My current Medtronic Paradigm 751 pump’s warranty expired last November and I will be eligible for a new pump this November under my Medicare plan. From
reading various entries on this forum, most of you are way ahead of me with current pump technology and cgms. Having dealt with Type 1 for 30 years, of which the first 10 or so involved using MDIs, and from then on wearing a pump from only one manufacturer, Medtronic, plus finger stick testing only, never a cgm, I’m a bit overwhelmed at the thought of a pump with newer technology and cgm at the same time. Getting all of that set up and trying to get it to manage my blood sugar with the results I now have, average A1C of 5.5 seems overwhelming to me. My doctor recommends the Tandem T-Slim with Dexcom cgm. Before Medicare, my insurance covered as many test strips as my doctor ordered, usually 6-9 per day. Medicare will only cover 4 and the meter’s strips that communicate with my current pump are not covered. With that in mind, I think it would be best to upgrade from strip testing to a cgm. Hopefully, I will be able to learn how to use such a system in not too long of a time period. I’m stressed just thinking about it. Has anyone else ever been in my situation or have any thoughts?
First let me congratulate you on an amazing A1C!
I consider myself fortunate to have just being diagnosed with LADA, aka T1 Diabetes, 7 years ago when I have so many choices for tracking and treating my T1 diabetes. I have been on a Dexcom CGM since my 2nd year with a form of T1 diabetes and an Insulet Omnipod insulin pump shortly after that. I am just now exploring updating to the Omnipod 5 with its connection to the Dexcom G6 CGM which it uses when determining the amount of your bolus and to control insulin delivery to keep you in range. I have only been on the pair for 3 days and its been a bit rocky for me. It is the learning stage for the Omnipod to understand me. I have no experience with tubed insulin pumps and they scare me. Based on my very limited experience with the new smart insulin pump I think learning to use the CGM will be easy. Getting the handshake between the cgm and a pump working to keep your A1C as low as it is now may take a bit longer.
I’ve been on the T-slim X2 for a few years and I love it. With the A1C that you maintain I don’t think most of the smart pump options will get you that result, but the T-slim can get you there with some “hacks”. I’m not the one to instruct you on that though since my A1C is in the 6’s and I’m happy for it to be there.
Dexcom on the other hand is life changing, even for those who already have a low A1C it gives you so much more information and will catch lows that may have been hidden by not having a BG reading every 5 minutes.
After 30 yrs with finger prick testing and multiple daily injections, the Dexcom was life altering for me. I waited another year to get the pump (Tandem).
Best thing about CGM: very few surprise “highs” and no disabling lows at all over two + years. The pump just made things a bit easier with integration; best thing about the pump is a flat line on my CGM over night, almost every night!
I went from 6-8 tests a day with a similar number of injections, to zero tests a day and a fresh infusion site every four days! And A1C went from 8% to 6%
See if you can get your dexcom going before you add the new pump. Getting the kinks worked out will be a lifesaver. I switched from Medtronic to Tandem, 3 years ago. I struggled with 2 new systems at once. It took me 2-3 months to get them working right.
My old Medtronic basal profile was useless. I had to start over with basal testing, even though my total insulin was the same, my rates throughout the day changed drastically. Getting used to dexcom took a few days.
I’m a big fan of baby steps.
Thank you, Judy. The Omnipod appeals to me since there is no tubing to get in the way. It would be nice to wear a dress now and then. However, the supplies would be more out-of-pocket costs for me but I guess it would all come down to which pump I think would work best. I can understand your “rocky road” starting a new system. Whichever pump I choose I think will be okay after getting used to it. It will be a matter of trial and error to get my numbers where I want them. I wish you good success with your Omnipod and cgm.
Thank you for your response. It encourages me to try the T-slim. Years ago, when I was still on multiple daily injections, I tried the Dexcom, but it drove me nuts alarming all night. I’m sure it has had improvements since then and may work better attached to a pump.
Congratulations on your improved A1C! That is a huge accomplishment! Your positive experiences with cgm Dexcom and T-slim have encouraged me. Thank you for sharing.
I think switching to any new system would be easier taken in steps. Thank you for that suggestion, Timothy. I’m anticipating quite a long learning curve but I will have to be satisfied with doing my best.
CGMs ARE THE BEST THING EVER. Seriously, don’t hesitate. They’re so small and barely noticable, but provided you with so much information and so much peace of mind not having to worry about surprise hypos anymore.
I’m impatiently waiting for Tandem’s new Mobi to be launched at the end of the year. It’s like a perfect hybrid of Omnipod and T:slim.
Like Omnipod:
- Same size, which is also half the size of T:slim
- 200 unit capacity
- Can be affixed directly to your skin and paired with a tiny, 5-inch length of tubing, for the NEARLY tubeless experience.
- Screenless and completely controlled by an external device, either a compatible phone or a PDM. (iPhone only so far, but they’re adding Android phones, too.)
- High water resistance rating. Can be submerged up to 2 hours at a depth of 8 feet.
Like Tandem:
- Control-IQ! A better algorithm that actually allows user input, and the only one with a super-narrow nighttime target range. (Okay, that’s my opinion, but I stand by it. And your doctor seems to agree.)
- Rechargeable battery and less waste! Soooooo much guilt with the Omnipod, throwing an entire computer away every 2 or 3 days.
- Has a bolus button directly on the pump, so you’re not tied to your controlling device. Control-IQ runs without it, too. You pretty much only need it to adjust settings.
- You have the ability to actually detach it whenever you want.
- It’s compatible with ALL of Tandem’s infusion sets and tubing length, so you have choices. (I’m actually pro tubing because it opens more site availability, not having to worry about sitting/sleeping on the bulky Pod or whether it has clear communication with your CGM… then I can just tuck the bulk of it away wherever it’s convenient.)
And then they threw in some new things, too. Like, a new cartridge design that should be much easier to fill. It’s clear, too, so you can see your insulin. It will also charge wirelessly, so no more fighting with the micro-usb cable in the dark.
I’ve gone through this feeling every time I’ve undergone a major regimen change—often enough that I’ve coined a term for it: “T1 Claustrophobia.” Feels a bit like getting dx’d all over again: all this new stuff to learn that somehow keeps T1 right up in your grille a lot more than your old routine that you were used to, whatever its drawbacks. It’s a stressful thing.
Lot of helpful comments in this thread, but I’d single out @Timothy’s for particular emphasis.
As he says, this is the simpler transition and you’ll probably find it liberating and revelatory. No matter how many you’re doing, fingersticks are snapshots; CGM is the movie. If I ever had to choose between pump and CGM I’d pick CGM every time. Expect to be surprised. There are also techniques that CGM makes possible that are harder with fingersticks, like pre-bolusing (taking your bolus and then waiting to see the down-curve on your CGM display before you start eating). If you’ve been getting a 5.5 with fingersticks you may be surprised to find there are some lows that have been hiding in the gaps. Great thing about CGM is that it keeps your data and you can look back over the previous day, week, month etc.
Highly endorse this. Like you I had a MT paradigm pump for years, starting before CGM came into my regimen. When it did, my set up was hybrid: Paradigm with Dexcom CGM. Unlike you, I did transition to MT’s first AID pump, the 670G, which meant using MT’s Guardian CGM. My experience was awful, so bad I want back to my old Paradigm + Dex setup and stuck with it for years. Totally burned on the whole concept of AID. It seemed to be optimized for people who struggled to keep a <7 AIC. When my Paradigm finally started getting glitchy earlier this year I bit the bullet and based on a LOT of reading users’ experiences with it I decided to give the TandemX2:CIQ a try. It’s a whole different beast than the MT version and I like it a lot. Way more open to user configuration and user input, where the MT experience was like HAL 9000 (“I’m sorry Dave, I can’t let you do that.”) I just had my first A1C after the transition and it was 5.7; previously I was hitting about 6.2.
Last thing: expectations management. Gonna quote @Timothy again:
CGM-driven AID is a whole different thing from what you’ve been doing. Tandem was great about setting me up with a trainer who was using the system and very experienced and knowledgeable. There are a LOT of wrinkles to how these things work, not all of them obvious. Even with CIQ there are certain parameters you might like to tweak that are hard-wired, and some of the things you can tweak may have different effects than what you expect. So yeah, get the CGM thing down first—even if you think you know your patterns pretty well it’s like going from low-res still-pix to hi-res video. Really knowing it will help you with the more involved process of getting CIQ dialed in.
Best of luck and please keep us posted!
Oh, the Mobi sounds really good! Maybe I should hold off on getting a new pump until that one comes out. Otherwise, I’d have to wait another five years, for insurance to cover it. In the meantime I can be learning the Dexcom CGM. I’ve read many posts about the complexity of set changes with the T-slim and that alone makes me dread changing pumps.
So, Timothy, I can hook up the Dexcom to my Medtronic Paradigm, or will Dexcom just work independently? I’m in the dark as far as CGMs go, but I know once I get a T-slim, it all works together, or at least that’s my goal.
I’d definitely recommend getting the Dexcom G6 (or G7) CGM but I would caution you to make sure you have insurance coverage for one now without messing up insurance coverage for a pump later. If you go with the G7 now and wait for the Mobi pump, there is a risk that the G7 won’t work with it initially as the G7 doesn’t work with the t:slim x2 today. I sure both Tandem pumps will support the G7 in the not too distant future.
I have a t:slim x2 with the G6 and I don’t have any issues with the tubing. I wear a Diabete-ezy Lycra belt at night and have a leather pouch on my belt during the day. I can also use the Diabete-ezy belt during the day. The pump is always in the same place but the infusion site moves around.
Ohhh… @bsmorgan makes a fair point.
I think the Dexcom G7 would be an easier introduction to CGM for you, since it has some major improvements over the previous G6 system. It’s much smaller, with an easier application and start-up process. And because it’s all in one piece, you don’t have to worry about different sensor and transmitter lifespans. But, if you think you’re going to select a new pump in November, the timing is tricky, depending on which pump you choose. You may need to consider G6 instead. They’ll probably offer you a free upgrade to G7 later anyway.
Tandem is starting to roll out G7 integration for the T:slim in the next few weeks. If you buy a T:slim in November, it will likely come to you already compatible with G7. If you think you might consider the Mobi, though, they have said it won’t have G7 compatibility until early 2024. If you buy the Mobi in November (limited launch, but you probably will still be able to purchase then), then you’ll need to be on the Dexcom G6. If you plan to wait a few more months for the Mobi in 2024, then G7 is a viable option again.
I have had Type 1 for 36 years and used a Medtronic pump, various models, for the last 18 years. Earlier this year I switched to Tandem & Dexcom. I had used all of Medtronic’s sensors and with the exception of the Enlite sensors, they all worked well for me. For someone like you who has never used a CGM I think Dexcom would be much easier. It is so much easier to insert. With Medtronic the insertion is far more complicated and you have to tape it all down. It just looks ugly. Dexcom is a one hand, one button insertion. Very easy and I barely feel it.
If I were you, I would try to get the Dexcom now to try it out. It won’t communicate with your pump but that’s okay for now, it’s good to try it. Ask your endo, he may have a sample to give you.
No dexcom won’t work with Medtronic. You would have to operate them separately.
But you will find that your corrections will make more sense with more data.
Thank you!
Yes, that sounds like a good idea. Thinking I needed to wait until November for a pump and a CGM, I ordered a 90 day supply of test strips and lancets so I doubt insurance will cover the CGM until the 90 days is up. I may check with my doctor to see if he would give me a couple of samples. Thank you for your input!
Thank you for the good information, Robyn. It sounds like it might be a good idea for me to wait until 2024 to get the updated G7 with the Mobi, if it all is available within a reasonable time, and if my Medtronic pump will hold up until then since it is already a year out of warranty. This whole decision seems like a gamble whichever I choose. I need to get used to living on the edge. 
So, if I get either a T-slim or wait for the Mobi and a cgm with either, what devices control all this? Does it connect with my iphone or do I need a transmitter for the cgm and/or either of those pumps?