Insulin Pump Options

Hi! I am new here so I’ll give some background first. I was diagnosed at 3 years old coming up on 20 years ago this Halloween! I have been on a Medtronic pump since I was 13. Currently, I am interested in looking at other options for pumps because I have graduated college and taken control of my own finances, I have found I have not been impressed with medtronics devices nor their customer service for awhile. I wanted to ask y’all have preferred using. What are your experiences with some of the new devices on the market? Tell me all of the pros and cons to help me make a decision with my endo. Thank you!!

Hi @ashlynnnoel and welcome to the forum. I had 4(?) Minimed (Medtronic) pumps before switching to Tandem’s TSLIM. I’ve been using TSLIM for about 10 years now and have never looked back. There are lots of forum discussions on the topic - including the CGM and closed loop systems for both - you’ll find lots of info on a search. Two things that people who switch from Medtronic are not crazy about are:

  1. The fill process is relatively cumbersome - there’s no adapter between the insulin bottle and the cartridge so you have to draw up insulin into a syringe and fill the tube. Some insulin is wasted in the process - I don’t recall how much; and
  2. Tslim plugs in to charge - no batteries, which some users prefer. I plug in while I’m at my desk, watching TV, or even in the car - and often use a portable battery brick. Whichever I use it charges quickly - 30-45 minutes tops, and probably less.

I’ve never looked back after switching pumps, and I’m very happy with the Control IQ closed loop. I never used Medtronic’s so cannot compare but you can check out user statements for yourself and I’m sure people will chime in here as well.

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Hi, Ashlynn, and welcome to TypeOneNation! My daughter (who is 13 now) used MDI for years, until a year and a half ago or so when she just couldn’t get the kind of control she wanted with shots anymore. For us, it was between Insulet’s Omnipod and Tandem’s tslim x2.

I really wanted Tandem for its hybrid closed-loop with the Dexcom (which she also uses, and which we love); she really wanted Omnipod because it’s tubeless and waterproof. We started with Omnipod (she’s the one with T1D, it’s her body, and I figured she was old enough to get the deciding vote), and she loved it. Hands down, it was a tremendous improvement in her BG management, and Omnipod’s customer service is absolutely stellar.

But still, she was having highs and lows at night that Control IQ would have helped with, and I convinced her we should try the tslim x2. It was an insurance nightmare, but she got it, and unfortunately, it just doesn’t work well for her. We never did figure out what was wrong, but after a lot of good-faith efforts by a lot of people, after trying every infusion set they sell, we finally gave up. Control IQ really IS brilliant, and it worked beautifully (I credit our time on the Tandem with helping us dial in the different basal rates she needs overnight WAY faster than we ever would have figured them out with just the Dexcom), but the best closed-loop algorithm in the world is worthless if the insulin isn’t reliably making into her body, and it just wasn’t.

So we went back to Omnipod, and we don’t look back. She really does prefer that it’s tubeless and waterproof, she likes the look and feel of the Omnipod over the tslim (Omnipod’s PDM — the controller for the pump — is a locked-down cellphone, which is sleeker than tslim’s), and Omnipod’s customer service is far better than Tandem’s was for us (though Tandem wasn’t bad. They just weren’t truly outstandingly terrific, like our Omnipod rep is.).

Oh, and there’s the minor matter of cost. Because Omnipod is filled through pharmacy for us, it’s literally free. Zero copay. Whereas the Tandem was DME, and very expensive, even after we got our insurance to cover it. So if finances are a consideration for you, definitely ask the reps to run the numbers for you with your insurance, and compare the quotes!

We do look forward — at some point, Omnipod will integrate with Dexcom, too (it’s on the FDA’s desk, so hopefully sometime soon!), and then we’ll have the best of both worlds for her.

In the meantime, we’re sticking with Omnipod. The pod itself is bigger and bulkier than Tandem’s infusion site, as far as what’s physically on your body 24/7, but that doesn’t bother her. For other people, the size of the pod would be a drawback, and they don’t care about the tubing, or needing to take the pump off to swim or shower, which do matter to my daughter.

But as with all things, YMMV. The bottom line for me is still the joy on my daughter’s face when she realized the technology meant she could skip the fingerstick and the injection and she could — in her words, while she literally danced around the kitchen — “just eat!”

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@ashlynnnoel Hello Ashlynn and congratulations upon “coming of age” and your view of taking responsibility. Welcome to the JDRF TypeOneNation Forum!

Like you, I used MiniMed pumps [3] for quite a few years and although I really liked them along with the comfort of eliminating up to 2,000 injections per year for 47 years, I realized that I wanted more - and the Medtronic glucose sensors then available weren’t worth the bother of sticking one into me. [NOTE: the new MiniMed 780G combined with the latest Medtronic sensor - currently available in Europe - is getting wonderful reviews.] After meeting with representatives of all USA pump Manufacturer/Distributers, I settled on the Tandem t-Slim x2; my reasoning:

  • Compatibility / interoperability with Dexcon glucose sensors that I was currently using;
  • With the “fast moving” diabetes equipment management device I didn’t want a pump that might be outdated before I finished reading the User Manual; I’m a Medicare beneficiary which requires waiting a full year after the manufacturer warranty expires. The Tandem pumps update both hardware and software via internet allowing me to change glucose sensors [from G5 to G6] as well as installing new diabetes management algorithm.
  • The pump size is relatively compact and the screen is the easiest to read of all - my old eyes are failing, yet I can read the t-Slim screen easily even when outside in sunlight.

And best of all, something I hadn’t expected, the Control IQ {CIQ] algorithm which became available January 2020 has assisted me is holding my TIR more than 20 percentage points higher than what diabetologists label as “Good Diabetes Management”

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Welcome, Ashlynn! As Dorie said, we’ve had a few discussions about the relative merits of various pumps. I can tell you I’ve had a great experience switching from Medtronic 670G to Tslim X2. There are some disadvantages, like the fill process, the fiddly touchscreen, and the highly redundant bolus programming process. But those are, for me, far outweighed by the much more accurate, reliable, and user-friendly sensor. Not to mention the Bluetooth connection to my phone means I have all my data at my fingertips, and it’s also automatically uploaded where my doc can see, without my having to do anything.

If you want more detail, there’s some good info and links to previous discussions here:

I will mention that I generally had good experiences with Medtronic customer service, although I found I had to call them a lot. It took a while to get things set up and straightened out with Tandem, but once things got rolling I barely had to be in touch with them. Which is good because wait times to talk to an actual human have gotten much worse this year. I think they’re shorthanded because of the pandemic, and probably dealing with a greater volume of calls as people find their lives disrupted. Earlier this week I had to wait 3 hours for a call back from technical support. That’s not been typical, but I have grown accustomed to waiting 30-60 minutes. Luckily, once I do get through to someone, I’ve been very happy with the people I’ve talked to.

Also, like Dorie, I like having a rechargeable battery. I can’t just carry around spare AAs anymore, but I don’t have to. Just need to plug in for half an hour or so every few days. Anytime you’re sitting near an outlet will do. Or just top it off every time you unhook yourself to take a shower. Whatever works.

Like Dennis, Control IQ has been great for me. Time in range around 85%. A1C down from the low 7s (when I was on manual injections with no CGM) to 6.5 on Medtronic to now 6.2.

I hope you find a good pump that works for you!

I recently switched from the 670g to the Tandem t:slim with Control-IQ technology. After being on the 670g for 4 years I could not take the constant attention required by the Guardian sensors. Especially the night hours when it would ask for confirmation BG’s to remain in automode. It was rare for me to get an uninterrupted night’s sleep. Another thing is that the Guardian G3 sensor inserts at a 90 degree angle. The Dexcom inserts a 45 degree angle so it is not as deep as the G3. With the G3, it was common for the insertion to be painful and I had frequent bleeders. I have to say that Medtronic was very good about replacing the sensor when that happened. And while their customer support was good, it always seemed to be my fault instead of a problem with their product.

The hemoglobin A1c test measures your blood glucose over a 3 month period. My A1c has never been under 7 in my 40 years as a diabetic. My last 3 before switching to the t:slim were 7.3, 7.2, and 7.4. My first A1c with only 8 weeks on the t:slim (and 4 weeks with 670g) was 6.3! The first time in 40 years I was under 7. I can’t wait for my next A1c with the full 3 months on the t:slim. It is possible I could be under 6! Not saying it will happen but it is possible. On the 670g I was in range about 70% of the time. With the t:slim I am close to 90%. Big improvement!

So, it should come as no surprise that I love the t:slim and Dexcom 6. Instead of being awakened every night for a BG or two, now I can sleep the whole night through. On the 670g I was having to finger stick at least 4 times per day. With the Dexcom 6 I rarely have to check my BG, maybe twice per month.

With C-IQ it is important to have an accurate basal profile. I had to make minor adjustments here and there to get it dialed in. Just be patient because it takes time. The more accurate your basal profile is the better C-IQ works. Another thing I like about the t:slim is that you have more control. For instance, there are times I need to use an extended bolus. The 670g does not allow this but it is an option with the t:slim.

Everybody’s body is different. But I can say that for my body, the t:slim works exceptionally well.

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I’ve been on the Medtronic 670G for several years. It has its benefits, but tends to disrupt my life so much that I plan to switch to T:Slim and Dexcom CGM soon. I’m waiting for my warranty to expire. No system is perfect, but I hope the change will help some. I like reading as many opinions as possible. I didn’t do that before. I hope I can get a trial product to check out prior to the switch.

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I believe Tandem allows you to “try before you buy.” When you’re ready - or even before - have your endo put you in touch with a Tandem rep for details. Frankly I don’t know if it’s a live device they give you to use with insulin following training, or a sample you wear perhaps with sterile saline so you can get a feel. I’m sure others on the site can provide that info.
Omnipod used to (and I imagine still does) allow you to try a sample out. I tried one a few years ago but it simply stuck to my skin. It was helpful to get a feel for size but that was it. Still, the pod is an option you might want to research. It is the only tubeless pump on the market, at least in the US.

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I was diagnosed with T1 in 2013 and have used the same diabetes group since then. Shortly after my diagnosis, my endo began pushing insulin pumps and put me in touch with a Medtronic rep. No mention of other insulin pump brands. A year or two later, he pushed to have me use the CGM system, and it was during training for that that I noticed my trainer was using a brand other than Medtronic (I think it was Dexcom.). She told me she preferred that brand over Medtronic. There are constant problems with the sensors, either bleeding when inserted or dying before their normal time. I have good insurance, so cost is not an issue. But I don’t like being given the bum’s rush to use a particular brand and it makes me wonder whether my endo is getting some kind of financial benefit to recommend Medtronic.

Hello Mary Ellen @hallomar , my first thought is that your doctor is not getting a financial reward for recommending or “pushing” any articular brand just because that would not be totally ethical. But that isn’t to say that the endo has not been overly influenced by a Medtronic representative or that your provider isn’t aware of better solutions. I used three different MiniMed / Medtronic pumps before I switched to Tandem 3+ years ago after I did intensive pump research, including meeting with representatives of all pump manufacturers. In my mind when was able to begin using a continuous sensor that “fit” with my MiniMed pump, I declined because the sensors didn’t perform well for me to be bothered.

I did begin using Dexcom G5 CGM along with my MiniMed / Medtronic pump several years ago and was very pleased with Dexcom performance. When it was time for me to get a pump replacement I chose the Tandem t-Slim x2 knowing that it paired then with the G5 and planed new Dexcom G6 sensor forming an outstanding iAIDs [integrated Automatic Delivery system].

I suggest that you do your own investigation and find time to meet with company representatives to find what will be best for you. A place to meet device representatives is at JDRF Chapter meetings and at TypeOneNation Summits; look under “Events” tab at top of this page. Good hunting!!!

hi @hallomar I’m sorry to hear about about your bad sensor experience but in my experience with 3 generations of Medtronic sensors… I never liked them enough to use them other than to “tune my basal rates”. anyway, like @Dennis said, Dexcom G6 is the most accurate and reliable sensor I am aware of. I am using the G6 about 8 months now and really appreciate it. There are also (I am hearing with no first hand experience) people using the Libre sensors Libre/Libre2 that really like the devices. The only other one is EverSense, an implantable device I have zero experience with.

ALL CGM measure interstitial fluid and not blood. All CGM have a bit of lag so the display “kind of” tells you what your blood sugar was, 20 minutes ago. All CGM have roughly the same inaccuracies as finger stick meters, and as long as you understand these things the CGM can be a great tool if it is working for you.

Pumps have changed through time from my perspective - today you have Tandem T’Slim, the newest Medtronic pumps and the Omnipod. You can google search them and look and see what each are like.

as of this minute, The T’Slim works with Dexcom and control IQ software for a more automatic insulin delivery. The pump can help you from going too high or too low based on the sensor.- now you still have to tell it you are eating… the automatic adjustments are more for when your blood sugar is drifting high or low, for example, while you are sleeping.

The only other one is the Medtronic with the Medtronic sensors, same deal with the automatic delivery.

so if you are after a feedback system that can respond to prolonged highs and approaching lows, it’s Tandem and Medtronic.

IMO, don’t be too upset with your endo. kickbacks are illegal, the thing is that most endos are not diabetics themselves and they tend to get familiar with 1 piece of equipment and also tend to not like to try new things. Now if an Endo decides to talk you OUT of a certain pump that would worry me more. anyway I hope you get some information and decide for yourself.

Hi @hallomar . I switched endo’s a few years ago due to a change in insurance and had already been using Tandem TSLIM with Dexcom G4/G5 at the time. In discussions with her even several months after switching she forgot that I was using Tandem and not Minimed. Apparently most of her patients used the latter - maybe by coincidence, maybe Tandem had not reached out to their office - I don’t know. Whatever the case, I urge you to do your own research on the options:
Tandem - which works with Dexcom to help manage highs and lows;
Medtronic, which has its own proprietary CGM. Medtronic users are hopeful that the coming upgrade/sensor will fix issues with the current version so you may want to wait for user experiences when the time comes (IDK when that will be). I thought I would throw that in to be fair and balanced.
And
Omnipod - a version of which has just been cleared to work with Dexcom - similar to what Tandem/Dexcom does: OmniPod 5 "FDA-Cleared" - Exciting news for those who prefer a tubeless pump!
Whichever you decide on, you will work with a rep for education and training. Hopefully your endo’s office would receive same, but don’t expect your endo to know the mechanics - they may tell you to adjust certain settings but they won’t know how to go about it.
That said, don’t forget your other option is to continue on injections. Many people do quite well and in some cases better with MDI than they do on a pump. You can use a CGM on its own with a handheld receiver or your cell phone to track your numbers. I keep a Freestyle Libre as a backup in case I have any issues with my Dexcom supplies and found it worked quite nicely and was similar in accuracy to Dexcom.
If you do choose to get a pump make sure you are doing it for your own right reasons and not because your doctor is pressuring you - and that you choose the one you believe will be best for you: you have to live with it after all, not your doctor.

It is illegal for a pharmaceutical or medical supply company to pay a doctor to recommend their brand. However, they are allowed to send representatives to tout the product and try to persuade the doctor of its benefits. (Such representatives are notoriously selected to be young attractive women, in order to be a little extra persuasive.) Representatives are very limited in what they can offer. It used to be that they were allowed to treat doctors to a lavish business lunch while offering incentives to work with the company. But now they’re only allowed to bring food worth up to something like $10, and they can’t give more than pamphlets, posters, and trinkets.

What probably happened is that one such representative made a compelling case that the Medtronic system was best. And, honestly, 3 years ago it probably was the best. The 670G was the first pump approved by the FDA to adjust basal rate based on CGM readings. That was a big and impressive step forward in pump technology.

But many of us here have found that the Dexcom sensors are far more accurate and reliable. Not everyone. Our bodies are all individual and some sensors just work better or worse for some people than others.

Blood at the insertion site will trip up any sensor. As Joe said, they’re not meant to measure directly from blood, but rather interstitial fluid. You may need to look for different insertion sites or review how you’re inserting the sensor. Avoid places where you’ve recently had a sensor or other needle. Avoid places that are bruised. Don’t push the insertion device against your skin too hard. Enough to make contact, but not enough to make an indentation. Avoid areas with scars, stretch marks, or where you know you’ve had a bad insertion before. Avoid places where your clothing will constrict around the sensor (where you’d have a belt, for example). Avoid tensing the muscles around the insertion site while you’re doing the insertion. A better insertion should hopefully give you better results.

As Dorrie said, there are options out there if/when you’re ready to switch. I hope you find one that works better for you.

I would like to add one thing to @WearsHats ’ excellent advice on insertion sites: pumps and CGMs come with recommended sites, which I presume have been evaluated and cleared as safe for use. Others may work for you even if they haven’t gotten “the blessing.” Keep in mind they may affect insulin absorption speed and your CGM may be more sensitive in muscular areas than in others.

I switched from 16yrs of medtronic pumps to tandem about 14 months ago. Medtronic customer service is head and shoulders above Tandem. That being said i have found Tandem and dexcom to be a far better aid in helping me maintain my glucose values. I was mid 7s with no sensor medtronic pump, right around 7 with medtronic sensor but very few nights without being awakened to check bg levels. After my switch my first a1c was 6.2 next 2 were 6.1 followed by a 6.2 most recently. I was 78% time in range with medtronic and 89% with Tandem and we decreased my high limit when i switched im pretty sure i would be well into the 90s under my old range limits. I miss medtronic customer service every time I have to contact Tandem but the results are so beneficial to my health i will cope with the service issues.

I personally have always found Tandem customer service to be very helpful. If you don’t mind my asking, what type of issues are you having when you find their support lacking?

It has always taken multiple hours to connect with anyone every time i have had to contact them. I have tried both waiting on phone and having them call me back. Once connected the service is fine but a multi hour connection lag is not ok in my book. The last time i called at 2pm est and was called back at 730pm est. It fell in the middle of my daughters orchestra concert so i missed the call back. I had to start the process all over the next day. That is not what i consider quality customer service.

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I agree. Interesting - I can usually get through quickly. Admittedly I may have experienced some delays due to COVID but nothing sticks out as memorable. I had a software issue the other day - they had to research it and I got a return call a couple of hours later. And I’ve called the past few months needing replacements I’ve gotten through easily. I wonder if we are being connected to different service centers - they have one in San Diego and another in Boise, ID. I’m also east coast. Apologies - I’m starting to drift. It’s my analytical nature.

I have to admit it has been several months since I have tried to contact them but i have never talked to anyone in less than an hour in 14 months, i could get through to a medtronic rep in less than 15min most times.

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I had good results from Tandem customer service at first, but the pandemic really seems to have put the strain on them. I had a few times where it took hours, if not longer, to get a call back. Hopefully they’ll be able to get their service back up to speed.

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