Diabetes and IVF

One of the reasons I gave for sharing our IVF journey was to do a small bit towards addressing the paucity of information about handling type 1 diabetes alongside fertility treatment. Of course, I then got wrapped up in the actual trying to get pregnant stuff, and so far have mentioned very little about the diabetes side of things.

Before I started IVF, however, I was somewhat frustrated by the lack of information about doing it alongside diabetes. There are a handful of threads of a variety of fertility forums, and a similar number on a range of diabetes forums, but just a few personal experiences recounted on blogs and very little credible scientific or medical literature.

That is not to say there is nothing of use, just not all that much and it would be remiss of me not to share a couple of helpful resources. One of the first sites I turned to is a blog written by Cheryl Alkon which is sadly no longer updated. Cheryl underwent fertility treatment back in 2006 and blogged her way through it, sharing a number of useful insights. She then went on to write the successful book “Balancing Pregnancy with Pre-existing Diabetes” (which I reviewed here). The book itself also contains chapters on fertility treatment. (Some of the information contained in the book may not be strictly relevant for readers outside the US, but it is an excellent starting point.) And another useful resource and personal account of the IVF process can be found on The Kaitake Blog, written by a New Zealand woman, who is happily currently about half way through her pregnancy.

I wondered, though, whether the fact that I couldn’t find more was because the combination of IVF and diabetes is not that common. But looking back now, having actually done it myself, I think it may be more likely that it isn’t talked about much simply because there isn’t that much to say that isn’t standard diabetes advice about frequent testing and adjustments.

And my own quietness on the subject is almost certainly a reflection of there not being that much to mention. I can honestly say that diabetes has not had a major impact on IVF, and whilst IVF has obviously affected my blood sugars to a degree, it has not been horrifyingly unmanageable. After all, if you live with diabetes, you have to be used to a bit of unpredictability!

If you ask people who, by their own admission, know very little about the process of IVF to share what they do know, many of them seem to mention the “induced menopause”. In proper IVF-speak this is known as “down regulation” – the process of shutting off the bodies own hormonal cycle, before starting to stimulate the ovaries to produce lots of eggs. However, this isn’t an inevitable part of the treatment, and not everyone undergoing IVF goes through the down regulation process, otherwise known as the “Long Protocol” (LP).

I was on the alternative option – the “Short Protocol” (SP) in which stimulation of the ovaries begins on around day 2 or 3 of the cycle, alongside drugs to prevent ovulation. As the name suggests, this a quicker treatment cycle, injecting for around 8-14 days in total,compared to 3+ weeks.

This has distinct advantages for people with diabetes. Firstly it is a less dramatic suppression and replacement of your own hormones, so my guess is that it has slightly less dramatic effects on blood sugar levels. And secondly, the shorter duration means fewer days overall of taking drugs with the potential to affect control.

As it worked out for me, I spent a month taking the contraceptive pill before commencing the active part of the treatment. This is common as it allows clinics to time your cycle, as well as reducing the risk of cysts (ha – that obviously didn’t work for me!) or the uterine lining not being thin enough. I’ve taken the pill before, albeit a long time ago, so I had some idea what to expect. Typically taking external oestrogens raises my requirements for insulin by around 25%. So I raised my basal rates around the clock and kept a close eye on the CGM. Which worked out well.

I then had a break of about six days between stopping the pill and starting to inject Burserelin, the medication which prevents ovulation. In my previous hormone-using days, I had a different profile set up in my pump for the hormone free week. However the week off medication was a stressful one, with discovering a cyst of my ovary and having it drained. I realised afterwards that I had maintained the increased basal rate with only a modest increase in hypoglycaemia during that time. And when I started Burserelin, everything fell back into place.

The leaflet included with Burserelin specifically mentions that it may cause raised blood sugars in people with diabetes. And based on my experience, I’d say that effect is equivalent to the effect of oestrogen. Your diabetes may, of course vary, as it is a completely different hormone. My best advice is to test, test, test.

The stimulation drugs – I was on Menopur – by contrast, had very little noticeable effect on things. I had a number of stubborn and sticky highs, but an equal number of troublesome lows. Overall, I’d say my blood sugars seemed a bit more volatile – swinging more from high to low – than has been normal for me of late. But stress and anxiety during fertility treatment have a lot to answer for too, and obviously it becomes impossible to tell for sure what is affecting what.

The bottom line, however, is that IVF with diabetes is totally do-able. Compared to the changes you will experience in pregnancy (which is the intended outcome, after all) it really is a walk in the park. As with everything diabetes, frequent testing helps. A CGM helps even more. And a pump provides the flexibility to react day-to-day and hour-to-hour much more than multiple daily injections.

I’ll definitely do it again if we have to. And diabetes would be a very long way down any list of reasons not to.

Monitor Me – Because I Need the Information

Watching Horizon – Monitor Me on BBC2 last night made me think about healthcare technology and apps in a slightly different light. Living with chronic illness since well before the advent of the world wide web, never mind smartphones and apps, the idea of self-monitoring health information isn’t at all new to me. I’ve been testing my blood glucose at home for three decades, albeit with meters which have got progressively smaller, faster and better featured. But because I think about my health every day, and collect certain information to help me maintain it, in the context of a pre-existing pathophysiology, the idea of using equipment to monitor what I regard as normal physiology hasn’t really occurred to me.

And to be honest, my overarching reaction is that this could well be overkill for most people, and simply a way to fuel unnecessary health anxieties – an increase the burdens on our health service – without improving any important health outcomes, especially as the use of so much home technology does nothing to address the long standing inequalities in health across the population. Those most in need of improved health outcomes are exactly those who often don’t have access to these sorts of technologies, nor the means to interpret the data they give. The program also did not look at how sustainable the changes they showed occurring in the short term really were, and how these might relate to more traditional models of health education. Clearly there is much quantitative research still be conducted before doctors will be prescribing direct from the App Store.

The part of the program which, inevitably, interested me the most though, was that which covered some novel new methods of monitoring actual health problems, rather than monitoring the healthy state. I was already half way through an eye roll, however, when they begun to trundle out a continuous glucose monitoring system, as I got the impression that they were treating it like a brand new technology – when in fact I’ve now been doing this for over seven years. That was quickly replaced with excitement though when I saw the neat integration in a mobile phone and the name DexCom at the bottom of that screen. I’ve been using a DexCom product (as a standalone unit, and then integrated in to my current insulin pump) for the last three years, and it’s a product that simply works. The idea of it working with my mobile phone is a very attractive one, although I’ve not had the chance to find out if this is actually a possibility in the pipeline for commercialisation.

Something became apparent to me, however, whilst following the social media conversations around the program. People seem to think that continuous glucose monitoring is all sorts of things that it’s not. They think it’s been around for years longer than it has (I was an early adopter – first real-time, at home systems came to market in 2005) or that it doesn’t yet exist outside of research programmes at all. They also seem to think that it is cheaper than traditional monitoring because it does away with the need to use so many expensive test strips. Unfortunately the technology isn’t cheap – sensors that are licensed for seven days currently run at around £50 each. The transmitters that last a year or so a several hundred pounds and the receiver in to four figures. Add to that the fact that you still need to use traditional finger stick monitoring to calibrate and before making dose decisions, and you can see the costs mount up. Convincing the NHS that this is cost effective is a long, hard road.

But most of all, people think it’s a gimmick. A game. An exciting gadget. They don’t seem able to comprehend the ongoing impact of actually “needing” to use this technology and relying on these results to stay as healthy as possible. They don’t think about the fact that you can’t necessarily pick and chose when to wear and use these devices, just as you can’t pick and choose when to have diabetes

When you have a chronic illness, monitoring your health is not something you do for fun or interest. You don’t do it in case you can spot early signs of a health problem. You do it because you have to in order to stay healthy. It’s a necessity more than a choice. Or rather, if you choose not to, the consequences can be enormous. If you choose not to run a sleep cycle app one night, chances are you will sleep fine. If you’re health conscious enough to use a pedometer, chances are you’ll take plenty of steps even on the days you don’t wear it. If, as a type 1 diabetic, you choose not to monitor your blood sugars, you could be taking a one way ride straight to hospital.

I don’t really expect people who don’t live in this bubble of chronic illness to get this, or to understand what relying on technology for your health really means, but I suppose that is at least part of the reason why I’m writing this now. I like a gadget as much as the next person. I’d be lost these days without a smartphone and I’m appreciative of the problems it’s solved and simplifications it’s made in my life. But I’m anxious not to see non-existent problems being addressed simply because we have the technology, and especially not to the detriment of people with true health needs.

Animas Vibe Dexcom G4 graph

For My Babies

I’ve been living with type 1 diabetes for three decades. Three decades sounds like a long time, but the truth of it is that I don’t remember a time before diabetes, so it only feels as long as my lifetime. Not knowing any different doesn’t mean it doesn’t bother me though. I’d absolutely be lying if I said it wasn’t sometimes an unequivocal suck.

I’ve mentioned countless times before that diabetes is an irritating and pernicious creature. There is nothing predictable about diabetes, and it has the capacity to affect every aspect of life whilst equally being affected by a ridiculous number of variables – beyond the obvious food, exercise and insulin doses comes stress, hormones, the weather and whether the day of the week contains the letter ‘u’.

I’d also be lying if I claimed to have this thing all figured out. I’m not sure that is even possible. There are plenty of times where I simply cannot be bothered with all the effort it takes to try to tame it. Some days I feel as though I’m chasing my tail from high to low and back again without doing anything differently to the day before, when everything stayed nicely in line, and that frustrates me beyond belief. So sometimes I give up and give in, stop trying to achieve the best control and simply coast along.

When I was a teenager, that was the most frequent state of affairs. As a young adult, the balance shifted to more time taking care of myself than not, but still with periods of time where I must hold my hands up and say it was completely neglected. In recent years, things have changed again.

Now, on the days when I can’t face multiple blood tests, the days where I want to eat without counting every last carbohydrate, or exercise without thinking about manipulating my medication, on the days where trying to find somewhere comfortable to wear my insulin pump sends me in to a rage, I try to stop and really think about what I might be sacrificing for the sake of a few minutes thought and effort.

I look at Thomas, and I think about the future. By the time I am my mother’s age and Thomas possibly has children of his own, I’ll have been living with diabetes, and taking insulin, for over sixty years. That is a long time, espeically when you consider that insulin for the treatment of diabetes has only existed for ninety years. But I know that I want to be there to see my son, and any future grandchildren, grow up. And I want to actually see it with my eyes, not be blinded by retinopathy. I want to be active enough to run around with them, and do so on my own feet. I don’t want to miss time bonding with them whilst I am attached to a dialysis machine.

And right now, I want to offer my future unborn child(ren) the very best start that I can. I want to keep finely balanced on the high wire of tight control, just as I did before and during my pregnancy with Thomas.

All my life the thought of complications from diabetes has nestled in the back of my consciousness and been something I’m peripherally aware of. But I’ve never been someone to be actively afraid on a day-to-day basis. It would be fair to say that blindness is one of my greatest fears, and that I’ve always wanted to try to stay healthy for my own sake, but the thought of complications, and their effect on my life alone, as a motivator for good control pales in to insignificance compared to the motivation to keep my babies healthy and to stay healthy for them.

I’m aware that this whole post sounds trite and twee, but it’s honestly true that where diabetes is concerned, I’d do almost anything for my children. I’m still far from perfect, and frequently get it wrong, but I am sure that I will never stop trying.

Walking a tight line

Top Tips For A Diabetic Pregnancy

Plan – Going in to pregnancy with more than 3 months of folic acid behind me and an excellent A1c made the early weeks much less stressful for me than I think they may otherwise have been. Aside from being less worried about potential complications, I didn’t have the problem of trying to drastically adjust what I was doing in terms of diabetes control. I’d already built in lots of good habits, so was free to focus on responding to the changes caused by my new hormonal status. I hated the thought that diabetes could be the thing to stop us trying to conceive once we were ready, but getting everything stable before we started was absolutely worth it.

Sort your hospital care out carefully – This is something I didn’t really do, and I ended up changing hospitals during the first trimester, which made for a bumpier ride than was probably strictly necessary. Think about the logistics of travel to your hospital both for frequent appointments, but also when it comes to actually giving birth. If there is more than one option locally, find out both about the general maternity services, but also what sort of experience they have in managing pre-exisitng diabetes in pregnancy. Ideally, you want to already know your diabetes consultant and DSN, and have a good working relationship with them.

Get used to lots of appointments – It can seem overwhelming. It can seem annoying, especially if you have a full time job to factor in. But all the appointments are there to make sure both you and the baby are well looked after. Try not to view them as an inconvenience and enjoy the unparalleled access to information about your pregnancy. Many non-diabetic women will be bemoaning the fact that they see their midwives so rarely.

However, Don’t be afraid to question what you are told, or what is usual “policy” – A lot of the care for pregnant women with diabetes is based on “one size fits all” policies. It’s essential that you are an active participant in the process though. If something is being suggested make sure you ask why. Ask what the alternatives are and what the risks and benefits of different approaches are. You can’t give informed consent if you haven’t been fully informed. It is often policy to see women with diabetes every two weeks, but in the early weeks, this felt excessive to me, as I was travelling a long way to talk about excellent blood sugars that we could easily have discussed by email. Remember that it is your body and your pregnancy. No one can “tell you” what to do. But at the same time, be sensible and respect the advice and experience of your health care team.

Test, test, test, or better yet, use a CGM – Honestly, I don’t think I have ever tested my blood sugars quite as much as I did during my pregnancy, and I don’t think I could have coped without a CGM to tell me which direction I was heading in at ay given time. The only way to have any chance of keeping your blood sugars as close to normal as possible is to know roughly where they are as often as possible. Testing, and writing down the results, is absolutely essential. You also need to be prepared to act on those results too.

Try to eliminate the lows – When you have the risks of hyperglycaemia drummed I to you frequently, lows can suddenly seem like a friend. Whilst it’s true that mild hypoglycaemia pose no threat to your unborn baby, it can carry risks for you. Frequent lows can lead to loss of the warning signs, which in turn increases the risk of severe hypoglycaemia, which may in turn put your baby at risk. Bouncing back from lows is also a major contributor to high blood sugars and a lack of overall stability. Eliminate the lows and it becomes easier to remain steady. Honestly.

Carb count carefully – eyeballing, or scientific wild guessing are no longer acceptable. The only way you can dose accurately for the food you eat is to know exactly how much you are eating. That means that wherever possible you need to weigh and measure your food. And you need to read food labels.

Low carb can be your friend – Eating low carb is a sure fire way to reduce or eliminate post-prandial glucose spikes. Low or no carb foods are also fantastic when you are hungry at a less than ideal blood glucose level. But don’t go mad. I had ideas pre-pregnancy that I would stick to low carb, and a limited range of foods whose effects I knew, for most of the pregnancy. This isn’t necessary and will make your pregnancy seem to last a lifetime. There is also some evidence that restricting carbs too much can be bad for your unborn baby.

Superbolus is definitely your friend – Minimising the post meal spike is one of the most challenging aspects of good control. The superbolus is a pump technique whereby you take some of upcoming basal along with your pre-meal bolus, and then reduce your basal rate to prevent a later low. This is much more difficult if you are not on a pump, but taking a larger bolus and then eating some of the carbs much later on is also a rough approximation. Bolusing 30 minutes before eating, especially in the morning, also gives your insulin a head start to increase the likelihood of its action matching the absorption of your food.

Don’t panic about occasional highs – this is so much easier said than done. I remember having a full on, tear soaked and snot-ridden melt down the first time I had a high blood sugar. People will throw around all sorts of analogies that are cheesy, but true: the occasional visit to the sweet shop for your baby won’t do them ay harm. It’s a fact of diabetes that highs happen, and you won’t be able to eliminate every single one. Just do your best to minimise them – with frequent testing, accurate carb counting and regular adjustments. Look at the bigger picture when faced with a high number. Frequent and sustained highs are much more of a problem than occasional spikes. It’s also easy to focus on the highs, so writing down all your results can help you to see that they probably aren’t as frequent as you think.

Night times really matter – If you can get your night time basal insulin sorted to keep you steady and in range all night, this not only gives you almost a third of the day within target, but also gives you a good waking blood glucose level which starts the day off much better physically and psychologically than a high or low number. It’s worth making the effort to test overnight frequently. This gets easier in later pregnancy as sleep gets harder!

Get comfortable making adjustments yourself – If you are the sort of person who tends to rely on medical staff to make the bulk of the changes to your insulin regime, get ready to change. The adjustments needed in pregnancy are too frequent to wait between appointments, or for someone to keep calling you back. By all means seek advice as often as you need it, but get used to trusting your own instincts. You live your diabetes every day, so you really do know it best.

Remember that the old rules don’t always apply – Four will probably not be the floor, unless you have severe hypoglycaemic unawareness. 3.5 will suddenly become an acceptable fasting level. Correction doses are no longer reserved only for numbers above , or 10, or whatever you used to use. 6.5 is now a number you can and should correct. You no longer have to wait 3 days to see a pattern. It’s OK to make changes on the fly.

Don’t be afraid to ask for medication for morning sickness – even if it doesn’t seem “that bad”. The effect of morning sickness for women with diabetes is very different than for women without. Whilst there is no doubt it’s unpleasant for everybody, trying to deal with bolus insulin and not knowing whether your food will stay down is an extra challenge you don’t need. If morning sickness is interfering with your efforts for good control, then taking medication is the sensible option.

Don’t expect non-diabetes staff in hospital to have a clue about diabetes – Be prepared to be your own advocate. Be prepared to take care of your own needs possibly throughout labour if you want – but certainly during early labour or if you are admitted for induction. Take plenty of your own test strips and medication. Also take plenty of food and treatments for low blood sugars – don’t rely on the hospital to have what you need when you need it, no matter how shocking that sounds!

Remember to enjoy your pregnancy too – Remember that there is more to this than just blood glucose levels, carb counts and estimated fetal weights. Try to set aside the focus on diabetes at least some of the time and enjoy your changing body shape, shopping for your new addition and feeling them kick and move inside you. Remember that you are a mum-to-be, not just a medical machine.

Remember, it’s only 8 months of your life – By the time you find out you are pregnant, there are only eight months to go. The obsessional focus on everything diabetes is finite. And you have the biggest motivation you’ve ever had. Once the pregnancy is over and you have your child in your arms, it will all seem more than worth it.

Diabetes During Delivery

What I didn’t include in all my lengthy posts about Thomas’s entrance in to the world is mention of my diabetes. I didn’t really want diabetes to intrude on those memories. To be perfectly honest, I didn’t want diabetes to be a part of it at all, but unfortunately there are no breaks from chronic medical conditions and even amongst all the turmoil of a failed induction and a very much unwanted c-section, my blood sugars still needed to be managed.

When I was admitted for the induction, it was agreed that I could stay on my pump, and monitor my own blood sugars, until I was in active labour. You may recall that I’d already had a frustrating discussion with my obstetrician about what would happen from that point. I’ll admit that I never had any intention of letting the hospital get in the way of what was best for me, but made a conscious decision to take things one step at a time. I was happy that they were happy to leave me to it to begin with, meaning I could save any battles for later. I was, however, told that if my blood sugar went above 8, I’d have to be transitioned to an intravenous sliding scale.

Of course, given that I was responsible for monitoring my own blood sugars, the easy way around this was not to tell them if I went above 8! But equally, I knew that there were good reasons for keeping tight control of my blood sugars at this final hurdle. So I set about managing them with military precision, using the task as something concrete to focus on during all the anxious waiting. Here, I can be honest and say that I did have a couple of blood sugars over 8, but since these were post-food and always came down quickly as the bolus insulin took effect, I wasn’t ready to own up to them. Similarly I stuck to treating lows myself with the stash of Lucozade and Jelly Babies we had amongst my bags. I didn’t trust the hospital not to want to treat low blood sugars with something wholly inappropriate – like milk, or hot chocolate, as I have experienced before, or rush to get me on to IV glucose that could start a whole unnecessary roller coaster soaring up high, and crashing back low.

On the day of Thomas’s birth, things were further complicated by the fact that I wasn’t allowed to eat anything in preparation for surgery. Since a c-section seemed so likely, I was actually made to fast from around 2am. The biggest challenge with fasting is avoiding hypoglycaemia, since treating it requires ingestion of food and so would instead have been an automatic transfer to intravenous glucose and insulin without passing Go and without collecting £200. With birth so imminent, I didn’t want to risk highs either, for a variety of reasons including not wanting to have a raging thirst, or hunger, whilst fasting, worry about healing less well if the surgery was performed at a higher glucose level and of course worry about increasing the chances of low blood sugars for my baby. My new “acceptable range” was between 4 and 7.

I’ll admit that I felt under pressure, if only from myself. With everything else slipping out of my control, I wanted to do something the way that I really, really wanted. By a strange twist of fate however, my body picked that very day to act a little as though I was cured. If it couldn’t do labour “properly” at least my blood sugars were behaving! I actually ran a temporary basal rate of close to or at zero for much of the day leading up to going down to theatre. I bounced along nicely just above the lower limit on the CGM, testing with a finger stick every 30 minutes to confirm. I was also tossed a life line by the lovely anaesthetics registrar who said that consumption of Glucogel was absolutely fine as it was so rapidly absorbed it would not pose a problem even with GA. In the hours before going down, I did consume the best part of a whole bottle to keep myself on the right side of the line. My final stroke of luck was having a midwife who herself had type 1 diabetes, and therefore completely “got” my need to do things my way, and fully supported me in that.

Testing Times

I was due a new insulin pump infusion set on the day of Thomas’s birth and I elected to put this in my arm so that it would be well away from the operating field. The CGM was more problematic. The week old sensor was on the left side of my abdomen, on the front of my hip. Right on the edge of the operative field. I assumed that I’d have to remove it and was nervous about flying blind. There wasn’t time to insert a new sensor and get it working, and since the first day often throws odd numbers anyway, I wouldn’t have felt the same confidence had I done this. To my utter surprise, however, I was allowed to leave the sensor in place, covered by a fresh piece of Opsite tape, which meant I could keep the CGM going throughout. Ian also kept my testing kit in his scrubs pocket whilst I was in theatre, although I can’t recall that we actually used it!

Once in theatre, diabetes went clean out of my head. I had bigger concerns about the spinal and whether or not I was dying. Ian, however, stepped up to the role we’d always planned for him to have, keeping a close eye on what was going on. We’d clipped the pump to the neck of my hospital gown and Ian diligently checked the DexCom line for me. Either the stress or the Glucogel caught up with me and he informed that I had double up arrows, indicating that I was rising fast. I opted to take a very tiny bolus to head off the high, but switched back to a zero basal rate again, ready to mitigate the effect of the removal of the placenta. I really didn’t fancy a crashing low. I did breach the high cut off, right at that last moment, but by then they were already opening me up and it was really too late to worry about.

I think the fact that I managed to keep such tight control, along with a few helpful healthcare professionals and not drawing too much attention to diabetes is what allowed me to get through with minimal fuss. Getting through with such brilliant blood sugars is a victory I want to claim all as my own, though. I’m still ridiculously proud of this graph form the day of delivery.

A short while after my transfer back to delivery suite, the DexCom sensor ended and needed to be restarted. Once I’d eaten, I commenced the pre-programmed lower basal profile on my pump – a profile much lower than my pre-pregnancy doses with the aim of avoiding hypoglycaemia whilst dealing with a newborn and to balance the possible blood glucose lowering effects of breast feeding.

Beyond this, diabetes doesn’t really feature any more in my thoughts or recollections. I am proud, for I have much to be proud of, but I’m so glad that this is the extent of what I can remember about diabetes on the day I became a mum.

Supertight

An almost “No-hitter” (A day in which there are no breaches of either the high or low alert thresholds on the CGM).

I’m ridiculously proud of this achievement, because obviously the closer together the lines, the harder it is to stay within them. This is supertight control.

I’ll be honest though, I cannot wait to loosen up these targets a bit once the baby is out of my body.

In To The Groove? Thoughts on the Animas Vibe and DexCom G4

I’ve been using my brand new Animas Vibe pump plus CGM for a week now, so I thought it was about time I reflected on the change which, in many ways, hasn’t actually been that big at all. Anyone outside Europe who is currently using the Animas Ping may be in for a bit of a disappointment if the Vibe, or equivalent, that becomes available in its place is the same as the Vibe that I currently have. The pump is essentially a 2020, with the Dexcom built in.

To be fair, there are some minor tweaks to the 2020 interface – some things have moved in place in the setup menus and there are forward and back arrows at the bottom of the menu screen to allow for easier scrolling. One of the big changes which is taking a massive amount of getting used to is that the results of bolus calculations are now auto-entered. So if the ezCarb and exbG functions suggest a bolus of, say, 4 units, the results screen will already have 4 units selected and you don’t need to scroll up from zero. I’d previously been told that Medtronic had protected this functionality and I think they’ve got around it by having a requirement to hit a button in the calculation result screen before the number shows up. But it is there and it’s a welcome change that will make bolusing faster once I stop starting to scroll up automatically!

However, there is no Ping functionality in the Vibe at all. There is no remote meter or remote bolusing. I have to admit that I find that disappointing even without having used the Ping. I think the Vibe has the potential to divide opinions because for some people having to fish their pump out to bolus, and equally to look at and deal with CGM alarms, isn’t ideal. Despite years of using integrated Medtronic CGM, I’m still on the fence. I expected to hate the separate Dex receiver when I switched, but now I’m worried I’ll miss it.

As for the CGM: First things first, the G4 transmitter is bigger than the Seven+ transmitter. As in, it sticks out quite a bit more. I find this a bit odd, but funily enough it’s exactly what happened to the Medtronic transmitter when they first integrated it in the pump. The original Paradigm Real Time 522/722 transmitter (the one with the little box and the wire, remember those?) was bulkier than the same style of transmitter that worked with the garage door opener Guardian RT unit. (I’m becoming quite disturbed by how many iterations of this technology I’ve now used!) I have no idea why this is, and don’t dare to hope it may mean a longer battery life. It’s something else that will take some getting used to though as it’s a significant enough difference that I keep accidentally knocking it on the surface of my skin.

As for some of the other features: well waterproof is nice, the same as previous Animas pumps, but as always, “waterproof” is really a customer service issue. There is nothing more waterproof about Animas pumps than Medtronic pumps, it’s simply that Animas will replace a water damaged pump. Medtronic will tell you tough luck if you deliberately submerged your pump and fried it. Cracks in the case of any pump render it non-waterproof and I’m convinced this is how my old IR1200 finally met its sticky end. And remember too that CGM works on radio frequency, so you won’t get CGM data whilst the whole system is submerged. (A team of pumpers recently swam the English channel wearing Vibes, and the CGM did pick up again instantly they exited the water).

The colour screen is actually beneficial where the CGM graphs are concerned. But here’s why: the graph disply is so small, in comparison to the stand alone Dex, that the colours are sort of needed to really see where you are. I was surprised at how different the display was, as the Animas screen is about the same height as the Dex screen. The issue is that it’s no where near as wide, so all the info displayed on the right of the Dex (current level, trend arrow etc) is squeezed at the top of the Vibe screen, with a consequent reduction in room for the graph. This is particularly apparent to me at the moment, as being pregnant I’m aiming for supertight control. You can’t easily visualise the difference between 4 and 6 on the graph as it stands.Personally I’d like to see some sort of option on the graph display to cut out the higher levels unless you hit them. A graph that usually shows 2.5 to, say, 14, might be adequate for a lot of people a lot of the time.

An important part of using CGM effectively involves looking at the trends over the longer term, as well as hour to hour. To do this, you obviously need to download the data to look at longer term trends. Personally, I’m a fan of the DexCom software. I found it easy to use and interpret and most importantly the download process was simple with the only drawback being the requirement to boot in to Windows – the slowest step in the whole process. Animas have done away with ezManager. (I’ll admit I never used ezManager for a number of reasons, so I can’t comment on how it compares) and now use a web based program called Diasend. Sadly this is a bit of a disappointment for me. It uses the same awful upload system that drove me batty with Medtronic, balancing the pump on a dongle and holding your breath that the transfer goes through. My first attempt hung FOUR times before the data transferred, which is particularly frustrating as you need to suspend insulin delivery whilst the transfer is being attempted, as well as losing CGM functionality – no new readings will be collected during this time. I’d much rather see a Dexcom style cable which actually plugs in to the pump. I know this could be an issue with waterproofing, but something has to be possible. I obviously don’t have a lot of data yet, so I’ve not totally got to grips with Diasend, but I definitely miss the overlaid Modal day as this was my most used DexCom report. I understand that direct sharing of data with your healthcare professional may be important for some people, but personally I don’t have a problem just emailing the reports. The content of those reports, and the ability to customise them, is much more important to me. So far I’ve spent a lot of tme searching for the data and eventually resorted to exporting it all in order to create my own trend graphs. Definite FAIL.

One more peculiarity that comes from the abandonment of ezManager: the option to access a food database is still on the ezCarb screen, but without ezManager, there is no way to set this up, so it’s essentially an empty menu. The User Guide states “the “Food List” option … is not yet operational with the Animas Vibe Insulin Pump you received with this Owner’s Booklet.” Which perhaps implies it will become functional at some point in the future. Not a biggie for me, since again I’ve never used a food database in my pump, but an oddity nonetheless.

The final big question: Is the G4 Sensor better than the 3rd generation sensors? Too early for me to call, especially as I haven’t really experienced any accuracy issues with the previous sensors. For the first few days I actually ran the DexCom alongside the Vibe for a bit of fun. It probably wasn’t a particularly fair comparison as the old Dex sensor was already a week old and I find that the accuracy of the sensors tends to be at its worst during the first 48 hours. But the old DexCom did win on picking up a low first on the first evening, although the Vibe caught up fairly soon. However, there’s a big but in this at present. Whilst I’ve not noticed a difference in results when the sensors are working, getting the G4 sensors to work has been more problematic. In just one week I’ve had to have two G4 sensors replaced as faulty, which is not a good ratio. I was surpsied to get several “ANT” (which somehow means “Out of Range”) alerts on my first evening using the Vibe – strange as the pump (and so receiver) is attached to me! I later got an “ERR 0” when I calibrated, which a cnsultatio with the user manual told me that I needed to wait 15 minutes and then recalibrate – something I have never had the equivalent of on the standlone Dex. Frustratingly though, when you recalibrate – for which there is no reminder – there is no real feedback. It takes the number and either works, or continues to display “ERR” leaving me unsure of whether I’d not waited long enough or where the problem lies. The first sensor dies completely on the second day, and the one I replaced it with also refused to be calibrated after 2 days.

Not the best start, especially when met by a customer service response of “Oh, we’re all still being trained on this. The only person who can help won’t be on until Monday….” But credit where it’s due, two new sensors dispatched and received rapidly, and the current sensor is so far trouble free.

I can say that I definitely prefer this to the (equivalent) Medtronic Paradigm Real Time 522 and 722 pumps that I used. Even leaving aside the sensor issues I experienced , the interface and display is far, far better. But I’m not 100% sold on the Vibe yet as, honestly, there aren’t any obvious benefits over the two part system other than having one less thing to carry and lose. And funnily enough, I do miss the extra receiver. We’ll see how it goes over the coming weeks, and how I feel about less stuff to carry when I’m schlepping a baby and all its equipment around!