Frustrated with current pump options

Technology & Management
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My warranty just expired this week on my Medtronic Paradigm 530G and I have been evaluating my options and am unhappy with what I see. I also am a Dexcom G6 user. I’ve been T1 for 32 years, and a pumper for about 20 years. I started with a Disetronic H-TronPlus V100, followed by the DIsetronic D-TronPlus, and my last 3 pumps have been Medtronic Minimed Paradigms (722/723/751).

What I like about my current Medtronic Paradigm pump: Size…it’s perfect. Robust build quality. AAA battery; keeps things small and the pump’s basic screen keeps battery life around 2 weeks. Easy bolus…how awesome it is to covertly bolus without having to take your pump out of your pocket. Only Con: Enlite sensors were always horrible. Wish it could integrate with Dexcom.

Omnipod: I don’t like the separate PDA requirement, but most importantly I need a 300 unit reservoir, so not really an option for me.

Tandem:
Pros: Seems like a decent interface. Dexcom G6 integration. Generally positive anecdotal reports from users about current Basal IQ algorithm. Slim profile. First pump manufacturer to receive FDA approval in the new device category called ACE (Alternate Controller Enabled); I think this qualifies it as the technology leader. Bluetooth upgrades, in theory at least, “through 2020”.

Cons: The draconian cartridge that is difficult to fill, is time consuming to fill, wastes insulin, and has a pigtail which makes the sleek looking pump feel too clinical. The Tandem also forces you to stock and travel with extra parts since the refilling syringe and cartridge are separate and not integrated like the Medtronic Paradigm reservoir system. Integrated battery that is sure to degrade over time as the batteries in our cell phones do so. Power outages are a real thing outside of the cities, and there’s something disconcerting knowing that I better have power banks charged up and ready for the next time the grid goes down. Financial stability of Tandem in question somewhat.

670G:
Pros: Brilliantly executed reservoir system carried over from the Paradigm. Financial Backing from Medtronic (deep pockets). My Paradigm supplies will still work with this new pump. Field support and doctor office support. Ubiquitous AA battery (wish they could have stayed with smaller AAA).

Cons: Size…somewhat bulkier than outgoing Paradigm pumps. CGM inferiority to Dexcom (It’s not even close for multiple reasons). Medtronic’s refusal or inability to innovate except in tiny, purposeful baby steps. Negative anecdotal feedback on the pump user interface. No real benefit in upgrading if I want to keep using Dexcom G6 except for warranty. Larger color LCD screen now needs a AA battery to power it instead of a AAA.

The Paradigm pumps have been around for more than 15 years and are market proven. I love their robust build quality, ease of use, and simplicity for travel. The design is essentially a copycat of the Disetronic H-TRONplus V100 in my opinion. Back in 1999, I chose the Disetronic because I thought it was superior to the MInimed 507c both in design and interface. I thought maybe Medtronic thought the same and eventually adopted a "if you cant beat them, then join them " mentality…at least on major design elements.

I think absent some major new developments in the market, I’m likely to just keep using my 530G pump out of warranty + Dexcom G6. Another option is to take my old Paradigm 722/723 pumps out of storage to experiment with Looping.

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The Tandem cannot be connected to a computer through Bluetooth. Your Bluetooth upgrades are incorrect. The pump connects using an USB cable. The Tandem reservoir filling process takes me 5 minutes to do compared to 3 minutes with Medtronic. The basal-iq is revered among users and not generally positive. Traveling with Tandem pump supplies is no different than traveling with Medtronic supplies. Comparing the Tandem X2 to the Medtronic 530 is like comparing a Model T with a Ferrari. When my warranty expired on my 530, I ordered the newly released 630. I was not impressed at all, immediately sent it back and ordered a Tandem. The 670 is a complicated and time consuming mess of a pump.

If you’re not happy about the choices right now and can wait another 6-12 months to upgrade, I suggest you wait. Tandem’s t:Sport, and Medtronic’s 780 will launch in the next 12 months.

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Hi Jason,

Thanks for correcting me on the Bluetooth / USB situation. I still mark it as a positive for Tandem that its abilities can be updated in the future.

As for basal IQ being “revered” instead of just “generally positive”, I think we’re on the same page here. I’ve read good things about Basal IQ.

Regarding travel, doesn’t the Tandem require 3 separate pieces/parts to replace its cartridge (excluding infusion set)? 1) cartridge, 2)syringe needle, and 3) syringe body/plunger. What I was referring to was the number of components and bulk required of those components. The Tandem has more components (3) versus the Paradigm reservoir combining all components into “one” piece. I know this may seem like I’m splitting hairs but travel anxiety is real. I usually travel with 2.5x-3x the amount of supplies I would “normally” need when I’m away from home so these considerations weigh on me. My OCD has me worrying about things like accidentally leaving crucial components behind or parts failing me while on the road; Medtronic has had bad batches of reservoirs in the past that needed to be recalled and I’ll never forget when I had two reservoirs fail on me from the same box.

630/670 hold no real appeal to me. There are some benefits I believe to being connected to a more financially secure organization like Medtronic; Tandem was on the brink approximately a year ago, which gives me some pause, but I really want them to succeed in the market.

I would love to switch to Tandem for the Dexcom G6 integration above everything else, but some of the trade-offs I’d have to make in switching ecosystems are making me nervous. I would love to see what Tandem can do to refine it’s offerings given another design cycle, but I haven’t read anything about the t:Sport. I was aware of the 780G however.

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I had anxiety over the Tandem cartridge as well. After you’ve done it a few times it becomes muscle memory and you’re done before you know it. The cartridge, syringe and needle don’t take up any space at all. I spent two months in Europe for my honeymoon and had no issues with the pump supplies taking too much space.

Tandem is very profitable now. Most of the stories of them going bankrupt were spread by Medtronic representatives. Tandem sued Medtronic for slander.

The Tandem t:Sport will debut sometime in the last half of 2020. It will be a tubeless pump running control-iq out of the box. There’s not a lot of info about this pump right now. If it holds 300 units, you and I will probably be interested.

Control-iq is still under FDA review. Tandem is hopeful that it will be pushed out before the end of this year. I’ve been told by my Tandem rep that both basal-iq and control-iq will be selectable options on the pump in the next update.

Like I said above, if you’re unsure if you want to upgrade now, then wait. In late 2020 Tandem and Medtronic will release new model pumps. I’m not a fan of Medtronic products anymore, the 780 looks very enticing from what I’ve seen so far.

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Very solid information in your post; I’ll have to reconsider my nervous preconceptions given your positive review especially since you’ve had the 530G as well.

I could live with the drawbacks of the 670G as a stand alone pump, but Medtronic I feel is so behind Dexcom in the CGM space that I don’t really want to consider it all. My experience with the Enlite sensors was very negative, and user reviews online suggest that the Guardian 3 has similar negatives associated with it.

One pump feature on the 530G that I really think I would miss on the Tandem is the Easy Bolus capability. Since the Tandem X2 is touchscreen only, that obviously would not be possible anymore.

I’m also weighing the possibility of Looping with my old 722/723 pumps, but I need to do more research on this one.

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The X2 has a quick bolus feature. It works the same way as the 530. You just press and hold the wake button and wait a few seconds for a vibration or audible alert. You can set how many units the pump will deliver with each vibration/beep.

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Hi @trifona and Welcome to the JDRF TypeOneNation Forum! I enjoyed reading your well-thought out first posting and look forward to hearing much more from you in the future.

In my humble opinion, what should most influence your pump decision are the features you want most for assisting you effectively manage your diabetes and the features that fit with your habits and lifestyle; the other decision is if a pump is your best choice. Somehow I survived 47 years living with diabetes without a pump [I had been encouraged to use on of the 1980 monster pumps] before choosing a MiniMed #515. My first pump was succeeded by two progressively “improved” Paradigm before I changed to the Tandem t-Slim x2 in January. The only “improvement” in the Paradigm pumps was integration with worthless glucose sensors - I now use Dexcom sensors.

I fully agree with your assessment about the Tandem cartridge system and its three essentials; with MiniMed pumps I needed to carry only two items [plus a vial of insulin] for a complete infusion-set change but now with Tandem, I need to carry five items for the set-change. The first few times filling the Tandem cartridge were a frustration, but as @Jason1 says he [and I too] got over the anxiety with time.

One of the Tandem features that attracted me was the very easy to read screen, even with my lousy eye-sight - I can read the pump without eyeglasses when I’m awakened at night. The other lead factor that attracted me is the ability to upgrade the pump software on line without the need to purchase another $9,000; I’m pushing 80 [diagnosed when a teen] and Medicare will only subsidize a new pump after the existing pump’s manufacture’s warranty has been expired for at least one year. I’m also looking forward to integrating “Control IQ” ; I’ve been manually trying to imitate Control IQ algorithm and was able to narrow my standard deviation to the lower 30’s range.

Wish you the best …

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Hey Trifona, haven’t talked with you since the early I-P days. I went from my H-tron + to the Animas Pumps for 16 years, when the last warranty and the Company expired I chose the Tandem (just hated being called by M/MM and told I was going to die if I didn’t buy theirs) Making the transition to the Tandem was a bit of a Challenge as I had been pumping Apidra in my Ping. Changing to the slower Novolog, though I had used it back in 2002, was difficult until Tandem came out with Basal-IQ. That allowed me to be more aggressive in my Bolusing and keep my lows above 70. Looking forward to the Control-IQ to reduce the Highs. There will be greater insulin wasted but once you reach that “Golden Age” and MC has taken over all costs the loss is not a bother. Best of Bgs
George

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Thank you for the reviews of all the available systems. I am still on my Medtronic 530 G. I’m fine with testing glucose several times a day since having a glucose monitor gives me so much anxiety. My 530 G has been out of warranty for a couple of months. Hoping it can last until a better alternative shows up. Just wondering If there is a way of telling when the pump has stopped working. Do I need to wait until it stops working completely or are there signs to be aware of? I’ve been with Medtronic pumps since 2011 and type one diabetic for more than 50 years. Last time I needed to get a replacement pump there was a minor problem with the battery case opening that they said could not be fixed. So I’ve had this pump since 2015. I know I’m out of warranty. Yet I’m not excited about the new options. Any thoughts are appreciated. Thank you

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Hi Jayne @alwayshopeful . I really like the positive inclination of your user name; hopeful is what us old-timers have been.

I’ve found that Medtronic has been understanding in providing replacement pumps [replacements are refurbished trade-ins] when it appears that a pump has failed; that includes one time they sent over night a replacement when my 523 gave a failure code.

How do you tell if a pump isn’t working properly? Good question; but for me it was once an “error code” and another time was by my observation in monitoring how far the built-in insulin-remaining “meter” reduced after I put in a specific bolus. I had been experiencing unexplained “lows” so I began writing down insulin-remaining values and comparing the differences with the amount of insulin I was using - basal plus bolus.

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Hi George,

It’s been years! I was glad to see your response!

Still wary of making an upgrade decision. Medtronic is pushing hard on their 670G and using as a selling point that I’ll get a free upgrade when the next pump rolls around. Still not interested until I see what their next gen looks like since I think the 670G was a beta product best on user experiences. I can’t wrap my head around switching to Guardian sensors right now; I haven’t done a finger prick test in weeks. The Tandem pump still has enough cons associated with the cartridge and wasted insulin to keep me wary. I switched last year to Novo’s faster acting Fiasp insulin and it has provided a noticeable benefit for me even though the pharmacy has to order it for me.

I hope I’m wrong but I have an eerie feeling that the FDA won’t approve Tandem’s Control IQ until Medtronic is ready with their next pump (690G?) which published speculation says is due by April 2020. We’ll see. I would love to see next gen hardware and algorithms from both both companies so I can make a more informed decision.

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Tandem has said on several occasions basal-iq will be released before the end of the year. I spoke with a executive at Tandem last week, according to her, they’re expecting approval any day now. Medtronic getting approval for their products has no bearing on Tandem’s FDA approval timeline. Medtronic’s next pump in their pipeline is the 780 which is currently in trials and slated for a launch sometime in the second half of 2020.

The only negative aspect of the Tandem pump is the reliance on Dexcom sensors. I’ve had terrible accuracy with my G6 sensors for the last 6 months. I don’t know what changed at Dexcom, but I will not allow my pump to adjust insulin flow into my body based on the Dexcom sensor readings. There are countless complaints on diabetes forums and Reddit regarding the G6 inaccuracy. I will not be updating my X2 until I see a significant change in Dexcom sensors.

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Hi @trifona. A lot of factors go into choosing a pump, some of which are matters of personal preference. If I could address a couple of your discussion items just to give a different perspective: I switched from Minimed to Tslim several years ago, and am now on my 3rd Slim, with Dexcom G5. I’ve never had a battery issue with any of my Tslim pumps. I would like to think battery durability is a feature required in medical devices that is not required in cell phones (although that would be nice). I typically plug in my pump while I’m sitting watching TV, and the process is remarkably fast. However there have been times I’ve completely forgotten, only to get an alert while I was in my car. I’ve plugged in into my car charger and am good to go in a short time. I recently bought my husband a couple of MyCharge Plus devices - his car charger doesn’t work and he is on his phone most of the day so he needed something. It fully charges his iPhone a couple of times over before it needs to be recharged itself. I’m using one to charge my pump, and my Tslim has gone from 35% to 60% in just over 10 minutes. I understand your concern about being able to charge your pump, but there are options, and if you keep a charger for your phone you can use it for your pump as well. And you don’t have to worry about discovering you’ve run out of batteries.
You also mentioned the amount of time it takes to fill the Tslim. When I get a new bottle of insulin I fill several cartridges and keep them in a sealed container in my fridge so they’re ready to go when I need them. I’ve never had a problem and have doing it for years. I assemble the syringes and needles, draw up the units, fill my cartridges and put them in the fridge. I can get 5 or 6 cartridges set in under 10 minutes, and when I start a new insertion site everything is ready. Thinking through going through that process every single time I can picture it taking several minutes. This way is a great time saver.
Just sharing a couple of options. I wish you the best in finding a pump that meets your needs.

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Hey Dorie!!
I LOVE LOVE LOVE your cartridge filling idea & I have to replace mine tonight so I will adopt ur idea if you don’t mind!!! But I will certainly give you credit for the idea!! I think it’s brilliant!! Go u!!!

I generally don’t mind the filling process. I also switched from 530G and I don’t waste any insulina but a few drops & at most it may take me a min or two longer than my 530.

I like many others had an AWFUL time w enliste and I wouldn’t go near a Guardian w a ten foot pole even if you paid me. I love my Dex and X2!!!

There was nothing bad about my 530 except it wasn’t integrated e my Dex and I absolutely HATED scrolling. I love the touch screen of my Tandem.

Thanks for sharing your idea!! Happy Holidays!!!

Sandy

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Be my guest - the idea was not copyrighted so it is yours to use :smile:. Take care!

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Decision has been made. I submitted paperwork with Tandem to move to their pump.

For while I was keen on waiting out next generation products since the hardware from both Medtronic and Tandem are several years old. I even toyed with taking one of my old Paradigm pumps out of storage to do the DIY Loop. I love the Medtronic Paradigm pump, as a pump, Paradigm today is essentially the same pumping experience I had 20 years ago with my original Disetronic H-TronPlus V100; knowing this I cannot in my heart of hearts continue to wait out the market for the next best thing.
however I feel I need to close the loop with my CGM to optimize BG control.

The 670G even as a stand-alone pump doesnt impress me. The hardware seems to have been designed by committee. It’s significantly thicker than the Paradigm in-part thanks to the larger AA battery to drive the color screen. It has 7 buttons? it has a cumbersome menu tree. Non-intuitive alarms. Automode doesnt share what actual basal rates are being delivered; only microboluses are reported. I dont want to calibrate 3-4x per day due to the subpar Guardian sensors. Medtronic sensors were not trustworthy when first introduced as SofSensors, they remained disappointing as Enlite, and reviews I’ve read all over the internet indicate that the experience with Guardian still falls short of Dexcom G6. No thanks.

My last A1C was 7.5 and I haven’t been below 7.0 in a couple of years; largely due to conservative overnight basals I’ve set in the Paradigm. I want to protect myself against hypoglycemic events during the middle of the night if I’m going to use tighter basals. I’ll be able to do this with the Tandem pump + Dexcom G6. The Dexcom G6 has been great for me and I’m happy that I’ll continue to use it with the T-Slim X2.

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Congratulations. This has been a difficult decision for you, i believe you made the right choice for your situation. My only advice is to run basal-iq for a few months and don’t immediately update the software to control-iq. You’re mostly worried of hypos, basal-iq is phenomenal at preventing hypoglycemic episodes. I’m not convinced control-iq will be as aggressive with preventing low BGs as basal-iq. Tandem have been purposely avoiding answering this question since the FDA approval of control-iq was announced. Once you update the software, there’s no going back.

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Hi Jason,

I’m looking forward to Control IQ helping to bring down my glucose in total but have been hesitant to get more aggressive on my basals without hypo protection. I like the idea of implementing the sleep activity profile to keep the bg range down to 112.5 mg/dl -120 mg/dl. What have you read or flagged that drives the concern about Control IQ not being as effective as Basal IQ on preventing hypos? Admittedly, I’ve focused more on Control IQ than Basal IQ in my own research.

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Hi @trifona, the Control IQ really does NOT offer you any more “hypo protection” than currently available assists - such as that available with Basal IQ. In effect, Basal IQ [totally] suspends insulin delivery at a higher BGL than that proposed in Control IQ; what Control IQ adds for hypo avoidance is reduction of basal for a broad [40+ mg/dl] BGL range before complete suspension. [This is in addition to the very important addition of hYper event modification.]

I very strongly recommend that you read the entire User Guide before activating the Control IQ feature. Control IQ technology is described in Section 4 of the manual, but I advise refreshing your pump knowledge by reading the entire manual - this is NOT a plug-n-play toy.

Unlike what was previously written, Control IQ technology is turned on [or off] by the User after the feature is added to a pump - if it doesn’t fit your lifestyle, you can very simply “toggle off” the technology.

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Unlike the 670, if control-iq is turned off you lose the low glucose suspend feature. At least with the 670, you’re still protected with the low BG suspend when auto mode is turned off. This is why I suggest using basal-iq for a while to see how their BG responds. If they find the loop function doesn’t work for them, and turn it off, all ability to have a low BG suspend with control-iq is forfeited and there is no way to get basal-iq back into the pump.

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