Wednesday, April 17, 2013

Omnipod Thoughts

Well, I met with two ladies from Omnipod yesterday in my quest to decide which insulin pump I want to go with. I must confess that I went into the meeting with two reservations which I tried very hard to push aside. I am trying to be as open-minded as possible during this research process. Animas surprised me in ways I hadn't expected and I wanted to give Omnipod the chance to do the same thing.

Omnipod is a completely different insulin pump setup than Medtronic or Animas. There are no tubes. At all. Nothing to clip on to your belt or tuck into your bra. Nothing to snag on doorknobs.

There are the pods and there is a PDM (Personal Diabetes Manager). The PDM looks kinda like a  chunky iPhone. It is the brains of the operation and is what you use to control the pod and insulin delivery. It also acts as a glucometre if you choose to use it that way. There weren't really any features on it that the other two companies don't have (temp basals, insulin on board etc).

The pods stick directly to your skin (the back of your arm, your lower back, stomach or thigh). Once you have it firmly stuck in place, you use the PDM as a controller. At your command, it quickly (but not painlessly I'm sure) inserts and withdraws the needle, leaving behind the cannula. You use the PDM to bolus, to change temp basals etc. Without the PDM, your pod will continue to provide your regularly scheduled basal insulin but is otherwise uncontrollable.

Here is what I learned:

The reservoir in the pod takes 200ml of insulin. So do the Animas ones. My Medtronic pump takes 300ml. I use every last drop of insulin before I change my sites. At approximately 45 units of insulin per day, I can get six days out of a Medtronic reservoir. I would get 4ish out of Animas and, in theory, the same out of Omnipod. The problem with Omnipod is that the pods stop working after 72 hours (plus an eight hour grace period during which time the pod beeps every hour, then every fifteen minutes, then constantly until you change it). They explained that this is an added safety measure to ensure pump users change their pump sites as recommended but, since I rarely, if ever, have problems going a full six days, I am not a big fan of being told I have to change the site every three.

Especially when each pod costs $30.00.

I live in Ontario and I get $2400 per year from the Assistive Devices Program (ADP) for pump supplies. If every single one of my Omnipod pods last the full three days and none need to be removed early or are accidentally ripped out from walking too close to a doorway, I will pay $3600 per year in pods. Subtract the $2400 I get from ADP and that's an extra $100 per month out of pocket. Add to that the cost I pay for insulin and test strips and I would be paying over $200 a month out of pocket. Omnipod did offer to contact my insurance company to find out if the costs not covered by ADP could be picked up by them. I will take them up on this offer because, at the end of the day, the cost would be a deal breaker for me.

Those are my two biggest concerns about Omnipod.

The size of the pods is a little disconcerting after being used to the size of infusion sites. They kindly left me with two pods (sans needle) to try. I've attached one to the back of my left arm and will wear it there for the next three days. It will have two swims in the pool and three sleeps. Once that one is removed, I'm going to try the second one on my thigh (I think) or my lower back. I just want to see if I can live with it.

I have to be honest. The thought of no more tubing and no more wearing the pump on my belt is appealing. But not if I hate the size of the pods. So I'm giving myself a full six days to see how well they fit into my lifestyle.

Here is what the pod looks like attached to the back of my arm. 

The other thing I'm not super fond of is the PDM. Having to think about, and carry, a separate device will be annoying at times. My Medtronic pump is easy in that I clip it on in the morning and go. It comes along for runs and bike rides and follows me into meetings and medical appointments. If I go with Omnipod, I will need to carry the PDM with me. Not a big deal most of the time but a big deal on long runs when I'm already carrying so much. A big deal during races too. It's nice to have a waterproof pump for the swim portion of a triathlon but it's not particularly helpful if the controller is tucked away in the transition zone because it isn't waterproof. As Doug said, I'm trading the convenience I had during runs for the convenience of a waterproof pump during swims.

I think I'm sounding much more critical of Omnipod than I was of Animas. I don't mean too. There are a lot of really appealing things about Omnipod and it is a serious contender for my ultimate affections. It  is a very different way of managing diabetes and I think I just need to wrap my head around the differences. Just like how I had to come to terms with the pros and cons of pumping after years of injections.

Omnipod pros:
- no tubing
- no pump to clip on my belt
- completely waterproof and can be worn swimming for hours
- must less limiting to my wardrobe (i.e. I can actually wear a dress every once in a while)
- if worn in the right place (which I have yet to figure out for myself), it will be pretty unobtrusive

Omnipod cons:
- must change pod every three days even if you don't need to (I am an adult. If my diabetes management works for me, don't presume to tell me to do otherwise).
- the cost of pods (if my insurance doesn't pick up the difference)
- having to carry the PDM around

**I have yet to decide if the size of the pod is a pro or a con. I'll let you know.

Now that Step One (pump research) is done, it's time for Step Two.

Step Two - find out if my insurance will cover the costs. If yes, I'm deciding between three pump options. If no, I'm deciding between two.

Step Three - make an appointment at the Diabetes Centre to have the paperwork filled out to apply for a new pump.

6 comments:

  1. This is insightful and you've indicated all of the reasons I've never even considered the pod (except that I don't swim - often). The biggest thing for me was what you said last, about how the pod decides for you how long you wear it. That makes me want to scream.
    I have always thought it's a good system but needs some serious tweaking.
    I love all of your information gathering though!

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  2. Very interesting indeed! I did not realize you could only wear the pod for three days. Not sure if this would work for me as like you I use every drop of insulin I have to keep the costs down. Also even though it may be waterproof, the PDM is not. Not sure if that would be a deal breaker though. I like that I can be in the water and control my pump right in the water. All that being said tubeless is pretty attractive.

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  3. Heather B in VancouverApril 17, 2013 at 9:28 PM

    For what it's worth ... I, too, used to go for as many days as possible on each infusion set and thought it was fine ... until my endo, examining CareLink data from my pump (when I was on CGM), pointed out some subtle trends that I'd failed to notice and strongly advised me to change sites every 2-3 days. She said the construction of those things is such that insulin delivery is compromised after that time (2 days for steel cannulas, 3 for plastic), resulting in higher BGs and/or unpredictable spurts of insulin. Grumpily I took her advice (not as bad as having my device force me to change my ways!), and I think it did make a difference for the better. All that said, however, I followed Scully's MDI lead about a month ago ... disconnected from my pump and remain a little surprised to say I love it.

    Anyway, great research you've been doing — I'm looking forward to reading the final verdict!

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  4. Thank you all!
    My 27 year old daughter who has type 1, is researching for her very first pump! It is a huge deal! And we want to do our very best to get her hooked up to the right device. So all of your personal research and comments have helped . Sincerely a Canadian consumer

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  5. Omnipod has very poor customer service, this was a deterrent in my decision making process on which pump to buy.

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  6. I also receive the government funding and it is a requirement of the program to change your site every 3 days from what my educators told me.
    Not changing the site this often could result in getting kicked off the program and receiving no funding.
    Has anyone else been told this?

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