This morning I made a big step. I reached out to Dexcom and Tslim to look into changing my pump/cgm combo. I’ve been a Medtronic customer for the last 9 years. I’ve been through the 523, 630, and 670. The Enlite sensor, the first terrible, awful iteration of the Guardian, and then much better Guardian. But now I’m ready to move on in search of lower A1Cs and a smaller, more modern less bulky pump. It’s hard to change even when much of my time on the 670g has been me feeling like I want to smash the pump to bits (usually in the middle of the night) although we’ve come to a more peaceful relationship the last two years (the better sensor was a major factor in that). But UGH change is so difficult for me. Especially when it comes to something I’ve grown so used to. This is all compounded by the fact that I will be seeing a new diabetes provider (not my choice, my more recent endo. moved) and I have NO IDEA what to expect. Plus, I’m on military insurance seen at a military hospital and you just never know what you’re going to get!!! It also makes getting ahold of people at the clinic near impossible and sorting through insurance information difficult. Anyways, I know I can count on my people here to understand (or at least some of you). I need to compile a list (for myself) of reasons why I want to switch. I am expecting a battle. The last few endos I’ve had really seem to be head over heels in love with Medtronic 670g. Frankly, I’m just over it (but I don’t think my provider will accept that as a good excuse, ha). My reasons to list so far:
I can achieve a better A1c with a more aggressive algorithm. I think I can also achieve better control and time in range with a different algorithm. I still hit lows in the 50’s frequently in Auto Mode.
I’m tired of a bulky pump and a company that refuses to listen to people to change it.
I make my own diabetes decisions everyday. I am in charge of my diabetes control and I want to switch, so there. (ha!)
Annnnnddddd that’s it. I feel like I need more. But I’m not super eloquent. I know its a personal choice, but does anyone have any great ideas on approaching the switch and bringing it up with their provider? Also, I can’t just switch endos if my endo gives me a hard time, so don’t even suggest it please. My insurance might be next to nothing, but I don’t have the freedom to just go out and find a new endo that wants to work with me. Not without paying cash in hand and our family doesn’t have the income to support that.
Anyways, thanks for any ideas you have and for listening.
Changing tech is always a HUGE lifestyle change. Consider decreasing other lifestyle commitments for a few months while you adapt to new tech - it will help things run more smoothly.
There are TONS of people on here who can help guide you with any questions/problems that pop up. Stay in touch.
Many insurance plans only allow a change to a new device once a certain time period since the last change has elapsed. That might be 5 years, and there’s no getting around it. When you buy a new system, you are making a long term commitment.
Thank you! Good idea for taking time off other commitments. So maybe after my daughters high school graduation and crazy family coming in. I got the call a few weeks ago that my most recent Medtronic tech was out of warranty and it was time to upgrade. I figure now is a great time to make the jump if I’m ever going to do it. Just hoping the tech I have holds out until I make the switch.
You live with your diabetes tech all day, every day. How well that tech integrates into your life is a valid quality of life issue. The doctor’s love of the Med-T hardware may simply be based on some Power Point slides that the Medtronic sales rep showed them. Or it could be the consensus of her/his doctor cohort at the last big diabetes meeting s/he went to.
But doctors (unless they also live with diabetes) don’t have to live with this tech 24/7. Therefore, I think any reasonable doctor should overweight the patient reported quality of life issues and underweight their own perceptions.
The Tandem system you’re considering is not some fly-by-night solution. It is viable, proven, and FDA approved.
If I were you I would try to speak to your doctor in a very pleasant tone and politely request that s/he grant you your requested pump. You could acknowledge that the doctor may not be as familiar with the Tandem tech and be unable to provide the back-up that they can give with the Med-T equipment but you’re happy to accept that reality. More finesse, less brute force argument is the tone you want.
No one should have to go hat-in-hand seeking permission from their medical provider to get the backing to buy an FDA-approved system that is indicated to treat people with your diabetes diagnosis. But I understand your situation of not being able to switch to another, more cooperative endo. Good luck and let us know what happens.
I think the biggest difference between the systems is how much control you have over it. Medtronic’s APS is easier on the doctors, because there’s so little for them to adjust. They don’t have to figure out what settings need adjusted And remember that the typical insulin-dependent diabetic isn’t meeting the minimum ADA guideline of 70% TIR. THAT’S who these systems are designed for (even Tandem’s)… that average patient who needs intervention.
On the other hand, Tandem’s Control-IQ is nearly entirely controlled by you. It responds according to how you’ve programmed it. There are a few people who just fall into a great initial setup, but many (I daresay most?) don’t have a good first impression of Control-IQ. Especially if you’re coming from a different pump, you can EXPECT to have to adjust your settings. However, once the settings get tweaked appropriately, there’s this Hallelujah moment where the stars align and you fall in love with it.
I’m a complete and utter Tandem fangirl. I love the company and how they do business. It’s been awarded the Best Places to Work award in both Idaho and San Diego, and you can just tell that their employees are happy and honestly happy to help you. I love the modern interface of the pump, the small size, and the rechargeable battery. It’s safety is unparalleled, because it keeps you entirely isolated from the reservoir of insulin. They actually roll out software updates! They’ve done a major update every year since I’ve been on the system, and some minor updates in between. Control-IQ that actually let’s me target a range of 110-120, and had made the best control of my life the EASIEST control of my life. The Dexcom integration, with other choices on the horizon…
But thanks to this community and others, I’m really starting to appreciate that it’s not the right choice for everyone. You’ve got to be empowered enough to understand pump settings and how to adjust them OR have a medical team that truly gets it and it willing to work with you. Otherwise, you might get left in an unsatisfied limbo. And change is difficult. There’s a lot of new techniques to learn. Tandem is a very different beast. You say you want change, but do you really have the personality to see the adjustment through?
Thank you for your response. I am not familiar with Tandem, but I know tweaking settings and adjusting to life on a learning curve was key for success on Medtronic. And I did have good success on it eventually (well, assuming an A1C of 6.5 is great). I agree that each piece of technology isn’t same size fits all. I almost wish I had another year left on my pump warranty. I’m really excited to see what the Omnipod 5 will look like and Tidepool’s algorithm as well. There aren’t a lot of options at the moment. It’s funny I started pumping 8 or 9 years ago and there were many more pumps on the market then although not any as technologically advanced as we have now.
As far as having the right personality we shall see. My thinking is that I can’t get any worse than what I have with Medtronic. I’m more than a little disgruntled that I don’t see them taking what they brought to market which was the first FDA approved “artificial pancreases system” and then making great strides from there. To me, they seem to be just resting on their laurels and not moving forward with their algorithm and technology. Not saying that they aren’t a good pump/cgm company, but I would like tighter control and better a1c outcomes.
[quote=“MKSSS, post:1, topic:87261”]
I’ve been a Medtronic customer for the last 9 years. I’ve been through the 523, 630, and 670.
[/quote]m cgms
I started with medtronic 507, and stayed with 523 through last year when I switched to Tandem X2. I switched to dexcom seven after using medtronic sof-sensors, now using Dexcom G6. So my use of medtronic pump was never automated from cgm data.
I have no regrets switching to X2. It took a couple months to get used to and tweak settings, but very happy now. My endo was very helpful in suggesting minor changes to my settings that resulted in noticeable improvements.
The only negative is a slightly more time/effort to change reservoir, but not bad after getting used to it. I also miss using Quick-sets.
I had Medtronic pumps for 18 years. I switched to tandem and dexcom about 9 months ago.
It was a tough transition because my settings were not comparable.
My basal settings were close to the same but my sensitivity and carb ratio was different.
It took me the better part of a month to get it going the way I wanted, and that was by making my own setting choices.
I reduced my carb from 1:22 to 1:15 and my sensitivity lower so that it would correct more aggressively.
It’s important to put your weight in accurately because it matters.
Now I’m real happy I keep my a1c around 6. Sometimes I get 5.8 or 5.9.
But the tandem algorithm won’t let you go much lower because it targets 112 in sleep mode.
If I could get taht target lower I could do better but I’m happy with it as it is.
All of the Stuff people complain about like filling cartridge and the crazy wasteful dexcom plastic that you throw away are not that hard to adjust to.
I suggest you get your basal rates right before you even engage the algorithm
Did you go through any basal testing when you first started Tandem? I only did it one time when I went from MDI to pumping. Thank you for your helpful responses! I wonder how different/similar the automated basal delivery is of each systems. When I started using the artificial pancreas system (We call it Auto Mode) with Medtronic my Active Insulin Time went from 4 hours to 2! And my carb ratio sounds similar to your situation- I went from 1:24 to like 1:10!!! Although it took me almost a year to figure out how to not stay high all the time.
Do you think you have good fasting blood sugars? I would really like to wake up 100. Or even under 120. In Auto Mode I am rarely under 120 and more like 130-140 waking up fasting.
Yes well it’s good that you know how to do it. So it will be easier on you. I did a sort of basal testing on myself. I put all my Medtronic numbers and watched it with out eating. I made some minor adjustments.
For me what was amazing is that I would not have predawn phenomena anymore and my fasting runs around 100 now, but I would prefer 90. I generally draw a straight line at night. I use sleep mode at night because I draws down a bit lower.
You can up your sensitivity if you want to push it a little lower.
I also learned how to better prebolus with bolus testing.
I would be fasting, then I would eat 30 grams of glucose.
Then time it for when it hit me, for me it is 30 min, but if I walk to lunch it’s 17 min.
I also got to see how much 30 grams will effect me. And that it takes me about 1.5 units to correct it.
Different carbs work differently, and if fat is involved it will almost double my insulin need.
Try to eat one powdered donut hole from drunken doughnuts and see what I mean. I don’t really like them, but u get the idea.
I don’t even eat pizza because the carb involved is just so much, and mixed with the fat, I just can’t figure how to do it.
It seems like 4 hours later, I’m still fighting it. Going low and back up. It’s not worth it.
But I suggest doing bolus testing because it was very different with my tandem than it was on Medtronic.
And tandem forces you into a 5 hour insulin on board limit, which is really silly to where I don’t pay attention to IOB.
I agree with Terry4. The decision of which pump to get is yours, not the doc’s. I’ve used Disetronic (back in the stone age), Cosmo, Accu-Chek, Medtronic, Tandem t-flex, and now Tandem t:slim. In each case, I had done my research and told the endo what I wanted. They’ve always said yes to it. I think the key is that you need to be very knowledgeable about the pump you want, and fairly knowledgeable about the ones you don’t want. If a doc thinks he will have to do a lot of hand-holding and one-on-one support, they will more likely insist on the pump they are most familiar with. But if they think the most they will have to do is to sign the Rx and then review labs every few months, they will probably do what you want.
The only comment my doc has made on a pump is the first time I saw my current endo, I was using the Accu-Chek pump. When I told him that, he said “Yuck”. Then I told him what I wanted (at that time the t:flex) he asked some questions to see why, then he said he’d take care of it.
I agreed with so much of what you said. Thank you for your honesty re. what you are going through. I read through the extremely helpful comments . Would love to change to tandem too, after years on pump and most of my 56 yrs .of T1 without a pump. I realized thru reading comments, that I don’t have a Dr./ nurse assistant that has the time to assist me with the tweaking, which I know I would need, after the initial training. Our dilemmas are not unique but groups like this can give us tips from real life experience. Wishing all drs, could do pumps and carbs for two months!
Let us know how you are doing. All of us have diff. challenges with this diabetes ,but we sort of need one another.
I changed from a Medtronic 670G in April after using them for 18 years. As the person paying the bills for your device and living with it, that right to change belongs to you. Medtronic was trying to convince me to stay with their pumps and upgrade, but I told them the only way I would is if they could prove they were working toward support of the Dexcom sensor. I was told by several staff they are not and will not move that direction because they have their own sensors. I told them that was unfortunate because I personally experienced many sensors falling off after exercise, inaccurate readings by as much as 80 points and alarms that were set off when actual readings were in a normal range. Using a Dexcom and Tandem combination the last two months has provided significantly fewer sensor issues (zero so far) and a pump that is smaller and lighter that allows me to control as I wish.
Is there a reason you have to change now? You never know but the new Omnipod is supposed to be out next year.It was supposed to be this year but with the Pandemic it set it back. You can never tell about these things or if it’s going to be better.
But just because it’s time for an upgrade or out of warranty doesn’t mean you have to get a new pump yet unless yours isn’t working well or it’s completely driving you nuts. Once you get a new pump you can’t get another new one for 4-6 years.
OK, I haven’t taken this step yet either, and it’s one reason I appreciate this group–if I decide to make the change, there will be others here who have lots of experience and knowledge. Did anyone try the Tandem “T:simulator”? It’s the application that lets you practice with the pump interface before you actually start using it. It seems like a good idea.
@Marie20 I don’t have to change now, but my current 670g is out of warranty which means if it breaks I will be unable to replace it without committing to another Medtronic pump and 4 year warranty. I’d like to change now since I don’t know much longer my transmitter is going to hang on.
I did, but that was like four years ago, so it might be different now. I think it’s an excellent training tool, but it is limited in its capacity. It has training modules to walk you through basic operations. It mostly helps you understand the pump interface, and find where where everything is.
It doesn’t actually integrate with your CGM. You can do practice boluses by manually entering all your details, but any training it gives you on the pump automation is all within their specific example tutorials.
The simulator just sort of tells you where things are etc. it’s no big deal.
The menus and doing a bolus etc are not difficult. Pretty much same logic as the Medtronic pump.
The difficulty is filling the reservoir so watch a video on that, I’m used to it now, but it was a learning curve.
Getting your settings straight will be the biggest hurdle, the sensitivity and carb ratios took the longest to fine tune
I got the call a few weeks ago that my most recent Medtronic tech was out of warranty and it was time to upgrade. I figure now is a great time to make the jump if I’m ever going to do it. Just hoping the tech I have holds out until I make the switch.