Choosing my next pump

I’m due for a pump renewal and would like some advice on what pump I should get.

I’ve been pumping for approx 8 years now and have been with Medtronic since the start. The reason is they seem to be the market leader in insulin pumps. There doesn’t seem to be much competitors (which is a shame) because I haven’t seen much significant improvement with Medtronic pumps in the 8 years I’ve been with them. A colour screen is the most I’ve seen as an improvement. Their support is also not very good.

I’m on the medtronic 640G at the moment, I looked at a few 670G reviews on youtube and my impression was there doesn’t seem to be much differences with the 640G. Are there any? The look and feel and user interface looks almost identical.

I’m just thinking whether I should get the Tslim instead this time? Has anyone used both and mind sharing your thoughts on which you prefer and why?

I don’t use CGMS - because its unreliable on me, the sensor barely gives me the right readings, and when it does, it lasts only about 2 full days. I’ve done troubleshooting with support and a number of medtronic staff and they basically told me CGMS is not for me. So thats not a thing I’m looking for.

The 670G without a CGM is more or less a 640G, because then you can’t use the auto mode.

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I like my 670 that I got last year, after almost getting an X2. Tandem’s failure to process my order for many weeks forced me to switch gears and have CCS Med request a 670 instead. I’m glad it worked out that way. I won’t mention the many things I don’t like about the X2, as people that have it and like it will complain about my comments because they don’t believe in free speech. Suffice it to say I don’t want ANY pump being controlled by my CGM as as good as it is, it isn’t perfect enough for me to trust it with my insulin delivery (basal). So I use a 670 and a G6. The 670 isn’t perfect but it is a nice upgrade from the 530. Set changes are fast, it can go one month on a Lithium battery, the screen is very easy to see in dim light or bright, direct sunlight.

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Tslim is a very good pump. I switched from Medtronic to Tandem last year and I am very happy. It is different, so if you get hung up on change and differences then you might just stick with Medtronic.

*Integrates with Dexcom
*Pump size is very small
*Basil IQ and Control IQ - most users have found these functions very valuable. Many threads on these features.
*No worries about batteries. The charge will last a number of days, but I just charge mine while I’m in the shower so very unsual that i ever run under a 90% charge.
*There is more insulin waste than Medtronic pumps. Doc may need to adjust your insulin prescription.
*Take longer to do a cartridge change. Takes me 3-5 minutes.

For me the pros far outweigh the cons and would make the exact same decision today.

Have you used Dexcom for CGM? If not I suspect you would have much better results.

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A good reason to consider the T-Slim. If you have only tried Medtronic CGM you really don’t know if one will work for you. Many people that find Medtronic CGM unreliable do well with a Dexcom. If the Dexcom CGM doesn’t work out the T-Slim pump is still a very good pump.

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Gary! Bite your tongue! LOL! The Dexcom CGM is the “court of last resort” :slight_smile: Wouldn’t that be awful to be the one person out of many that has bad luck with Dexcom sensors?

You might want to consider tubeless, and thus the Omnipod. One good thing about that choice is that there is very little upfront cost, so you can give it a try, and if you don’t like it, you’re not locked in for 2-3 years. Omnipod was recently classified as a pharmaceutical item, not durable medical equipment, and I think they basically give away the control device (a repurposed Android phone), and you just pay for the pods themselves. If you don’t like it, you can switch to something else. Many love theirs, some don’t, but trying it is made pretty easy.

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Unfortunately the omnipod is not available in Australia so I’m stuck with either tandem or Medtronic

Have you checked if your insurance will cover? Some/most UHC plans support Medtronics only, and some will allow Omnipod on appeal.

It’s no surprise, I’ve been very vocal about my choice, but I’m in love with the Tandem system. I don’t know what version is approved for use in Australia, but I used mine for more than two years without any CGM integration, and loved it then, too. Add in the G6 with Basal-IQ, and now the upgrade to Control-IQ (in sleep mode all the time for me), and it’s a game changer. I don’t think Medtronic can hold a torch to it.

There will always be those loyal to Medtronic because they’ve been an integral part of managing diabetes for many for so long, and of course we want different things from our D-tech…and yet if you read the stories, people are abandoning them in droves to flock to Tandem (and Omnipod, too). Medtronic isn’t growing up into the modern era very well.

Diabetes management is expensive and I use some of the reuse some of the supplies like the reservoir. I think its only meant for 3 days, but I see no reason why it cannot last for several insulin refills in my experience. Can I do the same with the reservoirs on the tslim?

Medtronic CGMs have always had a pretty bad reputation. Is that the only type you have ever used? 670g also has a pretty bad rap.

I think you are limiting your options a lot. If you run a 670g, you will be running a sensor. Thats how it works. Can you talk a little more about yourself as a diabetic and your experience?

There are competitors to MT. Many of them have much more industry respect. However, You will find that some markets only work with MT. Markets vary by geography. I live in the corporate headquarters of MT, and so I find that lots of docs and insurers in my geographic area only work with MT. But, thats because they strike deals and the tech is cheaper, not because the tech is better.

Do you set your own basal rates or do you have a Doc do that for you?
What a1c do you generally run? That will kinda influence my recommendations.

Technically, no. The official recommendation is to only use the cartridges (reservoirs) for three days, and then dispose. I don’t think there’s a lot of validity or reason for this, though, other than that was how they were used in the studies submitted for approval, and what they have to say going forward. Supposedly the plastic causes the insulin to degrade, hence the three day limitation. There may or may not be truth to that. Realistically though, nothing prevents you from reusing a cartridge and I’ve seen many people say that they do reuse them.

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I’m in my late 30s but have been diagnosed for 20 years for type 1. Pumping for 8 years or so, with medtronic pumps since.

I’m technology savvy so insulin pumps don’t intimidate me. I adjust my own basal and blouses depending on what I’m eating and my readings for that day and don’t rely on doctors for adjustment.

My hbA1c reading is generally between 6.4 to 7.1.

Cost is one thing I look at, while my pump is covered by insurance, all other consumables are out of pocket. CGMS is ridiculously expensive here for long term use and not subsidised. My experience with Medtronic CGMS hasn’t been the best to say the least… i was so stressed out when using it because of how inaccurate it was. No one in Medtronic was able to help me improve the reliability and I got the impression that they think I was just doing it incorrectly because it “should just work”, but no one could fault my steps when I explain to them what I do. It was so frustrating and I soon realised it wasn’t worth the cost and effort. So hence CGMS is not something I look for in a pump any more.

I need the pump to be discreet and reliable. I posted here in another thread recently on experiencing occlusions with the medtronic mios, I think it’s because of tissue scarring over time but I can’t be 100% sure. If going on Tslim can resolve that, I’ll be keen but I don’t think it will if scaring is the issue.

Medtronic is the market leader here and hence why I have been using them all this time. Companies like animas has since close down and accucheck is just not popular at all, I’ve never seen anyone with one of these. But as I mentioned in my earlier post, medtronic hasn’t been that innovative with their pumps… and I see no real improvements over the years, even user friendliness seems to have gone backwards with pump upgrades. Support isn’t the greatest, reps are not very responsive and don’t do what they say they will do. It’s literally fantastic service to get you in the door but see you again in 4 years when your renewal is due. Any issues in between, they are not really keen to help. I just keep with them because they are the most prevalent here, supplies are easily obtainable. Tslim is new to the market, I’ve heard people switch over but not sure how great their support is.

I’ve downloaded the simulator app for tslim today, my first impression was that the user friendliness isn’t that great but workable. When I’m trying to be discreet with my pump, i think the medtronic interface allows me to do this better with the up and down buttons and not needing look at the screen in order to press the exact position on the screen to input the bolus and basal values (if that makes sense). But it does seem to me that tslim is more tech savvy, i love you can download software updates to the pump - this is far superior compared with Medtronic. I don’t really care about touch screen. The self charging is also a plus.

It would be great if there was phone integration with the pump - where I can bolous or adjust insulin settings using my phone… I’m surprised Medtronic hasn’t been able to offer this yet. Not sure about tandem.

You provided a bunch of good information.

I think the only option for cell phone control of a pump is Loop . I think that Loop APS runs on your current MT pump, but that’s not for you. Its experimental.

I’m pegging you as a t:slim user. But, everyone will advise a libre sensor with that. I don’t think a libre is a bad fit for you since you aren’t a sensor user now. But, the cost may be prohibitive. I think you should ask @Jen because she’s used more pumps than anybody I know. She’s in Canada. I’ve never used t:slim (I’m an Omnipod pump/Dexcom sensor user), but they have a good reputation and I would use one. Jen will be able to provide more insightful info if she’s online this weekend.

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The t:slim has a quick bolus feature you won’t be able to sample in the app. It requires nothing more than pushing the one button on the pump. You tell it yourself how much insulin you want a button press to be worth. For example, my button if worth 0.5 units of insulin. If I want to deliver a 3 unit bolus I would long press the button until it vibrates, press the button 6 times, the pump will then vibrate 6 times to verify the request, and then one more long press to confirm. Discretion is not a big concern of mine, but I do most boluses this way because it’s easiest, even if it doesn’t read that way.

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Thank you to everyone who has replied.

Thanks for letting me know. You’ve explained it well :smiley: This feature does seem rather useful and something that should be in every pump. Nice to know, I’ll need to add that to my list of pros for the tslim when considering my next pump.