Wednesday, November 20, 2013

First Impressions: Asante Snap review

I am currently trying the Asante Snap insulin pump for 4 weeks. (This is going to be a thorough first look, folks. Go potty now.)

Watching their ads, I'd shrugged off their emphasis on how quick the pump is to change and prime in much the same way that I shrugged off Omnipod's "we've got no tubes!" angle. Big whoop. Having worn Omnipod off and on for 5 years, I find tubelessness to be a pleasant feature, but it's not life-altering. What else ya got?, I often ask the companies who tout a single major design innovation.

But Asante may actually be on to something. As I close out my first week on Snap, I am finding that my favorite thing about Snap is how little I have had to mess with it. I'm on Day 6.
  • No cartridge change (I finish up my 300 units today around dinner time)
  • No tubing change
  • No priming
  • No battery to mess with changing or charging (the controller charges its small backup battery off your disposable pump body battery)
Just a site change so far.

The prefilled 3 mL pen-style cartridge? I got an Rx and a box from my local pharmacy with 5 cartridges. That's about 30 days for me. I'm still on my first one. I haven't touched it. Same pump body (what the cartridge slides into). Because the insulin is not compromised by plastic cartridge or bag chemicals as it can be in other pumps, it sits happily in its original glass vial/cartridge, tucked safely away (I can see it through the viewing window - been missing visibility since switching to tslim and Omnipod), and I don't even have to change my TUBING until the cartridge is empty. Fresh insulin is coming through the tube straight from the sterile vial. (Snap's pump body is currently specifically designed for Humalog cartridges, but Novolog is coming next, they say - it will take designing an alternate pump body due to cartridge length and diameter. So, if you're a Novolog user, you'd order the pump bodies specific to Novolog cartridges.)

Breakdown of the components (3min):

But back to how much they've cut out... I changed my site on my third day. That's it. Just the site on my skin without the tube. That's all I've done. It's still ticking away on day 6. I'll use the last of my 300(+)u cartridge today and change to a fresh pump body/cartridge/tube today.
Snap weighs less than these, but is longer.
Also, I have a ridiculous number of insulin pumps.
I had a really engaging visit to their office and talked at length about what I love and hate about the many pumps I've been fortunate enough to have the opportunity to try.
from left to right: Omnipod UST400, Cozmo 1800, Snap, t:slim
Ken El-Sherif, their VP of marketing, explained Asante's philosophy to me about their wanting to help patients think less about their pumps. I met with Mark Estes, Chief Product Architect, who answered many of my concerns specifically. Who better to ask about design features than the chief designer?

What I loved about the tslim is the carb calculator that totals the carbs as you enter different foods, I'd say. We've got that, said Mark.

Video of me programming a bolus (~2min) while using the carb calc feature:

What I loved about the Cozmo was that it would keep track of missed insulin if I told it I was disconnecting, I said. Snap does that, he showed me. (It doesn't yet prompt you to ask whether you would like to take it. I look forward to future iterations perhaps populating the prompt with the missed basal value and asking if I'd like to take it and then not counting it against my IOB. For now though, it's enough that it tells me I missed 0.3u in the 19 minute shower I took. I likes keeping up with my basal, people.)

I also love that the folks at Asante have developed a relatively simple occlusion detection system where the tubing meets the cartridge rather than relying on back pressure at the infusion site like a traditional pump. Anyone who has had as many occlusions as I have (again, thinking of tslim and Omnipod) can appreciate detection earlier in the delivery process. This is a huge selling point for me. I want to know that the pump detects that it can't deliver insulin - not that it may or may not have partially delivered what I asked it to before it realized something was amiss.

An interesting feature for those moving to Snap from other pumps is that Snap calculates your IOB however you and your healthcare team prefer. Do you like the Minimed/old Omnipod model for IOB where only correction insulin is considered? Done. Prefer the Animas/Cozmo/Tandem/new Omnipod way of including your mealtime insulin? Done. It's in the pump settings.

In many ways, the menus feel Medtronic-esque. As I haven't been on an MDT pump in 6 years, I find myself thinking, where would ___ be on a Paradigm? And there it is. I had been enjoying more screen since leaving Medtronic for Cozmo/Omnipod/Tslim, but Snap uses their small screen efficiently. It's clear to read, low resolution (my husband explains to me that this saves their device a ton in battery), and I can read it fine in broad daylight. Still, the low res screen is NOT sexy. And the colors of the controller (currently dark blue, black, or a light red) don't excite me either. I'm told some brighter colors are coming our way (green, magenta, etc). I've done a decade on black pumps. Give me something that will whistle back at my pink Dexcom.
Hey girl, did your standard deviation fall from heaven or do you just have great control?
Speaking of playing nicely with integration, it's in the future, as with all their competitors. The graph screen that is currently kind of useless - overwhelming with symbology and axis information that I'm likely never to access - is a great placeholder for integrated CGM data. On the software side, they are first focusing on programs that clinicians will use to upload data in an office setting - programs like Diasend. I'm hoping that they make good on their talk of interoperability so that patients can find software that will provide useful data and, more importantly, be user friendly.
Graph teeth?
The pump is indeed feature rich in terms of operations and doesn't lack any smart pump features that I can think of beyond perhaps bolus/temp basal presets. It's also operable, however, for people who might want much less in a pump. Since you can choose to have the shortcut key function operate EITHER an audio bolus or prompt your "smart bolus" (bolus wizard), it seems designed for either the crazy calculators like myself or the set-dose brand-new-to-pump crowd. You can choose to bypass smart bolus (bolus wizard/calculator) capabilities and just do a "now bolus," too. But I was able to easily run a combo bolus for my correction plus BBQ burger and fatty onion rings (over a 3 hour period) the other night and also still layer a now bolus during its run to accommodate something else I ate. I think the hardest part for me so far is remembering each company's fancy term for their boluses (now/timed/combo vs standard/square/dual wave vs...).

I've grown accustomed in the last year to having my IOB in my face. Tslim and Omnipod both show you IOB on your startup screen as soon as you wake the pump and respond to the key sequence or confirmation screen, respectively. I'd like to see Snap's IOB more obvious. I have to wake the pump from blank screen (just like with other pumps) but then click status and then click one more screen (screen 2 pictured below) to see my IOB. If they could cut that by a button press or two, I'd be happy.
Taking you through the status screens.
Since I have been trying to log my data more (using MySugr), I find myself using the logbook screens often as I go back and add my recent temp basal or boluses to my app. The logbook doesn't currently remember your position if it times out. I'm hoping they can extend the timeout screen for this feature. I'm a slow data entry monkey. A data entry...panda.

Temp basaling is easy. No, it doesn't have presets (also no bolus or carb presets). It uses a positive percentage method for temp basal and calculates and presents what the rate is actually changed to. If I go in knowing that I want to run approximately 30% of my .95u/hr basal, I can make changes down to .05u, so it allows me to choose values like 37% (.35u) or 32% (.30u) or 26% (.25u). On my status screen, I can see time remaining. To cancel the temp basal, I go back into the basal menu. (I keep wanting to find it in the stop menu.)

I really like the alerts that Snap offers. My favorite is that, if you turn on BG prompt in your setup, it will ask you if you'd like to be prompted to check BG in the time you chose when setting up the device. Unlike what I remember with Minimed or Cozmo, it won't just automatically remind you at the ___ hours past bolus mark every single time you bolus. If I'm correcting a fasting in the morning and plan to bolus for my breakfast about an hour later, I don't need a prompt for three hours from now. At lunch however, a reminder to check in post-meal during that long stretch of afternoon is handy. So I can just click yes or no when it asks if I'd like a reminder. Too annoying? You can turn the feature off entirely.

Key beep volume is adjustable, alert tones are pleasant and designed to be heard in a range of frequencies. Innovation alert: The pump will actually alert you if it detects that it has suffered damage from a drop, from water seeping into the housing, or if the controller and pump body are separated. Also, expect a persistent (and growing in volume) alarm if the cartridge is empty.

And if you need a replacement controller (the non disposable portion), you can save an old pump body and instantly program your new controller with ALL of your settings just by - yeah, you guessed it - "snapping" it on.
Snapped and Unsnapped.
Waterproof? Always a big question. It's accidental dunk proof, but not recommended for submersion. With my tslim, I never felt comfortable taking it in the water. Cozmo, I've showered with, but honestly, it's my personal preference to disconnect. I lost a pod in the ocean in the Bahamas on our cruise in October and remembered why it's nice to have my pump tucked safely away in a beach bag or cooler.

Bren Kern, Asante's Director of Manufacturing, gave me a tour of the rooms with the gadgetry where people smarter than I put the devices through extreme conditions and make adjustments. I saw their production lines, their post-production testing area, and from a distance, their sterile areas for assembling their infusion sets (6 or 9mm cannula, short or long length tubing, angled or straight insertion options). I'm a 9mm, short tube, straight set girl. (And I like my coffee with Splenda and cream.) They make all the parts in house and ship through their distributors.

Oh, and it has a flashlight on it! Its purpose is to illuminate the infusion set to see that the pump indeed primed itself in the time it takes to screw on the cap. But it's also good for finding lost toys under my nightstand.

As you can see by now, I will try any pump. And I will try to find what I don't like about it. So far, what I dislike the most about Snap is that there is no quick way to put the pump back into its offscreen/sleep/blank screen position. If I've followed a menu series down a rabbit hole, I might have to click exit, exit, exit, exit to turn off the screen to slip it back in my pocket/the leather case/the belt holster.
Leather Holster vs Pump Clip - both w/ vertical/horizontal options
That reminded me of Medtronic - Act and Esc. While the tslim frequently put itself to sleep even when I didn't perform the double tap that turned off the screen (way too sensitive, I pressed once, I swear!), and Omnipod's power button is buried under 12 feet of plastic (why you be so hard to press, Omnipod?), I do love the buttons on this device. Punchy and plastic like my microwave display panel. A little like Verio IQ. Responsive. And re-assigned according to the on-screen menus like the Omnipod where they have different functions depending on where you are. The left and right buttons either scroll you through menus or +/- your BG/carb/dose values as necessary. The three horizontal buttons usually offer some kind of Act/Esc yes/no select/back binary option unless the far left button is needed for a third feature. They don't have the hardness of Cozmo buttons or the great rubber buttons of the Animas, but they scroll quickly, stop on a dime, and feel good. (I think about buttons a lot. Do you know how many freaking buttons I press in a day?)
Snap and the One Touch Verio IQ
What I like best may very well be the ease of changing that I poopooed. Break out the pump body, snap a cartridge in, screw on the cap, and boom, your pump is already primed. No fill needles, no cartridges, no priming.

Cartridge change procedure explained (42sec):

Low profile packaging (unlike Tandem and Medtronic) means less to carry, too. And a tiny glass vial that I can easily draw from with a syringe in an emergency? Again, awesome.
All you'd carry with you would be a spare cartridge,
spare set, & spare pump body (clockwise at 12, 1, and 2).
I'm going to enjoy finishing out my trial of this device (probably 24 days all told with my insulin usage). I think this company is doing some innovative things with design and certainly breaking me out of my paradigms (pun intended) about pumping with asking me to do so little to keep it up and running. They also don't want to make customers wait for their newest/latest/greatest. If they improve the pump controller (the only non-disposable part) or update the software or offer a bold new color, it's $99 to get whatever the new version is. (That's a philosophy that ought to please still-angry Podders.) It's also a very low startup cost with higher supply refill costs, much like Omnipod.

I plan to subject Snap to Thanksgiving dinner on Thursday. Oh the boluses. I bet that 300u cartridge of Humalog runs out sooner next week than it did this. :)

If you're interested in doing a trial like I'm doing, it's as simple as going onto their website and filling out a trial request.


  1. great breakdown of the Snap. honestly I hadn't heard of it until someone recently told me you were testing it out. It sounds very intriguing. DD is about to get a TSlim. She has used a Ping mostly since diagnosed although the last 5 months she has been in a study using another pump and CGM. She will be glad to go back to Animas while waiting for her TSlim. I would bet if the Snap was available now for her she would have considered it. She is excited about the sexiness of the TSlim but the ease of use with Snap really does sound cool. Although Im curious how well it would work for kids who don't come close to using 300u in 3 days. I mean if the insulin remains in the glass cartridge is should be fine for up to the 30 days that it would be good for on the counter - right? Except I wonder about body temperature. My littles only uses about 30u a day (holidays and such not included). Thus a 300 Units would last him roughly 10 days. My daughter would be at about 7 days. Would the insulin stay good for 10 days with the increased temp of being on the body? curious.
    Thanks for the very thorough post.

  2. this sounds awesome! i love that its sexiness is not in its appearance, but in its personality.

    once it gets to know her, i bet it will whistle back at your pink dexcom.


  3. Great review. For the past mont I have been looking to replace my 6 yr. old Cozmo, which I think is a great pump. I tried the t:slim, but after two weeks I am sending it back. I could live with everything but the fact that the screen is so darn hard to see. Small fonts, and impossible for me to see in bright sunlight, and very hard to see in shade. Having had PDR treated with lasers back in the '80s, and just recently cataract surgery, I believe Tandem failed to take into account diabetics with eye complications. Then there is an annoyance factor of pressing so many confirmation buttons....even if mandated by FDA they should realize how tedious this becomes.

    I will be trying the snap. I see that you found the screen to be bright and easy to read outdoors. I hope you can post a picture of the pump screen in sunlight. I hope you can post the rest of your review soon.

    And again, thanks for the great review.


  4. Thanks for your great reviews! I've been using Minimed Paradigm 522 for over 5 years now. Now is the time to try some new models out there. I'm meeting a rep next week and starting their 30 day trial in January. I'm also looking into T-slim and Omnipod. My main concern is that I'm only using about 20-22 units of insulin a day, which would leave me with way too much leftover after their approved 7 days period. I wonder if you could use it longer safely despite of their approval, or reuse the insulin somehow...I'll try to test it out, I guess;-)