Novolin R and Pumps

  1. The tubed pump, infusion sets, cartridges, and the insulin used in that pump are covered under Part B DME. Dexcom supplies are also covered under Part B.

  2. Right now there are not many pump choices in the US. Tandem connects with Dexcom and is the only tubed pump to do so. (Loop users like @Terry4 use old Medtronic pumps that work with Dexcom through masterful programming and intermediary digital devices such as Riley links.) Current Medtronic pumps only work with Medtronic sensors. Omnipod 5 and Tidepool Loop will eventually be integrated with Dexcom but they have not been released yet and as we discussed above, they will be pharmacy products under Medicare. Dexcom is still Part B if you use Omnipod under Part D. In the future it is likely that Tandem and Omnipod will have Libre options but that is not yet a reality.

  3. Omnipod is ideal for people who like to spend a lot of time in the water. But as we have discussed it will be much more expensive and that is a choice that you may or may not be able to afford. One option to consider is the untethered regimen where you take part of your basal with an injection of long-acting insulin (Lantus, Tresiba, etc.) That gives you a cushion of long-acting insulin when doing things like swimming while removing your pump. Here is one blogpost I wrote about using the untethered regimen and it gives links to others I wrote. If you use the untethered regimen, you would purchase your long-acting insulin under Part D.

  1. There are not great cases for Tandem to use in swimming although AquaPac has a microphone case (occasionally advertised for pumps) that works for some. They are very expensive and I found mine to be very large, buoyant, and uncomfortable. Some people just swim with their Tandem pumps and have no issues. I think Medtronic pumps are advertised as waterproof. Both Tandem and Medtronic will replace pumps for water intrusion.

  2. One thing not in your questions is that because tubed pumps and Omnipod are covered differently, you can actually buy both at the same time if your doctor is on board. I tried out Omnipod a few years ago to try Loop and purchased it under my Part D pharmacy plan. I was simultaneously able to keep getting my Tandem supplies. I hated Omnipod and didn’t stay with it for long but getting Omnipod is much easier than going through Medicare requirements for pump coverage under Part B. Omnipod basically just requires a prescription (and maybe a letter of medical necessity?) Not all Part D plans cover Omnipod and you have to do your homework. So the Omnipod for a beach vacation might make sense. For daily swimmers you’re back to the same roadblocks.

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Several years ago, before I started using Loop, I took a beach resort vacation for a month. I am not a lap swimmer but instead used the hotel pool and hot tub almost every day. I disconnected my tubed pump for these activities.

I would often be disconnected for an hour or two. I disconnected at my hotel room and would leave the pump there, suspended. So my disconnect time included time in the water plus time spent lounging and socializing around the pool.

I used the untethered regimen during this time, adding in a daily dose of Tresiba long acting insulin. My blood sugar control was surprisingly good and I found this tactic easy to manage.

I switch to using lantus for pool days. Although I have used a zip lock bag to go to a water park all day.
Sealed it with 2 iv3000 tapes. My pump never got wet.
I can give you detailed instructions if you want.

All, your discussion is VERY helpful. I do use Lantus as needed when I am without a pump so that could work though adjusting accurately for heavy exercise is complicated.
I did just now get off the phone with MiniMed whose new 770G pump is fully waterproof down to 12 feet which covers all I will be using it for. I am scheduling a demo perhaps at my Endo office in the near future and will update on my observations. I will also call OmniPod to see if they have any expectations of their new version being covered by Medicare Part B - which is my hope.

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https://www.medtronicdiabetes.com/download-library/minimed-770g-system

You may share (10%/90% or any other split you find desirable through experimentation) the basal requirements between the pump and the long-acting injectable insulin. In this way you may still be able to adjust your pump’s basal rate to help manage exercise.

A long time ago my decision for any pump decision was based on compatibility with Dexcom. I had liked my Medtronic pumps but did horribly with Medtronic’s first generation CGM. Medtronic’s sensors have improved and many people are satisfied with them. At the same time Tandem groups on Facebook are filled with people who hated Medtronic sensors and find Dexcom to be more accurate and require less work.

The biggest deal though as you look at Medicare is that Medicare does not cover Medtronic sensors. Some advantage plans do, but not many. About a year and a half ago it looked as though Medtronic sensors might finally get Medicare coverage but it didn’t happen. With a new administration and new people at CMS, I don’t know the status.

The main problem historically has been that Medtronic has not done the work to have their sensors obtain non-adjunctive status with the FDA. (If the FDA approves a sensor with non-adjunctive labeling, it means that a sensor is accurate enough to be used to calculate an insulin dose for meals and to correct high glucose levels.") Although Medtronic sensors are probably accurate enough for that designation, they haven’t done the legwork.

Medtronic currently has a program where Medicare people can buy sensors at a cheaper price and you could investigate that. They may tell you that Medicare will cover their sensors “soon” and that might be the case. But Dexcom has been covered since 2017 and Libre and Eversense after that…

Lots of people hope that Omnipod is covered by Part B in the future but I have never read anything to think that is going to happen. :frowning:

Good luck as you continue your research. Hopefully the “right” decision for you will become clear.

thank you Laddie. What you write fits with what the customer service lady told me. She said the sensors are not covered but they had a $60/month plan. (I would stay with OmniPod before I would pay that anyway…) I will stay with Dexcom most likely and if I use the G770 in retirement I will just manually enter the glucose numbers. That’s my thought for now. I am also hoping to try out the new OmniPod 5 that pairs with Dexcom if it comes out early next year before I retire!! Wow, that has been what I am waiting for!

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I just went to Facebook and read some very wise advice from Brian Mozisek in a discussion about Dexcom direct-to-watch: “Something that I have always said. Don’t make decisions based on promises of future tech. In the medical industry, there are so many uncontrolled variables that lots can change in the future and those timelines in the future.”

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Disconnecting my tandem for an hour for sauna, hot tub, swimming, hockey. . . I give myself a 0.5 u bolus (less for hockey) and then disconnect. I reconnect for another bolus after an hour, for another hour’s coverage if necessary. My phone keeps me advised via Dexcom if I’m heading out of range. The biggest problem with Tandem is the incessant beeping. I wrap it in a towel so it’s less irritating.
Edit: I think this got a bit off topic!

Regarding the incessant beeping from the Tandem when disconnected. You can set up a basal profile in your pump that is 0 basal and turn that on and control IQ off while swimming. @Robyn_H came up with that trick AFAIK.

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Nope, not me. I’ve definitely passed the info along… But I picked it up elsewhere myself. It’s a good trick for an annoying alarm!

Good practices to apply.

Terry, I reviewed the newest Medtronic which is waterproof and it gets horrible reviews on this website so I am questioning my next pump move!
Medtronic 770G Insulin Pump Pros Cons | Integrated Diabetes Services Some of the complaints are lots of annoying alerts and poor calibration. I am meeting the Rep on Thursday and will grill her!
It sounds like if you were starting out now you would use the T:Slim so I have contacted Tandem and will ask for a demo.
Any suggestions for questions I should ask would be appreciated.
I guess I will just have to learn to disconnect my pump when I swim laps and provide Lantus or an extra dose before the 1 hour swim practice!

Since your swim practice is only one hour, perhaps you don’t need a waterproof pump. You could bolus for 1/2 of the missed basal before swimming and 1/2 after. Sometimes simpler is better.

I don’t have any direct experience with a Tandem pump but its use of a Dexcom sensor is a big plus. Medtronic sensors have historically been less accurate and dependable than the Dexcom. Although I have read good comments about Med-T’s latest sensor, the Guardian.

I think that the Tandem algorithm performs better than Medtronic’s and that’s significant to me. Plus Tandem’s ability to remotely update the algorithm after the pump purchase is an important feature.

Questions you might ask Tandem:

  • Would you be eligible for a remote algorithm update? If eligible, how long would that last? Will there be a fee for those updates?

  • Does Tandem have any plans to update their algorithm?

  • Does Tandem allow returns within 30 days with a complete refund?

You’re smart to research both options and perform your due diligence. I don’t think you need to give too much weight to the waterproof aspect. It looks like you’re doing all your homework. Good luck with your decision.

You can download Tandem demo app or watch training videos to get a general idea of pump before your demo, especially if not new to pumping.

There is supposed to be a big update to tha algorithm and the tandem ap which will allow blousing from your phone.

I really want the update because I’m hoping the lower the target glucose, and if I could leave my pump in a pocket and not need to take it out, it would be a big plus.

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Regarding the MiniMed 770G, like other pumps, there are new algorithms and models in line for introduction by next year. I would not use the 770G at this time, but since I am not planning for Medicare until mid-2022, I will stay on OmniPod and move to the best choice when I move into Medicare by June of 2022.

Hi Laddie! I am just re-reading this and want to ask when you take your Lantus. Before being on OmniPod, I was taking 2/3 of my Lantus dose at 6 a.m. and 1/3 at 6 p.m. I think if I try this Untethered Regimen, I might want to take only the 1x per day dose. What are your thoughts and practices for this?

I am not currently doing in the untethered regimen. But when I have done it, I have done it both ways: one shot morning and one shot evening or only one shot in the evening.

One shot in the evening was good timing for me. I need less insulin in the afternoons so if the Lantus was wearing off, it didn’t matter. I need more insulin in the mornings , so if Lantus has a peak, it would be then. I set a phone alarm for my evening time and it was definitely needed. I have been on a pump too many years to remember injections.

You’ve maybe inspired me to go back to untethered. It works well for me but it adds “one more thing to do” to my life.

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