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February 19, 2014

Hypoglycemia, Insulin Pumps

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Question from Massachusetts, USA:

My 17-year-old son, who was diagnosed with type 1 at the age of 11 and has been pumping about 10 years, had a hypoglycemic seizure while in Disney World. Examining his Paradigm Revel pump, he had been dosed 24 units approximately 5 minutes prior to a seizure. He denies taking this dose, which is his maximum dose, but showed me how with just three or four button presses, he could get that maximum dose. The time stamp on the dose was during a ride on a roller coaster. We believe the pump was pressed in just the right way, during the ride, to deliver the insulin. It is our belief that the only way this could have been prevented would be to use the lock out on the pump. We have not needed this in the past, except when he was very young. I also want to alert others of such a dangerous event being possible. We are now looking at changing pumps, and adding a CGM. We are looking at the Animas ping and t:slim pumps. What is your opinion about these two pumps’ safety features?

Answer:

Both the t:slim and the Ping have lock out features. If the lockout features are used, accidental boluses from button pressing will not occur. Both pumps also offer a maximum bolus feature so that no more than the maximum bolus can be delivered at a given time.

The Ping also offers a maximum bolus in any 2 hour time frame as a secondary back-up.

Regarding a CGM, Animas has filed with the FDA to have their Ping become integrated with the Dexcom G4 (sold and called the Animas Vibe in Europe and Canada). It is not certain when the approval will come. Tandem Diabetes, makers of the t:slim pump, are speaking openly about future integration with Dexcom, but have not submitted to the FDA at this time.

Because of his age and similar safety features on the pumps we strongly encourage your son to take an active part in this decision. You may want to call both companies and meet with the local representative so he can see and work with the different interfaces to find the one with which he is most comfortable working.

NB