Choosing a new pump and CGM

Hi @adamrit I've used the 740g and now using the Tandem Slim.

I think we are all on the same page about worrying less about t1d.. the less faff the better IMO...

Personally I was ok with the 740g, it was my first pump though so didn't have a gauge to evaluate it against, had a few cracked cases and issues with teflon sets and reacting badly to them, but it wasn't linked via a sensor, now using the Tandem with G6 so all integrated and I love it, been using over 2 years on the Tandem and over 4 years with the G6, yes it's a bit of faff to fill but it can be done quickly and it's a minor niggle in the scheme of things, one thing i've found with the Tandem is that my sleep quality has improved massively, I can have uninterrupted sleep now which never happened regularly before as I have a flat line through the night. It does need to be charged every 2-3 days, but I carry a portable battery so can do that anywhere when sat down or just when i shower as it has to be detached then. Only issue with Medtronic was the issues with cracking pumps, supply wasn't an issue, Dexcom auto send a box every 3 months, but I call Tandem for pump supplies but am aware that can be auto done now too. Go for the Tandem is my advice, best wishes J

My wife has been on 780G and had nothing but problems with it. Medtronic customer service is terrible. Had major issues. The closed loop hybrid system is probably the most basic of the commercial options being bought in 3 rd party software which is getting on for being over 10 years old with little or no improvement. Overnight it’s not bad but if you bolus for food it suspends you way too long and causes highs which it’s very slow to react to. It’s generally way to conservative and with my wife causes swinging. Can’t cope with sickness/periods or anything that changes your blood sugar dramatically. The guardian 4 cgm is more inaccurate than 3s. Often being 2+ out.

Tslim, omnipod and pumps that support camAPS are better options.

Als diabettech.com is a great resource for closed loop systems

I switched from 640G to a tubeless pump (Omnipod Dash) which for me was a massive benefit. I'll never go back to a tubed pump. I thought Omnipod were teaming up with Freestyle Libre to provide a closed loop system, however I find Libre is just too wrong in real time (not just a 10-15 minute lag, but anything up to 40% wrong!!) I find Dexcom FAR more accurate, however I still only rely on blood tests and only use CGM for insulin management tune-ups twice or so a year. T1D just demands excellence, unfortunately no way round that.

I am currently on the Accu-Chek Insight and the Freestyle Libre 2. My Insight goes out of warranty early next year and I'm trying to determine which new pump to opt for. My options, as I currently understand them, are the Omnipod 5, Omnipod Dash, T-Slim, Medtronic 780G and Yposmed. I have the FSL2 on prescription but, again as I understand it, the Dexcom and Medtronic sensors are not available on prescription and have to be self funded. I'm currently in the information gathering phase and trying to understand the pros and cons of each of the systems. Any advice is most welcome.

I did use Medtronic 640 with G2 CGM. I wanted a close loop system and was offered T-slim with Dexcom 6.
The Dexcom 6 is the best CGM by far. So much more accurate. I almost never have to calibrate it.
The T-slim x2 is a big fiddly to load but once done it works well with Dexcom G6.
The charging has never been an issue just always have a charge lead and a plug whenever you travel! Similar to needing for your phone. I have even topped up using my phone battery!
I tend to top up charge every night but have gone 3 days without charging and fine.
My personal preferred is the CGM with Dexcom 6. Never tried 7. Any pump that works with the Dexcom 6 should be fine.

I started using a TSlim & Dexcom g6 about 5 months ago. Although fiddly to change at first, I use a video to help me learn, and I'm getting on really well with them now. The Dexcom needs calibrating at the beginning, then it's accurate. I chose the Tslim over the Medtronics, because I was advised (very unofficially, as my Diabetes Team aren't supposed to express a preference) that there were ongoing supply issues with Medtronics. I can honestly go hours now without thinking about diabetes, which is fantastic. I've only used a Libre before and find the Dexcom even better, once calibrated.

DMM49 said:

as I understand it, the Dexcom and Medtronic sensors are not available on prescription and have to be self funded.

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I think that it is the hospital Endocrinologists who decide if you can get Dexcom6 on prescription. In my case, the Endocrinologist said I could have Dexcom6 on a six-month trial when my pump was changed to t:slim X2. After the six months the Dexcom6 prescription was changed to permanent because my HbA1c had reduced sufficiently.

Dear Adamrit, DMM49 et al,

I used a Medtronic 640G and a hacked Bluetooth Libre 2 with Xdrip for several years and then moved onto a Tandem Tslim X2 with Dexcom G6 in February 2023. I understand your confusion and difficult making a choice. The manufacturers don’t make it easy do they? It’s interesting isn’t it how the manufacturers obfuscate to make clear easy, comparison challenging? Sadly, our NHS Diabetes Teams also struggle to advise too because of the wide variety of pumps available and difficulty comparing various pump pros and cons. I feel a good analogy is it is like trying to advise the differences between different mobile phone models and manufacturers… the rate of change means a constant need to keep up-to-date. To be fair, NHS staff are hugely over-subscribed and over-worked so it is entirely understandable they can struggle to keep up with patients like us who have a vested interest in keeping up-to-date and everything we can as soon as it comes out

Anyhow, after one year of research and waiting around to see if the Tandem Tsport (now called Mobi), the pump I actually wanted, would come out in the original timescales promised Xmas 2021/Jan 2022 I was forced to make a choice 3 years out of warranty (thanks Pandemic). So, I went for the Tandem X2 with Control IQ. To make this choice I used a table from an academic paper from late 2021 that compared the, (at the time), main available insulin pumps, sensors, etc. I even updated costs, etc, directly onto the table. Please see pages 5 to 7.

What I found most interesting and helpful was seeing a comparison made side-to-side with all the main comparable elements put in a clear table format with corrections made for the various statistical elements to ensure a useful comparison. This included, types of compatible sensors and their duration and accuracy, insulin compatibility, algorithm used, waterproofing, boost/exercise modes, warranty, power source, advantages and disadvantages, and perhaps most useful, the ‘(%) Time in Range (3.9 to10mM) achieved in pivotal trials’.

As you can see this element shows there is very little, Time in range (TIR) percentage-wise, differentiating between the pump models, with the CamAPS/Dana RS (TIR 76%) having the best results followed, by Medtronic 780G (TIR 75%) and the Tandem X2/Dexcom G6 (TIR 71%), etc.

The difference in blood sugar control impact between these pump/sensor systems was therefore only 1 to 5%...

In my opinion therefore, the key point in making your choice should not really be the type of hybrid loop system, but other factors such as ease of use, consumables supply, level of input required, particular system strengths and weaknesses, and vitally, how they would impact upon you as an individual. The reported 5% difference in TIR impact would certainly be improved more by your engagement. In other words, if you are really on top of your diabetes then it is likely the academic paper’s TIR 5% difference is negligible and what therefore counts is the other pump/ sensor factors and how they engage and impact upon you.

In my case, very simplified, the Dana RS and CamAPS system was rejected due to the Dana RS pump looking to an ‘old fashioned’ design and the CamAPS being a mobile phone and key ‘subscription’ based app. Yes, CamAPS would overall give a better result by a few percentiles but this would involved a more complicated set and start up, an older looking design pump and a subscription… what if I go abroad, how would this subscription be affected? What would happen to the hybrid closed loop system if I lose my phone?

The X2 on the other hand has its issues (signal loss due to screen facing antenna/ clunky reservoir change), but it looks and feels modern, is slim and unobtrusive, and importantly has it’s algorithm built into the Control IQ software onboard so no problem if you lose your phone. There is also the possibility of software updates and fingers crossed the Dexcom G7, Libre 3 and mobile phone bolusing are all coming as updates in the next two quarters.

The main issue with the Tandem X2 is it’s reliance on the Dexcom G6 which really is a huge step back from the Libre 2. The G6 is larger, more complex to insert and start and only lasts 10 days versus the Libre 2’s slim profile and 14 day lifespan. This should be fixed with the coming software upgrade.

The Medtronic 780G was rejected quickly due to the Guardian Sensor only having, at that time, only a 7 day application and needing calibration.

Now, as mentioned, the 2021 paper and its table are out of date due to Ypsomed, Omnipod, and several other new systems coming onto the market. However, I feel if you print out the table add a few extra columns you could add in their factors and it would help you make a comparison and thus decision.

So in summary, yes, it did take a little fiddling around getting used to Tandem’s system and eccentricities but after a week it was really as easy as the 640G. The X2 does have its issues… e.g., signal loss due to the antenna only facing out from the screen (face down in bed or your pocket results in signal loss), the fiddly reservoir with silly plastic connector that gets in the way of belts, etc, and the Dexcom G6, which is large and in two pieces and a faff to use. However, you get used to them and find work arounds quickly. Charging the battery really isn’t a problem as it charges lighting fast and I often do it while using my laptop or even carry a power bank. I’ve even discovered you can, carefully and disconnected, refill an old reservoir directly while still connected to the pump if you forget a new reservoir. Control IQ (CIQ) is good, not perfect, but good. Like all the Hybrid closed-loops it is not really a closed loop system at all, but rather a blood sugar assistant that makes some boluses for you to try and prefent a hyper, and can stop insulin which might stop a hypo. You as the user still have to do a lot of thinking, bolusing and checking. No where near as much as before but it’s not the holy grail of a fully automatic closed loop system. I feel the wording ‘hybrid’ close loop is actually misleading. Finally, I often leave my CIQ on sleep mode because it keeps my blood glucose target between 6 and 6.5. rather than daily standard 6 to 6.7. The X2 does not allow you to set your own blood glucose targets. This is another disadvantage as the Dana RS/CampAPS allows you to set your blood glucose level target. However, this comes at the price of more user input so swings and round-a-bouts…

I hope this helps in some small way

P.S. For some reason Diabetes.co.uk won't let me attach the article paper or a link to it so please google researchgate.net and search for article ‘Hybrid Closed‐loop therapy: Where are we in 2021?’. There is an option to read online or download. Please see Table 1. I'll also try and attach the pdf again

adamrit said:

Type 1 since 1956, I have used Medtronic pumps for about 20 years and sensors (no longer any hypo awareness). In September I can change my 640G to 780 + sensor 4, but I could change to a T-Slim plus Dexcom 6 or 7. There are plenty of disaster stories and heaven stories on both. Medtronic has suffered from supply problems every now and again for twenty years. They are currently having difficulty supplying sensors, which seems unbelievably incompetent. A known market forever and they run out of supplies? For a few years, it was hurricanes in Puerto Rico, now it is Covid. On the other hand the T-Slim seems very fiddly to fill with insulin. Probably no one has used both, but I would love some considered opinion on merits and non-merits.
I would love to spend less time worrying about bloody diabetes.
Adam
About 30 units Novarapid p d. irregular response to carbs, exercise, insulin, but generally healthy and active. HBa1C 7.5 (56). Pump 640G sensor 3, 5 finger pricks a day because sensor 3 not reliably accurate almost always 1-3 up or down.

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I've used Medtronic 640 for 4 years and now I use the t-slim with dexcom 6. For me the best by far has been the t-slim combo. It was a little bit more time consuming to refill with insulin but after a few weeks it felt no different than the Medtronic. The dexcom sensors however r 100% better than the Medtronic ones. I get a full 10days of readings with only 1 or 2 calibrations needed in the 10 days. The Medtronic sensors always used to fail for me after about 3 or 4 days. Also t-slim and dexcom customer service is way better than I had with Medtronic. Hope this helps.

I’ve had my Medtronic 670G for 5 years and am in the process of selecting my new system. I’m in the US, so I started reading about the 780G and Sensor 4 reports in Europe, before the pump was available in the US. I have read extensively about all the options. For me, the only other option is Tandem and Dexcom, since tubeless is not a priority for me. I think TSlim and Dexcom would be fine, but I’ve decided to go with Medtronic 780G. Partly, because I’m familiar with Medtronic and partly based on what I’ve read from other users. I discovered that plenty of Dexcom users get bad sensors. And, I’ve never had that problem with Medtronic. In fact, I extend my sensors to over one week. And, it’s pretty close to finger stick numbers. And, I’ve never read that anyone likes the Tslim pump setup. It’s described as cumbersome and odd, considering how many people complain about it. I don’t get it. For me Medtronic infusion set up is super easy.

I did have trouble with too many notifications previously with Medtronic 670g, but once I went into automode, everything changed. I’m doing much better. I know some people who are getting 100% TIR with Medtronic 780G, which blows my mind. It’s quite inspiring. I’m just trying for 80% right now.

I haven’t encountered any shipment issues with my supplies ever. Not sure if thats due to being in USA. That would be a dealbreaker for me, so I will check that out, before I make my final decision. Thanks for the heads up.

I have found both systems have users who love it and some who don’t. If I end up unhappy, I’ll have to live with it, or pay to switch. I have to accept that, I guess.

You seem to be going through a very thorough process which is to be applauded.
Do you mind if I ask if you had any luck with the Extended Infusion sets?

adamrit said:

Type 1 since 1956, I have used Medtronic pumps for about 20 years and sensors (no longer any hypo awareness). In September I can change my 640G to 780 + sensor 4, but I could change to a T-Slim plus Dexcom 6 or 7. There are plenty of disaster stories and heaven stories on both. Medtronic has suffered from supply problems every now and again for twenty years. They are currently having difficulty supplying sensors, which seems unbelievably incompetent. A known market forever and they run out of supplies? For a few years, it was hurricanes in Puerto Rico, now it is Covid. On the other hand the T-Slim seems very fiddly to fill with insulin. Probably no one has used both, but I would love some considered opinion on merits and non-merits.
I would love to spend less time worrying about bloody diabetes.
Adam
About 30 units Novarapid p d. irregular response to carbs, exercise, insulin, but generally healthy and active. HBa1C 7.5 (56). Pump 640G sensor 3, 5 finger pricks a day because sensor 3 not reliably accurate almost always 1-3 up or down.

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I like you had been using the 640 for 19 years and have recently started on the 780 with the sensor 4, I have to say I have been very pleased with the 780 and the sensor 4, I would not like to go back to the 640 although I was happy with it for 19 years
,

Hi @adamrit. Re your comment about Medtronic supplies. They’re currently low on G4’s due to ‘high demand’ (new to US market) and my last order is delayed. In fairness to them I don’t think they will see anyone run out and I believe they are addressing it.Hopefully nobody will say otherwise.
Your 68th year is awesome, long may it continue.

adamrit said:

Many thanks to all for the detailed answers. The results seem close, so it comes down to the amount of trouble dealing with Medtronic not being good on supplies and TSlim being fiddly to refill and other problems with manufacturers.

I won’t go with Omnipod because I don’t want to change insulin every three days. I may go with Medtronic 780G and sensor 4 because of familiarity. I’ll do more research on the other pumps which use Dexcom 6, which nearly everyone likes and finds accurate. My present Sensor 3 is so frequently inaccurate that I am finger pricking 5-6 times a day. Brittle diabetes makes life much harder. Raised and lowered BG without reason.
Very many thanks for everyone’s useful contributions as I go into my 68th year of Type 1.
Adam

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I can’t recall where you said you wore your sensor. I remember that I had a terrible time trying to wear mine on my stomach and it all improved when I switched it to my upper arms. That was the key for me. I rarely have a Medtronic sensor fail, unless I have extended it.

I don’t know what the current recommendation is by the company, but just wanted to add that info.