Four years ago, there was no iPad, or any other brand of tablet computer. Today there are tens of millions of individual devices, produced by a variety of companies. New diabetes technology isn’t on such a fast track, but the pace of innovation is increasing rapidly. Keep this in mind when choosing an insulin pump or CGM. Both kinds of devices usually carry a four-year warranty, and most insurers will refuse to pay for a replacement device any sooner than 48 months. At a retail cost of $5,000 to $7,000, the tab is more than most people can afford to take out of their own pockets.
This is the financial reason for doing your homework when buying a pump or CGM. There are at least six other things to consider that are equally important, all of which revolve around your diabetes needs, lifestyle, and how you feel about having a device attached to you most of the day and night.
Mara Schwartz, an RN and CDE who leads the “Introduction To Pump Therapy” class at Colorado’s Barbara Davis Center for Childhood Diabetes, shares the following insights. Schwartz has lived with Type 1 diabetes for 26 years, pumping for most of those years, so her advice is based on both personal experience and her work with thousands of patients.
1. An insulin pump isn’t a “Get Out of Jail Free” card
The most common misconception about using a pump or CGM is the belief that having one or both devices will instantly make diabetes management easier. While it’s true that pumps and CGMs enable tighter glucose control, they need to be calibrated frequently, and that requires finger sticks. You also need to bring good diabetes habits to the party. “If you aren’t already diligent about taking insulin with meals and checking your blood sugar, a pump can be very risky for you,” Schwartz said. “The responsibilities of diabetes management increase with pumping, because you have no background long-acting insulin in your body. This puts you at a much greater risk for Diabetic Ketoacidosis (DKA) if your pump malfunctions.” With rare exceptions, pumps are not for beginners. The Barbara Davis Center requires most patients to have lived with diabetes for at least 6 months before going on an insulin pump.
2. Tubing or no tubing
If you have an active lifestyle or work in an environment that would put a potentially dangling tube at risk for getting caught or pulled, than a pod might be a better choice than a pump. On the other hand, if you are a very small person, and the idea of having a pod attached to your arm or leg would feel too bulky, than the flexibility of tucking a pump into your pocket or onto your belt might be a better fit.
“Most people see a 20 percent reduction in their insulin needs with a pump compared to using a long-acting insulin,”
3. Total daily insulin needs
For a person whose insulin needs exceed 200 units a day, the Animas pump might not be the best fit because you’d be required to change your infusion site every two days instead of every three. Medtronic’s 723 model is designed intentionally for people who need more insulin, while their 523 model is virtually the exact same pump, but for lower insulin needs.
4. Size of increments in dosing insulin
For a child or adult who has a very high sensitivity to insulin, an adjustment of merely .025 units is useful for better control. Both Animas and Medtronic offer the most flexibility, with small increments in dosing.
5. Waterproof or water-resistant
Animas and Tandem pumps are waterproof, which means they can be completely immersed in water and still function. Other pumps are water-resistant, which does not guarantee that they will work after immersion in water. They require waterproof cases for extra protection. All pump manufacturers explain that the wear and tear of everyday use, accidental bangs or drops, can create cracks in the structure and allow water to seep into areas where it shouldn’t be. This means that even a waterproof pump could experience problems after being exposed to water because of damage to the structure from daily use.
6. Number of tools to keep track of
Some people just prefer the freedom of injecting (see “Give Him that Old-Time Religion,” Insulin Nation, issue 6). If you wear a pump and CGM, only Medtronic offers the two combined into one device. The OmniPod (no tubing!) is a two-device combination: the pod attached to your body holding the insulin and the PDM that allows you to actually press buttons and dose yourself.
“There is no one-size-fits-all option; you, the patient, play the most important role in finding the right pump for you.”
“Most people see a 20 percent reduction in their insulin needs with a pump compared to using a long-acting insulin,” said Schwartz, “so it can take a few weeks to make all the proper adjustments and make time for your follow-up appointments. And there’s always more to learn about the pump itself. You can’t learn it all in one appointment.”
Take your time, and choose carefully. Insulin pumps offer incredible benefits for a living with a disease that requires your constant attention. There is no one-size-fits-all option; you, the patient, play the most important role in finding the right pump for you.
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