# pump thoughts please, have I done my homework right do you think?



## Saoirse (Mar 18, 2022)

Dear all

Hi!  T1D for three years, on Dexcom G6 and just got (amazingly) approved for a pump.  I've attended the info session but not sure what I should choose - I've read every thread about pumps and I get there is no 'best' one, just the best one for you.  As i'm going to be wearing this 24hours a day for the next 4 years it feels like a *big* decision to get right, so I'd be so grateful if any experience pump users wouldn't mind reading and could you please check my thinking and let me know if I have missed anything?

My priorities:  discrete, links to a phone, can run closed loop.  
Pumps offered:  Medtronic 780G, Dana I, Tandem T slim, Medtrum Nano

Medtronic:  looks big and bulky, needs to run Medtronic cgm  -haven't asked yet  if I can have their cgm but I like the G6 and not keen to change
Dana I - small light and can be controlled via phone. can loop but only with camaps, only 4 basal patterns
Tandem - looks dinky but can only be controlled from handset, can loop, 6 basal patterns 
Medtrum - patch pump which I would ideally like but only loop with their sensor which is not offered - therefore no loop

On the basis of all of the above, I am coming down on the side of the dana, does that make sense please?  Have I missed any major drawbacks or is there anything else I should consider?  thanks so much!


----------



## helli (Mar 18, 2022)

Hi @Saoirse congratulations on your pump approval and great research. Your priorities are very similar to mine. 
Looping was not an option for me when I last changed.

I currently have the Medtrum Nano. I like the discreteness and the phone app. I was one of the first to migrate from the A6 pump to the Nano and they had some problems with the early releases. These seem to be resolved now. I used to have a tubey pump and, although I never had the problem of catching the tube in a door handle (it is pretty easy to hide away), I am happier with a patch pump. 
I am currently trialling the Nano CGM. It is too early to draw any conclusions yet. It provides auto-suspend for low blood sugars today and there is a trial to use closed loop to manage high levels.  Like you, my clinic will not fund the Medtrum CGM but I am nervously optimistic that there may be some changes in their policy with the currently draft NICE recommendations due to be published before the end of this month. I don't expect my CCG to suddenly find the funds for CGMs for all their patients with Type 1 on the 1st April but it may be something you want to consider.


----------



## trophywench (Mar 18, 2022)

Exactly how many different basal patterns does one person ever need? My life and activity levels have never varied that much day to day - on a regular basis - that I've ever made much use of different basal patterns and have never used more than two!    

 AFAIK all of em have the ability to accept a TBR however often you happen to need one - which for me ever since I started on a pump has been the thing I'd miss the most were it not there.


----------



## Saoirse (Mar 18, 2022)

helli said:


> Hi @Saoirse congratulations on your pump approval and great research. Your priorities are very similar to mine.
> Looping was not an option for me when I last changed.
> 
> I currently have the Medtrum Nano. I like the discreteness and the phone app. I was one of the first to migrate from the A6 pump to the Nano and they had some problems with the early releases. These seem to be resolved now. I used to have a tubey pump and, although I never had the problem of catching the tube in a door handle (it is pretty easy to hide away), I am happier with a patch pump.
> I am currently trialling the Nano CGM. It is too early to draw any conclusions yet. It provides auto-suspend for low blood sugars today and there is a trial to use closed loop to manage high levels.  Like you, my clinic will not fund the Medtrum CGM but I am nervously optimistic that there may be some changes in their policy with the currently draft NICE recommendations due to be published before the end of this month. I don't expect my CCG to suddenly find the funds for CGMs for all their patients with Type 1 on the 1st April but it may be something you want to consider.


Thanks so much for your thoughts and feedback - I'm following your thread on the cgm medtrum with great interest.  At the info day it seemed partly it was because of supply issues that they would not offer it.  Maybe this will get resolved, but I got the impression they were not at all keen to.  All other things being equal i'd prefer a patch (and yes I know how lucky I am to have this choice), but I think it won't be an option this time.


----------



## Sally71 (Mar 18, 2022)

The Tandem links with Dexcom G6 so you could keep your existing sensors if you had that one.  My daughter has that one running Basal IQ (stops basal if it predicts that you are going hypo and resumes it once you are rising again) and we are about to change over to Control lQ (adjusts basal automatically to try to minimise highs as well as lows).  It will also work as a stand-alone pump without the sensors. 
We had the Accu Chek Combo before which was remote controlled from the blood test meter, thought we’d really miss the remote control aspect but I don’t think my daughter finds it much bother at all having to do everything on the pump itself.  You can download an emulator onto your phone which turns your phone into a pretend pump so that you can learn how to use it.
Good luck and I hope you are happy with whichever you finally choose - you probably will be because it’s your first pump and you don’t know any different!


----------



## Lucyr (Mar 18, 2022)

What’s the reason you need it to link to a phone? That seems the main restriction on your choices, and sounds like you’re prioritising “links to a phone” over “can link with dexcom cgm”. Is there a reason for that priority?


----------



## Pumper_Sue (Mar 18, 2022)

Saoirse said:


> Dana I - small light and can be controlled via phone. can loop but only with camaps, only 4 basal patterns


Why would you want any more basal patterns? Most that is on pumps is 4 anyway


----------



## helli (Mar 18, 2022)

Pumper_Sue said:


> Why would you want any more basal patterns? Most that is on pumps is 4 anyway


I use more than 4 basal patterns depending upon what exercise I am doing (climbing affects my levels differently to cycling, for example), how long since I exercised (I need less the day after exercise), time of the month, normal and a spare I use when i tweak one of the other patterns


----------



## helli (Mar 18, 2022)

Lucyr said:


> What’s the reason you need it to link to a phone? That seems the main restriction on your choices, and sounds like you’re prioritising “links to a phone” over “can link with dexcom cgm”. Is there a reason for that priority?


Personally, I wouldn't prioritise phone control over closed loop but it definitely adds to the discreteness, especially when you have a CGM on your phone and it is much more convenient than carrying a separate PDM.


----------



## Lucyr (Mar 18, 2022)

helli said:


> Personally, I wouldn't prioritise phone control over closed loop but it definitely adds to the discreteness, especially when you have a CGM on your phone and it is much more convenient than carrying a separate PDM.


Would you not have to carry a battery pack if your phone was controlling both cgm and pump to make sure phone battery didn’t run out? Plus meter and carbs and spare pump/injection supplies… by the time you’re carrying that lot I’m not sure a seperate pdm could add that much?


----------



## helli (Mar 18, 2022)

Lucyr said:


> Would you not have to carry a battery pack if your phone was controlling both cgm and pump to make sure phone battery didn’t run out? Plus meter and carbs and spare pump/injection supplies… by the time you’re carrying that lot I’m not sure a seperate pdm could add that much?


Writing from actual experience of using and insulin pump, no I do not need to take all these things with me for a few hours.
For a shopping trip or gym session or a drink down the pub, I take phone and GlucoTabs which fit in my pocket.
if I am going out for longer or if I am driving, I take a bag and with meter and strips. I do not need a pump spares or insulin pens, I take a syringe in case my pump fails.
The same for a day in the office which, as I usually work from home means a 2 hour train journey each way.
I only need to carry all the gubbins you mention if I am away over night.

i never took a bag with me for a night out until I had diabetes. I am pleased to return to my “old ways” with a phone controlled pump.

And a PDM is not just another thing to carry, it is also another thing to lose.


----------



## Saoirse (Mar 18, 2022)

trophywench said:


> Exactly how many different basal patterns does one person ever need? My life and activity levels have never varied that much day to day - on a regular basis - that I've ever made much use of different basal patterns and have never used more than two!
> 
> AFAIK all of em have the ability to accept a TBR however often you happen to need one - which for me ever since I started on a pump has been the thing I'd miss the most were it not there.


That's great you have a solution that has worked/is working well for you.  Diabetes and lives are wondrously diverse and different people may                                                                                                                                                                                                                                    need different things 


Sally71 said:


> The Tandem links with Dexcom G6 so you could keep your existing sensors if you had that one.  My daughter has that one running Basal IQ (stops basal if it predicts that you are going hypo and resumes it once you are rising again) and we are about to change over to Control lQ (adjusts basal automatically to try to minimise highs as well as lows).  It will also work as a stand-alone pump without the sensors.
> We had the Accu Chek Combo before which was remote controlled from the blood test meter, thought we’d really miss the remote control aspect but I don’t think my daughter finds it much bother at all having to do everything on the pump itself.  You can download an emulator onto your phone which turns your phone into a pretend pump so that you can learn how to use it.
> Good luck and I hope you are happy with whichever you finally choose - you probably will be because it’s your first pump and you don’t know any different!


Thanks so much for this - really great to hear your daughters experience and I suspect you are right, just go with the what seems like the best option, and it will all be new and interesting!


----------



## Saoirse (Mar 18, 2022)

Lucyr said:


> What’s the reason you need it to link to a phone? That seems the main restriction on your choices, and sounds like you’re prioritising “links to a phone” over “can link with dexcom cgm”. Is there a reason for that priority?


Because I am used to using my phone to run the D6 amd I like the normality of it. Also I spend a lot of my life teaching or in meetings and I don’t want to be fishing out a pump when I could use an app on the phone which is less likely to be noticed.


----------



## everydayupsanddowns (Mar 21, 2022)

I don’t think there is a ‘wrong’ first pump. Any one that you choose will do the same main things, and each will have some little foibles that irritate you along with some features and functions that you think are brilliant.

Have you asked your clinic which they support? Not all clinics offer all pumps/models.

The tSlim and Dexcom G6 is probably the ‘best’ combination of tech I’ve ever had. There is a planned smartphone app thatbis supposed to launch sometime soon - but ‘soon’ in diabetes tech can be a pretty elastic term!

If you’d like a look at the menus/interface on the tSlim there’s an emulator you can download for your smartphone which allows you to play with it as if it were a pump. 

Good luck with your decision!


----------



## Saoirse (Mar 21, 2022)

Dear All, Thanks so much for your thoughts and feedback - I've spent the last couple of days reading pumping insulin and watching youtube (I recommend Nerdbetic for all things tech and She'sdiabetic (for a really good review of tslim and medtronic). The pumps in the first post are the ones my clinic offers - I would love an omnipod but its not possible, so I'm heading for a Dana+dexcom+loop.   Really looking forward to getting started, though anticipating some bumps along the way


----------



## Saoirse (Mar 21, 2022)

everydayupsanddowns said:


> I don’t think there is a ‘wrong’ first pump. Any one that you choose will do the same main things, and each will have some little foibles that irritate you along with some features and functions that you think are brilliant.
> 
> Have you asked your clinic which they support? Not all clinics offer all pumps/models.
> 
> ...


Thanks especially for the tip on the emulator - am going to mention it to my clinic to get them to include it in the powerpoint presentation - it was really helpful in deciding


----------



## everydayupsanddowns (Mar 21, 2022)

Saoirse said:


> Thanks especially for the tip on the emulator - am going to mention it to my clinic to get them to include it in the powerpoint presentation - it was really helpful in deciding



Hope the Dana works well for you 

I know @Inka really rates it.


----------



## Inka (Mar 22, 2022)

Saoirse said:


> Dear all
> 
> Hi!  T1D for three years, on Dexcom G6 and just got (amazingly) approved for a pump.  I've attended the info session but not sure what I should choose - I've read every thread about pumps and I get there is no 'best' one, just the best one for you.  As i'm going to be wearing this 24hours a day for the next 4 years it feels like a *big* decision to get right, so I'd be so grateful if any experience pump users wouldn't mind reading and could you please check my thinking and let me know if I have missed anything?
> 
> ...



@Saoirse I have a Dana RS and it’s fabulous. I’m not sure about the Dana i but the RS can loop with OpenAPS too, and, indeed was developed with the help of #wearenotwaiting (loopers). The pump itself is very robust, simple to use, and over the three years I’ve had it, I’ve had zero problems. It also looks as good as the day I had it whereas others pumps I’ve had have got worn.

The AnyDana phone up is brilliant. I never get my pump out as I can do everything on the app. It makes it so easy to change the basal, for example. I find 4 basal patterns is plenty.

I ruled out Medtronic because of their customer service, the look of the pump, and the fact it wasn’t very robust. I was also offered the T Slim but ruled that out because I absolutely hate the idea of having to recharge it every day. I’ve never had a Medtrum but I don’t like patch pumps because there are less areas to place them, they get in the way of clothes because, unlike a tubed pump, you can’t move them round as suits you, and I just don’t think the tech is as good. I also need to be able to use a variety of different cannulas.

So, yes - IMO you’ve made a good choice if you’re going for the Dana! It’s my favourite of the many pumps I’ve had.


----------



## Saoirse (Mar 22, 2022)

Inka said:


> @Saoirse I have a Dana RS and it’s fabulous. I’m not sure about the Dana i but the RS can loop with OpenAPS too, and, indeed was developed with the help of #wearenotwaiting (loopers). The pump itself is very robust, simple to use, and over the three years I’ve had it, I’ve had zero problems. It also looks as good as the day I had it whereas others pumps I’ve had have got worn.
> 
> The AnyDana phone up is brilliant. I never get my pump out as I can do everything on the app. It makes it so easy to change the basal, for example. I find 4 basal patterns is plenty.
> 
> ...


Thanks Inka!  Great to hear you've had such a postive experience, that's really reassuring - I'm really looking forward to starting on the pump now


----------



## meha1209 (Mar 23, 2022)

Hello! 
Congratulations on being approved for the pump! I was curious about the process on getting the approval since I have been considering getting a pump too. Is it a lengthy/ difficult process? I would really appreciate if you could shed some light on it. Thank you!


----------



## Inka (Mar 23, 2022)

Have you spoken to your consultant @meha1209 ? And have you looked at the NICE guidelines to see if you would qualify? Those are the first steps.


----------



## helli (Mar 23, 2022)

meha1209 said:


> Hello!
> Congratulations on being approved for the pump! I was curious about the process on getting the approval since I have been considering getting a pump too. Is it a lengthy/ difficult process? I would really appreciate if you could shed some light on it. Thank you!


The best way to find out is to ask your DSN as it varies greatly by CCG.
Probably worth checking the NICe guidelines to build your case.


----------



## meha1209 (Mar 23, 2022)

Inka said:


> Have you spoken to your consultant @meha1209 ? And have you looked at the NICE guidelines to see if you would qualify? Those are the first steps.


Hi! I did take a look at the guidelines but from what I understood, a lot of it was about poor glycemic control. And while my numbers aren't supremely great, they aren't too bad either. Neither do I have hypo unawareness. So was wondering if that disqualifies me from getting a pump. I don't have an appointment with my Diabetes anytime in the next 2 months, so will probably have to wait it out. Thanks!


----------



## meha1209 (Mar 23, 2022)

helli said:


> The best way to find out is to ask your DSN as it varies greatly by CCG.
> Probably worth checking the NICe guidelines to build your case.


Will do! I will have to wait for my next appointment though  Thanks!


----------



## Saoirse (Mar 23, 2022)

meha1209 said:


> Hello!
> Congratulations on being approved for the pump! I was curious about the process on getting the approval since I have been considering getting a pump too. Is it a lengthy/ difficult process? I would really appreciate if you could shed some light on it. Thank you!


Hi -  basically at my review having talked through things, a pump was suggested to me, which I was surprised about. They asked me to think about it and then I confirmed I would like to be considered for funding at MDT meeting.  That took about  2 weeks (apparently this meeting happens once a month), then another two weeks or so for the information session.  Actual pump start is slated as May/June.  So really the timeline has been (unusually?) fast.  As Inka and Helli suggest having a chat to your DSN/consultant is good idea and I guess have a look at the guidelines too.  Good luck!


----------



## Inka (Mar 23, 2022)

meha1209 said:


> Hi! I did take a look at the guidelines but from what I understood, a lot of it was about poor glycemic control. And while my numbers aren't supremely great, they aren't too bad either. Neither do I have hypo unawareness. So was wondering if that disqualifies me from getting a pump. I don't have an appointment with my Diabetes anytime in the next 2 months, so will probably have to wait it out. Thanks!



I’m not sure if “disqualify”is the right word, it’s more that pumps are an extra for those who can’t solve their problems by other means. That’s one of the things you have to show - that you’ve tried a number of things to solve your problem and that they haven’t worked.

It’s worth mentioning to your team though, so don’t be put off asking for more information. At least then you’ll know where you stand


----------



## SB2015 (Mar 24, 2022)

Hi @Saoirse You have certainly done your homework. 

I am currently using the Medtronic 780 in a closed loop. That would now be my priority in choosing a pump as looping has meant I just don’t have to think about Diabetes as much, since my pump is continuously sorting things out in the background. 

Having said that my first pump was way before looping was available and I thought just having a pump was fab as it gave so much greater flexibility. I was another bigger user of different profiles for days when Temporary Basal Rates (TBR) weren’t enough. I still only used three regularly . Whatever facilities your pump has you will get used to if and like it. 

Let us know how you get on.


----------

