Pump Update + CGM Advice (Medtronic 640g or t:slim X2)

[GingerGG]

Hi everyone! Long time reader, first time poster Hope you're all doing well!

I have been diabetic for nearly 20 years, on a pump for 10 years, and I am (over)due my third pump update. My biggest problem since diagnosis is that I do not test nowhere near enough which means my control is not tight enough, so I am looking into self-funding a CGM alongside my new pump (I have given up with begging for NHS funding at every appointment).

I have been using the Medtronic Minimed 640g pump for the past 5 years, and have gotten on alright with it. It's easy enough to use, and I like the integration between the testing kit and the pump. I do not like how much plastic you have to use to inject the infusion set but needs must.

I am leaning towards getting a new Medtronic 640g and investing in their CGM because it's familiar and because of their new self-funding packages, but I also have been considering the Tandem t:slim X2 Pump alongside dexcom.

Any opinions advice would be great! (I also have some weight to shift, so if that would potentially sway the decision, would love to hear it!)

For ref, the pumps I have been offered to choose from:
Advanced Therapeautics: DANA RS, Tandem t:slim X2 Pump, Omnipod DASH Pump, MiniMed 640G (& potentially Medtronic: MiniMed 670G), Roche: Combo or Solo

 

[DunePlodder]

I'm a happy user of the t:Slim with a self funded Dexcom.
The Dexcom has been very reliable for me, usually with no calibrations. From what I read this is a big advantage over the current Medtronic CGM.

 

[Maco]

Hi @GingerGG, is there any reason your CCG wouldn’t fund you with the latest Medtronic 780G instead of the 670G? Especially if your willing to fund the guardian 3 CGM yourself to run alongside, you’d then get the automode features. If they would fund you the 780G & you funded the sensors you’d have the closed loop system with automode.

I’m fortunate & I have funding for the 780G & the CGM and honest it’s absolutely brilliant.

 

[Chas C]

I'm a t:slim / Dexcom user and would add its great but I'd agree with @Maco as you already have Medtronic.

 

[GingerGG]

Hi @GingerGG, is there any reason your CCG wouldn’t fund you with the latest Medtronic 780G instead of the 670G? Especially if your willing to fund the guardian 3 CGM yourself to run alongside, you’d then get the automode features. If they would fund you the 780G & you funded the sensors you’d have the closed loop system with automode.

I’m fortunate & I have funding for the 780G & the CGM and honest it’s absolutely brilliant.

I'm not sure why they haven't mentioned the Medtronic 780g as being an option, but I may have to ask. How long have you been on the 780gm with the CGM? Any cons to look out for?

 

[Maco]

I'm not sure why they haven't mentioned the Medtronic 780g as being an option, but I may have to ask. How long have you been on the 780gm with the CGM? Any cons to look out for?

Since January the 7th, A1c before starting 83 with a predicted a1c of 47 now. The positives far out weight the negatives, automode is amazing. Once you get your carb ratios correct & swap into automode your very rarely out of range which is set at 3.9-10mmol. Having the pump automatically correct any highs or sense your going high and react before you would even know to is a game changer. Then the pump automatically gives you background basal insulin depending on your needs.

1 negative if any, it does struggle if you go really high. Say for instance you massively under count the carbs in a meal & your glucose sky rockets upto 15/16/17mmol it does struggle to get you back down quickly enough. This has only happened to me twice (takeaway food) & all I do is come out of automode, take a corrective bolus and once back into range swap back to auto.

 

[DunePlodder]

@Maco My experience with the t:Slim is very similar, including the fact that if I do go high, it takes a long time to bring me down. Like you I will sometimes do manual corrections, but have to be careful not to over do it.

 

[InsPump]

Since January the 7th, A1c before starting 83 with a predicted a1c of 47 now. The positives far out weight the negatives, automode is amazing. Once you get your carb ratios correct & swap into automode your very rarely out of range which is set at 3.9-10mmol. Having the pump automatically correct any highs or sense your going high and react before you would even know to is a game changer. Then the pump automatically gives you background basal insulin depending on your needs.

1 negative if any, it does struggle if you go really high. Say for instance you massively under count the carbs in a meal & your glucose sky rockets upto 15/16/17mmol it does struggle to get you back down quickly enough. This has only happened to me twice (takeaway food) & all I do is come out of automode, take a corrective bolus and once back into range swap back to auto.

Hey Maco, is it a function on the pump that you can come in and out of auotmode?? Just been reading some of your and others posts on the new Medtronic 780g. Based in Ireland and due to get the new version shortly.

 

[searley]

This is my first pump and I chose the tslim and don’t regret it

I got it because the extra feeling of safety from the dexcom

Legally I have to test about 8 times a day.. but when relevant to driving not necessarily the best times for insulin doses so the Dexcom saves extra testing

My Tslim has controliq so I have the best control I’ve had in 10 years

Would I want to swap now…. No

But…. On the Tslim Facebook group I see people that have been on Medtronic curse after the first 48 hours of poor control after the Tslim swap…. It seems to need totally different settings and they have not been patient enough to get it set up right.. they simply expect to copy the setting across and it will be ok

 

[Maco]

Hey Maco, is it a function on the pump that you can come in and out of auotmode?? Just been reading some of your and others posts on the new Medtronic 780g. Based in Ireland and due to get the new version shortly.

Hi, yeah you can come in/out of automode but there’s not really a reason to do it. The only time I’ve heard of people coming out of automode is if they’ve gone really high. They cancel automode and take a corrective dose, personally I’ve never came out of automode when I’ve got really high. I’ll stay in automode and still give a corrective dose

 

[InsPump]

Hi, yeah you can come in/out of automode but there’s not really a reason to do it. The only time I’ve heard of people coming out of automode is if they’ve gone really high. They cancel automode and take a corrective dose, personally I’ve never came out of automode when I’ve got really high. I’ll stay in automode and still give a corrective dose

Super thanks for that. Looking forward to getting the new pump and getting starting with it. Automode sounds great. Thanks