Hello. I’ve been on MDI for my entire diabetic life, 21 years. It has worked fairly well for me over that time, using Levemir and novolog. I also use the freestyle libre 3 CGM sensors with xdrip and juggluco to help manage things.
As I look down the road to the sunset of Levemir, I’m thinking about insulin pumps and AAPS. I’ve never used a pump. I am thinking it would be advantageous for basal delivery, and possibly for boluses also.
This is kind of a broad topic, but what are good pumps? It looks like the omnipod system is pretty popular. I like the idea of not having tubing, as that always seemed to be a drawback to pumps.
Also, are there great cost differences? I’m on high deductible insurance currently, and usually don’t come close to my deductible- my insulin and test strips are fully covered by insurance, so my only expenses are doctor visits and CGM sensors.
What kind of A1C numbers are realistic with pumps? I’ve averaged somewhere between 5.1 and 6.1 over the course of these years on MDI. However, I have had a fair amount of low BGs over that time frame.
Hi @mike_g , I’ll wade into this lengthy topic first.
There are many here that can give you better information on the looping side of things, and current costs.
Regarding pumps. If you go through insurance the price is generally higher for acquisition unless the pump and supplies are furnished through pharmacy. If the supply chain is through DME, and you have a high deductible plan your choices are to pay cash direct to manufacturer (if possible {best deal price wise}) OR choose the pharmacy direct route and pay cash/high deductible.
Omnipod uses the pharmacy direct route. Tandem is starting to but is still mostly mired in the DME architecture. I bought my last Tandem pump cash direct from Tandem at almost half the insurance cost. Tandem will sell pump supplies direct with a current Rx. I don’t know how Medtronic is currently operating, sorry. Maybe someone else here has that knowledge and will fill in the blanks.
Definitely helps with basal, because it can be tuned hour by hour to match what your body actually needs. (Actually, can be tuned every 5 minutes which doesn’t matter, but also “on demand”, like “give me this many units per hour for the next xyz minutes” which helps with periods of exercise, stress, and more.)
And it’s convenient to have insulin always available for corrections without having to carry a pen or syringe and vial.
You’ll be able to get the same results with a dumb pump because your A1C is the result of your paying attention to your BG and your good decisions about how much insulin to take. A good algorithm (in a smart pump or in a system such as Loop) doesn’t replace your decision making, it just tries to do the right thing when you aren’t paying attention. That reduces the amount of work you need to do, and also takes excellent care of your BG when you are asleep, provided your pump settings are good. The settings for carb ratio, insulin sensitivity, and basal likely will need to be different from what you are using with MDI.
One thing that will change with a pump is the need for you to recognize and compensate when the pump thinks it gave you insulin, but your body is not reacting as if the total insulin dose actually made it to your blood stream. In that case you will need to override the algorithm and take more than it thinks you need, and maybe change the infusion site too. A nuisance, but no big deal.
Both @elver and @bkh have offered good comments about the cost issues, advantages, and disadvantages of a few pumps. Would that purchase of a pump was straightforward, but it varies greatly by insurance company, manufacturer, and your personal views. I personally found switching from MDI freeing in that I didn’t have to worry about having pens, needles, etc. with me all the time. I’d encourage you to look at the various form factors (the smaller Tandem Mobi, patch (i.e. tubeless), longer tubed versions; how much insulin it may take to fill the tubes or the method to do it (look at YouTube/online videos of manufacturers); what insulins the pumps are recommended/approved for. You may also want to look at whether a PDM (Personal Data Manager) is required or if they have an app that your phone will work with and let you control the pump. Ensure you look at what CGM the pumps work with as well: I believe Medtronic only lets you use their CGM. If using insurance to purchase to DME channel pump, know that some have hefty price tags and are limited in the number of years between when insurance will allow you to buy another/different pump if so; if sold via pharmacy benefit (like Omnipod Dash and the 5 versions) then this restriction doesn’t apply. And while you’re looking at pumps, you might want to evaluate the whole AID system (CGM, pump, and software to take the CGM data and tell the pump (within bounds) what to do; these come in various types and abilities from pump manufacturers as well as the DIY community, if you’re willing to go that route. After narrowing down the offerings a little to meet your insurance and personal druthers, then ask whatever questions you have and many here will be glad to give their advice and recommendations.
Certainly a lot of research ahead – there are so many options!
I have the Tandem t:slim X2 insulin pump. I’ve enjoyed Control-IQ, especially for sleeping. I like that Tandem does periodic software updates for improved features. The Tandem app is hit and miss; I had to turn on “developer functions” on my phone so that it wouldn’t update operating systems, since app updates lag quite a bit.
My insurance allows me to get a new insulin pump every 5 years (same as Tandem’s warranty). I think I have had 1-2 warranty pump replacements over the past 10 years using Tandem so staying in warranty has been worthwhile for me. If you get a warranty replacement, you have to ship back the old pump. If it just goes out of warranty, you can keep the old pump. You can still use your pump after the warranty expires, but Tandem won’t let you upgrade the software and I suspect customer service would be less helpful.
Everything varies by insurance company, but here are some numbers for reference. I’m on an employer-sponsored “value” insurance plan (not “traditional” high premium and not a “high deductible” HSA plan). I got a new pump in 2023, before I’d met my deductible. Here’s the breakdown from my insurance statement:
Billed amount: $8541.67
Allowed: $4600.00
Deductible: $875.00
Coinsurance: $745.00
Copay: $0.00
Adjustment: $3941.67
Paid: $2980.00
Your responsibility: $1620.00
Pump supplies (cartridges and infusion sets) are generally my biggest insurance expense every year. Looks like last year I paid about $1500.00 for pump supplies. I always put at least that amount in my FSA.
I always try to have many extra infusion sets on hand. Poor absorption on occasion, plus the doorknob curse is real… but then again, I’ve also ripped my CGM off on a doorframe, so I might just be a klutz.
@mike_g I didn’t think of it sooner, but you may want to visit the IDS website (https://integrateddiabetes.com) and look at the chart/article by Gary Scheiner (insulin pump comparisons and Reviews by Diabetes Educator) and maybe even pay for an initial consult on pumps (they are reasonable but don’t deal with insurance, you’d have to do that). My understanding is all the folks at IDS are T1s and have used various pumps at one point. Scheiner wrote the book Think Like a Pancreas which many folks highly recommend (you can buy or dl it at the IDS website). There’s another called Pumping Insulin that also comes highly recommended (I have not read this one.) Either of these may help you resolve whether to look further or chose a pump if that’s your decision.
I am a new Omnipod user and am very impressed. It takes 4/5 pods to ”learn” your trends, bolus easy to override automated to bolus. Without insurance it would be 600-800 a month. Depends on how many your dr prescribed. My deductible was $490 for introductory month and $500+ for 3 month supply. After I reach $2000 that should end.
