Technology Comparison
With three Type 1’s living under the same roof, we are actually running three different types of systems. I am a huge proponent of #YDMV (Your Diabetes May Vary), demonstrated daily by the fact that we don’t all do or eat the same things to manage the exact same condition. My husband is currently wearing the 670G, my daughter wears an Omnipod and Dexcom G6, while I am Looping with a G6. Our insurance will let me upgrade my pump this summer, so even though I have an almost never used Medtronic pump (3 years old and non-loopable, mind you) sitting as a backup, I have been looking into my options. Which made me wish there was a consumer reports of sorts for all the different insulin pumps and technology out there.
Integrated Diabetes has created a great list of the pro’s and con’s of all the top three contenders (2 out of 3 of which we’re using) and Beyond Type1 has a pretty exhaustive post about all the different tech out there too. But I wanted to give you guys all the information about all the different options in one place, with personal accounts from both the people who loved and hated each option. Information overload? Maybe. But I’m that person who reads (and writes) all the yelp and amazon and Goodreads reviews before investing in a simple cup of coffee.
We will be posting two detailed blog posts with personal accounts of people using the best pumping options available at the moment: Looping (a little giveaway regarding which method I think is “best”), T-Slim, Omnipod, and the 670G. The idea is to get you perspectives from people who both love and hate each option so you can hear the good, the bad and the ugly. My pet peeve is insurance companies trying to tell you what method of care is the best for you. But that’s also why my daughter was the first kid on a Kaiser Permanente plan in Southern California to ever get an Omnipod. Don’t tell me how to take care of my kid.
Insulin Pumps Overview
1) Looping: in the simplest of terms, this is a DIY hack to turn a very specific set of older Medtronic pumps into a closed loop system. It is an app that you have to build yourself, but it’s not half as scary as it sounds. You have to understand how the algorithm works to some extent (the ISF, carb ratio’s, insulin duration, etc.) to make the most of it. It isn’t a set it and forget it system. When in closed loop, the system will adjust your basal levels for you to keep you at the target level you set. You have the option to run it as an open loop, where you can see the suggestions the system makes based on all your above settings, but it won’t automatically make those basal or bolus adjustments for you. Also important to know, it will never bolus for you. It will tell you a suggested bolus based off the information you give it and you have to essentially authorize that bolus.
You will need:
1) an iPhone 2) a Riley link ($150) 3) a specific Medtronic pump 4) access to a Mac to build the app 5) a developers license ($99) 6) a CGM. I will write a very detailed blog post about my experience and link back to it here very soon.
2) T-Slim X2: Full disclaimer, I have no personal experience with the T-slim (yet). But I have experience with the Dexcom and Guardian (aka Medtronic) sensors and based off of the fact that the T-slim works with the Dexcom, it already wins. The basic things to know about T-slim are 1) it has a sleek touchscreen interface 2) it works with the Dexcom CGM 3) it is run off software updates, so anytime a new feature comes out, you can remotely download the new feature instead of needing to wait/pay for a hardware upgrade 4) their latest upgrade allowed for Basal IQ to essentially shut off insulin to help prevent lows.
3) Omnipod: Insulet makes the only insulin pump without tubing (for now). It is the only option that includes a remote control. Meaning you don’t have to be right next to your kid, don’t have to mess with a fanny pack or parental controls or digging around however you got your tubed pump hooked up to your kid. It is also the only one that gives you a few more site options because using a pod on your arm is way easier than snaking tubes up the inside of your shirt. I believe it is also the only insulin pump with an automated insertion (so you don’t ever even have to see the needle).
4) Medtronic 670G: this was the first FDA approved hybrid closed-loop system. It automatically adjusts your basal insulin based on your CGM readings and suspends you before you drop to whatever low limit you set for yourself. It will also automatically restart your insulin delivery once you are back in range. That sounds awesome, if their Guardian sensor worked as nicely as it sounds. I’ll save that part for our blog post on it, because I know people that it has worked wonderfully for as well. YDMV.
CGM overview
1) Dexcom: I LOVE THE DEXCOM G6. It has been ridiculously accurate for both my 3 year old and myself. It is the only sensor with FDA approval to require no calibrations. I love being able to wear it for a full 10 days. I LOVE the automated insertion that you can barely feel (its bark is worse than its bite). We have been using the Dexcom system for over 4 years, and I have loved all of them. They keep getting better and better, and I can even ask Siri what my blood sugars are with their app now.
2) Eversense: Again, no personal experience here.This is the only long-term CGM option out there. It is an implantable sensor that allows for 3 months of continuous glucose monitoring. It uses a removable and rechargeable transmitter and works via an app for real-time monitoring. The process of insertion and setup apparently takes about 1.5 hours (based off a fellow T1 mom’s experience). It is only FDA approved for 18+.
3) Freestyle Libre: I have only met a few people using this, but apparently the automated insertion is painless. It doesn’t work like the other two in that you won’t get continuous reports. Instead you have to wave the reader over the sensor to get a reading, after which it will also display the current glucose level, a trend arrow, and an 8-hour history. It has a sensor life of 14 days which is the longest lasting sensor on the market.
4) Medtronic Guardian: I used the first physician use CGM back in 1999 that allowed my doctors to get a better idea of what was going on with my blood sugars. I also used the Guardian when it was first approved by the FDA back in 2004. It was big and clunky, and for me, it was painful and inaccurate most of the time. It was what turned me off the concept of CGMs until it was time to try and get pregnant and I wanted to get my blood sugars in better control. My husband is using the Guardian with the 670G right now, and it is wildly inaccurate for him at least 50% of the time. It usually says he is lower than he really is, meaning he is running higher than he needs to be and getting less insulin than he should.