Insulin pumps

I know there’s a few fellow Type 1’s on here so thought I’d seek some opinions on choice of insulin pumps; looks like I have the choice (I’ve eliminated two others) of either the YpsoPump or the Tandem t:slim X2.

(The two I’ve eliminated are the Omnipod as I want a pump I can clip onto my belt or put in a pocket, and the Medtronic 780G as a colleague has one and finds it lacking robustness.)

I’ve been using Libre2 CGM sensors for well over two years and the clinic has already lined me up to change to the Dexcom G6.

Thanks.

My daughter 9 has always been Tslim intially with Libre 2 now with dexcom G6 and it works very well. The Tank holds just over 200 units she uses 40ish a day and i change her site every 2 days. Not sure how many units an adult uses but might be something to factor into you decision

Initially she had the Basal IQ technology which switched off insulin delivery if it predicted she was going low. This works really well. She now has has control IQ which can deliver additional Insulin when she is going high in addition to cutting off when she goes low.

The control IQ is not great it cannot really react quick enough to help with highs. The diabetes team have said that other pums have a much better algorithm to help control / limit higher levels and if that is something you want maybe the T slim is not a great option for you.

Work mate is on tslim.and I’m on Ypsomed. No real complaints about either.

I was on a Medtronic pump before and I’d get 3 days before changing. Ypsomed is a smaller reservoir and I get 2 days now.

I was on libre 2 and it worked well – and a month before their update which then allowed it to broadcast readings without scanning, I got moved to Dexcom g6.

G6 is good, but this one is consistently losing signal with phone – got 1 more sensor to go before it is replaced and I’m hoping the next one will be like the first and be a solid connection.

I’ve no personal experience of tslim so can’t say anything about that, but my work mate was on a Medtronic pump with its own closed loop and he hated having to calibrate it daily with a blood test.

Ypsomed and Dexcom uses an app called CamAPS FX which does the closed loop stuff – when connection is constant, it is brilliant.

@DickBarton  @docgeoffyjones

Thank you both; pluses and minuses for both pumps… I’ve got a ‘tech clinic’ appointment lined up so I’ll be able to actually get a better feel for both pumps.

Forgot to say (as I didn’t read your whole post originally) – the closed loop system does work well, but it does have issues with rapidly changing levels – it just doesn’t react quick enough to counter them.

I’m not trying to take a dose of insulin 10-15 minutes before I eat as this seems to help reduce the spike – downside is I need to know what I’m going to eat so I can work out the carbs and then split that between an immediate dose and the rest over the next couple of hours.

It does seem to stop the pump when my blood is dropping – but in a lot of cases, the blood is dropping too low to prevent it going hypo (think I need to adjust my lower limit to help combat that).

This does seem to work for me, but it isn’t quite so dramatic a change as I had hoped…so I’m still trying to work it out (been on it for about 6 months now). I’d recommend giving it a try to any diabetic on a pump as it does seem to make improvements – I’m sleeping right the way through the night as my bloods are more flat line (they weren’t bad before but now they remain almost flat I don’t wake up – what a revelation!!!).

@househusband

happy to help if you have any more questions post them here or send me a PM and I will be happy to answer them.

780g owner + CGM

I’ve always used a Type1 Tactical holster as Medtronic belt clips are notoriously poor. I’ve not had any issues whatsoever, but Medtronic pumps do have somewhat of a history of developing cracks out of nowhere. They replace them, obviously, but then you have to set it up and allow it to go through all it’s warm up and learning your use before it’s back to “normal” again. Takes a little while.

Type1 Tactical make holsters for most of the pumps out there atm. SOLID bit of kit. I initially bought mine for my 770g but the 780g is identical in proportion.

The new G4 sensors initially were failing around 3-4 days (meant to last 7 days with little calibration. When I do check my blood sugar, it’s generally around 0.5mmol/L off so acuracy is much improved. And my fingers feel so much better not having to calibrate 2-3 times a day. Must have been a batch issue with the first runs of G4 as many users had the same issue, but this hasn’t been a problem over the last 3 months.

I run the app on my phone so it’s tracks and uploads your results to Carelink so your endo or treating team and see how you’re travelling and advise accordingly. Slight technical issue as my phone updated to A14 and the app hasn’t been updated to work with the new version of Android just yet. No biggie for me, but I know people who use the remote monitoring app to follow their kids levels through the days and nights. No more waking your wee one up to take a BSL at 3am!

Feel free to ask anything, will help if I can 🙂

@docgeoffyjones  Thanks – I may well do!  I take it that you are, actually, a medical Doctor?

@aphex_2k  Am I right in thinking that the Medtronic pumps need daily calibration with a finger prick..?  I seem to get that impression.  I’ve bookmarked https://www.type1tactical.com/ for getting a holster if I for the Tandem or the Medtronic.

@househusband, as far as I know, yes about the daily calibration – my work colleague was over the moon to move to the tslim and Dexcom as he didn’t need the daily calibration tests. (Aware you weren’t asking me…sorry)

I think I may have sorted my loss of transmitter connection – appears I have 2 Dexcom Bluetooth connections on my phone…I’ve removed one and since then, no issue with signal loss…might be a fluke but appears to be ok (for now).

@househusband no not any sort of doctor just a stupid childhood nickname.

I have been taking care of my daughters diabetes for nearly 4 years. she has always been on a Tslim so i am very familiar with the pumps and have transitioned from Libre with the Tslim to Dexcom G6 and closed loop control with the Tslim.

In terms of Tslim durability we are on pump number 3. The previous 2 both stopped picking up the cartridges. As long as you have a pump to return you get a new one but this can take 2-3 days so make sure you have pens ready just in case. A back up program like mylife to do your calculations is worth setting up.

Pump data and setting can be accessed via logbookweb, (you need a computer and USB) which makes keeping track of changes to your program very handy. (especially if you do need to switch back to pens)

You will also need pump insurance which is about £7 a month. https://insurance4insulinpumps.co.uk/

My son is due a change shortly, and it appears he’s likelt to get CGM. Will need to look into the options, but he’s a current Medtronic user – lots of supplies that I assume will be OK with the new version !

i’ve been using the libre 2 and an omipod dash for a couple of years and i’m curious why you wouldn’t want it stuck on like the libre? the idea of having to clip a pump on a belt  (or pocket) has put me off the closed loop systems for the moment. i find it pretty easy to use and it’s improved my levels (or the combination of the the 2 unit has anyway).

my life is pretty variable from day to day, so having to adjust things is just the way I’m used to doing things. apparently they’re not too far  off having a closed loop stick on system here (france) so i’ll be waiting to see how that turns out…

Steve

@svensvenson I think I’d prefer the idea of having a system with the cannula line so I can move the pump around, put in a pocket or on my belt, rather than having it fixed it one place for three days or so.

fair enough, personally I was already used to having the libre stuck on my arm so the jump to having another device stuck on me was minimal. Previously I’d always resisted the pump precisely because it involved a belt etc. and I don’t wear pyjamas, much less a belt, in bed ( but each to his own…!) basically if you have a choice and you can get something that works for you, the change to a pump is amazing.

I also use the Omnipod and I would struggle to go back to a cabled pump now, it’s pretty good. I also had the same concern as you OP but for me at least it’s a benefit rather than an issue (no disconnecting for a shower for one). Not sure if it’s still the case but Omnipod used to offer a 90 day trial with no tie-in, could be worth a go to cement your feelings about it (if still available).

Slightly OT (sorry OP) but @svensvenson if you’re happy to run open source stuff I’m pretty sure you can go closed loop with what you have. (Assuming you have the ‘cgm’ upgraded L2). I ran mine on AAPS (Android) for a couple of years, now running on Loop (iOS). Takes a lot (but not all) of the normal T1 mental strain away.

Hi HH

re: daily calibrations

Nope. 780g and the new G4 sensors do not require an initial or daily calibrations. For some reason the G3 needed at least 2 calibrations per day and even with that the accuracy was often quite different from a BSL to your interstitial reading. The G4 lasts up to a week with no need for daily calibrations (but they do say that any time you do a BSL to zap it to the pump to “help” with accuracy. Anecdotally, my BSL is usually less than 0.5mmol/L off what my sensor is telling me.

I’ve used a variety of pumps and CGM from Medtronic over the last 10 ish years. Been very happy with the 780g and the G4 sensors since I upgraded. I’d love to give you my a1c but I’ve not done one for a while. Over here I went maybe 8 years without seeing an endo and when I did book in to see one he said “if you were my pupil you’d be top of the class, you didn’t need this appointment”. That was maybe 3 or 4 years ago. Medtronic seem to prefer “time in range” as a better judgement of how you’re doing than an a1c. I’m usually 80% +/- in range. I’m usually out of range because I’ve done something silly like eating pizza, or a curry (avec naan bread and a modest amount of rice, bhajee’s and pakora). It’s my own fault, I know. 🙂

Thank you all for your replies… looks like I’m going for the Ypsopump.

It got to the point where I was splitting hairs in comparing the Tandem and the Ypsopump so the deciding factor was that Fife NHS are doing the mandatory courses for it in January so I can start much sooner; they wouldn’t be doing any for the Tandem until May as there were no other takers, and even that an uncertainty – they wouldn’t offer courses for only one person.

I was put off the Omnipod as it would need a separate device to talk to it.

I was due to have a Dexcom 6 setup session tomorrow morning in preparation but, most inconveniently, I have popped my COVID cherry and gone down with it for the first time and the diabetes clinic, quite understandably, didn’t want me onsite.  The rep/salesman for Dexcom has agreed to do the training online with me on Monday morning so I can proceed with the pump program.

Quite frankly I’m flabbergasted that it has taken this long to get COVID considering I’m a high school teacher.

Dexcom is the best CGM system my youngest used. Couldn’t get that on the NHS here though. On Medtronic now, so using all their stuff together, which has its own advantages. Anyway… Dexcom is good… glad you’re getting it… the sooner the better…. enjoy!

You will also need pump insurance which is about £7 a month.

SHIT! Have never updated the pump insurance since they moved to a different system. Better sort that…

Mrs Mac uses T slim with dexcom g6.
Absolutely life changing for her.
It gets paired with her phone and she can get alerts on her Apple Watch.
Modern tech is flipping brilliant.

The Ypsomed pump is cheaper than the Medtronic I was on, so my pump insurance dropped a quid. The Ypsomed is apparently just under £2k and apparently that means it falls under many people’s home insurance. I kept the separate insurance as I suspect it would be actioned and resolved much quicker than home insurance would (thankfully, no experience of either).

Yet another change to my choice of pump!

I’m all set up on the Dexcom 6; the Dexcom rep kindly did an online Teams session so I was able to tick all the boxes and proceed – turns out he lives in Glenrothes, in which I teach, but his kids go to a different school!

In a total about-turn I’m starting in the pump that @datsunman is on – the Omnipump 5.  Just before Christmas I got chatting to their UK team and they sent me a trial kit (empty pump) and I wore it for three days to see what it was like; by the end of the second day I started to forget it was there.  It should mean that I should be fully ‘closed loop’ sooner rather than later.

The Ypsopump was seeming more and more of an uncertainty as the clinic cancelled the January start for it due to supply issues (that put me off!) and they always seemed vague about the Tandem…

The running costs for the Omnipod 5 are also more of a subscription than upfront so I’ll have the option to switch to another system rather than being stuck with it for four years – that itself was another consideration.

Again, thanks to all of you that have commented here – much appreciated!

That sounds like great news, good result!

I used Medtronic pumps for a few years. I changed to Omnipod Dash a couple of years ago. I find it much better, no “being followed round the bed by the pump”, and the ability to set a square bolus before getting in the shower.
IMHO, you’ve dropped on lucky.
My Diabetes Specialist Nurse suggested I listen to “Juicebox Diabetes” podcast, and I find some of them really interesting, although they are a bit American.

Pump update.  @chipster Yes, I think I have ‘dropped on lucky’!

Well… almost three weeks on the Omnipod 5 and, my, what a revelation.  Time in range has increased from 59% pre-pump to 82% over the last two weeks  and I had a 95% day last week.  The quality of my sleep has vastly improved and I’m finding my levels of stress and anxiety (diabetes and otherwise) vastly decreased.

And, as a middle-aged man this is a major win, I’ve had NIGHTS WHEN I’VE NEVER NEEDED TO GET UP FOR A PEE!

Hahahaha…I found that as well, absolute revelation. If I ever wake up now, I know my blood isn’t quite right.

Excellent results over last few weeks…mine aren’t great – increase in exercise and not getting my dose timings quite right.

If I don’t eat or exercise, my levels are absolutely level all day…so I need to do further tweaking.