On May 17, Asante Solutions held a launch event at their Sunnyvale, CA, headquarters. Their new Snap pump (formerly called Pearl) is ready for prime-time, and they wanted to debut it to a group of online advocates -- giving us the opportunity for a four-week trial run, and also premiering some of their rather edgy marketing videos (think SNL does insulin pumping! more on that later.)
They are currently rolling out the product in the Northeast initially, building up their network of trained educators and also their reimbursement options.
For the California launch event, the DOC group included myself, the venerable D-blogger Scott Johnson; Michael Robinton of Insulin-Pumpers.org; Jeff Hitchcock of ChildrenwithDiabetes; Manny Hernandez, Emily Coles and Corinna Cornejo from the Diabetes Hands Foundation; and Adam Brown and Kira Maker from diaTribe.
We started out by watching a pretty compelling presentation by Asante's CEO David Thrower about how the company is razor-sharp-focused on patients and their needs, rather than designing for clinicians as is traditional in the medical device world. I personally love this, although Michael Robinton pointed out that this strategy may not be entirely practical, since doctors and CDEs often drive demand. In any case, I was anxious to dig into the details of what new value the Snap offers us patients over other pumps on the market. And dig we did, as a big portion of the day was actually training the subgroup of us who'd signed up for the trial run. I am currently a Snap pumper, complete with tubing!
Disclaimer: As a user of the tubeless, integrated OmniPod pumping system for the last seven years, I have to admit that reviewing the Snap is like comparing apples to oranges -- or a wireless apple with built-in glucose meter, to an orange dangling off your belly via plastic tubing, with no built-in glucose meter. Unfair, I know, but I was really curious about the Snap, and about "regular" insulin pumping on the whole. So I took the plunge. But I have to begin by commenting on this major changeover.
On Living with Tubing
To be honest, I'm not liking it. Let's face it, tubing gets in the way, and I spent the entire first 72 hours on the Snap wondering why anyone would choose to wear a tubed pump if they didn't have to. One of my biggest issues was being naked. You just can't do that comfortably when you have a chunk of plastic attached to your body via tubing, because there's nowhere to hook the plastic chunk. If you let go and it falls, ouch! You're yanking the cannula out. Every morning and evening while getting ready for work/bed, I found myself scrambling to put something on just so I'd have a place to hook the pump. Grrr.
Going to the bathroom was a new adventure too, as the pump often comes unclipped from my clothes and ends up sort of swinging around the toilet while I'm trying to do my business. TMI? Too bad. I don't like tubing in the john, got it?
I didn't like tubing at all in bed either -- having to yank the cord to move the chunk every time I moved around, grrr. Not so pleasing.
I learned to respect the priming and look out for kinks -- two issues I never had to deal with on the tubeless OmniPod. First of all, even though the Snap has the advantage of super-fast auto-priming, you still have to push that button, Amy! D'oh. When I rolled past 300 mg/dL later that evening and the numbers wouldn't budge, I called the CDE assigned to us. She was wonderfully patient with me as I barked orders at my daughter to look for bubbles in my tubing. "Oh yeah, Mom, there's a huge air patch in here!" she reported. Great. So maybe coiling up the tubing as tightly as possible and stuffing it down the front of my pants wasn't the best idea -- as cleverly discreet as it seemed at the time.
Pros of the Snap
OK, so none of those tubing issues are unique to the Snap. What is unique to the Snap are some pretty nice features, that in my book make it much more appealing than "traditional pumps" on the market:
They say it's designed for "real-world practical ease of use." The nuts and bolts of that are basically that it offers some nice conveniences, including:
* I think it's really clever to create a disposable pump body that uses insulin pen cartridges you only need to change once a week. Funny no one ever thought of this before! No wait, they did... check out the PicoSulin entry in the 2009 DiabetesMine Design Challenge. Wonder if the Asante folks ever saw this?
* Because of the snap-in cartridge, you get super-fast auto-priming -- this is the thing the company is most proud of, and the biggest differentiator they're focusing on in marketing efforts.
* In total, setup requires 14 fewer steps than a Medtronic site change, they told us, and you do it just once a week, moving your infusion site every three days.
* It's intuitive to use, in the sense that the screen offers big, bold lettering, and the menus are pretty darn easy to scroll through and understand.
* You get two choices of how insulin on board IOB is recorded and calculated -- either "corrections only" or "all." I chose all, which is not an option on the current OmniPod model, something that always bothered me. This of course means your calculated corrections take into account ALL previous insulin given recently, whether for meals or snacks or a BG fix.
* You never have to change or charge the battery because it's built into the pump body, the part that holds the insulin cartridge and is disposed of weekly, or after it's empty -- there's a little window on the side to help you see how much insulin is left. (btw PWD advocate and athlete Bill King did a marketing video for Asante on the battery issue.)
* For the disposable pump body, the company offers a recycling program with a prepaid envelope sent to you in the packaging (nice!)
* The pump also has a built-in flashlight, which some of us DOC'ers thought was a pretty cool and useful feature! As my mom would say, that's kind of like choosing a car based on the cup holders, but heck, it's been very helpful for me groping around in my bedroom at night, or when I need to do a fingerstick in a dark place.
* The price is right... between $600 and $800 upfront costs for the controller (just $120-$160 out-of-pocket for PWDs with good insurance), plus about $12/day for supplies (around $2.40 a day insurance co-pay), comparable to the OmniPod. Also the system will be easily upgradable, with guaranteed fees of just $99 for a new controller when the time comes -- all according to VP of Marketing Ken El-Sherif.
Oh, and a bit off-topic, but in case you're wondering: Asante is a made up word that sounds French for something like, "to your health," El-Sherif says.
Cons of the Snap
My biggest beef is the way the Snap handles temp basals -- which I normally consider a "killer app" for pumping insulin. That is, I love the fact that with the OmniPod, I can create and store pre-set temp basal programs for different types of exercise, sick days, etc. The Snap currently doesn't allow this, although I've told the company it should!
Also, the Snap's temp basal setting doesn't show negative percentages, like the OmiPod does, but rather positive percentages of your existing basal. So where I might have used -25% for 1 hour with OmniPod, I'm now doing 75% with Snap. This might not be a downside to many folks, but the unfamiliarity of it threw me off a bit.
Finally, there are too many screens to click through to get to the temp basal area! I counted 10-14 clicks through menu choices -- waaaay too many when you're dropping low and trying to dial back your basal, while your brain is shutting down.
The marketing team, including Marketing Director and part designer Mark Estes, were very proud of a feature whereby when you disconnect the pump body, it later tells you how much insulin you missed, so you can make it up. I thought this was incredibly cool and useful until I realized that this is not the case if you just disconnect from your infusion site. Rather, you have to actually physically separate the pump -- controller from cartridge piece -- and when you do this, the controller beeps insanely until you reconnect the two. Also, if you leave the pump body apart from the controller for more than an hour, the small back-up battery in the pump body drains, so that it no longer retains time and date info. Grrr.
I also had trouble with correction calculations. This may be just me, because I have an unusually high sensitivity to correction doses, especially overnight, so I have to be very cautious with dosing. But more often than not, the Snap seemed to recommend "no correction" at all times of day, even when I felt that I was unacceptably high long after meal dosing.
The one drawback on the pump screen is that the "graph" view attempts to display BG values up to 500, but the small screen makes the information so very tiny that it is barely discernible, and therefore not useful.
Also, this pump still only accepts Humalog cartridges, and I know many patients are concerned because their insurance may only cover Novolog -- although I have to assume that if you're able to get a prior authorization by your insurer to cover this fancy new pump, then part of that coverage would also be for the particular insulin required (?)
The quick auto-priming was good, although somewhat lost on me, because I don't have experience with another tubed pump to compare it with. I can't help thinking all the emphasis on fast autopriming is a dig at Tandem's t:slim, the other new alternative pump on the market. That one looks and feels sexier, with its iPhone-ish shape and color touch screen. But as our correspondent Wil discovered, the priming process is very slow, which is clearly a con for some people. Still, the t:slim beats the pants off Snap in terms of aesthetics, I think. So it's a matter of priorities, I guess.
Speaking of aesthetics, how sexy does one feel wearing this pump? Or any pump, for that matter? This has been a big topic of conversation in FWD circles (females with diabetes) of late -- especially at the recent Diabetes Sisters Conference in North Carolina, where even the session I led on diabetes technology took a sharp turn into the bedroom. He, he.
I reminded the gals that when I did a few posts early on about whether wearing the OmniPod could hinder your sex life, all it took was one guy commenter chiming in to end the speculation. He wrote something along these lines: "Are you kidding me? No little piece of plastic is gonna keep any guy from going for the gold!" Well OK, then.
But personally, a tubed pump makes me feel very un-sexy. I really don't know where to hide the thing so it doesn't interfere with fashionable outfits (yes, I'm a clothes horse!), and being naked with a tubed contraption is just downright impractical. You have to have to hold the pump in your hand. Yes, you can disconnect, but not for too long without suffering the consequences, and I don't like having to worry about soaring BGs during... you know.
Speaking of sexy, though, the folks at Asante want us to know that their pump is so fast and easy to set up that you'll have plenty of time for... you know. This is illustrated in some edgy promotional videos they've created, that we plan to debut later this week here at the 'Mine. We can't wait to hear what the community thinks of this bold new approach to diabetes marketing!