replacement pump

[heasandford]

Sorry I havent been here for some time, personal difficulties like everyone I'm sure

I have discovered that I am due a pump update in January, much to my surprise. The Roche Combo I use will no longer be available from 2022, and I was hoping that there would be some new pump technology available

Am I the only person who wants a pump with remote control?! I just want to be able to leave it under my clothes and do all the calculations and delivery from an external source!
I do need bolus advice, and I occasionally use the multiwave and a temporary basal rate, but I don't think I'm worried about prefilled cartridges.
I have Libre 2 which I do mostly like, but I would consider self-funding a different CGM if it has a link/feedback to the pump. I'd like something that warns me that I MIGHT go low in half an hour rather than telling me I have! But I also want to be able to control alarms!

As always I find you experts on here have the best advice! I watched the Diabetes UK tech conference, and while I enjoyed some of the speakers I was too distracted by the chat on the side - I can't walk and breathe at the same time so no chance! I would so love to try the closed loop, especially if it gives less micro-managing

Thanks!

 

[helli]

Am I the only person who wants a pump with remote control?

Absolutely not. A number of pumps have PDMs which are, effectivel, remote controls. Those I know of (OmniPod and Medtrum) are patch pumps but there may be tubey pumps with PDMs too.
i have the Medtrum which has a choice of PDM or phone app. I use the app to minimise what I need to carry (and could potentially lose).

Unfortunately, each CCG offers different pumps. Some only offer one pump and some offer four or five. Therefore, before setting your heart on a specific pumps, it is best to talk to your local diabetes team and find out what your choice is.

 

[helli]

I have Libre 2 which I do mostly like, but I would consider self-funding a different CGM if it has a link/feedback to the pump. I'd like something that warns me that I MIGHT go low in half an hour rather than telling me I have! But I also want to be able to control alarms!

I use Libre 2 and the xDrip app (great if you are techy and happy to go off-piste, petrifying if you are a technophobe). It includes a predictive alert and pucks up readings via Bluetooth so you don’t need to scan.

(Sorry for the multiple messages, I got excited by your first paragraph and then, when I carried on, I realised it is not easy to insert a second quote when I edit an existing message on my phone.).

 

[PattiEvans]

I've also been on the Combo for 8 years next month and do not want to have a pump without a remote control - even if it's my phone, in fact all the better if it is. I was at a wedding one time wearing a dress with the pump in a little pocket I'd sewn to the dress lining. I'd forgotten the handset... oh the palaver! Had to go into the toilet and take the dress off... shudders! Last time I spoke to anyone, which was in May the choice was Omnipod or Medtronic . However due a new one on 17 Nov and no one has contacted me re: the current choices. Hope you can get what you want @heasandford - do let us know.

 

[Inka]

Find out what pumps they’re offering @heasandford I’ve had various pumps over the years and now have a Dana RS. I can control pretty much everything on it from my phone, which is very convenient indeed. It’s also guaranteed for looping. You can use Open APS as a DIY loop or pay for it’s official loop software. It was developed in conjunction with #wearenotwaiting

 

[SB2015]

I am using the Medtronic 780G with closed loop through self funding their own sensors. I would not want to go back on that now as it gives me such a good Time in Range BUt I have to access the pump to do a bolus. I still find that frustrating as I too had been on a Combo for eight years, and loved being able to tuck it away at the start of the day And leave it be, doing everything remotely. I look forward to seeing which Closed loop ones offer remote bolus ing when I next change in there years time.

 

[heasandford]

Some great thoughts but sadly as you say it looks like I may not have any choice! Apparently only alternative I'm being offered from my team is an Ypsopump which you have to directly bolus, although 'QUOTE...there is a phone app which links to intranet based system for reviewing data. This is also going to offer a remote bolus feature in the future (MyLife Dose)'
oh dear! not sure I can wait in case it doesn't happen!

I'd like to hear about linking Libre 2 to xdrip, I posted another question about this. I am a bit scared of the tech, but I'm very good at following instructions! I used miaomiao with the Spike app on my phone until it got removed by Apple, loved it and then lost the plot trying to get it back, never did manage. (Then life took over and I no longer have the time, full time carer)

 

[helli]

I'd like to hear about linking Libre 2 to xdrip, I posted another question about this. I am a bit scared of the tech, but I'm very good at following instructions!

Your best bet is to join the xDripIOS* Facebook group where you will find downloads, instructions and support.

*As you mentioned Spike, I assume you have an iPhone. There is a different app, xDrip+ for Android. They have a different Facebook group.

 

[nonethewiser]

I am using the Medtronic 780G with closed loop through self funding their own sensors. I would not want to go back on that now as it gives me such a good Time in Range BUt I have to access the pump to do a bolus. I still find that frustrating as I too had been on a Combo for eight years, and loved being able to tuck it away at the start of the day And leave it be, doing everything remotely. I look forward to seeing which Closed loop ones offer remote bolus ing when I next change in there years time.

Shame about it not having remote programming option, pump is up for renewal & Med 780G is one that's been offered.

 

[SB2015]

Shame about it not having remote programming option, pump is up for renewal & Med 780G is one that's been offered.

For me the advantages of the closed loop outweigh the inconvenience, now.
It didn’t initially as it took a bit fo getting used to.

 

[nonethewiser]

For me the advantages of the closed loop outweigh the inconvenience, now.
It didn’t initially as it took a bit fo getting used to.

Guardian sensors were mentioned by dsn, not eligible for nhs funding as only being offered to those with no hypo awareness, at £40 each couldn't justify cost as use libre anyway which get on prescription.

That closed looping sounds ideal mind, future looks good with tech like that around.

 

[everydayupsanddowns]

Nice to see you again @heasandford

Rumours of a phone app for Tandem tSlim continue to circulate. Will be interesting to see what that offers when it eventually launches.

Good luck with your pump choice. Hope you are offered a good range.

 

[heasandford]

I've also been on the Combo for 8 years next month and do not want to have a pump without a remote control - even if it's my phone, in fact all the better if it is. I was at a wedding one time wearing a dress with the pump in a little pocket I'd sewn to the dress lining. I'd forgotten the handset... oh the palaver! Had to go into the toilet and take the dress off... shudders! Last time I spoke to anyone, which was in May the choice was Omnipod or Medtronic . However due a new one on 17 Nov and no one has contacted me re: the current choices. Hope you can get what you want @heasandford - do let us know.

Haha, been there too!
I'm not feeling hopeful I must admit, although there are advantages with all of them. I was just hopeful of some new tech coming our way!

 

[DouglasXKR]

Using as an analogy a closed loop control system for an electric motor, you can easily provide a feedback loop that speeds up, slows down or stops the motor. With current diabetes technology you can only speed up or slow down, you can’t stop. Obviously there is a fudge somewhere that I’m missing?

 

[helli]

Using as an analogy a closed loop control system for an electric motor, you can easily provide a feedback loop that speeds up, slows down or stops the motor. With current diabetes technology you can only speed up or slow down, you can’t stop. Obviously there is a fudge somewhere that I’m missing?

I think I am misunderstanding your analogy because the most common and simplest closer loop control is to suspend (stop) the basal when levels are heading towards hypo levels.
Unfortunately, as injected/pumped/manufactured insulin works slower than "natural human created" insulin, the suspension has to be initiated early to stop the blood sugar dropping too low.
I use basal suspend frequently on my pump to stop the drop when exercising. With Fiasp insulin, I need to suspend my basal an hour before jumping on my bike.

 

[DouglasXKR]

when levels are going low, you can’t reverse it. Any algorithm errors which are driving the level too low are irreversible. There is a constituent of the pancreas which will reverse a fall - it’s name sounds like a French painter Gauguin - but is difficult to handle.

 

[Ellie Jones]

I use the Medtronic 640g, which does have a very limited remote bolus function from the meter, you can set up via the pump, several boluses such as dinner, snack etc. Which you can instruct via the BG meter.

You can also connect the Guardien Sensor to it, but this give very limited connection, and not a closed loop like the 670g is.

I actually do now miss my Combo, and it seems sad that they've not brought in a newer model to replace it.

 

[everydayupsanddowns]

when levels are going low, you can’t reverse it. Any algorithm errors which are driving the level too low are irreversible. There is a constituent of the pancreas which will reverse a fall - it’s name sounds like a French painter Gauguin - but is difficult to handle.

To my mind @DouglasXKR - it’s a bit like an oil tanker. You can stop the engines, but you have to act early enough for it to slow down in time.

Yes you can stop all insulin deliveries, but as you say there may still be insulin on board. However the glucose-lowering activity of that will decay over time, so once you’ve suspended insulin delivery, the amount of active insulin from the last micro-dose of basal will have 4-5hrs of life, but the micro-dose of basal from 2 hrs ago will be half strength at best. So there will be a sort of taper. Most likely not much insulin reduction happening for 30-45 minutes, but then more and more potent ‘stopping’ of insulin action 🙂

 

[heasandford]

I have now been told that my CCG are looking at the Medtrum patch pump which I think I'd really like as a replacement for my Roche Combo which being take off the market (although I can have one and they will support it for the next 4 years)

It's not entirely clear online how the Medtrum works when provided without the CGM. I asked about the cost of this if I fund and it seems to be similar to funding the Libre which I have to say I did for 2 years before the NHS funded me. (I know I am very lucky to be able to afford it, and was persuaded by a friend who made me look at what it meant financially versus health (compare smoking!)
What I meant to ask was, has anyone got experience of the Medtrum CGM system, I've searched but can't find anyone?

 

[heasandford]

To my mind @DouglasXKR - it’s a bit like an oil tanker. You can stop the engines, but you have to act early enough for it to slow down in time.

I love this analogy, I stole it from you some time ago and I use it all the time to explain to friends about insulin!