Animas Vibe

In Memoriam

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Nobody really knew what to expect from her presence when she entered into this world on May 16, 2016. But she was something that had been wanted for a long time. A very long time.

From the moment she came out of the box, she was loved.

She may have been seen as a foreign object, but she quickly made herself at home. She could often be found clipped securely to the left pocket of trackpants, shorts, sleep pants and trousers.

Her first official piece of business took place over a plate of bacon and eggs in the hospital cafeteria, and it sure was an exciting moment.

She was a far more than just a material being that departed the hospital on the afternoon of May the 16th. She represented hope. A way forward. A fresh start, for the companion that she would be servicing.

There were several times over those first few months of her life where her capabilities were seriously doubted. Site failures, air bubbles, stubborn highs, weakening lows, unicorns and basketfuls of emotions were weathered.

She was a little chunky. And clunky. As she got older, her skin began to peel. She often inflicted feelings of complacency over the course of her life. She served three remarkable stints inside a drawer for a month at a time, delivering a basal rate of zero.

But there was something that could always lure her back out of hiding. She offered a great deal more convenience. Her basal coverage was far better than what her predecessors could ever offer. She was a great motivator to watch blood sugar levels more vigilantly, and learn about the gazillion things that affected them. For the majority of the time, her benefits were seen to outweigh the constant attachment.

Throughout her lifetime, she upheld a dependable reputation. While residing in Perth, she travelled to Sydney, Adelaide, twice to Melbourne and back. She weathered many coffees, cannoli, pasta nights and chocolate. She endured constant handling during daily physical activity, relied upon for temporary basal rates and frequent glances at insulin on board.

She may have been taken for granted at times, but she never complained one bit.

She departed this world at 9am on October 11, 2018, surrounded by her nearest and dearest. She would love to have been laid to rest in the company of the companion she had faithfully serviced for the last 30 months, but it was sadly not to be.

Instead she is destined for a body bag addressed to distributor AMSL Diabetes in NSW, where she will finally be laid to rest.

To my trusty Animas Vibe, my first insulin pump and the very thing that has given me back a life with type 1 diabetes.

Your legacy will live on forever.

May you forever Rest In Peace.

16.05.2016 – 11.10.2018.

Trust.

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When I first started on an insulin pump two years ago, my diabetes educator prescribed me with insets. During those initial weeks, site changes were an awfully overwhelming experience, causing several hours of anxiety following each change.

The pressure from the ‘inset’ insertion device would often trigger bruising and bleeding on my very lean body. I would spend hours watching my site and my blood sugars like a hawk, just waiting for signs of failure. I could really feel the sites ‘digging’ in as I crashed on the couch watching a movie or laid in bed at night. It wasn’t uncommon to feel stinging when I administered mealtime insulin boluses, either.

Then there was one tumultuous night where I discovered a kinked cannula hours after a site change, as I was on the verge of DKA (when all I really wanted to do was kick back and watch Serena Williams play in Wimbledon).

I’d be lying if I said I didn’t question whether insulin pumping was the best option for me.

Thanks to the help of the diabetes online community, I eventually found an infusion set that went in on an angle, and was inserted manually with my own two hands and a needle. And it’s quite honestly the very reason that I am still able to use an insulin pump with confidence today.

Although I never believed it would be possible at the time, I now realise that I very rarely have infusion sets fail on me. I can place an infusion set with ease, alternating around the left and right sides of my stomach, and go about my day without giving it a second thought.

I guess I’ve been reminded of this in recent weeks as I’ve tried to reconnect to my YpsoPump, which does not have angled sets, on several occasions (more about the YpsoPump here and here).

The 90 degree sets simply don’t agree with me.

When I spend relentless hours of my life managing diabetes, the very last thing I have time for is tending to tethering issues with the devices that I use.

My Animas Vibe gives me the option that I trust the most to infuse insulin into my body 24 hours a day, and that’s why I’m happily sticking with it for the time being (although I wouldn’t say no to a #TslimForFrank, either…)

Lack of Back-Up.

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I was in the bathroom at work when I first noticed it. A small, deep purple bruise was forming beneath the clear plastic window of my infusion site.

I was a little surprised, given that it had already weathered 24 hours worth of insulin boluses and a good night’s sleep. But I was also not surprised, given it was placed smack bam in the centre of my stomach where I have the least meat on me.

My mind wandered to the pencil case sitting on my desk, however I soon realised that the spare infusion set sitting in there belonged to my YpsoPump. Not a match for the late Animas Vibe I had replaced it with three weeks ago.

My mind wandered to the demi pen and needles that I carry around with me. However, I soon realised that there was no insulin cartridge in there because I’ve been feeling a little paranoid about insulin going bad until recently.

My mind wandered to the Chemist outside, which would probably loan me some insulin if I presented my NDSS card and promised to return with a script. However, I soon realised that it would be wasteful given all of the insulin I had in my fridge at home.

My mind wandered to the low carb chicken salad that I had packed for lunch. However, I soon realised that there were also amazing croutons in there that I had baked with the chicken juices. Not to mention that my blood sugar might also be a little high if the site was failing.

My mind wandered to the needle that was contained in my YpsoPump infusion set. However, I soon realised that there was no way that I would be able to macgyver it to reapply my failing infusion set into a fresh spot.

My mind wandered to my lunch hour, where I would probably have enough time to drive home and come back. However, I soon realised that even though I lived close enough, I could not be bothered rushing there and back and wolfing my lunch down afterwards.

My mind wandered to my Dad, who I felt super guilty for bothering, but who I also knew wouldn’t ever complain about having to deliver an infusion set to me at work.

It’s been a long time since I’ve had an infusion site fail on me well after placing it. I guess in the back of my mind I’ve been putting off updating my travel kit, telling myself it won’t happen. 

I bring my pencil case carrying all of my diabetes back ups with me almost everywhere I go. I hardly ever need to fall back on it when I’m out and about. And yet the one time I do, I don’t have the right stuff in there!

YpsoPump: The First Few Weeks (Part One)

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I’ve been staring at my chunky old Animas Vibe with its holes in the coating and an interface from the ‘90s, thinking about how I will possibly be able to while away another two years before its warranty is up. I’ve been dreaming up scenarios in my mind where new pump options would arrive on our shores and be rolled out to existing Animas customers sooner rather than later.

But I never, ever, really imagined that I would have one of these exciting new options in my hands so soon.

(This is the part where I tell you that Ypsomed Australia provided me with a YpsoPump and consumables to take home and trial. Followed by the part where I tell you that was no expectation that I would write, or even trial the pump itself. Followed by the part where I remind you that there’s a bias in place and that you should take my enthusiasm with a grain of salt).

I’ve been YpsoPumping for almost four weeks, and I am absolutely loving how sleek and light it is. When I started pumping insulin two years ago, I wanted it purely for the benefit on my blood sugars. I never thought that this sleekness was something that I could ever ask for, or want, in a pump.

It weighs eighty three grams, inclusive of a AAA alkaline battery and filled insulin cartridge. To put that into perspective, It’s about half the size of my wallet and a third of the size of my iPhone. Did I mention that it’s slimmer, too? I hardly notice it in my pocket when I’m lounging on the couch or in bed at night.

It’s also way quieter than my late Animas Vibe. I no longer hear the swish of insulin boluses being delivered. Or that little ‘tick’ every three minutes as the pump infuses basal insulin into my body.

The interface is made of up of predominantly symbols and numbers, rather than words, which definitely took some getting used to.

It also has a touch screen, which can only be switched on by pressing the button on the side of the pump. The main menu also has a three tap access code before you can go in and administer insulin.

Basal rates can be set in increments of 0.01 units per hour, which gives greater customisation than the 0.25 units on my late Animas. The biggest challenge for me is that they can only be set on the hour, rather than the half hour. So when I wake up at 6.30am, I can only set my elevated waking basal rate to run from either 5am or 6am, rather than my ideal time of 5.30am. I’ve been experimenting with some basal tweaks this week, and hopefully I’ll be able to work around this.

I’m also liking the vibrating reminders when my temporary basal rate is finished running. I tend to sleep over middle of the night alarms, but the pump has even woken me up during the night to let me know a temporary basal rate has finished running. It’s a really handy feature to have, reminding me to check my blood sugar and evaluate whether I need to run it for longer.

The biggest difference to my late Animas is that the YpsoPump does not contain a bolus calculator. That is contained in the companion mylife smartphone app. Or any other bolus calculating app, for that matter. So you would need to open your app, work out your bolus, and enter that number into your pump. The app then syncs with the pump via Bluetooth to obtain insulin data. At the launch event, we were told that the pump could eventually be controlled from the app.

I have no problem using a phone app to calculate insulin boluses. I’ve done it before when I’ve taken pump breaks. But I found it frustrating having to wait a good 15 seconds for the app to sync with my pump so that I could do a bolus calculation. I’m so used to being able to quickly glance at my insulin on board during the day before various activities. Not to mention that having my Bluetooth constantly switched on is a drain on both my pump and iPhone battery. As a result, I must say that I’ve been slacking off on bolus calculations.

I expressed to the rep last week that it would be helpful if the bolus calculator worked independently of having to sync with the pump. After suggesting that I could switch my insulin therapy settings to Multiple Daily Injections, I’ve been able to do just that. So long as I’m logging all of my bolus calculations and insulin doses in the app, I’ll be able to see my insulin on board without having to sync the pump via Bluetooth.

The pump can deliver insulin boluses in increments of 0.1 units, which is slightly less than the 0.05 my late Animas allowed. The bolus calculator automatically subtracts insulin on board from a bolus calculation, which might not always be necessary. It also lacks the flexibility to make adjustments to insulin to carb ratios or insulin sensitivity factors for things like physical activity. However, it is working a lot better for me in MDI mode.

I know just how hard a good bolus calculator is to find, and for me a diabetes app without one simply has no value. Ypsomed do appear to see the bigger picture of people who don’t use pumps and CGMs, and I’m confident that the company is working hard to make Multiple Daily Injections and glucose monitoring ‘smarter’ as well.

If you are looking for a bolus calculator, you can search for the ‘mylife app’ in your Google Play or App Store.

Come back tomorrow for part two of my review of the YpsoPump!

Updated: Find part 2 here!

Stamp Of Approval

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“You want a pump, don’t you?” Gwen asked me in the hallway outside of her office on Monday afternoon.

“The doctor’s written here in your file that you’ve made up your mind and that you want a pump. Have you picked which one you want?” 

I knew which pump I wanted. It’s not like there was a huge choice to pick from, anyhow. I guess I was just a little surprised at how quickly things were moving. I honestly thought that I would have had to justify to Gwen why I wanted the pump.

“Right, I don’t think I have any of the Animas forms left,” Gwen replied as she hurried off towards Reception to retrieve paperwork for the Animas Vibe insulin pump that I’d picked.

We sat down in her office, where I was met with a stack of paperwork. We completed the order form for the pump itself. We completed forms to be sent off to my health insurer, who would be covering the cost of my pump. We completed forms to be signed off by the endo. We completed forms to be sent off to the NDSS, in order for me to be eligible to purchase subsidised pump consumables. We talked through order forms for the consumables that I will need to purchase prior to pump day. And we completed content forms so that everybody has permission to liaise with everybody throughout this whole loooonnnnnng process.

Gwen grabbed her diary from reception, flicking through pages in search of a block of free days for pump fitting. We eventually settled on a Monday and Tuesday in mid May, where I would be hooked up and trained under the supervision of both Gwen and a representative from Animas.

Gwen has been a significant part of my diabetes journey since the day I first walked into her office nearly six years ago. She’s been the one of the few constants I’ve had among an array of rotating diabetes healthcare professionals. I felt as though I owed her an explanation as to where my decision had come from. I felt like I needed to explain to her why I was abandoning the method of injections that she had taught me to do. In some way, I felt as though I needed her stamp of approval in order to move forward with this scary new way of managing my diabetes. 

But the words were struggling to escape from my mouth. I was overwhelmed.

“You don’t need to explain it to me,” Gwen said.

“I do. I never made this decision lightly. That’s why I didn’t decide straight away back in November. But injections are a lot of work. I don’t do the same things every day. I don’t eat the same meals every day. I don’t live that regimented lifestyle that seems to produce those good results. I feel like I owe it to myself to give the pump a go. My hba1c has been fluctuating within the range of a point over these last few years, and I’m aiming for it to be more stable and at the lower end of that range.”

But no matter how many words I managed to string together that day, I realised that this wasn’t Gwen’s decision to make. It was mine. It was a decision that I made for my own diabetes, and my own life. It was a decision that I will have to own. Right now, it’s a decision I’m damn well proud of.

Gwen totally respected that this was my own choice to make, and she never once tried to sway me either way. But it was still nice to feel a stamp of approval in her final words.

“I think you’ll enjoy pumping. I think it will give you the edge that you’re looking for.”