Asante Snap Insulin Pump – Not Your Usual Set Change
by Adam Brown
Under one in three people with type 1 diabetes in the US is on an insulin pump, and for those with type 2 diabetes on insulin, it’s less than 1 in 100. This, despite the fact that pumps can help patients:
- Lower their A1c (~0.5% or more, depending on starting A1c)
- Spend more time in their target glucose range (e.g., taking small boluses to micro correct through the day)
- Have much more flexible eating and exercise patterns
- Take insulin discretely
- Use advanced insulin dosing features (e.g., temporary basals, extended boluses for high fat meals)
- Improve their overall quality of life.
With those benefits in mind, I often wonder why more people aren’t on insulin pumps –I recognize that although not everyone is, I’m very lucky to have access to this sort of diabetes technology.
Asante Solutions, maker of the Snap insulin pump (previously known as the Pearl), did some market research, and the company identified four reasons why many patients might not want to go on a pump:
Perceived complexity (“A pump will make life harder”)
Cost concerns (“I don’t want to spend that much, especially when I am not sure I will like it”)
Misperceptions about what getting a pump means (“A pump means my diabetes is at its worst”)
Concerns about control (“I don’t trust a machine”)
Asante designed the Snap to specifically address the first two barriers noted above. I wore the pump for a couple of weeks and what follows is my experience using it.
Simplifying Infusion Set Changes
Pre-filled insulin cartridges
Seven days between insulin cartridge changes
“Less prep time. More life time” is one of the Snap’s snappy taglines, and it’s this attribute of the pump that most stood out for me. Unlike other insulin pumps on the market, where a reservoir, cartridge, or pod must be manually filled with a syringe, Asante’s Snap uses pre-filled Humalog cartridges; (the company is also working on a Novolog cartridge). That makes infusion set changes a LOT faster. On average, changing an infusion set and reservoir took me just over two minutes with the Asante Snap, compared to a bit over three minutes with the Insulet OmniPod, four minutes with the Medtronic Paradigm and the Animas OneTouch Ping, and around nine minutes with the Tandem t:slim. While a few minutes do not seem like much, anything that takes time away from diabetes is great.
The Snap’s pre-filled Humalog insulin cartridge is one of the biggest time savers, since I find that messing with syringes and flicking air bubbles usually takes at least 30 seconds. Asante also added what it calls an “auto-prime” feature: once the pre-filled cartridge is slipped into the pump and connected to the infusion set, it immediately primes the entire line of tubing in a less than a second. It’s impressive to see in person – insulin literally drips off the end of the infusion catheter nearly instantaneously after connecting the tubing to the cartridge. I have found priming to be the single most time consuming aspect in the set change process, so the auto-prime feature is a welcome innovation.
There’s one additional aspect of the set change process that Asante has really improved. The 300-unit Humalog pre-filled insulin cartridges are FDA approved for up to seven days of use in the Snap. (They are made of glass, and there is some evidence that the insulin stays more stable in glass than in standard plastic reservoirs.) Since I use about 25-30 units of insulin a day, one pre-filled insulin cartridge easily lasts me a week. Of course, I still needed to change my infusion site every three days, like any other pump, but the benefit of a seven-day cartridge label meant I only needed to change out the pump’s insulin cartridge every other set change – another time saver. My schedule looked something like this: Monday (infusion set and cartridge change; ~2 minutes); Thursday (infusion site-only change; 40 seconds); Sunday (infusion set and cartridge change; ~2 minutes). That translates to less than five minutes per week spent on reservoir/set changes with the Snap vs. the 10-27 minutes I have found with other pumps (which require a new reservoir fill with every set change). This translates to 6-19 hours saved per year! For those who change their sets every two days, the time difference is even bigger.
Using the Snap
Simple menu structure
Fast menu navigation
Large on-screen font
When I first picked up the Snap, I immediately noticed the shape – the pump is about the same thickness as a Medtronic Paradigm or Animas OneTouch Ping (though a bit shorter), and it is slightly wider than either pump. This didn’t bother me too much, since I know the pump’s overall design is really built around the long pre-filled Humalog insulin cartridge. For me, the time savings on the aforementioned set change outweighed the slightly longer pump body, though I realize some people place a greater emphasis on wearability size – if you do, Insulet’s second-generation OmniPod or Tandem’s t:slim might be better options . That said, Asante told me that the Snap is about 25% lighter (with insulin) than other pumps. As with most things in diabetes, there is no one-size-fits-all!
The Snap’s user interface is unique and reminded me of a video game controller. There are five buttons surrounding the pump’s screen, and each is labeled with a small on-screen indicator tab to denote its function in a particular menu. Unlike other pumps, where menus are laid out vertically and you scroll up and down, the Snap’s menu is laid out horizontally – you scroll right and left using both of your thumbs on opposites sides of the screen. It definitely takes some getting used to. Overall, I liked the simple and intuitive menu structure: Bolus, Stop, Basal, Prime, Log Book, Setup. I generally found that items were always located in the sub-menu I expected, making it easy to navigate.
In terms of bolus speed, Snap was faster than most pumps I’ve tried. The standard test I’ve applied in recent test drives – programming a combination meal and correction bolus for 30 grams of carbs and a blood glucose of 165 mg/dl – took me an average of 15 seconds on the Snap, a bit slower than the nine seconds on the Tandem t:slim, slightly quicker than the 18 seconds with the Medtronic Paradigm, and much faster than the 26 seconds with the Animas OneTouch Ping.
While the Snap’s screen is black and white, the font is huge as far as pumps go – about 40% bigger text than the next largest menu option on the market. I thought it was great of Asante to “go big,” as many people with diabetes are visually impaired. Indeed, Asante told me that around 50% of the people in the pump’s beta trial wore reading glasses. The pump screen is also easy to read outdoors, which cannot be said for all pumps on the market. In the future, I think Asante could consider a color screen (and perhaps a touchscreen) for the Snap, though I recognize those additions come with the caveat of needing a larger and/or rechargeable battery.
The Asante Snap has several other unique features that I think are worth mentioning:
Flashlight! I’ve certainly fumbled around in the dark with a dimly lit pump screen in front of me, aimlessly trying to find my keys or avoid tripping. As a result, I was glad to see that the Snap actually has a built-in LED flashlight, which can be turned on with one button press on the home screen. It stays on for 15 seconds, presumably to prevent too much of the battery from being sapped. I thought this was a superb feature, and very well designed.
Very LOUD alarms. The first time I heard the three-day infusion set change reminder alarm, I thought it was our smoke detector! The pump volume can be set very loud at your discretion, and if there is a really critical pump alarm, you will know it immediately! (One Asante employee called it DefCon 1). One note: the Snap does not have a vibration setting, though quieter audio settings are possible.
No battery changes or charging. The Snap actually consists of two parts – a reusable controller and a disposable pump body. The battery, pumping mechanism, and pre-filled insulin cartridge are all in the disposable pump body, meaning that every time you switch out the cartridge and pump body (every seven days for me), you are also changing the battery. Asante told me that the battery lasts about ten days, so if you are willing to use the pre-filled Humalog cartridge beyond its FDA approved seven days of use (this is technically “off-label” use), you could go a full ten days without needing an insulin cartridge change!
Occlusion alarm. Asante originally designed the Snap to have a highly sensitive occlusion alarm. It was so sensitive, in fact, that the company scaled it back after initial consumer feedback. Asante found that for most occlusions, massaging near the infusion site will clear the blockage more than 80% of the time.
Drop detector. I didn’t give this a try, but if the Snap is dropped and damaged, the pump will let you know it. Pretty cool given the potential for danger, though I’m not sure how often most patients will see it go off in practice. Definitely nice to have.
Areas for Improvement
I found a few small areas that the Snap could be improved.
Bolus calculator – reverse correction. For those not familiar with the term, a “reverse correction” is a useful feature of bolus calculators that automatically subtracts insulin out of the calculation when you are hypoglycemic. For example, if my current blood glucose is 60 mg/dl, my target blood glucose is 100 mg/dl, and I’m about to eat 30 carbs, the calculator should recommend I take only 1.8 units of insulin, not the usual 3.0 units I would take for 30 carbs (the 1.2 units is the reverse correction to bring my blood glucose of 60 mg/dl back to 100 mg/dl). It really bothered me that the Snap’s bolus calculator does not reverse correct a meal bolus dose for a blood glucose less than 70 mg/dl. In these cases, the Snap displays a hypoglycemia warning message and then kicks you straight out of the bolus calculator menu. Since I often eat more than the number of carbs I need to bring a low blood glucose back up to target, the lack of a reverse correction struck me as unfortunate – nearly every other pump has this feature.
Bolus calculator – showing IOB in isolation. I noticed pretty quickly that the boluscalculator did not show the specific amount of insulin-on-board (IOB) when looking at the details for a bolus calculation. Rather, the detailed calculation shows one number to denote the recommended correction insulin minus IOB (not IOB on its own) – this made it difficult for me to follow the pump’s logic in arriving at the final insulin calculation. I often override the calculator anyway, but I like seeing the full calculation laid out.
Bolus calculator – screen size. While I didn’t find the horizontal screen layout to be a major problem, the bolus calculator is the biggest area where it’s a limitation. I’m used to seeing the arithmetic in a vertical layout, so the Snap’s horizontal layout and right/left scrolling make it harder to connect all the different bolus calculator pieces (meal, correction, IOB, total).
Slight noise of the pumping mechanism. I found that the sound of the Snap’s pumping mechanism delivering insulin was louder than other pumps I’ve used. The Asante reps told me they’ve heard this feedback and have already improved the Snap – it would be great if they could do a bit more to make the pump even quieter. It’s a very, very small thing, but when you’re in a dead quiet room, you can definitely hear the pump delivering insulin.
Color/touch screen. As I noted previously, I think this would be an asset to the pump, though I understand the tradeoff for battery life and cost.
CGM and blood glucose meter integration. Asante does not currently have blood glucose meter or CGM integration, though the company told me these are on the docket for future Snap controller upgrades.
Downloadable. The current Snap data cannot be downloaded, though by the end of 2013, Asante will be rolling out an updated controller that can download to both the Glooko and Diasend platforms. This is a huge win in my book. Both programs are web-based, can sync with a wide variety of glucose meters, and are intuitive to use. In my mind, the future of diabetes data will revolve around hassle-free download and integrated data from many different devices – it’s great that both platforms are moving in that direction.
Cost and Getting on the Snap
As I noted, cost is a big concern for many when deciding to go on a pump. Asante has adopted more of a ‘pay-as-you-go’ model with the Snap. The idea is that the upfront cost to get on the Snap is much lower than most other pumps (Animas, Medtronic, Roche, Tandem), while the ongoing cost of using the Snap is higher. I’ve provided a general guide of pricing below, though the amount you actually pay out of pocket initially or monthly will depend a lot on your own insurance situation. For instance, when getting a brand new pump in the past with Aetna insurance, I’ve had no out-of-pocket cost, even though the list price for the pump was over $4,000.
To date, the typical total cost (the amount insurance pays plus the patient co-pay) for the Snap controller has been approximately $775, similar to the ~$800 cost of the Insulet OmniPod and much cheaper than the Tandem t:slim (about $6,995), the Medtronic Paradigm Revel (about $6,500), and the Animas OneTouch Ping (about $6,300). However, ongoing costs for the Snap are higher than those for traditional pumps. The company estimates that the monthly total cost of Snap supplies is approximately $375 (the amount insurance pays plus the patient co-pay). This is close in price to the OmniPod and more expensive on an ongoing basis than buying infusion sets/reservoirs for other tubed pumps. In short, to figure out how much it will cost you to get on the Snap or any other pump, it’s best to contact the company directly.
I was glad to see that the Snap will be easily upgradeable – for $99, users will get a new controller when new features come out (e.g., downloadable, CGM, etc.). The upgrade will be offered regardless of how long a patient has been on the pump.
I was also excited to see that Asante is offering anyone a risk-free, four-week free trial of the pump. Not even a deposit is required, and the trial does not involve insurance. Patients get a month of supplies and simply return the controller when they are done. What a fantastic way to let patients try before they buy! Asante advises diaTribe that demand has been very high for trials. You can find out more here.
Overall, I thought the Snap was a very good insulin pump, especially for those who have never pumped before and are hesitant about making the switch, or for those who want to spend as little time as possible on changing their infusion set. Asante tells me that like Insulet, it is seeing a nice proportion of users coming from multiple daily injections. For more information, visit www.snappump.com.
Adam is the co-managing editor of diaTribe and the Chief of Staff at Close Concerns. He was diagnosed with type 1 diabetes at the age of 12 and has worn an insulin pump for the last 11 years and a CGM for the past three years. Most of Adam's writing for diaTribe focuses on diabetes technology, including blood glucose meters, CGMs, insulin pumps, and the artificial pancreas. Adam is passionate about exercise, nutrition, and wellness and spends his free time outdoors and staying active. He can be contacted at [email protected] or @asbrown1 on twitter.