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[IPk] Animas and Other pumps

Woh... I had not intention of starting WWIII.. so I will clarify what I have
posted. I cetainly had not intented to upset anyone and If I have, I do

My posting about the superiority of the Animas2020 is based on our personal
experiences of using MM, Cozmo and Animas pumps over 5 years of pumping and
10 years of diabetes; it is not meant to be a definitive guide. Whatever
pump one chooses it is better than MDI and of course one of personal choice.

I like to think of different pumps as you would different cars... with some
being like a Skoda at one end and others more like a Mercedes or Lexus. If
you are getting NHS funding for the pump, why not go for the upmarket
models? After all, all cars will get you from A to B but surely the ease and
comfort of how they do this is also an issue? (especially if funding is not)

Firstly, I must say that I did not and would not say the Spirit is cr*p.
Just that its a very basic pump. I do know a few people (adults) who find
the minimum basal increments to be an issue, including a few who post on
this list.

About the Minimed.. I am pleased that a few people report good customer
service experiences, but this does not seem to be the norm. Aftercare and
service is essential when you consider you are signing up to a 4 year
contract. (The Cozmo and Animas customer service has been excellent - I
cannot comment on others from personal experience).

Minimed and Bubbles: You just need to review past postings on this site to
know that many many people do experience bubble problems with the MM
cartridge. I was unaware of the Leur adpater until last week when I saw
someone wearing a 522 with the adapter. I guess it works, but it did look
quite bulky.. the Animas is a small, neat and inconspicious pump. Although
many do not experience bubble problems regularly, there have been numerous
postings on this list on the various methods/tricks used to fill a MM
cartridge and one person recently reported (on list) ending up in A&E
because of bubbles and their pump did not alarm.. I personally feel that if
you are just starting pump therapy, the less nuances the better your chances
of success. The Animas cartidge has additional o-rings and is made of a much
sturdier plastic than the MM ones, which if you squeeze the MM cartridge it
actually opens up the o-rings and lets in air. The Cozmo cartidge is also
easy to fill and didn't give us problems in this area.

As far this 3 x an hour delivery, I must disagree with Diana. The Minimed
goes for what it calls "pulse delivery" rather than continous infusion. It
may well only be relevant for low basal rates and not have an impact on
higer rates. All other pumps deliver every 3 mins.. hence the Spirit's big
back page ad on this month's issue of Balance is a knock on MM's delivery!
I have just spent over an hour looking for this on the MM website and can no
longer find the details! It was on their website back in February when I was
trying to convince Sarah to give the MM another go so she could have the
CMGS. I also called the US customer care back then and was told that the
pumps delivers in pulses and the pulse method more closely mimics the body's
natural release of insulin. I have also had my phone on redial to MM
customer care for the last hour to try to clarify this but after repeated
mailboxes had a recorded message saying "too busy to take the call". This
was pressing the button for being a new customer, so I hate to think what
service existing customers are now getting.

The MM delivers in a minimum 0.05 increments or multiples thereof. So on a
basal of 0.1units an hour this will deliver just 2 pulses an hour vs the
Animas which delivers every 3 mins even at low rates. Even on a 0.5/hr basal
it would give 10 pulses.. so doesn't get parity of delivery to every 3
minutes below this basal rate. The issues arise where for example basal is
say 0.15/hr. Since the pulse starts on the hour.. you'd get 2 pulses of 0.05
in the first half hour but only 1 in the second half hour. This can be an
issue for disconnecting and basal segment changes. So if you had basal set
on 0.15/hr, for an half hour segment, you would actually get 0.1 delivered
not 0.75. A greater issue is when using temporary basal rates.. so if you
are reducing say for sports and lower accurate delivery is important the MM
can still only deliver in 0.05 increments. Please note I am talking about
the actual insulin delivery rather than what you set and think the pump is

As far as pump choice, my understanding from the NICE guidelines is that you
should be allowed to choose the pump which suits you best..Yes certain
hospitals do have contracts with Minimed (as Minimed is known to fund the
nurses) but that does not mean you shouldn't push for the pump of your
choice..after all you're then stuck with it --literally --for 4 years.

The issue of waterproofness is to us quite important. Sarah must bolus her
breakfast insulin 20 minutes before eating or she will have a high
mid-morning spike. She boluses, then showers, then eats breakfast.. it is
not a good idea to bolus then immediately disconnect. Similarly, in the
evening, she may want a bath after dinner and before bed, so again,
disconnecting is not practicle. Having said that, there are waterproof
pouches you could put the MM in, but why add another hassle?

With reference to the MM CMGS, my experience is of the older versons, but
technically, its time-lag is quite significant. It doesn't cope well with
sharp drops or rapid rises, but having said that any CMGS is better than
none. The Dexcom will be in the UK by the end of the year and our personal
experiences of it are fantastic.. their Customer care is also brilliant.
Sarah managed to flush her first one down the loo and we were sent a free
replacement immediately.

I did not say anything against the Cozmo. We did pump with it for 4 years
and customer service is good. However, in the first 3 months of this year we
went through about 6 pumps. Two were for over-delivery issues... the pump
alerted for "non-delivery", the pump showed cartridges had around 40units
remaining yet were completely empty! Others such showed error messages,
buttons failed or screens went blank.
Cozmo policy is to send refurbished pumps as replacements... we have
received 5  replacement pumps in 4 years that failed to start up at all! (3
of these were whilst in the US and resulted in Sarah having to go back onto
MDI for 2 weeks whilst at diabetic summer camp). Cozmo recalled over 1000
pumps in February this year because of over-delivery probelms, but
interestingly only recalled US pumps and none in Europe. The Cozmo is a good
product but they have been having problems.. I am happy to hear these
haven't affected kids on the CWD website.. but accuracy and durability must
surely be an issue when considering what pump to choose.

With reference to Di's comments about having IOB calculations, carb counters
and bolus wizards.. these are handy time saving functions which are useful
but not essential. Given the postings a few weeks back about people having
difficulties with maths, surely these features  for them would then be
invaluable. Sarah can calculate her IOB in her head and similarly calculate
food and adjustment ratios and boluses. However, as said, when starting on a
pump there is so much to learn and to take into account, having these
functions does simplify matters. The IOB calculation on the Cozmo is based
on straight line usage so is not accurate. I cannot comment on the IOB
calculation of the newer MM's as I do not have experience of them.

Interestingly, I dont know of anyone on an Animas who has then switched to
another brand. Again, I do apologise if I have upset anyone on the list and
certainly have not intended to partake in "pump bashing". I have purely
given our personal experiences of the various models. I'd still say that the
Animas is the Lexus/Mercedes of pumps and once integrated with the Dexcom
will be the Rolls Royce.

Karen Persov
Mum to Sarah age 11.5 - diabetic since 18months old, also Hypothyroid.
Pumping Animas2020 and Dexcom, HbA1c 6.6% (during puberty)
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