Cost of an OmniPod System & wasting precious insulin?

Diabetes Technology Insulin Pumps
1

My son David was Dx last December at age 4. We’ve been doing injections for the last year b/c our health insurance was a HDHP with a 10G Ded. So we’ve been paying cash OOP for everything in this last year. I was also preggo when he was diagnosed so we couldn’t apply for new coverage until baby was born and “deemed” healthy.

We finally got approval for a new policy under Blue Cross that our whole family is doing. With that said, we are finally exploring our options for a pump.

Right now we spend $300/quarter for lantus/apidra pens and draw out the insulin with syringes (more insulin for your money with the solostar pens).

We burn through 250-300 strips a month (Freestyle Light)

And pay for syringes.

We’ve been given 2 boxes of OmniPods and a remote (PDM?) by our CDE to keep until we decide to go for it or try something else, or switch back to syringes. So right now there is no cost in.

As I’m starting to calculate the costs, even with our new insurance I’m not sure we can afford it.

We are looking at 50% prescription benefits up to $1200. Nothing covered past that $1200.
Meet the 2K ded. and then 80% is covered. Test strips/pump stuff is DME which applies to ded. (which I’m sure you all know)

Our son has only had the pod on for 2 days but he hates it. He does not like having something attached to him. We haven’t said anything to him about one or the other to try to sway his thinking, we wanted to see his inital reaction. He told me he wanted to take the pod off and do shots instead.

How long should we try to encourage him to try it, we don’t want to take the $$$$ plunge if he’s not liking it. What do you feel about cost of omnipod vs. traditional syringes.

We only use about 10-15 units/day (max) and can get 35-40 days out of a pen effectively. I just choke at the thought of throwing away 50 units of insulin every 3 days. That’s 9 pens a month for the omnipod!

We were doing Apidra/Lantus and are now pumping Apidra.

I’m really liking the pod!!! But I’m not the diabetic, I’m just trying to do what’s best for David and be a good mom. If he loved the pod I’d really try to make it work financially.

Thoughts?

2

Why would you throw away insulin? You only have to load as much as you need (I don’t think there’s a minimum). I would say if he hates the pod, and the shots are effective, then keep doing shots until he’s sick of them. The great thing about the pod from a control standpoint is that is gives a continuous basal dose of insulin, much like a pancreas does. Thus, many people get much better control with a pump. If you are getting good control now, however, I’d just stick with the shots.

3

Hi Jim,

Our CDE said that you have to load 85 units just for the pod to work. We’d only use 30-40 in the 3 days that it is on. Is there a way to extract the insulin and re-use it?

We do have good control with injections, our last A1C was 5.9, 6.3, 5.4 - we are just trying to figure out what is the best thing to do before he enters kindergarten next fall. We thought he’d like it more than injections, but now that he’s had it for a few days, he wants to switch back. I feel like the control is that much easier than injections, it’s a lot easier for me as a parent, but I want to do whats best for him too.

4

Yes, the pod requires a minimum amount of insulin (I though it was 80 units, but might be 85 as you say). As for withdrawing insulin, it is not recommended after the pod has been worn. The insulin has been exposed to body temperature for 3 days and the likelihood of it degrading gets higher the longer insulin is exposed to temperature. Plus, if you continually withdrew and mixed with new insulin, after a while you could have VERY old insulin mixed in there - not a good idea.
I agree with Jim that if your son has good A1c numbers and doesn’t mind the shots, then it’s hard to justify a change. OmniPod will definitely cost you more than shots (as will any pump, by the way). I’d be willing to bet after a couple/few years, as your son matures and the “honeymoon” period wears off (i.e., control starts to slip), he might be open to trying a pump - then you can “push” OmniPod when he is more receptive.
As a parent of a 3.5-year-old I definitely know the challenge of convincing a child to do something that he has already decided he doesn’t like - best to wait until that “decision” in his own head wears off, if you ask me. :slight_smile:

5

Thanks Eric. Great advice! I don’t want to ruin the pump experience for him and so we’re just letting him come to his own conclusions for right now. Our main concern is when he enters kindergarten next fall. There is not a school nurse and there is only one elementary school in our town. Our options are limited and the only other kid that is diabetic pumps a mini-med. The school is being difficult with the possibility of giving injections as we are discussing our 504 plan with them right now.

I think we are going to try to encourage a few more pods, give it 2 weeks and then if he still is not happy about it then not bother with it.

Thanks for the tips on the insulin, that makes sense with the old insulin.

6

It is true that a lot of people take a few weeks to get the hang of the OmniPod system, so it might be prudent to tough through it to see how his perception changes.

7

I agree with the others that if shots are working and he prefers them, then that might be the best for now.

But switching to the pump for school can be more convenient. Have you considered the Animas PING? As someone who wears a tubed pump, I can tell you that I find infusion sets much more comfortable than attaching a half egg to my skin. I know many people prefer the OmniPod, but you might want to try the PING just for comparison.

Also, although the PING costs more up front, the on-going costs are less (infusion sets, cartridges). Given your insurance situation, that may be the less expensive (in terms of OOP) option.

8

We’d like to try before we buy, and are on the waiting list for the PING that is circulating through the pediatric patients in our Endo’s office. I appreciate everyone’s opinion especially you all as users, as I’m not the one dealing with it actually attached to my body.

I did waste 4 pods today though trying to change the pod for the first time. That was a frustrating experience, hopefully it will get easier with each pod change. How often do you change out the infusion set on the Animas?

9

Every 3 days, but you do not need to refill the insulin cartridge then.

I change infusion set every three days and insulin cartridge every 10 days (depends on the daily insulin use).

10

How much insulin is required to put in the pump to activate it?

11

I think 20 units to fill the tube. Otherwise any amount can be loaded. I always fill it full. Given that the pump is not attached to your body, it doesn’t spoil if left in the pump longer.

12

I subscribe to the “if it ain’t broke, don’t fix it” philosophy, so I wouldn’t force my child to use the pod as long as he is under good control with injections. Once he gets in kindergarden, you may find that he wants to change, then you can steer him to OmniPod again. Under any circumstance, if I could not keep my child under control on injections, I would insist that he try a pump to see if it helped. I would let him choose which one, as long as I could handle it financially.

I was on injections for 2-1/2 years and could not get under control. I am doing much better on the pump, and I hope to get totally under control. I will find out how much better when I go for my next round of bloodwork in December.

13

Thanks for the input. I think our big issue is kindergarten. It’s going to be a nightmare, I can already tell. We’ve done our third pod change now (and gone through 4 pods on top of that because it wouldn’t activate) and its short of being traumatizing. The little guy is in tears every time we even get close to a pod change. I don’t know if he just bruises easily but his waist looks like he’s been in a brutal boxing match. Even at the site where our CDE set the first pod. I think it was good to try, I really liked the control. Even though we were doing good with injections, it was even better with the pod. We are currently on a waiting list for the MM or the Animas so hopefully we can have a little break for David before trying something else out. Thanks everyone for your input, I’m sure we’ll be back when it gets closer to insurance time!

14

Hi - our son is 3.5 years old and has been using the OmniPod for almost two years. He was diagnosed at 15 months and we were on shots for 9 months. Because he was so small, when he was on shots we often required 0.25 units and syringes come in 0.50 units - so we would have to eyeball his dosage (I’m sure you know what I’m talking about) that said, we had a huge problem with shots. Switching to the pump for us, was very helpful. It sounds like shots are working well for you but I totally understand your issue with Kindergarten. Our preschool loves using the OmniPod and I have to say, I don’t think I would feel comfortable having someone draw up medication in a syringe for my child, mainly because the doses are so small that it would be quite easy for someone to make a mistake. That is just my personal opinion, I do have many friends whose kids are on shots and their public schools handle it just fine. I think this is one of those areas where you have to decide what’s comfortable for you. It takes about 2 months to get your pump settings right and to figure out all you need to know using a pump. We’ve only used the OmniPod and I will tell you that Will doesn’t even notice it most of the time. That said, I doubt he remembers his life pre-diabetes. A tubed pump might freak him out more than the OmniPod, mainly because of the tubing and the fact that he has to wear the pump in a belt around his body. We’re doing a CGM study right now through Stanford and the biggest pain for us is having him wear the receiver in a belt around his waist. I find that limiting for him and really annoying for me to keep reminding him to put it on, etc… The beauty of the OmniPod for toddlers is that it’s on their body and it takes a lot to get it off. The PDM is separate so they can’t mess with it (my son loves anything mechanical - in fact, he’s already figured out how to turn the alarms off his CGM!!) Will’s preschool teachers are not intimidated at all by using his pump and it’s nice that the BG monitor is part of the pump. It’s very compact in that respect.

In the end, you are in charge of his diabetes and you need to do what makes you feel the most comfortable. You want to try to make it easy for him at school and more importantly, easy on yourself and the teachers. Find out if the school has experience with diabetes and if so, who would be doing the shots, etc. I find that the longer we’ve lived with diabetes, the easier it becomes.

Let me know if you have any specific questions regarding the OmniPod in toddlers - Hang in there!!

15

Hi Susan,

Thanks for the tips. We took a break for about a week and it is amazing seeing how much easier it was for the two weeks we tried it out. I really liked it, David what having major anxiety issues when it came time to take the pump off and put on a new one. We had one pod left from our Dr.s office before we ran out of our samples and put it on for Thanksgiving. It came off within 24 hours. How do you keep it on? In 12 pods, we’ve only had 2 stay on for the full three days. I’ve looked at your tips and tricks post (I think it was yours) with putting it on, prepping the area, taking it off and still, the pod just rips right off the sticky stuff. Now I think I’m more concerned about it actually staying on him more than anything. We’ve tried love-handles and below the waist line for placement, he won’t let us do it anywhere else. Everytime one rips off, I keep wondering how active toddlers, children and people that are Omnipod people keep it on? Maybe I am doing it all wrong? Anyways, sorry to visit my concerns on you, I just really don’t know what to do. I can totally understand having someone draw up insulin and the concerns associated with that. I hadn’t thought about it that way before. We do not have a school nurse and this will be the first child ever entering the school system in our town with type 1. Makes me a nervous wreck!

16

Hi Adrienne -

I’m surprised you’ve had problems with the pod staying on. We have only had the actual pod rip off from the adhesive a few times. Will worn his OmniPod on the top of his bum for the first year - just switching sides with each pod change and had no issues. Now, we rotate between the back of his arms, his bottom and sometimes the front of his thighs. Will knows not to mess with the pod when it’s on his body, is your son playing with it or touching it? Sometimes, if you don’t get it so it lays flat, it could make it easier to catch on something and then rip off. Also, sometimes the soap you are using can affect how the adhesive stays on the body. We use MediSolv to take it off and it works like a charm.

Regarding school, if you decide to stay on shots, since you are using pens for insulin, you could have them do the same amount of insulin a day. I actually do that with Will’s snack for preschool - I always give him a 10 gram snack so that all the teacher has to do is type in 10 grams and call it a day. Makes everything much easier.

Regarding putting the pump on and off - you can use Lidocaine to numb the area if you want - we never have but do use it for the CGM since the needle is very long. If you do use lidocaine (you can get it over the counter) - make sure to take it off with soap and water, dry the area and then use alcohol, otherwise, the adhesive will not stick at all. Make sure too that when you put the new one on, you are pinching up the skin so the cannula gets in properly. If you read past posts of folks new to the OmniPod, it does take some getting used to. There is a real learning curve so don’t be disappointed that you seem to be going through a few pods. After a while, you’ll get the hang of it. Also, you only need to fill the syringe up to the min fill line for it to work. We get two bottles of Humalog a month and go through an entire bottle for the month (you can only use them for 28 days once you open them anyway…)

Hang in there. It does get easier!