I’m new to this forum but was hoping to get some resources/opinions in regards to getting an insulin pump. Any feedback is greatly appreciated.
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Hi Chelsea. Generally people do better on pumps that use CGM data than people do on MDI. But you are you. How long have you had diabetes? How is diabetes affecting your life? What is on your pump pro/con list?
In case you don’t want to share, that’s fine, here’s the best advice I ever read about insulin pumps by @DrBB:
As someone who defected from Medtronic to Tandem, which I’m very happy with, I think they’re both about equally effective in terms of TIR, overall sensor accuracy and other measurables. For me, having experienced both, and having a background in UX (User Experience design) it comes down to a difference in design philosophy—what the engineers are aiming for as the ideal and how that gets reflected in how the thing behaves—what it communicates—what it’s like to use it and to live with it 24/7. To put it briefly, I think the MT ideal has always been to do as much as possible to take the difficult, unpredictable and crazy-making business of managing blood glucose out of your hands through automation. Hey, that’s why they call it “auto” mode. That has a strong appeal for a lot of people, but for others, you may find it feels like a lot of roadblocks are in your way when you try to tweak things for yourself. If you’re more hands-on, in short.
Being who I am, and having run away screaming from the first Medt AID pump, the 670G, I was very pleasantly surprised to discover after several weeks of use that the Tandem philosophy is quite different. None of this stuff is explicit, so maybe that’s why it was so surprising, but what I discovered was that the CIQ system wasn’t trying to make decisions for me, but to offer suggestions I was free to override or accept, without having to pop out of the system into dumb-pump mode. As a f’rinstance, it was only after several weeks in that I was quite shocked (pleasantly) to discover, when doing a bolus calculation, that all the fields were editable. These weren’t commands being spit out by the Algorithm, they were—gasp!—being offered to me as suggestions. My pump was there to help, but it wasn’t there to push me into the backseat and take over.
Now, I don’t know the 780G from experience, and I have read that there are a lot of things they are doing better now. And I also want to stress that there are a LOT of people who very much DO want a smart system that will do all of this stuff for them and relieve the stress of having to make decisions about this […] edit every day of their life. “Just take care of this for me and leave me out of it" is a perfectly valid thing to want. I think it’s particularly true for people who are struggling to get their A1C down from 8s or higher into the high sixes/low 7s that I know plenty of T1s only hope for. Also for parents and caregivers, for whom this whole business is even more of a nightmare than it is for us patients. OTOH, if you’re more hands-on and want to squeeze the best results out of the system you can, based on your own knowledge and experience with your own particular metabolism, but do want some smart assistance with that, that’s more the sweet spot for the Tandem CIQ.
The other stuff isn’t nothing. I really liked the Mio Advance inset system vastly better than the old-school spring-loaded thwack-and-bruise system Tandem uses. I struggle with that a lot. Also the reservoir injector thing is kind of kludgy. But just as a general matter, pumps introduce a lot more failure points than the direct simplicity of MDI. None of them are free of compromises and annoyances. But for me, having gone through this decision process recently, I found the most stressful thing was getting all the feature details and pluses and minuses to add up to some kind of sense of Yeah but what’s it going to be like to LIVE with this thing??? I think that’s the real question—hopefully this helps.
Hi @Chelsea1992 and welcome to the forum! Insulin pumps are great, and people do do best when they are paired in a loop with a CGM, as @spdif mentioned. But many people do just fine on injections, and sometimes better. Some people must use one to help manage highs or lows, others do want better control even if extremes are not an issue, and others like them because of the convenience. I don’t mean to minimize the technology when I say this but it helps to be a gadget person. If you’re not, and the idea of wearing something 24/7 doesn’t appeal, a pump may not be right for you. I’ve been pumping for 30+ years but my doctor started broaching the idea 4 or 5 years before that. I didn’t want to - until I did. But since I’ve started I’ve been all in.
My first 4 pumps were Medtronic’s. They now have their own proprietary CGM but I switched to Tandem pumps before they came out so I never used their closed loop system. A few years ago I switched to Omnipod, which is tubeless, and am planning to switch to iLet next year. I’ve run the gamut of pumps currently available in the US. This may sound odd but if you’re thinking about pumping but not sure if it’s for you, check out Omnipod first: there is no commitment so you can switch at any time (tubed pumps typically have a 4 year commitment). The pods are about the size of a small egg but thankfully flatter, and I believe you can try a sample to see what it looks and feels like on, if you have issues with the adhesive, and how you feel wearing something around all the time. Of course the entire pod - the pump - is on your body while other pumps take up less real estate on the body but there is tubing to contend with. Some people mind, some don’t. It may sound obvious but some people wish they had thought about that after getting it.
Make sure you discuss with your doctor what a pump will and won’t/can and can’t do. It’s not a “plug and play” device and there is still work involved whether you use the loop with the CGM or use manual mode and adjust on your own. Infusion sets - which go into your body - are generally changed every 3 days and each pump has a minimum amount of insulin that must be filled in order to work. If your insulin needs are very low you may find yourself wasting insulin.
You may want to find out about insurance coverage on your own. I think it’s safe to say most major insurances cover Medtronic, Tandem and Omnipod (Omnipod is covered under pharmacy benefits while the others are durable medical equipment, or DME) and maybe the iLet as well and the question might be what percentage you need to pay. When I’ve tried taking to my insurance I’ve found that what I thought was a simple question was more complex than I imagined. So reach out to the pump companies and they will assign a rep to do the legwork. They may have recommendations about which of the suppliers your insurance works with, may be the best to use (although customer experiences do vary).
I decided ages ago that I hate pumping much less than I hated shots. So now I pump. At the time pumping meant I could drop my long acting insulin (at the time it was Lantus) which was great because now I could be more or less active, and I could manually adjust my basal and not always be high or low. Also I travel for work so when I’m out of my time zone it always messed up my basal when I was on shots. My opinion is to ensure which pumps are covered and then pick one they are all nearly identical. The twiist and iLet are the newest and omnipod, Medtronic and Tandem the more established. Have the sales rep demonstrate them all and pick the one you like. (Also consider the costs too). I use Tandem Mobi paired with Dexcom G7. Good luck. 
Adding Twiist since it is new and the integrated in-depth is not current https://www.twiist.com/it-fits/pwd/stay-in-the-loop?utm_medium=cpc&utm_source=google&utm_campaign=twiist+PWD+Brand±+General+Core&utm_term=twiist+insulin+pump_exact&utm_content=Brand±+Pump&gclsrc=aw.ds&gad_source=1&gad_campaignid=22855324706&gbraid=0AAAABAzV6onJGRb-twViUMxhdGNz2QNL5&gclid=EAIaIQobChMIw77tisjCkQMVLkhHAR1ikzwnEAAYASAAEgL3G_D_BwE