Insulin pump opinions & recommendations

Hello @kenag, I saw your post and am glad to offer my input. It’s great you are doing your research before committing. You seem to be well prepared to get started with treatment. I’ll just add that starting treatment with a pump before learning Multiple Daily Injections treatment is difficult for me to fathom. (Plus, if you have a pump failure and have to go on injections temporarily, you’ll need to know how to inject. MDI involves long acting insulin for around the clock coverage plus fast acting insulin for meals and corrections. But, you can discuss it with your endo team or a certified diabetes educator. Learning MDI first would have benefits, imo.)

I’ve been type 1 for over 25 years. I’ve been on a Medtronic pump with integrated CGM for about 7 years. The Medtronic 780 G4 is awesome. I stay in Smart Guard or automated mode which provides you with the amount of insulin it calculates you need based on its algorithm determined by learning your needs. So, it sets my basal dosage and provides micro doses to correct as necessary. I input my carbs and it determines how much I need based on carb/insulin ratio and current blood sugar level. Right now it’s G4, but will soon transition to Simplera CGM. Great reviews. Of course, it alerts for highs and lows. My last A1C was 6.7 and I know I can do even better.

I would encourage you to get any kind of cgm to use as you start insulin. That will give you confidence to dose appropriately. If not, set an alarm to wake you up to finger stick at least twice during the night, until you confirm you feel lows. I always did and would awake abruptly. Keep juice by your bed and always a sugar source within reach.

I think a lot can be gained by being active in the online diabetes community. I know of a video that discusses the various pump options that is hosted by 2 type 1 endos. I’ll provide you links if you PM me. There’s a lot of opinions and information out there. It helps….especially the support. Good luck!

Thanks for all the great info. Pump failure is probably another “plus” for the omnipod since you can just put on another one and you’re running again.
I’m on the Libre 3 CGM right now but I’m not that fond of it. Its limited iOS integration, lack of Watch support, and archaic UI is pathetic. Thus the switch to G7.

@kenag I was diagnosed with type 1 diabetes at age 18. I’m 68 now. (Too much history in those 50 years to go into much detail!)
I had a Medtronic pump quite a long time ago. It wasn’t a great experience and I ended up switching to multiple daily injections.
About 2 - 3 years back I got a continual glucose monitor a Dexcom G6. 1 - 2 years ago I got an Omnipod 5 pump. These were recommended by a Mayo endocrinologist.
Now I am considering upgrading to a Dexcom G7.

I was first diagnosed with type 1 at age 78, and I live alone. I was never given the option of a pump but went directly to multiple daily injections of insulin and was given a Libre sensor. At this point in my life (age 83), I have no interest in having a pump or learning how to use it. Given my lifestyle (not much!), checking my meter and giving myself a painless injection gives me something to do and gives me control over my condition. Many people like having a pump, so maybe you will be one of them. I agree with Celia about learning MDI before going on the pump.

My husband has had Type 1 diabetes (“TD1”) for 60 years and we have been married for 46 of those years! So even though I am not TD1, I have a few thoughts I feel competent to pass along.

I agree with the comments here to get used to MDI before you select your pump….not only because it’s important to have an MDI regimen that you feel comfortable with….but also so you will know your insulin: carb ratio and your correction factor. I suggest this because some pumps will have lower insulin capacity than others. Thus, if you find that you need a lot of insulin to cover your carbs, you may want to choose a system that holds more insulin and requires fewer site or device changes. For example, the Tandem Mobi that you are considering only holds 200 units of insulin, the Omnipod 5 also holds 200 units of insulin and the iLet holds even less at 180 units of insulin….whereas the Tandem T:Slim X2 insulin pump can hold up to 300 units of insulin per cartridge fill.

As for the pump that you choose, check with your Endo or Diabetes Educator to see if they have a “loaner” pump or pumps that you can try. If that is not an option, contact the companies themselves, explain that you are “in the market” and ask if you can try one of their pumps for free for 30 days or so. All that they can say is no!

And check out FB and Reddit forums. There are likely groups devoted to each of the pumps that you are considering. My husband uses a Tandem T:Slim X2 and we have picked up a lot of good tips from the Tandem FB and the Tandem sub-Reddit groups. An advantage to the Tandem pump is that its software can be updated by downloading from Tandem’s website. Just something else to consider.

I'll throw my 2 cents into the mix:
I've been on pumps for 22+ years. Been type 1 since 1970. I'm totally sold on insulin pumps. And a pump connected to a CGM brings it up to another level. Extremely easy to take the meal time boluses. No carrying alcohol swaps, needles, pens, insulin, etc. Count the carbs, input carb number and it is done. The pump calculates the amount of insulin. Same for corrections.
Tubed or tubeless ? General consensus is for tubeless from what I've seen. I've always had tubed pumps and I don't see myself changing this coming November. Failure of the pump itself is extremely rare. I have had 3 pumps changed out by Medtronic during the 17 years I used Medtronic. Weren't total failures either. Like an error code given. Pump was still working. Called Medtronic and I had a new pump the next morning in each case. Customer service was excellent. Coming up on 5 years with my Tandem t:slim with Control IQ and have not had a failure of the pump at all. The issues that are for me is the interface between the infusion set and me. Bent canula in the infusion set or placed in an area that doesn't want to absorb insulin for whatever reason. Usually scar tissue from years of injections and infusion sets. Easy to change an infusion set with a tubed pump. Tubeless requires a whole new pod and wasted insulin. Plus contacting the company to get a replacement pump.
I heard of the iLet pump about a year ago and it is pretty much a hands free device. No carb counting. Just input if the meal is small, medium or large. That's where it takes time for the pump to learn what your definition is of meal size . That pump must be used with a CGM. And my understanding is, perhaps the best a1c one can achieve with the ilet system, is around 7. Which is an average of blood glucose of 154. Perhaps someone on the iLet pump can chime in with better insight.
You mentioned that the tendency for more lows with the Mobi. The Mobi runs the same algorithm as the t:slim with CIQ. I have not been awaken with a low blood sugar since getting the t:slim in November, 2020. Morning glucose readings 90-115. YouTuber "Diabetec" last video was using the Mobi. His likes and dislikes. But he has always been a tubeless guy and is sponsored by Omipod. Though I think his reviews are fair. He doesn't like some of the things about Omipod either.
BTW: My Mayo Endocrinologist recommended the Tandem pump to me. Really glad he did because I wanted to stay with Medtronic. Medtronic pumps have been very good but their CGM's have not been getting good reviews at all. Hopefully the Medtronic users with get a decent CGM. Believe Medtronic is getting an agreement with a proprietary Libre sensor.
The best to you in your selection process. Take care.

Excellent point on that YouTuber and his sponsor. That’s probably where I got it from. Thank you for the great input.