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.
Thanks for the update as I do remember when you were ready to choose the Dex receiver over the Vibe. Last week I wrote about my concerns of upgrading to the Vibe. This coming week I will provide an update and will be sure to provide a link to this blogpost. A great post, as always (although not frequent enough any more!)
Laddie – I’ll have to read your posts about upgrading. I look forward to it! I’ll put a wingback in an edit of this article. The more we can all share opinions, the more informed people can be.
And frequency is something I struggle with. I want to say something meaningful, and sometimes that gets hard to come up with. Exercise, dogs, my wife always take priority. But, I can at least handle once a month, and anything on top of that is gravy! 🙂 Thanks for the kind words!
Great post. I feel the same way about basically all the points you made, esp. the inability to change the Y axis scale, which I’ve been mentioning to Dexcom support reps for years.
One other thing I noticed that was worse about the Vibe compared to the Dexcom G4 is that the high and low threshold increments are less granular (+- 10 instead of 5) , as are the snooze increments.
I totally agree with you there. It drives me bonkers that I cannot change my low trigger from 4.4 to…say 4.2 or 4.0 (and in your case, 10 instead of 5). They really slapped on the mmol/L as it’s in non sensible increments. My low is 4.4 and my high is 7.8. Talk about silly.
Another extreme annoyance, which I am going to make a separate blog topic, is the loss of communication due to static. It takes a mix of luck and black magic to ensure I don’t loss communication if I have on a cycling jersey and a wind jacket, or some synthetic shirt and a running jacket. It’s totally hit and miss, and I can’t seem to get anywhere with support on this one. I want to experiment making a “sleeve” to put over my Dexcom (yes, I wear it on my upper arm for almost 2 years now) to try and ward off static. There’s nothing more infuriating then heading out for a 3 hour bike ride and have it fail in the first 20 minutes. If I restart it picks up the transmitter again, but still has to wait two hours to calibrate. Anyways, like I said, another blog post. 🙂
There’s no perfect system for sure. Until there is, the dexcom has me. I’m just curious if Gen5 will use bluetooth and maybe get rid of the static+rf issues.
Pingback: My Vibe Decision | Test Guess and Go
Last winter I had problems with my Dexcom and static: http://testguessandgo.com/2014/04/17/dexcom-and-static/
For me it only happens on leg sites and I’ve been lucky it doesn’t happen with arm sites. It’s definitely related to what clothes I am wearing and only happens to me in Arizona with its low humidity.
I wonder if an arm band would work. It would probably have to be cotton or some non-synthetic fabric.
When it comes to diabetes, if it’s not one thing, it’s another….
Oh it’s totally clothing related. I think I remember seeing your post on it. Mostly synthetics in combination with any other material seem to trigger it for me. I first noticed it happening when I was driving back to Newfoundland from Texas. On each morning I’d go for a run. In Portsmouth, NH, I finally got into my own climate – snow! I went for a run with a merino long sleeve shirt and a marmot variant jacket and had a lost communication issue. However, I’ve had runs with that jacket since without issues. Ironically, my TdC wind jacket triggered it right away (primal wind jacket). I have two running jackets – Pearl Izumi PRO and Arc’Teryx Incendo – and they are hit and miss. (Side note: I am only “naming” products so people can understand the different materials, I am not gear bragging) In fact, I wore the Incendo over my singlet during the Cape to Cabot 20k in the middle of a freaking hurricane and didn’t have static issues. You’d think the wind and rain…but nope. However, in that case, there was only one layer rubbing. Maybe the key is having two layers that rub to create static. The funny thing is – none of my “Changing Diabetes” team novo nordisk stuff triggers it. Magic!
So it’s totally random, but so far my observations are natural layers are better – wool, who can exercise in cotton!?!? 😉 However, they are not impervious as I’ve experienced time and time again.
My biggest static problem these days is with my ear buds and iPhone. I often feel a buzz in my ears as I walk in the house after a long dogwalk listening to music/podcasts. I have to be careful to take the ear buds out of my ears before disconnecting them from the phone or else I can get a terrible shock. It mostly happens with the Apple ear buds which i like because of the volume control on the cord.
I am surprised with your climate that you have so many static problems. I rarely have a problem in Minneapolis–just Arizona and the desert.
Maybe that’s it – windy days when it’s dry may be the culprit, whereas a wet run won’t cause issues. Another variable to consider!
On a side note, you’ve given me all the more reason to be a Luddite and stay with my dumb phone. 🙂
Yeah, a cotton sleeve should help. You can probably just buy an extra large cotton wristband. And just to be clear, when you say “to put over my Dexcom”, do you mean over the transmitter?
Also, are you confident that you’re generating the static electricity while exercising, and that it’s not coming from the dryer? In other words, do you use dryer sheets or some other method to prevent static electricity from building up during drying?
Keep us posted. Thanks!
I am actually pretty confident it’s exercise and condition induced. Another good example of a technology that can be influenced by this is chest heart rate straps. On a windy descent it’s easy to have the excess wind generate noise and static that easily causes erroneous readings – that or my new max hr is over 220 😉
Also, none of my fitness apparel is put in the dryer.
And yes, I meant to cover the transmitter.