tslim_G4_with_TransmitterLast week, Tandem announced that the FDA approved their new T-Slim G4 Combo, integrating the pump with the Dexcom G4 CGM transmitter. Along with the Animas Vibe, that gives us two G4 integrated pumps, systems where you can see blood sugar readings on the pump screens. That’s great news.

The bad news (to quote this article from Diabetesmine):

Tandem’s new combo device is nearly obsolete on arrival given that last Fall, Dexcom rolled out an advanced algorithm that’s more accurate than its original G4 and that new algorithm is not included here. Moreover, Dexcom’s G5 direct-to-smartphone sensor was also just approved by FDA and will be available in the coming weeks — putting Tandem another square behind the latest tech. 

animas_vibe_features(The Animas Vibe is also G4 integrated and not compatible with the new G5. I have an agreement with Animas.)

This mixed news touched off an interesting social media conversation about appreciating what we have in terms of diabetes technology. Many people expressed excitement about how fast new gear is getting FDA-approval and coming to market.  Others – like me – expressed frustration.

A good example of the first way of thinking is this this well-written and thoughtful post  by Kari W. A few tweets throughout the day from others asked the DOC to just be thankful for what we have, that we’re “beyond blessed” with d-tech and what else could we possibly want?

The second is illustrated by D-Dad Greg Dooley writing that his 5 year old daughter’s Omnipod system failed three times. Three pod failures and a belly-up PDM.  A friend posting on Facebook that her son just switched to a T-Slim and one of the first comments is a warning to be careful. “The screen is delicate. (My daughter’s) dropped it and cracked it twice.” Our Animas Ping system hasn’t changed since 2008, but we still think it’s the best option for my son and stayed with it this summer when our four-year pump choice window opened up (don’t even get me started on that).

When I posted these examples, and that I felt d-tech lags behind other sectors, I was told the tech has come a “tremendously long way in ten years” and “what more did I want out of a pump?”

Really? Glad you asked!

I want an agnostic system where my pump talks to my CGM and my phone. I want to be able to program a temp basal in advance (say, for 5pm baseball practice tomorrow night) for any amount of time. I want a meter remote that can be used without cancelling pump communication with a CGM or a phone. I want insets and CGM sensors that stick better, with less irritation, that last longer and hurt less. I want more choices of what insulin can be used in what pump and a system that’s less susceptible to pressure and temperature changes or static. I’d love to change my alarm chimes & volume as easily as I change ring tones on my phone. Better brightness adjustment on meters would be good too. How about more accurate meters while we’re at it? To say nothing of the bionic or artificial pancreas (and of course we all want a cure, but that’s a different post…).

I don’t understand why I have to be just be grateful for the diabetes technology we have.  I’m inspired by We Are Not Waiting and CGM in the Cloud even though I do not remote monitor very often (and I’ve never used Nightscout). Without the push from these groups, I truly believe Dexcom would have left the Share cradle on the market a lot longer, and we wouldn’t be talking about the FDA approving the G5 this quickly. But, the moves ahead in CGM technology lead us to wonder why the pumps don’t seem to keep up speed. I know they’re different companies, I know it’s propriety, I know we’re told it’s complicated and medical, but it’s 2015. This thing should talk to that thing (hat tip, James Wedding of the Nightscout Foundation).

Of course, of course, of course, I’m grateful that we have access to insulin let alone all the higher tech gear I’ve talked about. I’m thrilled and thankful that we aren’t sharpening or boiling needles at home. But is this our standard? Be happy it’s not as bad as it was? Unless we push, things will not change. Unless we demand better, we won’t get it. Our kids and our community won’t thank us for not speaking up. They’ll be glad we did.