Tandem vs Omnipod...i need the truth

T1D Tech & Daily Management Support
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One other thing I should have mentioned…

Since you’re newly diagnosed and about to become a new pump user, you are going to have a lot of questions. Your endo sounds good, but she won’t be available to answer everything. This forum is great, but not always ideal for getting a rapid response. I’d suggest using Facebook and requesting to join a users group that supports the pump you select. For example, if you select Tandem, look into the “Tandem T-Slim X2 users” and “Tandem Diabetes Control-IQ User’s Group” groups.

Good luck!

Mike

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I wanted to thank all of you for your fast and great responses. They all gave me a lot of information to consider and reread many times over. I think for some reason the t:slim is for some reason making sense to me for right now although I have a good week or so to decide which way to go. I believe seeing my Endo for the first time will hopefully straighten me out a bit and make my life a little easier. Right now I feel like I am on a never ending roller coaster ride. Yeah I know, that’s Diabetes for you. However, I am a great student of whatever I am involved with in life. There is always room to learn something. I found out this is one of them. I described to others that being diagnosed as a Diabetic was a big ball of fear dumped on my lap and with each piece of information I can learn, that ball becomes smaller. I know that this will indeed be my lifetime journey. For some reason I am thinking, please correct me if I am misspoken, that the t:slim along with my G6 device will for now at least put me in greater control of my health even tho some of it is automated. It seems a pump regardless of really which one will be better than my current concoction of 1 40u Lantus shot at bedtime and 4 other sliding scales shots per day. It seems like my dosage is correct maybe 30-40% of the time. The rest or 60-70% of the time I am way too low, 47 the other night, or way too high. In the last three months I have learned to count carbs well but that really hasn’t seemed to have stabilized me enough to be comfortable with myself. I do like the idea of also looking at Facebook groups as well. Again, thank you all very much for all of your ideas and advice. I will update again in the future.

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I’m afraid to go to sleep tonight

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If you’re leaning towards the Tandem, I’ll second the recommendation for it. It’s worked well for me, and for many of our community members here. (As you’ve seen, some have had bad experiences with it, too. We’re all individuals with unique bodies, needs, preferences, etc.)

You’re already using a Dexcom, which is great.

In terms of BG control, the major difference between the Omnipod and the Tandem is that the Tandem is able to do a lot more automatically.

The Omnipod will give you a steady background basal dosage (akin to the Lantus you’re currently taking, except it’s a slow drip of Humalog/Novolog instead of a single time-release shot) and then boluses as you request them (akin to the sliding scale shots you’re taking now).

The Tandem will directly connect to the Dexcom, getting readings every 5 minutes. It will then adjust the basal rate to compensate. If you’re running high, it’ll give you a little extra. If you’re running low, it’ll automatically slow or stop the insulin flow. If you’ve been running high and it’s been at least an hour since your last bolus, it will automatically give you a correction bolus. Likewise, when you want a bolus (for meals or to correct for a sustained high BG reading) it will automatically factor in your current BG and adjust accordingly, adding or subtracting insulin as needed to compensate if you’re above or below your target range.

Either system can give you better control. Getting that slow basal drip is more like what your pancreas would do, and most people’s bodies respond better to it. Likewise, having the pump always inserted means you can give yourself as many boluses as you want without an extra needle. So if you have a light snack or you find yourself running a little higher than expected, you can give yourself a couple of units with no pain or fuss. There’s freedom in that if you’re used to taking a few shots per day and structuring your meals around that.

But the Tandem’s Control IQ will do more than the Omnipod is currently capable of doing. Automatically adjusting your dosage every 5 minutes (based on both your current BG reading and the recent up or down trendline) can do a lot to help steady those highs and lows. It’s not perfect; you’ll still get some highs and lows. But they will likely be less frequent and severe, and the pump’s alarms will warn you if it thinks you’ll be going below 70, if you’ve been above 180 for an extended period, or if you’ve gone over your chosen high BG threshold.

Personally, switching from shots to a smart pump dropped my A1C a full point, from low to mid 7s to low to mid 6s. Hopefully it’ll be just as successful for you.

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Thank you very much. Now tonight i am afraid to go to sleep

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Why? Afraid you’ll go low? If so, have a bedtime snack. Running a little higher than normal now and again is okay. You can make up for it with better control later.

Do lows not wake you up? You can set your Dexcom to alert you if you’re too far out of range. I know the signal has been intermittent, but it should be able to reconnect soon enough.

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I was a 47 the other night. Wasn’t good. Sleep hasnt been bad but this last week or so has been sketchy and so far to me unpredictable. Just when i thought i was getting better at it

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I hear you. It’s a long haul. Hopefully switching to a pump will help. A low BG is scary. Like I said, you can have a bedtime snack. Something that will digest slowly and ensure you don’t go low. A low BG should wake you up so you can take care of it. And you’ve got the Dexcom as backup. Keep some food by your bedside to be sure. You can do this.

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@Dolphinjer Dennis makes an excellent point about your doctor’s statement about whether you need a pump. Don’t get me wrong: I love mine and have been using a pump for over 30 years (Tandem for about 10). However - and I do apologize for throwing some additional confusion into the mix - some people do fine on shots and in some cases even better than with a pump.
I’m not a medical professional so this is personal opinion: I am of the personal belief that it’s good - best - to get a solid foundation in doing things “old school” before advancing with technology, unless there are solid reasons for jumping straight to the technology side: so it’s worthwhile to spend some time learning to manage yourself on shots. That may work just fine and you might find you actually like it - and you can use a CGM with shots, with a handheld receiver or smartphone to see your readings. Pumps are very durable but in the event something does happen it’s good to know how to manage with injections while waiting for a warranty replacement.
Having said that, you must use a pump to have the benefits of a closed loop sytem, which is what your doctor may have in mind: the loop uses readings from your CGM to adjust insulin flow. It uses certain internal programming calculations to adjust for exercise activity, but you need to determine - largely through trial and error - how far in advance to turn that feature on and how long to let it run when you’re finished. It also adjusts for sleep, and that can be set in a schedule or started and ended manually.
The loop is an excellent feature that is now available with Tandem and Medtronic and there is lots of user feedback for both that you can look at. I believe Omnipod’s is still in the works.
The loop is excellent but it’s effectiveness requires having good background settings in place - carb ratios, correction factors, and basal rates - any or all of which may vary at different times during the day independent of one another. You’ll work with your doctor to get the initial ones in place, but chances are they’ll need to be tweaked before you find the ones that work best, and they’ll need to be changed from time to time. Getting them in place takes some hard work and time, which is well worth the effort but that needs to be set before going to the loop. I’ve had some in place for a while but they’re not working as well as they used to so its time for me to do some testing and tweaking.
Your head is probably spinning now and for that I apologize; at the same time, that may be all the more reason for getting a good foundation on injections first - again assuming there are no factors that require you jump into a pump right away. So I refer back to my original suggestion of finding out why your doctor wants you to use a pump - and go a little further and ask if there is a need to rush. You may find it’s your doctor’s preference while it may not be yours - and not an absolute necessity.
While you are trying to absorb everything you might find it helpful to read *Think Like a Pancreas * by Gary Scheiner. The author works with diabetes in the medical profession, and has Type1 himself; so he has a valuable perspective you might find helpful. And while the book is educational I found it to be an enjoyable read.

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If you’re worried because of the learning curve, it will be OK. It just takes some time.

If you’re afraid of low blood sugar, eat an extra snack with some fat and protein, like peanut butter. Letting your blood sugar run a little high while you’re learning will not hurt you, you have to play for the long game.

One great benefit of Tandem is “Sleep” mode. In Sleep mode, the pump makes tiny changes to your basal rate, trying to keep your blood sugar level at around 120. If you start going low it will stop insulin delivery completely.

T1 changes. If you haven’t done so already, discuss with your endo how to test your settings.

Mike

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Gerald, when you get your insulin doses calculated and timed properly, fear of sleeping will diminish, if not go away entirely. What your 47 mg/dl indicated the other night was that you took too much insulin for the amount of food you ate, or timed a dose improperly.

Sound simple to correct, but it really isn’t easy especially where you are new to this insulin thing. Keep in mind too, that you are human and your body is a living being and changing constantly - just because a certain dose worked yesterday doesn’t mean it is correct today. You can read a food label of two different foods having equal carbohydrate counts but your body may interpret those carbs differently. That is, unless your an android.

Your diabetes is still “young” and your body may not have completely killed-off the insulin-producing beta-cells so it is possible that you had taken what should have been the correct insulin dose injection and then your beta-cells kicked in and pushed you down to 47 mg/dl during the night. I suggest that you abandon the pre-set alert settings on your Dexcom G6 - the G6 allows different setting patterns, such as daytime and nighttime limits. For instance, my 9:00 PM to 9:00 AM In-Range settings are 85 - 145 mg/dl meaning that during my sleep hours I will be alerted by the G6 30 minutes before my BGL will drop to 85.

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Hi @Dolphinjer . I hope you got some rest last night. FWIW I’m so ancient, BG meters weren’t available until about the time I finished college, and CGMS some years later. We learned to recognize signs of lows, and thankfully I woke up when I started to feel them. Use your CGM to help easy your fears - you can set it to alert you when you get to a certain point (120 is highest number you can set as your low on Tandem) and you can decide if you want to have a snack for your peace of mind.
Your endo will work with you to adjust your insulin, and your nutritionist can help you find some snacks that should tide you over while you sleep at least until things are set so you don’t need anything. If you live with family or a roommate, have them train with you. They’ll be your support system, and sometimes others can recognize signs of something happening even before we do.

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One additional thought: some people have a diabetes alert dog (“DAD” for short). Obviously, don’t get one unless you’re willing and able to care for a dog, but my understanding is that DADs are truly great companions, as well as life- and sanity-savers for some people.