# replacement pump



## heasandford (Oct 23, 2021)

Sorry I havent been here for some time, personal difficulties like everyone I'm sure

I have discovered that I am due a pump update in January, much to my surprise. The Roche Combo I use will no longer be available from 2022, and I was hoping that there would be some new pump technology available

Am I the only person who wants a pump with remote control?! I just want to be able to leave it under my clothes and do all the calculations and delivery from an external source!
I do need bolus advice, and I occasionally use the multiwave and a temporary basal rate, but I don't think I'm worried about prefilled cartridges.
I have Libre 2 which I do mostly like, but I would consider self-funding a different CGM if it has a link/feedback to the pump. I'd like something that warns me that I MIGHT go low in half an hour rather than telling me I have! But I also want to be able to control alarms!

As always I find you experts on here have the best advice! I watched the Diabetes UK tech conference, and while I enjoyed some of the speakers I was too distracted by the chat on the side - I can't walk and breathe at the same time so no chance! I would so love to try the closed loop, especially if it gives less micro-managing

Thanks!


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## helli (Oct 23, 2021)

heasandford said:


> Am I the only person who wants a pump with remote control?


Absolutely not. A number of pumps have PDMs which are, effectivel, remote controls. Those I know of (OmniPod and Medtrum) are patch pumps but there may be tubey pumps with PDMs too.
i have the Medtrum which has a choice of PDM or phone app. I use the app to minimise what I need to carry (and could potentially lose).

Unfortunately, each CCG offers different pumps. Some only offer one pump and some offer four or five. Therefore, before setting your heart on a specific pumps, it is best to talk to your local diabetes team and find out what your choice is.


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## helli (Oct 23, 2021)

heasandford said:


> I have Libre 2 which I do mostly like, but I would consider self-funding a different CGM if it has a link/feedback to the pump. I'd like something that warns me that I MIGHT go low in half an hour rather than telling me I have! But I also want to be able to control alarms!


I use Libre 2 and the xDrip app (great if you are techy and happy to go off-piste, petrifying if you are a technophobe). It includes a predictive alert and pucks up readings via Bluetooth so you don’t need to scan.

(Sorry for the multiple messages, I got excited by your first paragraph and then, when I carried on, I realised it is not easy to insert a second quote when I edit an existing message on my phone.).


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## Pattidevans (Oct 23, 2021)

I've also been  on the Combo for 8 years next month and do not want to have a pump without a remote control - even if it's my phone, in fact all the better if it is.  I was at a wedding one time wearing a dress with the pump in a little pocket I'd sewn to the dress lining.  I'd forgotten the handset... oh the palaver!  Had to go into the toilet and take the dress off... shudders!  Last time I spoke to anyone, which was in May the choice was Omnipod or Medtronic .  However due a new one on 17 Nov and no one has contacted me re: the current choices.  Hope you can get what you want @heasandford - do let us know.


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## Inka (Oct 23, 2021)

Find out what pumps they’re offering @heasandford I’ve had various pumps over the years and now have a Dana RS. I can control pretty much everything on it from my phone, which is very convenient indeed. It’s also guaranteed for looping. You can use Open APS as a DIY loop or pay for it’s official loop software. It was developed in conjunction with #wearenotwaiting


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## SB2015 (Oct 23, 2021)

I am using the Medtronic 780G with closed loop through self funding their own sensors.  I would not want to go back on that now as it gives me such a good Time in Range BUt I have to access the pump to do a bolus.  I still find that frustrating as I too had been on a Combo for eight years, and loved being able to tuck it away at the start of the day And leave it be, doing everything remotely.  I look forward to seeing which Closed loop ones offer remote bolus ing when I next change in there years time.


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## heasandford (Oct 24, 2021)

Some great thoughts but sadly as you say it looks like I may not have any choice! Apparently only alternative I'm being offered from my team is an Ypsopump which you have to directly bolus, although  'QUOTE...there is a phone app which links to intranet based system for reviewing data. This is also going to offer a remote bolus feature in the future (MyLife Dose)'
oh dear! not sure I can wait in case it doesn't happen!

I'd like to hear about linking Libre 2 to xdrip, I posted another question about this. I am a bit scared of the tech, but I'm very good at following instructions! I used miaomiao with  the Spike app on my phone until it got removed by Apple, loved it and then lost the plot trying to get it back, never did manage. (Then life took over and I no longer have the time, full time carer)


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## helli (Oct 24, 2021)

heasandford said:


> I'd like to hear about linking Libre 2 to xdrip, I posted another question about this. I am a bit scared of the tech, but I'm very good at following instructions!


Your best bet is to join the xDripIOS* Facebook group where you will find downloads, instructions and support.

*As you mentioned Spike, I assume you have an iPhone. There is a different app, xDrip+ for Android. They have a different Facebook group.


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## nonethewiser (Oct 24, 2021)

SB2015 said:


> I am using the Medtronic 780G with closed loop through self funding their own sensors.  I would not want to go back on that now as it gives me such a good Time in Range BUt I have to access the pump to do a bolus.  I still find that frustrating as I too had been on a Combo for eight years, and loved being able to tuck it away at the start of the day And leave it be, doing everything remotely.  I look forward to seeing which Closed loop ones offer remote bolus ing when I next change in there years time.



Shame about it not having remote programming option,  pump is up for renewal & Med 780G is one that's been offered.


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## SB2015 (Oct 24, 2021)

nonethewiser said:


> Shame about it not having remote programming option,  pump is up for renewal & Med 780G is one that's been offered.


For me the advantages of the closed loop outweigh the inconvenience, now.
It didn’t initially as it took a bit fo getting used to.


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## nonethewiser (Oct 24, 2021)

SB2015 said:


> For me the advantages of the closed loop outweigh the inconvenience, now.
> It didn’t initially as it took a bit fo getting used to.



Guardian sensors were mentioned by dsn, not eligible for nhs funding as only being offered to those with no hypo awareness, at £40 each couldn't justify cost as use libre anyway which get on prescription.

That closed looping sounds ideal mind, future looks good with tech like that around.


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## everydayupsanddowns (Oct 25, 2021)

Nice to see you again @heasandford 

Rumours of a phone app for Tandem tSlim continue to circulate. Will be interesting to see what that offers when it eventually launches.

Good luck with your pump choice. Hope you are offered a good range.


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## heasandford (Oct 25, 2021)

Pattidevans said:


> I've also been  on the Combo for 8 years next month and do not want to have a pump without a remote control - even if it's my phone, in fact all the better if it is.  I was at a wedding one time wearing a dress with the pump in a little pocket I'd sewn to the dress lining.  I'd forgotten the handset... oh the palaver!  Had to go into the toilet and take the dress off... shudders!  Last time I spoke to anyone, which was in May the choice was Omnipod or Medtronic .  However due a new one on 17 Nov and no one has contacted me re: the current choices.  Hope you can get what you want @heasandford - do let us know.


Haha, been there too!
I'm not feeling hopeful I must admit, although there are advantages with all of them. I was just hopeful of some new tech coming our way!


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## DouglasXKR (Oct 31, 2021)

Using as an analogy a closed loop control system for an electric motor, you can easily provide a feedback loop that speeds up, slows down or stops the motor. With current diabetes technology you can only speed up or slow down, you can’t stop. Obviously there is a fudge somewhere that I’m missing?


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## helli (Oct 31, 2021)

DouglasXKR said:


> Using as an analogy a closed loop control system for an electric motor, you can easily provide a feedback loop that speeds up, slows down or stops the motor. With current diabetes technology you can only speed up or slow down, you can’t stop. Obviously there is a fudge somewhere that I’m missing?


I think I am misunderstanding your analogy because the most common and simplest closer loop control is to suspend (stop) the basal when levels are heading towards hypo levels.
Unfortunately, as injected/pumped/manufactured insulin works slower than "natural human created" insulin, the suspension has to be initiated early to stop the blood sugar dropping too low. 
I use basal suspend frequently on my pump to stop the drop when exercising. With Fiasp insulin, I need to suspend my basal an hour before jumping on my bike.


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## DouglasXKR (Oct 31, 2021)

when levels are going low, you can’t reverse it. Any algorithm errors which are driving the level too low are irreversible. There is a constituent of the pancreas which will reverse a fall - it’s name sounds like a French painter Gauguin - but is difficult to handle.


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## Ellie Jones (Oct 31, 2021)

I use the Medtronic 640g,  which does have a very limited remote bolus function from the meter, you can set up via the pump, several boluses such as dinner, snack etc.  Which you can instruct via the BG meter.

You can also connect the Guardien Sensor to it, but this give very limited connection, and not a closed loop like the 670g is. 

I actually do now miss my Combo, and it seems sad that they've not brought in a newer model to replace it.


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## everydayupsanddowns (Nov 1, 2021)

DouglasXKR said:


> when levels are going low, you can’t reverse it. Any algorithm errors which are driving the level too low are irreversible. There is a constituent of the pancreas which will reverse a fall - it’s name sounds like a French painter Gauguin - but is difficult to handle.



To my mind @DouglasXKR - it’s a bit like an oil tanker. You can stop the engines, but you have to act early enough for it to slow down in time.

Yes you can stop all insulin deliveries, but as you say there may still be insulin on board. However the glucose-lowering activity of that will decay over time, so once you’ve suspended insulin delivery, the amount of active insulin from the last micro-dose of basal will have 4-5hrs of life, but the micro-dose of basal from 2 hrs ago will be half strength at best. So there will be a sort of taper. Most likely not much insulin reduction happening for 30-45 minutes, but then more and more potent ‘stopping’ of insulin action


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## heasandford (Nov 2, 2021)

I have now been told that my CCG are looking at the *Medtrum* patch pump which I think I'd really like as a replacement for my Roche Combo which being take off the market (although I can have one and they will support it for the next 4 years) 

It's not entirely clear online how the Medtrum works when provided without the CGM. I asked about the cost of this if I fund and it seems to be similar to funding the Libre which I have to say I did for 2 years before the NHS funded me. (I know I am very lucky to be able to afford it, and was persuaded by a friend who made me look at what it meant financially versus health (compare smoking!)
What I meant to ask was, has anyone got experience of the Medtrum CGM system, I've searched but can't find anyone?


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## heasandford (Nov 2, 2021)

everydayupsanddowns said:


> To my mind @DouglasXKR - it’s a bit like an oil tanker. You can stop the engines, but you have to act early enough for it to slow down in time.


I love this analogy, I stole it from you some time ago and I use it all the time to explain to friends about insulin!


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## everydayupsanddowns (Nov 2, 2021)

heasandford said:


> I love this analogy, I stole it from you some time ago and I use it all the time to explain to friends about insulin!


LOL!


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## trophywench (Nov 4, 2021)

heasandford said:


> I have now been told that my CCG are looking at the *Medtrum* patch pump which I think I'd really like as a replacement for my Roche Combo which being take off the market (although I can have one and they will support it for the next 4 years)


So - I went for another Combo, got in it January 2021 - and already have only been able to order 1 box of untubed cannulas and 1 box of tubed whereas I wanted to order 2 untubed and one tubed, to last me 2 months.  As I need to change my cannula every 2 days this means I'll have to re-order every ruddy month for the next 3.5 years.  NOT ideal.


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## Pattidevans (Nov 4, 2021)

I had that same thing back in the early summer @trophywench  but last time I ordered they said “oh that’s over, you can order what you want now”.  Anyway if my new pump comes through quickly I will send you anything left over of my stock.


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## Inka (Nov 4, 2021)

heasandford said:


> I have now been told that my CCG are looking at the *Medtrum* patch pump which I think I'd really like as a replacement for my Roche Combo which being take off the market (although I can have one and they will support it for the next 4 years)
> 
> It's not entirely clear online how the Medtrum works when provided without the CGM. I asked about the cost of this if I fund and it seems to be similar to funding the Libre which I have to say I did for 2 years before the NHS funded me. (I know I am very lucky to be able to afford it, and was persuaded by a friend who made me look at what it meant financially versus health (compare smoking!)
> What I meant to ask was, has anyone got experience of the Medtrum CGM system, I've searched but can't find anyone?



@helli uses the Medtrum, if I remember correctly @heasandford


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## helli (Nov 4, 2021)

Inka said:


> @helli uses the Medtrum, if I remember correctly @heasandford


Thanks for the tag Inka.
I do use the Medtrum and like the size of the Nano pump and the phone app.
However, I do not have the CGM - despite the similarity in price with the Libre, my CCG will only fund Libre unless I was pregnant.

@heasandford I am happy to answer any questions about the pump.


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## heasandford (Nov 7, 2021)

helli said:


> Thanks for the tag Inka.
> I do use the Medtrum and like the size of the Nano pump and the phone app.
> However, I do not have the CGM - despite the similarity in price with the Libre, my CCG will only fund Libre unless I was pregnant.
> 
> @heasandford I am happy to answer any questions about the pump.


Thanks Helli, I'm hoping to get a demo example soon. 

The only thing that puts me off is the insertion, and of course learning anything new, but I'm going to have to do this eventually with the Combo. I have liked it, although I've been having trouble with the meter and bluetooth connection to the pump, so I am interested in a different one. 

Have you any issues with your, anything that would have put you off if you'd known about it beforehand?


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## trophywench (Nov 9, 2021)

Bluetooth connectivity between meter and pump with the Combo is normally down to either being too far away from each other, or I have found either replacing the meter batteries solves it  - or just opening the back of the meter and rotating each of the batteries does, cos they last ages longer than the one in the pump.  When you do remove the meter batteries, not a bad idea to 'tweak' the metal connections occasionally.


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## heasandford (Nov 9, 2021)

trophywench said:


> Bluetooth connectivity between meter and pump with the Combo is normally down to either being too far away from each other, or I have found either replacing the meter batteries solves it  - or just opening the back of the meter and rotating each of the batteries does, cos they last ages longer than the one in the pump.  When you do remove the meter batteries, not a bad idea to 'tweak' the metal connections occasionally.


I have done all this, and it doesn't immediately solve the problem, although the connection does reinstate after a while. Since this happened about 4 times in 3 weeks (always at inappropriate times!) they have sent me a replacement meter which at the moment is fine. 
My Medtrum Demo Patch arrived today!


helli said:


> Thanks for the tag Inka.
> I do use the Medtrum and like the size of the Nano pump and the phone app.
> However, I do not have the CGM - despite the similarity in price with the Libre, my CCG will only fund Libre unless I was pregnant.
> 
> @heasandford I am happy to answer any questions about the pump.


Where do you site your pump? I believe I am a similar shape to you, not much fat anywhere! Does lower back mean upper bottom?? Should I message you privately for more details rather than taking over, or do you think others would be interested?


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## helli (Nov 9, 2021)

heasandford said:


> Where do you site your pump?


I usually site my pump at the front. Either below or above my waist. 
I have placed it lower back (above my belt) but I seems to have less fat there and experienced occlusions. 
I found upper bottom was a problem when carrying a bag and sitting.

Some people use their upper arm. I have not tried it.


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## heasandford (Nov 11, 2021)

helli said:


> I usually site my pump at the front. Either below or above my waist.
> I have placed it lower back (above my belt) but I seems to have less fat there and experienced occlusions.
> I found upper bottom was a problem when carrying a bag and sitting.
> 
> Some people use their upper arm. I have not tried it.


Thanks, ok
Do you get irritating alarms ie at the end of a programme etc? (Sorry if I'm being irritating too!) I have been happy enough with my Roche pump and service, I'm just concerned that the technology has been superceded and it wont be able to be changed for the next 4 years


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## helli (Nov 11, 2021)

heasandford said:


> Thanks, ok
> Do you get irritating alarms ie at the end of a programme etc? (Sorry if I'm being irritating too!) I have been happy enough with my Roche pump and service, I'm just concerned that the technology has been superceded and it wont be able to be changed for the next 4 years


The only alarm I get from my pump is if it has an error and it vibrates.
As the Medtrum is a patch pump, the cost is biased towards the patches so I was led to believe it is easier to swap if you don't like it. I was told to insure my previous (non-patch) pump for £3000 whereas the cost to replace (and insure) the Medtrum pump is only £300. Hence, less of a problem to swap.
And Medtrum upgrade the pump so you are not stuck with it for 4 years if they bring out a new version.


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## heasandford (Nov 12, 2021)

helli said:


> I usually site my pump at the front. Either below or above my waist.
> I have placed it lower back (above my belt) but I seems to have less fat there and experienced occlusions.
> I found upper bottom was a problem when carrying a bag and sitting.
> 
> Some people use their upper arm. I have not tried it.


Thanks, ok
Do you get irritating alarms ie at the end of a programme etc? (Sorry if I'm being irritating too!) I have been happy enough with my Roche pump and service, I'm just concerned that the technology has been superceded and it wont be able to be changed for the next 4 years


helli said:


> The only alarm I get from my pump is if it has an error and it vibrates.
> As the Medtrum is a patch pump, the cost is biased towards the patches so I was led to believe it is easier to swap if you don't like it. I was told to insure my previous (non-patch) pump for £3000 whereas the cost to replace (and insure) the Medtrum pump is only £300. Hence, less of a problem to swap.
> And Medtrum upgrade the pump so you are not stuck with it for 4 years if they bring out a new version.


Thanks. I'm still wondering whether it gives me anything the Roche doesn't. I seem to remember you use a Libre 2 and put in the results for the bolus calculator? Whereas with the Combo the meter results are used to deliver the insulin directly. (I'm not good at decisions these days!)


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## helli (Nov 12, 2021)

heasandford said:


> I'm still wondering whether it gives me anything the Roche doesn't. I seem to remember you use a Libre 2 and put in the results for the bolus calculator? Whereas with the Combo the meter results are used to deliver the insulin directly. (I'm not good at decisions these days!)


I am not familiar with the Roche (I had an Animas prior to the Medtrum).
I do have to manually enter my blood sugar into the Medtrum app but I had to do this with my previous pump and never found it onerous. I assume if you have the Medtrum CGM, you will not need to enter your blood sugars as the CGM uses the same app as the pump.


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## Squirrel768 (Nov 15, 2021)

everydayupsanddowns said:


> Rumours of a phone app for Tandem tSlim continue to circulate. Will be interesting to see what that offers when it eventually launches.


My understanding is that the tandem phone app is currently being trialled in Manchester ... but don't fancy the cost of moving LOL. Hope to get a t:slim in the new year ...


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## heasandford (Nov 15, 2021)

Squirrel768 said:


> My understanding is that the tandem phone app is currently being trialled in Manchester ... but don't fancy the cost of moving LOL. Hope to get a t:slim in the new year ...


But it's still hidden under my clothes!! If they are all using phones or PDAs, why not the bluetooth?? I could say it's because they are designed by men....


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## helli (Nov 15, 2021)

heasandford said:


> But it's still hidden under my clothes!! If they are all using phones or PDAs, why not the bluetooth?? I could say it's because they are designed by men....


A few years back, I asked about having a phone app for my pump and was told there was some health and safety/security concerns which, at the time, the phone manufacturers were reluctant to take on. Apple did not want to be responsible for the wrong amount of insulin to be bolused, for example. 
Given Medtrum have a phone app, I assume this has been overcome but some pump manufacturers may be a bit low in catching up.


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## heasandford (Nov 15, 2021)

Interestingly my diabetes consultant (that makes her sound very unapproachable which she is definitely not) who I had a video meeting with today, suggested that I hang on to my pump for a while. Clearly, things are happening!


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