Ethan would be big enough, about 70 lbs and growing. There is a lot of good feedback out there concerning the Tandem. Thanks for the feedback re: knocking off infustion/pod sites. Good to know it was about the same for you. I am concerned about that on either one, but almost impossibe for me to assess which he’d be more likely to knock off or pull out.
2 Likes
This is one of my biggest concerns in switching to pumping. Regardless how a bolus works out, I’ve SEEN and KNOW what was given. I’m not wondering about pump failure, issues, etc.
I also have, which I am sure is a normal yet irrational worry, of having the insulin actually ON him. There is something unnerving about that, and fear that too much insulin will be accidently given. Obviously many many people successfully pump, and love it, so I’m sure it will be a fear I will work though
3 Likes
It is possible that this will happen…EAT…but honestly, when my son started pumping we worked out a system where he would text us what his current blood sugar was, how many carbs he was going to eat (including the crap he traded for or purchased in the lunchroom), and how many units he was going to give. We double checked the math and approved his bolus. That lasted about 6 months until he was happily capable of dosing on his own. You could potentially try something like that.
1 Like
People who inject make mistakes too. They grab the wrong pen or vial and give the wrong insulin. They forget one of their injections, or think they forgot and then end up double-dosing. They accidentally dose less or more than they intended to. I think I’ve made all of those mistakes a handful of times over the years. I’m not sure one system is safer than the other in that regard. At least with a pump, you can check its built-in records to confirm what you did.
9 Likes
For me it’s exactly the opposite. Wearing a pump means I always have insulin with me, and it’s really easy to take corrections whenever indicated. Without the pump I would worry about going high and not being able to do anything about it.
Pumps don’t go haywire and pump in massive doses of insulin, and anyway if Ethan always has a roll of glucose tablets nearby then “too much insulin” is never scary or a big deal: just eat some glucose, problem solved.
All pumps make it really easy to see how much insulin they delivered, and how much active insulin is estimated to be in the bloodstream (“IOB” - insulin on board). That turns out to be very useful: if my BG is 160 and falling but my IOB is 1 or 2 I’ll do nothing whereas if the IOB is 8 I’ll eat more carbs right now.
If there’s an infusion site failure, the CGM will alert that the BG is going high, and if telling the pump to give a correction bolus still doesn’t fix it, that’s all the clue I need to change the infusion site. (If the BG is going seriously high, I’ll use a syringe just to eliminate all ambiguity, but generally it suffices to try a correction and if it’s not working or I smell insulin from the infusion site just change it.)
3 Likes
Back when I was on MDI I took my evening Lantus and a half hour later was crashing desperately hard. I ate glucose after glucose after glucose and finally got the plummeting BG headed back up. The only explanation I came up with is that I thought I grabbed the Lantus but must have actually taken Novolog. That kind of error is simply impossible with a pump.
5 Likes
Another thing with a pump, you do not have ANY long acting insulin. The basal is just short acting given in small amounts over time. So it is easy to change that rate, or just stop/suspend basal at any time.
With MDI, you are taking a long acting that gives no such ability. Once it is in your system, it is there for its time.
And with a pump, you can always carry a few syringes and take some insulin from the pump and inject that way. I do this if I have a site failure while at work. I just take some from the pump and inject as needed. Then change the site, etc. when I get home. Simple and easy safety net, and you have the insulin with you in the pump at all times (even when ‘empty’, there is still insulin in them to use.)
6 Likes
However pump data entry such as number of units or carbs to bolus for can also do harm with extra digits. Some pumps have setting for max values, that helps limit.
5 Likes
Human error is possible no matter what solution you go with and whether MDI or pump you can make mistakes in entering data, administering too much/too little insulin, over compensating carbs/insulin, etc., etc.,
The main benefit for us with going to a pump was just less work OVERALL…there’s still a lot of work as there’s no magic button, but going from MDI to pump just allowed us to breath some and when going to loop we have been able to breath even more. There are always issues though and I don’t see any current or future technology that isn’t going to be error full-proof or require some form of manual intervention…aka, the G6 sells itself as “hands free, no calibrations” but the reality is…that is the case for only SOME PEOPLE.
The only thing that would fix all these issues and result in no complications, additional work, etc., is a cure. And I’m still hoping for it ASAP!
5 Likes
It’s good to have long-term goals! I just reached my 50th anniversary of hoping for a cure.
8 Likes
Sorry for delay been dealing with COVID vaccine yuckness, but all good.
A lot of providers push Medtronic pumps which limits your choice of CGM to Medtronic (for an integrated system). Where choosing your CGM first opens your options for pumps. Dexcom integrates with Tandem and other pumps that are in the process of building integration (Omnipod) with Dexcom.
For me I want options.
5 Likes
I have a 17 yo who has been on omnipod since shortly after diagosis as a skinny underweight 11 yo (70-80 lb). In terms of pump generally, we definitely feel many more pros than cons, the main ones being as others have mentioned, not having basal insulin in the background so there’s more flexibility to respond to unpredictable events, and being able to eat flexibly because you can always bolus again for another piece of pizza or whatever, without another stick. In terms of which pump, we went Omnipod in order to avoid tubes and it’s definitely been right for us – my kid is a multi season athlete, lots of clothing changes and contact situations. It’s also nice to be able to “zap” him while sleeping for middle of the night adjustments, so buttons on the separate controller has been good. The loop factor is a big deal, but there is a hybrid loop system coming for the dexcom and omnipod pretty soon (I’m not the expert on when, others know a lot more, but hopefully within a year?) so we’re holding out for that otherwise I would definitely be looking into the DIY looping systems. I just asked him whether he would ever switch to a tubed pump (he’s seen lots of varieties at diabetes camp) and he says quote “nah. Tubes are wierd. I get snagged up enough listening to my earbuds with my phone in my pocket”. Which is true he’s a clutz 
. And although it wouldn’t matter to me much as a boring middle aged person, I think the discreetness factor of omnipod has been a consideration in a kid going thru the teenage years – being able to use a separate phone looking thing to bolus and the pump rarely “showing”. I am not sure if tslim has an option for buttons not located on the pump? But I could see an adult actually preferring the convenience of one piece. Bottom line, I think both have advantages but for a kid headed for middle and high school, many prefer the omnipod. I have heard some girls prefer tslim for smaller profile under clothes and flexible location, not an issue for my perpetual soccer short wearer.
Good luck with whatever you choose!
5 Likes
@katiereeder I started DIY looping my 5yo daughter (Dexcom/Omnipod) a few months after it was launched in 2019 and noticed a significant improvement in her Time in Range. A lot less “zapping” in the middle of the night. You can always easily revert back to not looping. The configurable automatic suspend might also be a considerable improvement during exercise.
I would encourage you and your son to try it.
*Omnipod DASH does not loop as far as I am aware.
Ed
3 Likes
I know Tidepool submitted for FDA approval in Janurary their looping system for Onmipod/Dexcom. Not sure where that stands as of now, and COVID has obviously slowed this (an likely several other advancements) down.
2 Likes
I’m sort of in the same boat. The warranty on my Tandem is up in October, so I need to decide which pump.to move forward with. I LOVE my Tandem with CIQ, but being tubeless looks appealing, especially with Omnipod 5 and Horizon available in the very near future (projected Horizon availability by Insulet was Q1 2021).
Automatic insulin corrections and ease of use are my primary motivators. Cost (both initial and recurring), availability, and ease of acquisition second. My insurance covers both as DME (why UHC!, Why?) I like the product roadmaps for both companies, one is fully integrated with Dexcom, and the other will be shortly, though I’m not keen on carrying a pdm to manage my pump. I’m sure there are ways around the pdm, but I haven’t discovered them yet. Both systems allow for “followers” which I am a huge fan of - that feature has saved my proverbial butt more than once.
I would be curious to hear the reasoning of others if they had to.choose between Tandem and Omnipod, and why. I think they are both great pumps for adults, and one slightly better than the other for pediatric usage. What would you choose? Why?
3 Likes
I prefer a tubed pump because it decouples filling the insulin from changing the infusion site. I fill the insulin reservoir to the max and use it until empty because this reduces my effort and also reduces waste of insulin and supplies. I tuck the tube in my pants so it doesn’t stick out and get snagged. Ever. It’s not like a long headphone cable in that regard.
Also with a tubed pump the infusion site is really small, so there is a huge variety of places where it will fit. With a pod I would imagine the size does tend to constrain the choice of suitable sites.
3 Likes
But how is carrying the PDM any different than carrying the Tandem pump device?
If you don’t carry the Tandem pump, you don’t get basal and can’t bolus.
If you don’t carry the PDM, you also can’t bolus. But you can either still get basal, or turn basal off before you leave the PDM behind, your choice.
So leaving the pump or PDM behind - the basal option with the PDM gives you an option, whereas with the Tandem it does not.
Curious of your thoughts on this.
5 Likes
On the other hand, with a pod you can put it a lot of places that you can’t put a tubed pump, like the back of your calf. It seems like some places would be awkward for a tube. At least running a tube from your calf up to your pocket to carry your pump seems like it is not practical.
5 Likes
just to comment on this point - setting up dexcom/omnipod/loop means you would not need a PDM*. you would not necessarily need to use the loop full algorithm, you can set it up to be the same as the POD/PDM programming.
*does not apply to Omnipod DASH, only older PODs
Ed
3 Likes
Interesting point. I guess context is everything since you would have to carry one or the other. The PDM is basically a locked down cell phone unless you have a Knox enabled compatible Samsung for the next iteration of the Omnipod. I’m not really a Samsung fanboy, and the thought of carrying 2 cell phones around seems annoying. I admit the reality might be better than the assumption, sonic guess an experiment is in order to determine whether or not reality or assumption is correct. The Tandem pump is small… really small and easy to hide and forget in a pocket.
Does the Omnipod integrate with XDrip on Android?
2 Likes