10 things you need to know before shopping for a pump

buying a pump

Deciding to use an insulin pump for the first time can be exciting and daunting.  Whether you have been using insulin for years or are newly diagnosed, you have most likely heard all sorts of good…and bad things about insulin pumps.  As you begin your research to find the best insulin pump for you, you quickly find yourself in wading in a foreign language.  Let us translate some of the things you need to know when shopping for an insulin pump.

What is a basal rate?

One of the first terms that you hear is “basal rate”.  This is your background insulin.  It will replace the long-lasting insulin that you are currently using.  On injections, you inject a set amount of insulin into your body once or twice per day. 

With an insulin pump, you will set basal rates that will deliver that insulin in tiny amounts throughout the day.  These amounts can be extremely small or they can be larger depending on age, insulin sensitivity, and other factors that your diabetes team will help you with.

To give you a rough idea of what your basal needs will be, total up all of the long-acting insulin that you use in a 24-hour period.  Take that amount and divide it by 24.  This will give you a base idea of what you will require. 

A child who is only using 12 units of background insulin would need basal rates of at least .5 units per hour (and perhaps smaller).  An adult who is currently injecting 36 units per day would not be as concerned about small basal rates. Again, your exact rates will be set with the help of your diabetes team but this will help you to understand if you need to be concerned about smaller or larger rates.

What does it mean to bolus?

Another thing that you will often hear is the term “bolus”. That is the amount of insulin that is used to cover meals and correct high blood sugars.  If you have been on multiple injection therapy, this is the amount of rapid-acting insulin that you have been using.

For children, there is often a need for very small bolus amounts.  They might require .05 of a unit or less so small bolus rates are vital. In the case of teens, there can be a need for much larger bolus dosing.

Can you change the bolus delivery rate?

Large bolus dosing leads us to our next term–rate of delivery or delivery speed.  If you require larger amounts of insulin at one sitting (think pizza or pasta meal), you may prefer an insulin pump that will deliver the bolus to you at a slower speed rather than all at once.  Some people experience discomfort with large bolus amounts. 

Remember that your diabetes may vary so what is important for one person may not be a concern for another. Choice is important!

Do you want to be attached to your insulin pump 24/7?

insulin pump

Some people are okay with a tubed insulin pump.  They may even feel comforted by its presence.  Other people hate being attached to something.  You have to decide which you prefer—infusion sets and tubing or a patch insulin pump and PDM. 

How much insulin will you use over three days?

Insulin pumps require that you fill your pod/cartridge/reservoir with insulin on a regular basis. Pods currently hold 200 units of insulin. The Medtronic 670G and the Tandem t:slimX2 both hold 300 units.

Some people are okay with changing cartridges and infusion sets at different times, others want to do it at the same time. Either way, if you are using larger amounts of insulin, you may want to consider a larger insulin container.

Will you be using a continuous glucose monitor?

A Continuous Glucose Monitor or CGM is a device that constantly monitors your blood sugar levels.  If you are already using a system, you may want to know if it works with an insulin pump. Stand alone devices can be used in conjunction with the insulin pump of your choice but only specific brands “speak” to specific pumps at this time. Right now, the t:slim™X2 works with a Dexcom® system.  The 670G works with the Medtronic® Elite system.  If you are using the Libre™ Flash Monitoring system, there is currently no insulin pump that links directly to this device.

What is your body type?

infusion sets

Are you thin or do you have a bit of extra body fat? Are you athletic or pregnant? All of these questions are important when deciding on the best infusion set to use with your new insulin pump. 

Each pump company has their own names for the various infusion sets but infusion sets basically fall into three categories.  There are sites that go straight in (90-degree sites).  There are infusion sets that can be placed on an angle up to 30 degrees. Finally, there are 90-degree steel infusion sets.  Each infusion set works best with a specific body type. Make sure to discuss these options with your diabetes educator or pump trainer.

It is important to consider if you will need a certain type of infusion set before you purchase an insulin pump. Not all pumps currently allow you access to all types of infusion sets.  Because you will be wearing your site 24/7, you want to make sure that you have the most comfortable fit for your body type and lifestyle.

Are you visually impaired in any way?

The lighting of the screen and its font size can be something to consider when choosing the right insulin pump.  They can have a touch screen, a touch bolus or physical buttons that have to be pressed to deliver insulin and change settings.  It is important for you to feel comfortable with which ever option your insulin pump has.  You want to be able to view it in all lighting situations including when responding to those 3 am alarms.

Do you need to lock your pump?

Will the insulin pump be used on a small child? If so, you may want to ensure that you can lock them out of the insulin pump settings.  Buttons and touch screens are often relatively easy to use but you don’t want small children to be able to easily access their touch bolus and accidentally deliver insulin unsupervised.

What are the payment options?

If you don’t have private or public insurance coverage for your insulin pump, you will want to discuss payment options with your rep.  Do they have a payment plan? How does the plan work?

If you have insurance, will they work with your insurance company on your behalf or will you have to be the go-between?

diabetes costs

Purchasing an insulin pump is a huge decision. It is important that you understand the key feature before you begin your search. 

Diabetes Advocacy has helped to make this a little easier for you by creating a 20-page ebook with all of the above questions and more.  This downloadable document gives you things to think about before you purchase your insulin pump as well as prompts to ask your pump rep at your first meeting.

pump book

An insulin pump is a long-term commitment. You will be with your pump 24/7 for the next 4-5 years. It is important that it fits your needs and your lifestyle.

Take me to the insulin pump ebook.

How to manage airport security with an insulin pump and CGM

traveling with your insulin pump and CGMIn May of 2012, after reading about a friend having problems getting their insulin pump through security at a US airport, I did some research on the subject.  Should you put your pump through the x-ray machine? Can you wear your CGM through a full-body scanner? There were a lot of questions in 2012 and there still are in 2018 so I reached out to a few friends in the industry to see if things have changed at all.  Here is what you need to know when you are traveling with an insulin pump or CGM.

Get your complete guide filled with tips and to-dos when traveling with diabetes. 

If you wear a Dexcom®

The Dexcom® G5 is cleared to take through metal detectors, be hand-wanded and be worn during flights. There are a few situations to be concerned about, however.

NEVER put your receiver or extra sensors through an x-ray machine.  Ask the security personnel to do a hand-check of the items to avoid permanent damage of these devices.

According to Dexcom®, the effects of full body scanners on CGM components have not been studied. It is therefore recommended that you do not take your Dexcom® through one.

Once you are through security and on your plane waiting for takeoff, make sure to set your app to airplane mode, keeping the bluetooth on and leave your receiver turned on.

If you use FreeStyle Libre

The Dream Big Travel Far blog contacted the people at FreeStyle and asked what the guidelines were for air travel with the Libre.  This is what they reported.

“We recommend the user notify security personnel when going through airport security screening. the user can go through X-ray machines while wearing a sensor. We recommend the reader be powered off during a flight and not used for scanning a sensor. However, the strip port on the reader can be used to take blood glucose or ketone readings during flight. Turning on the reader with the Home Button will activate the radio. The user must turn on the reader by inserting a test strip so as to not activate the radio.”

If you wear an Omnipod

Good news for Omnipod users! You can wear the pod through the metal detector, x-ray machines and full body scanners with no worry.  The PDM can also go through the X-ray. Insulet does recommend that if you are selected for a “pat down” you disclose that you are wearing the pod.

If you wear a Medtronic® insulin pump

Medtronic® insulin pumps can be worn through metal detectors and be wanded.  They should NOT be sent through x-ray machines however.

Medtronic® also notes that your sensor and transmitter must be removed if you are going through a full-body scanner. If you do not want to remove your sensor, you can ask to be pat down instead.

If you wear a Tandem® t:slim X2™ insulin pump

Tandem® t:slim X2™ can be worn through metal detectors and can be wanded.  They should not be sent through x-ray machines.

Changes in air pressure cause bubbles to form in insulin, and the related expansion can cause unintentional insulin delivery.  This is NOT a problem in the Tandem pump.

The pumping mechanism used in Tandem pumps isolates the insulin reservoir (bag) from the user line, so if bubbles are formed in the cartridge due to pressure changes, the internal bag will expand, but no insulin will be delivered to the user from the reservoir.  The only volume in line with the user at any given time is the insulin in their infusion set and cartridge tubing, and the contents of the 0.3 unit Micro-Delivery chamber.

There is no need to turn off your t:slim X2™ during takeoff or landing.  This system runs on Bluetooth which can operate during flights. If you are also using a Dexcom CGM that you are viewing with your smartphone, turn the phone on airplane mode and then turn on Bluetooth.

If you wear an Animas® insulin pump

A detailed list of where you can and cannot wear your Animas® pump can be found in my May 2012 post.

Animas® insulin pumps can be worn through metal detectors and can be wanded.  They should NOT be sent through x-ray machines.

Animas® pumps should not be worn through full-body scanners.

Click here for more tips on traveling with diabetes!

Sad to see Dex Leave

Ready to use DexoCom!
Ready to use DexoCom!

As I mentioned, we were privileged to be able to try using a DexCom for seven days over the Christmas holidays. I was super excited. My son however was not exactly thrilled but willing to see what all of the fuss was about.

I am pretty sure I allowed him to put down his suitcase and open his Christmas gifts, but I don’t believe I gave him time for much else before we learned how to start the DexCom process.  I had been encouraged to watch the video a few times before actually inserting the device, so I had my son sit with me as we began.  The video paused and allowed you to do a step before continuing.  This was very user-friendly.

As we reached the insertion stage, my son suggested that we stop a bit and replay multiple times before injecting him with anything!  I agreed.  I was terrified that I would mess up.  Not only are these sites expensive, but we only had one to try and our rep was away enjoying the holidays.  I had to be perfect!

I was finally confident that I should be able to do this. My son was not exactly feeling the same level of confidence but eventually relented and allowed me to jab his body with the large contraption. It was a success! The sensor was in his body and he had not died. I asked him about the level of pain he experienced.  (It didn’t look like a big needle so I never even suggested asking him if he wanted to numb the area–bad mom)  He said it was close to having a site inserted–maybe a little less painful.  I was psyched!

Next came putting on the transmitter.  That was a challenge. I understand that it gets easier with time but I will say that figuring out how to get it to attach the first time took us a bit.  Once it was on, it was time to wait our two hours before the first calibration.  I was super excited to see what would happen.  My son was still not as thrilled but glad to no longer have his mother poking at his belly.

Two hours later we did our first calibration and my son resumed his normal activities. One of the first thing he did after putting in the sensor was to enjoy a nice jacuzzi tub.  The sensor is waterproof but I was still having a mild heart attack wondering if it really could take this.  I told my son that all was fine as long as the receiver stayed dry…but I was still nervous.

Would the jacuzzi mess things up? Despite telling him that he didn’t have to test as much with the DexCom, I made him test a few times just to prove to myself that it really was as good as everyone said.  The research didn’t lie.  The end users didn’t lie.  This little machine was awesome!

The accuracy was not perfect the first few days.  I had been told that the DexCom accuracy was not as great on the high-end as it was on the low-end.  We found that to be true.  When it said he was high, he was often higher still. That didn’t bother me though. It showed me a trend. He was high and going higher (we had a bad site).  It really didn’t matter if he was 15 or 25 (270-450). He was high and needed a correction. A finger stick gave us where to correct from but the DexCom told us if we were on the right track.  For me, the combination was amazing!

image
Yes! It really did say he was dropping!

During the trial period, we had extreme highs (First lesson–do not calibrate when high. Since the accuracy already isn’t great, your sensor will be off a bit more than when its calibrated at reading closer to in range).  We also had lows.  The first low my son had while wearing the sensor came as we arrived at our cabin. We were unpacking our gear and of course he couldn’t help.  He was low.

“Really? Is it working? Did it tell you that you are low? Can you feel it? Are you actually low?”  My son scarcely avoided an eye-roll and passed me his receiver. It read low! There were downward arrows! He said that yes he felt low and we treated him.  The DexCom then told us that he wasn’t falling any more.  He could help us get the rest of the gear out of the truck and he would be fine! Oh happy days!

Yes, I loved the DexCom.  As we became more familiar with it, the accuracy also improved. I am not sure if  the sensor was working better with his body or if the increased data that it had to work with through a few days of calibration improved the accuracy but it was wonderful!

At night, I would get up and take his receiver into my room so that he could have a break from diabetes care.  It sat on my night side table and instead of getting up and poking him, I could roll over and watch a graph.  A non-D parent will never know how soothing looking at a graph can be but let me tell you, it was AMAZING!image

There were nights that my partner wanted to throw it out the window.  My son was high.  The DexCom told me so.  We corrected. The DexCom said it didn’t work.  We injected.  The DexCom said he was falling.  We wanted that.  The constant dialogue of beeps and vibrations were sending Larry over the edge while giving me peace of mind.

Not all nights were full of alarms.  The DexCom allowed me to also see my son have some of the best readings.  I watched one night in amazement has he maintained a steady 4.9mmol (88mg/dL) for hours.  Such a lovely number would normally have sent me into a night filled with stress. Would he drop? Would he rise? I would be testing a lot wondering or I would be pouring chocolate milk down his throat hoping to slow down a decline in blood glucose levels.  With the DexCom, I was able to simply relax and  watch a perfect night unfold in front of me.

The biggest gift that the DexCom brought me was pride in my son.  When he moved away to live with his father, we said he would share readings with me and we would talk about his care.  Well, reality was very different and with the exception of “yep, all is fine”, I have had no real information on how he was doing.  When he visits with me, there are often problems due to change in activity levels and eating as much of Mom’s food as he possibly can in a short window of time.

He still ate a decent amount.  He also was a little less active that he might have been at his father’s but his readings were generally quite good.  The DexCom showed us a few issues–some of which he knew about but hadn’t dealt with. Together we talked about changes.  He challenged me about some ideas and after a discussion, we made the adjustments that we both felt were required.  I was proud to see that he had listened to what he had been told over all of these years.  He was taking ownership of his disease and doing a good job of it.

I was sad to see day 7 arrive.  It was the end of life with a CGM.  It also meant that my son was heading on a plane back to school and his other home.  The last part was the hardest but it also hurt that he would be leaving without this amazing technology.

I asked him what he had thought about the whole thing.  Once again, he was not impressed with the extra site. I think he quite enjoyed being able to simply look at a graph to know what to do about his readings–he was rising, he was falling, he was nice and steady.  He is not quite ready to carry a second device however nor is he ready for a second site.  I see that changing in time.

Our rep kindly offered to let him use it again in the near future if he wants.  I am sure we will take her up on that offer.  I can see his attitude towards the DexCom changing with both use and the changes in his circumstances–moving from the classroom into the workforce.

I was always a firm believer in the benefits of this technology.  This one week trial just confirmed it.  Anyone living with diabetes should have access to this device.  It will change their lives and improve their diabetes care.  A running live-stream movie of blood glucose readings rather than snap shots throughout the day offers such incredible freedom and peace of mind. It should be a standard of care for everyone who has to live with diabetes.