Animas finally going away

Animas is finally disappearing from Australia, and not only Vibe users will be affected.
This article lists many important and urgent pieces of information for users of Animas Vibe, Tandem t:slim X2, and Accu-Chek Combo pumps.

History

In 2017 we heard that Animas was leaving the insulin pump market (being closed down by its parent company Johnson & Johnson). Early last year we heard that worldwide sales of the Animas pumps would cease. Since then it’s been a gradual change, with AMSL (the Animas distributor) introducing the Tandem t:slim X2 pump and transitioning in-warranty Vibe users over to it.

Initially the Tandem pump was using the same Animas infusion sets as the Vibe (using a luer-lock version of the Tandem reservoir). Then in February 2019 AMSL introduced Tandem equivalents of these, along with the t:lock reservoir that’s standard for Tandem pumps overseas. Unfortunately not all the same options of tubing length are available in the Tandem versions though.

Both versions of the Tandem reservoir have been available, and people have been able to use either Animas-compatible luer-lock infusion sets, or the Tandem t:lock versions. Until now.

As of September 1st 2019, the luer-lock Tandem reservoirs will be withdrawn from sale. I expect the NDSS lists will be updated to show this at the start of September.

Tandem users who have been preferring non-t:lock infusion sets (such as some of the Animas sets available with different tubing lengths, some Accu-Chek sets with very short tubing for small kids, Medtronic Quick-Set, etc) are facing migrating to the t:lock options. Or at least stocking up on Tandem luer-lock reservoirs in the remainder of August.

It’s time!

But that’s not all. As of October 1st 2019, no more Animas consumables will be available to AMSL from J&J, and they have to withdraw these from the market. The NDSS lists should show these changes in an October update.

Warranty on Vibe pumps will cease at that point too, so all in-warranty Vibe users should have transitioned to the t:slim by then (or pray that they don’t need warranty support).

Unfortunately not all of them will. Reasons people may be keeping their Vibe pumps include:

• Because they don’t like the Tandem pump.
• Because the Tandem pump can’t work for them (e.g. it has some different restrictions on minimum basal rates).
• To use as emergency backup in case their in-warranty pump fails.

Anyone continuing with a Vibe at that point will have presumably stocked up with a supply of Vibe reservoirs as well as compatible infusion sets. There are compatible non-Animas infusion sets, but there are no other options for Vibe reservoirs.

But other people use these infusion sets too, not just Vibe users. Pumps such as the Accu-Chek Combo also use a luer-lock connection. So what can we do?

Luer-lock infusion set choices

There are still quite a few luer-lock infusion sets that will continue to be available. You just need to find the right ones.

I wrote up the infusion set options available through NDSS last year. It might be worth checking that article again for some details about these infusion sets.

For some of the Animas sets there are exact matches available. They’re actually made by the same company (Unomedical) for all of these pump manufacturers.

Animas set	Identical option
Animas Comfort	Accu-Chek TenderLink Medtronic Silhouette (not “Paradigm Silhouette”)
Animas Contact Detach	Medtronic Sure-T (not “Paradigm Sure-T”)
Animas Inset II	No exact match: find something else.
Animas Inset 30	No exact match. But TenderLink and Silhouette are the manual-insert versions of this. Medtronic’s SilSerter device is compatible with the Silhouette.

If you’re an Inset II user and looking for other 90˚ teflon options you do have a few to choose from:

• Cleo 90. Has integrated inserter.
• Medtronic Quick-Set (not “Paradigm Quick-Set”). Should be used with QuickSerter inserter.
• Accu-Chek FlexLink. Should be used with LinkAssist inserter.

For Contact Detach users, it’s also worth noting that the Accu-Chek Rapid-D is another steel cannula you can experiment with.

Ordering new types of infusion set

As an NDSS member registered as a pump user you can purchase any of these via your normal NDSS channel (e.g. your pharmacy). Look at the “IPC order form” on the NDSS Product and Supply page, find the options with the appropriate model, cannula and tubing length, and make a note of the relevant NDSS Codes. Give those to your pharmacy and they should have no excuse for getting the wrong thing, even if they have to order it in.

In fact it’s often easiest to print the form, mark up the ones you want with a highlighter, and hand that to the pharmacy.

If your pharmacy has not got the stock in within a few days, ask them for an ETA. Remember, if their supplier tells them there’s no stock you may have to try a different pharmacy.

Conserving your reservoirs

This seems relevant both for Vibe users as well as users of the luer-lock Tandem reservoirs. I’ve mentioned this before, but it’s worth repeating.

There are good health reasons for not using cannulae for longer than 3 days (for teflon sets) or 2 days (steel sets). But you do not always need to replace the reservoir at the same time!

With my own insulin use, a 300U reservoir will usually last about a week. 200U for 5 days. And unless I’ve been in extreme heat conditions (well above 40˚C) my insulin has continued to work fine for the entire week. That’s been with Humalog and Fiaspro. I haven’t tested Apidra to the same length (although obviously Apidra doesn’t work in the Tandem pump).

Especially if you’re trying to conserve a limited supply of reservoirs, you may want to take this opportunity to not waste them. Some people are able to reliably fit 6 days of insulin into a reservoir, and change the reservoir with every second infusion set. But it will obviously depend on how much your average daily total of insulin is.

Conserving your infusion sets

You should definitely change your cannulae regularly, but if you’re like me and only use a new tubing set with each reservoir (see above) then maybe each second infusion set’s tubing is going to be thrown away.

Once you discard the tubing the Animas Comfort is the same as the:

• Medtronic Silhouette and Paradigm Silhouette
• Accu-Chek TenderLink (which is available without tubing)
• Tandem VariSoft 30

So you could use these for every cannula where you’re not going to need the tubing, and thus stretch out your supply of Comfort infusion sets.

Similarly, without tubing the Animas Contact Detach is the same as the:

• Medtronic Sure-T and Paradigm Sure-T
• Tandem TruSteel

I’ve even done the same thing with Animas Inset II sets. The Inset II can be inserted without attaching the line to a pump, and then detach and discard the tubing (and then move the existing tubing over to it). In my experiments I found I just had to increase the cannula fill amount by 0.2U (thus 0.5U for a 6mm cannula, and 0.7U for 9mm) to compensate.

To conserve your stock of Inset II, you might use the Medtronic Paradigm Mio sets (which only differ from the Inset II in the pump connector on the other end of the tubing) for every second cannula. The Tandem AutoSoft 90 sets are also compatible.

Keep an eye on the expiry dates

When you have a stockpile of reservoirs and/or infusion sets, then especially if you manage to conserve them via the above methods, do keep an eye on the expiry dates.

I have used pump consumables (and CGM sensors) that were “mildly-expired” with no problems, but you should avoid it if you can. Definitely use the older ones first.

Don’t wait until October!

There are plenty of infusion set options still available, for Vibe users, Combo users, and even DANA pump users who have luer-lock adapters (although the manufacturer does frown upon those).

Remember, this includes users of other pumps who have an old Vibe in the cupboard as an emergency spare.

If you haven’t already done it, now is the time to experiment with some of these options (and maybe stock up on the last Animas consumables you won’t be able to replace).

Check the expiry dates on your purchases

Unfortunately some of the pharmacy wholesalers have recently been supplying some infusion sets and reservoirs past the expiry dates printed on the packaging.

Before you leave the pharmacy, check the dates on the boxes, and get them re-ordered if they’ve expired.

In fact there should be at least 6 months left on them when they’re delivered to you. The consumables don’t magically stop working when the expiry date is passed, but legally they should not be supplying you with expired goods.

NDSS limits

There are limits on how many sets you can purchase at a time through the subsidised NDSS scheme. They’re documented on the NDSS website, and are based on a rolling 180-day window. Within the last 180 days, there’s a limit of 90 infusion sets and 90 reservoirs.

I’m not sure that these quotas are always enforced. I ran into the limits some years back when trying to purchase enough spares for an extended Antarctic expedition, but I sometimes hear stories of people managing to purchase more than nine boxes at a time without completing extra paperwork. Do at least be aware of the official limits.

Yet another reason to not leave your ordering until the last minute!