“Hard” or “soft” expiry dates: a Spirit Combo story

We see “expiry” dates on many medical items, and some of them are often treated with a little disdain. For example, lancets tend to last for aeons, and CGM sensors don’t stop working right when their expiry date passes. The Accu-Chek Spirit Combo pump has a few “features” many people seem to not be aware of, and the one I’m writing about here is related to the age of the pump.

Insulin pumps generally have a 4-year warranty and support contract. After 4 years we get a new pump (here in Australia that’s generally through private health insurance, although some insurers are now pushing back to 5 years and more where they can). Our old pump may still work, and makes a great backup device (e.g. when I travel to remote destinations such as Antarctica or even just outback Australia I will have my backup pump somewhere in my luggage).

This 4-year support arrangement also applies to the Accu-Check Spirit Combo. And many people still have older Combo pumps around that they use as backups. Over the years, with my backup pumps of all models, I will regularly power up the pump and switch to using it for at least one cartridge. This reassures me that there’s a good chance it will work in an emergency if my main pump fails, and it also means that the pump should be programmed with recent settings.

I know many people happily using Medtronic and Animas pumps which are quite old but are still working great: they just don’t have any warranty. But there’s a slightly hidden issue with the Spirit Combo.

Warnings and Errors

The pump can report a range of errors, including simple things like low battery or cannula occlusion alarms. Two of them are of interest here:

Error E6: MECHANICAL ERROR

The manual advises a reset routine that involves a new battery, and starting fresh with a new cartridge and infusion set. This rewinds and resets all the mechanics of the pump. But if the E6 error recurs, the advice is to contact the Customer Care team for more assistance (presumably with the expectation that the pump may need replacing).

Note that apparently E6 can occur if you don’t follow the cartridge change process properly (resulting in small amounts of insulin dripping into the cartridge compartment). This was documented in a 2015 TGA recall action.

Error E7: ELECTRONIC ERROR

The routine for this requires removing and replacing the pump’s battery, re-priming the infusion set, checking all settings (including date and basal profile) and continuing. Again, if the error recurs, contact Customer Care.

Hopefully these E6 and E7 errors will never occur, but if they do at least the pump gives you a chance to reset it and try again. The pump also has a range of warnings, including things like “cartridge low” to prompt you to refill the pump. But one is particularly relevant here:

Warning W4: CALL FOR UPDATE

The manual says “The pump has reached six years of life. You way want to consider updating to a new product.”

Discussions with tech support staff indicate that apart from that subtle sales pitch, there’s a side-effect. Apparently after W4 has been triggered, any subsequent E6 or E7 error will be fatal and the pump will be unusable.

What does this mean?

This doesn’t mean that once the expiry date passes the pump would immediately stop working. The pump should continue trucking on as before.

As you’ll see from the image at the top of this article, I’m expecting this to happen on my backup pump next month.

Hopefully your pump will never get an E6 or E7 error. But be aware that if it does after the pump is six years old, that may be “all she wrote”.