Need to pick new pump and possibly use CGM

Hello I’m new to this and any diabetes forum. I’ve been T1D for 28 years and have been on a pump for 21 years, without CGM though. I need to get a new pump since pump timer alert has gone off. I’ve been using the AccuChek pump and its predecessors since I began using a pump in 1999. It has worked well for me and I’ve been able to keep my A1C between 6.8 and 7.2 . So now that I’m in the market for a new pump (and AccuChek no longer sells pumps), I’ve been researching and honestly I’m very intimated by all the new technology and CGM also scares me. I have always manually bolused, calculated amounts based on my insulin to carb ratio and have also calculated corrections when needed. Having one more injection site isn’t nice to think about (with the CGM) and I’ve always used “tender” infusion sets which aren’t as painful to inject. Any thoughts on what pump I should consider and whether CGM is also something I should start? I realize I’m a dinosaur lol

I’ve been on Tandem’s T-Slim for many years after switching from Medtronic. There is an interactive app you can use to get a virtual feel for what it’s like to use the T-Slim. I love using my Dexcom CGM - I find it so much more convenient than sticking my finger over and over - and if I’m in a position where I’m starting to feel a little funny I can just pull out my pump or my phone wherever I am to see what’s going on. I feel much safer with it and did even before I started using BASAL-IQ and then CONTROL-IQ, which I’m grateful to have now.
That said, you can use T-Slim with or without Dexcom’s CGM, age vice versa.* And you can enter your own carbs and have the system calculate the dosage you need. You can also do a manual bolus but that must be done in increments of 0.5 or 1.0 units; so if you calculate that you need 3.2 units you cannot enter that exact amount.
You sound wary about making a change and I don’t want to make you nervous but you will want to know, if you use Basal IQ or Control IQ you are locked in to using it. But you can use Dexcom as a simple CGM so you can keep track of your numbers continuously. If you were to consider using a CGM, given your reservations I would recommend using it just to see your readings, then consider upgrading to Basal or Control IQ when you’re more comfortable. Don’t let your doctor push you into one of those if you’re cont comfortable committing to it.

*You can also use Dexcom CGM without a pump - it has a small handheld receiver that works with it, and there is a phone app as well.

Wishing you the best in your decision - it’s a commitment you don’t want to take lightly and I don’t blame you in the least.

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@deyisocorro Hi Deyanira, and welcome to the JDRF TypeOneNation forum!

Your decision about which new pump to choose, or your decision not to use any pump, should depend on what YOU want from any tool. A pump, a CGM, a needle & syringe, are all effective tools for managing diabetes effectively, but whatever you use depends on how you employ the device.

For me, I chose to use a pump a little over 15 years ago, after using injections for 47 years, just to cut out 2,000++ injections every year and be happy with only 130 insulin infusion sets per year.

For choosing a pump, I suggest that you list what “tools” you want, or need. Then look at all pumps available, and some very interesting pump that should be available, and select the one that best fits your needs - for now and for what you anticipate in the next few years. Once you narrow your choices, speak with manufacturer’s and get to hold the pump in your hands and see if your needs are satisfied.

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Yes I have been very happy with my pump and am very hopeful that I’ll be happy with a more advanced pump. I will certainly ask lots of questions beforehand! Thanks for your response.

@deyisocorro, Deyanira, you have been given wise counsel by Dennis & Dorie. The application of the technology present today is somewhat overwhelming. I have been pumping for 20+ years also. I have used a CGM for about 18 years.

Dorie has given you the same information I would have shared. Tandem has a great pump called the t:Slim (everything Tandem does is the letter ‘t’ followed by a colon). Tandem’s cloud data repository is called t:Connect. There is now software for the pump that allows the pump to use CGM data and make automatic adjustments in basal rates. One watches out for lows only, BASAL-IQ. I have been on CONTROL-IQ (CIQ) since January and it watches highs and lows. The only down side I have found with CIQ is the CGM points are hard coded in the software. I really like CIQ. It got me thru an ICU & subsequent hospitalization for open heart surgery.

Dennis is right on target. Look at all of the insulin pumps on the market where you live. Most of us on this forum are in the States, and therefore share accordingly, devices available in the USA.

After you have completed your research of pumps and CGMs, make the list of features you need, want, like, etc. Let your research guide your decision.

Share what you learn and decide. Sharing is how we all learn. Please, share where you are located if not in the States. It really expands our horizons. Welcome.

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@987jaj, thank you for your response. I live in Houston, Texas and based on my insurance I believe my two pump options are Medtronic and Tandem. I have been researching and highly value the opinions I’ve been given so far. I’m glad that the Tslim pump and CGM has worked well for you and even got you through major surgery; that’s very encouraging to hear. I will keep researching and will let you all know what I decide to go with and how it works for me. I’m glad that I have this option of reaching out to T1D since I’m sure I’ll have more questions once I begin learning this new technology (to me lol)

@wadawabbit, Dorie, thank you for taking the time to respond and for your well wishes. I will certainly take your advice into account and will reach out if I have any questions that you all can help me with!

It’s always my pleasure to help.
While Tandem and Medtronic are the major players, don’t count out Omnipod of your insurance covers it. I believe they are working on their system to work with Dexcom’s CGM to adjust delivery similar to Basal IQ or Control IQ with Tandem. I can’t really speak to it myself since I don’t use it, but there are many people on the forum who love it. Omnipod is the only tubeless pump, which is a “must have” for some, although it does lack some of the technology features of a Tandem or Medtronic right now.
I like to know all my options so if your insurance does cover it, don’t forget to include it in your research. It’s a big decision and commitment so I hope you can take your time.
BTW, the tender infusion sets you use now resemble the AutoSoft 30 sets I use. Insertion doesn’t bother me. You might check with your medical supplier to see if they’re the same.

Oh I’ll certainly look into the AutoSoft option! Thank you so much for your help!

**Hi there, you have received a lot of good advice in your quest for a new pump. Well I am no real expert but I have had Type One for nearly 75 years going from just a syringe and a bottle of insulin to a Medtronic pump with a Dexcom G6. I am also on Medicare which does provide me with some restrictions but has been a very helpful service when managing your costs, but offers some restrictions of advancing to a better technology. My only comment to you is that I live in Bellaire which is in Houston not far from the Texas Medical Center and would be glad to help you in any way if you so desire. My number is 713-876-1515, but please let me know your telephone number as I don’t answer any Unknown Name calls. My email is Leon

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PS (PPS? PPPS?:flushed:)
If you want to just dip your toes in the water with a CGM, check out the Freestyle Libre. It’s not as fancy as Dexcom’s or Medtronic’s, but it will give you an idea what is like. Now, when I say “not as fancy,” whereas Dexcom and Medtronic CGMS give you constant readings, with the Freestyle you have to swipe your receiver over the sensor - which is worn on the upper arm - to see your patterns since the previous swipe. It’s actually very convenient, and the receiver is small and doesn’t get in the way.
I don’t know if there are any restrictions with your insurance about switching from a Freestyle to one of the others so it’s something you should ask about to be on the safe side. I keep a couple on hand as a backup - my insurance pays part of the cost but less than my Dexcom. It’s much less expensive than the others but then again did not have all the features - but you could see what is like to wear one and not have to turn your fingertips into pincushions.

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Definitely something to think about. I’ve heard of it but will research it more, thank you so much. I have to make a decision pretty soon, but I’ll reach out if I have any doubts or questions!

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I’ve been through multiple pumps, and by far the best one is the Omnipod. It works well, is completely wireless, and also does not fall off while swimming. For CGM’s, going with anything other than the Dexcom is a massive mistake. It is the most accurate and most convenient. Also, it seems like most of the AID (automated insulin delivery) systems being developed are designed for use with the Dexcom G6.

If you choose to go with Omnipod, I would suggest using their Eros style pods and not the newer Dash pods. I think the old remote is actually faster and easier to use, and there is an amazing AID system called Loop that is not compatible with the Dash. If you would like to still go with Dash and are deterred by the Loop’s lack of FDA approval, I think that Tidepool should be releasing an AID with Dash and the Dexcom G6 shortly.

Thanks Drew for your response. I honestly hadn’t even heard of the Omnipods until very recently. Even if I don’t go with a tubeless pump just yet, I’m curious to definitely trying it in the future!

I have been T1D for 68 years and with Medtronic for 28 years. I am very happy with each of the Medtronic pumps I have used and happy with the service I receive from the company. Yes, occasionally I talk with a techie that does not help much, but you get that with any company. And YES, definitetly get a CGM. I used the Dexcom G5 and now G6 and am happy with the performance. My CGM has saved me numerous times from lows. I would consider my CGM one of the best advancements since insulin. Staying on this site will help you also.

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I just wanted to give an update as to what pump I ended up choosing and why. It took me over 3 months to get my pump after ordering it, I’m guessing mostly due to Covid. My insurance only gave me two choices, the Tandem or Medtronic and I ended up going with the Medtronic 670G. I’ve been on the pump now for about a month and overall I’m very satisfied with it. Due to cost, I have not begun using CGM (and was one of the reasons I couldn’t go with Dexcom), I’m hoping to try it in the near future. But so far, this pump has kept me in a much better range than my previous pump. It does take more steps to maneuver especially I’ve found in the bolus wizard where I’ve had a high beginning BG and I have to keep pressing the up arrow to reach my number! But I’ve been home during this time and so it hasn’t been a big deal. I also like that I can remote bolus from the BG monitor when I don’t want to take my pump out. That feature was nice during a recent dinner at a friend’s house. Also, we had a very bad snow storm in Texas and had no power for several days. I’m glad my pump uses a AA battery and didn’t have to stress out about charging my pump. I also like that it’s waterproof since I spend lots of time in Costa Rica and worry about it getting wet. Overall I’m very happy with my pump!

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Hi Leon, I’m so sorry that I just read your message after all of these months. I appreciate your help and giving me your contact information. I am considering using the Dexcom once I am able to so I might reach out with any questions at that point. Thank you so much!

I have never been sorry by going with the Dexcom equipment. I have been a T1 for 75 years & a Medtronic user for 25 years. My Medtronic 630g’s warranty is up in June and I want to go with a Tandem with the G6 or stay with Medtronic 770 and Guardian Sensor which does bother me using the Guardian which has had problems. Does anyone know if Medtronic has upgraded Guardian to be competitive with the G6 or G7?

Hi Dennis, I have been reading your articles and relies with interest as I will be selecting a new pump with a CGM this next year at the end of my Medtronic warranty on my 630b pump as well as my Dexcom G6 CGM. I have been studying a lot of information about the best selection and there are some (+) replies and (-) replies to the Medtronic and Tandem selections. Having been on a Medtronic pump for over 25 years, I have found it difficult to change, but my findings are swaying me toward the Tandem with Dexcom, primarily because of the negatives toward the Medtronic Guardian 3. I have been very pleased with the accuracy of the Dexcom CGM and depend on it almost solely for my readings for the 630. Medtronic has always had a good pump without the CGM and it most likely has a good comparison with the Tandem pump, which only has a couple of negatives compared to the new Medtronic 7070 including such as the preparation of the Reservoir and the charging system which seem almost minor to me. So, it is likely if I do not have any problems with Medicare I will go with the Tandem and CGM even though they are separate devices which has not been a problem for me for a number of years with Medtronic. I noticed you have used a source indicated as Jared & Jason. Just what have they done for you? I would like to contact you sometime even though I may be a little older at 90 and a Type One for 75 years. If possible, let me know how I can contact you sometime in the future.esc

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Hello Leon @rlu5300 , I’m pleased to be able to share my experience selecting and choosing the Tandem t-Slim x2 infusion pump and the Dexcom G6 monitoring system. Like you, I’m a survivor of the very rudimentary diabetes knowledge of the 1960s and now enjoy the wonderful tools and refined insulin that have come into play. With questions, you can reach me any day on the Message tool on this Forum; simply click on my User Name or Picture, above and then select Message. I’ll try here responding to each of your questions/concerns mentioned in your post; let me know if I miss any. Since my research and purchase [December 2018] there are new pumps available, and soon to be available - the MiniMed 780G appears to closely copy features of the t-Slim x2.

  • Before finally changing from a series of MiniMed [Medtronic] pumps, I did extensive research on all available pumps and those approaching the market. Then met personally with manufacturer representatives so I could hold the pumps in my hand and read the screen information and ALL menus without eyeglasses. Three positive factors stood out with the Tandem: (1) only pump at the time that could have software updated - important with Medicare requiring one year after manufacturer warranty before replacement. (2) The brilliant and clear screen allowed me to read, even in sunlight. (3) The very compact and convenient size made possible by a built in rechargeable battery and the Insulin cartridge that is only 3/8 inches thick.

  • The Dexcom G6 is the most accurate continuous sensor currently available on the market (the G5 was slightly more accurate). The testing I refer to is where sensor reading accuracy is compared by laboratory testing.

  • Insulin Cartridge / Reservoir filling: In practice, there is very little difference, although the Tandem Cartridge, with needle/syringe, requires one step more than the bulky Medtronic with its unique fill-connector. The Tandem 3/8 thick Cartridge permits a much slimmer case than the 5/8 diameter Medtronic Reservoir. I don’t know if the 780G MiniMed, currently in for FDA approval, has changed reservoir type.

  • The Tandem battery charges very quickly and only about 15% of a charge is used each day. Being in an area that could loose electricity for days, I keep a couple of battery bricks on hand - recently I tested a sola brick, given to me on Father’s Day, to simultaneously charge my pump and S-10 phone; both devices fully charged with 1 hour using less than 10% of the brick-stored power.

Basically, I’m very happy with my now 2 1/2 year Tandem experience. As a real positive is the Control IQ [CIQ] algorithm which became available exactly 1 year into my t-Slim x2. For the 18 months I’ve been using the CIQ, my Time-In-Range [TIR] has been higher than 90% calculated by the AGP Standard report. Also. Tandem support is the best support I’ve found anywhere for any product/service. Last Friday at 4:55 PM my pump displayed an “error message”; I waited about 20 minutes before calling Tandem - by 5:30 PM a replacement pump had been shipped. By 10 AM Saturday, I was putting a new cartridge into my replacement and then began pumping.

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