Omnipod Classic or T:Slim

Diabetes Technology Insulin Pumps
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I know there have been a lot of topics on comparisons, so i promise I’m not trying to rehash the same conversation.

My personal story and reason for posting is I have been waiting, and waiting, and waiting for the Omnipod 5. My insurance has covered the Classic under DME, and I didn’t see any advantage of upgrading to Dash, especially when the 5 would come at some point. I just found out that my insurance switched pharmaceutical plans, and of course the new plan doesn’t cover omnipod Dash nor will it cover the 5 (but it still will cover the classic through DME). After multiple conversations, it doesn’t look good for the 5.

My classic has been out of warranty for over a year, and in the past 3 years, I have had 2 PDM’s die/malfunction. Omnipod was so awesome in the latest one to give me one “out of warranty” replacement. My newest one’s meter has been going out, so I’m afraid it’s on its last legs. So I feel as if I need to either “re-up” the classic with a new 4 year commitment, or upgrade to the Tandem T:Slim.

I’ve had a great experience with Omnipod, and I’m really apprehensive of going to tubes (never had a traditional pump), but I’m just having a hard time with the thought of making a 4 year commitment to really old tech when i have an option of doing a loop system like Control IQ.

I don’t feel like I need the loop to get my numbers under control. I’ve been between 6.5 and 7.0 for a few years now. Sure there is room for improvement, but I’m happy with my control. Where I see control IQ being a benefit is on my long cycling rides and runs, and when sleeping, where it can help keep things stable. Also I’m a one meal a day intermittent faster, and it is frustrating when I have to eat a date or two to recover from a low, thus breaking my fast before my eating window.

Any tips, advice, or anything is appreciated. Just typing this all out has been helpful!

TLDR: I really want to experience the loop, (not the diy loop). Insurance doesn’t cover Omnipod 5, only Omnipod classic. The thought of missing out on looping technology for another half decade is tough, but the thought of tubes scares me too.

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You’re kind of in the same situation I’m in, except my out-of-warranty pump is the T:slim X2. I love the pump and I’m a massive fan of Control-IQ, but I’ve already been wearing it nearly 5 years. I don’t want to commit to another 4 with it, when there’s so much exciting stuff on the horizon. It’s a nit-picky thing, but the micro-usb charging port on it makes it feel really outdated to me. Someone who’s less of a techie than myself might not even notice that, though. The biggest insult is that Covid has stretched that horizon out indefinitely. The pipeline for 2022 looks nearly identical to that of 2021, since nothing got moved through the FDA last year.

What I really want is Tandem’s forthcoming Mobi pump, formerly known under the working name T:sport. It will be Tandem’s run at Omnipod competition. Half the size of the T:slim X2, screenless, and entirely controlled by your mobile phone. All the programming is stored on the pump, though, and it will have a bolus button onboard, so you’re not tethered to your phone. Unlike Omnipod, though, you don’t throw it away. It’s durable. And at least at first, it will have tubing. It will work with all of Tandem’s existing infusion sets, but will also have a short 4-inch option that you can use with adhesive to mount the pump to your flesh for a nearly-tubeless experience. In a follow-up update for the Mobi, they’re going to introduce what is essentially a hybrid infusion set/docking station for the pump, turning it completely tubeless like the Omnipod.

Unfortunately, we’re still waiting… It was supposed to be released in 2021, but they haven’t even filed it with the FDA yet. They can’t submit it for approval until their Mobile Bolus update the the T:slim X2 gets approved (which has been anticipated “any day now” for nearly a year), because the entire Mobi platform is built on that.

I keep hoping nothing happens to my pump in the meantime. If something catastrophic does happen, though, I have 2 options. Tandem will still send me an overnight courtesy replacement, so long as I start the paperwork for a renewal. But I’d be locked into another 4 years with the X2. Tandem has said that there will be upgrade opportunities to move to the Mobi, but I have no idea at what cost. OR I can just go back to MDI while I wait for things to play out.

If my pump died tomorrow, I think I would lean towards the latter choice. I just really want something new and shiny. 4 years is practically an eternity in tech years these days, let alone 9. But I’m really attached to Control-IQ. I might go through withdrawals, and wind up renewing the T:slim quickly after all.

If you want to see what’s in Tandem’s pipeline, you can watch the webcast of their R&D Day here: https://investor.tandemdiabetes.com/events-and-presentations it’s pretty interesting.

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Nice summary of your post. I’ve been living with an algorithm dosing my insulin for more than five years now. Your sentiment that you don’t want to miss out on the looping technology for another five years is legitimate. An algorithm with customized settings is a real step up in glucose management.

I would be tempted to go with the Tandem Control-IQ system in your case. There are many happy current customers of that system. While you are currently happy with the Omnipod Classic, a system that could improve your time in range and reduce glucose variability will enhance your metabolic life.

Sometimes you don’t appreciate an improvement until it takes place and then wonder how you did without it. I know there is risk with fussy insurance policies but sometimes the risk is justified.

By the way, don’t be afraid of tubes! It’s not as big of deal as Omnipod marketing has led you to believe. I’ve lived with tubed pumps for 35 years now. While I have rarely caught my tubing on a door handle, I have never actually pulled out an infusion site. If infusion set tubing was debilitating and a major detractor of quality of life, there wouldn’t be a huge demographic of people like me choosing to live with it every day for decades. Tubing is not big deal.

Good luck with your decision. Please keep us posted on how this plays out for you.

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Thank you! I know I’m probably being dramatic with the tubes. I have the simultaneous blessing and curse if being a late T1 diagnosee, as I was nearly 25. So i was able to experience 25 years of “freedom” before, and now I’ve experienced 10 years of Omnipod.

Other positives i have thought about that comes with Tandem.

  • Having the pump on me at all times means I never experience the “where did i leave my PDM” moment.

  • The pump is a lot smaller than classic pdm, so it’s a lot less cumbersome to keep it on me on bike rides and other exercises where I’m gone for an extended period and may need to make a correction.

  • Infusion sets and cartridges are independent. With the pod, if the cannula messes up, while pod is gone.

We’ll see. I was told I have a 30 day window to send it back, but i really don’t want to do that unless it’s something i absolutely can’t live with, and I don’t think that’ll be the issue.

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You are not alone! I was diagnosed at 30.

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Yes to those positives with tubing. 1 and 3 were my big reasons for never getting an omnipod. I’ve always needed to change infusion sets at no more than 3 days, but I have only rarely had periods when my insulin need was predictable enough to count on filling the reservoir to run out at that same interval. So, I fill it when it runs out (I usually fill it to closer to 6 days than 3, though in hot weather I put in less) and waste less insulin.

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I’ve used a Medtronic pump and the Omnipod, but I haven’t used a tandem pump yet. I’ve also used MDI for more than half the time I’ve had diabetes - 26 years.

I only started the Omnipod a few months ago. I’m very much looking forward to the Omnipod 5 being available. I’m expecting that by the end of the year, and I will be switching as soon as it is an option.

I considered a tslim initially, but the tube was a huge deterrent for me. It really just depends on the person. There’s nothing like waking up in the morning and getting up to use the bathroom only to realize your pump is dangling from your infusion site. I was either laying on it in my pocket (super uncomfortable) or had it dangling from my person when I tried to get up.

Tubed pumps are worth trying. Just keep in mind that once you’re past the trial period, you’re going to be stuck with that particular pump until the warranty is up. You could always switch to MDI though if you really didn’t like it.

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I just reread this and am confused. I don’t think there’s any 4 year commitment with the Omnipod dash.

The PDM only costs $150 to replace if you need to replace it.

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As many of you know, this was just approved. Available by summer.

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You are probably right. That is probably a better way to go about it if I stay on the old system.

I also just found out that since the Tandem will go through DME and the Omnipod 5 will go through pharmacy, the 4 year commitment will not apply. I just won’t be able to order infusion sets and Omnipods in the same month. So that eases my mind a little.

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I have really loved the Omnipod. I hadn’t even considered the Tandem, even though Control IQ has been out for awhile. But when I started hearing and learning about the Omnipod 5, and the closed loop system, I just had my mind set on it and how it will help my active lifestyle, and help me push my a1c from mid 6’s to low 6’s. So when I found out my insurance changed Pharmacy benefits and it will no longer cover the Dash/5, I then started to seriously consider the Tandem.

I spoke with a few people for my insurance, and also with people from Omnipod. I was assured that if the new Pharmacy plan decides to cover the Omnipod (they are appealing), that I could move to the Omnipod 5, even if I upgrade to the Tandem, since the Tandem is through DME and Omnipod is through Pharmacy. The only limitation is that the insurance will only cover either the infusion sets or the Pods for a 90 day cycle, which is totally understandable.

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The mobile bolus update got approved, but I was speaking of the Mobi pump when you quoted me. They announced yesterday during the investor call that they don’t plan to submit it until this summer, so ETA end of the year or early next year. I’m starting to consider the Omnipod 5 myself if Tandem is going to just sit on their finished tech. They say they’re doing “human factors testing” now, but that’s BS. They said a long time ago that the system was finished and Tandem employees have been wearing them, so they’ve already done all that. I think they’re intentionally stalling because as they said, “we haven’t reached the full potential of the X2 yet.”

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Yeah, I have lost all faith in timely releases, seeing how many times the Omnipod Horizon, now Omnipod 5, was delayed. And even now, after the FDA has cleared, there is no telling how long before it is ready for mass distribution. I should have made the switch 2 years ago when control IQ was released. When it comes to diabetes technology, I won’t make the mistake of “waiting” again. Take the best that’s available now, and get what’s coming down the “pipeline” whenever it comes out.

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That’s interesting! I’m glad you were able to get that clarification. As long as your coverage of the Tandem pump is pretty good, I don’t see any down-side to trying it out. Once the Omnipod 5 is released to the wider market and is covered by your insurance, you can try it out. The opportunity to compare would be nice.

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That’s a wise position when attempting a timely insulin pump purchase. Four years can seem like forever when waiting to refresh your insurance eligibility. But the calendar rolls on and unanticipated better tech may appear while you’ve being held on the market sidelines following your last insulin pump purchase.

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That’s my same frustration with Tandem. I’ve been through 3 major updates with them already, plus a few minor ones. They’ve always been ready to launch as soon as the FDA approval came down. A few weeks wait at most. They could only process so many prescriptions at once, but they were rolling out updates to the que right away. So why with this update are they only just now training staff? Why wasn’t that done months ago while thrive been twiddling their thumbs waiting?

I’ve been a massive Tandem fan girl since I started researching pumps 6 years ago. I still think they’ve got the best product and the best pipeline, but now they I’m in limbo waiting for the one I REALLY want, I feel like they keep letting me down.

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I hope for the both of us things get sped up!

Off topic (but since it’s my topic I guess I have the right, lol), I read somewhere else that you use the XC infusion sets. I think I am leaning to trying the TruSteel. Do you have any experience with that? Consensus is that the XC is better than the 90, so that would be my second choice.

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A lot of people really love them, but steel sets scare me, so I’ve never tried. At least not as an adult. I used them briefly in the 80s, before rejecting the pump that was as big as I was. I remember being terrified to move with it, but that might have just been childhood histrionic. Steel sets cause way more damage to your flesh than the soft tephlon ones, hence the need to change then every 2 days instead of three. Damaged flesh leads to scar tissue, and scar tissue prevents you from absorbing insulin. They can also be more painful. These are the reasons the soft sets were developed in the first place, as a major improvement over the steel ones. I personally feel they should be reserved for those who can’t use the soft sets.

My personal opinion is a very unpopular one, though! There are a lot of people who love the steel sets. I even know of T1 doctors using them, so they must not be as scared of scar tissue as I am. From what I’ve seen, most people who make the switch do so because they’re tired of kinked cannulas, since the steel sets can’t bend in half. Except the kinked cannulas can be completely avoided with a little gentle care. There are tiny little details that the trainers and customer support don’t understand the importance of, so the points don’t get driven home.

The problem is that you can pull the soft cannula sets off their introducer needle. If the cannula extends beyond the needle, it will collapse on itself when it hits your skin. So long as it’s firmly seated on it’s needle, it can’t bend. At least not without bending the needle, too. Just like kinking a hose, the insulin can’t get through and hours later your BG is through the roof and you’re trying to decide if it’s a fluke or a bad infusion set, and playing the “to yank it, or not to yank it?” game.

The biggest trick is simple. There’s a blue plastic cover on the cannula/needle that you have to remove before inserting the infusion set. If you just yank it off, the cannula will stick to it, and you yank the set up, too. Simply twisting that little blue cover until it spins freely, and THEN pulling it off, will nearly eradicate kinked cannulas completely. The less critical tips are to pull the adhesive backing off to the side and around the inserter, rather than pulling it up, and to not tuck the tubing into the half-circle cutout (which allows the inserter to sit flush against your skin without the tubing interfering) until AFTER you’ve cocked the mechanism. I do always hold it up to the light just to double-check that that needle is sticking out, though.

If you want the same level of control and manual insertion as the steel sets, then the Varisoft sets are also a great option. They pretty much give you all the benefits of steel, while removing the actual needle. I don’t know why they’re not more popular. I only prefer the XCs over the Varisofts because the Varisofts are a two-handed application procedure, and I can put the XCs on my backside (arms, hips, etc…) without help. If I was only using sites on my front half, I would absolutely choose Varisoft.

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Thank you for that info! The main reason for me going with the steel was for the fear of those kinked cannulas. You may have given me hope to try the XC’s first!

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