Happy Snappy

After a 30-day trial and a talk with my endocrinologist, I've decided to start pumping officially with the Asante Snap insulin pump.

I'm frequently asked how I have the opportunity to try so many insulin pumps. The answers, briefly, are (1) having an endo who trusts me enough to allow me to experiment, (2) having a husband who will financially support and encourage an "early adopter" mentality, and (3) paying for some of it out-of-pocket so as not to tempt fate with my insurance company.

In this particular case, Asante actually approached me about their 30-day trial in mid-2013 and I had the opportunity to start the trial in November. Because they were soliciting my feedback, they also offered to let me keep the controller portion of the product if I wanted to start using their system. What worked to my benefit was that my insurance covers the monthly supplies and that my endocrinologist was happy to write me the prescriptions I needed. I am Asante's first customer in Texas.

Somewhat related to my decision was that I am being forced onto Humalog in 2014 by Express Scripts International (my insurance plan's Pharmacy Benefit Manager) and Snap is currently Humalog-only (with plans to design a Novolog version), so this was something I felt I could move forward with.

I always have anxiety about switching to a new pump. What if I don't like it? Asante is so confident about their product that they will let you try it for 4 weeks. That really piqued my interest. I tried it and I liked it. And the startup price is so low that, even if they hadn't offered to let me keep a controller, I would have been able to manage the low out-of-pocket costs to switch to the device.

I don't have much more to report about the device than what I reported in my initial review after my first week on it. I felt the same at the end of my trial as then. I really appreciate how little I have to think about the pump itself.

I will echo what Kim said about Snap's lackluster accessories. Much like the Dexcom G4 leather belt holster, I am certain they were designed by and for men. I don't like the options for a case or clip that Snap came with, but I don't usually like belt clips or leather holsters on my pumps (or my phone either). Maybe it's because I don't wear a belt and I often have a kid on my hip that knock those things off.

I prefer drop clip cases that hang from a beltloop and stay out of my way - like the Clip n Go that I used with my Cozmo and the Tallygear G4 case I use for my Dexcom. Fortunately, however, the Tallygear Dexcom case (of which I own three) is perfect for the Snap and I'm loving that I can see the full pump face and control all the buttons without fishing it out (though I do have to remove it to use the handy flashlight). The pump is visible, accessible, yet protected.

I love how quickly I can change out my site and that I don't have to change the tubing unless I'm changing the whole pump body. I just change the site every three days.

And on Day 6, I can change the insulin cartridge and pump body and tubing in under 2 minutes and did it in the dark the other night when I got the low insulin alert before bed.

I love how little I have to carry around with me. I'm carrying a tiny purse that holds my wallet, phone, keys, glucose tabs, meter/strips/lancet, syringe, 3mL pre-filled cartridge, slim pump body, and site. I love tiny purses and women with diabetes never get to carry them! (I was the only 5th grader in my class with an old lady handbag.) And now I have an itty bitty zippered barrel bag.

I don't love being back on Humalog. I'm not going to lie. My highs do seem to drag on for longer. It's not as peppy as Apidra, but it's a battle I was willing to fight only so hard (more on that later). If I'm going to be on an insulin I'm not thrilled about though, I love that I get to use these awesome little 3mL vials and I don't have to worry about compromised insulin or air bubbles and that I get the whole 300+ units from it. I can continue pumping on Snap down to the very final .05u of the vial.

I do like Omnipod still, but it's just never going to be my favorite pump. Its idiosyncrasies are often maddening. I didn't ever experience the frequent pod errors people complain about - on the old or the new versions of the systems, but my occlusion rate was always very high. Maybe once a week. And pods would fall off. Occupational hazard of having little feet climbing all over me, I guess. And the PDM was so often still in my purse or on the kitchen counter when I'd be in bed with a sleeping toddler on my arm and want to bolus. I do like wearing the controls on my person. That's probably the best testimonial for a tubed device. I want it right there with me.

I am optimistic about Snap. I think Asante is a confident and capable new challenger to the existing pump market and I love how responsive they've been to me. I am 10 days in with my new RED controller (thank you for allowing me to exchange for the color I wanted, Asante) and, knock on wood, I'm problem-free.

Well...at least as far as my insulin pump is concerned.

Strip Safely

If you or someone you love has diabetes, I want to shock you for a second.

If you don't have diabetes, I want to put this shock into perspective.

Blood sugar meters are all crap. See these numbers?

They're all essentially wrong. My plasma glucose was 104.

And they're mostly within FDA's acceptable variance range. The one on the far left was -22% off, but the other four performed within the +/-20% allowance.

Meter companies and the FDA worked together to set these (arguably loose) standards. And they're thankfully petitioning for tighter standards (+/-15%) in line with international recommendations. The PROBLEM is:

1) More than 25% of blood glucose meters already fail to meet current standards.

2) There is no post-market regulation of these meters or their strips. Once released into the wild, subject to weather or age or drug interactions or, I don't know, Tuesdays, there's no one checking to see if they continue to meet standards.

3) New Medicare laws will bring low-cost, low-quality meters and strips to millions of people with diabetes. Without a regulatory process in place, people will get hurt.

4) I take a different amount of insulin depending on that number. Not enough insulin can kill me. Too much insulin can kill me. I play Russian Roulette every time I take my dosage. In the above example, I was about to drive a car. On a highway. I had to make a decision about taking insulin for the 124 or eating a snack for the 82 before I got behind the wheel. It's the kind of decision I make 6-8 times per day and I'm usually basing it on that number.

So what can we do? Join me in writing to our lawmakers. Join us. Please. Below is my letter.

Tripping on Strips

We, The Undersigned - Tuesday 5/14 Link List

Today's Prompt: Recently various petitions have been circulating the Diabetes Online Community, so today let’s pretend to write our own. Tell us who you would write the petition to – a person, an organization, even an object (animate or inanimate) - get creative!! What are you trying to change and what have you experienced that makes you want this change? (Thanks to Briley of inDpendence for this topic suggestion.)

Unrelated announcement: Today marks my 200th post at Sweetly Voiced!

I have some serious things I'd petition to change, but I'm almost tired of hearing myself complain about them (like meter accuracy and, I don't know, METER ACCURACY).

So instead, I'm going to take a lighthearted turn.

I'm petitioning test strips.

Clean yourselves up!

Seriously, I find you in my washing machine, my food, my car, my purse, my garage, my fridge. Affixing yourself to my baby's diaper. Stubbornly stuck to the bottom of every waste can.

Not just my own strips either. I see your friends. I see them in parking lots outside restaurants. Hanging around like the little hoodlums you are. Lounging in public restrooms. Under tables.

You're like little bugs, scurrying from the light.

Except, you know, you can't move.

Stop making excuses. Throw yourselves away.

In a More Making Sense Kind of Way

My first official "vlog" and, of course, it's while suffering from low blood sugar symptoms. Brace yourselves for a ramble.

What I meant to say was that I knew that there would be a period of transition as I switch from a meter that's significantly lower than my actual blood sugar to one that reads slightly higher. What my body has adjusted to as "normal" now has to shift by 30-60 mg/dL.

Imagine being asked to move 10% more quickly for an entire day. Or drive 20 mph slower on every road. It's just off enough that your whole sense of reality is challenged.

As I mentioned in an earlier post, I wasn't sure what I wanted to do, but I am a woman of action and needed to do something. So I asked for an Rx for One Touch Verio IQ strips and have been trying to just acclimate to its readings. For high numbers, it has meant a touch more insulin. That's not too big a deal. For numbers between 70-100 on the meter though, I am feeling low blood sugar symptoms that I shouldn't be feeling in that lovely non-diabetic range. My old meter would have clocked them as lows.

On days like today, alone with my children, I choose to cut myself a little slack. Symptomatic? Overtreat and accept consequences. It doesn't help me get to where I need to be...but it helps me get through where I am today.

Meter, Meter, Pump, and Meter

Meter, meter, pump, and meter,

Too much data would defeat her.

Threw up her hands, said what the hell?

And there she left it very well.

Sometimes you realize why they always say, "Just pick a meter and stick with it."

I have been using Abbott Freestyle products since they were Therasense Freestyle products - 8 years? 9 maybe? They have a tiny blood sampling size, they have a light on the test strip port. They changed their meters to Lite meters - I kept mine. I have 3 or 4 Freestyle Flashes. I championed their continuous glucose monitor; then they bought it back from me. They changed their strips; I stayed loyal. I used the Cozmo Cozmonitor (a Freestyle meter), then the Omnipod PDM (a Freestyle meter).

But I had to go and stir the pot.

I'm planning to switch to the Tandem t:slim this fall and I heard that it will be shipping out with Lifescan's new One Touch Verio IQ meter. I can't stop hearing about this meter. I know the background music for their commercials (it plays during every commercial break for Dora and the Bubble Guppies - because my two year old should be asking "What does your blood sugar meter tell you?"). Several of my bloggy friends are liking it.

Okay, I'll start using the Verio then. Big whoop.

So I checked my blood sugar on it for the first time when I was having hypoglycemic symptoms. The number came back over 30 mg/dL higher than my Freestyle Flash and Omnipod PDM. That's weird, I thought. Tried it again. Same.

Tried it while stable. Same. Tried it while high. Same. Every check was between 30-60 mg/dL higher than the Freestyle readings. I called One Touch. They promptly sent me a new meter. Same.

So what's going on here? Will I go ahead and switch to this meter?

I decided I'd test all the meters I have against the blood draw my endocrinologist would be sending off to the lab at my quarterly checkup...just to satisfy my curiosity.

Now, there's some discrepancy between plasma values and fingerstick values. And the BIG (and I do mean BIG) issue is that FDA allows a meter to be +/- 20% off from the plasma value. You can blame FDA, but FDA says that meter companies are not asking them for tighter. There are groups lobbying for +/- 15%. I'd like to see +/- 10% personally, but anyway...

My point is that I'm no quality control expert and I wasn't conducting an error-free experiment. I just wanted to see.

I loaded up five meters with test strips. I washed my hands. I pricked my finger and got one big drop of blood and began to disperse the blood across all five strips.

Myabetic Memento

This post is a review for a product from Myabetic.com. (I have no affiliation with the company and this review was not solicited.)

I wanted a meter case that could also hold my wallet, phone, and continuous monitor. Myabetic is one of many companies that offer discounts to TuDiabetes members, so I checked their site and fell in love with their Memento case.

And Customer Service resolved my issue within 24 hours of my call and is sending the missing piece to me, so they get an A+ for that as well.