Can't decide on Insulin pump

#1

Hello!
I have never used an insulin pump before but have been using a Dexcom CGM for about 3 years. My current A1C is 6.2 and my goal is to get under 6 and hopefully the pump will help with that.
I am aware that there is an option of the Omnipod, Tslim, and Medtronic pump. My endo told me that the Tslim works with the Dexcom so I am favoring that but honestly I don’t know as a tubeless pump sounds good also. Does anyone have advice for a first time pump user?
Thank you in advance for your feedback.

#2

Very happy with Tandem x2 with Dexcom G6 integration. I was a long time Medtronic user, but switched to Tandem this year because of the Dexcom Integration, Basil IQ and the upcoming Control IQ. I’m very happy with my decision.

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#3

I am also like @Jim26. I used Minimed/Medtronic for almost 20 years with no complaints. I never had any issues with any of the pumps I used. Switched to Tandem about 5 years ago and made the switch to TandemIQ. I love it and can’t wait for the next download (so nice to just plug the pump into the computer and get a new program vs waiting for warranty to end before getting new program.) the Dexcom connection is also a big selling point for this system.
I have been pumping since 1990 so I have only known pumps with tubes. There are many who love the tubeless aspect of Omnipods and it also connects with Dexcom.
At this point, you just need to look at those details. What is the most important thing for you? How big or small is your basal rates? What kind of CGM do you use or prefer? If using a tuned pump, what kind of infusion set will give you best success? How often do you run into door frames (with Dexcom or pods). Where do you want to wear your pump? So many questions and details with each choice. I have found there is no pump that gives me everything I want, so you need to think about what is the most important and what might be an annoying issue(like Tandem loading takes a little longer than Medtronic but I live with it because I love the system), but it might drive you crazy every 3 days.
So, my suggestion is research and ask questions when you come across something you’ve read. And also think about what is in the future and how soon this needs to happen. Nothing more firsthand getting a pump and than a new one hits the market and it has everything you wanted but now you have to wait 4/5 years.

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#4

In an ideal world, you would be able to trial a few pumps for 30 days or so before selecting one. If you live in the US and use a health insurance plan to help finance your pump, you will not be eligible for a replacement pump for four years, five if on Medicare.

Medicare, by the way, uses a 12-month rental model for the first year and this enables beneficiaries to turn in their pump and choose a replacement.

Some doctor’s offices have pumps available for their patients to try but I don’t think many do that.

I have used insulin pumps almost continuously since 1987. Tubed pumps are the primary type I utilized. I am overall happy and comfortable with tubed-pump use and I don’t see a tube as a huge downside the Omnipod marketing makes it out to be. I did trial the Omnipod for five months back in 2012 and had many problems with occlusions and infusion site absorption anomalies. I think I’m in a minority with this experience as I continue to read many positive experiences from Omnipod users.

I think your A1c of 6.2% is great. You may or may not be able to improve your A1c with a pump but a pump offers many conveniences that I find necessary. I like the ability to tailor my basal rates over the typical day as I need more basal insulin in the early morning hours to combat dawn phenomenon.

The pump’s memory is much better than mine. When I’ve taken the occasional pump break using multiple daily injections (MDI), I inevitably find myself wondering whether I took my long-acting basal injection or not. Sometimes I’m wondering whether I took my meal dose or not and what the amount was. I’m then faced with the prospect of missing a dose or double dosing, neither an attractive option.

I love having my insulin with me and am never faced with forgetting my insulin and supplies when I leave the house.

I think my pump has improved the quality of my life but I’m aware of people who place much more value on the technical simplicity of MDI and a reduction of overall diabetes paraphernalia.

The only way you’ll be able to assess how a pump might help you is to actually try it.

If I had to choose a pump to trial from the three that you listed, I would choose the Tandem X2 with the Basal-IQ software combined with the Dexcom G6 sensor. I currently use a Medtronic 722 pump as part of the automated insulin dosing system, Loop.

Good luck with your choice.

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#5

I started with Dexcom first and got the OmniPod 6 months later because I realized that I needed a lot of mini corrections to achieve optimal results. I never considered a tethered pump.

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#6

With a CGM, I find MDI to work just fine. There are days when I think a pump would be superior, but then other days not so much. Agree that pump demo’s are an ideal way to go, and of course it all depends on what your insurance will and will not cover.

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#7

@pineapple if memory serves Omnipod will be utilizing the Dexcom G6 in the near future. Their version of the Closed Loop system will be using the G6 even though the G7 will be nearing release, according to an Omnipod rep I spoke to last March.

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#8

Tandem plans to release T:Sport later in 2020, which is described as patch pump with Dexcom CGMS integration. Would also have Control-IQ.

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#9

I love my Omnipod and it will be nice to have it connect to the Dexcom. But I never have to worry about tubes and I never have occlusions. I don’t get crimped tubes and I can roll and sleep on my Omnipod and not worry about it. I love the Omnipods ability to put it so many places and it’s not that big. It’s also very easy to program for different bolus and basil programs or just give yourself extra insulin if you feel you need it. You can enter BG level, or carbs you eat, but you don’t have to if you don’t want to. I do have an occasional pod that doesn’t work at the onset.

It’s just so easy to use a pump and get better dosing. I never bothered when I took shots to give insulin for 5 carbs or less, with a pump, it’s just hitting a couple of buttons. I can correct for my different basal requirements during the day versus night and I can lower my basal amounts when I exercise. I wouldn’t go without it now I’ve been on one.

The biggest downside? I do spend more time thinking about what dose to take whenever I eat something, or go to the dentist or take a shower. The dentist requires less insulin, a shower more. I ignored more things, I’d take a shot to cover a meal and a snack later or this is how much I’m eating, this is how much I’ll take and I’ll prebolus it. Now it’s prebolus and give a dose when I eat and extend part of that a half hour so I stay nice and even keel.

Whichever you pick, if you pick one, my say is a pump, any pump is a huge plus!

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#10

I’m using an X2 w/G6 integration and Basal-IQ. I’m frankly thrilled with it’s performance with or without Basal-IQ turned on.

I have used Animas and Diesetronic tubed pumps over the past 35 years and having the pump tethered to me by the tubing has never been an issue. I like the ability to see all the system components (infusion site, insulin delivery, pumping mechanism) for troubleshooting purposes.

I have no hands on experience with Medtronics or Omnipod. My Endo is very enthusiastic about Tandem. He likes Omnipod particularly for kids who are often playing sports and other physical activities where a tubed pump might interfere. Ditto for adults if that is their lifestyle.

Whichever pump you choose, I think you’re making a big step forward. Good luck!

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#11

My 7yo just got a T-slim X2 less than two weeks ago (with Dexcom G5 integration, no Basal-IQ yet). No previous pump experience to compare to, and only 3 months on MDI (diagnosed in Feb this year).

Even without the Basal-IQ, it’s super easy to use, with the bolus calculation automatically picking up the BG reading from his CGM. Type in the carbs (the pump will add them up for you) and it will calculate the bolus for both meal and correction bolus. As it tracks IOB, it’s also really easy to dose for each part of the meal as you go, for instance if you decide to have a second helping. It’s so much more convenient than having to give another needle. Plus (important for kids in honeymoon) it not limited to doses in half units, so goodbye to having to feed him up to the next increment, or say no to “please, just a little more!”.

Treating lows is easier on a pump because you can suspend basal rather than just eating a fistful of sugar (based on 2.5 hours duration of action, suspending for as little as 10 minutes lowers your basal IOB by 10/150 = 6.7%, because in steady state some of the IOB is always expiring). It’s therefore much quicker to get your BG back into balance with your basal insulin than when you’re using a long-acting basal.

We haven’t had any issues with occlusions (either at the site, or from kinking the tubing) using the contact detach infusion sets (90 degree steel needle, 60 cm line), and no problems with irritation so far. It’s not properly waterproof which is fine for now, but beach days could be a nuisance when his basal needs go up.

We chose this pump on the basis of the X2 looking like a good long-term option for manufacturer supported automatic mode operation, without necessarily staying locked in to Dexcom CGM if another player should enter the market.

We didn’t like the OmniPod from the waste perspective, and also (despite being smaller than most pumps) they’re still a pretty chunky thing to have attached in a fixed spot, and a 7yo has pretty limited real estate! Even the Dexcom sensor stands out enough to get caught, and we’ve had several fail early from getting dislodged during play (probably about 20% of them).

We were put off the Medtronic 670G by anecdotal complaints about the CGM, the inability to choose your own target BG in auto mode, and tales of it being very ‘needy’ in terms of managing alerts and alarms.

The only downside we have experienced with the X2 is in setting temp rates, and is probably only a factor because he is still in honeymoon and needs little or no basal. The problem is that on the T-slim you can only program a “Temp rate” as a percentage of the basal rate defined in the profile you are running. Because the minimum basal rate you can program is .1 units per hour (and he needs less than half of that), we have the profile set to alternate between delivering 0.1 and zero units. If he’s low, no problem, we can set a “temp rate” of 0% for however long we want. But if he’s running high, and the basal rate is set to zero, setting the “temp rate” to 200% won’t do anything because two times nothing is still nothing. The only options are to either give a correction bolus, or add an extra time period into the profile (which takes about 10 button presses - a pain at 2am).

If you’re in the US (or somewhere else the insulin cost is coming out of your pocket), you may also need to consider that pumps waste a lot of insulin compared to MDI, particularly if you don’t use much. For instance, the X2 minimum cartridge fill is 95 units, and you are supposed to replace the cartridge every 3 days (though many people go 6 or more days). Filling the tubing uses about 20 units, could be more if you have stubborn bubble. We were going through a bit over half a vial a month on MDI and I estimate we will go up to 3-4 vials per month with the pump. If you actually change your pump cartridge every three days you will use a minimum of 200 units a month just priming, plus whatever proportion of each cartridge you don’t use up.

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#12

I recommend Tslim or Omnipod.

Pumps are more work to maintain, but if you are up to it, go ahead and give it a go.

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#13

We love Omnipod, for us, no tubing is a big deal! But would really love to have the option of a Basal Q sort of thing.

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#14

An addition on the Omnipod Pump, you don’t have to worry about it getting wet. I go snorkeling all the time and I set a 60% decreased temp basal rate about a half hour before for 2 hours. That way I’m still getting some insulin.

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#15

Thank you very much for your feedback! I agree the downside is that I will have to think about doses and diabetes overall more, but I think it will be worth it in the long run!

#16

This is a good point. Thank you much for your feedback :slight_smile:

#17

Thank you! I think the hardest part is just taking the step to do it. But I remember how my life and A1C changed for the better once I got the CGM so I believe it will be worth it.

#18

Thank you so much for your detailed note and honest opinions! It is a bit overwhelming with all the options and starting on a pump so just trying to research and get as familiar as possible with the pump and this has been very helpful. Thanks again! :slight_smile:

#19

Thank you! I believe this will be a great step forward and hopefully better control will be the sweet reward!

#20

Thank you very much for your feedback. I am hoping along with an improved A1C I will also have the conveniences you mentioned. I reached out to my local Medtronic rep and they said they allow a 30 day trial and Omnipod does as well. I’m going to try these two first and see how I do.