A Ping or Two...

Kelly Close and Dana Lewis are no strangers to insulin pumps. Kelly used her first Animas 1200 pump in 1999 and later switched to the Insulet OmniPod, won over by its simplicity. Dana got into the pump game about five years ago, choosing the Medtronic Paradigm because she was in love with the Bolus Wizard, exciting colors, and the "chameleon effect" whereby the business look of the Paradigm makes it look like a pager instead of a medical device. Kelly and Dana were talking pumps recently and came up with the idea to test drive the new Ping insulin pump - officially known as the OneTouch Ping Glucose Management System. For obvious reasons, we'll call it the Ping from here on (as opposed to OPGMS). For those of you who are already Ping users, Animas has issued a recall of the Ping’s meter due to a software issue. Please read our alert below for a more detailed description of the recall.

The Ping handheld meter(top) and Animas pump (bottom)

background

In a nutshell, the Ping is a traditional insulin pump (the Animas 2020) attached wirelessly to a handheld meter and remote. The main unique feature of the Ping is that it has a remote controlled meter that talks to the Animas 2020 pump wirelessly for easy transmission of blood glucose readings to the pump. The meter also acts as a remote control for controlling certain pump functions so you don't have to whip out your pump every time you need to correct a blood glucose trend or bolus for that extra peach. The Ping also offers unique data options for collecting, organizing, and downloading multiple parts of the blood glucose control puzzle: basal rates, carb boluses, 500 foods in bolus calculator, exercise times, correction boluses etc. It has graphs that you can look at onscreen to assess your diabetes control and it is compatible with the Mac!

dana discusses Ping SOOTB - Straight out of the box

"Diabetes has a lot of baggage,"...this was my reaction when seeing my Animas pump trainer walk into my living room. Between the bags of supplies and the two pumps soon clipped on my pocket - I was comparing sizes - I felt inundated with pump paraphernalia. For some reason, the Ping system (meter + pump) brought home the fact that diabetes treatment is becoming very tech-savvy and incorporating more and more gadgets. Since I'm slow to change my diabetes routine, this was the first time I connected so many different devices, compared to the one hulk of a blood glucose meter I needed five years ago. I was optimistic about having another option to deliver insulin yet slightly hesitant to hop on the wireless train - I don't use the Ultra Link with my Paradigm, so I was curious to see how much I would actually use the remote transmission feature of the Ping.

kelly gets pumped about data

It's been a while since I've used an Animas pump, and I was a bit hesitant about getting back to tubing after four years on the OmniPod. I confess to being a 100% Mac person, and when I first realized that the Ping was Mac compatible, I could've kissed it. Now, I have never in my life kept a meticulous logbook and food diary. The same goes for consistently downloading my meter or continuous glucose monitor. BUT, that's not to say I don't get at least 50 screen views on my CGM everyday, and I certainly know the benefit of looking back over a week of glucose readings or insulin dosing.

In fact, I live for those moments - "A-ha!" moments as Dr. Irl Hirsch, terrific endocrinologist and diaTribe advisory board member, calls them - when I do look back and complete a new part of the glucose control puzzle. I always feel guilty that my basal rates have only really changed three times in three years when I was pregnant. To properly optimize a basal rate, I would have to record all my food data, boluses, and exercise, but with the Ping organizing and storing all this information, I'm one step closer to a better basal regimen. The downloading software was very simple to load, and after just a few minutes flipping through well-organized graphs, I realized I had been consistently under-bolusing for breakfast and subsequently over-bolusing the breakfast correction. Who knew? And my afternoon basals? I don't want to even talk about it.

I remember Dana talking about how she liked the ability to organize and analyze her data on-the-go and organize it by meal or time of day. "This motivated me enough to glance once a day or so and helped me recognize a pattern of my lows in the morning that week! I was then able to compare my numbers after dinner to realize that it was my exercising and not my basal rates, that were throwing off my overnight numbers." Until Dana filled me in, I hadn't even realized that one could see graphs on screen - looking at quick stats is helpful as you can see what percentage of time per day you are within target blood glucose ranges and also what times of the day most need improvement. While almost every pump now allows downloading and examination of trends (though none were Mac compatible until now), we both agree it's nice to be able to do this on the go.

A-ha!

dana notes some adjustment difficulties

I consider myself pretty pump savvy so training didn't take as long as expected. I like the information on the pump's home screen, which includes the current basal setting and the amount of insulin left in reservoir. I like seeing my basal rate and my reservoir status in exact units. I learned that you can "lock" the pump to prevent accidental bolusing - great for when my pump is on the outside of my clothing. However, I was also surprised that you cannot use the remote-controlled Ping meter to bolus if the pump is locked, thus thwarting my plans to wear it under my dress one day.

Furthermore, I was incredibly struck by the fact that you cannot use the Ping meter to adjust/set temporary basal rates or suspend the pump - what a disappointment. As a full-time student involved in a dozen student organizations while holding down several part-time jobs, the ability to fix or suspend basal rates, sometimes with little warning, is essential for my lifestyle.

kelly discusses advances in the ping

I was pleasantly surprised to find that insertion of the infusion set was much less painful than I remembered. The sets are so much better now that the insertion has been partially automated. While it is still easier on the fully automated OmniPod, it's eons better than back in the fully manual days. The screen on the pump itself is phenomenal and probably the best display out there in terms of color and brightness. I find myself using the remote control (meter) screen a lot more than I use the pump screen, and unfortunately, the meter screen still hasn't quite reached the same quality. Still, the remote insulin dosing is excellent.

I found it much easier to get the Ping up and running than I remember for any of my previous traditional pumps, although I think the OmniPod is still the easiest pump to use because of its speed very straightforward user interface. That said, the Ping's pumping convenience and smarts impressed me quite a lot. My main complaint relates to the hourglass that comes up on my Ping meter screen during usage - those few seconds add up when dealing with a 24/7 disease like diabetes. It seems like this could be fixed by a faster processor - next generation, hopefully!

Regarding noise, I find the audible "whoosh" sound the pump motor makes when delivering a bolus or basal insulin to be comforting. It's almost like my pump is telling me, "Hey Kelly, you're all set for insulin." Then again, maybe this should be "user-settable" (and kudos to the developers for all the customizable settings available!).

dana's first ping day

I thought I would notice a different pump on my jeans, but I really didn't. My friends and classmates did, though, because it made a loud "whooshing" noise when it delivered a bolus or gave part of my basal. It was loud enough to interrupt a professor and made me embarrassed to bolus to correct a high in class. This is one area where Kelly and I disagree.

I suspended and disconnected to take a shower the first evening and forgot to un-suspend insulin delivery. I forgot the first night, and later in the week I made a similar mistake and went several hours overnight without insulin. Pump/CGM makers, please heed our call for greater ability to customize (read: LOUDER) pump/CGM alarms!

kelly's clipping and scrolling issues...

In terms of accessories, I think the belt clip needs tweaking. The spring in the pump belt clip is very tight; so tight that you need two hands to get it to settle in your waistband. When trying to hoist up a child, clipping on your pump needs to be done with one hand - virtually impossible, though we understand this is in redesign.. Another aspect that should be reworked is the scrolling on the meter. I can never quite get the hang of the initially slow scrolling when you push the up/down button and then the sudden acceleration as you hold down the button for a few seconds. This is likely a software fix, and I hope the manufacturer can also reduce, as earlier noted, the processing delay that often crops up when cycling through menus or dosing insulin.

dana talks about food, ezBG, and ezCarb features

The days passed, and I adjusted to a different pump and different settings. I liked using the meter to bolus using "ezBG" or "ezCarb." These were two functions I could use through the pump or meter to calculate how much insulin I need as a correction and/or what to give for the carbs I was eating (comparative to Bolus Wizard in Paradigm pumps). The CalorieKing food database was impressive and came in handy when I was eating out. However, I am still frustrated by the inability to cycle through menus easily and the fact that I had to press buttons hard and often to get to something that was easily accessed on other pumps. It is easier to get to insulin on board (IOB was two pushes compared to my average five), but if I accidentally pressed into the Menu, it took me seven button pushes to get back to the home screen.

final thoughts

Kelly: Having three children under four years of age makes being connected to a pump by an infusion set a little dangerous. The number of sets at risk of being pulled out by inquisitive hands is way too high!

Beyond our suggested improvements, I am extremely happy to see more pumps going wireless. I would imagine this would be great for parents who have young children on pumps - any parent would love to be able to dose their young child's insulin from up to 10 feet away - and in small (one quarter unit) basal rate increments. This might even reduce any negative feelings that kids may have about insulin since they are less likely to grow up thinking about "insulin time" as the time when they have to drop everything to get an injection or have mom or dad fiddle with their pump.

Dana: I wonder if there is a generation gap at play here. Kelly loves the Ping and she's in the business world. Other adults I talked to expressed a lot of interest about the colored screen and large font/clock setting. However, I am still frustrated by the whirring noise when it delivers insulin, not being able to use the meter for more functions (temporary basal changes, suspending!), and having someone from across the classroom know exactly when I'm bolusing.

I think that those looking for a pump that does not come across as a tethered medical device would get the most benefit out of the Ping. On a theoretical note I consider using the Ping wirelessly and checking the graphs on the go as the next closest step to a closed loop without wearing a CGM, and progress is progress!

our suggested areas for improvement:

1. Enable the Ping meter to adjust/set temporary basals and to suspend the pump. Enable the Ping meter to deliver insulin even when the pump is "locked" from button pushing. Even though changing basal rates isn't required that often, Dana said she'd like to do that from the meter as well while Kelly felt like that was asking a lot.

2. Improve the belt clip

3. Shorten the processing time between steps

4. Improve the screen of the meter and make the screen of the pump a little easier to see outdoors in sunlight

what we liked the most

1. Wireless communication between the pump and meter - no errors in entering fingerstick readings

2. All the data is in one place - food, insulin, exercise, correction boluses - and downloadable to a Mac computer (and PCs too of course)

3. Graphs on the meter and instant data that helps identify problem areas - and areas of success

4. The CalorieKing food database - integrates nutritional information for 5oo food options in the bolus calculator on the Ping meter!

Editor's note: Animas, the manufacturers of the OneTouch Ping system, recently issued a preemptive product recall and replacement for the Ping’s meter. This recall comes after a software programming glitch was uncovered: "If the Ping meter and the Animas Pump are not paired and in radio frequency (RF) communication, or if the two devices are paired and not in RF communication, the bolus calculator on the Ping meter may malfunction giving an incorrect recommended dosage. Animas notes that this issue only occurs when the blood glucose value, manually entered into an unpaired/non-communicating meter, is lower than your target value but higher than 70 mg/dL. It is important to note that below 70 mg/dL, this programming glitch is not an issue since you get a warning message on your pump.” Ping users will be receiving a detailed message from the company in the mail as well as instructions on how to have your Ping meter replaced. All new Ping systems will have this glitch corrected.