what helps you decide what pump?

Engineer88 said:

Might be worth you joining the AAPS groups on facebook as there are very few users on this site.

I personally use the Dana R with a right hand luer as the Combo wasn't an option I had.

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kitedoc said:

Hi @Cobia, From my viewpoint as T1D and pumper in Adelaide, not as professional advice or opinion:
Are you saying that you will only consider the DanaRS and the Accucheck Combo?
Because in Oz there are also these companies providing pumps - Medtronic, Tandem, CellNovo and Ypsomed.
see www.bioicwookie.com - Insulin Pumps In Australia - August 2018.
Please do not restrict your choice until you have considered all of them.
There are some web articles comparing one brand to another and also some forums commenting on pump reliability or otherwise, level of service provision and particular operational trouble with use of various pumps.
Also checking which pumps are currently using CGM and which can be looped or will soon be upgraded to loop.
And there is the question that whilst a private health insurance (or if you are very very lucky, the Aussie Govt) will pay for your pump, the consumables like reservoir and infusion set are on NDSS which still costs you plus CGM is not likely to be subsidised for you..
Your endo can no doubt advise you on much the of options above (to some degree, you will still need to do your own homework), plus on how crucial it is(or not) to be on loop or CGM.
Yes, some persons use basal only on their pumps but you would need to weigh up the convenience of being able to have the carb count and BSL inputted and bolus calculated and then readily bolused in by the pump, against having to do your own calculations, find the bolus insulin, draw up and inject then dispose of the needle/syringe etc.
Best Wishes.

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kitedoc said:

Hi @Cobia, I thought I would post this separate:
Choice of pump:
Advantages over multiple injections:
- indwelling cannula under the skin means only one actual injection through the skin every 72 hours (sometimes only 48 hours)
- the basal rate is 'sculpted' by the endo to best cover basal needs including DP (Dawn Phenomenon) see on Home Page under Type one Diabetes - DP. The basal rate can vary between day and night, something that long acting insulin cannot always cover.
- with the bolus side set up, the bolus doses for meals and for correction of high BSLs are easily done
- reminders and alerts prompt one to do forgotten meal bolus and remind one of when to change sites etc
- option of some pumps to display and use CGM and loop which greatly simplifies control of BSLs
- the finer tuning of the pump reduces the number/risk of hypos
- insulin doses can be given more discretely in company, at restaurants etc and many types of carrying devices are on the market.
- most pump companies provide pumps with excellent reliability and service and prompt provision of supplies, and through their reps, help train Diabetes Nurses about the latest models and work well with such nurses to help solve patient's problems
Disadvantages:
- bolus doses may sting
- sometimes a cannula goes in bent, or becomes bent, or detaches and BSLs rise more quickly as there is no long-acting reservoir of insulin in the body (alarms often do not detect these 'slow-downs in insulin delivery). Finding the right length and style of cannula can take time. Cannula troubles as above are the most usual pump problem.
- The tubing between indwelling cannula and the pump can become tangled on things and lead to the cannula being pulled out so requiring extra vigilance and taping etc.
- a scar tissue can form at old infusion sites and make insulin delivery near those sites less reliable - the problems usually takes years to develop
- cosmetic - some find the bulk of the pump unsightly and the need to find more suitable places difficult
- some pumps have a degree of waterproofness but not all - the ability of a pump to survive being splashed or immersed briefly may enhance its use for persons who undertake certain sports.
-some pumps seem more prone to failure and need of replacement or repair, some companies are not as prompt with provision of supplies or advice
- some pumpers complain of the difficulties with removing the pump for showers, intimacy etc. and the pump getting in the way.
- whilst pumps have come a long way, there are still occasional failures of the pump, so supplies of short and long acting insulin and syringes need to be carried in case of the need to revert to multiple insulin injections, spare batteries or charging cord and power bank etc.
I hope that helps.

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kitedoc said:

Gidday again @Cobia, one thing about all the pumps is that you cannot read the ##** screens in the full sunlight.
Just the same as with mobile phones !!
The waterproofness of most pumps would handle a sheep dip but you would wish to have a good extra patch of protective adhesive over the cannula entry site. Wearing a pump inside the shirt, in a pouch with ice blocks may do the trick , temperature-wise.. There could be the risk of damaging a pump on railings, gates etc so padding ++.
It might pay to try putting a thermometer and ice brick in a neck or waist wallet , wear it on a couple of hot working days and to see how the temperatures go plus see how long the ice bricks last before needing changeover and how well back -up ones in the esky last.

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kitedoc said:

HI @Cobia, Glad you have all the latest information.
Whilst I am not out in the heat most days, I do live in Adelaide and so am used to ensuring my insulin stays cool enough.
So cooler blocks for the spare kit carried around, ice brick inside the shirt if need be or the pump carried in a bag strapped to my waist with a block inside it.
I also fly kites in summer, so have had to cope with standing, walking, running on the sizzling beach sand for hours at time. The ability of the adhesive patches, used on pumps or infusion sets, to withstand the heat and sweat is a real issue, too.
One thing that was reassuring for me was that my new pump, the Tandem Slim. has an alarm to indicate if the insulin in the cartridge of the pump is nearing maximum safe temperature (= 30 degrees C) ( and also when getting to 2 degrees C ), plus an alarm if the pump itself is reaching a temperature at which the electronics are likely to fizzle out.
I am not sure if other pumps brands have these temperature alarms but they sound like a good idea for those in Oz.
With exercise, the beauty of the pump is that usually (there is never an always) adjusting the basal rate of the pump down say 20, 30, 40 % at a specified starting time and finishing time around the exercise time plus perhaps repeating this at a ? different % for part of the night when exercise has occurred in the afternoon, early evening as well - helps to prevent hypos due to exercise (BSL drops near after the exercise time and the later BSL dip ? 6 to 12 hours later) and is actually easier and usually much more accurate than trying to do it with adjusting doses of the multiple insulin injections.
The main reason I was put on a pump was to prevent night hypos, that 8 plus injections of insulin per day could not cope with and probably contributed to!.
So preventing hypos, particularly at night was a big deal for me.
Please do take your time and keep asking questions!!

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