I’m curious how others in the Type 1 DM community have fared when transitioning from using Loop to Medtronic’s MiniMed 780G pump and either Guardian 4 or the Simplera Sync sensor.
I have been well controlled using Loop for approximately 6-7 years. However, I see the writing on the wall in that I’m using an old Medtronic pump which is no longer supported and is showing signs of aging.
Tidepool has received FDA clearance to use Loop technology, however they have yet to sign on with a company which provides insulin pumps.
I am also not computer savvy so the Loop updates have always been traumatic.
I was hoping to mimic the level of control and ease of use as Loop but have the necessary support when my pump fails and not have to struggle through periodic updates.
I love my Dexcom sensor and am skeptical about switching to the ones compatible w/ Medtronic. However, I am also skeptical of switching pumps from Medtronic simply to keep the Dexcom sensor. It is a difficult balance as I have become familiar and dependent on both.
Of course, insurance will also dictate many of my choices.
Any advice or experiences with the transition are appreciated.
Unfortunately, the release date is frustratingly vague.
Getting an Omnipod would allow you a backup if your old Medtronic fails. That said, I personally found Omnipod’s infusion system too unreliable to be a good fit for me.
Thanks for that update about the Twiist pump! Here is their website with more info about the pump; they plan to sell it through “the pharmacy channel” but it is not disposable like Omnipod so not sure how that will work out. It seems like it will confuse a lot of insurance companies (and pharmacies).
We went pretty deep into what little is available about the Twiist in this topic:
The Embecta patch style pump that’ll use Tidepool in a few years is also mentioned.
Simplera isn’t out yet for the 780G, maybe sometime next year. Its a one piece CGM which is a vast improvement but like the Dexcom G6 and G7 the simplera doesn’t show any significant improvements in accuracy over the Guardian 4. You’d have to try it and see how it works for you. I’ve been told by docs Medtronic has a trial period, same as Tandem, and that the trial can be extended to 60+ days. Get the time period in writing if you take advantage of a trial.
Even new pumps can fail. Do you have an unexpired bottle of Lantus and a box of 32G 4mm syringes in case of emergency?
This sounds similar to my experience. I used a Dexcom CGM with a Medtronic Paradigm for many years before Med released the first commercial AID, the 680G. I was an early adopter, which meant making the switch to the Med CGM, the Guardian3. The CGM was ok, not great, but the AID system SUCKED. I ended up putting it back in its box and going back to my Paradigm/Dexcom setup. A year ago my pump started acting flaky and I was faced with the decision of where to go next. My experience with the 680 soured me on the whole concept of commercial AID. Everything I’d heard about Loop suggested it was a very different experience, but alas my Paradigm was one version past being compatible. I the end I decided to go with Tandem with CIQ, and I’m surprised at how happy I am with it.
Here’s the the thing. There are two different design philosophies here. Medt is trying to create a box they can market as alleviating patients from all the complexities and burdens of managing their own insulin management. The problem is that in order to do it, they’ve concluded they have to lock down a lot of parameters those of us who are fairly hands-on and sophisticated about are used to controlling ourselves.* I call it the HAL9000 approach: “I’m sorry Dave, I can’t let you do that.” I know the 780 has a lot of improvements, but everything I see indicates that basic philosophy hasn’t changed. I knew I didn’t want that, so I decided to try the competitor, but with much skepticism based on my 680 experience. Only to find that the approach is completely different. Tandem is much more aimed at creating a technology that will ASSIST you, not elbow you out of the way and grab the wheel out of your hands. For example, the Med auto-mode completely ignores things like your basal and other user-determined profile settings, while the Tandem CIQ system is built on top of those settings. Other things being equal, it leaves them alone, but intervenes when necessary to attenuate highs and anticipate lows. One thing I found astonishing was something I only discovered a few weeks in, b/c after my Medt experience it never occurred to me it would be this way, which is that when entering a bolus all the fields are editable. Including your BG level. I was pretty gobsmacked, given my experience with the 680 of having my hands continually being slapped away from the controls. I find the pump does a pretty good job of making the right decisions, but they’re functionally framed as suggestiions, not hardwired settings you have to drop out of the system entirely to modify on your own.
Everything I read from Loop users tells me the Tandem way of doing things is much closer to that open-source UX philosophy than Medtronic. And you get to stick with Dexcom. To me Loop sounds much closer still to what I would consider ideal for me, given my temperament and level of experience. I deeply wish one of the major commercial companies would take it up (kind of like when Mac adopted Unix as the foundation of OSX). But until that happens I think you’ll find Tandem much closer to the experience you’ve been accustomed to.
*It’s not just that you don’t have to, it’s that you CAN’T.
@DrBB, great summary of the distinctively different design philosophies in play here. The more conservative, “keep your hands off” MedT philosophy chafes at anyone who has enjoyed success with the “assistive” systems.
This is especially true if you’ve gained some level of mastery with the Loop DIY system. I’ve used Loop since 2016 and while my aging brain would love to share the management burden, I continue to wait for a new commercial AID system that makes the design balance point closer to the “more participation” end than the dictatorial.
I’m just not OK with allowing any system to let a 140+ BG ride for hours on end to satisfy the “play it safe at any cost” mindset. Unfortunately, the insulin pump market can’t enjoy economics like Apple. Beta Bionics iLet pump is a huge disappointment to me but I respect the designers attempt to satisfy a larger piece of the market than people like me. I am a minority within a minority.
I’m happy to read positive accounts of less restrictive commercial AID systems like Tandem. It represents movement in the right direction. I’m spoiled by my long experience with DIY Loop and its ability to set a target BG as low as 87 mg/dL.
Together with a therapeutic carb-limited way of eating, I’m able to maintain long-term A1c’s in the 4.8-5.4 range without the management burn-out risk. It’s a nice sustainable path that I concede is not for everyone.
I’ve got my eye of the Twiist pump that is FDA approved but has yet to announce a production date. I am concerned by its announcement that procurement will occur via the “pharmacy channel” and wonder how that will economically affect my Medicare coverage.
The apparent design trade-off between flexibility and management burden can be eased by those willing (and able!) to put some effort into learning how exogenous subcutaneous insulin works. I know that’s a mouthful, but clearly understanding basal rates, the carb ratio and correction factors coupled with a good algorithm is a powerful tool!
It’s a bit more complicated at first but ultimately with some practice and power of habit you can make your life and health so much better! But it does get harder before it gets a lot easier.
I am under the same perspective as you Dr.BB and Terry. I appreciate being able to have full control over my set up and have become accustomed to daily life using Loop. I cannot imagine going to a different program, but again I am also a realist. The Twiist pump does not have a set release date, there are still key details which are lacking (what CGMs are compatible/contracted), and most importantly what will the insurance coverage be?
My current Medtronic pump will stop working at some point in the future and not sure how easy it is to find a replacement which will have the same issues of limited shelf-life and no manufacturer support.
Thank you Dr.BB for describing the difference between Medtronic and Tandem. I talked to early adopters of the 680G and they had remarked how little control they had over the system and how it kept their BGs in the mid 100s without recourse. I was hoping Medtronic would change this but apparently not. I will look into my insurance coverage for Tandem so at least I have a path to follow when/if my pump dies and Twiist is not an option. At least I have insulin pens as a backup but now this seems very primitive.
I initially looped for 6 years on a paradigm pump, but switched last July to the Omnipod Dash to try it out with Loop. I have enough supplies to switch back to Medtronic if I wanted to, but find the pod is a lot less hassle in regards to clothing, showering, and sleeping (and no Rileylink needed). The medtronic infusion sets are somewhat better in that you can choose different cannulas.
However, the Medtronic 780 is apparently a huge improvement over previous models. TCOYD (Take Care of Your Diabetes) endocrinologists Steve Edelman and Jeremy Pettis give their review. Note that Steve Edelman is a long time looper and Jeremy Pettis a longtime Tandem Control IQ user. Dr. E+P's Review of the Medtronic MiniMed 780G AID System - Taking Control Of Your Diabetes®
