General Pump Advice

I’ve just started using a Tandem T Slim Pump and so far so.
Currently Basal IQ software, Control IQ update July-ish.

Sorry if these have been asked time and again, but if any of these questions could be answered, it would be much appreciated;

  1. Who do the various cannula types benefit, eg: who tends to benefit from steel, vs a 90 degree plastic?etc

  2. Even if it was available for me now, should I get and understand the ratios operating the pump calculations before jumping into hybrid closed looping/ Control IQ ?

  3. Are there any accessories you would recommend?

  4. What are the best places for carrying a pump day to day?

  5. What are the most common accidents or fails/mistakes that lead to pumps being damaged or broken

  6. Would rotating cannula sites around my abdomen suffice, or should I rotate round all possible body locations for best practice?

  7. What is the main thing you wish you were told when you started pump therapy?

I am on an Omnipod, so a lot of these I can’t answer for you. But on your second question I honestly think it’s better to learn how to dose properly before letting something take it over for you? I just think you approach the use of the automation better knowing why it is doing what it is and a more understanding of the process. But I guess maybe not necessary so it’s your choice.

You want a good area to rotate in. And some of us seem more sensitive than others to site issues. I have been having more of a site issue lately or pods not working right, in my case you can’t tell which it is. So I use my abdominal area but am now thinking about exploring other areas.

On question 7, I wish I had known there was a tubeless pump earlier, I had hesitated getting a pump because I didn’t want to mess with tubing. I wish I had known how much easier it would make correction dosing and small dosing for snacks. As for actually starting using my pump. Maybe to keep a better eye on failures, I wasn’t really told much about it beforehand. It’s not that common, but it does happen.

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That in the early days of pumping, most people wanted to know why my “pager” had a “wire” and what was it connected to.

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I use the Medtronic 670g so I cannot answer each of these but will try to answer as much as possible.

  1. Who do the various cannula types benefit, eg: who tends to benefit from steel, vs a 90 degree plastic?etc

Do some experimentation and try a few. You will likely hit a grove and that will do it for most days. I have used the same set for over 20 years, but I ask my CDE and Medtronic for a sample set of choices each year. That way I stay current and try new things.

  1. Even if it was available for me now, should I get and understand the ratios operating the pump calculations before jumping into hybrid closed looping/ Control IQ ?

No, and yes. It is unlikely you will know it all, after 20 years of pumping I still do not understand them. So think of it as a learning curve. Sure try some slopes, but do not think you have to be a pro skier before you try something else.

  1. Are there any accessories you would recommend?

I always say look at some cool pump decoration.

  1. What are the best places for carrying a pump day to day?

For me my belt. or front pocket.

  1. What are the most common accidents or fails/mistakes that lead to pumps being damaged or broken

Toilets, - concrete floors, - door knobs

  1. Would rotating cannula sites around my abdomen suffice, or should I rotate round all possible body locations for best practice?

I use a 12 day rotation. Left Abdomen, Left leg, Right Leg, Right Abdomen

  1. What is the main thing you wish you were told when you started pump therapy?

Pumps will not solve all your problems. Diabetes is tough, be creative, count carbs, give yourself some grace.

@Marie20 I hope you don’t mind me asking you about the OmniPod…I just got a call today from the rep here in my area and we were discussing the possibility of me switching. I’m currently on the Medtronic 630G and under warranty until 2023. When she informed me I could switch and not be held to that and be able to be tubeless, etc needless to say I became VERY interested. I use a Dexcom G6 CGM. I currently have it on my arm and haven’t noticed bumping into anything with it on where it is…my question is, how thick are the pods and do you have any issues with the size of it?

My biggest complaint about the Medtronic 630G besides it’s proprietary CGM system (which I absolutely HATED hence why I switched) is that my infusion sites tend to come out sooner than 3 days regardless of where I put them. I don’t know if it’s due to the pump getting pulled to where I can bolus or what is going on. I had to change an infusion site in the middle of the night last night because it came out (actually left the little canulla in my skin til I pulled it out).

How long have you been on Omnipod? What were you on before Omnipod and what made you switch if you were on something else.

Emily

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“That in the early days of pumping, most people wanted to know why my “pager” had a “wire” and what was it connected to.”

@MM1 - LOL! I have gotten funny looks like “where’d the old pager come from and why is she using it”. No one has questioned me about it. Maybe I’m unapproachable??? Whatever!

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I absolutely love my Omnipod. It’s less than a half inch thick and about 2 inches long one and a half inch wide. They can send you a sample so you can apply it etc and see. Plus I’m sure they still have their 30 day guarantee. Although insist on quick training so you have the full time. I personally read through the manual and put in the settings before the rep showed up. I kept my settings over the doctors that she had brought with her.

In other words it’s very easy. . The manual explains everything. But it is helpful to have the rep show you the first time filling it and placing it etc. They don’t have a loop system yet, from a rep I talked to today they are aiming at releasing it at the beginning of next year. But until it’s released you really can’t tell.

I wear my G6 on my arm too and prefer it there, I save my stomach area for my pod. Omnipod was my first pump, I avoided a pump because I didn’t want tubes, nor did I want tubes while at work. My endo is the one that said what about an Omnipod? I wear one, look! A cute story, she started patting herself all over her body until she found it on her arm, I laughed. But I have found myself doing the exact same thing. You completely forget about it and don’t feel it, you have to “find” it. She was a type one too.

I have been using it for almost 3 years now? I think one thing that is a hindrance to some people is that medicare covers it under part D. My insurance completely covers it, but some medicare patients have to pay a co pay sometimes? And second, the pod only holds 200 units. At the beginning they put me on Humalog U-200 because they thought I would have to change my pod every 2 days. It turned out that I used less than half with a pump so I didn’t need to but I did stay with the concentrate. So if you use a lot of insulin that could be a detriment. You change the pod every 3 days and you have no choice at 3 days and 8 hours it will start screeching at you.

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I was just on their site and requested a test pod. That’s one of my concerns…so when I get it I’ll go from there. I LITERALLY last week started back on my pump and it was done in an urgent manner for me to go back to work (physically at the office from where we’ve been working from home due to COVID). I had been using the InPen and I LOVED the technology it brought with it and the G6 together. However I did not see me doing shots (lunch, then bolus - correction, etc) while I was there. That’s when my PCP agreed to do an order to put me back on my pump. I already had my supplies here, I just needed the insulin and a refresher course on how to use it. I am between Endos right now. The first appointment available was July 7th and there was no way I could wait that long to go back on my pump. Now that I’m back on it, and FINALLY heard back from OmniPod (I’d been researching them once I found out I couldn’t get the Tandem T:slim since I’m still under warranty until 2023 with Medtronic) today, now I REALLY think I want to switch. I’d also like to be able to talk my Dr. into us managing my pump and everything from their office instead of me having to see an Endo. I’m not sure if I’ve convinced them of doing that yet, but told them with their support and my research I feel like we’d be able to pull it off. Not to mention the OmniPod rep told me tonight that Dr. Marney (the new endo) doesn’t refer very many patients to OmniPod because she prefers Medtronic. (Just my luck), so to please my case with my Dr. I gave my list of benefits for the OmniPod…$0 copay for the Pods at the pharmacy. I wouldn’t have to go through a DME provider that would go to my $2500 deductible before anything was paid AND it’s a regular prescription. I’m currently on 150 units/day to allow for basal and bolus on the U-100. However, we are still tweaking around with it. I personally feel like the basal of 1.5 u/hr is too low. The first time I was using my pump (last year) my basal was like 3.5 u/hr or something like that. I REALLY like the idea of being tubeless. I wear a LOT of dresses and skirts for work with no place to put my pump but in my bra or clip it to the neck of my dress. Neither are working out well for me.

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Steel if you have allergies to the plastic they use.
90 degree plastic, I think would be for someone who was ultra thin, but I’m not sure.

Yes, I would not attempt to use this without getting the basics down first.

I’m not the one to ask.

Purse. I have no idea how men get by.

Probably dropping them.

It will work for a while, but you will have to rotate eventually. I am primarily a hip insertion person, but I do occasionally need to rotate to arms.

Your CGM is your most vital piece of equipment for safely operating a pump. Your CGM needs to be accurate and in good working order.

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@EGreen76 So the biggest hurdle I see is the insulin usage which the problem mostly goes away with U-200 insulin. But it’s not “approved” for a pump. My last endo was a type 1 and prescribed it all the time so people could go on an Omnipod. A lot of people wanted a tubeless pump. She knew there was no problem with it once you understood the differences in programming. So the hurdle could be your GP not being familiar with it or the endo not liking to do it.

If you use U-100, you might be able to give yourself a basal shot a day of something else and do some adjustments of basal rates on your pump, I believe @Terry4 is doing that. And then all the boluses on your pump. But it only fits 200 units, so at a full 150 a day you would have to use a pod a day and I’m not sure insurance companies go for that? I don’t have a clue. May.be the insulet rep would know. I know endos can get approval for one every 2 days, by saying you have to change it.

I know my current endo still justifies my Humalog U-200 with the insurance company so “I don’t have to change my pod as much”. The U-100 would work for me but I did well on the U-200 and wanted to stay on it.

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Like @Marie20, I think pods are terrific. Never used another pump so I do have a narrow frame of reference. I use Humulin U500 in my Omnipod (also not approved) with very solid results. Been on it about 5 years now. My insulin daily total use immediately dropped dramatically to 1/3 of my prior MDI total. You may find that U200 will last the full 3 days. My A1C dropped in 3 months from the 8’s to 6’s. And it immediately stopped the morning highs if I didn’t use a bedtime shot, and vice versa, the night time lows if I did. Getting a steady basal dose made all the difference for me. I would like to rachet down from U500 as I always have insulin left when the pod expires but my Endo doesn’t want to change anything right now.

I never considered a tubed pump. The pods are so easy to change out. 5 min max. Yes, the PDM is clunky (I’m on the old system still not DASH) but it’s so easy to manage your insulin once you get your basic settings sorted out. My CDE had 25% of her clients on Omnipod with non-approved insulins so she was able to set my settings almost 100% right from the get go.

I started on Omnipod w/o a CGM since as a Type 2 my insurance would not cover a CGM. In fact as a Type 2, I had to push to get a pump. Am now under Medicare and have not added CGM to my regime although I know most Tudiabetes posters would consider this unwise and/or short sighted.

Insulet has provided excellent customer service and have promptly replaced the 10 or pods in 5 years that didn’t seem to work properly. I can order pods directly from them and they bill Medicare (who won’t pay as I do not have Part D) and cross bill to BCBS (who does pay).

Can’t think of any accessories. Street knowledge I’ve picked up: I do a .5 bolus “just because” whenever I change a pod. If I don’t, my BG runs high on day one. Just found that amount by trial and error and have heard of a few other people who do the same. And watch the accuracy if you use the PDM for testing. Mine was 50 points off on BG readings above 140). Only found out when I was in patient for surgery. It explained why my A1Cs were a few tenths higher than I expected for about 6 months. I should have cross checked it with another meter sooner but didnt. Insulet promptly replaced it.

Try it. I think you will like it.

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