Which pump?

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B3NNYBUDDY

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Type 1
I have been T1 diabetic for 11 years and have been on the Omnipod for a couple of years now and going to have to change as it doesn't seem to be effective. I am on Novarapid and have 120 units a day of basal and bolus on average 100 units. My Hba1c is 110 (12.2). My DSN does not know why even with such large doses of insulin sugar levels are remaining high. I am also on full dosages of Metformin to help with insulin absorption. I have been offered:
Tandem T-slim (Air liquide) with Dexcom CGM or
Medtronic 780g with Guardian 4 smart guard sensors as alternatives to the Omnipod. Has anyone got any experience with either pump and whether they would be an effective solution?
 
Wow - that must be difficult for you if the pump didn’t help. Hopefully, a tubed pump will help a bit though as you’ll be able to choose the right sets and cannulas for your body. I find I need certain cannulas for certain areas else I don’t get good absorption.

@everydayupsanddowns uses a T Slim and @SB2015 a Medtronic. Mine is a DANA so I can’t help with your choice from any experience.

Welcome to the forum 🙂
 
If you are taking so much insulin, I would have though the size of the cartridge is important.
All pumps I have used have a maximum of 200 units which would not last you a day but I know there are some which take at least 300 units.

Have you thought about taking a pump break? If your sites have become a problem, you may find more options with injections. If not, I second Inka's comments about a tubey pump as, in my experience, you have ore site options.
 
Good point @helli My pump is 300 unit but I don’t know about the others. Another possibility is to use a different pump regime where you take some of your basal by injection, the rest by pump. There are various similar options.

But I do feel experimenting with different cannulas is a good starting point.
 
Hi @B3NNYBUDDY I don't quite understand. You say you are on a total daily dose of 220u but the Omnipod only holds 200u insulin. So it wouldn't last you a day. In which case I am surprised they gave it to you. I know when I had the choice of the Omnipod or the medtronic one of the stipulations for being able to have the Omnipod was that 200u would last me 3 days. I know the Medtronic holds 300u.
 
Hi @B3NNYBUDDY

Welcome to the forum. A great place to tap into a wealth of experience.
I am using the 780 with the Guardian 3 sensors, but will switch to Guardian 4 when I renew my contract. I use it in a closed loop system (like an artificial pancreas) where the sensor and pump have a chat every 5 min and do automatic adjustments to my basal rate as necessary.

Having used a Roche Combo for eight years I found it hard doing the switch over and it was hard to trust the automated system at first. I now love the system, and find I think a lot less about my diabetes as well as getting a lot more sleep as the pump and sensor sort out any wobbles for me through the night, and I regularly wake up in the 5s.

The cartridges are either 300 units or 180 units and are changed every two or three days.
It is a tubed cannula which is different from the Omnipod but it was I have always used so know no different.

Do come back with any specific questions.
 
Pattidevans said:
Hi @B3NNYBUDDY I don't quite understand. You say you are on a total daily dose of 220u but the Omnipod only holds 200u insulin. So it wouldn't last you a day. In which case I am surprised they gave it to you. I know when I had the choice of the Omnipod or the medtronic one of the stipulations for being able to have the Omnipod was that 200u would last me 3 days. I know the Medtronic holds 300u.
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When I first started on the Omnipod it would last two days but as I've increased insulin they haven't lasted a day. For the last few weeks I've split it so that the Omnipod does basal and then I inject for bolus.
 
You could do that with either of the other pumps too. The Tandem holds 300u although they are weird cartridges and I’m pretty sure you lose a bit during the refill. I don’t think there’s any pump which can hold more than 300u. But with integrated sensors it would alert you when you were high and would automatically try to correct by increasing basal and then doing correction doses automatically so you wouldn’t have to think about it so much. As others have said there are also different types of cannulas that you could try to see if there is one particular type which suits you better.
 
Welcome to the forum @B3NNYBUDDY

Sorry to hear you are having a tough time with your diabetes management and what sounds like insulin resistance.

I think it would be worth chatting to the reps to ensure that either of the systems you are considering are designed to work at your TDD. I know that the tSlim has minimum insulin requirements and weight for using Control IQ, but I’m not sure about any upper limits? Pump reps might also be aware of others using their tech with higher TDDs, and how it works for them.

Is the Metformin helping your sensitivity?

Have you tried running a basal check, to see how your basal profile works without meal doses?

https://www.mysugr.com/en/blog/basal-rate-testing/

How are your sites? Any lumps and bumps? Do some areas absorb better than others?
 
Hi again @B3NNYBUDDY A few more thoughts - could you have another condition affecting your insulin sensitivity? If you’re ok saying, what’s your BMI? And have you tried experimenting with dietary adjustments to see if that helps eg a very low fat diet can improve insulin sensitivity?

I think sometimes insulin resistance can be a vicious circle, and it feeds on itself. So breaking that circle can help.

Finally, have you tried different insulins to see if they help at all? Different insulins suit different people so it’s always worth trialling something else.
 
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