What do I want/need? Pump, CGM, Pod?

Diabetes Technology Insulin Pumps
1

Hello T 1’s and their mommies (and daddies). I’m an old T1, a LADA, so I beg your time to help me make the right decision… I’m a three year old diabetic, so please bear with me…

I am going to the doctor on Wed. to get the pump (or so I promised my mommy!) and I want to know what questions I should ask or what product I should ask for…

3 years dx’ed. Very very brittle. I had the mistaken notion that pumps were for kids, but I’m getting clued in. I had a wonderful honeymoon, then I rebelled, lost control and getting it back. I understand the concept of “control” now. I bolus extra Novolog before sleep b/c of the dawn thing and extra in the morning. I suppose I had to get a 12 on my last “2” A1C tests, incredible foot pain and other neuropathic symptoms to get my head out of the sand. (Yes I scored a twelve, tried harder and then scored another twelve. Huh? I started taking mad records and I’m testing more and figured out the dawn thing. I’m praying for a better score on Wed.)

I imagine that a pump or pod or what-have-you will keep the insulin delivery constant, so my body doesn’t go upsy-downsy all the time (even test 8x’s a day, only bolusing Novolog4-6x’s per day.) No more blurry eyes, no more shocks to the old body here.

But I have questions:

1… What’s the deal with the CGM’s? They sound so dreamy. I would love to really know where my bs is heading… Enough of the guesswork. The “OMG! What’s my number? I feel weird,” thing. I would love my glucose to be monitored.

Question 1.5;)… What about the sensor feature? I have had great luck in catching lows. Thus far. I live alone.

  1. The pod v. a pump (with tubing) sounds better for an old vain lady like myself. Omnipod doesn’t have a CGM integrated into their system and from what I’ve read, the Omnipod seems both expensive and wasteful. Their website doesn’t explain how we get our basal (lantus) but I suppose that’s a question for the doctor.

  2. What about the cozmo integrated pump? Did i read that right? One tube for all. The CGM’s have tubes too, right?

  3. If I get an old school pump, do I have to take it off to swim? I understand that you really shouldn’t take off a continuous insulin delivery system device. Which is why I’m leaning toward the pod. I’m disabled. Swimming is my best exercise.

  4. Do i get a pod and a monitor? One on each arm like a two-armed bandit! I could deal. I’m not that vain. Actually. I’m really that old.

Finally… THE QUESTION that the doctors will know nothing about…

Are these devices covered by Medicare?

Everything with the disease seems overpriced, so I want to invest in the right device(s).

2

Hi Maureen! I will answer some (but not all of your questions)…

Any of the pumps or pods use only fast acting insulin (Novolog, Humalog, Apidra) and when you are on a pump you no longer need to take long acting insulin (Lantus). The pump gives you the fast acting insulin as basal (slow drip every 5-10 minutes) and bolus (when you eat or to correct highs). So you will only use one type of insulin on the pump.

Some people prefer the OmniPod, others prefer tubed pumps. Personally the tubing doesn’t bother me at all. If you like to swim a lot, the Animas pump is also waterproof and I know many Animas pumpers who swim with their pumps.

The Cozmo pump went out of business recently. So you will not be able to get that one.

You should research MiniMed Paradigm pump (with real time CGM), Animas PING, OmniPod, and Accu-chek Spirit. These are the major pumps currently on the market.

I think that Medicare does cover the pump in some cases. They usually require that your body produces very little insulin (low c-peptide blood test).

Hope this helps!

3

Sure does help! Thanks Kristin! Googling right now.

4

http://www.diabetesnet.com/diabetes_technology/insulin_pump_models.php

The above is a link to a pump comparison chart. Deltec/Cozmore is no longer available though.
My son uses the OmniPod and we are very happy with it. We don’t have any trouble swimming or anything of that nature.
If you have any specific questions on the OmniPod that you think I can answer, feel free to ask. Good luck with your decision!
Lo

5

The MiniMed has a CGM in it or so said their site. http://www.minimed.com/products/insulinpumps/#

Thanks for the chart, Lorraine. I’m getting a clue now.

Huh. So no more lantus? Seems like the more gentle of the 2 insulins. OK. So the guesswork game will begin again.

I like the way you write, Dark Cloud. i will take your advise and keep it simple.

6

Yes, the minimed’s pump is integrated with a CGM in that the pump displays the BG info from the CGM sensor. You have two devices inserted however: the insulin pump site and separately, the cgm sensor.

7

So this, http://www.abbottdiabetescare.com/adc_dotcom/url/content/en_US/20.30:30/product/product_category/Product_Category_Profile_0004.htm is NOT Cosmo? It’s not on the Diabetes Mall link. I use freestyle and like the Apple User I am, I have been drinking the Freestyle KoolAid, but am almost out of strips and willing to buy OneTouch.

This one http://www.diabetesnet.com/diabetes_technology/insulinpumps_animas.php even has software for Mac (wow!), but I’m confused as to how it’s “remote” with a meter and yet needs to be clipped to your belt?

8

The first one IS Cozmore and no longer available.

The Ping has two controllers. One like a traditional pump and an additional one you can use remotely.

http://www.animascorp.com/animas-onetouch-ping-insulin-pump.aspx

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With the Animas Ping the meter can tell the pump how much insulin to give you so you do not have to touch the pump to take insulin for a meal or correction. What is good about this is it means you can put the pump in more hidden areas on your body rather than your belt without worrying about bolusing. I wear my pump in my bra between the “girls”. I never touch it during the day once it is there, I use my meter to take insulin. Some people will put the pump on their calf in a holder you can buy for that purpose. Once again, the pump is hidden from the world so you are more discrete. Here is a link to a video I did on how the meter tells the pump what to do.

As far as Medicare coverage, alot of that depends on the exact type of diabetes the doctors put down for your diabetes diagnosis. They do not like to cover t2 for pumps. T1s they will cover since our bodies don’t make insulin anymore. Medicare may require you take a c peptide test to prove your pancreas is kaput. Once they see that your pancreas doesn’t make insulin, usually they will approve the pump as long as your doctor says you need one.

10

Everyone has done a great job answering your questions so far.

I have had Type 1 since childhood, but started a pump at age 20, so no, they’re not just for children. They’re for anyone - type 1 or 2 - who needs insulin. The pump delivers a constant supply of fast-acting, so you don’t need Lantus in the background. The reason diabetics need a basal insulin (through a pump or a long-acting) is to account for the tiny amount you need to absorb throughout the day to cover basic metabolic processes - specifically breathing. When you begin infusing that insulin via a pump, you no longer need the slow-release of Lantus. The pump can fine-tune down to .05 unit increments in many cases.

I have worn pumps from Minimed, Cozmo, and Omnipod. I think they all have pros and cons. I’ve been on the Omnipod for two months now and absolutely love it. They are starting a pod recycling program next month, so my concerns about any wastefulness have been much alleviated. I feel like I throw away a lot less with the pod anyway than when I had to throw away all of the infusion set and reservoir cartridges and their wrappings. The pod is low profile, waterproof, and very reliable, so I’ve liked it a lot. It’s completely tubeless and you control all of it with a remote device.

I wear a (separate) CGMS device as well - Abbott’s Freestyle Navigator. I generally wear the Navigator sensor and transmitter on the back of my arms, under my sleeves, and the Omnipod either on my abdomen, small of my back, butt, or legs. I’ve been wearing the Navigator since November of 2008 and I have almost nothing negative to say regarding its functioning, its reliability, or its technology. It’s comfortable to wear, it’s accurate, and it takes the same Freestyle test strips as both the Cozmo and the Omnipod, so I’ve had that going for me, as well. I don’t mind wearing non-integrated devices, but if you prefer an integrated system, the Minimed Paradigm with the CGMS system is the way to go. Your insurance, Medicare or not, will require a different approval process for a pump than it will for a CGMS. You will likely be approved instantly for an insulin pump and have to jump through hoops (denials, appeals, etc) to gain coverage for the CGMS sensors, even if you go for an integrated device. CGMS devices (Dexcom, Navigator, Minimed) are all wireless and do not have tubes. You wear a small sensor poked into your skin, a larger transmitter that tapes to the skin over it, and then carry a wireless device (Dex, Nav) or have your pump pick up the data (Minimed).

While Cozmo is not an option for you anymore, I encourage you to let the device reps court you and talk sweet talk to you. Last time I went shopping for a new pump, I met with reps from every company who met me for coffee and told me why theirs was the best. I could care less about the selling points, but it gave me the chance to hold the devices in my hand, press buttons, and get a feel for their user-friendliness. It’s like a high tech syringe you’re going to rely on for the next four years. Make them win you over.

11

Love the video. Nice Sound FX. OK. So the pump is connected to the bolus site by some sort of tube, right? That’s why you have to wear btwn your girls. And the pump is wirelessly connected to the meter? Or… I’ll watch it again. Got it. 2 separate devices. Meter you carry. Pump that you wear.

I have small girls. I never wear bras! guess that might change.

Looks like there’s a showdown btwn Ping and Pod now.

12

You got it, the pump is attached by a tube to my infusion site and the pump and meter talk to one another wirelessly. I always carry a meter everywhere with me anyways so I it wasn’t a big deal to have to carry a specific meter.

If the girls are small you could put the pump on the side of your bra, lots of ladies clip it there. You have lots of choices other than clipping it onto your waist.

Make sure you order a pod demo kit. They are free and will let you know if you like the feel of the pod. It was too bulky for me, I kept knocking it off! I went through 3 demos before I gave up, hahaha! Some people really love the pod and once it get a little more narrow (not so thick), I will definitely be trying it myself.

BTW, I have been diabetic since I was 13 and just got my first pump at age 35. So they work good for almost any diabetic who is willing to test regularly.

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I agree! Meet with the reps and let them show you all about their products. This is what I did and it made my decision easier. You will live with this pump for the next 4 years so you want to get the best fit for your life style.

14

infusion set. wot? Looked that one up on the Diabetes.net link Lorraine gave me. All new info. never heard of this part of the system. http://www.diabetesnet.com/diabetes_technology/infusion_sets.php The missing link is staring at me. choosing a needle! The needle is on your skin, not the machine! I am properly schooled. And now my stomach is upset 28 gauge and lower. ew… With the picture of the tubing and all that stuff I have yet to even see! Well, duh. I gotta get my head around this… I’m thin. I’m thinking a 90 degree angle.

Teflon or metal?

The tubing grosses me out! Since I’ll be holding the device in my ■■■ somewhere (my girls being not big enough), I’ll need long tubing, I guess.

3 years, same hospital. I have all the proof of a pancreas that went kaplooey.

I need the smallest co-pay. i’ve even been using a cheap meter lately b/c of green energy. I don’t like giving the pharmas any of my energy, green or otherwise.

Then again, the cheap meter from Korea uses proprietary infusion sets. (Now that I know what an infusion set is!

Mimimed seems to be having a firesale, Dark Cloud. Wot up wid that recall? Might be good timing for me. Found them, http://applieddiabetesresearch.org/. !!/m

15

No, Maureen, there’s no needle (except to introduce the insertion). It’s a cannula - a little plastic-like catheter (that’s the teflon) - that’s about 6mm-9mm and lies just under your skin.

16

Wow., ladies, Thanks so much. Let the woo’ing begin.

The race is on between the Pod, the Ping and the MiniMed. I’ll check out the Korean Company, Sooil, but I think it’s safer to stay with the stuff the pharmacies stock!

I am grateful to all of you and to my Creator who prompted me to post here. I learned so much in a few short hours. I can’t tell you how grateful I am.

You folks have had this all your life. Remember I am only a 3 year old. I really thought that the pump was just about convenience for active children. Now i see it’s about control. Average bg’s in the 300’s… up and down all the time - is not cool. The idea that “It’s acceptable b/c I am T1 LALADADA. Whatevs.”… I used to believe that. No longer… It’s all a learning curve. (Hi, Miss Nutritionist!) I even figured out how to lose weight by a high BS - all on my own, part of my “I don’t want this disease” thing! I really did that. I read about diabulemia later. Wow. Was I so clever!? - acting like a rebellious teenager in my second year of insulin use. I suffered mad consequences - partially b.c I am older. Let’s just say my heart was displeased. That organ is better now. Control through pen tip after pen tip for months was very hard to achieve. Time for the pump. I’m gonna eat a bowl of cherries to celebrate!

I am scared of nighttime los, tho. I should probably sleep at a friends’ house the first night or two.

17

Oh, just so you know, pharmacies DON’T stock pump supplies. They’re considered “durable medical” and you will have to have them shipped to you either from the manufacturer or from a licensed durable medical supplier. Your Medicare benefits will have a special co-pay for durable medical. Find out who they prefer for supply shipment.

18

Schisa. O well. Rite Aid even has a cheapo meter on their shelf now. (NYC doesn’t do Walmart. K-Mart made a “deal” with the city. Politics. Bleh.) The pharmacy supplies the insulin, though? I guess I’ll be changing that up to regular humulog. Another Q for the doctor. I’m sure there are plenty of pharma reps lurking around the toys at the diabetes center! hehe. Love the toys! But I’ll call them anyway and get my free pod.

19

So you say teflon over metal?

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I didn’t catch that. Which company you don’t pay the co-pay? i’ve been using a cheap meter with no co-pay. When i call them, they speak to me in spanish! Compared to my freestyle it’s not so bad.