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Getting an insulin pump – pump demo – Animas Vibe

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Animas Vibe pumpsAnimas Vibe pumps

Rung five – (un)official pump demo – Animas Vibe

We went to yesterday’s JDRF Discovery Day in Bristol not just to listen to their talks but also to meet up with lots of people from the online Twitter community for diabetes, affectionately know as the #DOC. One of them, Annie, is a huge advocate for Animas pumps in general and especially of their latest offering the ‘Vibe’ which her daughter has been using for a few months.

*Stop Press: Because Annie is such an advocate of Animas, I propose they are renamed Anniemas for the rest of this article.

What’s in a name?

(If you’re a kid reading this please skip this section.)
Vibe! Vibe!? Why on earth!
This was either a very clever marketing ploy or people in Anniemas’s* Department of Pump Naming lead very sheltered lives and need to get out more.
Amy’s 15 year old sister Emilia has already told Amy she can’t have one of these pumps due to the name and even at 12 Amy knows what it means. At lunch yesterday I got a giggle out of Emilia yesterday by telling her that Paul sat opposite had a black Vibe in his pocket.
If Amy gets one of these I’m going to have to tippex out the name on front, either that or smirk every day I see it, for four years – that’s a lot of smirking.
Dear Anniemas*, for the record please do not call your next pump The Rabbit.

First, the Anniemas* 2020

Annie’s daughter has just recently got the Anniemas Vibe pump and when you change pumps you get to keep your old one, which in this case was the Anniemas* 2020.
The 2020 is very similar to the Vibe, a little smaller in length due to the extra bits the Vibe needs to incorporate CGM (continuous glucose monitoring).
Armed with some old insulin Annie showed me how easy it is to full the pump reservoir from a Humalog 10ml vial, although to be honest I was all fingers and thumbs as this was the first time I’d tried anything like this.
Once the reservoir was filled Annie effortlessly primed the pump quicker than I could ask ‘Annie, how do you prime the pump?…oh, you’ve done it”. 🙂

The Inset II infusion set

Animas Inset II infusion sets in multiple colours

Annie passed me one of Anniemas’s infusion sets, the Inset II, which comes in three colours, this one being white. Some people say the pink ones hurt less; I think that may be a myth.
Anniemas’s* infusion sets are self contained, everything you need to do a set change is contained in the set itself: there’s no need for you to carry any set insertion device like you do for the Accu-chek Combo.
These infusion sets fit any pump whose reservoir has a Leur lock at the top, so they can be used on Anniemas*, Roche and Medtronic pumps. I found this out from another Twitter user who used to use an Anniemas* 2020, moved to a Roche Accu-chek Combo but didn’t like their infusion sets so uses Anniemas* ones instead.
Annie talked me through preparing the set for insertion. I said “you do know I’m not going to put this on myself don’t you?”. She just smiled.
Once the set was prepared I re-iterated I didn’t want to insert it on myself – now though I wish I had – so Annie took it, pulled up her sleeve and inserted it into her upper arm. She didn’t flinch. I’ve only found out since that she’d never done this before in her arm and didn’t know whether it would hurt. She says it didn’t, I’m glad.

Bolusing and calculating carbs

Bolusing on any pump is a relatively straightforward affair and the Anniemas* is no different than most. It does have an audio bolus option which is designed to allow you to bolus without looking at your pump. As Paul – who runs GBDOC web site and tweetchats – said, you press then button and it beeps allowing you to count the units, meaning that a hidden pump does not have to be accessed. Don’t be confused though, this is not a rival for the covert bolusing offered by the Accu-check Combo.
Amy and I played with the insulin-filled 2020 and within seconds she was bolusing, dripping insulin all over my fingers – the little tyke! (ha ha). We played with all the other functions and it made Amy realise that a transition to this pump wouldn’t actually be a problem.

Food list

Annie hasn’t really set this up on the new pump but the Vibe has a food list. It’s a list of up to 500 foods and their carb values and could serve a limited use, although with mobile phones these days and MyFitnessPal – other apps are available! – it’s hard to see it being used a great deal. Ironically, for a pump which is regulated in the UK (but not the US) for CGM use, the food list is not populated in models outside of the US. So UK users need to create their own food list, from scratch.
Having said all this it could come in useful as Amy is due to go to Europe on a school trip a few weeks after (hopefully) getting her pump. We could therefore pre-load a Vibe with a list of common foods indigenous to where she’s staying. This would be useful as she’ll not have an internet connection on her phone whilst there.

It’s waterproof

Yeah, yeah, it’s waterproof, it’s got an IPX8 rating just like the Accu-chek Combo has. So why then do Roche tell you to try not to get the Accu-chek Combo wet, whereas Anniemas* actively encourage an occasional dunk.
A friend Laura told me last week that a mutual #DOC friend was at the Anniemas* stand at this year’s HPC13 conference and their rep told her to dunk her Vibe in a pint glass of water and leave it there. They’re obviously pretty confident about their IPX8 rating. (IXP8 means ‘Protected against water submersion – The equipment is suitable for continual submersion in water under conditions which are identified by the manufacturer. ‘.)
For info Medtronic’s Paradigm Veo pump is rated as IPX7 (Protected against water immersion – Immersion for 30 minutes at a depth of 1 meter).

Ergonomically easier to sleep with

Paul made a very valid point (I’d not thought of) when he showed us the back of the Vibe. It’s curved. This, he said, made it much nicer to wear against a curved part of your skin. He also said that as he’s got to carry or wear his constantly for the next 4 years it makes sense to pick a pump based on weight/size/design. It’s a very valid point (yet again).

Travel in India with type 1 diabetes – insulin availability and pricing

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the Monsoon Meandering trip route
The route for our ‘Monsoon Meandering’ 4 week trip

In late July 2011, exactly 7 months after Amy was diagnosed with type 1 diabetes, we backpacked around India for four weeks, in a trip we called Monsoon Meandering.

This is post 9 in the series about that trip and its planning and how type 1 diabetes played a part.

This post is not borne from experience but from information some of my good friends in India have provided me, following questions asked via the #DOC (Twitter diabetes online community). I’d like to thank my friends Gautam, Madhu and Yogesh for their help in getting me the information for this article.

NOTE: If you’re interested in diabetes supplies other than insulin take a look at this post: buying diabetes supplies in India

Insulin availability

A quick straw poll of some UK Twitter users gave me a list of the most frequently used fast and slow acting insulins: (all sources courtesy of my friend Gautam.)
Fast-acting – Novarapid – is available, including flex pens. source
Fast-acting – Humalog – is available. source
Slow-acting – Lantus – is available. source
Slow-acting – Levemir – flex-pens are available, can’t confirm about cartridges. source

IMPORTANT UPDATE: Since posting this article last night my friend Gretchen, who is insulin dependant and travelling in India at the moment, has said that she could not find Humalog anywhere in Puri or Kolkata (Calcutta), even though getting it in those places is not meant to be a problem. Bear in mind that whilst Puri is tiny and only has a population of 200,000, Kolkata is a major city with a population of 5 million. Both are on the west coast so perhaps Humalog is not readily available there?

Insulin – example pricing

Using the sources listed under ‘Insulin availability’ above as of now – 6th January 2013 – the following prices apply. The rates are very good at the moment, I’ve seen rates 25% lower.
The current rate of exchange rates for Indian Rupees (Rs) are: £1 = Rs88, 1 Euro = Rs72, US$1 = Rs55 (source)

Speed Name Type Rupees £ Euro US$
Fast Novorapid 1 x 3ml Flexpen 555 6.31 7.71 10.09
Fast Novorapid 5 x 3ml pen cartridges 2211 25.13 30.71 40.20
Fast Novorapid 1 x 10ml vial – for pump 1450 16.48 20.14 26.36
Fast Humalog 1 x 3ml pen cartridge 408 4.64 5.67 7.42
Fast Humalog 5 x 3ml pen cartridge 2040 23.18 28.33 37.09
Fast Humalog 1 x 10ml vial – for pump* 410* 4.66 5.69 7.45
Slow Lantus (Optiset) 1 x 3ml pen cartridge 763 8.67 10.60 13.87
Slow Levemir 1 x 3ml Flexpen 988 11.23 13.72 17.96

* surely this can’t be the correct price but it’s the only one I could find; it’s more likely to be similar to the Novorapid 10ml vial of Rs1450 (£16.48, 20.14 Euro, US$26.36)

Next up – food glorious food

Travel in India with type 1 diabetes – buying diabetes supplies in India

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the Monsoon Meandering trip route
The route for our ‘Monsoon Meandering’ 4 week trip

In late July 2011, exactly 7 months after Amy was diagnosed with type 1 diabetes, we backpacked around India for four weeks, in a trip we called Monsoon Meandering.

This is post 8 in the series about that trip and its planning and how type 1 diabetes played a part.

This post is not borne from experience but from information some of my good friends in India have provided me, following questions asked via the #DOC (Twitter diabetes online community). I’d like to thank my friends Gautam, Madhu and Yogesh for their help in getting me the information for this article.
 

Do I take everything or just enough?

The answer to this will always come down to personal preference and the length of travel time. Personally, I’d rather always take enough – in fact, more than enough – supplies for the whole journey as I don’t want to spend time looking for supplies instead of enjoying the holiday. If we got the chance to travel for many months obviously things would be different.

Quick note for people from the UK: we’re very lucky in the UK to get virtually everything for free* from our superb National Health Service, so it may not be immediately apparent that many countries’ residents do not. So you will have to pay for anything you run out of, or replace after loss.
 

Can I get what I need in India?

Probably; almost certainly if you’re on multiple daily injections, as opposed to a pump. It is possible to buy supplies either off-the-shelf or via prescription from these leading brands: Novo-Nordisk, Eli Lilly, Accu-chek, BD (needles/swabs), Johnson & Johnson, Abbott, Freestyle, Bayer and Sanofi. Although these companies sell certain products please don’t rely on them selling everything you currently use. See the HealthKart links further down this post to view information about what may be available.
 

Buying without a prescription

India does have a Doctor prescription system but many things that are only available under prescription in the UK (for example) can be purchased off-the-shelf without the need for a prescription. Other things that should require a prescription can sometimes be bought without a prescription just by talking to a pharmacist who’s willing to sell it, but of course I’d not recommend trying to break the rules. 😮
It seems most things other than insulin and insulin-pens can be bought without prescription.
My friend Yogesh from Delhi told me “Most of the chemists will give you medicine without a prescription, heck half of them act as doctors as well and plenty of people just ask them what medicine to take for ailment, rather than going to the doctor.”.
 

Getting a prescription

My friend Madhu from Hyderabad sums it up well: “Not hard to get doctors prescription or medicine here in India. One way to do it is to get a letter from your GP saying what medicines one takes and more than anything to know what is the composition of the medicines. Any reputable doctor here would do a quick check and give a local prescription. Any mid size hotel here has a doctor who is their house doctor. If not one can go to the major chain hospitals like Apollo which are reputable”.
 

HealthKart.com and some example pricing

Take a look at HealthKart.com to see what types of things are available online, which should give a rough indication what is available offline too. Often online purchases in India are more expensive than in real shops and although HealthKart breaks this rule it’s not much use if you haven’t got a permanent address in India. So this is just for info only: http://www.healthkart.com/diabetes
(meters, test strips, needles and syringes).

* obviously it’s not ‘free’ as I pay my taxes to fund it but you know what I mean.

Next up – insulin availability and pricing

Travel in India with type 1 diabetes – cooling insulin with Frio wallets

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the Monsoon Meandering trip route
The route for our ‘Monsoon Meandering’ 4 week trip

In late July 2011, exactly 7 months after Amy was diagnosed with type 1 diabetes, we backpacked around India for four weeks, in a trip we called Monsoon Meandering.

This is post 6 in the series about that trip and its planning and how type 1 diabetes played a part.

The first part of it has been reproduced from the Monsoon Meandering blog article I wrote.

From my original article…

Some gadgets are purchased purely out of desire, others are desirable but serve a purpose and others are bought simply because a problem needs to be resolved. Yesterday’s purchase of Frio wallets was definitely made to solve a problem, but I like the geekiness value it has.

So what is a Frio wallet?

A Frio wallet is a small wallet with an special inner wallet which contains crystals that by using evaporative cooling will keep insulin at the correct temperature once they’ve been activated.

How do you use it?

It’s so simple: just immerse it in cold water for up to 12 minutes (first time use, depending on the wallet size you’ve purchased) and wait until the crystals have turned into a gel, at which point they swell considerably. Every two days or so you’ll need to repeat the process and you can keep doing that for up to 28 days. After 28 days of solid use just let the wallet dry out and then it’ll be ready for your next trip.
After activation the inner wallet is dried and then placed in a special outer wallet which stays dry, so can be placed in your bag, suitcase or pocket as required.

How much do they cost?

Yesterday we purchased a Large Wallet and an Extra Large Wallet for £15.50 and £19.00 respectively. We only bought two as we wish to separate the insulin / pens just in case a bag gets lost or stolen. So, £34.40 for a lot of peace of mind, that’s a small price to pay.
We bought ours from Nomad Travel Shop in Southampton who had loads in stock but people in the UK can also buy them direct from Frio UK.

Post trip analsyis

Do they work?

Yes, they do.
We found that one of our wallets worked better than the other but both dropped the temperature to stay within the safe range for insulin.
We found that they worked less well in the hotels that had air-conditioning which is not surprising as they work by evaporation. Luckily those hotels also had a fridge which we used in preference whilst in the room.
As we went in monsoon season I wonder whether the Frio wallets would be even more effective during a dry season as evaporation will occur more easily.

Which size was best

Once the water has expanded the gel walls of the wallets the space inside decreases immensely and things can be difficult to fit inside. For that reason I wish we’d bought two extra large wallets.
But we fitted a lot into each one: two Novo pens, two spare Novorapid (bolus) insulin and one glucagon kit.

Next up: flying, medical letters and adjusting basal

Travel in India with type 1 diabetes – the diabetes travel kit

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the Monsoon Meandering trip route
The route for our ‘Monsoon Meandering’ 4 week trip

In late July 2011, exactly 7 months after Amy was diagnosed with type 1 diabetes, we backpacked around India for four weeks, in a trip we called Monsoon Meandering.

This is post 5 in the series about that trip and its planning and how type 1 diabetes played a part.
The first part of it has been reproduced from the Monsoon Meandering blog article I wrote.

From my original article…

Most of the planning and preparation for this trip has been going really well but we still had one area of concern: the diabetes medical kit. Today we decided to sort that one out so we could relax a little more.

As a little background, after the last trip where we used very, very little of what we actually took we vowed that any medical kit for future trips would be small, very small. For our main medical kit this maxim will still ring true and it’s a good job because we’re taking rather a lot of medical stuff for Amy’s diabetes management.

So here it all is. Well actually it’s not all there, we’re taking double of everything you see in the picture, split across two different bags just in case one gets lost or stolen. This may seem a little over the top but there’s no way I’m risking losing a bag and being in the middle of nowhere for a few days with no Insulin immediately to hand.

Diabetes Travel Kit

Diabetes Travel Kit

Roughly in a top to bottom, left to right list here it all is: Accu-check control solution, Ketostix, Accu-check sterile lancets, Novo-pen 4mm needles, Accu-check testing strips, Novo-rapid insulin spares, Novo-rapid pen including cartridge, Levemir pen including cartridge, Glucogel, Glucagon, Accu-check blood glucose testing kit, Detro tablets, spare battery for Accu-check meter

Each bag’s worth of supplies can be broken down like this

To keep any medical supplies cold
– 1 x extra large Frio wallet

For blood/glucose level checking
– 1 x meter with multi-clix lancing device
– 34 x multiclix units, each containing 6 lancets
– 150 x Accu-check testing strips
– 1 x Accu-check control solution to test the meter if required

For the injections
– 1 x Novo-pen for Novo-rapid insulin, kept in a Frio wallet
– 1 x Novo-pen for Levemir insulin, kept in a Frio wallet
– 100 x Novo-pen 4mm needles
– 2 x spare Novo-rapid insulin cartridges, kept in a Frio wallet

For treating hypos (hypoglycaemic attacks)
– 2 x Dextro Energy packs – these are easily available in India under brand names like Glucoburst
we’ll also have other foods to hand at all times
– 1 x Glucogel, for treatment of a bad hypo*.
– 1 x Glucagon, for treatment of an extremely bad hypo*, to be kept in a Frio wallet
* luckily we’ve not yet had to use any of this

For anything else
– 25 x Ketostix, for testing for Ketosis
 

Post trip analysis of the kit

What we wouldn’t take next time Nothing! We didn’t need to use the Ketostix, the Glucogel or the Glucagon (thank God!) but you can’t leave these at home.
What would we take more of? Dextro tablets. According to my research prior to the trip dextrose tablets are available in India but we looked in Delhi, Aurangabad and Hyderabad and didn’t find any; we asked at pharmacies and couldn’t find any. We ran out – see next ‘Running out of dextrose tablets’.
 

The almost serious bag loss

Having packed everything in two bags we felt safe and confident that we’d never be without the necessary supplies, even if we lost a bag. That was until we lost them, BOTH.
At the hotel in Orchha we put all of our rucksacks – bigs ones first – into the autorickshaw. Jane and I climbed in first and rested the diabetes-supply-filled-daysacks on top of the luggage, just behind our heads. The kids got in and the driver drove away slowly as it was raining and the road was full of potholes and bumps.
He got a call on his mobile and unbelievably (for autorickshawwallahs) stopped.
Then two guys pulled up on their motorbikes, shouting at the driver in Hindi, although they didn’t seem angry.
Then we saw the bags, all dirty and wet. The guys had spotted them fall out, which happened as there was no fixed back to the autorickshaw, just a rain cover. The guys wanted no money and wouldn’t take what I offered. That’s what people in India are like, they’re just happy to help (mostly).
 

Running out of dextrose tablets

In the first couple of weeks Amy had quite a few hypos, caused because she was injecting before she ate and then deciding she didn’t like it so much. At this point we weren’t carb counting and she was taking a regular amount depending on the size of the meal. After a week or so we realised what was happening and started doing the injections afterwards.
We were running out of Dextrose tablets and we looked everywhere we could to find some, when we weren’t sightseeing. It didn’t seem like a big thing as we were going to the bigger cities of Aurangabad and Hyderabad and would surely find supplies there. We didn’t.
In Hyderabad I started getting nervous as we were soon boarding a train to Hampi (station:Hospet) and that place is really out in the middle of nowhere. I didn’t have much hope of finding any in Hampi.
We went to a pharmacy and then another and they could offer us was powder, the type used by bodybuilders, in huge containers. We didn’t buy anything.
It’s worth pointing out that in India there’s so many possible alternatives, so many things are sweets. A good example is Barfi, a sweet mostly made from milk…and sugar. It contains on average 17g of carbohydrate per piece, keeps for ages and is available absolutely everywhere.
At the time though we fixated on the need for dextrose tablets, rather than the bigger picture of needing emergency simple carbs.
I emailed our DSN in Royal Hampshire County Hospital in Winchester and got back a reply almost instantly saying “don’t panic, just get hold of some sugar cubes at a cafe or shop and use 2 cubes for any hypo” (followed by some more complex carbs of course). It was so nice to have someone tell us what to do and break our fixation.
We ran totally out of dextrose at our hotel in Hospet and explained to the waiter who just said “take these cubes, all of them”. We had enough cubes for several hypos and every now and then we did same thing and got a stash of more cubes.
We never did find any dextrose tablets.
UPDATE: My friend Gretchen, an insulin dependent diabetic, is currently on her travels and has found it impossible to find dextrose/glucose tablets too.
 
 
Next up – cooling insulin with Frio wallets