A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016
- Name: Wil
- Location: New Mexico, United States
Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).
Wednesday, July 31, 2013
Tuesday, July 30, 2013
When film ruled the world
Monday, July 29, 2013
Friday, July 26, 2013
They ain’t twins
Thursday, July 25, 2013
Oh, snap! I’m unsnapped!
Wednesday, July 24, 2013
Tuesday, July 23, 2013
Not a pump paradise
Monday, July 22, 2013
Let’s eat. NOW!
Friday, July 19, 2013
Prime time meets primetime
Thursday, July 18, 2013
Wednesday, July 17, 2013
Snapping up a Snap (and a disclaimer)
Tuesday, July 16, 2013
So WTF is a Snap?
The Snap is the new-kid-on-the-block insulin pump. It’s also a whole new kind of insulin pump. Which, I guess, means I’d better review the old kinds of insulin pumps to get everyone on the same page.
A traditional insulin pump is the world’s most expensive insulin syringe. It’s a box that holds three days’ worth of insulin and enough computing power to fly three guys to the moon and back half a dozen times. The devices cost thousands ($6-10K) and have a wide range of features that most users never use. That’s the “durable” part. Inside the pump is a short, fat, motor-driven syringe that’s filled with insulin. The syringe, often called a cartridge or reservoir, is connected to thin plastic tubing. The other end of the tubing is connected to a person with diabetes. Every three days or so, you pull out the reservoir and throw it away, along with the tubing. You then must fill a new reservoir, usually by sucking insulin out of an old-fashioned glass vial. The filled reservoir must then be inserted into the pump, new tubing attached and filled with insulin, and you are good to go for another three days.
It isn’t as bad as it sounds.
The pump has only fast acting insulin in it: Apidra, Humalog, or Novolog. The machine covers your basal insulin needs by a slow, constant, automatic drip of fast-acting insulin that can be customized throughout the day to match your body’s needs. When you eat, you tell the pump how much you are going to eat, and the pump crunches the numbers to figure out how much insulin to give you. But it’s no artificial pancreas. A pump is dumber than a stump. It’s the ultimate garbage-in, garbage-out system. If you eat more than you tell it, your blood sugar will go high. If you eat less than you tell it, the pump will over-dose you and you’ll go low.
Still, with some small effort, you can accomplish awesome diabetes control on a pump.
For the longest time, all pumps were like this. Which is to say, tubed. Then a number of years ago the “patch” pump was introduced. The tubing was eliminated, the insulin was moved from the device to a pod that stuck onto the user’s body, and the whole system was controlled with a wireless handheld. Suddenly, we had two types of pump systems to choose from.
Like anything in life, there are ups and downs to the two systems. Insulin pump tubing has an amazing ability to snag on passing doorknobs, and cats just love to wrestle with this most-important of lifelines. While both of these problems were solved with patch pumps, the patches are easily knocked off, are uncomfortably large for some users, and as worthless as a glued-shut Swiss Army knife if you accidently leave your controller on the bathroom countertop in your haste to get away for a romantic weekend at a Five Star resort. Most resorts have got you covered if you forgot your shampoo, razor, deodorant, condoms, or comb. Forget your insulin pump controller? Sorry. Your screwed.
The Snap is a traditional tubed pump, but it’s not like any tubed pump we’ve seen before. First, instead of having a reservoir that needs to be user-filled, it uses prefilled pen cartridges. Second, the electronics dock with a disposable base unit that holds the insulin and has a throwaway motor and power system.
Here are the parts:
The flat thing with the buttons on it is the controller. It’s the brains of the system and the user interface. That’s the part you keep.
The funky plastic part that looks like a miniature version of those big foam fingers fans wave at the Super Bowl is the body. It’s disposable, and holds the insulin penfill and the power supply. It also has the motor that drives the plunger that delivers the insulin. And yes, it too, is disposable. I can’t wait to dissect one of these to see what makes it tick!
And the last item is the infusion set. It’s not a standard infusion set, which means that you can’t use the closet-full of sets left over from your previous pump. But unlike some pump companies who have made proprietary infusion sets to control the market, the Snap set has some unique features that were needed to make the system work.
To put it all together and make a working pump, you slip the penfill into the body, attach the infusion set, snap the controller on, and you’re ready to rock and roll. Is it really that simple? No, of course not. And we’ll go through the whole process together soon. We’ll also talk about all of these parts and pieces in great detail before we are finished, but for now, how does all of this come together? What’s innovative here?
First, by using penfills as pre-loaded insulin reservoirs, the whole process of filling up the pump is dramatically simplified. How simplified? You’ll just have to wait until my next change and I’ll walk you through it. It also dramatically reduces the risk of air bubbles in the system.
Second, because the insulin is in a glass vial rather than in a plastic reservoir, you can carry it around with you a lot longer. Twice as long, in fact. So now, instead of complete site changes hitting you an average of every three days (by the book), you only need to change your insulin and tubing once a week or so. Of course, the body site still needs a fresh cannula every three days, but this dramatically reduces the ongoing headaches of pumping.
Third, your battery or plug days are over, o-v-e-r. The disposable body charges the pump for an insulin run—usually a week, depending on your daily dose requirements. How does that work? Each disposable body has a AAA battery sealed up inside of it that powers the motor and the attached controller. We’ll talk a lot more about this in the future, but for now, all you need to know is that if you are Snapping, your days of carrying spare batteries (or a cord and keeping one eye out for a wall plug or unused USB port on someone’s laptop) are over.
Fourth, the pump has both drop and water-invasion sensors that warn you if the pump sustains a damaging shock (like when it falls out of your underwear at 2 a.m. and smacks into the Saltio tile floor at 122 miles per hour); or sustains internal water damage from being in a bubble bath too long with a pair of identical twin super models. Hey, it could happen.
Fifth, it’s cheaper. Maybe. At least it’s cheaper to get started with. A controller sells for between $600 and $800 bucks, depending on the supplier. That’s about 10% of the cost of a traditional pump. In the long run, since the consumables are more expensive, it can actually cost you more, but depending on how your insurance is set up, it could still easily be the best deal in town.
And finally sixth—and this is getting waaaaaaaaaay ahead of ourselves—for the first fucking time ever, we can choose what method we want the pump to use to calculate our insulin on board (IOB) instead of being forced to use the method the pump company thinks is best for us. That’s just so cool that I had to mention it and I think we should all send “Thank You” cards to Asante for doing this. Mine is in the mail.
As soon as I can find a frickin’ stamp.
Tomorrow: How I snapped-up a Snap
Monday, July 15, 2013
I couldn’t have made this up if I tried: About 15 minutes before the start of the clinic all-staff meeting last month, as our crew was gathering, one of the docs was venting about her changing role in the world of medicine. “I used to actually practice medicine,” she was saying, “You know, actually make people healthier. Now my job is to click. That’s my entire job description. Just to make sure everything gets clicked in the right place and right time.” To illustrate the point, she made mouse clicking gestures with her index finger.
She was complaining about the new burdens of electronic charting. The same ones I vented about in these pages a little while back.
“Well,” said one of my coworkers, helpfully, “I read yesterday that ‘click’ and ‘snap’ are now the two most commonly used words in the English language.”
The lady doc considered this for a moment, her finger still raised in the air, then replied dryly, “I don’t know which is more depressing: My new job description, or that tidbit of information.”
I suppressed a grin behind my coffee cup.
“What does ‘snap’ mean?” asked another staffer. “I’ve never heard it used before.”
There was an embarrassed silence as my peers struggled with the best way to define what’s apparently one of the two most commonly used words in the English language.
Being the resident wordsmith, I stepped into the void. It’s urban slang for ‘Oh shit,’ I said. The New American Oxford English Dictionary according to Wil.
It was about a week later that I arranged to take a test drive of Asante Solutions, Inc.’s new Snap insulin pump. Remembering the conversation about the word ‘snap,’ I wondered what bonehead would name his company’s new insulin pump the “Oh, Shit!” pump. Must’a got his MBA from Waterloo, Trafalgar, or Agincourt U.
Of course, if we delve deeper into the linguistics of snapism, we realize that, just like “oh, shit,” snap is nothing if not flexible. It can be used with a positive or a negative connotation. Consider:
Oh, snap! I left my wallet at the nudie bar. Not that I ever have.
Oh, snap! This is good whiskey! Not that I ever drink.
And often “snap” is used when making fun of oneself, not unlike Homer Simpson’s forehead-slap and “D’Oh!”
But back to the Snap pump. This being Asante’s opening bid on the American diabetes tech market, I can’t help but wonder, will investors end up saying, “Oh, Snap! I invested in Asante!” Or will they laugh all the way to the bank? Will the device take the diabetes world by storm, like the slang word it’s named after, or will it be another Homer Simpson moment in diabetes tech history?
I’ll let you know in a month, because I’m actually snapping away right now, as I write this, and I’ll keep snapping right on for the next thirty days. Yep. Welcome to another LifeAfterDx in-depth test drive. Over the next month, I’m going to post daily snapshots of life with Snap. At the end of that time, I’ll let you know just what kind of Oh, Snap! we have on our hands.
Tomorrow: What makes a Snap a snap