2017 pump choices: why did you pick yours?

i am currently on the 523 Paradigm Medtronic. when my warranty was up on my previous MM pump, i was considering switching to the Tandem Tslim. it was smaller and lighter and it looked so cool. however, i was very uncertain about having a touch screen as opposed to buttons. i had not ever had a Smart Phone before and was no good at using my husbands iPad at all. retarded is the word that comes to mind.

but i thought, oh, i could definitely get used to it. but then i saw that the reservoir came outside the pump itself, and i did not care for how it felt on my body. i was also concerned that it was too young in its existence and that maybe i would have problems with it that had not yet been tweaked out.

i have used Medtronic for 17 years and have always been a satisfied customer. their tech support and customer service is incredible. they stand by all of their products, and you get to speak to a real live english-speaking person (many of whom are Ds themselves or have Ds in their lives). they replace products w/out question and have over-nighted me anything urgent.( even once when i was on vacation in a hotel)

neither its size or its functions have ever disappointed me. i like that its sturdy and reliable. there are some functions that i wish it did have, but, hey, i pick and choose my poison.

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Please flush that word from your mind. Technology adverse maybe but retarded, Oh hell no.

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then just call me “slow.”

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The biggest challenge is a blood-based CGM

Actually I think we need to rethink that. The consumption of glucose does not happen in the blood stream, it happens in the cells which are in the interstitial fluid. I think we have this preoccupation with blood glucose because of legacy issues, it was easier to measure in the blood, but I believe the clinical significance of glucose levels is in the ISF, where the glucose is consumed.

There are many many papers about the fact that insulin suppresses counter-regulation. So in some ways the tail of the insulin action is as important if not more so than the onset.

Sub-Q fast pump-delivered insulin (whether basal or bolus) takes hours to be absorbed, long acting (MDI) is worse. Insulin is always there preventing your otherwise happy alpha cells from doing the job of keeping you alive when you go low.

I recently saw a return to counter-regulation when my son’s pump failed, and I only had short acting insulin where we were, so I was giving him basal using short acting shots (through his pump site actually). Due to him being on 0.1U/hr overnight, and the impossibility of drawing this up in a syringe, I had to go back to basal shots every 3 hours or more. I saw several instances of clear counter-regulation.

I’ve discussed this with others, and some Affrezza users swear they see it as well, since Affrezza is gone so quickly. Think for a moment about the dose size options with Affrezza, and what that would mean if you only had those dose choices on a pump.

i feel like if i could get the accuracy of a pump delivery system without using a syringe, i would do it in a heartbeat.

You could perhaps try dilute insulin? Also there are electronic pens out there (like the Pendiq) which claim accuracy down to 0.1U - basically a pump mechanism in a pen.

The consumption of glucose is not nearly as relevant as the amount of glucose in the blood. I am not sure what value you think an interstitial glucose reading gives you over a blood reading. The interstitial level is delayed, and is directly related to what was in the blood 15 or 20 minutes ago.

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