Path: senator-bedfellow.mit.edu!faqserv
From: summers@cs.utah.edu (Jim Summers)
Newsgroups: misc.health.diabetes,misc.answers,news.answers
Subject: misc.health.diabetes insulin pump discussion
Supersedes: <diabetes/insulin-pump-disc_888320485@rtfm.mit.edu>
Followup-To: misc.health.diabetes
Date: 10 Mar 1998 13:06:00 GMT
Organization: Paleolithic Refugia
Lines: 730
Approved: news-answers-request@MIT.Edu
Expires: 24 Apr 1998 13:05:39 GMT
Message-ID: <diabetes/insulin-pump-disc_889535139@rtfm.mit.edu>
References: <diabetes/faq/part1_889535139@rtfm.mit.edu>
Reply-To: summers@cs.utah.edu
NNTP-Posting-Host: penguin-lust.mit.edu
Summary: An extended discussion of insulin pump usage, models,
	and features.
X-Last-Updated: 1996/05/19
Originator: faqserv@penguin-lust.MIT.EDU
Xref: senator-bedfellow.mit.edu misc.health.diabetes:78210 misc.answers:7286 news.answers:125169

Archive-name: diabetes/insulin-pump-disc
Posting-Frequency: biweekly
Last-modified: 28 Sept 1995

=====================================================================
Subject: Introduction

                        Insulin Pump FAQ 2.0
                                 by
                             Jim Summers
                  Last Modified:  Sept 28, 1995

            Copyright (C) 1995 James D. Summers 

Permission is granted to make and distribute verbatim copies of this
document provided the copyright notice and this permission notice are
preserved on all copies.  No changes may be made to this document. Copies
may be sold for profit only with the express permission of the author.

=====================================================================
Subject: Contents of the Insulin Pump FAQ

       Disclaimer
   A.  Brief description of insulin pumps
   B.  Pump Issues
      1) Basal Rates
      2) Battery Life
      3) Water Resistance
      4) Ease of Use
      5) Daily Dosage
      6) Wearability
      7) Ease of Button Use
      8) Representative Service
      9) Durability
      10) Easy visual checking
      11) Occlusion Alarms
      12) Type of syringe (glass vs. plastic)
  C.  Types of Insulin to Use
  D.  Buyer's Guide (updated to December 1994)
  E.  Representative Information and Available Publications
  F.  Notes

=====================================================================
Subject: DISCLAIMER (an unfortunate but mandatory part of any modern document):

THE AUTHOR MAKES NO WARRANTY OF ANY KIND IN REGARD TO THE CONTENT OF THIS
DOCUMENT, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OF
MERCHANTABILITY, OR FITNESS FOR ANY PARTICULAR PURPOSE. THE AUTHOR OF THIS
DOCUMENT SHALL NOT BE LIABLE FOR ERRORS CONTAINED IN IT, OR FOR INCIDENTAL
OR CONSEQUENTIAL DAMAGES IN CONNECTION WITH THE FURNISHING OF, USE OF, OR
RELIANCE UPON INFORMATION CONTAINED IN THIS DOCUMENT.

=====================================================================
Subject: general insulin pump info from Diabetes Forecast

The following is from _Diabetes Forecast_, October 1992:

The insulin pump is not an artificial pancreas because you still have
to monitor your blood glucose level. But many people prefer this
continuous system of insulin delivery over injections.

Insulin pumps are miniature, computerized pumps, about the size of a
call-beeper, that you can wear on your belt or in your pocket. They
deliver a steady, measured dose of insulin through a cannula (a flexible
plastic tube) with a small needle that is inserted through the skin into
the fatty tissue and taped in place. In the newer catheter products, the
needle is removed and the soft, Teflon catheter remains in place. On
your command, the pump releases a bolus (a surge) of insulin; this is
usually done just before eating to counter the rise in blood glucose.

Because the pump can release an incredibly small dose of insulin
continuously, this delivery system most closely mimics the body's normal
release of insulin. Finding this ideal basal rate for continuous flow
plus the appropriate boluses for your body requires time and a great
deal of communication between you and a health-care team that is
familiar with insulin pumps.

Insulin pumps are not for everyone. To use a pump, you must be willing
to test your blood glucose at least four times a day and learn how to
make adjustments in insulin, food, and exercise in response to those
test results. You also need to understand that an insulin pump will not
cure diabetes - and in fact may even require more work than your
previous treatment plan.

You'll want to check with your insurance carrier before you buy a pump
and all the supplies, although most carriers (except Medicare) do cover
these items.

Many people have chosen the insulin pump because they believe it enables
them to enjoy a more flexible lifestyle. Pumps deliver very precise
insulin doses for different times of day, which in many instances are
necessary to correct the pre-dawn phenomenon. Before you consider pump
therapy, ask yourself: Am I willing to assume this level of
responsibility for my diabetes care?

It is easier to spill ketones if there is a blockage or disrupted flow
when you are on a pump because you have no long-acting insulin in store.
The hardware can be awkward at times because you wear it 24 hours a day,
and you have to be fastidious about cleanliness, so it's not for
everyone.

End Article

=======================================================================
Subject: General insulin pump info from the FAQ author

Further information is written by Jim Summers, and is my *opinion*.
Please do not make any heath care decisions without first consulting a
Health Care Professional.

The above article and my notes below may make the pump sound like a
difficult device to learn.  This is *not* the case.  Those I have talked
to have adjusted to the pump very quickly, and love it.  People also tend
to worry about "programming" the pump; however, this falls into a couple
of very easy to learn items and the fact that you are gaining much
better control tends to make one very confident with the programming, not
fearful of it.

Another common misconception is that a device is "inserted" into the
abdomen or that surgery is involved.  All that is involved is a simple
needle with plastic tubing attacked to it.  Using it is very similar to
an injection, except the needle stays in (attached with tape) for a while
longer.  

An insulin pump delivers Regular insulin 24 hours a day at a set rate
("basal rate"), plus it gives you the ability to "bolus" at meal-times
to account for the influx of calories.  Some are waterproof or
"water-resistant," others are not.  The pump has a line (tubing) that
runs from the pump to a site (usually in the abdomen) that the user
changes every 2-4 days.  Some people seem to wear the same site for
many days, others have to change the sites very frequently.  Insulin
travels from the pump to the body through an infusion set. The
infusion set is a piece of plastic tubing that has a threaded end to
connect to the pump. On the other end is a needle or a Teflon
catheter.  The infusion set is one of a few different types: a
straight or bent needle, with or without a butterfly to help hold the
set in, or more expensive Sof-Set catheters. I use a catheter with a
Tegaderm covering.

=====================================================================
Subject: my personal experience with insulin pumps

As far as different models go, I have personally worn the following:

Betatron ][              6 years  [DISCONTINUED]
Betatron IV              3 months [DISCONTINUED][RECALLED]
MiniMed 504             11 months 
Disetronic H-Tron V100   3 days (loaner test)
MiniMed 506              Since 12 November 1992

I rate the two pumps currently in production below (the MiniMed 506 and
the Disetronic v100), applied to criteria that I personally think are
important.  The items are presented as a list of things to look for in a
pump.  I will reference older pumps sometimes in order to mention good
features that they had when looking at the newer pumps for comparison
purposes only.  All comments given to me are edited for brevity and
inserted.  My thanks to those who contributed to this document, especially
those who helped with information about their use of the v100. 

=====================================================================
Subject: Should I try an insulin pump? What should I ask about?

When looking for an Insulin Pump, most brochures say something like the
following: 

  "You are prime to be considered for a pump _if_ you:
  o  desire to maintain closer control of blood sugars
  o  do not have rigid schedules but wish rigid control
  o  are willing to test your blood sugars more frequently"

>From there, there are a number of things to consider about a pump, one
of the biggest being, "Will my insurance pay for this thing?"  After
that, you choose a model.  There are a lot of things to consider.

Below is generally what *I* think is important, with added details and
issues brought forth by other pumpers, and a rep from MiniMed and
Disetronic. (My rep was here for questions while I edited this; I called
Disetronic and asked them relevant information.  I also got a lot of
feedback from a couple of v100 users to balance my comparisons).  Your
Health Care Professional may disagree, and you should discuss any
decisions with them.

====================================================================
Subject: 1) Number of basal rates.  

Do you need different rates at different times of day?  [506:6],
[V100:24].  The V100 definitely wins here -- you set every hour of the
day: Very nice, but also very unnecessary. You probably don't need more
than 4. (I use 5, but I am playing with it right now.  I had no problem
using only 4 with the MiniMed 504.)  Over the life of the  pump, your need
for basal rates may change.

Another subject here is "Temporary Basal Rates".  This is a rate that you
can turn on quickly (as opposed to programming it in for two hours, then
taking it out).   One uses such rates for intense activity, or rarely for
sedentary activities (thus, one could cut one's normal rate in half for a
few hours of racquetball, or increase the rate slightly if you were going
to be on an airplane for a few hours or had the flu).  The 506 allows 
setting the rate to any setting, for any length of time in 30 minute 
increments.  

The V100 will only decrease the basal rates, and only by units of 25%,
50%, 75%, and 100% (though this is generally enough for just about ANY
situation you might run across) in a two hour shift only.  However, if
you needed to up your rate (due to illness or menses enforced inactivity)
you could not do this with the V100.

====================================================================
Subject: 2) Battery life.  

The 506 uses 3 watch batteries (357s).  You change them approximately
every 1.5 months for about $6 for 3.  I also like the fact that you can
just run to any store and buy new batteries for the 504/506 any time of
day.  You have to order the V100 batteries.  The V100 uses two Disetronic
batteries.  They cost $75/10. One battery is for electronics and one is
for the pump motor. Each battery needs to be replaced every 2-4 months. 

The V100 has one battery dedicated to electronics and one to pumping,
while the MiniMed Pumps run the electronics and the pump off of the same
batteries.  I don't see how this could possibly affect how the pump works
or make one pump better than the other.

V100 batteries are more expensive, and cannot be purchased off the shelf.
However, their batteries allow waterproofing, while regular batteries
would not.  MiniMed's battery carrier is waterproof.

Battery life:
  506:  3 Eveready 357 / 1.5 - 2 Months
 V100: ~4 Disetronic   / 6 Months

====================================================================
Subject: 3) Water-resistance.  

Can I take it into the shower?  Can I get it wet?  If I get pushed into a
swimming pool am I out an insulin pump?  The 506 is "water-resistant," or
"splash proof," depending upon the rep you talk to.  You aren't to take
them into the shower or submerge them, but anecdotal evidence from users
suggests that an accident isn't going to destroy the pump.

The V100 has a "cap" that you can put on the cartridge housing to make it
fully submergible.  You cannot fly with this cap in place because it
covers openings that allow for pressure change.  However, even without
the snap-on cap the pump is practically waterproof.  Users have showered
without it, and have accidently submerged it, without any problems except
that the housing needed to be dried out with a paper towel.

A lot of this discussion may become moot as better infusion set
technology comes out.  MiniMed has a "Sof-Set-QR" (for Quick-Release)
that easily takes the pump off for bathing, etc.  Both ChroniMed and 
Disetronics and expected to release similar products in the near
future.

====================================================================
Subject: 4) Ease of figuring out how the damn thing works.  

If I'm in insulin shock, I don't want to remember a 5 code key sequence
to stop it.  The 506 EASY, V100 MEDIUM.

The 506 is menu driven, push one button at a time, type of operation.
One button is a menu that flips you to different screens (bolus, basal
rates, daily dosage, special items, HOLD, etc.).  I favor the 506 over
the V100.

The V100 is command driven. Different key combinations do different
things.  V100 users say that they can program their pump without really
looking at it (it beeps clearly); I would never try this on the 506. 

In sum, while both machines will take a bit to get used to, I believe
that once you start using one it will quickly become second nature to
use, and will not seem unusual or difficult at all (and the other
pump will seem odd).

====================================================================
Subject: 5) Daily dosage.  

How much did I take today?  Yesterday?  The day before?  Knowing how much
you took before is a GREAT way to enforce dieting -- if I stick to 35-40
units a day and stay in control, I lose weight. Easy, eh?  If I took 60+
units yesterday, it means I snacked too much, even if I am in control: 

                V100 Amount from 12am; last bolus, regardless of time
                506  Memory of last 7 days, 12am to 12am.

Some people don't really care how much insulin they had the day before.
It's a matter of taste and what you rely on to help control your Bgs.
The 506 has it if you want it; the V100 isn't useful here unless you
want to check it at 11:59 to see you dosage for that 24 hour period.  The
506 also has memory of the last 7 meal boluses, (useful for checking how
much you have bolused in the last 2-4 hours before taking another bolus),
the v100 only has one.

====================================================================
Subject: 6) Where do you wear it?  

The 506 has a belt clamp that is great -- I don't have to wear a belt, it
has a beeper-like hook on it.  The V100 can be worn on a belt or like a
beeper by threading it through the carrying case. Both pumps are small
enough for many women to tuck into a bra (around 3oz.).  I would rate both
pumps even on this.  Pumps can be worn on belts, in pockets, tucked in
socks, under panty hose, or hung with velcro on bras (under arm or in
cleavage).

Both also have cases that can be worn with the pump.  These cases have a
flap that you can raise to access the buttons on the pump.

====================================================================
Subject: 7) Easy-to-press buttons.  

506 YES, V100 YES.  The 506 has inset buttons like most modern microwave
ovens.  You may have to press them more than once before you get a signal
through.  The V100 has big pooched out blue buttons, placed so you can
hold the pump and press the buttons at the same time with one hand.  The
506 needs two hands or one hand and your full attention.

MiniMed argues that it's just "appearance" that pressing a button is
harder, but actually it doesn't take as much pressure as the actual
button on the V100.  I still like the V100 better.  Other users
have disagreed with me here, stating that you also have to press
buttons on the V100 more than once, and if you mess up it is harder to
back up a little rather than starting over.   In sum, try both pumps out
and see what your fingers like better.

====================================================================
Subject: 8) Fast representative service

I haven't worked much with Disetronic, but they seem eager to please and
offered alternatives for whom to meet with.  MiniMed has worked very hard
to increase their customer service, I have no complaints about them.  They
have been in contact with me about this FAQ, offering suggestions and
articles about pumps and insulin in general that I found very useful.  

I have heard only high praise for Disetronic, and have had good dealings
with them myself.  However, these dealings were all in relation to this
FAQ rather than as a customer.

MiniMed's Clinical Services department is truly awesome -- they have been
very quick to help me with any physical problem with my pump, and have
bent over backwards to make sure that I have gotten good service from it.
I give them my highest praise.

I would *strongly* suggest that you get a rep. you can work with.  If you
don't get along with your rep, then you aren't going to be comfortable
calling him up at 2:00 AM telling him your pump broke and you need an
immediate replacement can he help please? (Actually, you should be
calling the 1-800 number in such a situation, but reps are who you deal
with most often).
 
====================================================================
Subject: 9) Durability ("Can I drop it on concrete?")  

I haven't tested this thoroughly, but I certainly drop mine a lot.  Be
sure to ask about fragility.  I have dropped the 506 numerous times on a
variety of surfaces, and it is usually unfazed.  However, a few times I
have dropped it and it has reset completely.  This is a good safety
feature, but slightly annoying when you're in a hurry (on the other hand,
I guess a seat belt is too).  The casing has chipped a little, but the
pump runs just fine. 

I think the V100 would win here -- it has molded, rounded plastic that
looks like it could star in one of those luggage commercials.  V100 users
say they have dropped it everywhere with no problems. 

It looks like both companies know that pumps must be very durable to be
able to take unexpected impacts, and have built them to last.

====================================================================
Subject: 10) Visual Checking

Can I visually check the insulin level and determine if I am indeed
getting correct dosages? 506 YES. V100 SORT OF. 

Actually, for the 506 you need only look in a little window.
Alternately, you can lift a small lid and look.  For the V100 you need to
unscrew the syringe from the pump, take it out (the drive shaft will come
too) and then look at the syringe.  The V100 has an unmarked glass
syringe; the MiniMed syringe is plastic and has markings every 20 units
along the outside.  

The v100 now has a new "clear" plastic pump case.  You can see through
this case into the cartridge and visually check the amount of insulin for
those that desire visual checking.  Note that the V100 does count down
with a counter how many units it thinks you have left.  However, this
number is artificial -- it starts at 315 units and goes from there, but it
doesn't REALLY know if you started with 315 units or not.  If you fill
your syringe correctly it should be close, but I'm paranoid, and I like
visual checking. 

====================================================================
Subject: 11) Occlusion

When does the occlusion alarm go off (i.e. the alarm that tells you
that you haven't been getting insulin, that the line is somehow jammed).
This is an important feature.  Personally, the occlusion alarm tends to
go off because the syringe in the pump is empty, not because of jamming in
the tubing (see the Polyfin discussion).   MiniMed and Disetronic have
different things to say here, I'll give you what the reps gave me in both
cases:

                              **MiniMed**
  PSI occlusion alarm    MiniMed  504/506:         4-11 psi (~2.5u)
                         Disetronic H-Tron V100:  14-35 psi (~10 u)

                              **Disetronic**

  The pressure we are talking about is too sensitive to really gauge
psi -- those figures are bogus.  Actual rates are influenced by a
number of factors:

 o type of infusion set
 o battery age and strength
 o usual basal rates

This usually causes an alarm to go off on all pumps between 3-9 units,
and it doesn't really matter which pump you use.  The quote here was
that MiniMed's numbers were "irrelevant."

Note that the v100 operates at a higher pressure, and thus can often
overcome occlusions as the pressure builds.  This is why the occlusion
alarm goes off at a higher psi (obviously, this doesn't help if the
cartridge is empty).

                              ** Me **
I disagree here.  I often suffer from "Out of Insulin" occlusions.  I want
an alarm to go off as fast as possible, and the papers I have read
indicate that the 506 does alert earlier than the v100.

I would note two things here.  The first is that most patients only
rarely experience a clog or jam.  My only experience with them in the
past few years is 95% due to empty syringe alarms.  Depending on your 
schedule, you may experience this alarm quite a bit if you forget to
fill the syringe as needed.

The second is that it is recommended you NOT use Sof-Sets with the V100,
because insulin will leak out the top flap of the catheter before the
occlusion alarm goes off if a blockage occurs at the tip of the cannula.
[Sorry, got ahead here.  The Sof-Set is a catheter infusion set, VERY VERY
comfortable.  There is a small area where you pull the "introducer needle"
out that can cause problems with the higher pressure V100 occlusions
alarm.].  Note that some users on the net have reported using the Sof-Sets
with no problem.  MiniMed is *very* opposed this -- the v100 simply runs
at a pressure that is too high for the Sof-set.  I realize a lot of this
paragraph sounds like "technese".  To  sum up, it is a possible hazard to
use Sof-Sets in the v100, so don't do it.

Both Disetronics and ChroniMed are about to start distribution in the U.S.
of a new detachable catheter infusion set.  It should be usable for both
the v100 and the 506 (I don't have any technical papers supporting this at
this time). 

====================================================================
Subject: 12)  Glass vs. plastic syringes.

At one point there was concern that plastic tubing/syringes could degrade
insulin.  With the development of Polyolyfin Tubing, this is no longer a
major concern.  (Also, see the "INSULIN" chapter below).

The Disetronic uses glass syringes.  This means that you can't be as
casual with it (glass breaks easier than plastic), but it isn't a big deal
-- the glass is fairly strong.  The MiniMed is made of plastic, so you can
clamp the tubing, remove the syringe and let it hang free while you shower
or such.  Neither manufacturer recommends re-using syringes, as there can
be erratic delivery when lubricant in the syringe is lost, and because of
the chance of infection.

=======================================================================
Subject: C. Types of Insulin

Before the introduction of MiniMed's Polyfin Tubing there was concern
about insulin crystallizing in the tubing.  The solution was to use
"Buffered Regular", an insulin designed specifically for pump users for
the purpose of causing fewer occlusions due to crystallization.  Now that
Polyfin has been developed, this isn't really an issue.  If you feel you
should use Buffered Insulin, then by all means do so.  On the other hand,
if Regular isn't causing you any problems, then there is no need to
switch. Let your Doctor guide you here.  If you are a pump user
experiencing many occlusions, then I would suggest switching insulin to
[buffered/ unbuffered] and see if that helps.

I called the two major insulin producers (Lilly and Novo Nordisk), and
got the following information:

LILLY:  They refused to say that their Regular insulin would go into a
pump.  They instead referred me to the pump manufacturer.  Nonetheless,
I have used Lilly Regular for the entire use of my pump with no problems
whatsoever. [NOTE:  Lilly used to make Buffered Regular Insulin, but
discontinued this a few years ago.]

NOVO NORDISK: Makes of Velosulin.  I received a flyer in the mail in May
1995 showing a picture of an insulin pump next to a bottle of their
insulin, part of their boast that their Regular insulin has always had a
buffering agent in it.  They produce a "Buffered Regular" (Velosulin BR).

Begin Article

Quoted from MiniMed Newsletter, with permission:
           "Confused About Insulins?"  
         by Linda Fredrickson, MA, RN, CDE

Over the past few months customer confusion regarding insulin has
increased and so have the number of calls to Clinical Services.  Because
several popular buffered insulins were recently discontinued, people want
to know which insulin to use in their pumps.

When pumps were first used in the late 1970s, only animal insulins (beef
and pork) and infusions sets which were not insulin-friendly were
available.  At that time, a study demonstrated less clogging with
phosphate buffered pork insulin and many centers began using phosphate
buffered insulin for their pump patients.

However, today MiniMed infusion sets are made of an insulin-friendly
material (Polyfin(R)) and are less likely to cause the insulin to clog or
lose its potency.  Currently there are several types of regular insulin
used in the pump these include Velosulin(R) human which is buffered and
the unbuffered insulins, Humulin(R) R  and Novolin(R) R.  It is important
for pump users to better recognize the problems with clogging and potency
(unexplained high blood glucose values signal these problems) and to
consult with a health professional regarding appropriate substitutions IF
they experience problems.

End Article.

=======================================================================
Subject: Buyer's Guide

This is the pump comparison that _Diabetes Forecast_ published in their
October '93 Buyer's Guide.
[UPDATED as of December 1994] 

Two pumps compared:      MiniMed 506
                         (MiniMed Technologies)

                         H-Tron V100
                         (Disetronic Medical Systems)

Size (inches):           (506)  3.40 x 2.0  x 0.8
                         (V100) 3.36 x 2.16 x .75

Wgt. (ounces):           (506)  3.6
                         (V100) Less than 3.5

Battery type/life/cost:  (506) Three 1.5-volt 357 batteries (2-3 mo. life).
                         Available in many retail or jewelry stores 
                         (V100) Two 3-volt silveroxide. 2-4 mo. life.
                         Available from Disetronic and their distributors.

Infusion set:            (506)  24" & 42" Polyfin (insulin-compatible
                                tubing). 24" & 42" Sof-set (non-needle).
                                Sof-Set-QR.
                         (V100) 21", 31", 43" co-extruded insulin-
                                compatible tubing, straight or bent
                                needle, with or without butterfly. New
                                line of catheter products due Nov. 1995

basals (# & range):      (506)  6 profiles, advanced temporary basal
                                rate (can deliver more or less insulin
                                for a set duration of 30 minutes to 16
                                hours). range: 0.0-25.0 u/hr.
                         (V100) 24 plus temporary. 20 deliveries per
                                hour at any programmed rate. range:
                                0.0-10.0 u/hr.

smallest bolus:          (506)  0.1 unit
                         (V100) 0.1 unit

insulin concentration:   (506) u100, u50, & u40
                         (V100) u100

alarms:                  both pumps have alarms for occlusion, runaway,
                         and near empty.

warranty:                (506)  4 yrs. with lifetime motor guarantee
                         (v100) 4 yrs. of use 

features:                (506)  Toll-free 24-hour service and support.
                                memory recall (up to seven days). Pump
                                conducts a safety check every minute,
                                every programming change, and before
                                each motor stroke. free video on pump
                                therapy. waterproof, floatable, and
                                impact-resistant protective case
                                available.
                         (v100) Patient receives two pumps and free
                                safety inspections. The pump is
                                waterproof without an additional case.
                                Pump performs safety checks as well.
                                video and manual available. toll free
                                24 hour support service. The pump is
                                compatible with all infusion sets.
                                [ED NOTE: MiniMed says their 
                                Sof-Set and Sof-Set-QR is incompatible]

====================================================================
Subject: Representative/Company Information: MINIMED TECHNOLOGIES

DeNetta Elmo (800) 933-3322 x3463 is the current MiniMed patient 
information coordinator.  She wears a pump and answers calls from 
people considering pump therapy.  She can send out packets and 
videos to callers.  She can also get you in touch with your area
representative.

cost: 
  MiniMed 506  : $4095

Test Policy:  MiniMed has a "Trial-Run" program, as well as trade-in and
rental programs available so that you can test a pump with purchasing it. 

Publications: "Introduction to Insulin Pump Therapy" a published FAQ
about pump therapy by MiniMed, is a free publication.  This is the best
thing to get to start you deciding if you want to use any pump or not.  I
personally have a copy, and I give it 5 stars. You can order this at the
1-800 number.

"The Insulin Pump Therapy Book: Insights from the Experts" -- Written for
Physicians and Nurses, it is useful for pump users in that it is an
authoritative and complete reference book written by medical leaders in 
the field.

MiniMed also has a newsletter which comes out a couple times a year.  They
have generally informative articles and testimonials.

Videos:  "Beyond Injections" -- interviews with pumpers from various
backgrounds, etc.  the rep was big on this -- sounds like those
people on "you may already be a winner" to me.  It's gone through a
revision recently, and is really supposed to be pretty good.  It does go
in-depth on a number of issues.

Symposiums:  MiniMed hosts a number of symposiums around the country in
order to introduce doctors and nurses to pump therapy.  They've been doing
this for quite a while, explaining the concept of pump therapy to the
medical community and educating them on the nuts and bolts of how insulin
pump therapy works.

Web access:  MiniMed has just set up a web page!  The address is
HTTP://WWW.MINIMED.COM, and you can order more information from MiniMed at
that site.

Comments about Disetronic: The rep. was down on Disetronic for a
variety of reasons, the two most important being the PSI argument
presented above, and the fact that if you leave on the cap you can get
a bolus problem from the v100 in an airplane, and if the cap isn't
on, your pump isn't waterproof, only water-resistant.  FAQ 2.0 tries to
address these issues above in the Q&A issues.

NOTES BY JIM: V100 users note that getting the pump wet without the cap
is not a problem. 

======================================================================= 
Subject: Representative/Company Information: DISETRONICS

I called the Disetronic 1-800 number and talked to a rep there, here is
the information I got from them.  

Number to call for more information: 1 (800) 688-4578

Test Policy:  Depends on local distributor, but basically:
Fill out paperwork to purchase (i.e. insurance data and bio). then you get
30+ day trial.  *OR* often your doctor will have a loaner, and then you
don't need the paperwork.  He sounded like this was the best way to go. 
Also try your local diabetes support group.  They might have loaner pumps
(our local diabetes supply store had a loaner it was willing to share on
test-drives) available for testing as well.  I have heard that they have
a trial-run program, a rental program, and a trade-in program.  Be sure to
ask about all of these options when you talk to them.

cost:  $3995

For this you get 2 pumps (one backup), each with a 2 year warranty. Each
pump is programmed to run for two years. You get "end of use" warnings
before the two years expires. At the end of the two years, you return
the pump to the company. They service it and return it to you with
another two years on it. There is no charge for this unless the pump
needs repairs not covered by warranty. You can continue this cycle
indefinitely.

Videos: untitled.  Introductory video on pump use, why pumps are good,
basics of programming the v100.

====================================================================
Subject: Representative/Company Information: Jim's notes

Now that the reps have had their bit, remember that they are trying to
sell their product.  Personally I think both of these pumps are good
pumps.  I went with the MiniMed because that's what I was started on. 
With this document in hand, you might want to have a deeper discussion
with your doctor about which pump better meets your needs.  He probably
will prefer one over the other simply because that's the one he is most
familiar with.  That's a bad reason for you to go with that pump.  You
should take a look at both of them and see which one fits your
requirements better. 

Also, remember that both pumps may come with various amounts of "sugar,"
i.e. more batteries, syringes, a couple Sof-sets and different types
of skin tapes.  This helps ease the initial cost of the pump, but
remember that you have to buy these same items for as long as you own
your pump.  Both companies are obviously quite willing to give you
incentives to buy their pump; a large portion of their income is
based on these disposable items rather than the pump itself (just like
test strips are the costly portion of a blood test kit).  I encourage
you to try to get all the "freebies" you can when you order your 
pump through your rep.

Finally, I would like to add that, if you are interested in a pump and 
your physician thinks pump therapy is a good idea, look at what is 
available, maybe even try more than one pump out.  Why not?  Call both
companies and get their information packet, and if the pump looks
interesting, call and ask about their current "trial program" for you to
test their pump.  They want your business, they are willing to expend
resources to instruct you in their pump.  Take advantage of this to find
the pump that suits your needs the best.  Numbers for MiniMed and
Disetronic are listed above.  

I sincerely hope this helps you in your search for an Insulin Pump. 
Comments/suggestions about improvements to  this document as always
welcome.  Also, if you decide to get a pump and  this information helped
you, please drop my name to your rep -- maybe I can get a free set of
syringes out of it. :) 

Finally, if you have any questions about insulin pumps feel free to send
me e-mail to "summers@cs.utah.edu".  I will gladly help in any way I can. 

LostBoy
Jim Summers
summers@cs.utah.edu
(801) 596-8442  

version information:
1.0  24 nov 1992  
2.0  28 sep 1995 [Many updates, corrected notes]


