Braille Monitor                                            June 2016

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Another Insulin Pump User

by Bridgit Kuenning-Pollpeter

From the Editor: In the April 2016 issue we ran an article about the use of insulin pumps, trying to explain what they do, why a blind diabetic might wish to use one, and some of the pitfalls that spring from less-than-ideal accessibility when one cannot see a visual display. In that article was the concern that newer pumps are not more accessible than their predecessors and that those which can be used by the blind are extremely limited.

Bridgit Kuenning-Pollpeter is a Federationist from Nebraska. She serves as president of the Omaha Chapter in addition to serving on the board of directors of the NFB of Nebraska. She is currently an MFA student, studying creative writing at the University of Nebraska Omaha. She lives in Omaha with her husband Ross and their son Declan. Bridgit was diagnosed with diabetes at age four. She says diabetic treatment has changed so much since she was diagnosed. She’s been using an insulin pump for twelve years and loves it despite the fact that no talking pump yet exists. Here is what she says:

I have been a type 1 diabetic for thirty years. Going through the gamut of diabetic methods and tools, I have seen a lot. Diabetes is an individual experience, meaning what works for some doesn’t work for everyone. Certain protocols and treatments are essential for any diabetic: performing frequent glucose tests, being mindful of carbs and nutrition, taking insulin and/or other medicines if prescribed, doing exercise, and engaging in general healthy living. However, the amount and level of exercise I do may not be appropriate for you. Or you may be able to eat pizza with little change in your glucose readings, while I may require a lot more insulin to counterbalance the carbs. I may have fewer insulin needs in a day, while you may need more. It can take time to figure out what works best for each person. This includes deciding if using an insulin pump is right for you.

I have been using a pump for twelve years now, and I love it. A quick shout-out to my endocrinologist, who suggested I switch to a pump years ago. He never blinked twice at the thought of a blind person using a pump, and, in fact, was the one to initiate the conversation. I have had the best control over my diabetes since switching.

The reasons I love the pump: It allows me more flexibility with when and what I eat. I’m busy and active, and my schedule is not the same every day. I’m not shackled to a rigid meal schedule. It allows me to set various basal patterns throughout the day, simulating a pancreas better than most insulin regimens. If I consistently run lower at certain times of the day, I can lower basal rates for that time of day. If my weekend schedule is vastly different from my weekday, I have an entirely different pattern I can switch to for the weekend. With my pump I can actually set several different basal patterns if I want. I also do not have to keep vials of insulin and syringes on hand or insulin pens and syringe caps all the time. The pump is on me at all times, and when I need to bolus, I press a button on a pump. A bolus is the insulin you take after eating carbs.

In April’s issue of the Braille Monitor, Veronica Elsea shared her experience with several pumps. Being an Animas Ping user, I wanted to share my experience, especially since I use the pump daily. Like Elsea, I used a DelTec Cozmo for years. I loved it, and if Smiths Medical were still in production, I would use the Cozmo. However, when the time came to switch insulin pumps, I found the Animas Ping to be the most similar to the Cozmo. I have now been using the Animas Ping for almost three years, and I have not found it overly difficult to use and am generally happy with it.

Elsea states, “Most actions require more confirmation steps than they do on many other pumps.” I find this statement a bit misleading only because it comes across as if many functions are difficult to access or navigate, but in my experience, it’s simply that the pump asks the user to press okay after most steps as a security measure. For example, when changing a cartridge, it will ask you to press okay for each function, those being unwind, load, prime, and fill cannula. The same confirmation is required when using the touch bolus button on the side of the pump. You press the touch bolus, it beeps twice, you dial how much insulin you want (each touch beeping), then it counts back what you delivered (making a beep for each count), then it beeps twice again letting you know you can hit the button to deliver the insulin. All this is done to ensure safety with the pump. It may take a few seconds longer than some pumps, but I find it helps me, making sure I’m doing the correct function before moving on. In a nutshell, with most features it’s a matter of pressing the okay button after each function.

The Animas Ping only has five buttons. On the face of the pump, three buttons are in a column to the right. The large round button on the bottom is the okay button. Above okay are the up and down arrow, up being above the down. On the side of the pump to the right is the touch bolus, between the cartridge reservoir and battery. On the top right is an indented button, which is the contrast button. For sighted or low-vision users, you can change the contrast of the screen, making it easier to see visually. So the button layout is simple and easy enough to use. The primary buttons you use are okay and up and down arrow.

Elsea also states, “Would be able to enter BG manually if one could verify by keypad beeps. As it is, pressing button a bit too hard can cause scrolling, which would lead to errors.” In three years I have never had this happen. While it’s unfortunate the pump does not beep each time you press a main button on the face of the screen, I have never had a problem with scrolling. The buttons are tactile and make a slight click which gives audio confirmation. Each time I press a button, it does the function. Scrolling has not been a concern, nor have I had errors due to this. If you press and hold, then yes, it will scroll—similar to pressing a key on the computer. If you hit it once, it does the command you want; if you hold it down, it scrolls or does another command. Again, in three years I have never had a problem with scrolling—and keep in mind that I use the pump daily with no assistance.

If you want to enter glucose readings manually, it is possible, and scrolling is not a major concern. I do not use this feature, but I do use the temporary basal adjustment, which allows one to increase or decrease basal rates for a certain period of time. I arrow through the percentages and times, choose what I want, and set it. This is handy when exercising or increasing activity, in which case you would decrease levels. Or if running higher and bolus corrections are not helping, but you don’t necessarily need a permanent change, you can temporarily increase levels. I have never had a problem with scrolling when using this feature.

Even with my Cozmo, I have always used the touch bolus when bolusing. Because my carb/insulin ratio can change meal-to-meal, I do old-fashioned carb counting in my head, then deliver it up with the touch bolus. You can adjust this button so that each time you hit it, it dials a certain amount of insulin. For me the touch bolus button is set to deliver a half unit of insulin each time it’s pressed. So if I need two units of insulin, I press it four times. I often don’t need much insulin, so this is why my unit is set on half a unit. You can set it to deliver one unit or more with each press, depending on your bolus needs.

Entering basal patterns can be done without sight. When entering the basal pattern, it’s always at the same place. As long as you can keep track of your place, it’s possible. I prefer to have sighted help, but it is possible, and my husband (who is also blind) and I have done it before in a pinch. This is another function in which I have never had a problem with scrolling.

It is true that custom alarms cannot be set for low battery or low cartridge, but generally you know when a cartridge is low or the battery needs to be changed. The Animas Ping suggests using lithium batteries, which last up to three months, while regular batteries last about a month. So one would have a good idea when the battery needs to be changed. For me, 200 units of insulin lasts about a week, so when I hear an alarm at the end of the week, I’m 99 percent positive my cartridge needs changing. Now in three years I’ve had one alarm alert me that was not a battery or low cartridge warning. I knew instantly it was not one of these alarms because it was not time for either to be changed. I had to ask for sighted assistance to read the screen to find out what the alarm was. It was nothing major, but I was unable to determine the problem alone.

Here’s a handy tool I’ve used for my pump along with other things: using the FaceTime feature on my iPhone works well if I need sighted help. Someone can read the screen of my pump right over the phone. I have only had to do this a handful of times, but it works well.

I have either memorized menus or have written directions I follow for menus for the functions I can access. Yes, some functions are a bit complicated to follow even with written directions, but enough of the pump is available to access in this manner to allow me to use it successfully. My A1-C, which determines glucose levels over a three-month period, is great, and my overall health is good, so this would demonstrate that if you choose, using an insulin pump can be beneficial to diabetic management. And the Animas Ping is a choice that works well for nonvisual users. In my personal experience, considering it has no talking function (which is what we truly need), it has been beneficial and works well enough, allowing me to manage my insulin needs and diabetic care.

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