Right before Thanksgiving, Asante Solutions started shipping the first few MySnap insulin pumps to users who ponied up the $99 for the upgrade over the summer. We were able to get our mitts on one of the first for a test drive, and I've been wearing it for the last couple of weeks for this initial hands-on review.
There's more to the new MySnap insulin pump from Asante than just a personalized look that offers users 250 different color options. Under the hood, the upgraded pump sports a short list of significant new features. But what really makes the features exciting isn't so much what they are, but where they came from — because they came from us, the users!
Remember, the first Asante Snap (renamed from the Pearl) was FDA-cleared in 2011 and launched in Spring 2013, so this is the company's first update to that debut device. Asante has been making an effort to both actively and passively seek and absorb user feedback; they hosted a select group of patient advocates at their HQ pre-launch, read blogs and otherwise plugged into social media, and recently even formed a small advisory board of PWDs (people with diabetes) made up of both users and non-users of the Snap pump to help them brainstorm future designs. (Disclaimer: I was asked to be on this board and accepted, under the conditions that Asante has no influence on what I think, say, or write.)
The MySnap should be called OurSnap, because it is, truly, a child of the diabetes community.
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First, let's be clear that both the new and old Snaps are traditional "tethered" pumps; insulin is delivered to the PWD via tubing and infusion set. Where Snap breaks from the pack is in how it holds the insulin. All other pumps of this kind use disposable plastic casings called reservoirs (or bags inside like the t:slim) that have to be filled from an insulin vial and inserted into the pump. Snaps don't. They use 300-unit pre-filled glass cartridges designed for reusable insulin pens that slip into a disposable pump body section that the permanent Snap controller "snaps" onto.
This design not only speeds filling, but also extends wear time, with double the approved lifespan in the pump over the rest of the pack. And unlike some of the 300-unit reservoirs on the market, Snap can use nearly every drop of insulin in the penfill.
Also of note is the fact that Snaps do not need batteries or charging. Ever. The disposable part, which lasts a week or so, supplies power to the system. It's nice not to have my Go-Bag weighed down with spare batteries or to be spending all my time on the lookout for power outlets.
I admit that I'm a big fan of the original Snap pump. Why? Because I'm a busy man and I don't have a lot of time to waste on an insulin pump. Snap is fast. Fast to load with insulin. Fast to change. Fast to get insulin into my body. The menu and delivery system is lean and mean with fewer button presses than any other pump, and almost no "are you sure" screens between me and my bolus. Plus, I don't need to change it as often, and that saves me time, too.
New Setup = A Snap!
Going from Original Snap to Upgraded Snap was, well, it kills me to say this, but it was a Snap. Literally and figuratively. I just took the new Snap controller out of its box, snapped it onto one of the dead bodies I'd used previously, and all my pump programming was uploaded into the new controller from a non-volatile memory chip that lives in each disposable body, and serves as a backup storage system for my settings.
In a snap my basal rates, insulin-to-carb ratios, correction factors, alarms, preferences—the whole enchilada—migrated to the new controller. I was ready to roll in seconds as opposed to the seemingly endless entering of data that moving into any other new pump entails. All I had to do was choose what color I wanted to use to highlight menu options on MySnap's new color screen. (Green, blue, aqua, yellow, red, pink, purple, or grey.) I choose blue to match my eyes.
Currently, with 11 colors of frames to choose from, plus 11 faceplate color choices, and 8 different design elements to put on the faceplate, it's possible to create something like 250 totally different pumps by mixing and matching the colored components. There's not much risk you'll bump into someone else at Wal-Mart wearing YourSnap.
Asante has an online tool that lets you design the pump they can build for you. It's more fun than online Lego. The colors online don't look much like the real thing, though, and the folks at Asante say they are working on this. My advice: if you're serious about this pump, ask for their color sampler swatch book that reminds me of a miniature version of the bundles of carpet samples you see at Home Depot.
New and Different?
Screen: The biggest change you'll probably notice after the personalized pump style is the screen. Yes, the MySnap has a new LED color screen that makes it look more modern for this 21st century. But this much-trumpeted improvement, like most color screens, is harder to read out in the sun than the old black-and-white LCD screen. And being a color screen, I find I'm predisposed to try to touch it to operate the pump. (That's how all other color screens on the planet nowadays work, right?). But the MySnap retains push-button operation underneath and to the sides of the color screen.
Ironically, this new screen is easier to read anywhere else than outdoors, but this has nothing to do with the color. On the original Snap, most menu items are in ALL CAPITAL LETTERS. Now, the menus read like, well, the 'Mine. And like all other written text we're used to.
IOB Display: I'm sure I'll hear cheers when I tell you that Snap joins Tandem and OmniPod in displaying IOB (insulin on board) front and center on the main screen when you wake up the pump. Now more pumps on the market sport this user-demanded feature than not. (Can you say: Power to the Pumpers?!)
Temp Basals: If you like to use temp basal rates—and if you use a pump why wouldn't you? — you'll love the fact that there's now a temp rate shortcut button. If you enable this feature, the left-most button takes you straight to the temp basal settings without having to go through the main menu. Also, if you are running a temp rate and have to change pump bodies because you ran out of insulin, the temp rate will automatically migrate to the new body and continue working with no intervention from the user! That's huge.
However, I really wish the temp rate menu would remember my last setting rather than default to 100% and one hour, or at least give me a user-selectable option of "remember last temp rate." Why? Because I always enter a 30-minute temp rate at zero flow when I'm headed low or having a low. It would be a nice time-saver when seconds, quite literally, count.
Alarms: Dear to my heart is a change in how the Pump Alarm feature works, which previously was one of the few slow things on the otherwise speedy Snap. I use this alarm on Old Snap as a defacto site change reminder, but it is a huge pain in the ass to reset the damn alarm. It's buried under a ton of menu items, taking a full 24 button presses just to get to the point where you reset it. And you need to do this every three days! Imagine how delighted I was to learn that MySnap resets the alarm automatically with a cannula prime. And there's also a shortcut on the status bar that lets you reset it with a couple of button pushes.
Customized Settings: What else? Well, on Old Snap there's a mish-mash of ways that time is presented in various menus. Some are in decimal fashion and some are in minutes and seconds. The new MySnap standardizes all time in the min & sec format. Other new features include a cleaning up of the optional bolus detail screens to make them easier to read. Like with Old Snap, if you want to know the math behind the bolus you can press a button for details, but Snap doesn't force you to review the formula used before each and every bolus like some of the other guys. You can just deliver the bolus and get on with life. Again, for me, it comes down to less time pressing buttons means more time for life.
Light: The built-in flashlight now runs for half a minute, not the dash-for-the-bathroom-in-the-dark 15 seconds of the Old Snap.
Data: And in case you missed this exciting announcement, Snap data can be downloaded into Diasend (both from the older and newer models). In less than two minutes, you can suck 90 days of data out of the pump and into the cloud. And of course, as we covered before, Asante was first up to bat working with Tidepool, so before long that open data-sharing will be available on the platform Tidepool creates.
Hands-on, MySnap feels much like the original Snap; the only major change being that Asante has dropped the glossy fingerprint-prone faceplate for an improved (IMO) matte-finish one. The buttons maintain their springy feel. The new Snap is a hair thicker, literally a hair. In fact, I wouldn't have noticed except for the fact that MySnap would not fit in the belt clip of the original Snap. MySnap is also a hair heavier, tipping my Salter kitchen scale at 1.5 ounces compared to Old Snap's 1.3 ounces.
All things considered, that's a pretty nice little collection of consumer-driven upgrades to a product that was pretty likeable in the first place. But are there things I don't like about MySnap? Oh yes, there are.
What's Not to Love?
Insulin-Limited: Of course, one of the biggest Snap-killers for many PWDs is that fact that you can't use Novolog or Apidra in the pump. As of today, Snaps can only use Humalog. Personally, I'm insulin agnostic, but for some people one brand of fast-acting insulin works much better than the other brand, and many health plans force PWDs into using one brand or the other, regardless of what's best for the patient. So not having a Novo option cuts a lot of folks out.
Don't fret, Novo-compatability is coming soon, we're told. Rumor is that Asante will file for a Novo body approval with the FDA right after the first of the year, and here's what the company tells us about all this: "We are doing this in a way that makes it simple for PWDs. Specifically, the controller that people already have will be able to work with both Novolog and Humalog. People using Snap that want to change insulins will simply have to buy different supplies. So, if a person would like to switch from Humalog to Novolog and then back to Humalog, they will be able to make the switch with Snap simply."
Proprietary Sets/Tubing: Yes, this MySnap has proprietary tubing and infusion sets that you can only get from Asante specifically for the Snap pumps. But it's for good reason, they tell us. The specialized design of the Snap pump end includes the detection system for occlusions, and then because you can use the penfill for six days, the sets have a pair -- one with tubing and body and a second one with body only.
No Vibration: While Asante engineers have added snooze alarms to many of the alerts, there is still no vibration option for those who need it or want it. Only audible noises for now.
Menus: A minor annoyance that irritates me on an every-three-day basis with both Old Snap and MySnap is the order of the prime menus. The good news is that Snap pumps auto-prime the infusion set tubing when you attach it to the body. Really, it's pretty amazing; you just plug it in and—BAM!—the tubing is full of bubble-free insulin. So you'd almost never need to prime the tubing. And yet, the tubing-fill that "never" happens is higher in the menu structure than the cannula-fill I have to do every three days. Huh?
My MySnap... Well, MyLoaner MySnap came with a faux suede case designed for vertical wear that includes a cheesy loose-fitting plastic clip to allow for horizontal belt wear. I loathe this case and clip, although Asante is hardly alone in the crappy case department. But apparently something else is in the works -- "a new plastic case," so says the note card Asante sent with my new pump:
To Upgrade or Not to Upgrade?
Current snappers are apparently snapping up the MySnap so quickly that Asante is running behind on production, with a backlog several months into next year. So what happens if you are new to pumping and want a MySnap, or are wanting to switch from another brand to the Snap? According to an email from my local rep, anyone who orders by the end of the year will get an Old Snap to tide them over and let them start pumping right away, and then get a free customized MySnap in a few months (normally $99). Maybe not ideal, but an interesting workaround.
So what about me? Will I trade in my old new girl for a newer one with a pretty face? If it were just the personalized box and a color screen, no, I wouldn't. I'm not that wild about color screens, and I actually like the old fashioned blue back-lit LCD of Old Snap.
But this isn't just a cosmetic upgrade. I really like some of the new features. Chief among them for me is the temp rate button, IOB on the main menu, and automatic re-setting of the pump alarm — all things that speed up an already fast pump. That's worth $99 to me. And like the power windows and remote start on my new Jeep, I suspect it won't take long to become dependent on some of MySnap's other new features, too.
What about the things I don't like about MySnap? Well, for the most part, except for the color screen, all the things I don't like on MySnap are on Old Snap, anyway, so I might as well cash in on the improvements I'll enjoy. I have nothing to lose.
So while MySnap isn't perfect (what is?), one thing's for sure: I know Asante is listening to me, and to all of us. And I'll bet NextSnap won't have that damn tubing prime in the wrong place...
Finally, speaking of next-gen devices -- we are sorely missing Dexcom integration here, which we will have soon with new Animas Vibe pumps and is coming down the pike with the Tandem Diabetes t:slim G4 combo and an OmniPod combo version in which G5 data will be displayed on a future PDM.
Based on comments from Dexcom CEO Terry Gregg recently during a public TV interview and what Asante CEO David Thrower showed the crowd at the AADE Annual Meeting last summer, a Snap pump-Dexcom G5 combo that be viewed and controlled from a smartphone is definitely under development.
Asante's marketing chief Ken El-Sherif says: "We believe that phone integration is a superior solution as it allows more convenient display on a larger and richer user interface. Also, it has the potential to reduce the delays currently found between CGM technology and a pump." He's says their next-gen device will incorporate Bluetooth technology for connecting data to the cloud. "With the user's permission, for example, this connectivity would allow loved ones to easily track status remotely."
These future plans are all very exciting, but it's all at least a year away. So in the meantime we will have to be content that Asante is listening to us in their device design.