Every Pump Compared - How The Automated Insulin Systems Work
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- Опубліковано 19 чер 2024
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This episode walks through all of the automated insulin pumps currently available in the U.S - the iLet from Beta Bionics, Omnipod, Tandem's tslim X2 and Mobi, and the Medtronic 780g. We cover algorithm and setup, water resistance, cgm support, which is best for who, and how cost and warranties work.
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DISCLAIMER: This podcast is not medical advice. Always consult with your doctor before making changes to your health care.
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Chapters:
Intro - 00:00
All the US Pumps - 3:40
Who Should Wear Which? - 00:11:37
Pump Failure Rates - 22:11
Pump Algorithm & Setup - 25:30
CGM Compatibility - 42:40
Supported Insulins - 46:07
Cost and Warranties - 47:56
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#t1d #diabetes #insulin #insulinpump
I've been using the medtronic pump since 2017. I upgraded last year to their latest version 780g, and I'm very happy.
I just got my A1C back over the weekend, and it was 5.4.
Awesome job!!!
Well done. I’m not diabetic but hba1c 36mmol/mol (5.5%) per the dac machine I tested with at work. (Work and have an interest in diabetes)
I don't understand why anyone would use medtronic when Tandem is an option? Is Tandem more pricey in the US? Medtronic is all around garbage IMO and I have used both.
ive been using medtronic since they first came out with them. When they started doubling in size, I'm no longer interested. Time for a change.
A nicely done comprehensive overview of all things diabetes dosing. Thank you.
Great video! Insurance plays a giant role in what the patient can get.
Type 1 for 57 years…. I use a Medtronic 670G pump. Once Medicare lets me get a new one (next year) I will upgrade to the most recent Medtronic pump. I don’t find the battery archaic at all. If my pump runs out of juice, I just put in a new battery. I never want to have to charge a pump. I hope they never switch to that. What do you do when it’s charging? Do you just sit there waiting? Do you disconnect? For how long? Sounds like a pain to me. I can carry an extra battery with me if it needs changed. I don’t have to find somewhere to plug it in. I also use Dexcom and even though they don’t talk to each other I do fine making adjustments manually. I actually prefer that. I’ve had Dexcom be off on readings for a few hours after warm up, so I wouldn’t want it automated because of that. It’s nice that there are different choices. You can pick the pump that best suits your needs. This was a very informative video. 😊
Thanks for sharing! love your take. Will you try the Medtronic Simplera Sync CGM when it comes to the US? It will work with the Med 780g algorithm for closed loop...im very curious about it!
I have the 780 Medtronic, I have also used the Omnipod 5/DexcomG6.The "lots of extra work" for Medtronic references in this video amount to 2 fingers ticks a day for Guardian 3 sensor, Zero for Guardian 4 and charging the sensor for 20-30 minutes once each time you change sensors (weekly). Dexcom is genius for catering to people's need to avoid these simple steps. In real life I charge it and its almost done by the time I get the sensor attached. You pointed out the "archaic" as a significant reference. Funny they dont want to charge a sensor, but they want to charge a pump, to be modern. AA battery change takes me 11 seconds, show host prefers to charge things, but full charge in 11 seconds speed can't be touched by the others. I plan to try the Tslim for fun and to use the DexcomG7, but at 75 % TIR Control is not an issue. Better control is a hobby. You will enjoy the 780 if you like your current 680. The bg control is amazing, with a little help from a pump added to your efforts 👌. Voilá!
Such a great overview! I used tubed pumps for years and now use Dash pods with DIY Loop or iAPS. I just can't imagine going back to a tubed pump. Tubeless for my life is so much more convenient. I am also glad that you covered warranty and cost coverage.
I will note that, for me, Omnipod is much cheaper. It is covered under my pharmacy benefit and I have no warranty lock-in and no deductible. I didn't pay anything for their PDM (even though I never use it, but do keep it as a back up). I just pay about $100 every three months for pods. I was actually paying more under the DME benefit for tubed pump supplies (in addition to about $900 for the actual pump at the time of purchase). But as you note, this REALLY varies depending on your insurance plan.
One other thing about Omnipod - it is really nice if you travel a lot. With tubed pumps, there are more separate supplies that you have to remember and pack. With Omnipod, the pods take up very little space and are in nice self-contained packages. Omnipod site changes are also much faster, and this too is helpful when traveling.
Used omnipod 5 went low carb and closed looped almost stopped basal. Forces 50/50 split I am more 70/30. Manual mode is not so manual it still does calculations no one could explain what it was doing went back to dash.
I just got rid of my 670G, and am now using a Tandem:tslim X2. It's made a huge difference. I wouldn't stick with Medtronic unless the improved sensors with the new 780G are approved here in Canada. Being woken up in the middle of the night to re-calibrate is ridiculous. They also have a goofy, complex sensor installation.
Great video. Thank you. Based on the comments of your expert, I am glad I made the choice of the Tslim. Great control with work on my part. Which I am more than willing to do.
This is super helpful for me- thank you. Like Gary I was diagnosed 40 yrs ago and I’ve been using Medtronic forever. Medtronic is great but it’s somewhat become complacent technologically in recent years and so I’m exploring alternatives. This is a great explainer of the main differences - thank you
Glad we could help!! :)
Great information. I have been using Medtronic for 20 years ish! I just backed out of going with the ilet after a first training , second chance thoughts, and a deeper dive into personal research. At the same time. I wanted the upgrade for the 780G and Guardian 4 which I wanted for standby. I do count carbs. Guesstimate on unknowns with sometimes horrible guessing. I adjust by adding more carbs to offset to help lower the highs. Some days I am extremely active, and I can't see my self disconnecting. Pushing a button to suspend works best. As technology advances, I am not a fan of built in rechargeable systems like my phone and the newer systems. Eventually under the right circumstances spells trouble. We are more human then robotic. Popping in a fresh battery when it calls for one is peace of mind. A self contained system pump and rechargeable sensor works great. Dexcom 7 sensor was quicker to catch glucose changes before the Guardian 3 I was wearing at the same time, but. It would catch up not to long after. Do your own research , what is good for me will be different for others ,and, insulin delivery and management systems.
Been a loyal Tandem user since 2017 and have not regretted my choice. Love the algorithm and the flexibility of being able to make small adjustments to my carb ratios and correction factors for different time frames in the day. And love the Dexcom integration.
Also, as of today (couple hours ago), Tandem connects with the Libre 2!
Great and informative episode
Coming from Minimed tech after 20 years and having no experience with Tandem or the Artificial Pancreas, how do you find Tandems infusion set technology? Are they easy to use and do they have a bunch of styles like Minimed? Thanks
@@DigitalCircus777 I’d say they’re very similar. I think whatever Medtronic infusion sets have, Tandem has an equivalent (except for extended wear). The default 90 degree canula set is super easy two step process when inserting it. I used it for several years before switching over to the steel needle set. The steel needle by far the easiest if you’re used to daily injections since you manually insert the set by hand. The only one I had trouble with was the 45 degree infusion set. I found it was a bit inconsistent with finding the correct angle with the applicator device and it was a bit more involved with needing both hands to use it. Justin has a video of him trying out both Medtronic and Tandem infusion sets (although he does insert some of them wrong) if you were curious about seeing them, but I think there’s very minimal differences between the two.
does it connect with the libre 3?
@@DigitalCircus777 sorry for the delayed response I didn't see this notification. To answer your question - to the best of my knowledge, all the minimed infusion sets have a tandem equivalent. There are 90 degree cannulas, angled cannulas, variable angled cannulas that are manually inserted, and a steel 90 degree needle. The only thing Tandem doesn't have is the extended wear infusion set. All have various options for cannula and tubing length. The applicators from what I've seen are very similar.
@@swimm3r137 at the moment, the tslim does not connect with the Libre 3, only the Libre 2 Plus (not the normal libre 2).
I love the double A battery of the Medtronic. Less hassle than plugging stuff in.
Good overview, thanks
Very interesting. I'm a tslim user and not at all moved by the mobi (mostly because I learned about the sigi before learning about the mobi). My doctor recommended the tslim because it held more insulin. I was curious about the omnipod because in the summer I'm in the pool 4-6 times per week. However, after watching this, I think the tslim is the best option for me because ciq is absolutely great but I want the option to override as needed. So until the sigi comes out, I'll disconnect at the pool. Thanks for this episode.
Been T1 for 14 years, always on MDI but have just been referred to the pump team for a possible HCL. This video has been invaluable to learn about the main differences between the HCL systems, pros & cons etc. Even living in the UK this was still well worth the watch. Much appreciated 👍
Yikes. MDI was 30 years ago. They should have told you to get a pump from day 1.
@@rsilvers129 wanted one from day 1 but didn’t meet the criteria required to get one.
Thank you for this video. I started with Medtronic’s years ago and then switched to Omnipod. Took a pump break for three years. Using the InPen. Now considering going back to pump. On Medicare so Omnipod is cost prohibitive. Had absorption issues also. Looking into tandem x2. And will switch to mobi when available. Not crazy about tubing but the mobi has a five inch set. Thinking I can place anywhere on body because controlled with phone app.
780G....amazing...went from 7.1A1c to ..5.8A1c...A GOD sent..
Super interesting, thanks for sharing. I've been on the Medtronic 780g with Guardian 4 sensor since 2021, and recently struggled with keto diet, due to higher protein and fat intake (and slow carbs). This pump does not allow dual / square wave boluses on Smartguard (the auto-mode), which caused hyperglycemia for me, a couple of hours after dinner (which could've been prevented with a prolonged bolusing method, like the Tandem pump does allow on auto-mode). This urged me to manually adjust with extra boluses - which kind of defeats the purpose of a pump with an algorithm. I'm considering switching to Tandem or iLet, but will first try to optimize my hb1ac on this system.
this was a great interview and information. Gary statement "dont quote me on this" old saying . obviously he was recorded on video. LOL He was a great guest and a wealth of information
Thank you very much..I was waiting for this type of Video...I am from India
Glad I could help!
Great vlog
I'm getting on the iLet next week. Super excited!
yay!! good luck :)
@@diabe_tech thanks! Really is helping my treatment
Wow. I haven’t seen such a smart UA-cam vid EVER. Nice job.
I am not a pump user, but the content is interesting and informative. Thank you
I got the omnipod 5 about a month ago. Absolutely love it, the reason i went with omnipod is because I couldn’t imagine going about my life with a long tube on me. On top of that the commitment of 3 to 5 years was a huge downer.
Before I was using U200 insulin for meals, when they told me you should only use U100 insulin. I got scared this slower acting fast insulin wasn’t going to work.
I had no problems with the U100 insulin. I’m really happy with the omnipod
really? Omnipod seems so weird to me since I've only used a medtronic pump with tubes. It seems so different. I'm down to try it but it looks basically the same thing without a tube. The interviewee said it's the exact same thing as a pump in that you still need infusion sets, to change sites, etc. Is the lack of a tube the only difference? For me, I don't like the idea of needing to use a phone.... If you get rid of the tubing, you then end up needing a phone. Sounds like a wash
Jason...I'm currently using 115 units per day of U-100 Insulin on my Basal program! I'm on the the TSLIM X2 implementing 300 units. Can I use a stronger strength Insulin ie; U-500 if I wanted to try the Tandem Mobi System 200 units to maybe equal 3 days? Also, FYI...Medicare Part B WILL NOT COVER the Omnipod system because it is a tubeless pump and therefore, not considered a DME (Durable Medical Equipment). It is covered under Part D but very expensive! The Mobi should be covered under Part B as it is still tubed!
Great overall review and very helpful for those undecided. One question, where’s the link to the “Think like a pancreas” podcast you mentioned?Thanks.
Whoops! Threw it in there.
I had the 780g, tubes are no fun, CGM frequently disconnects from pump usually at night, have to sign up for 4yrs of using medtronic via. insurance and warranty (I don't know if the other tubed pumps are similar to this?). My biggest complaint of the 780g, while in auto mode you are unable to give yourself a manual bolus. I have switched to Omnipod 5 and really only one drawback for me, I need more insulin to last 3 days. I use on average 80-100 units per day, omnipod5 is not made for big T1D people. Am waiting for the concentrated insulin to be FDA approved for pump use.
Thank you for some good information👍
Agree completely about thr Minimed CGMs that have only marginally improved. Time to Step up your game Minimed or allow communication with other devices like Dexcom and Freestyle Libre.
Omnipods and Dexcoms coordination makes automation so much easier. Yikes, if they could only make their Omnipods stay (I've been using infusions for years and also use Skintac and Tap that didn't help very much) in and work all the time. Really bothers me having to send back half full of insulin Omnipods when they fail to get another replacement.
What waste and yikes why doesn't Omnipod recycle? Thw landfills are full enough with smartphones and computers... 😮
Speaking of visual issues, I agree that Omnipod is very easy. Medtronic is next - I was able to fill the reservoir and put a new set on even on a bad vision day. Tandem is harder plus the text in the unit is smaller. I think I'd have to get that syringe assist device on a bad vision day. As to CGM, the Dexcom 6 system is easier, Medtronic Guardian 4 has a lot of fussiness. Simplera, Dexcom 7 will both be as easy as Libre.
I'm about to start on the Omnipods Dash. Here in Australia, without health insurance, the t-slim is around $10,000. The omnipods are now subsidised by the NDSS and I can access them for $200 per month (including pods). I've been a type 1 for 26 years.
Wow! So Australia is like US? You don’t have free healthcare? Excited for you to start Omnipod!!
@@diabe_tech Our hospital services are all covered by the government. Emergency, surgeries, out patient services etc. Depending on what kind of private health insurance you have will depend on how much rebate you get when buying things like pumps. But, even accessing your retirement money (superannuation) can be a drama. You can apply to withdraw funds to buy a pump, but I know if one T1D that had their application rejected as "un-necessary". The Dash has just become available as a subsidised product, which is awesome! But it's still a $168 per month subscription fee to Insulet/Omnipod, then $30 per month for the pods from the pharmacy. Honestly, I've been waiting years to try a pump, and I can't wait for my training day!!!
Hi there
I wear an infusion pump, but not for insulin…for apomorphine An advanced medication for Parkinson’s. I get the needle in the stomach in the morning and it comes out in the evening. What stays in me for the day is it very thin silicon tube which I think you call the cannula. I don’t have a gadget with the spring for putting the needle in, it’s done by hand had a shadow angle 45°.
One of my programs is, I would love to be able to exercise by swimming occasionally. But it’s not possible to unclip the tube to the fitting. . Whereas the incident fittings the insulin fittings I’ve seen on UA-cam can be unclipped, have a swim or a shower, then clip it back on again. So I’m wondering if it’s possible that I could use my pump with the much narrow tube that you diabetics use, but have it fitting with one of your clip devices to the tummy, so I could have a swim.
My dose I believe is 25 mg per day a day being about 12 hours., it’s a 50% diluted apomorphine totalling 5ml.
So may I ask is this flow rate possible with the insulin tubing and fitting, and do you think it possible to fit your very narrow tube to my tube orpump.
I use an apo-go pump
www.researchgate.net/figure/Crono-APO-go-O-apomorphine-pump_fig2_263015573
I’m just this minute wondering if the tummy end fitting is made by apo-go.
But would be interested to hear any input anyway. Do you unclip and go swimming? Any problems?
Awesome 😎
I love my Tandem TSlim with sleep mode 24/7. Once I dialed my correction and I2C ratios in lows are rare and my TIR is 98% yet still eat somewhat high carb.
I discovered the 24/7 sleep myself. Regular setting is way to slow to react.My problem is the insets really a problem. Insets are the weakest link in any system and the companies should be working on a much better delivery system,
@@Roadpizza I wonder if you would be one of those who would have better luck with the TruSteel infusion sets. I would reach out to a Tandem trainer (your Endo's office should have contact information for one) or call Tandem and request some for a trial. I have found they work great for those with a lot of scar tissue, regular occlusions, or issues with leakage and find the TruSteel to be the best.
How can I learn more about IAPS use with an OMNIPOD insulin pump? I’m assuming it’s Omnipod dash, but I could be wrong. Also, could you list all of the insulin pumps that can be used with the DIY IAPS software/controller?
Well you have forgot about the Ypsomed ( Ypsopump ) and the CamAPS FX App to run a Loop with Freestyle Libre 3 or Dexcom G6.
The omnipod is Amazing for kids my daughter moves all night long 😊
I'm confused. I started using the Tandem pump on 5/13/24. My pump is set at 110. You and others on UA-cam say the Tandem is fixed at 112.5. What am I missing?
Is the blood glucose value shown on the CGM during exercise actually right? I did finger stick to compare to the CGM value, and they were dramatically different. Is it possible that the interstitial fluid values are much lower than blood glucose during exercise due to the arm muscles using glucose when the CGM is on the back of your upper arm? This would seem to be especially the case for exercises like swimming where arm muscles are engaged.
CGMs are about 10 minutes behind blood sugar readings. When exercising, your blood sugars can change quickly in 10 minutes meaning your CGM and blood glucose meter readings can be very different in readings. Do not calibrate your CGM in these instances as then it will cause your CGM to be inaccurate once your blood sugars level out. When your blood sugars level out, the readings on your CGM will closely mimic the readings from your blood glucose meter.
I was on BetaBionics trial. I was very excited but it just doesn’t work well enough. I would eat two burgers and go over 300 because there is no way to specify carbs and it needs to guess conservatively to keep you from going low.
Hi, I would like to ask you from which university I can obtain a degree to be diabetic educator?
Which pump would work better if you don’t eat carbs? I'm currently on Omnipod Dash. I didn’t like tge Omnipod 5 because the targets were too high, mine is 70-120. Also it wasn’t giving me any insulin,basal.
I would suggest trying the Tslim with Dexcom G6 or G7. Lately I have been going on a eat once per day routine. Just supper. No other meals or snacks. And the Tslim does great at keeping blood sugars in the 70-170 range if all you are getting is basal insulin. Just add some small manual corrections if you start seeing it creep higher than it should. I think your no carbohydrates diet would be similar to eating once per day and eating nothing for 23.5 hours a day. No carbohydrate regimes should be handled by almost all basal since there is no carbohydrates to spike the blood sugar.
@@russellseaton2014 I was on tge x2 before Omnipod. The issue of why I switched was their customer service. It was horrible and I wonder if their targets would work for me. My A1C's have been between 5.3 and 5.5 for tge last 8 years and don’t want to go back to even a 5.8. It’s improved my vision and no neuropathy in 50 years since dx. Thanks for the info and suggestions! Looks like I need someone here to help me with info.
I just switched from Omni to tslim for 2 reasons: tighter control and my Omni failed while swimming for me a lot. Ruined several vacations. I just couldn’t trust it in the pool, lake or ocean. Would fail/blare alarm as soon as I got in the water. Does anyone have this problem?
Wow thank you for sharing because the ONLY reason I considered the omnipod was because of it being easier for swimming. I'll stay right here with my tslim until tandem releases the sigi
You left out ypso pump, diabeloop (insight) etc..
0:00 choosing what we eat is one of the biggest decisions we make in terms of diabetes management
whats the screen behind you with your blood sugars shown?
There are two. One is a SugarPixel the other is Tidbyt. Links to both are in the video description. Helps me out when you use those :) I also have a video explaining them on the channel!
I really want to know who makes that “Dexcom clock” my own terms behind you
There’s a product link in the description of the video. There’s Tidbyt and SufarPixel on top. Tidbyt takes a little more setup process but I have instructions on here.
Omnipod has extended bolus and does have temp basal ability. Also has various profiles. Not sure why everyone keeps talking about pods who are supposed to know better but are giving wrong information. I have been using omnipod for nearly a year and it works as hard at control as the user does. All the same except no tubes or infusion set.
He also states only ilet has updating or learning algorithm but omnipod also learns. So again misinformation
Also use activity mode not manual mode for exercise or heavy use to prevent hypoglycemia. Manual mode is fine and learning things is great but this guy is almost pushing his choice only.
There is any pump with cgm all in one?
Nope not yet
How do pumps handle CGM errors of 50 mg/dL or more?
You are making the classic and understandable error of thinking a wrong CGMS reading will seriously affect the amount of insulin the pump gives. But it doesn't. I was on the Medtronic 670G and its very inaccurate Guardian CGMS. 20-30-40-50% errors were almost constant. Compared to my blood sugar meter. But with a target of roughly 70-170 mg/dl, the CGMS reading doesn't really need to be too accurate to still maintain acceptable control. Believe it or not. You're sort of just trying to hit the broad side of a barn. And not have anything land on the roof or the grass in front of the side. A big CGMS to meter difference can still manage that. Now, it is better to have an accurate CGMS and feed that data to the pump. I now use the Tslim and Dexcom G6. Very accurate CGMS compared to the meter. And it does a much better job of keeping me in range compared to the old Medtronic 670G. The 670G was a C grade. The Tslim is a B grade. Or maybe B+ grade. Much better. But the 670G C grade was still sort of maybe possibly OK I guess.
I never thought of carb counting it's not easy
I've got lots of great tips for carb counting. Check out my videos here on my channel - search carb counting on my page!
I’ve used Omnipod dash but it was very uncomfortable
Medtronic received CE Mark approval for Simplera Sync
I SAW!!!!
Mobi doesn’t provide TDI totals. Mobi infusion sets super complex. Little pump has to be 12 inches above or under sites. I went back to omnipod dash. Don’t like closed loop nonsense.
Which has best algorithm
I plan to do an entire episode on algorithms soon! There's some great algorithm info in this video.
The Tslim has fallen behind algorithm wise, compared to the 780g and Ypso
You have to disconnect to charge Mobil. Sucks.
The medronic clip its not only upside down but also very fragile. I had three and the three of them broke with a short period of time. I gave up and accepted that it will never work🤣
Ypsopump?
Not yet available in US.
8K?!!!!! What?! I understand R&D, I understand research, I understand the company must make their money back, plus a benefit, but 8K for a device that does not cost more than $100 to be manufactured... it's robbery. Who can afford that kind of money?
It costs way More than $100 to make, I work at one of those companies.
You are right, more than 4k with a good after sales service it's robbery
Ilite would work for me because I don't workout
I tried tandems pump n think its junk. I had 3 different pdms they would loose time, erase my basal rates, couldn't upload to computer for doctor and even educator and doctor couldn't upload info. It would change the date, not accurate or reliable. Customer service sucked, pump issues are always your fault not the device.
why are you allowing health guru balance levels advertise on your site. His claims are dangerous
omnipod makes 3400% more medical waste per year as compared to tube pumps. Worst pump on the market imho.
Such biased opinion against medtronic...are you for real????!?!?!?!
I am wearing the 780 pump with the guardian 4 sensor. Here is the truth from somebody who has been wearing it since the day it came out: the sensor lasts for 7 days. It is accurate without calibration during the 7 day wear time. The accuracy even after 6 days of wearing the sensor and not calibrating (since it's not needed) is within 2% of the blood glucose meter.
Insertion the sensor DOES NOT include many steps!
Infusion sets I use are disposable and super easy to install!
Getting started on the pump consisted of the initial setup and guidance on using the pump, inserting the infusion set and the sensor. Than, after 24 hours(if I remember right) the pump goes into closed loop mode and that's it! I had a phone conversation with my doctor just to let him know I'm in the closed loop.
My aic was above 9 with the 640 pump and sensor ND now is in the low 7s. I have to say that I am overweight and that affects the control.
My time in range is above 75% and some days over 80% without overnight hypos that I was suffering from with previous systems.
I do see an huge advantage having my pump and sensor made by the same firm. That is how the system works the best. Just like a Ferrari transmission doesn't fit a Porsche engine.
Your whole review feels biased to me. Sorry buddy! I wanted to see a fair comparison and not a bashing of one of the leading companies in the industry...
Thanks for sharing. I’ve gotta re-listen to the episode now. I think it’s fair to criticize and be hard on all the companies and pros/cons. I’ve heard great things about the 780g algorithm, but there are downsides as well, just like all the systems. I’ve got some more content on Medtronic and 780g and the new Simplera CGM coming out on here.
@@diabe_tech being hard on companies is great. Dishing out false information is something I would be very careful with. My experience has been very positive and the doctor you hosted on the show seems to have biases.. That is the feeling I got and am disappointed. I normally don't write (to the good or bad) on videos I watch, but listening to all that for almost an hour.. I simply had to. Sorry
The Discord of AAPS banned me because my experiences do not reflect the experience of the community. A Frenchman named Robbie banned me, dude claims to be doctor working as dentist. When I told this guy my aunt and uncle are dentist and anesthetist he banned me from discord.
Don't trust anything you hear from AAPS their knowledge is flawed and based on ego.
IT'S A MAJOR SCAM PEOPLE!!!! DON'T GET TAKEN!!👎👎👎👎❌⭕❌⭕⭕