Pump Upgrade – Decision Time/ Advice Appreciated

[Rickmac1988]

Hello all,

Hope you're well!

First of all, appreciate how many threads there are on this already and the wealth of info available.
However, starting a new thread with the hope I might get some advice on the options I have and from people that may have been in the same boat.

To set the scene: my current pump (Accu-Check Spirit Combo) is now out of warranty so I'm eligible for an upgrade, and considering it's something I'll be using for the next 4 years, I don't want to take the decision lightly.

I've been using Accu-Check pumps for 10+ years now so I'm used to how they work, good customer helpline etc, however I've been told by the nurse today, that Accu-Check are not moving as fast in the market as other pumps, and also if I go with Accu-Check again it's hard to get the data from the pump for appointments etc etc. So going for the same pump again feels like a bad choice.

Before I go into the options I have, just want to note a few of the pros/ cons with the current pump:
Pros: Easy to use, great helpline, battery lasts a long time, easy to change cartridge, used to functionality, can wear on a run, can bolus discreetly using buttons
Cons: don't use the blood kit that pairs with it as have a Freestyle Libre - so handset is redundant, can't download data at hospital anymore which makes reviewing information very difficult, pump has 'occlusions' on a regular basis which ends up with pump going into stop in the middle of the night, better solutions now on the market, doesn't enable best control of diabetes

The pumps I've been offered the chance to upgrade to are below, and I've listed a few pros/ cons against them :–

Omnipod DASH
Pros: No tubing, gives more flexibility to lifestyle, would change life not having a pump and tubing attached - might make me happier in general
Cons: Quite big, no ability to bolus without handset, no smartphone app as alternative to handset, have read it can cause skin reactions, can fall off in hot/ sweaty conditions, doesn't sync with Freestyle Libre

Question: Anyone who uses the Omnipod - any thoughts on the above? Have read people say that the helpline are quick to get replacements out etc, however how many do you get on a prescription/ is it limited supply?

Tandem T:Slim X2
Pros: Sleek design, interface looks easy to use,
Cons: doesn't sync with Freestyle Libre, re-chargable battery (it's easier with current pump to just replace battery and not have to worry for over a month - though I know it's not as environmentally friendly), looks like a nightmare to replace insulin cartridge

Question: Anyone who uses the Tandem - any thoughts on the above? Is it as bad as it looks to change the insulin? Any more pros about it? Is the closed loop tech ("Control-IQ advanced hybrid closed-loop technology adjusts insulin delivery to help prevent highs and lows") as standard or only if you have the pairing Dexcom CGM?

Medtronic MM640G
To be honest, have written this one off and putting the choice between the above two. This one looks too big/ clunky for me.
Though open to hearing any feedback from anyone who uses this one!

As always, thanks in advance for replies!

Cheers,
Rick

 

[Chas C]

I moved after using Combo and Insight to the t:slim. I don't recognise the worries you have over it. The battery lasts when fully charged about 4 days, I charge it daily whilst having breakfast (I have charged it in the car when travelling and from a power pack before when on holiday, never had any issues). The cartridge is no different than a Combo really, but not as good as the Insight, easy to change. If you have any more questions please ask.

I'm using the CIQ function which is great, you would likely need to move to the Dexcom (recent Nice announcement should ease this).

 

[Juicyj]

Question: Anyone who uses the Tandem - any thoughts on the above? Is it as bad as it looks to change the insulin? Any more pros about it? Is the closed loop tech ("Control-IQ advanced hybrid closed-loop technology adjusts insulin delivery to help prevent highs and lows") as standard or only if you have the pairing Dexcom CGM?

Yes definitely write off the 640g, that was my last pump and have now been on the tandem slim for a year.

Recharging the battery is no issue at all, just keep a couple of spare chargers lying about and you can recharge whilst driving, in the shower etc etc, I just make sure that I charge when it goes down to around 40% and charge it twice a week.

Changing insulin is a minor point, it's easy once you know what your doing. All pumps require a set change so it's not a tool for comparison IMO.

When used with Control IQ and Dexcom, it's doing the minor basal tweaks for you, it can't be used for this without the Dexcom. It doesn't prevent the highs and lows but it does make it easier to manage them, you will still need to keep an eye on levels to tweak pump settings, but your more likely to stay within your range once you've finely tuned your settings, the Clarity software on Dexcom makes it easier to pinpoint issues with control though. Pro's for me are sleep quality, I have never had great sleep since being diagnosed with type 1 but can honestly say my sleep now is so much better, it's rare to get night time hypos once your basal settings are tweaked, I now see a flat line every night in range which for me has been a massive game changer as more relaxed. Also my time in range is hugely improved. The only downside on this pump for me is that I still struggle a bit when exercising for longer than an hour as the exercise mode doesn't quite hit the nail for me, I can drop suddenly when exercising but of course I am mindful of this so have other ways to manage it.

 

[Peter03]

I voted for the 640g but I am really looking forward to the 780g, although the diabeloop system looks good

 

[Rickmac1988]

I moved after using Combo and Insight to the t:slim. I don't recognise the worries you have over it. The battery lasts when fully charged about 4 days, I charge it daily whilst having breakfast (I have charged it in the car when travelling and from a power pack before when on holiday, never had any issues). The cartridge is no different than a Combo really, but not as good as the Insight, easy to change. If you have any more questions please ask.

I'm using the CIQ function which is great, you would likely need to move to the Dexcom (recent Nice announcement should ease this).

Thanks for the reply, Chas. Good to know you were in a similar position moving from the Combo to the T:Slim and the hesitancies I have you don't think are an issue. It does look good, and definitely an option I'm swaying towards.

Is there a handset with this device or does everything need to be done on the pump itself? And on the Dexcom front, keen to explore that though believe you need to self-fun at the moment. Assuming the NICE announcement mentioned might mean different in the future?

Cheers!
Rick

 

[Rickmac1988]

Yes definitely write off the 640g, that was my last pump and have now been on the tandem slim for a year.

Recharging the battery is no issue at all, just keep a couple of spare chargers lying about and you can recharge whilst driving, in the shower etc etc, I just make sure that I charge when it goes down to around 40% and charge it twice a week.

Changing insulin is a minor point, it's easy once you know what your doing. All pumps require a set change so it's not a tool for comparison IMO.

When used with Control IQ and Dexcom, it's doing the minor basal tweaks for you, it can't be used for this without the Dexcom. It doesn't prevent the highs and lows but it does make it easier to manage them, you will still need to keep an eye on levels to tweak pump settings, but your more likely to stay within your range once you've finely tuned your settings, the Clarity software on Dexcom makes it easier to pinpoint issues with control though. Pro's for me are sleep quality, I have never had great sleep since being diagnosed with type 1 but can honestly say my sleep now is so much better, it's rare to get night time hypos once your basal settings are tweaked, I now see a flat line every night in range which for me has been a massive game changer as more relaxed. Also my time in range is hugely improved. The only downside on this pump for me is that I still struggle a bit when exercising for longer than an hour as the exercise mode doesn't quite hit the nail for me, I can drop suddenly when exercising but of course I am mindful of this so have other ways to manage it.

Thanks for the detailed response @Juicyj! You've given me a bit more peace of mind re my thoughts on the 640G too. Battery feels less of an issue now, and as you say, once you get used to changing the cartridge it's probably a doddle. I remember hating changing the cartridge and priming on my Combo but it's second nature now.

Regarding spare cartridges with the T:Slim - do they provide enough backups etc? That's one thing I'm fond of with Accu-Check in that I have a good backup supply of cartridges, needles, infusion sets etc. Hoping that would be the same with a new pump supplier.

Good to know about 'exercise mode' too, assuming it doesn't have a 'temporary basel' functionality like the Accu-Check?

Thanks again!
Rick

 

[Juicyj]

Hello @Rickmac1988

I always order in 3 months of supplies and call them up a month before I run low, the service is pretty good and get supplies within 2 days.

There's 2 preset modes already set up - sleep and exercise, however if the exercise mode doesn't work for you then you can set up your own basal setting, I find that if I keep either exercise or sleep in use constantly then I can run a tighter range as they are based on operating on tighter ranges. I find that for me personally using the tandem that I prefer to low carb most of the time to keep this running in range, but of course when I fancy a takeaway/blowout then that's fine too, but like seeing the line stay within range and can keep within the range around 70-80% of the time, but that's me, some run better than this - join the FB Tandem page if you decide this is the one for you as lots of useful advice on there from other users, you'll find Tandem Slim pump users are pretty happy with the performance of this

 

[Rickmac1988]

Hello @Rickmac1988

I always order in 3 months of supplies and call them up a month before I run low, the service is pretty good and get supplies within 2 days.

There's 2 preset modes already set up - sleep and exercise, however if the exercise mode doesn't work for you then you can set up your own basal setting, I find that if I keep either exercise or sleep in use constantly then I can run a tighter range as they are based on operating on tighter ranges. I find that for me personally using the tandem that I prefer to low carb most of the time to keep this running in range, but of course when I fancy a takeaway/blowout then that's fine too, but like seeing the line stay within range and can keep within the range around 70-80% of the time, but that's me, some run better than this - join the FB Tandem page if you decide this is the one for you as lots of useful advice on there from other users, you'll find Tandem Slim pump users are pretty happy with the performance of this

Thanks @Juicyj! Ah 3 months supply is perfect and the 2 day delivery sounds the same as Roche!

Thanks for the clarity on the preset modes as well, good to know it offers that functionality. I wish I could be the same as you and low carb but unfortunately I am a big fan of carbs FB group sounds interesting too, I've just requested to join so will be good to see what others have to say about it too!

 

[Chas C]

Thanks for the reply, Chas. Good to know you were in a similar position moving from the Combo to the T:Slim and the hesitancies I have you don't think are an issue. It does look good, and definitely an option I'm swaying towards.

Is there a handset with this device or does everything need to be done on the pump itself? And on the Dexcom front, keen to explore that though believe you need to self-fun at the moment. Assuming the NICE announcement mentioned might mean different in the future?

Cheers!
Rick

There is no handset, everything is pump only, I got used to it. Soon there will be a phone app, there is already one is USA for pump data and there's soon to be one for pump management too (hopefully it will be quickly approved for outside USA too). As you probably already know using Libre, you can have your readings on your phone, watch, PC/iMac, carplay etc and now use voice requests too eases the need for pump access only to when its needed rather than pulling it out just to see status.

One thing I have missed is the remote capability of the Insight and Combo, but certainly not the huge controller and its failure rate.

As for Dexcom, until to the new Nice rules are in place (this spring I'm told) then its a post code lottery and then if your region does support you'll need CCG approval too. I moved about a year ago from around 8-9 yrs of self funding to getting it provided.

 

[NicoleC1971]

Thanks for the reply, Chas. Good to know you were in a similar position moving from the Combo to the T:Slim and the hesitancies I have you don't think are an issue. It does look good, and definitely an option I'm swaying towards.

Is there a handset with this device or does everything need to be done on the pump itself? And on the Dexcom front, keen to explore that though believe you need to self-fun at the moment. Assuming the NICE announcement mentioned might mean different in the future?

Cheers!
Rick

Same here. Went from Roche to Tandem and have used with fsl but mainly Dexom.
Cons - the app crashed the sensor transmitter though the basal adjustments still work and I am not (somewhat neurotically checking my bgs every 5 minutes) so can't use the Clarity app with its lovely graphs etc!
Pros - after the ease of the cartridge system on my old pump I was dreading the manual filling part of the Tandem system but its easy even with my partial sight. Have had less occlusions than I did with Roche too. The cartridge holds 300 units but I put about 200 in and change it 2x weekly which it reminds me to do.
As you say the charging part is easy and the charge does last more than a few days though giving it a quick charge whilst you shower is probably best.
Best of all I learnt today that my last hba1c was 48, down from 64 (usually mid 50s) in spite of few teething issues. It has saved me a few nocturnal hypos and keeps me steady in exercise too.
My graph on the pump display is very flat rather than my usual excursions and very in range and I hope that more CCGs start offering the Dexcom option but if anyone can afford it this tech is a game changer.
I have low carbed for a while now but this pump really handles my minor bolus needs really well. If I up the carbs it isn't a magic bullet and would take me a while to get back into range if ever, without an appropriate slug of bolus insulin.
That said I am sure the next generation of pumps will be talking to your sensors and given the size of the UK market I would expect that sensor to be fsl.

 

[searley]

I have tandem and dexcom and love it

The charging is not an issue... 10 minutes a day while in the shower is all that's needed.. although if you bg control is good the battery lasts more than a week

I have no difficulty filling or changing the cartridge and a complete set change takes less than 5 minutes