGM transmitter or sensors.

Ok, pick yourself up off the floor.

Back to the core decision. Should I get the Animas Vibe pump, or one of the Medtronic pumps?

Here are the main points as I see them:

Animas Vibe / Dexcom

  • This is the pump I have been looking at getting for the longest time.
  • It has combined pump and CGM.
  • It uses Dexcom CGM which is the most accurate available in NZ at present. Animas and Dexcom are currently involved in The Artificial Pancreas Project.
  • Waterproof.
  • Larger, colour screen.
  • Offers smallest increments for insulin delivery. I need this.
  • Insulin pump (including CGM receiver) fully funded.
  • Dexcom transmitter (approx $1000) and sensors (approx $125 each) are not funded.
  • Dexcom sensors last up to 7 days.
  • Fancy bolus, fancy basals yada yada yada...
Medtronic 522
  • Combined pump and CGM.
  • Uses the Medtronic (Enlite?) CGM, which is not as accurate as the Dexcom based on the research I have done. The brochure the rep gave me doesn't even state accuracy!
  • Pump is funded.
  • As with Dexcom, the Enlite CGM transmitter and sensors are not funded. The rep did not have a price-list with her and is yet to send these to me.
  • Sensors last up to 6 days.
  • Fancy bolus, fancy basals etc.
  • Quite easy to navigate menus.
  • Small grey screen.
  • Has a back button.
Medtronic 722
  • As per the 522, but has a larger reservoir which could come in mighty handy during a pregnancy.
  • I am not considering this pump, rather if I went with the 522, I would ask for a 722 loaner during pregnancy.
Medtronic VEO
  • As with the 722, but offers additional software that works with the CGM system. This Low Glucose Suspend stops insulin delivery when blood sugar drops and the diabetic doesn't respond to alarms. It has other specialised alerts as well, but the rep didn't explain those very well. She also didn't have a VEO brochure even though she knew I was interested in it. Overall it's a very attractive idea... having hypos prevented for me. Hell, I've had two hypos since going to this damn appointment.
  • But it is very expensive and is not fully funded. I'm not even sure it's funded at all, since it doesn't appear on the Pharmac schedule. From the way the rep was talking it would seem that Pharmac is paying funding for a 722 and then the patient is actually getting the VEO. How that works through the machinery of Pharmac funding is beyond me.
  • Still have to stump up the pennies for the CGM bits'n'bobs. Wow. This is sounding like it's getting to pricey.
That's all I can think if now. I am quite tired (big field trip with the students today, plus visit to the rep, plus went low twice, plus all the grocery and petrol shopping, plus cooked dinner!) and need a nap.

If you have advice or feedback on making this choice, chuck me a note in the comments :)

p.s. I got the results of my HbA1c back = 41 mmol/L = 5.9% = !!!!! This is the first time it's every been under 6% and I wasn't even trying to accomplish that! I was trying to make it go UP!

Monday, August 12, 2013

Animas rep visit - insulin pump

A couple of bits of news:

  • met with the rep from Animas today and looked at the Animas Vibe insulin pump and the Dexcom CGM system.
  • an update on where we're at with the IVF: hooray! We have been able to switch to another doctor!

So, the exciting news first: I got to hold my first insulin pump today. Sounds silly I know, but I have seen so many pictures and heard so many people talking about them online that to actually get to hold and play with one was a big thing for me. It made it more real.

The rep was really helpful and met with my and Hubby just over lunchtime. She asked me how much I knew about basal and bolus insulin, just to get to know the level of my knowledge. Then, in the hospital cafeteria (I know! I would have preferred somewhere a little more private too!) she opened her kit of demo pumps and showed me how they work.

Since I am VERY interested in getting the CGM (continuous glucose monitor) too, I asked to see those as well. The Dexcom system looks great and I am very keen to try it out. In fact, I was offered a one-month trial to see if I like it. Just have to buy a box of four sensors ($125 p/sensor) and they lend me the transmitter and receiver. I want to do this and see if I like the Dexcom receiver enough to buy the standalone unit too.

The Animas Vibe insulin pump itself looks like a good option with many features that I like. It's waterproof, has small dosing increments, and a high-contrast colour screen. The screen is clear but it's not always immediately intuitive so I think that would just take some practice to get used to. The Vibe pump acts as the receiver to the Dexcom system, although it has slightly older algorithms compared to the Dexcom receiver.

Unfortunately, nothing about the Dexcom is funded, although the Animas rep suggested that "they" (govt, I presume) are looking at funding them in the future for a select group. When I asked if that select group was likely to be people already using the Dexcom CGM, she replied yes. So that is something positive to look forward to. The receiver and transmitter each cost just shy of NZ $1000 each, plus the monthly running cost for full time wear of about $500. Whew. Not cheap, but don't have to wear it all the time. At one sensor lasting 7 days, that's $17.90 per day. Ridiculously expensive, anyway you look at it. But I figure I want to have access to this level of sophisticated technology to better my health in the lead up to IVF.

My Diabetes Nurse Educator (DNE) stopped by and said she wants me to meet with the Medtronic rep also, which I think is a good idea before committing to something so major. I think that is next Monday???

I asked my DNE how long it would take before a prescription could be written for my pump, and even though I have an appointment to see my Endo towards the end of this month she said I shouldn't have to wait that long since I already have approval for funding. She is just interested to get a couple of people into pump training (2 x half days) at the same time for efficiency's sake. Fair enough. But so much waiting. I wanted to sign up for a dexcom trial right away! lol.

The IVF stuff. Right so we got a letter saying we have a Pre-IVF appointment and we needed to confirm said appointment. It didn't really say anything about what would be covered or even who it was with. So I rang them up and said, can I change it from a Wednesday to a Friday? Yes. What is it about and can we do it via Skype? No, there may be a ultrasound scan involved, and you will be doing the plan for IVF. Can we switch doctors? Umm, can I call you back?

We wanted to switch from Dr R (who has been nothing but bad news, I'm sure she's a nice person but treatment-wise, not my favourite person. I just don't have faith in her) to Dr S (who performed the successful sperm retrieval without Hubby feeling any dramatic emergency-room level pain!!!). The receptionist wanted to know why. I just said that we had had several poor experiences with Dr R, and a very good experience with Dr S. She said that Dr S was on leave at the time we needed out appointment, and the next one for him was about a whole month later.

She called back again, after working her magic where she had managed to scored us a Friday appointment with Dr S the week we needed it! Wahoo! I was just so happy!

So gotta go and have the spiel again from anther doctor, and I hope this transition will be permanent. Dr S gives us both a feeling of confidence and control that we weren't getting from Dr R.

Good things happening :)

Saturday, August 3, 2013

Pump application....

... Approved!

I have just received my letters from Pharmac saying my application for Special Authority for an insulin pump and consumables has been approved.

Now I need to talk with my doctor about choosing a pump (although I'm pretty sure of which one I want, as there is a choice between the Vibe and Medtronic) and doing pump training. He will also write me the prescription for the actual hardware which I have 3 months to get filled.

The application for the consumables will have to be reassessed in 9 months: if the pump is not doing good things for me by then, the consumables-funding may be withdrawn.

So, exciting times. I am about to join the cyborg club.

Also I'm really interested in getting a CGM (self funded) and if I choose the vibe then the dexcom system works with that. Can't wait to try that out.

At the same time that Pharmac took over funding the pumps in New Zealand, they also chose to change (ruin?) the funding for blood glucose meters.

New Zealand diabetics now only have 3 of the Caresens brand meters to choose from. 3 meters across the whole country! Anyway my Caresens N-Pop has been inconsistently missing hypos and giving me erratic readings.

I have been to visit the local opposition MP just yesterday and he suggested raising the issue of the poor-quality Caresens meters to the Health Select Committee.

We'll see. I don't expect anything dramatic to happen in a hurry, but all Pharmac needs to do to resolve the situation is to allow all Type 1 and insulin-dependent diabetics access to other meters via Special Authority. They are already doing this for some diabetics which is not fair as it creates a dual standard of care.
I know that in the US (and UK?) there is a campaign called Strip Safely aimed at bringing awareness to the issue of inaccurate test strips.

The ISO standards committee has just released a new standard for accuracy too, lowering the tolerance from 20% +/- down to 15% +/-. It would be excellent to get test strips more accurate, as an insulin pump in not going to work to full effect with just estimations of my blood sugar.

Anyway that's all for now. Oh wait! No its not! We've got an appointment for our "Pre-IVF" meeting back up in Hamildog. I suspect it won't be that much different to the previous 2 meetings, so I'm going to call the clinic and find out what it's about before booking travel and accommodation. I mean, it might be something we can do via Skype instead and save about $400!