What should I consider when choosing a pump?

[Finn]

At my last endo appointment, I was asked if I was interested in a pump. I was caught off guard, so I wasn’t ready with questions.

I have another appointment next week where I plan to ask about it. I’m not sure what pumps are available (I’m in Germany), but what sort of things should I ask about and what should I consider in my research?

I know I’m getting ahead of myself with this question, but what do users with tubed pumps do when sleeping? I move around a lot when I sleep and I’d be worried of the tubing getting tangled in the bedsheets.

[Karl.n]

I’ve had a bunch of medtronic pumps as well as omnipod now.

-First is whats available and covered. Not sure about Germany, but EU is generally different from US/UK.
-Do you have a cgm or meter you prefer? Which one? Some pumps will work with some cgms, but they are not universally compatible. Are you willing to switch?
-Do you want to close loop (ie have automated insulin delivery based on cgm readings)? Most offer some form of closed loop now, but do so in very different ways.
-Tubes vs none. I like the tubeless omnipod but never had a huge issue with medtronic. Generally I’d clip the pump to my waist band and never had it get tangled in the sheets except in the rare case I was trying an infusion set on my arm. Tubes come in various lengths, so you can get shorter if the tubes are getting the way. Honestly i have more issues now bumping the omnipod against something and falling off than I did pulling a tube and yanking something off.
-What do you want your user experience to be like? They’re all different and at least in the US I’ve been able to try them out with a rep before buying.

[CarlosLuis]

@Finn

I’m not sure what pumps are available (I’m in Germany),

This was the first thing I tried to learn. Boy, did GOOGLE fail big time. I have no idea which pumps are approved in Germany.

A lot really depends upon the pump whether tubeless or not. There are benefits to both. I personally chose the Tandem T:Slim with C-IQ as I was already using the Dexcom G6 CGM. At the time the OmniPod 5 (tubeless patch type pump) was not yet available. I did not go with Medtronic because of different CGM and some other stuff.

As to patch pumps I thought that I would clumsily knock it off on a door jam or something.

I wanted to see what the the algorithm would do. It is more conservative than me, but I am learning how to do mini overrides on boluses that will take my average BG below 6.1mmol/L or 110mg/dl. That’s neither here nor there.

Sleeping with a tubed pump works well for me. I don’t sleep nude keeping the tubing under my pajamas. My pump came with a case that has a belt clip. I found some mildly elastic belts, called invisible belts, on Amazon that I wear 24/7. They were relatively cheap and came in a 4 pack, so they can be laundered.

I am a roller as I sleep, but fortunately I never sleep on my stomach. I sleep mostly on my right side, then back, to left side. A funny thing, no matter where the Dexcom sensor is located when I an on my left side I will get a false hypo alarm. WTF!

I’m not sure what to ask your endo. It would be helpful if you knew what the options are.

[CarlosLuis]

@Karl.n

Honestly i have more issues now bumping the omnipod against something and falling off than I did pulling a tube and yanking something off.

Ah ha, Karl, That was my concern for going tubed.I was sure that would happen to me.

[TomH]

@Finn I’ve only used the Omnipod Dash. But here’s my take in no particular order:

1. What’s available?
2. What will your Endo support? What does he/she/they recommend? Why?
3. What training is available, what format, what cost?
4. Does it operate with your phone, separate PDM, both, existing/planned CGM?
5. What will insurance cover vs what’s my out-of-pocket cost?
6. What insulin’s can be used with pumps you’re interested in?
7. Does insurance cover the insulin’s used, supplies needed?
8. Do the pumps you’re interested in interact or work with the CGM you have/those available to you?
9. If your interested in/are planning to use an iAGC as an AIDS, what pumps/CGMs support the software/hardware system?
10. Is it tubed/tubeless? If tubed, what lengths available? What infusion port types available for it? How is it carried (belt clip, pocket, separate worn sling, etc.)?
11. Does it carry sufficient insulin to meet your needs for the life the infusion set?
12. What infusion sets work with it? (Soft, metal, 45°, 90°, other?)
13. What settings does it allow/offer (basal rate, bolus limit/ICR, ISF, CF,Control IQ, Basal IQ, other)
14. Is it simple enough for you/caregiver to understand and operate effectively?
15. If you travel, what are you going to have to bring with you? Are supplies available where you go frequently/all the time?
16. What batteries/chargers does it take? How many do you need and where?
17. When it doesn’t, or parts of it don’t, work or it/they break(s), what’s your back-up system? How long does it take to implement? Will what you need be available if not at home? Will it work or be available to you “on the road?”

I’m sure there are many more, some practical, some of choice. I did not have such a list, just dove in and found out. You’re doing it the right way!

[Finn]

Thanks all.

I’ll get the list of what’s available to me and go from there. I’ve tried Googling and couldn’t figure out what’s available here, plus it may vary state by state and between insurance providers. I’ll ask for a list of pumps at my appointment on Thursday.

I currently have Libre 3 and I think I could switch to Dexcom when this prescription ends in November 2023 (I can only change every 12 months l). I’m not sure if I’d be able to switch sooner than that if I got a pump, but I could just operate in manual mode until then.

I’m pretty certain I want tubed, but I’ll see what is available and what’s recommended.

Luckily I don’t have to worry about a lot of the hassles with insurance that people in the US need to consider. I’m certain all insulin would be covered similar to how it is for me for pens now: €5-10 for a box of 5-10 pens. I’m not sure how much everything else costs. Prescriptions are generally €5-10 a piece, but I have no idea what the actual pump would cost.

I currently use Humalog and Lyumjev on MDI. My TDD is 25-30 units (15-20u bolus, 9u basal), so for a 3-day infusion set, I’d need one with a minimum fill amount of 100u, I think.

I’m pretty good with tech, I love data and I like fine tuning my factors, so I’d like something that allows me to adjust my target blood sugar, factors (they change a lot with my menstrual cycle) and activity. I work from home so do a lot of sitting at the computer, but also go for long walks a few times a week.

There’s a lot to consider and it’ll be easier once I’ve got a list of my options, but these questions are all really helpful.

[TomH]

@Finn One of the other responses talked about Omnipod’s getting knocked off; while others report similar occurrences, it depends on your job, sports, kids, etc. I’m retired do woodworking, refinished a cabin exterior (up/down ladders constantly with equipment), and similar, though no big-time sports (rock climbing, baseball, etc.), I’ve only had one pod come loose (it was salvageable) while on a cruise getting wet in the pool/ocean daily; probably the salt-water/pool water did it in (never lost one due to showering with it on, though I tend to dry the adhesive patch with a Kleenex). I chose Dash because I didn’t want a tube and was planning on trying Loop. I now use Loop to integrate my Dash and G6 on my iPhone (a few others have their own software, most have to use a separate device) to do away with a separate “phone” size device for the G6 and one for the pump (3 devices? Never! 2 maybe, 1 is ideal!). That said, there’s something to be said for being able to have the infusion site in one location and the pump elsewhere; the offset is the tube and insulin waste to fill the tube. Whatever you choose, definitely try to simplify the need for “things” to carry with you, like phone apps for the CGM and pump with the PDMs as backup when needed (hopefully never). Also, keep in mind some pumps have “warranty” period that can be up to 5 years long and many/most insurances won’t let you switch at their cost until that period is over (Make sure to add this question to your list: What’s the warranty and what are the restrictions of it?).

[TomH]

@jo_jo You’re points about how Tandem is disconnected for swimming and bathing are great considerations for anyone considering the different styles, as is the recommendation on the clip (I think something similar was stated in another stream/forum). I also like your comment on committing to trying something for a period of time. While I knew I liked the pump, vice MDI, for the ease of bolusing, it was initially both a mental and physical challenge getting used to having something attached to me, probably similar for the tube experience. This is what makes FUD great, the different perspectives from people with different experiences and perspectives!

[MM2]

@TomH

getting used to having something attached to me, probably similar for the tube experience.

Interesting how many folks make this comment. But I think its a benefit to be attached and never forget to have pump with me. I like the convenience of not dealing with different vials/pens for basal and mealtime insulin. I enjoy nibbling throughout the day, with insulin pump to easily bolus for it, or basal adjustments for exercise or corrections. Since switch to Tandem X2, I let my pump do more work, less interaction by me.

For some people/kids, the patch pumps may offer additional benefits that are not of interest to me.

[Karl.n]

@jo_jo

Also, when you unclip the Tandem, there’s an exposed needle at the end, so it’s hard to deal with where to leave it (ie I wouldn’t want it just on my beach towel while I’m in the water or in a locker at the pool). There’s also a opening at the site, which they do provide caps for, but like 2 per month supply so save up on those if you care to cover that hole, which I’d recommend doing so in lakes, oceans, and public pools, but I never do in the shower or bath anymore. For the needle end, I thought about trying a toothbrush cap, because it has a little hole for the stem, perhaps that would work, but I haven’t found a solution yet, and as far as I know, most people don’t worry as much about it as me.

That was one thing I always appreciated about Medtronic’s Quikset, they were incredibly easy to detach and not worry about. Just two female ports that would line up and stay out of the way when detached. Once upon a time I heard there was an adapter for the third party sets.

[Karl.n]

@Karl.n

Quikset

Quikset? Quickset? Quick-set?

[CarlosLuis]

@jo_jo

Also, when you unclip the Tandem, there’s an exposed needle at the end, so it’s hard to deal with where to leave

One thing you could do is to trim off the adhesive pad from the next set your remove. Clip the cannula off as well. You can stick in on your pump with double stick tape… Then you could stop insulin, disconnect the tubing and click it to your pump.

Here’s a picture. I didn’t actually stick it to my pump but you get the idea.

[Finn]

I had my pump appointment today and here are my choices:

• Omnipod Dash
• Medtronic 780G + Guardian sensors
• T:Slim + Dexcom G6 (and soon, Dexcom G7)
• Ypsopump + Dexcom G6

I’ve narrowed it down to T:Slim and Ypso.

I’m currently on FreeStyle Libre 3, but when I move to a pump, I’ll also be moved to Dexcom G6.

I currently use Lyumjev and Humalog, but Lyumjev isn’t approved in either T:Slim or Ypso, so I’ll use Humalog or NovoRapid.

Whatever pump I choose, it’ll cost €3600 but will be fully covered by insurance (thank you, German health care system). So cost doesn’t play a factor in my decision. Whatever I go with, the pump will be free.

I’ll have the pump I choose for 4 years, then I can switch if I want to. If the battery in the T:Slim starts to go bad in that four year period, I can get a replacement pump.

Once I make a decision, I could have a T:Slim in 4 weeks, or an Ypso pump in 8 weeks. The Ypso pump was just approved in Germany and apparently it’s quite popular, so there’s a bit of a longer waiting period. The pump educator was a T:Slim user and she said she likes her T:Slim, but she was looking forward to getting an Ypso pump next year when her 4 years on T:Slim is up.

A few questions for people who have used either a T:Slim or Ypso pump:

What do you like and dislike about your pump?

What made you choose your pump?

What have you learned or experienced that you wish you’d known before choosing your pump?

Have you had any issues that have made you regret your
pump choice?

[TomH]

@Finn Congrats on the info you’ve obtained. Wish I could help, but have no experience in either one of the pumps you’ve narrowed it down to. I believe Ypso has been in use in Canada for sometime and am sure there are people here and elsewhere to offer advice on both. Here’s hoping whichever you choose is a good experience and aids you in reducing the efforts involved!

[Finn]

Thanks @TomH.

At the moment, I’m leaning toward the T:Slim, but we’ll be spending the weekend researching to be sure it’s the best choice. It doesn’t seem like either of them would be a terrible choice - they both look like good pumps, each with pros and cons.

One major pro of the T:Slim I realized yesterday is that there are a lot more T:Slim users out there right now, so I’d be able to get more help, tips and insight from the internet (forums, YouTube and blogs) for T:Slim than I would for Yspo. With this being my first pump, that support would be a huge plus.

[Hammer]

@Finn

I currently use Lyumjev and Humalog, but Lyumjev isn’t approved in either T:Slim or Ypso, so I’ll use Humalog or NovoRapid.

Lyumjev works great in the Tandem pump!
Fiasp is the one that doesn’t play well with the Tandem cartridges.

I strongly feel that the faster acting insulins and the Control-IQ setup is the best way to go right now.

I don’t know about the Ypso pump.

I am currently using the Omnipod 5 because my insurance doesn’t cover anything Tandem based. (This will change soon I hope.)

T:slim X2 is a really good pump.
There are a few things that are easily overcome, but still irritating.
Filling the cartridge takes some getting used to. If you have OCD and make sure to take your time, then once you get the hang of them, they are no problem.
If you are more of a ‘meh, that’s good enough for now’, then you might have issues.
They are picky about getting air in them. Just watch some youtube videos and you can see how to get around those issues.
Tandem has you locked into their infusion sets. But they do have a number of different types, lengths, angles, etc. So you have pretty good odds of finding what you want/need.
I still have my X2 pump. It is almost a year out of warranty and still works great. Always had great customer service from them. And their local reps have always been SUPER helpful! They would overnight me supplies if the VA wouldn’t get my prescriptions right, or get delayed, etc. Can’t say enough good things about Tandem Reps. They have all been wonderful people that went above and beyond to help!

The Control-IQ part of the tandem pump is, in my opinion, the best commercial hybrid loop on the market at this time.
Out of the box does a pretty decent job.
And if you want to tinker with your settings, you can really make it do a dance and jig to the tune your playing (still not as good as the REAL Loop systems, but, great for a commercially available system.)

I will jump back to Tandem when they release their next pump. I am not as happy with the Omnipod5 for control reasons. But I really do like the lack of tubing!

[JessicaD]

@Finn I am not a pump user, but the initial thought that hit for me was also your “major pro”: you’ll be able to get lots more Tandem input from users here than with Ypso. That is definitely valuable (and would be a major driver should I ever decide to try a pump again). Good luck with your decision!

[Karl.n]

@Finn

I had my pump appointment today and here are my choices:

• Omnipod Dash

It would be interesting to know how German health care handles the newer Omnipod systems. Insulet has setup the infrastructure to not lock into a 4 year warranty cycle, so you can jump in and out of their system.

[Finn]

Thanks for all your help, everyone!

I sent off an email to my diabetes clinic this afternoon with my choice: the t:slim! They seem to think I’ll be able to get it and the Dexcom G6 in the next month or two!

@Hammer

Lyumjev works great in the Tandem pump!
Fiasp is the one that doesn’t play well with the Tandem cartridges.

I’ve heard the same from others on here. Is Lyumjev approved for the t:slim in other countries or is it being used off-label? I have no problem doing things off-label as long as my endo will prescribe it.

@JessicaD

I am not a pump user, but the initial thought that hit for me was also your “major pro”: you’ll be able to get lots more Tandem input from users here than with Ypso.

This played a big role in my decision making. I haven’t seen many Ypso users on this forum or others, so I’d be troubleshooting alone if I went with Ypso. With t:slim, I’ll have many other users with years of experience to get t:slim-specific tips and tricks from.

@Karl.n

It would be interesting to know how German health care handles the newer Omnipod systems. Insulet has setup the infrastructure to not lock into a 4 year warranty cycle, so you can jump in and out of their system.

I’m not sure on this. I wasn’t interested in a tubeless pump, so we didn’t talk about Omnipod much in my appointment.

[Hammer]

@Finn

I’ve heard the same from others on here. Is Lyumjev approved for the t:slim in other countries or is it being used off-label? I have no problem doing things off-label as long as my endo will prescribe it.

Unfortunately I have no knowledge about how it is prescribed in other countries.
I know that Fiasp clogs up the Tandem cartridges. I would get 1.5 to 2 days tops before I had issues.
Lyumjev has no issues at all in the pump. I have even refilled a couple cartridges when I had some issues getting supplies.
Only real gripe with using Lyumjev in the Tandem pump is that when on Control-IQ, you cannot change the TIME for how how it thinks insulin is active for. And Lyumjev has a much shorter time under the curve for me. (I can change the time with the Omnipod5, but the O5 is not nearly as aggressive as I want it to be. Mainly for basals.)