Thursday, June 18, 2009

Initial Impressions about the Omnipod insulin pump

At the end of May, we switched Ethan's insulin pump out and have been trying out a new type of pump. Ethan was diagnosed with Type 1 diabetes in December of 2004 and has been using the Minimed Paradigm pump since spring of 2005.

All in all, we've been very pleased with the Paradigm pump. For those of you who are not familiar with insulin pumps, here is a brief description:

(image ganked from here) The pump is about the size of a pager (remember those?) or a flip phone (closed). It has a slot for a reservoir which is filled with insulin and the electronics which dictate how quickly the screw-driven pump will administer the insulin. A minimal amount of buttons on the face allow users to input blood glucose readings and adjust the dosage as needed. The pump itself is connected to the body via some tubing, through which the insulin must travel to reach the infusion site. The infusion site is a place on the body where a small canula is inserted using a disposable needle. Once the needle has placed the canula, it is disposed of, leaving the flexible plastic canula inserted in subcutaneous fat just below the skin.

As I mentioned earlier, we were pretty content with the pump, as it offered us greater control and less hassle in managing Ethan's diabetes. The high points were:
1) Typically, we only had one injection (the infusion site) every three days, which is how often we had to replace the site and reservior. Before the pump, Ethan got at least 5 shots of insulin each day, more when needed (which was frequently).
2) Whenever we did have a problem with the pump, the company, Minimed was FANTASTIC about helping us solve it. The most extreme (and impressive) case was one Friday morning, when the pump inexplicably shut down. Although we had backup supplies and were prepared to weather the weekend using syringes, Minimed jumped through all kinds of hoops to get a new pump there by the following afternoon. Unable to find an overnight delivery option, they purchased a commercial airline seat for the pump, put it on a plane and had it flown into Abilene regional airport, picked up by private courier and delivered to our doorstep within 24 hours. This was all without us pitching a fit. We were perfectly okay with waiting until Monday, but given Ethan's fragile medical history, the company decided on this action on their own.
3) Online ordering and billing was easy and we never had any problems getting supplies.

The downsides of the Paradigm pump for us were:
1) The infusion process. We tried using the quickset infusion set, but the springloaded device didn't work well for us and we had a lot of misfires that resulted in unusable supplies (when you use three sets to do one infusion, it adds up quickly). Also, it was a little painful for Ethan. So we switched to the Silhouette inserter, which worked better but required us to stick Ethan by hand using an inch and a half long needle every three days. For various reasons, the angle and depth of the infusion was different everytime, affecting the absorption of the insulin, and thus, it's effectiveness.
2) The tubing. Anytime we had a high blood glucose reading, the first culprit was the tubing. Air bubbles, kinks, and even outright disconnection from the pump while not common, were also not uncommon. Also, even though it didn't happen very often, there always remained the chance that the tubing would be caught on something and damaged or get pulled out. Admittedly, this only happened twice in the four years we used it.
3) The canula. Again, it wasn't common, but it was also not uncommon to have the adhesive wear off a bit and the canula work it's way out, delivering its payload of insulin on the surface of the skin instead of underneath. This also tended to be painful for Ethan and a source of great discomfort.

Soooooo.... when we heard about the Omnipod, we were pretty jazzed. It addressed all of the main concerns we had with the Paradigm pump. It was self-contained (no tubing) and the infusion process was precise (always delivering the canula at a 45 degree angle 1/4 an inch below the skin, every time. It is spring loaded and instead of the two-three second process that happens by hand, it happens in 1/250th of a second, minimizing the pain). Also, the pump has a window on it so you can see for sure that the canula is inserted in the skin.
(image from here)

So, after using it for almost a month, here is my review:

Overall, I'm impressed. Ethan's blood sugars have been more consistent and lower than we were able to typically manage with the Paradigm pump. The process of changing sites doesn't take as long nor is it as complicated. It seems to be less painful, according to Ethan's reactions and recovery time after site changes. He's been to Karate and been swimming with it and it functioned as promised.

Here are my concerns:
1) Adhesive. The backing that attaches the pod is not adequate. I understand that it is probably difficult to find a balance between something strong and durable enough to last for three days but weak enough to be able to remove easily and painlessly. However, it is just not up to the task of keeping up with a 6 year old boy... We've had to use medical tape (the type they use to secure IVs in hospitals. This works, but is annoying for several reasons a) we shouldn't have to take an extra step to secure it and b) the edges of the adhesive attract lint and when we remove the tape, the remnants stay on for days, despite attempts to use alcohol, acetone or other adhesive removal liquids.

2) Pod malfunctions. In four weeks, we've had two malfunctions that have required replacing the pump. Not only is it distressing to have to put Ethan through the process before the three days, but it is expensive, as well. In addtion to the expense of the pod, we are also out the insulin that is in the reservoir. Even when insurance covers it, insulin is EXPENSIVE.

3) Canula. I am glad that the window is there, but the combination of a poor adhesive and a pod malfunction left us in a high blood glucose situation for two days before we figured out that the canula never went in. After almost 24 hours of inexplicable high BG numbers, I finally gave Ethan an injection with a syringe and treated his ketones. Amelia was the one who noticed that the canula wasn't in.

4) PDA device. I know they're trying to keep expenses down, but this is just poorly engineered. The buttons are clunky and not very intuitive. The interface is too multilayered. Although it is designed to communicate wirelessly with the pump and displays the last BG reading when you activate it, that feature only works when you are within a foot of the pod. If Ethan is in another room and I'm just looking at his numbers, it takes four menus to get to his latest BG reading. Also, one of the times we had a malfunction - a communication error, the PDA instructed me to change the pod immeditely. However, my more immediate concern was to check Ethan's glucose. Because the PDA is also his glucometer, I was unable to bypass the ERROR screen and simply check his sugar. I had to dig a spare glucometer and check him (and then dose him, as he was high) before I could change the pod. There should be a manual override so you can use the PDA as a glucometer regardless of pod malfunctions. The PDA includes an onboard library of common food items and their nutritional information. This is just gimmicky. Any competent diabetic (or caregiver) will know this stuff by heart or will have access to a better source of information. Remove this function and save space, memory, or ... something.

So, am I happy we switched? So far, I think it is almost even between the two pumps. They both have strengths and flaws. I haven't interacted with Omnipod's customer service, but I need to call them and address my concerns and find out what our options are for recovering some of our expense when their product malfunctions. I'll try to keep you posted. Cheers!


Anonymous said...

WOW! Ethan has GROWN! I didn't know he already had hair on his belly! *Ü*

We have a friend here who has diabetes and uses the pods. They went straight to them from insulin shots. I have heard them complain about them as well - but I have not paid attention to the PDA portion at all.

sirEller said...

great reviews. thanks. just yesterday I was changing out my infusion site, and the adhesion stuck to the high quality spring loaded device, thus when I attempted to yank it out, the needle apparently wanted to stay in and come out all at the same time, thus bringing with it some of that red stuff that I think is supposed to remain in my capillaries. Yes, flaws for both.

Anonymous said...

Thanks for this post! Our 7 yr old was diagnosed just after Memorial Day this year. She's doing well and a pump is probably in her future. Thanks for a comprehensive "real life" review of your pumps. I don't know where her Diabetes Team will steer us, but I'm glad to have info in order to ask good questions when the time comes.

Grace and Peace,

Lovin' like crazy said...

Glad that you have appreciated the review. Tomorrow, we meet with the clinic to go over the setting for Mary Hannah to get *her* Omnipod! I'll keep you posted on her experience with the pump. (see previous posts for info on MH's diagnosis experience)


Fenbeast said...

I've just put my 2-year-old son on the paradigm pump and am experiencing the whole tubing-failure problem you describe first hand. I'm glad (in a way) to see your comments about it because I thought the problem was me! So now I'm searching out ways to deal with the whole tubing issue. We've had him on the pump 3 days and each of the last two nights he's gone sky-high with ketones because of bubbles in the tubing.

okhorselady said...

Thanks so much for the real llife reviews. My daughter was diagnosed with diabetes when she was 5. She was on the injections but they really didn't work for us because of our schedule. She got her MiniMed pump and her diabetes were much better controled...our problem is the tubing...not getting kinked or any problems like that(we use the Sure-T set) but she is very active and pulls the needle out (more often in the summer). We were considering the Omnipod but now think we'll wait and read more of your experiences with it because other than my daughter pulling the needle out, we haven't had any malfunctions with the tubing and the one time her pump malfunctioned, Minimed had a new one to me the next day.