Animas Vibe – an in depth, long term use review

Last year I wrote comparing the Animas Vibe and the Dexcom standalone receiver.  At that time, I summarized my thoughts that while the Vibe had great features, I felt the Dexcom standalone was a better unit overall.  The wonderful thing about opinions is that they can change. 🙂  Maybe not change, but evolve or adapt to suit.  At the time of the review I wrote that the Vibe was better for running (less to carry) and for anything involving water.  Well, Newfoundland is wet quite a lot of the time  and I ran a lot in 2014.  Still, what changed?  I have an amazing Animas rep who loaned the pink beast loaner pump for my Marathon – and it performed smashingly well and made running that much less complex that I was swayed.  Still, there was the issue of the cost of a whole pump, but Animas Canada offered an upgrade from the Ping to a Vibe at a “nominal” cost I decided to bite the bullet.  I say nominal because when I bought the ping state-side I was told 99$ upgrade, but Animas Canada was not on board with that.  C’est la vie, but I do mention it because it costs more to update in Canada vs USA.

So what have I learned being on a Vibe and abandoning my standalone receiver since August?  Rather than rehash what I wrote last time comparing the two, I’ll jump into a more in depth review of each aspect of the pump and why ultimately, it’s better for me right now.

Interface

The Animas Vibe has improved the Ping interface in a few ways.  For those of you familiar with the Ping, you will even start to wonder if it’s just the same pump; however, some great changes have occurred.  First of all, there is a left and right arrow in the settings window! 

That doesn’t sound like much, but it’s a huge deal that you can go left and right when trying to tweak settings.  The quick bolus button is still there on the right side of the pump, but the contrast button on top now serves a great purpose.  It’s a quick access button to the pump CGM trend graph. One push brings up the last viewed graph, and then subsequent pushes go through various contrasts – very helpful if you are trying to view on a bright sunny day. However, if you accidently hit another button while trying to access the pump, the contrast button won’t just bring you to that screen – it only goes to the trend graph when the pump is not “awake”, so you have to make sure you don’t manhandle it in a rush trying to see a number.

One issue with integrating pumps and CGMS is the extra button pushes required to get into the CGM.  It’s not too bad on the Vibe – yes, it’s buried one submenu; however, the quick access button generally alleviates this issue.  Maybe in future models they can have a dedicated CGMS button (rather than dual purposing the contrast button), but I understand that they didn’t want to make a button that is solely for CGMS when market uptake is not always there.

 

One downside is that the Vibe is like the Ping – it lags and doesn’t respond while it’s dishing out it’s little blast of basal insulin. So, if you are trying to navigate the pump while it is basal dosing it will seem like it’s frozen.  This was less of an issue with the ping because you simply didn’t interact with it as much for two reasons – no integrate CGM and the Ping BG Remote.  However, the Vibe eschews the ping blood meter (which I’m okay with, it was clunky, large, and I wasn’t a huge fan of it) and also has an integrated CGMS.  With integrated CGMS you interface with the Vibe a lot more, and that means you’ll get these freezes from time to time.  Usually it’s innocuous, but if you are trying to do something while say, running, it can be annoying!

The CGM Portion

Rather than delay talking about it, let’s get right into it – the CGM is why you would upgrade.  While the Dex stand alone receiver is fantastic, it’s another device to carry.  This isn’t much of a problem if you have pocket room or just day to day doing stuff, but when you’re active the convenience of integration is appealing.  But integration is useless if it’s done poorly (ever try and read a Medtronic CGMS graph?).  So how did the Vibe fare?

For the most part, it does a pretty bang up job with some trade-offs that you really have to decide for yourself.  In the good camp is the most useful screen on the pump – before the usual 1, 3, 6, 12 and 24 hour trend graphs is a screen that shows your trend arrow and your insulin on board (IOB).  This is fantastic!  If you set this as your home screen and are running you can easily see “okay, I have 1 unit active, I’m a 4.8 mmol/L with a down arrow, I should eat!”.  Sometimes when I’m active it’s too little to rely on listening to my body to read the signs of a low.  They can hit faster at times during activity, so knowing my IOB and trend I can gauge if I need to fuel up based on my intensity and duration remaining. 

Seriously, this screen and the one-hour trend are the two screens I use while exercising.  The three hour screen is useful for day-to-day management and especially useful in gauging “success” in post-meal glucose rise.

However, on the flip side – the 12 and 24 hour graphs are nearly useless due to the size of the screen and the time it takes to render them.

 

I’m wishy washy on the 6 hour screen; it’s useful for trying to manage a sticky high and figure out if you are making progress.

On the neutral front, both the Dexcom and Animas interface annoy me for one simple reason – you cannot scale the vertical axis.  I can only think of one time I’ve needed a glucose over 22.5 mmol/L, and that was when driving from Phoenix to Las Vegas with a jammed up infusion site.  Other than that, I am treating the high before it happens.  By not allowing customizable Y axis it really causes me to squint since I tend to prefer my numbers in the tight control band I set.  I find the inability to change Y axis scale compromises the minutiae of detail that folks with tighter control may appreciate in point to point trend analysis that gets lost when zoomed out.

Alarms

The Vibe has two areas that I’m not please with – alarm volume, and alarm tones (or lack of variability).  A huge selling point of the Dexcom stand alone is the alarm volume and customization.  On hypo alert that thing was a saint waking me up in some extreme lows.  If you set it on a table it would vibrate you awake before the darn sounds went off!  The Vibe is a bit of a step back.  By sticking to the form factor it does not allow you to get very loud.  It does vibrate first, before an alarm.  Most times I feel this, except when I’m running or cycling and there is already so much movement that a small, low frequency vibration is going to go unnoticed.  It wakes me up more often than not (and if not me, my wife), but sometimes it can take a few minutes before it’s successful.  It works, but it’s not as good as it could be.  Also, you cannot customize alarms like the Ping or have different sounds for different alarms.  I really liked this on the Dexcom stand alone, but my wife liked it infinitely more as she knew if she had to panic to wake me up (low), or get ready for a long, drawn out, grumpy me to try and wake me up during an overnight  high.  It also helps us figure out, without glancing, what is going on – and that is really helpful when you are active.  Sometimes you can’t just look at the screen.

I have read that there is a new receiver being released which will dual band and directly talk to the Dexcom Share app.  It will basically rebroadcast oiver Bluetooth.  That’s a sort of “band-aid” fix that may at least deal with the alarm volume overnight – just have it share to a tableside iPad or iPhone and that issue is dealt with, but it won’t alleviate the problem during the day for those of us curmudgeons who don’t abide smart phones (like myself). 

Finally, if you are one that likes to silence it all, I must point out that there is one alarm you cannot silence – it’s the calibration sound.  Say you bolus using eZBG – enter a blood glucose and bolus accordingly.  After the pump delivers it’s bolus it then lets out a beep and asks you if you’d like to use it as a calibration.  I have not been able to silence this beep, so just be aware that you can beep at times when you may not want to (think savasana in yoga).

Glad they kept it the same

So one thing Animas really got right was their metal belt clip.  That thing is bullet proof!  I clip it on to everything – every day stuff like belts, jean pockets, boxer shorts, bed sheets, etc.  For cycling it clips to jersey pockets or wind vests – even the bottom hem of a gilet without pockets!  I’ve had no issues during 70 km/h descents and vigorous out of the saddle climbs.  See if you can spot the pump on my outrageous coffee themed jersey – no problem on an off-road mud ride!  Climbing I can clip it to my leg loop of my harness without much of an issue unless I’m doing off widths.

Prior to getting a Vibe I had thought the Dexcom was more convenient in certain sports (like cycling, climbing); however, in cycling I find that I like having my bars clear; especially here in Newfoundland where you’re always climbing!  Being able to ride the flats is worth having to slow down or stop to read your pump – and that’s if you even have to, because honestly, reaching back to check your pump is not much different than digging in your jersey for food.  And then there’s the waterproof factor – more on that later.  For climbing it’s one less item to carry, and it’s not like I’m going to be checking my BG while in the middle of a crux move.  My wife is the only other person I trust with my blood monitor, and honestly, she’s also one of the few I trust to belay me, so – I’d rather her hands on the ATC than the Dexcom.  Call me crazy but that’s my life line! 🙂

Another Ultimate Convenience

Waterproof – it should be apparent, this was a huge benefit of the Ping over Medtronic, and now Animas has made it possible to not worry about water and the Dexcom.  In the past I’ve been paranoid about the Dexcom on wet rides and missed out on valuable BG information while waiting for the swim start of a tri with the added stress of leaving my Dexcom in transition and hoping it will pick me up when I got out of the swim.

My extreme test case was running with the Vibe during the Cape to Cabot 20K 2014 race – during Hurricane Gonzalo.  Even if it was double digit temperatures, the wind and rain was causing me to go hypothermic.  I was shaking at the start of the race form the cold – drenched to the core.  The pump kept on ticking and worked admirably.  You can’t get much more extreme than that.  The picture doesn’t do it justice, but these are the conditions it survived (and as a bonus, it’s a shot of me photo bombing some real competitive runners).

But what about the future?

And here’s where I have concerns – the Vibe feels like a pump that’s half in the future and half in the past.  It’s basically a ping with an attached CGMS, and that’s not bad – the Ping was a tank.  But, this design decision has caused some compromises.  Essentially, it’s not future proof.  Dexcom has released an updated algorithm to their stand-alone receivers which cannot be uploaded to the Vibe.  This is not a game changer (I still use the vibe), but the upgrade would really benefit me as it lowers MARD and especially the time to recover from lows.

Also, Dexcom is pushing ahead towards the Gen5 which will be a Bluetooth transmitter.  This is a feature not found in the Vibe.  They haven’t indicated yet if it will dual band, but I imagine it will be BT only.  This is great for talking directly to smart phones, but not good for Vibe users.  I can only hope Animas has something in the pipeline and considers future proofing pumps a bit better for the future.  Dexcom tends to innovate faster than pumps, and right now that makes the Vibe a bit vulnerable in a year or two.  Given the cost of pumps this is a concern.

Conclusion

While the Vibe may not be perfect, it’s a great stepping stone in integration and my pump of choice.  I still have a fully functioning Dexcom receiver that has sat in it’s box since day 2 of being on the vibe.  I don’t regret it – I’ve learned to adapt to the differences, and it’s made it more enjoyable.  However, I am concerned about how vulnerable it is given the pace of innovation in CGMS technology. 

On a side note – Animas has really stepped up their game in Canada.  When I moved away in 2010 there was nary much heard about them, and now I find their support amazing.  I’ve called in with an order and off hand mentioned that I had some issues with infusion sites and rather than chastise me for doing something wrong (here’s looking at you Medtronic), they connected me with a nurse (which I hesitated, see comment about previous chastise comment) who offered up some replacements!  And my local rep?  I can’t say enough kind words – she’s friendly, always willing to help, interacts with the local D community, and walks the walk of an active diabetic lifestyle.  Seriously, she just did the Chicago Marathon this year – how cool is that; a pump rep and a role model for the community all in one.