Having been looking at insulin pumps for about a year now, it’s plainly obvious that there are different standards in operation globally regarding healthcare sign off, but equally, different manufacturers have targeted different features for different audiences. There is, however, one truism about the insulin pump.
What it does is, very simply, pump small increments of insulin, continuously, via a subcutaneous cannula. Once you get beyond that, the functionality becomes about how you can apply variations and “cleverness” to make managing that process much easier.
With my pump having been my best mate for only a month, I’ve already drawn a few conclusions about what I like about it and what I’d like to improve.
- Remote control
- Integrated blood glucose monitor
- Simple to use
- Variety of usable transfer systems thanks to Luer Lock
- Connectivity to Diasend
- Pump interface
- No CGM interface
- Full remote control
- Multiple Basal Rates (minimum five)
- Standard, Extended, Multiwave and Super Bolus modes
- TBR in 5% intervals
- Minimum increments 0.01u (but customisable)
- Open bluetooth protocol
- CGM integration for Medtronic Smartguard like application
- Upgradeable CPU ROM to allow for BiAP future-proofing – if it has to last four years I’d like to have Artificial Pancreas capabilities
- Basal Rate maintenance on pump (allowing for remote to be placed elsewhere)
- Smartphone integration
- All data uploadable to a standard platform not a manufacturer proprietary platform – a standard platform can be something industry standard, not necessarily an open platform, although I’d like to thing that the manufacturers could get together and create “Dia-FIX” so that they all used standard protocols for communication
- Customisable alerts so that different sounds/pulse patterns can be used for different things
Tubed Pump customisations
- Uses standard insulin penfill cartridges (and can be adapted to different manufacturers cartridges)
- Luer Lock connector (nothing proprietary thanks)
- Clips designed so insulin comes from bottom of reservoir, not from the top where the bubbles are
Patch Pump customisations
- Max 200u reservoir (as a patch it needs to be relatively small)
- Angled or perpendicular cannula
- Can be used as a patch or tubed pump (similar to the Cellnovo model)
- Full pump control system (similar to Combo or Insight, not just bolusing like Medtronic)
- Smartphone performance level, i.e. base it on something like Android with a custom skin but a decent battery
- CGM integration
- Blood test meter (preferably using the cheapest available NHS strips to make them easily accessible, e.g. SD Codefree) which should be able to test blood ketones
- Data reports including BG trends, variance, etc and overlays with carb and bolus values integrated with existing food databases
Fundamentally, it should be a system that can communicate with either of the pump hardware options using a standardised remote/software package, so that you have the possibility of using either.
One criterion, several criteria.
Otherwise, good points, exept: an artificial pancreas isn’t feasible!
Thanks for the feedback. If you’ve read the rest of the site, I would hope you’ve changed your mind as Automated Insulin Delivery is very feasible and has been in use for some time.
Haven’t you noticed how small the improvements are in all published studies? Yet they are always exaggerated (but you have to be good at statistics to realize that). And CGM data are low-pass filtered so that tops and valleys get smaller.
With the one approved and widely used commercial system that’s out there, yes I’d agree that the improvements are not earth shattering. Likewise, the DIY systems don’t tend to show massive improvements in Hba1C or Time in Range indication, although many of the people using those start from an already pretty impressive position.
What you’re failing to take into account is the other benefits that people see, namely in relation to reduction in hypoglycaemia, which does tend to show much better results, and also in quality of life. When using CGM alone, waking up in range, day after day with no overnight alerts for lows is not that easy. Both the DIY and commercial systems do allow for this to happen, and these are the factors that people find most refreshing about them.
We often focus on clinical outcomes to the detriment of quality of life/psychological ones, and those are where much of the benefit can be found.