Pound the (OmniPod) Alarm

From: System Documentation: New OmniPod PDM Model UST400

Have you ever experianced an OmniPod alarm that wouldn't stop? Have you gone online to find out how to save yourself from the incessant squeal and receive tips like: You can open the pod and take out the batteries, put it in the freezer, hit it with a hammer, or my favorite... I put it in the driveway and ran it over with my car.

While I have to admit that a few of those tips sound like a great stress reliever, you don't really have to go to all of that trouble. All you need actually, is a paper clip. The new smaller OmniPod has a manual shut-off port (Just like the first generation did) for stopping that annoying alarm! If you'll refer to the diagram above that I borrowed from page 131 of the system documentation for the new OmniPod PDM Manual (Model UST400), you'll see where the port resides.

Just follow the instructions and don't forget to give the paper clip a firm push (It has to break through a thin layer of plastic) and the alarm will be no more. Best part? You won't slip with a kitchen knife as you try to crack the shell open and cut your finger off.

Helping Children with Diabetes Gain Independence Part 2

If you read part one last week you can skip this little description and move on to the post...

So a while back the people who make the OmniPod asked me if I would like to contribute to their new blog called Suite D. I said yes, but I had one caveat that I honestly never thought that they would agree to - but they did!

See, Insulet wanted me to write a series of posts about how we use text messaging to manage Arden's type I and I wanted to tell that story here on Arden's Day. My caveat? I get to repost my writing here after it has run on their blog. This is not something that many websites would agree to because they understandably want their content to be fresh and exclusive -- I want to give major kudos to Insulet for agreeing. You may be wondering what I said to get them to allow me to do this... Well, it was simple really. I couldn't write for them and give them my full effort if I felt like my writing was taking something from Arden's Day and taking something from you. I was honored to be asked and I wanted to take the freelance work, but not at the expense of my readers here. So we struck a simple, and I think, very reasonable deal. I get to repost after the piece has been live on their site for at least thirty days. A BIG "way to go!" from me to Insulet for being so cool and blogger friendly! Here's part 2 of my 6 part series on gaining independence through technology, part 1 is here.

I sat down in my daughter’s 504 meeting after she finished second grade with a plan. Each year we make small adjustments – preparations for new aspects of the school day that come with advancing to the next grade level. These meetings are very productive, somewhat brief and usually not very eventful.

The nurse began to talk about how we could give Arden a little more responsibility with her diabetes management in third grade. This was something we did each year during this meeting and sometimes, if warranted, during the school year. We strive to shift Arden’s diabetes care onto her plate bit by bit, as she is able to accept new responsibilities. The idea is to slowly get her acclimated until the day comes when she is completely self-managing her diabetes without even realizing anything has changed.

I like that process very much and it was working extremely well. So well, in fact, that before the nurse could finish her thought I stopped her and said, “I don’t want Arden to come to your office next year. It takes up too much of her day and I think the lost time is damaging her learning process. She is missing vital parts of instruction and I want to change that.” They of course agreed, but were initially confused about how I intended to change the situation.I continued, “Arden is going to manage her diabetes herself from now on and I am going to help her. She will handle everything right from her desk and I will oversee each decision with text messages (and phone calls if and when necessary).” 

Cue the blank stares…

I filled the silence before anyone could protest too much. Our previous governor signed a bill giving students with diabetes the ability to test their blood glucose anywhere in the school. So testing in the classroom wasn’t an issue. And Arden’s 504 plan already allows her to carry a cell phone, so all I needed to do was explain that sending text messages wasn’t going to be a distraction to the other students. They were intrigued.

I began to explain how much better I imagined Arden’s A1C would be if we could make small adjustments throughout the day instead of only addressing her blood glucose every few hours. Then I turned to her teacher and asked how much cumulative time she thought Arden missed each day while she was at the nurse. She replied, “Forty-five minutes maybe.” I didn’t hesitate to show off my impressive math skills and said, “That’s almost four hours a week… fifteen hours a month.”

They couldn’t disagree with my argument. Everyone knew that a student can’t thrive when they miss that much of their school day. There were a lot of faces in the room and I could see on each one of them that I had made my point. I reassured them that my idea would work and that we should try.

Arden and I practiced all summer and came up with our own little diabetes management shorthand. I found a few emoticons that were representative of the arrows on Arden’s continuous glucose monitor and we were off.

Putting Arden’s New Diabetes Management Plan into Action

Today, almost one complete year later, even I can’t believe how well my plan has worked. One week towards the end of the school year Arden’s blood glucose had been low all week. I didn’t know why. I had been using temp basal rates and adjusting boluses, and she just kept running low. I’m talking about blood glucose levels in the 50, 60 and 70 range – situations that required immediate action.

But guess how many times Arden had to go to the nurse’s office that week? Zero. Guess how many times Arden had to go to the nurse’s office all year? Yes, you guessed it… zero! Arden did not need to leave her classroom once to address a diabetes-related issue. We treat lows, bolus for highs and count carbs all with text messages like in the screen shot above.

This simple technology that most everyone possesses is one of the most valuable and productive diabetes technologies that we employ. The independence that it gives Arden and me is unmatched. The peace of mind that being able to text her brings me is soothing. The effect that this process has had on her diabetes management is staggering! Just wait until I tell you about Arden’s A1C in my next post.

FDA Approves Medtronic Low Glucose Suspend

"MINNEAPOLIS – September 27, 2013 –Medtronic, Inc. (NYSE:MDT) today announced the U.S. Food and Drug Administration (FDA) approval of the MiniMed® 530G with Enlite®, a breakthrough, first-generation artificial pancreas system with Threshold Suspend..."

Read the rest of this exciting press release at the link.

First Impressions: New, Smaller OmniPod

Demo Pod with Clear Shell

Clearly the new, smaller OmniPod is... new and smaller. But is it different, better and will your BGs magically be perfect when you use it? Most importantly... is it still the OmniPod that you know and love? What follows are my unfiltered initial thoughts about the new OmniPod system. This blog is not a complete rundown of every change and feature, today I'm writing about the stuff that jumped out at me after using the new OmniPod for about a month. Arden has recently completed the first box of ten pods and I feel ready to share my thoughts on that experience. Okay, are you ready? Are you excited, nervous, wrought with fear? No need, it's pretty much the same OmniPod, just smaller, newer and with a few changes that I think are worth talking about.

Size

In my opinion, size doesn't matter as much as footprint. Insulet has said in the past that the new OmniPod is, "Approximately 1/3 smaller than the current pod". That sounds impressive, and it is, but what does it mean and are the measurements as important as the overall experience for the wearer? Let's take a look...

You can see in the images above that the new pod is smaller in dimension, though the numbers suggest not by much. That reduction, however seemingly insignificant, has created a footprint that changes the way the OmniPod interacts with even the smallest body and that is in my opinion, what is so exciting about the new pod.

Our first month with the new pods has shown me that the reduced footprint brings:

Less drag - During activity or motion, the pod doesn't pull when your body changes directions in the same way that the old pod did.

More site possibilities - Small or lean people can sometimes have trouble finding locations on themselves that don't present challenges. The new pod creates more sites for those people. One example is that Arden can now wear the pod on her lower back, a site that wasn't available to her with the first generation pod because of it's larger footprint.

Less noticeable - The reduction in overall size and height creates more opportunity for the pod to match up with your body's natural contours. The reduction in size has created a device that is one step closer to being a seamless part of the wearer. It may take years before a pump exists that the wearer can't feel, but this is definitely a positive step in that direction.

Smaller means lighter - Not 1/3 lighter but there is a noticeable difference when you hold the two in your hand.

Easier to hide under clothing - You know, cause it's smaller.

It's cuter - What, it is!

PDM (Personal Diabetes Manager)

One day last year Arden's 1st gen pod experienced an error about four minutes before her bus was about to pull up to our home and I was able to change that pod without Arden missing her bus. How could I do it so fast? Muscle memory. I was at the point where I didn't need to look at the buttons during the insertion process, I'd done it so many times over the years that it was like typing. I had no need to look at the keys or even pay complete attention to what I was doing because I'd done it so many times before.

With the new system I find myself looking down at the PDM and perhaps that's not a bad thing. There are a few new screens and some redundancies that are meant to add safety. I can see how they were needed and I don't imagine that it will take users of the previous PDM very long to learn them. New users shouldn't be bothered greatly by the differences because none of the new screens are ridiculously unneeded or difficult to maneuver. It's my understanding that some changes were deemed necessary by the FDA so, like them or not, they are here to stay. Here are two examples of new screens:

If you look at the image below you will see that the new PDM requires that you confirm who you are before beginning. If you look closely you'll see that the "Confirm" button even changes positions each time that the PDM comes online. This may not be a safety issue for most people but in households with multiple people using an OmniPod, it's a big deal. You don't want to bolus the wrong person, a problem that is increasingly more possible with the new PDM's stronger signal range. Temp basal adjustments now require an extra step but the process removes the confusion that some experienced in the past by asking you up front if you want to increase or decrease the basal rate. Bonus, you are now informed of when the temp basal will begin and end on the final temp basal screen (I like that feature).

Signal strength - So this is a feature that I think may only matter to caregivers of people who use the OmniPod. I don't imagine many adults are being bolused by another person, so signal distance probably isn't an issue for them. Having said that, the signal distance is greatly improved. In fact the distance is a vast improvement over the first generation PDM and it even works through some walls and floors (Though not as well as the DexCom G4). Take note that the PDM can still have an issue finding the pod at close range if your body is shielding the pod. Overall, the improvement is amazing... if you don't believe me you can check out this video that I recorded and see for yourself.

Nuts and Bolts and Stuff that went wrong.

We've had three pod failures during the first box and I'll admit that I was worried for a few minutes but it's been smooth sailing since then. Coincidence? Early product issues? I don't know. What I do know is that Arden has been using the OmniPod for a very long time and we've maybe had, I'm guessing, twenty that have needed to be replaced in four years. The strangest part about OmniPod errors is that they come (At least in this house) in bunches. We can go six months without one and then have three in a month. It's difficult at times not to look into things too deeply when that happens but in the end, it always seems more like a fluke to me than anything else. Plus, other pumps have their own issues that OmniPod doesn't, so I take the spectacularly good with the bad.

Here's where I love OmniPod and the recyclable nature of the pump. I bet that we've all experienced an error that sometimes requires us to send the pod back to Insulet for inspection. Those pods help the company to learn why errors are happening and when they have their answers, they are able to make adjustments to future production runs that eliminate the issue. In short, OmniPod is able to upgrade their pump without having to replace each users device and that only benefits the consumer.

So, does it suck when three out of ten pods fail, it does. Did I get pissed when that happened, I did. Did Arden complain about having to change her pod three times in five days, you better believe it. Do I have more than a reasonable expectation that this won't be the situation for every box we receive, absolutely. Am I hopeful that six months from now the issue we experienced will be eradicated, I am.

Other Stuff

Apparently filling a new pod with more than 200 units of insulin can cause an error. Be on the lookout for a communication from Insulet about that soon. In the meantime, don't fill your pods with more than 200 units.

The syringe that fills the pod has a much short needle than previously.

The cannula is blue now so you can see it easier after it has deployed.

The PDM reminds you to test after a new pod has been placed.

There's a little window on top of the new pod that turns pink when the cannula has been properly inserted.

The cannula now enters at a different angle, Arden doesn't notice the difference and insulin delivery is unchanged.

Insulet Customer support has been overwhelmed of late making it nearly impossible for customers to get their calls through. I've had trouble and I know from watching online conversations that so have most of you. The other day however, on August 31st, a CSR picked up my call on the first ring. That experience led me to wonder if Insulet was perhaps getting a handle on the problem, so I reached out to the company and asked if they would like to make a statement here on Arden's Day about the recent trouble they've had answering the phone. 

With regards to customers calling for service, we realize that we haven't lived up to our usual standards lately, and we apologize sincerely to anyone who's experienced this first hand. We can assure you that it is our foremost priority to get back to our usual high standards of service. Our customer support teams have worked around the clock to respond to all inquiries in a timely manner, and in response we've done our best to expand the teams to match the high demand. As we've ramped up, and as we're getting closer to having converted all of our OmniPod wearers, we're also experiencing better service levels. We're not quite there yet, but we're seeing good improvement. To clarify a little bit, the nature of phone calls are manifold, and the teams equipped to respond to certain types of calls are not one and the same because they require different types of expertise. Unfortunately, while a majority of calls have been related to orders, you will find that some of these calls end up with our product support teams and vice versa. Billing is an example where we don't receive a lot of calls typically.  We do acknowledge the inconvenience and disruption this has caused to some, and for that we're truly sorry. We appreciate your understanding and cooperation as we finalize the transition of all users onto the new OmniPod. - Hjalte Hojsgaard, Director of Marketing for Insulet

Final thoughts

The overall size decrease is amazing, a smaller footprint means everything to kids wearing the OmniPod insulin pump.

I wish the transition went a lot smoother than it did but I'm hopeful that many lessons were learned about product transition as well as how to navigate the world of the FDA while seeking clearance for a new device.

Arden likes the new OmniPod a lot!

I don't see any changes in Arden's BGs with the new pod. They aren't any better or any worse.

We haven't experienced any change in adhesive potency. Swimming and bathing are all status quo for Arden.

Arden wants me to tell you that the sequence of clicks that occur before insertion has changed. Those of you who prepare yourself mentally for the needle buy counting those clicks will need to adjust.

I'm already excited to see what the next generation of improvements will bring!

Important! I am currently providing Insulet with six written pieces for their blog Suite D. Two have already run, one will post soon and three more are on the way. I was compensated for my writing. Please know this, no freelance job is more valuable to me than the integrity of Arden's Day and the information that we (You and I) use to make important decisions about the health of the people that we love. If there was something bad to say about the new pods or if I had any concerns about something Insulet related, I would say so here without hesitation. Insulet has never asked me to have thoughts that aren't my own and if they did or ever do, I would decline. I am only compensated for the writing that I do for their blog and I am not compensated in any other way. My family pays the full amount that our insurance doesn't cover when we buy Arden's OmniPods.

Update on Wednesday, September 25, 2013 at 11:03AM by Scott Benner

Arden just received a new supply of OmniPods from Insulet and this note was included in the order.

New Smaller OmniPods have Arrived!

Arden will put her first one on Monday!

Thoughts and a review as soon as possible.

#Excited