Wednesday, 24 December 2014

Second Pump Lucky, CellNovo Fails, Roche Insight to the rescue?

Noticing again how long it has between blogs, I really should stop implying that I’m going to do this weekly, perhaps a commitment to publish somewhere else would be what it takes.  I can feel another entry adbout making promises I can’t keep and burning the candle at both ends coming on.  But that’s another time really. Suffice to say that this September to March period doesn’t get any easier year on year; I take my normal workload and add at least 50% and then try and maintain training as well.

This October was worse than usual, losing two Tuesdays to getting started on the Cellnovo pump, and of course that tends to then disrupt the entire week from any kid of travel point of view.  I also had a trip to Trinidad, a training course and two new team members to break in. November had trips to Reading, Edinburgh, Tunisia and the Orkneys and December had another training course, Aberdeen and then on my supposed week at home another trip to Addenbrookes and one to London. Overall, I’ve had 8 weeks in a row with travel and three of the last 13 weeks overall at home.  In amongst that I’ve had a failed pump, reverting back to MDI and restarting a new pump, so that’s two lots of basal testing to deal with and a set of completely screwed up repeat prescription.
That’s not to say “poor me”, it just is what it is, and I wouldn’t still be doing it if I wasn’t still enjoying it, but I am looking forward to ten days break at Christmas

So why two pumps? Well let’s just say the Cellnovo did not live up to it’s concept.  In fact it was downright unworkable.  The idea was good in principle, but in hindsight if I’d been given all of the information at the time of choosing I may have held off for what I eventually ended up with, the Roche Insight.

So the concept with the Cellnovo is to have two programmable, rechargeable pump bodies, controlled by a separate handset with integrated BG meter.  You then connect an insulin reservoir to the pump after having filled it with insulin from a 10ml vial.  The reservoir has a short piece of tubing (50-150mm being the versions I had), which then connects to a separate cannula. The pump body has a bit of one half of Velcro stuck to it and the other side is stuck to your skin and holds it in place.
So what was good about it was the size of it and the short length of tubing, and the rechargeable nature of the thing.  Assuming it was working, the not so good bits were
  •   A lot of stuff to carry about, spare pump, insulin reservoirs, syringes and needles, cannulas (with excessive packaging), bits of Velcro
  • The pump had pretty sharp corners, meaning that you had to be very careful with placement and it was not as comfortable as I imagined when sleeping.
  • The insulin reservoir has a hard wired timer in it, with a three day limit (which I had not known about beforehand). This timer gave a 12 hour warning, once, and then at 72 hours exactly, whatever you were doing, the pump stopped and there was no way to extend this however inconvenient it might be.  The real effect of this was a lot of wasted insulin in my case plus a need to plan changes early, wasting more insulin
  •  The handset was in regular contact with the cloud, every few minutes day and night which had two effects, the handset battery being little more than a day and in my case acting as potential source of ignition on petrochemicals plants.
The practice was worse than that, and I’m not the only one to find this. As a result of around 10-12 people who started on these around the same time as me, I think only two are still using it and Addenbrookes are not offering to more patients until the problems are ironed out.

My specific problems included:
  •   One complete failure of the handset. Simply decided not to unlock itself. Particularly annoying as this was just two weeks into use and I was also suffering an unknown pump failure at the time (from the beeping going on) and I was in the middle of a three hour drive.  I eventually unlocked it to then need to replace the pump with the spare one and a new insulin reservoir, wasting the one I’d changed earlier that day.
  •   One completely failed pump, just stopped working.  Would not communicate with the handset and developed a tendency to eject it’s insulin reservoir spontaneously.
  • I had repeat problems with insulin reservoir changes.  The concept being that the pump and reservoir were attached to each other, synched and then got on with it.  In reality, I was experiencing several failures in this system with pump and reservoir losing communication and/or just failing to synch to start with resulting in the need to refill a second brand new reservoir. 
Overall, as a result of these issues,  it was causing me more stress than reassurance.  Coming back to all my travel this autumn, I ended up carrying extra supplies just in case of failures and I basically lost all confidence in the pump though not knowing whether or not it was actually going to work at any time.  So when I was given the option of stopping it and moving onto the Roche Insight I jumped at it, even taking a three week break from pumping altogether.
You might think this was a rash decision, but not really.  Roche are a well proven name in the game of insulin pumps, and this was my second choice anyway.  The only thing that turned me off of it was the tubing, but there are several other features that I hadn’t known about beforehand that I see entirely as positives.

  • Use of pre-filled insulin cartridges (only 160U which is an issue for some, but not with my low doses) that can last 6 days before replacement, based on risk of denaturing.  Cartridges very easy to change with a simple endcap that is a push, twist, lock fit integrating the tubing.
  •  Alternating the cannula only and full cartridge change every three days. The cannula inserter is great as well, with a very clever mechanism to hide the introducer needle.
  • Handset battery is superb, lasting three days or more so far, and can be turned completely off.  
  •  Handset auto start on insertion of a BG test strip.
  •  Less obtrusive during exercise

Not so good
  • No rechargeable battery usage in the pump itself, uses AAA lithium or alkaline only.  Battery life good so far though
  • The tubing – 70cm so far, still getting used to that, and I’d be lying if I said it wasn’t intrusive, but putting the pump in an arm strap MP3-holder is reasonably unobtrusive and comfy to sleep in.
  • The size of it – it’s quite a bit bulkier than the Cellnovo which was matchbox sized, where the Insight is about the size of an old-fashioned pager.
  • Need to tailor the supplies, so far I only have supplies of cannulas with the tubing and cartridge connector. I need to tailor this to be a mix next time.
Overall though, it’s been a damned positive experience and BG control so far is good. My insulin usage is actually even lower than on the CellNovo as the Insight has a 0.01U/hr basal increment rather than 0.05U/hr.  Starting from the basal setting I’d got to on the Cellnovo just needed a few tweaks during the day time with the night test being done as I type.  I’ll write up the general procedure on another occasion as a blog on pump management (not that I’m the expert yet), and I’ll include the other thing I really like about pump usage, which is the BG management during exercise, which so far has been an absolute boon with a massive reduction needed in carbs to fund exercise just because I’m xx hours away from a bolus or haven’t dropped my basal 10 hours earlier.

So, Merry Christmas to all, and I’ll see you soon.