Making a choice – by Andy Broomhead

andy-thumbnailMy warranty is up and it’s time for an upgrade! I’m not talking about my mobile (though that can’t come soon enough) – it’ll shortly be time for a new pump!

Regular viewers may recall my current pump was bestowed on me as part of a two year clinical trial (you can read the before, after and further after on my own blog), and I was subsequently allowed to keep hold of it as I’d seen a lot of benefits from using it. As it was part of the trial, I’d not selected a particular make or model (but I’ve been very happy with what I’ve had).

I was chatting to my Diabetes Specialist Nurse (DSN) about how it really doesn’t seem like nearly four years have passed since I started on this particular party of my Type 1 journey. In some ways it feels longer – I can’t really remember being without it now. In other ways it seems like only last week I was getting instructions on how to change reservoirs and cannulas.

I’d assumed I’d just get offered the upgraded version of my current pump (which is a Medtronic Paradigm Veo) – it hadn’t occurred to me that there’d be choice, though obviously that’s no bad thing – informed patient choice should be at the heart of things like this. So we talked about what’s out there and I went away to investigate.

Twitter views

I started with Twitter. The only people I know nearby that have (or had) pumps were all through my trial so none of us had any experience of anything else, but I knew that people on Twitter had a wide range of experience with different makes and models, and would be able to give me a more balanced appraisal of these devices than any online sales pitch. So I posed the question… “What are the pros/cons of the Medtronic 640G, Animas Vibe, and Cellnovo pumps?”

The first reply I got was the one that ultimately shaped my decision… “It depends – what are you looking for out of a pump?”

As I said at the start, I’d not really considered I’d get a choice, and as such, I’d not really thought about what I wanted. What was new out there that my current device couldn’t cope with? What was most important to me having to live with this 24/7? What was I prepared to compromise on? To the internet I went – product pages open for the three pumps I was putting under the microscope. I watched videos, read product descriptions, downloaded brochures, considered things I might have to self-fund.

At this stage, if this is something that you’re having to do for yourself, I can recommend the Animas website for a few quick comparisons – they list some key features/specifications of the Vibe against several other competing pumps on the market.

Priorities

There were some things I wasn’t too bothered about. Size and weight weren’t important to me so I discounted them – whilst one pump might be slightly bigger or heavier than another, it wasn’t significant enough to worry me. Pumps aren’t the size (or weight) of house bricks any more thankfully. After my debacle earlier this year, being waterproof was definitely important to me. All three of these are waterproof so whilst that’s a big plus point, it didn’t help me differentiate.

I decided to consider the Cellnovo separately as it’s a patch pump and the other two are of the more conventional variety. I don’t have a huge problem with being connected to something all the time, especially when it’s keeping me alive, though, having said that, when I’m wearing a cannula and a sensor of some kind, I feel more conscious of it all. I tend not to sleep as well and I’m more aware of the perils of actually catching my arm or adhesive coming to the end of its life. On the other hand, the Cellnovo has a built in accelerometer (it tracks your movement) so would being able to compare exercise and insulin more easily be beneficial?

In the end, this was the first to get struck off the list. I think wearing something bigger all the time would put me off, and a friend who’d recently started with one has had a lot of teething troubles with hardware failures. I know the latter is something that you’ll get with any device, but it’s something I’ve not experienced in four years and obviously reliability is a big factor to think about.

Contenders

So it’s down to a straight knock out between the Vibe and the 640G. Both come with the ability to use sensors (Dexcom and Enlite respectively) but I know I’ll be self-funding those if I decide to use them. The costs for either run into several thousands of pounds a year (for 24/7 usage) so I decided overall price wasn’t a deciding factor (thanks to @Colonelblighty for his help there). The Medtronic Enlite sensors will allow the pump to suspend insulin delivery if it detects a hypo on the horizon. That’s appealing to me – if I’m going to pay for sensors, getting that extra benefit would be useful.

But what helped me make a final decision was surprisingly mundane in the end. I’d love to be able to show you pages of notes I’ve made, lists of articles I’ve read but for me it boils down to something pretty simple. There are risks with anything like this – the pump might malfunction regardless of which one you choose. I’m really thinking about spending £3500 a year on sensors, so making that a key part of my decision making seems silly. But what I do have to do is go through the process of set changes and wondering if I have enough insulin to last me an extra day.

I know I’m supposed to change my cannula every three days (and Carolin – if you’re reading this I definitely do…) but sometimes getting an extra day (or two *ahem*) out of them to coincide with a new reservoir of insulin makes a big difference. The Medtronic pump holds 300 units of insulin, Animas Vibe 200 units and the Cellnovo 150 units. With the Medtronic I can get away without having to stick a needle in my stomach for an extra day or so every week (or maybe another 50 times a year).

Having to think about a decision I wasn’t expecting to make got me to think about what it’s like to live with Type 1 diabetes from a practical point of view. What really is important when it comes to managing this thing I live with every minute of my life? I’ve never really thought about it in these terms before. Typically I get blinded by technology and go for something new and shiny that sounds good but ends up with a lot of redundant features I rarely use. This time it feels like I’ve been incredibly clinical, sensible (and even grown up…) and I’ve made a decision that’s best for me, that my team support me on.

Hopefully it’s clear this is just my thought process I used to help me decide which pump was best for me, but for the avoidance of doubt, no pump company has asked me to write this and you should always consider what’s best for your own care yourself (in conjunction with those specialists who support you).

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