Advice on what pump to choose

My husband was diagnosed w type 1 diabetes 2 years ago at the age of 32… he has been through highs and lows as far as levels and mentally with managing… I have wanted him to get at the very least a CGM bc he has a very active and sometimes dangerous job (power lineman) that he doesn’t want to give up. He finally accepted the fact that this is life and he is now ready to proceed with a pump and CGM… I have done most of the research and felt the Medtronic would be the best fit for him bc it can delay insulin up to two hours and would help him avoid lows on the job and it has the CGM all in one unit… the Endo however stated that he did not currently have any patient on the newest Medtronic pump and that previous model had issues with the CGM not being accurate…it is very important that the CGM not have issues… For anyone using the newer Medtronic- how is the CGM? Is it pretty accurate? Also we have considered dexcom with omipod bc of dexcoms accuracy and omipod being tubeless … anyone using this combo and how do u like it?? Any advice is much appreciated as this is a big step for my husband as he has struggled with accepting his diagnosis

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I’m using a Medtronic pump but with a Dexcom CGM. I think both are the best at what they do and it’s too bad they will never be combined because of Medtronic’s inferior proprietary CGM. I don’t think the low suspend feature will be useful for preventing lows. It kicks in once a person is already hypoglycemic and suspending the basal takes a long time to bring someone out of it. Your husband would still have to treat hypos with food right away and this feature wouldn’t change that. If anything it could lead to high blood sugars later on if your husband treats with food and the basal is suspended for a period of time. I think it could be life-saving for people who are hypoglycemia unaware and don’t have a CGM, and/or who have bad hypos during sleep and don’t wake up from them however.

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The suspend on low in the Medtronic 630 does kick in when a person has reached a low threshold, but the user sets that limit himself. So if one wants to be extra safe, s/he can set it at, say, 80 (which isn’t that low) and the basal will be suspended then. Also, there is an additional and very helpful feature of “alert when going low” which lets you know that you are trending in the low direction (same for high), so you can take measures early as well. While the non-integrated setup might work well for you, I think the OP describes circumstances where the integration will actually be extremely helpful.

Tandem is working on an integration with the G5 which will predict the low and reduce the basal based on that prediction so as to avoid the low entirely.

You can get the Tandem t:slim X2 and Dexcom G5 now and use them non-integrated. The Tandem pump can then be remotely upgraded via software download when Tandem has this Predictive Low Glucose Suspend (PLGS) integration update completed, approved and ready to roll out. The obvious downside is the integration is not available now so it is always guesswork when it will actually be ready. Tandem’s current “Launch Goal” for the PLGS integration is “Early 2018”.

https://www.tandemdiabetes.com/about-us/pipeline

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I use both Dexcom and OmniPod and love them both. This combination works really well for me. The Dexcom has been a life-changer for me because it allowed me to really see for the first time ever exactly how I react to certain foods and in what time frames. With OmniPod, I love the fact that it’s tubeless. While my job is not physical (I work in an office setting), if I am trending lowish and about to go shopping, or into a meeting, or church - any environment where I can’t pay attention to my Dex, I will many times run a 0 temp basal for 30 minutes to an hour to stop that downward trend and allow my body to catch up with the insulin. The ability to set variable temp basals depending on activity and situation is invaluable.

Personally, I chose to start on the Dexcom first and once I became familiar with that technology and how to use it, then I added the OmniPod. I was diagnosed w/ Type 1 in my late 20s and, like your husband, went through a period of adjusting to the idea of the “new normal”. I stayed on injections for many years, so I was a little older when I went to the Dexcom and OmniPod. For me, it was easier to get used to one tool at a time and how to manage that tool because I felt like I may have been frustrated starting both at the same time.

Overall, though, life-changing in the most positive way.

Also, just a side note. Bless you for supporting your husband and being there for him. My husband didn’t know what he was signing up for when we married because I wasn’t diagnosed with Type 1 until years after we married. While he can never fully understand what it’s like to manage this condition, he has always been there for me through the highs and lows of diabetes, literally and otherwise. The people who love and support those of us with diabetes have a special place in our hearts.

Take care and best of luck with your journey.

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My husband and I have been together for 15 years and I love him whole heartedly- he was diagnosed W celiac 7 years ago and I took it upon myself to “fix” that for him and feel as though he was dependent on me for food choices etc… when he got diagnosed with diabetes I felt like I had to support him but I could not do it for him which was very hard… I did not know what I was signing up for but I love him and want him to be with me for a very long time!

This info is amazing! We only have a couple people that we know to ask for advice! When reading about eveRythung it can be overwhelming -Thanks for the info!

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I am a very satisfied Medtronic customer since I was diagnosed with T1D at 29 (9 years ago). I went on the pump right away and while I “test-drove” the Omnipod before I decided which pump to go with, I found it unexpectedly bulky. That is not to say that your husband won’t like it, but to recommend trying to get an actual sense of both set-ups by seeing/wearing on his body (without insulin) both before he decides. Usually a good endo practice can help you with that, but you might want to contact local reps for the companies to ask for such orientation on your own as well.

Once I decided on Medtronic, I also experimented with their sensors at the time, but found them painful and not that accurate indeed. The improvements they have made with the sensors in the years since have been dramatic. For the past 2.5 years I have returned to actually using a Medtronic Enlite sensor almost daily. I am currently pregnant (i.e., even more vigilant about every single BG value) and find it invaluable. Yes, there are issues sometimes. This would be the case with ANY sensor. The overall level of accuracy is fine and the sensors are comfortable and solid. [For what it’s worth, my A1c results over the whole time have stayed in the high 5s (and more recently, since pregnancy started, low 5s) without a single low that has required medical assistance. In fact the lows I do rarely experience are typically from mis-estimating carb amounts in food, not a common occurrence. I eat ~100 carbs/day (by no means low) and do not stick to the same foods everyday – that’s actually a big one for me! I also exercise regularly and ski in the winter. These activities require a different basal setup, which any pump gives you the flexibility to do, but the point is that I live as normal a lifestyle as I did prior to diagnosis, which is my own criterion of successful management.]

I am currently also in the Medtronic Priority Access program (for the newest system, the 670G, which should come with the new Guardian3 sensors and adjust basal levels automatically in Auto-mode), but have not yet received that system , so can’t speak about it from first-hand experience. The clinical trials show a further improved level of accuracy, comparable to the Dexcom one.

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I attended a TCOYD conference this year, and had the fortune to meet several people that have inside knowledge of both the Dexcom and Medtronice CGMs. Inside knowledge as in they were involved in the research and field trials. Their public statement at the conference was that the new Medtronic CGM component of the 670 was as good or better then the Dexcom G5 for accuracy. They also acknowledged that Medtronic hasn’t always had the best CGM track record with users in the past. They were also talking about what is in the pipeline and projected release dates. Tandem x2 with G5 integration late 2017/early 2018, Omnipod with G5 early 2018, Medtronic 670G imminently, Animas Vibe with G5 late 2017.

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My son, Caleb, has been using OmniPod for nearly ten years and Dexcom for eight. However, for the last six months he’s been using a Medtronic pump.

Caleb much prefers the OmniPod for its tubelessness and probably because he’s been using it for so long he’s grown extremely comfortable with it. He has not had any issues with the Medtronic pump and adapted to its use very well, but it is cumbersome for him mostly because of his athletic activities. One thing I like about Medtronic is that Caleb has not had a single site issue that we are aware of. There were a couple of times that we changed a site early bc we thought there might be a kink or clog, but after changing those sites, that didn’t appear to be the case.

Caleb has never used Medtronic’s CGM so I can’t speak it its accuracy. I can say that Dexcom’s accuracy is pretty phenomenal and claims are that G6 and beyond only get better. Caleb doses off of dexcom readings with full confidence.

The reason Caleb has been using Medtronic is to utilize a user created hybrid closed loop system. The automatic lowering of basal based upon predicted bg is very helpful to mitigate against impending lows, but as others have said, it is not a failsafe measure. While this system has worked quite well for Caleb while he is on a trip to Europe without family or anyone trained in his care, he is anxious to get back to his OmniPod system when he returns.

It’s too bad there isn’t yet a greater user base to share 670 experiences and likely successes. It seems like it could be a wonderful system and relieve a lot of the mental anguish people living with diabetes endure. If it used Dexcom, we would consider it. We are not interested in trying another CGM system particularly while other closed loop systems that use Dexcom are in the works, like Bigfoot and iLet.

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Are you able to find any diabetes meetups near you?
I was diagnosed at 32 years old (misdiagnosed as Type 2 for 1.5 years) and was using MDI until my wife found a Diabetes Happy Hour in Seattle, where we lived. I was amazingly helpful!

There I got to see people’s different pumps and CGMs and hear their thoughts & opinions about them (and other useful diabetes tricks) so I ended up with a Medtronic 523 and Dexcom G4… and I love the combination.

I too started with the CGM first, then after a few months I switched from injections to the Medtronic pump. I’ve had that pump for just over 4 years and recently replaced it with an identical one.
I was in the process of switching to the Asante Snap the week they went out of business!
I considered the Omnipod (and used the Tandem in multiple clinical trials for the bionic pancreas) but decided that my A1C is nice and low with my current combination… so I’ll stick with it for now.

But I will never switch away from my Dexcom… no matter how integrated any other pump company is!

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I am a user of the Minimed 530G and Enlite CGM (the one used by Minimed). I have been a user of Minimed since I first got started on an insulin pump (between 15-20 years ago), and since I first started using CGM (a couple years ago). I think the pump is great, never any problems with it. As for the CGM, it is very true that it is usually not as accurate as the meter BG numbers, but that will always be true because it uses a different technology. CGM can be used to get an approximation at any time, but it’s main purpose is to help you figure out patterns so you can use the most efficient basal and bolus rates on your pump. There are, however, things that can put the CGM in a “bad mood”. One of my stories from when I first got my CGM is that I layed on my stomach in bed, causing the CGM to send a bad signal, so my pump thought I was low (off the charts low), so then I got some food, ended up high, then my CGM claimed lowed once I laid back down, etc. I hadn’t learned much about the CGM at that point, but it shows that there are things that can cause incorrect info. My suggestion is get it, try it for a year or so (so that you can get the experience and learn the little things cannot be taught), and then decide. Also, the reason your endo doesn’t have anybody on the newest model is probably because of the stubborn insurance companies (I would love to get the newest model, but they won’t give it to me yet). So I would say go for it, most of the pros & cons are the same for all of the options anyway.

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We can dose insulin using Dexcom, so it is definitely more than determining patterns.

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Agreed. We also dose from the Dexcom G5. We find it super accurate.

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I’ve been using the Dexcom CGM along with Tandem pump for a year and a half and it has been life-changing for me. It’s very accurate as long as you calibrate it once a day (just by entering your blood sugar reading, one fingerstick ). This certainly beats 3-4 finger sticks. I sleep so much better at night with the reassurance of being alerted to a pending low. I’m more comfortable keeping tighter glucose control during the day since I’m always aware of what my glucose is. In addition to the Dexcom transmitter I have the app on my phone which is convenient to glance at in Sofia settings and also serves as a backup alert at night. I could never go back to being without it.

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My story is very similar. Misdiagnosed at 32 for 4 years.

I just started using the Medtronic 670g with the new sensors last week. I find the new sensor much more accurate than the enlite sensors I have used for many years. I am not yet using the auto mode where the pump can adjust basal rates based on sensor readings, however, the pump now has the ability to suspend before I’m low, and restart as my BS increases. It’s already done that for me a few times. I like it so far. I started on a medtronic 506 pump in 1992, so I’ve used most or all of their pumps over the years. I also like the helpline and customer service. Hope this helps. Best wishes to your husband. I also have an intense job where I really need to avoid lows. He does for sure.

I think you pretty much wrote my new post for me. I know I have a post earlier in this thread about the 530G & Enlite, but I have also switched to the 670G & Guardian 3 CGM since then (I’ve actually even been using Auto Mode for at least a month). The pump is definitely a nicer interface with more features, but the most important thing is the Guardian 3 CGM. I probably should have stopped even trying to ever get the Enlite to work, it never gave me good numbers, constantly gave me calibration errors, and was overall pretty useless (although I will admit that I prefer the Enlite tape over the Oval Tape that comes with the Guardian 3). Ever since I got the 670G & Guardian 3 my numbers have improved so much I can hardly describe it! Auto Mode is also great, although it does take some getting used to, because it is a very different way of using an insulin pump. I like to refer to it as “Artificial Intelligence for Insulin Pumps”. One thing that some people have trouble realizing is that instead of lying to your pump (saying your BG is higher than it is or claiming you are eating more carbs than you really are) you need to tweak your settings (carb ratios, for example). Sometimes this can take a couple weeks to perfect everything, but it will all be worth it in the end! If you don’t like the idea of Auto Mode and want to stay with doing everything the way you used to, I would still recommend the Guardian 3 CGM (although if you don’t want Auto Mode you may decide to get the 640G, since that is the only major difference between 640G & 670G), because it is a MAJOR improvement over the Enlite.

I had to stop using auto mode because it made me low all the time. It continued to administer microboluses when I was already low, as low as 56. The educator couldn’t figure out why, and every conceivable adjustment was tried to no avail. So I’ve been on manual with the low auto shut off in place. The G 3 cgm is way better than the enlight for sure.

Have a great day! :innocent: