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djtech2k

Insulin Pump Info

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djtech2k

Hello.

 

I am a type 1 diagnosed about 22 years ago.  I currently use insulin pens and a dexcom for monitoring.  I have thought about a pump for years but have had reservations about a few things.

 

I have not researched in years now so I am looking for info about the best options available in pumps now.  I know some have integration with CGMS, which is great.  Like I said I use a Dexcom now.

 

Anyone have any good info or suggestions?

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NoraWI

The only pump that integrates with a Dexcom is the T-slim. Look into them. Right now is a time of flux for both pumps as well as CGMs since the FDA approval of the first closed loop system by Medtronics. Animas has exited both the U.S. and the Canadian markets. There are effectively only 3 pump manufacturers actively selling in the U.S... Medtronics, Tandem and Insulet, with their Omnipod, a tubeless pump. Medtronics has their own CGM. Lilly is developing their own pump, not on the market at this time. And there are several pumps made outside the U.S. that may move to fill the void left by Animas. The next two years promise to bring more technology for the management of diabetes. But I sure wish for a cure already... :o ...It's time.

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djtech2k

Thanks.  That’s why I write here because the things I remember seem to be very different.  I am not stuck to the Dexcom so I would consider a better option but there seems to be so few options.  What’s the deal with Medtrum and Cellnovo?  I just saw a bit about them so was wondering about it.

 

I have avoided pumps for years because I was a bit afraid of it.  First, for a long time my testing history was poor so I knew a pump was too dangerous.  I also hate needles and such so putting on the catheter into my skin was a bit of a fear.  Now that I have been using the Dexcom, those are a lot less of an issue.  I do really do not want to have 2 different catheter in my skin so I wish I could just have one site that does both pump and monitor.  I struggle to find good spots that stay attached now.  I also am very concerned about the attached tubing.  Definitely makes me nervous.

 

I am aware of the Omni Pod but that pod looks huge, the technology of the control device seems old, and I wonder about the injection of the needle since it goes straight in and not on an angle.

 

Thats why I am starting to look for anything new that might be better.  From the sound of it, choices have gone downhill not gotten better.

 

Years ago I looked into pumps and there were more options.  I really narrowed my choice to the Animas and the Cozmo.  It’s surprising to see that they are gone now.

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NoraWI

Yes, both Animas and Cozmo are now gone. And they were great pumps and had excellent customer service. Choices ARE narrowing. As to the CGMs, I don't use one but have read a lot of commentary about them. Consensus is that there is none better than the Dexcom. Now that Medicare has decided that CGMs are useful in diabetes management, I may apply for one. Don't be put off by the tubing. I have used a tubed insulin pump for almost 8 years and experienced only twice when they got snagged on a doorknob. I am mostly unaware that there is tubing. The insets are also unobtrusive. Ask for a demonstration by the remaining pump companies. That should help you make a decision. Otherwise, you could wait and see what new developments appear. It promises to be interesting.

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djtech2k

This is still pretty depressing....

 

So few options and not much advancement in the past 10 years or more.  I appreciate my Dexcom a lot but it seems like pumps are being phased out yet there is no replacement.  Seems like insanity.

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NoraWI

No, pumps are not being phased out. Pump manufacturers are being forced out of the market. There are plenty of other pump manufacturers in the rest of the world who don't even want to get embroiled in the aggressive U.S. market and the FDA approvals. Animas exited only the U.S. and Canadian markets. They still exist in the rest of the world. There are other manufacturers out there as well. Cozmo went out of business because of patent infringement lawsuits instigated by Medtronics. There are still many out there who fondly remember their Cozmo insulin pumps. Medtronics has beat all other pump innovators through FDA approval with their closed loop system using their own CGM. Tandem is presently working on a system based on their T-slim and the Dexcom CGM in a closed loop. They claim that their system won't require a change of hardware, only an addition of a software app to the T-slim. They just haven't gotten to the point of FDA approval right now. The next 2 years will be eventful ones with more gadgets that will "improve" diabetes management. Sadly, I don't hear of any great earthshaking news in the development of a cure. :(

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don1942

Hey DJ!

 

i totally disagree with your statement that there has not been much advancement in the past ten years. I started with the Medtronic Revel about eight years ago which only pumped basil and bolus insulin in accordance with preset or manual input.

 

I just received my Medtronic 670 G which automatically suspends insulin when I go low and automatically pumps insulin when I start to go high. I often wake up with readings in excess of 200 in the night and need to bolus. If I don't wake up,  I go even higher. The new 670g will allow me to sleep through the night with the assurance the pump/CGMS will, for the most part, avoid these situations.

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djtech2k

I do see what you are saying, but I guess its a matter of perspective.

 

I am a technology person and do technology for a living.  When I look at innovation, I do not see it in pump therapy.  I mean when I looked at pumps over 5-10 years ago, there were more pumps available.  CGMS was extremely new but was available.

 

Now I am sure there are some new features or "tweaks", but largely the tech does not seem to have changed.  The CGMS is now more mature and can be integrated with only 2 pumps now.  I guess from my standpoint, the innovation seems dead.  Besides tweaking some features, not much has changed.  Again, I am a technology person so maybe its just my perspective.  Minor features are nothing more than very small software changes.  I do not know of any other area of technology that as survived that has moved this slow.

 

Maybe I am unrealistic and overly optimistic that pumps or other technology should or will be much better.  When I was diagnosed around 1998, there were I think 2 insulin pumps available.  They used the same pumping mechanism, bolus/basil, and same tubing and insertions that are used now.  In my eyes, that's not a good sign.

 

Like I said, I am just starting to get up to date with whats available now, but it makes me increasingly frustrated with the way medical technology is being handled here in the US.  I love my country, but I am disgusted with how the FDA gets away with things they do and how the large pharma companies control the FDA and so many people in congress.  Why are better treatment, drugs, and technology available in other countries?  Its just terrible that the FDA and the lobbyists prevent innovative treatment from being used simply to keep the billions of dollars rolling for the same dated treatments we have been doing for decades.  The same can be said for terrible diseases like cancer.  Its very sad....and frustrating.

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NoraWI
1 hour ago, djtech2k said:

Now I am sure there are some new features or "tweaks", but largely the tech does not seem to have changed.  The CGMS is now more mature and can be integrated with only 2 pumps now.  I guess from my standpoint, the innovation seems dead.  Besides tweaking some features, not much has changed.

A correction... the CGMs work smoother and supplies work longer and they are integrated into 2 pumps but to different degrees. The Tandem T-slim does not respond to the Dexcom CGM. The information is supplied to the user and it is the user's responsibility to take decisive action to withhold or increase insulin. The Medtronics is considered to be a closed loop system which means that the pump accepts blood glucose information from Medtronics proprietary CGM and has an algorithm that acts on the information automatically, withholding or releasing more insulin. That's a big difference and what makes their 679g product a closed loop system.

 

However, to me, an ideal artificial pancreas would also release glucagon when appropriate in addition to withholding or releasing insulin. I remember recently reading about a trial with a system like that which has not yet sought approval from the FDA.

 

But you are right that there has been very slow and limited innovation in pump design over the years. That is in great measure because the manufacturers all have a slow release program going on until the maximum dollars have been milked from their product. Then, and only then, will they dribble another little tweak to attract additional users. Of course, that is my own speculation on that matter (and I have been accused of being paranoid when it comes to big pharma).

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don1942

I am definitely not into technology, but to me, the development of an algorithm that controls the amount of a potentially dangerous harmone into the human body to, in effect, sustain life is a major technological breakthrough. Or, perhaps, I don't understand the intracacies or lack there of of an algorithm.

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djtech2k

I completely understand your point.  And again, I think its just different perspective. 

 

CGM has been around for years now.  Of course it has gotten much better, but its not a new thing.  Having any device "listen" to the CGM sensor and display or use that data is an elementary task when it comes to the tech side of things.  That's my frustration.  Pumping has been virtually the same for 10 years or more.  CGM has been around for over 5 years, maybe more, and although it is better, it still isn't where it should be.

 

So why would this be true?  The only realistic answer I can come up with is that the drug companies/lobbyists/FDA make too much money on the outdated treatment to innovate something new.  I can see no other reasonable explanation.  Look at things like the cellphone.  Look how far advanced cell phones are now and compare that innovation to what has changed with pumping insulin, or just treatment in-general.

 

Sorry, my frustration is getting the better of me.  I want a better way and even when I wait a couple years to come back and check on the "new" things, I seem to get nothing but disappointment.  I do not think more pump options, more tubeless options, more integration with CGM, and single insertion/canula is not too much to ask.

 

Just as a quick measure of current pump companies...

 

I sent an email (or web form submission) to all the companies I could reach via email (Some didn't even offer an email/online option) and asked for over 1 week ago.  To this point, I have not received any response from any of the companies.  Wouldn't you think they would be in contact with potential customers?

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TX_Clint

I think it's the patent catch 22. In order to promote technological innovation patents are a necessity. But on the other hand in the fast paced world of present day technology the patent system can lock-out further innovation for too long a time period and stifle competition. A patent can last up to 20 years from the date of application. For older types of technology this worked and was fair but for today's digital world 20 years is an eon.

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djtech2k

I agree.  Its a mess either way.  Its a crying shame that the tech behind pumping insulin are not better or even moderately current.

 

My current experience is that It doesn't even seem like the current pump companies want to sell the product.  I wrote an email to all companies that offered an email address and have only received 1 response...from OmniPod.  The rest have gone unanswered for well over a week now.

 

I like the tubeless part of OmniPod, but the pod looks huge and the control device looks ancient.  Unless its changed a lot recently, the last one I saw was like a tech dinosaur.  Its huge, out-dated, has no CGM integration, and so on.

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notme

I am using the 670g and definitely have put my trust in a machine.  It is the only way the 670g will honestly work.  If you try to out smart it when in Auto mode, you only set yourself back.  The algorithms take time to “learn” and you just have to trust and be patient.  A1c right now is 6.2, the lowest it has ever been as a type 1.  Giving up control has been the hardest part but I would not go backward right now with technology.  

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Bar&In

I just couldn’t do it notme, give up entire control to a machine. Hats off to you and best of luck, just not my cup of tea. Don’t get me wrong I love my pump over MDI but need to be the one making decisions when it comes to insulin entering my body. 

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don1942

In my opinion, the user actually makes the decisions, but in advance. The user decides the parameters  (I:C ratio, Basel rate, etc.) to be programmed in, enters the carbs to be ingested, and let's the pump do the calculations. Also, the user can alter the parameters at any time to make improvements.  Accordingly, the user is making the decisions and the pump is putting them into effect.

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djtech2k

I don't think I could ever do that.  I do not mean let the pump decide, but I mean putting in information like carbs.  That's just too much work and planning for me.  Whatever solution I use needs to be simple and easy.  I will have a CGM (use Dexcom now) and I calibrate it with regular glucometer 2x per day.  I really do not want to have to do a lot more than that.  Measuring carbs and things like that seem like am impossible task for me.

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notme

In manual mode you have control of IC ratio and active insulin time.  The rest is calculated by the pump.  If you can’t hand over the trust, then this pump is not for you.  If you don’t want to work at it to get it going correctly (and it takes a LOT of work)then this pump may not be for you.  

 

I am a particularly hard to control diabetic.  I felt I had little choice but to try.  My blood sugar can go from 66 to 190 in ten minutes or less.  Dawn phenomenon is my worse enemy. I go from 99-180from 7 am to 9 am without ever taking a bite of anything.  Coffee sends me well into the 200 range.  This pump is my last hope for now, for a somewhat normal life.  I embrace it with both hands. 

 

Manual mode with this pump has has also been a huge improvement.  Many people have opted to stay in manual mode with suspend before low activated.  It has stopped many lows at night for people but functions as a normal pump otherwise.  

 

The pump, either way, is worth it.  

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1668880

As was pointed out before most CGM companies do not want to improve their equipment because they will loss out on $$$ from their buyers. I was using the Dexcom 7 plus till the receiver busted and went back  to using the meter. Along come the Dexcom G4 Platinum and I came back it had better specs then the 7 plus. The next update was the Dexcom G4 Platinum with share and the only new thing was being able to send the results to an Iphone followed by some Android phones. The next update was the G5 which got rid of the receiver by using bluetooth so you could use your phone but Dexcom then made it were the G5 transmitter would die in 98-112 day. So they went from having a transmitter that lasted 365+ days to one that last 112 days. The only reason for this is greed they want more money $$$$. When it was discovered that you could replace the batteries in the transmitter to make them work again Dexcom then made the  transmitter only able to pair once so it could no longer be used. If they were not so greedy they could make a transmitter with replaceable batteries or even rechargeable batteries so the size would not increase but do to them wanting to be greedy they don't. As for insulin pumps the best one on the market is the Medtronic 670G. If you are able to find one the Animas Vibe would have been the pump for you but now you have to go to Europe to get one. https://www.animas.com/diabetes-insulin-pump-and-blood-glucose-meter/animas-vibe-insulin-pump I had the Animas Ping pump but ran into issues with my bg dropping to low and the pump continuing to deliver insulin so that is the reason I am getting the Medtronic 670G because it is a closed system that when set correctly will manage my diabetes for me.  

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djtech2k

Ok, well as I had said before, I normally come back to see what has changed or look for opinions, so here I am.  Still the same diabetic that could always improve my health.  I am still using the dexcom and its great.  I am in the process of upgrading to the newest model, I think G6. 

 

I have always had interest in a pump, but never pulled the trigger to get one because of things that I don't think I will like or that are realistic for me.  I am afraid of lows, but I think I could learn enough to be ok.  The things I do not like are: the connected tube, multiple injection sites.  Since I use a Dexcom, I really do not want to have to have 2 different things connected to me at all times.  I do not have an easy time with the dexcom because I find it hard to find good spots that are comfortable enough that will also stay attached.

 

So, I am back to ask about anything that might be new with pumps or that might help me.  I am always looking for info on the pumps that are available.  Its sad to see that each time I check back, there seem to be less pump options.

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