Can an insulin pump kill you?

August 26, 2009

DeathFor me, and insulin pump is the best thing that could happen to me since becoming a diabetic. It has allowed be a level of flexibility and control that has never been possible before. With the pump I’ve been able to get as normal a life as a type 1 diabetic can have and I’ve been able to achieve nearly normal glucose levels with a fraction of the effort that it would take otherwise.

I wear a Medtronic Paradigm 522, and trust it with my life. Is exactly for that reason that recent news published in the canadian newspaper The Windsor Star where someone got killed by their pump.

Steven Krueger used an insulin pump for four years after nine years of daily injections, and according to his parents “it allowed him to accomplish things he otherwise would not have been able to do as a diabetic. He received his scuba diving certificate, completed the Red Cross Lifeguard Program and earned his recreational pilot’s licence.

Steven’s pump failed by giving him a lethal dose of insulin and he died in his sleep three years ago at the age of 27, while living in British Columbia. The cause of death was confirmed by the B.C. coroner’s office. Dr. Phillip Neufeld at the Health Canada lab in Ottawa tested the pump and confirmed the failure and cited some additional interesting facts regarding the Medtronic Minimed Paradigm infusion pump, model MMT-511 that Steven used.”

Other deaths by lethal insulin doses have been recorded in the past, but the pumps have never been tested and therefore, a solid link can not be established. I must admit, however, that the thought of my pump having the potential of killing me makes me nervous.

I can only hope that Medtronics newer pumps have corrected any potential issues…

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More accurate meters on its way

August 17, 2009

accuracy

7.5mmol/l (or 135 mg/dl)… that was my first blood test result today… but how accurate is really my meter… can I really trust that number?

In a study performed by the Department of Health of the UK, One-hundred-and-two patients with type 1 and 2 diabetes were observed performing a capillary blood glucose test. Immediately afterwards, a venous sample was taken for glucose and the two values compared. Only 47% of patients’ results were accurate to within 10% of their corresponding laboratory value.

After reading this you may feel, like I did, that your meter is completely useless and that you may as well toss a coin or throw a dice before chosing your next insulin dose. It is important, however, to understand the current regulations for glucose meter accuracy. According to the American Diabetes Association, a test result from a home blood glucose meter is considered accurate if it falls within ±20% of a lab test.  Comparing a meter’s test result with a lab test is the only valid method of determining whether or not your glucose meter is really accurate.

On the other hand, it does not seem like everything is lost. In a report published in the New York times a few weeks ago, the commissioner of the US Food and Drug Administration (FDA) indicates that there is a move to lobby the International Standards Organization into revising the international standard to mandate higher meter accuracy. Furthermore, according to a letter from the FDA, if the international standard is not revised, the agency may recognize the new requirement on its own, effectively making it mandatory for approval into the US market.

While this is not yet a done deal, it definitely looks promising.


Review: Accuchek Performa

August 6, 2009

accu_check_performa_monitor_1.jpgWith the near release of the Accu-chek nano here In Australia, I thought I would publish here a review of the Accu-chek performat I conducted for Reality Check a few months ago.

The performa is the international version very similar to the Aviva sold in the US. It boasts 5 second result and one of the best lancet devices on the market

Advantages:

This meter is meant to give results in 5 seconds and use 0.6microliters of blood, but these numbers don’t show the real picture. For some reason, it requires a lot less blood than my Optium Xceed which on paper requires the same amount of blood. It also uses better suction technology in the strip so the filling is super fast, much faster than any other meter I’ve tried.

The strips come in a canister with a hinge which make it very convenient as there is no need to fiddle with foils or lids. The meter also comes with the highly regarded Softclix, by far the best lancet device around these days.

Disadvantages:

No backlight, not that I really use it that much, but is the only thing I could really miss. The meter and case are also a little big bigger than the Xceed, but still very manageable.

Verdict:

I was very happy with my Optium Xceed before getting this one, but now that I have used the Performa, I’m completely hooked to it.

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Accu-chek serious market comeback

July 27, 2009

avivacombo_spirit_mFor at least a number of years, Roche Diagnostics, through their Accu-Chek brand has been providing people with Diabetes with products on the Insulin Pump and Glucose Monitor markets. While this products have been heavily marketed, many people think they were not exactly leaders in the field.

Here in Australia, Medtronic and Animas are the two most prescribed brands of pumps, and many health processionals recommend people don’t choose the Spirit, which is the current generation of Acchu-Chek insulin pumps.

Now everything may be about to change, with the release of the Accu-Chek Combo System. Initially available in the UK, this combo of pump and glucose meter has the potential of making Roche a serious player in the market of Insulin Pumps.

The Pump has a number of characteristics often found only in pumps made by the bigger pump players. This first notable feature is the connectivity between the meter and the pump. By using Bluetooth technology, the meter has the capability of acting as a remote control for the insulin pump. More importantly, the communication is interactive and two-way, which means that “information flows between blood glucose meter and insulin pump automatically or on command, as appropriate”.

avivacombo_face_mmol_mThe other feature that was visibly missing on the previous Accu-Chek pumps was a bolus wizard. This new system, however, comes with a new feature called bolus adviser. While I have not yet seen how it actually works It sounds very positive. The pump also saves all the data about blood glucose, food, boluses, etc, serving as an electronic diary to keep all the information in one device.

Now, of course, the big question is whether the pump is as look as it goods, or even whether its going to be enough to bring Accu-Chek pumps back from the dead. Personally, I will have to hold my judgement until I get to see one in the flesh, which is likely to take a while considering this pump is still only available in Europe.

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Is the artificial pancreas really on its way?

July 16, 2009

For a while now people with diabetes have been hearing that a cure may be just 5 years away. After almost 90 years of having injected insulin as the only way of staying healthy with D there may finally be light at the end of the tunnel.

There is a number of interesting paths being pursued by researchers. One that seems to be taking a lot of traction is the artificial pancreas. While a lot of improvement has been done in insulin pump therapy in the last few years, the pump manufacturers seems to be still far from an automated closed look system.

Researchers at the University of Virginia Health System tested a computerized system that controlled overnight glucose levels and reduced hypoglycemia levels five-fold. The new system has been tested on 20 people with Type 1 diabetes, also known as juvenile or insulin-dependent diabetes. Each patient was admitted to the hospital twice for 24 hours each time. All patients had identical eating, sleeping, and exercising activity during the admissions.

Here is an video from JDRF about the Artificial Pancreas project:

“This artificial pancreas could one day greatly improve the current methods of self-treatment for Type 1 diabetes.” said lead investigator Boris Kovatchev, associate professor of psychiatry and neurobehavioral sciences in the university School of Medicine. “Instead of a patient having to measure his or her blood sugar with a glucose meter several times a day and self-administer insulin injections, this system would continuously regulate the patient’s blood glucose, much like the way a non-diabetic’s pancreas functions.”

Is the artificial pancreas really on it’s way? Well, maybe we need to wait another 5 years….

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Review: Medtronic Minimed Quickset infusion set

July 2, 2009

quickserterA few weeks ago I conducted an evaluation of various infusion sites sets for my Minimed Paradigm. After writing about the Thinset reservoirs, the Inset II and the Cleo 90, I thought it would only be fair to write a formal review of the Minimed Quicksets. These are one of the standard  sets made for the Paradigm, but is also available with a luer lock connection for other pumps.

Advantages

The Quickset is a high quality set, well built, and very reliable. The adhesive is the best of all the sets I’ve tried, and in my case has resisted water, sweat and serious abuse for well over 3 days.

The other good thing is the inserter. It uses a high precision spring loaded mechanism. It goes in quickly and without any pain. Having a reusable inserter also means less waste, and less impact to the environment.

Disadvantages

The downside of having a reusable inserter is that you need one wherever you are changing your set. This can be challenging for emergency kits and backup supplies. Inserters are not cheap, and at $60 each, I won’t be buying one for each of my backup kits  anytime soon.

The other slight disadvantage is size. The Quickset adhesive is slightly bigger than the other sets, and is white, so it’s bit more visible.

Verdict

Overall, this is probably the best set I’ve used so far, so I will probably keep using it on my pump. I will, however, keep a couple of the other sets in my backup kits, one in the car and one in the office.

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Review: Freestyle Lite blood glucose meter

June 25, 2009

Freestyle LiteFREESTYLE Lite by Abbott Diabetes Care
This is the latest generation of the Freestyle meters. It offers some of the standard inclusions that you would expect in any modern meter today, 5 second tests, compatibility with alternate site, and more.

Size: 40 x 75 x 17 mm

Advantages: The Freestyle Lite features no calibration which I must admit is no big deal for me, although some people may find it convenient. It also has a bigger display, which I’ve heard is one of the shortcomings of the Papillon. This meter takes the smallest drop of blood I’ve ever seen in a meter, and I have actually never managed to under dose the strip, even when I’ve been convinced I would.

The meter also has backlight, which I was very indifferent about in all my other meters, but the fact that this one lights up the strip makes all the difference. Now I suddenly can test in the darkness of a cinema without having to worry about light. I must admit pricking your finger (or in my case your palm) in the dark takes a bit of getting use to, but is perfectly doable. Putting blood in the strip, however, would be impossible without the tiny but really effective light.

I’ve been downloading the data to my computer, using both the free software from Abbott and a piece of specialised software that I’ve been using for a while. It works great in both instances (how did I keep logs manually before this is now beyond me). It uses a special cable but the same as both the old Papillon (Freestyle Flash) and the Caresens.

Disadvantages: This meter is not perfect. For starters, it comes with the same butcher knife style pricker that I’ve seen in most Abbott meters (I’ve quickly solved this hiccup by substituting it with my trusty Softclix). The strip canister is smaller than other meters, which makes it a bit difficult to put your finger in to get a strip. I have to turn the container upside down, which can turn into a mess sometimes. The case is the same size to the Optium Xceed (and almost identical) which makes the point of being the smallest meter in the market a bit useless.

While the strips only use a very tiny drop of blood, it does not have a window to see your blood being “sucked” into the strip, which makes the wait for the confirmation sound a bit annoying. The strip also absorbs the blood from the side and not from the tip, which makes dosing awkward sometimes.

The main issue is that the results don’t seem to be comparable with any other meter I own. I’ve done a full side by side comparison (testing with two meters over 2 weeks) with both the Optium Xceed (Precision Xceed)  and the Accu-chek Performa (Aviva) and the number of the Freestyle seem to be higher by about 8% to 16% higher than the other two?

Verdict: This meter is a first class fully-featured meter. Like all others in the market it has its good and bad things and is up to you of wether it fits your requirements. Personally I have now replaced all my meters with this model.

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First Look at Medtronic Patch Pump

June 18, 2009

Let me start by saying that the information in this post is, at the time of publishing, more than a week old. Although it is not fresh from the press, I still thought was important to share here.

During the American Diabetes Association conference in New Orleans, CNBC interviewed Bill Hawkins, Medtronic chairman & CEO. This was your typical analyst interview where Medtronic commented about their products, the new Paradigm VEO and their work towards a closed loop system.

What was really interesting, is that for the first time, Medtronic showed to the media the prototype of a patch pump.

Medtronic-patch-pump

Medtronic’s patch pump, which so far does not seem to have a name, is expected to compete head on with Insulet’s Omnipod. I personally would like to see how it compares, and more importantly for me, whether will be available here in Australia. The Omnipod is still only available in North America and is not expected to be available anywhere else for a while.

Maybe this will be our chance to finally move to a tubeless pump, but obviously there is a long road still to go.

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Review: Inset II infusion set

June 9, 2009

Inset-IIToday I’m concluding my 6 day test drive of the Inset II infusion set (also known as Inset in some markets). It’s been an interesting experience, specially considering that is the first non-Medtronic set that I try in my Minimed Paradigm 522.

These infusion set is manufactured by Unomedical, but is also marketed by Animas. It is available in three colors here in Australia (Blue, Pink and Grey) although a fourth color seems to be available in the USA.

The Good

For me, the biggest positive of this set was the integrated inserter. In the past, I’ve had some issues with infusion sets getting stuck to the reusable inserter. By using an integrated, single use inserter, I’m sure to get a perfectly placed, always working set.

The set is small and compact and easy to keep around, specially good if you want to carry in your bag. It was also good to see that once you have completed the insertion, you only need to put the cap back on and throw in the garbage bin. No need for a sharps container as the needle stays enclosed, great specially if you need to do an emergency change on the road.

The Bad

There are a number of things that I didn’t quite like about this set.  Having a single use inserter means that the quality and feel of the device is not as good as some of the reusable ones. In particular, the Inset does not use a spring to shoot the needle in but instead, it creates tension by twisting some of the plastic. This also means that the insertion is not as precise as it should, which ultimately increases the risk of a painful insertion.

I also didn’t like the connector on the set. Instead of the twist off motion on other sets, the Inset uses a straight pug, which I found hard to connect and disconnect.

The adhesive is a bit smaller than some of the other sets, and seemed to be more affected by water from the shower. That said, it lasted the full 3 days without any issue. This, however, may be more of a problem for those who wear their sets for longer.

Verdict

While so far I really like these set, I will probably not continue using them in the long run. For much that I like the concept of an integrated single use inserter I really value the precision on the insertion movement.

I have, however, decided to keep a couple of these sets in each of my emergency kits, as they would come handy in case I need to change my set while away from home.

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Review: Thinset Reservoirs

June 6, 2009

Thinset reservoirA few of you may remember that a few days ago I ordered a few supplies to do a comparison between different infusion sites available.  Most of the infusion sets I ordered had a luer lock connector, so I needed to order a special reservoir as well. The reservoir is called Thinset reservoir, and is made in the USA by Applied Diabetes Research.

The Good

The biggest thing about this reservoir is it’s that it allows Minimed Paradigm users like me to use luer lock infusion sets. This effectively means that for the first time since the introduction of the Paradigm series of pumps, we have the flexibility of choosing any set available in the market today.

In addition to this, there are also a few features worth noting. In particular, the plunger has a stop at the end of it, which makes impossible to separate the reservoir spilling insulin all over the place. It also has clear markings in the barrel, so it is easy to read.

The Bad

While I really appreciate the freedom of choice that the Thinset reservoir gives me, it’s also fair to say that this reservoir is not perfect, specially when compared with the standard Paradigm reservoir.

The first thing that becomes obvious as soon as you take the reservoir out of the package is that it does not have the guard/vial holder that I like so much on the Paradigm reservoir. Instead, you get a syringe style needle that you need to insert in your vial and then hold manually. Probably not a big deal for those used to handle syringes, but for me (I always used pens before the pump) it feels like juggling and balancing at the same time.

The other thing that feels odd about this reservoir is it’s fit in the pump. Don’t get me wrong, it fits with incredible precision on the compartment, but the main issue is the bits that end up sticking out. The reservoir has two little wings at each side of the connector to twist the reservoir in place. This in conjunction with the actual luer lock connector make the whole setup a bit more bulkier than the simple elegant Paradigm connector.

Verdict

Overall, this is a very good product because of the options it opens for all paradigm users, but for me, it’s use will be dependant on whether I choose to use a luer lock set going forward.

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