Insulin pumps: Tell me about yours!

In My Humble Opinion
1

I am a Type 2 diabetic and I am having a lot of trouble controlling my sugars (especially fasting sugars) with the non-insulin medications. The latest research indicates that Type 2 diabetics can achieve excellent control (and therefore better long-term outcomes) with insulin pumps, so I am strongly considering getting one.

I haven’t looked into it much, but I understand there is quite a bit of variation amongst insulin pumps, and that choosing the best pump can have a lot to do with personal taste and your own specific flavor of diabetes.

So I would really appreciate it if SDMB diabetics who use insulin pumps would tell me about theirs. Which one do you use? What do you like about it? What are the drawbacks? Do you have any issues that using a pump has not resolved?

Thanks in advance!

2

Oh, and please tell me what it is like to travel with one! I am planning a trip to the Galapagos Islands and possibly also Macchu Picchu next year.

3

There are really only 3 pumps on the market in the US right now - the MiniMed, the Animas, and the Omnipod. From what I’ve read/researched, none of them are bad, people like them, but they do have differences, some slight, some big.

The one really HUGE difference between Minimed/Animas and the Omnipod is that MiniMed/Animas (which will from now on be referred to as “M/A”) are tubed, and the Omnipod is a pod. Meaning, the M/A is a little box that looks sort of like a pager, and it has about 2 feet of tubing that you snake under your clothes to an insertion point.

The Omnipod, on the other hand, is a little plastic “pod” that you fill with insulin and stick to your butt (or wherever) and control with a remote control PDM kinda thing.

That one difference, to me, was everything. I can’t imagine dealing with tubing, having to snake it through clothes, dealing with it at night, etc. So I went with the Omnipod. I’ve had it for a little over a year now, and so far, I love it.

Drawbacks to Omnipod:

  • some people have trouble getting it to stick

  • the M/A pumps have choices of different types of insertion sets - different lengths of canullas, different angles, etc. The Omnipod, because it’s an all-in-one kind of thing, doesn’t have any choices here. If you are one of the minority of people who don’t work with the Omnipod’s insertion set, you’re out of luck.

  • Omnipod has a slight difference in how it calculates insulin-on-board when you do corrections compared to the M/A. Some people really don’t like it.

I personally don’t have any issues with any of these things. My pod sticks just fine, the insertion set works, and I don’t care about the insulin-on-board calculation.

Between the Minimed and the Animas, the big differences are:

  • The Animas has a wireless remote, so you can stash the pump in your pocket or wherever and still bolus. The Minimed always has to be accessible.

  • The Animas is a slightly newer design. I liked the menus a bit more.

  • The Minimed has the option of a built-in CGMS (continuous glucose monitor). However, of the three CGMSs on the market right now, it’s pretty much the one people like the least.

So, getting to your specific questions:

Which one do you use? The Omnipod
**
What do you like about it?** Just about everything. I do wish the pod itself was a little smaller, and they are working on a version that’s 45% smaller.

What are the drawbacks? The biggest drawback is that once it’s on, you don’t take it off until you change it (typically 2-3 days). In practice, this makes it difficult to sit in a hot tub or take a sauna or take a bath, because you’ll cook your insulin. Both of the other pumps can be disconnected and reconnected easily. I really wish they’d fix this because sometimes I do want to jump in the hot tub when my pod is on my leg or my back! (it’s not so much of an issue if it’s on my arm because I can hang my arm out of the water.)

Do you have any issues that using a pump has not resolved? Well, so far my pancreas hasn’t come back to life. I think that’s a bit much to ask of a pump, though.

Traveling: I don’t see any more issue traveling with the pump than traveling without a pump. The big hassle with traveling is keeping your insulin cool, and that has to happen regardless of if you’re using needles or a pump. I haven’t had any issues flying with it or anything like that.

What else? I can’t imagine going back to MDI, even though I had pretty decent control on it. I hate needles. I find the convenience of a pump makes my life seem more normal - on MDI, I’d often either not bolus for small bits of carbs or just not eat them. With a pump, it’s no big deal to eat a couple M&Ms and bolus for 2 carbs. That doesn’t seem like a huge deal when I type it out, but man, I can really get a pity party going for myself if I think I can’t eat M&Ms when I want to. :stuck_out_tongue:

The pump is also really nice for things like dealing with morning glucose dumps and exercise - for example, I can turn down my basal rates if I know I’m going for a bike ride and reduce the risk of going low.

You can really fine-tune basal levels as well. I’ve got it to the point where I can go all day with no significant change in my blood glucose if I don’t eat carbs.

That’s about all I can think of for now. I’d say if you’re at all interested in a pump, call the different manufacturers and have 'em send a rep out to show you their wares. I looked at all 3 of them before buying, and it was a huge help to be able to actually see the hardware, play with it, and talk to the sales rep.

4

Wow, the Omnipod sounds cool. I had the Minimed when I was using an insulin pump, and yes, the tubing was pretty annoying to deal with, particularly when taking showers and whatnot. I mean, it wasn’t insanely annoying, just slightly annoying; for showers, I’d just pop the quick-release off the cannula and leave the pump on the side of the sink while I showered, and then pop it back on when I got out. But having a little snap-on pod sounds like it would be so much easier and nicer.

I don’t have a lot to add to what Athena said. The joy of an insulin pump is that you no longer have to time your daily activities around your insulin injections. And you don’t have to carry insulin needles with you to restaurants and stuff.

5

Thanks! I didn’t know there were only three, and I am very interested in the Omnipod. I had no idea that I could get reps to come and show me pumps.

One thing I should have thought to ask about is cost. I think my insurance will mostly cover the pump, but what does a month’s supply of insulin cost? Is insulin generic?

6

Oh you’re not even on insulin yet! Heh, that’s practically a whole other subject.

Insulin is not generic, at least not the stuff you put in a pump (Novolog, Humalog, and Apidra are the 3 brands of rapid-acting insulin currently available, they’re mostly interchangable). The base cost (that is, before your insurance does anything) is about $100/vial, give or take. A vial is 1000ml. How much you use is totally individual - I use about 30-40 units a day, so a vial lasts me about a month. Type 2s are typically going to use more because you’re resistant to insulin. How much more, who knows?

Pump costs are different, too. In general, the M/A is going to cost a lot up front - about $6K - but then is only about $100/month for supplies (insertion sets, etc).

The Omnipod is different. The up-front costs are smaller - about $1K - but the pods themselves are about $500 for a box of 10.

Once again, these are pre-insurance prices. What your insurance will cover and what your co-pay will be is something you’ll have to talk to them about. I once did a price comparison with a guy who was on a Minimed, and it turned out that the total cost over 4 years (the typical replacement time) for the Minimed versus Omnipod were practically the same for our insurance companies. That’s not the price WE paid - that’s the price the insurance company paid - but thought I’d mention it because initially it looks like the Omnipod is more expensive.

If you’re not even doing MDI (multiple-daily-injections) I’d highly recommend doing that for a few months before you get a pump. You need to figure out if insulin even works well for you, and get used to carb-counting and all that. All the stuff you learn for MDI is needed for using a pump, so you might as well figure out if you even want to do it before you spring for a pump.

Oh, one last thing about the differences with pumps - the Omnipod has a blood glucose meter built into the PDM. The Animas has one on the wireless remote. The Minimed doesn’t have one at all. So depending on which brand you get, you may need to also carry around a meter. That’s another score for the pod IMO - the less crap I need to carry around, the better.

7

I’m currently in “training” to transition to an OmniPod from MDI (Type 1.5 diabetic, oh joy). I chose the OmniPod because, like Athena, I can’t imagine dealing with the tubing all the time – I’d be petrified of getting tangled in it or yanking it out. The flexibility it offers, just seems fantastic, and well, I won’t be a mass of bruises anymore, which is good! :slight_smile:

As far as cost goes, my insurance has a $150 deductible and covers 80% of the cost after the deductible. My startup costs basically came to $416 for the PDM and the first three month’s supply of pods (and an extra box), and then I end up on $166 every three months for the pods.

Insulin is not generic, but your insurance should cover it, especially with a pump – I’m currently paying $25 for a box of 5 3ml Novolog pens (still doing MDI for a couple more weeks) that contains about 300 units/pen and lasts me a good while. But then I also have to pay for the Lantus (long acting, basal insulin), so the Novolog lasts longer than it would if I was just pumping.

8

Does the pump put out insulin or a regular basis ? Or is it based on a glucose reading?

I am type II but just on drugs now.

9

Yeah, the pump tries to mimic the way your own pancreas would work. So the way your own pancreas works is to give out a “background” or “basal” insulin to keep your blood sugars stable, counteracting any glucose being dumped into your body by your liver, etc. When you eat, your pancreas produces insulin also, to help utilize the carbohydrates you’ve just eaten.

The pump works on a similar way. Once you’ve figured out your basal insulin rate, you get a “hit” so to speak, of rapid acting insulin (Novolog, Humolog or Apidra) every few minutes (I think the Animas does it every 3 minutes, the OmniPod every 5), so that you always have a background level of insulin at its “peak action” time. If you get dawn phenomenon, you can pre-program your basal rates for early morning to compensate, much like your pancreas would. If you’re doing heavy exercise, you can dial down the insulin or switch it off. When you eat, you tell the pump how much you’re eating and your insulin to carb ratio, and your blood sugar in case you need a correction too.

I’m pretty new to this (I literally just got the pump today and had a training session yesterday!), and I’m sure I’ve missed stuff out that Athena will be able to correct me on!

10

Holy crap. That’s way more than I expected.

Given that I will have to pay 25% of the cost of the pods (I think), it’s going to jack up my monthly prescription bill significantly.

Yeah, I’m kind of thinking into the future on this. But I have a bunch of health problems that are inter-related. A lot of diabetes meds typically used for Type 2 are not available to me. Insulin is definitely the next step because there are no other possibilities left.

I already do carb-counting, so that’s not a big deal. I am super careful with my diet. In fact, a major problem I have with metformin and Byetta, my current meds, is that I have to eat more carbs than I want to in order to make the medications work at maximum efficiency. So my diet is more unhealthy, with more calories than I want to eat, and still I don’t have good control. The more I try to lose weight, the higher my blood sugar numbers go. On top of that, the Byetta gives me constant nausea that makes it incredibly difficult to do any moderately strenuous activity. I have stopped working out since I started it. It’s totally counterproductive.

I do injections now with the Byetta. I know I will probably have to start out with injections for the insulin, but a pump is almost certainly where I will end up. A pump would be a better strategy because of the special issues with my other health problems. Also, I am increasingly having neuropathic pain in my feet and hands, even as my control improves. (Which is a total WTF, but it’s true.) A pump is supposed to be the best method for eliminating that.

So I’m pretty sure that a pump is where I’m headed, sooner or later.

Yeah, ditto.

Thank you so much for the information. I have another appointment with my endo on Thursday, and I want to be informed when I talk to him. He is going to want to put me on 10 mcg of Byetta, and I just can’t take that. I swear, they should call that medication Bulimia. I feel like I need to be able to demonstrate that I’m ready and willing to do insulin therapy. Everything I read indicates that is what’s best for me, and that doctors are too reluctant to start it because they’re worried that patients can’t handle the responsibilities involved. So I want to show that I’m totally capable.

Something has to change.

11

Angua got it right.

The only thing I’d add is that it is very much a manual process. A lot of people - me included before I became diabetic - think you just slap it on and forget about it. Nothing could be farther than the truth. Not that it doesn’t make things easier in the long run, but you are still having to monitor your blood glucose, count carbs, do corrections, etc. etc.

12

Is it a big deal to get a pump “installed” on your body or can you do it at home?

13

This will be such a relief to me, though. Right now, all I can do is take my meds as prescribed, eat as I am supposed to, and then sit back and get upset and frustrated when my blood sugar numbers just don’t behave like they’re supposed to.

Question about the Omnipod: I played with the website and saw the little video about basal insulin “programs,” where you can tell the pod how much basal insulin to give you at certain times of day. They demonstrated three different programs. Are the controls limited to a certain number of set programs, or can you adjust it to whatever you need?

14

You HAVE to do it at home. It gets changed every 2-4 days, so you do it yourself.

For the pod, it’s just a matter of filling the pod with insulin, sticking it on your body, and pressing a couple buttons on the PDM. The insertion is more or less pain-free (occasionally you hit near a nerve and feel a little pinch but nothing bad at all.) The nearest I can describe the feeling is like getting hit lightly with a rubber band.

15

Once you’re fully trained up on how to use it, to the satisfaction of your health care team, its very much a DIY at home process. For the Pod, you fill it with your insulin for 2-3 days (depending on how long a Pod will stay on you), and tell the PDM you’re ready to activate. The nice thing about the OmniPod is that there’s no dealing with the cannula insertion. The PDM primes the Pod (removing any air bubbles) and automatically inserts the cannula into you on activation.

16

How does the pod stay on your body? Is it sticky? Or does it just stay on based on the needle staying in your skin? It seems to me it would fall out easily but I guess not.

I knew a guy who had an experimental pump 20 years ago. He was in a clinical trial. I think his was totally in his body. He had to go get checked a lot since it was still in trial mode.

17

Are you sure you’re Type 2? Because your description is pretty much what I went through for 6 months before I went to a specialist who said “All those drugs that weren’t working? It’s because you’re Type 1, not Type 2.”

They even wanted to put me on Byetta at first (when they still thought I was Type 2), and I was flat out afraid of it because it seems like everyone says what you do about the nausea, and I don’t much like drugs that haven’t been out for at least 5-10 years. I argued with the Endo until he relented and put me on Lantus (a long-acting basal insulin) instead of Byetta. That helped with my morning numbers, but didn’t do a damn thing for post-meal numbers.

Hmm I’m not sure what you’re asking. You can have more than one basal program - I think up to like 24 - but I’m pretty set with just one so I haven’t mucked with it.

You can also do temporary basal programs, where you say (for example) “Instead of .5 units/hour, give me .2 units/hour for the next 3 hours.”

You can also just go change your basal and it stays changed until you change it back. I did that for a while until I started to forget to change it back, now I do the temp basal thing.

RE: Prices. The prices I quoted are before-insurance prices. Your actual co-pay will probably be less, because your insurance company probably gets better rates. For example, the box of pods that are $500 retail are only $350 when my insurance buys them, because they’ve negotiated a lower rate. So if you only pay 25% of that, then it gets even cheaper.

Also - most insurance companies consider pumps & supplies as Durable Medical Equipment (DME), not prescriptions, so you may have a different plan/copay altogether for that. You probably want to check.

18

Yep, its sticky. Its attached to an adhesive dressing type thing that sticks very firmly onto your body. Although you can use products like Skin-Tac to make your skin sticker…

19

I don’t know. The evidence tends to suggest that I’m a Type 2, and there is a strong family predisposition to Type 2. I had PCOS at age 14, which is an identified precursor to Type 2. I have the stereotypical body type. But who knows? I’ve wondered. Some days the meds work just right. Other days, they don’t.

I think the more likely reason is that my other health issues interfere with good control. I have a terrible problem with insomnia and disrupted sleep cycles. Well, that leads to increased cortisol production and higher blood sugar numbers. My drugs don’t work so well on days when I’m not sleeping right. Unfortunately, my doctors have concluded there is nothing they can do for me to resolve the sleep issue. Sleep meds make the problem worse. Diagnosis: my brain is really screwed up in ways they don’t understand and can’t fix.

So I need my diabetes management to be able to deal with the times that my sleep cycles go off the rails and my blood sugar numbers go up.

I don’t usually like new drugs either, but my mother had excellent results with Byetta, so I was willing to try it. Unfortunately, the nausea gets worse the longer I take it, which is…unusual. Sometimes it works great. Some days it doesn’t. I have tried to figure out what the pattern is, to figure out why, but I can’t identify one.

I know Lantus is the next step my endo will want to take (in addition to what I’m on now). But that will put me on three meds, with side effects that are keeping me virtually housebound some days. I don’t want to live like that if I don’t have to. And the studies indicate that if you’re a Type 2 on 3+ drugs, you’re highly likely to get better results long-term on an insulin pump. And if the nausea were gone, I could get back to a normal lifestyle.

That answers my question. I need to be able to make programs to deal with the odd wake/sleep cycles.

Yeah, I realized that was probably the case after I posted. I do get better coverage for equipment.

I am hugely grateful for the information!

20

So is it hard to get it off your body?