# Pump upgrade options/suggestions?



## Phil65 (Mar 12, 2019)

Hi All,
Not been on this sight for ages! Hope you are all well and keeping in range!
Just had my Annual review/pump clinic, all went well A1c of 6.7 (50) and all other results good. I currently have an Insight pump (hate the meter!) previous the spirit combo. I am due an upgrade, one that preferrably has or will have cgm capability. I have to go back next month and get a hands on with the available options. My consultsnt is suggesting the Ypso (maybe because cheaper?) and that the Medtronic 640g is too an expensive option (that was my take on it.)
I do use a lot of insulin and go through a 1.6ml cartridge every day, so the Combo was good with a larger 300ml cartidge. I do like the idea of smartphone/app technology.......any suggestions?


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## everydayupsanddowns (Mar 12, 2019)

For CGM integration the options are changing/improving all the time.

I think your current options are:

MM640G with Enlites
MM670G with newer/better Enlites (only available in a few centres at the moment while the training spreads)
Tandem T:Slim with Dexcom G6 (limited availability at present from what I can tell)

Animas is no longer available.

Dexcom also seem to be partnering Ypsomed for something in the future as are Roche with Eversense, but as far as I know neither of these has a launch date yet.

Alternatively you could look into Loop/OpenAPS/Android APS with either Libre (available to more people on prescription under the new national criteria from April) or various flavours of Dexcom. In which case you might want to go back to Combo, or look at DanaRS, both of which seem to have good integration with Spike App/Nightscout/#wearenotwaiting options.


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## Pumper_Sue (Mar 12, 2019)

I've only read negative reports about the ypso, so do your research if going down that route. 

Ps lovely to see you again Phil


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## Pigeon (Mar 12, 2019)

Just had a look in the YPSO website (have to admit I'd never heard of it!) and it doesn't seem very clear to me whether it has a meter that interfaces with it, bolus wizard calculation etc. Also only 2 basal profiles - I had the 640G and I like the fact you can have multiple profiles - I have a work day and day off one but you can have more than that so e.g. if I'm making a lot of changes I can copy what I have to start with in case I want to revert to it after a few days. I'm very happy with the 640G, have never used the CGM interface though. I'd say do your researcvh and decide what you want then push for it, never mind cost as the difference will be quite small when you think you will keep it for 4 years and the cost to the NHS if your control deteriorated or you had a hypo or DKA resulting in hospital admission as a result of not being able to set things how you need to or if the pump were to fail.


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## pottersusan (Mar 12, 2019)

I would thoroughly recommend the Medtronic 640 with Enlite cgm sensors.


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## Phil65 (Mar 13, 2019)

everydayupsanddowns said:


> For CGM integration the options are changing/improving all the time.
> 
> I think your current options are:
> 
> ...



Thanks for the advice Mike, my team due to cost make the Medtronic probs a no go, don’t like the idea of the ypsomed, so might stick with the Insight even though I don’t use the meter! Have you heard anything positive about the air liquid tandem?
I read your blog yesterday (not been on this site for ages) and so sad to read your end of year blog, hearbreaking.


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## Phil65 (Mar 13, 2019)

pottersusan said:


> I would thoroughly recommend the Medtronic 640 with Enlite cgm sensors.



That is my chosen route but down to money with my CGG/Consultant!


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## Phil65 (Mar 13, 2019)

Pumper_Sue said:


> I've only read negative reports about the ypso, so do your research if going down that route.
> 
> Ps lovely to see you again Phil


Thanks Sue!


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## Phil65 (Mar 13, 2019)

Pigeon said:


> Just had a look in the YPSO website (have to admit I'd never heard of it!) and it doesn't seem very clear to me whether it has a meter that interfaces with it, bolus wizard calculation etc. Also only 2 basal profiles - I had the 640G and I like the fact you can have multiple profiles - I have a work day and day off one but you can have more than that so e.g. if I'm making a lot of changes I can copy what I have to start with in case I want to revert to it after a few days. I'm very happy with the 640G, have never used the CGM interface though. I'd say do your researcvh and decide what you want then push for it, never mind cost as the difference will be quite small when you think you will keep it for 4 years and the cost to the NHS if your control deteriorated or you had a hypo or DKA resulting in hospital admission as a result of not being able to set things how you need to or if the pump were to fail.


My thoughts too.


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## Pumper_Sue (Mar 13, 2019)

Phil65 said:


> That is my chosen route but down to money with my CGG/Consultant!


Hi Phil, I'm assuming you come under Devon CCG and they have no problem with the 640 so if that's what you want go for it. 
Point out ever so polite that's it's you who has to use the pump for the next 4 years and also point out all the negatives of the ypso pump and all the positives for the 640.


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## Phil65 (Mar 13, 2019)

Pumper_Sue said:


> Hi Phil, I'm assuming you come under Devon CCG and they have no problem with the 640 so if that's what you want go for it.
> Point out ever so polite that's it's you who has to use the pump for the next 4 years and also point out all the negatives of the ypso pump and all the positives for the 640.



Haha Sue, yes, I’ve done that! My consultant is just trying to save money but if I self fund CGM it might increase my chances! Fingers crossed.


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## trophywench (Mar 13, 2019)

Point out it isn't saving the NHS a single penny in the long run - dunno how old he is obviously - but possibly longer than his employment by the NHS or anyone else!

A box of 5 Insight pump carts costs more or less the same amount as a box of 5x 3ml pen cartridges or a single 10ml vial of insulin.  They already know everyone on the Insight automatically costs more in insulin - even my Insight where my box of pump carts lasts me 23/25 days compared to your 5 days, costs more than the 1 vial a month (3x 3ml pump reservoirs plus a third of the next one) in the Combo - yet that's perfectly OK apparently.

Does NOT compute Captain!


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## everydayupsanddowns (Mar 13, 2019)

Phil65 said:


> Thanks for the advice Mike, my team due to cost make the Medtronic probs a no go, don’t like the idea of the ypsomed, so might stick with the Insight even though I don’t use the meter! Have you heard anything positive about the air liquid tandem?
> I read your blog yesterday...



Thanks Phil, much appreciated. I only know a couple of people on the Tandem in the UK, but have heard good things. I’ve joined the FB group (mostly US users) to get a feel for experiences of the TSlim in action. There’s also a smartphone emulator app you can download to see how the menus etc behave.


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## trophywench (Mar 13, 2019)

I'm sure someone on here said they had a TSlim and regretted it - ISTR he'd been forced to back on MDI too many times cos it failed that often and he was sick of it ?


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## everydayupsanddowns (Mar 14, 2019)

trophywench said:


> I'm sure someone on here said they had a TSlim and regretted it - ISTR he'd been forced to back on MDI too many times cos it failed that often and he was sick of it ?



I think that was a CellNovo?

TSlim has only just come to the UK (only CE marked April last year).


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## trophywench (Mar 14, 2019)

Could be Mike - I always thought I liked the cut of the Cellnovo's jib the only time I saw it at Warwick Uni on a Diabetes UK Big Day Out - about a month after I took possession of my first pump - 2009 ish?


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## Phil65 (Mar 14, 2019)

everydayupsanddowns said:


> I think that was a CellNovo?
> 
> TSlim has only just come to the UK (only CE marked April last year).



The TSlim looks good, 300ml cartridges which suits me, can use with/without CGM, like the update through app, mmmmmm dilemma, I am meeting Medtronic rep soon as I have said I will self fund CGM but the 640 works with and without CGM but the 670 only works with CGM. Not sure what to go for!!


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## Pumper_Sue (Mar 15, 2019)

Phil65 said:


> The TSlim looks good, 300ml cartridges which suits me, can use with/without CGM, like the update through app, mmmmmm dilemma, I am meeting Medtronic rep soon as I have said I will self fund CGM but the 640 works with and without CGM but the 670 only works with CGM. Not sure what to go for!!


Hi Phil,
as far as I know you can use the 670 without sensors, (manual mode) But to have the 670 in this country you have to agree to buy a years supply of sensors. That's the way I have read it anyway


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## HOBIE (Mar 15, 2019)

I am very happy with my 640 but would love the 670. Good luck


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## spiritfree (Mar 24, 2019)

Hello Phil. I had pump changed, just before Christmas, from the accu chek insight. I have got the Medtronic 640 which can use sensors with. The customer service is good. The pump is a lovely little pump. I would really recommend this pump.  I hope you are fit and well.


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