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Tube Pumps

Discussion in 'Parents of Children with Type 1' started by Leah, Nov 3, 2013.

  1. Leah

    Leah Approved members

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    Hi! Im 15 years old, and am currently using the Omnipod. I am considering switching over to a tube pump so I can have more options as to insertion sites. I was just wondering what the pros and cons are of different tube pumps. Also, it is possible to shorten the tube to less than a foot if I wear the pump next to the site?:)
     
  2. moco89

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    Pick a pump that you think you would be happy wearing for 24 hours a day, 7 days a week, for the next four entire years. I would not recommend picking a pump for its features, or what features "are going to be coming out soon", as the features are basically almost the same, from pump to pump. The pump company representatives are frequently lied to about upcoming pump release dates and features, and end up being untruthful to customers.

    * Pros/Cons by pump
    http://www.integrateddiabetes.com/p_compar.shtml

    * Pump comparisons (basically insulin pump specifications, side by side)
    http://www.diabetesnet.com/diabetes-technology/insulin-pumps/current-pumps/pump-comparison

    * Infusion Set Comparisons (specifications, basically--scroll down to get to the charts)
    http://www.diabetesnet.com/diabetes-technology/infusion-sets

    Hawkeyegirl has an exceptional review about the T:Slim pump.

    Give me 24 hours to collect more information for you.
     
  3. misscaitp

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    The main pumps out there are Minimed 530G, Animas Ping, Tandem, and Omnipod.

    Minimed 530G is new, it's features are mainly built around the enlite sensors. It's main feature that is has is low suspend, which uses the CGM to predict low BGs and suspend insulin. Also, in comparison to the Dexcom the CGM allows for different targets to be set. They have been in the business of pump making the longest. And they do have a BG meter that communicates with the pump. I would say the negative is that other the different color, Minimed hasn't really changed in making the pump aesthetically pleasing.

    There's the Animas Ping with Remote, which provides the ability to have a tubed pump but also a remote that allows you to not only test your BG, but also bolus. So it's kind of like a tubed pump with an optional feature of remote to deliver boluses without having to take the pump out of your pocket. The biggest negative that I have heard from the people I know on Animas is the amount of steps needed to bolus, particularly once it calculates the bolus instead of just pressing deliver you have to dial up to the suggested amount. And that is due to patents on the bolus wizard.

    Tandem is the newest in terms of brand, but they are known of course for their touch screen and smallest basal delivery units on the market (.001). And even though people fear the fact that it is a touch screen, it is very durable and they even have had competitions to see what would it take to break the screen. It has a really nice interface (colorful and self-explanatory) and touch bolus abilities. Also, instead of rounding off with carb estimating, it bolus wizard functions almost as a calculator (it can add 15 carbs +28 carbs+13 carbs without you having to do mental math). The cons are that the BG meter given does not communicate with the pump and the amount of time it takes for a insulin cartridge change. Also, that apidra cannot be used in the pump. It also has to be charged, so while no battery, it can be either a negative or positive.

    And you can shorten the tubing. There are accessories that can be bought that you can wrap the pump tubing around; one is called tubeguard by unomedical.

    I personally like tubing more, mainly because I can inspect the tubing for air and I have more of a visual of the site. I personally find it more reliable than the Omnipod, which I am currently on.

    Also, you could always just have the pump representatives come out to your house for a demo/hands-on experience.
     
  4. Ali

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    Leah
    I am a pump user. I like tube pumps cause I love the straight in steel set. I also find pods except on vacations too bulky to wear under most of my clothes. I only wear sets on my tummy and the CGMS on my arms. I love the Tandem but I love the integration of the MM Cgms and pump the most. Once Dex is integrated with more pumps the options for me will be better. I find of the tube pumps Minimed the easiest to use. I use a smaller amount of insulin so I like the smaller reservoir option and I like their upgrade option, at least in the past where I could upgrade to a better pump for minimal cost. If you can, get all the reps to come and visit and let you handle the pumps.
    Ali
     
  5. moco89

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    Here is a detailed review on the T:Slim pump.

    * http://forums.childrenwithdiabetes.com/showpost.php?p=833678&postcount=1

    Be aware that people that use Apidra often experience occlusion errors and high blood glucose values due to the pump's proprietary (custom) reservoir design. Many people who do not want to change their insulin from Apidra end up returning the pump.

    The reason why the occlusions happen is because of the chemical composition of the Apidra insulin. Most rapid acting insulin is compatible with insulin pumps due to an added phosphate buffer solution in the insulin, which prevents clogging and occlusions. Apidra does not have this phosphate buffer solution, which causes this problem.
     
  6. Sarah Maddie's Mom

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    Hi Leah,

    Maddie (also 15) has had a cozmo, ping and MM723 and I'm pretty confident that I can speak for her and say that if she were to get a new pump today, it would be the t:Slim.

    Biggest negative on the Ping, the 200u cartridge and the dial up bolus.
    The MM has 300u but it's nothing to write home about - it's a bit of a tank, it works but it's not as transparent and ergonomic as the Cozmo was

    The t:slim holds 300u, has a site change reminder (which we really like) looks amazing and seems to be making it's users very happy. That would be her pick.

    On the shortening the tubing question... we've been using a 23" for ages.. there used to be something on the market, a little plastic circle that was designed to hold excess tubing... not sure if it's still made

    ETA - don't know if this works, or if you really want another thing to clip on, but this is the tube keeper other people have mentioned http://www.homecare-supplies.com/supply.cfm/insulin-injectors/TUBEGUARD-FOR-INFUSION-SET-TUBING.html
     
    Last edited: Nov 3, 2013
  7. obtainedmist

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    Molly uses the 23" tube with the Ping and just tucks the excess. She rotates tummy, love handles, upper bottom, backs of arms. The cartridge size has never been a problem, but she was 17 at dx. The "dial up" on the Ping isn't an issue as well, she's quick as lightening. The remote is only used when she's wearing a dress. Otherwise, she prefers to use her pump to dose. Her pump is out of warranty next Oct. and we will be looking at either another Ping or the T:slim. Hope you find one you love!
     
  8. mmgirls

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    If you go with Animas they have a tube winder thingy that you can use instead if the clip.

    When we trailed the t:slim the bulky-ness of the cartridge piggy tail to the site tubing was really annoying.

    At this point I think you just need to get your hand on each pump and run them side by side and see which feels most comfortable to use.
     
  9. Megnyc

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    Hey Leah!

    I have used Medtronic pumps for over 10 years. I also sometimes use the omnipod.

    Pros of MM:
    really durable
    super easy to bolus
    super easy to set temp basal
    amazing customer service
    international presence
    menus are really intuitive to me
    300u reservoir-- I only change it every 6-12 days
    site/reservoir changes are really quick and easy
    any type of insulin works
    easy quick battery change (only every 6 weeks at most)
    no dial up bolus

    Cons of MM:
    Not the most attractive pump
    Not integrated with dexcom
    Annoying process of changing basal rates (there is a workaround but it requires having a time frame for basal for every hour)
    Bolus speed is slow (could also be pro)

    I personally prefer tubed pumps because I just have a tiny site on my body (I use arms, legs, upper bum, stomach, and back for sites) and can put the pump in my pocket or clip to my pants or bra. I can also disconnect for certain times up to an hour and only have a tiny thing on my body vs the pod which is a big lump that can get knocked off or in the way. In terms of swimming and water skiing I prefer the pod since I get ketones quickly if I stay disconnected for over an hour. Since I have both, I switch back and forth depending on how I feel. It really is the best of both worlds!

    The tslim looks great but just fyi I have yet to talk to anyone successfully using apidra in it. That is the main reason I haven't switched to it.

    Feel free to send me a PM or reply here if you have any specific questions about the medtronic pump. Personally, I really love it and can only complain about how it looks. And since it is a medical device and all, that may not be the most valid complaint :eek:

    ETA: I think it would be really useful for you to try the infusion sets. I would suggest the mio/inset since you are used to the automatic insertion of the pod. I personally think they are basically painless to insert. It is just one squeeze and it is in. Your endo should have samples. Or, if your parents are ok with it, I am happy to send you a few to try out. You can also put them on your parents to see how they work!
     
    Last edited: Nov 3, 2013
  10. MomofSweetOne

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    You might want to start the process with which CGM you want to use. You and your dad did awesome with MM's CGM, but now you're using Dexcom. Which do you prefer? Will the low glucose suspend be something you'll want for your college years? Once you've made that decision, it will make your pump choices somewhat easier -

    1) If you want Dexcom, you might be able to buy a Revel with CGM right now since the 530G isn't approved for pediatrics. If they won't let you, then you'll know to write them off your list of considerations. They're not the only fish in the pond and you have several other choices that aren't integrated.

    2) If you prefer the MM CGM over the Dexcom, then the 530G isn't much different than a Revel other than the low glucose suspend. My daughter likes her Revel a lot. I find it much easier to program than the pod. I prefer the multiple basal profiles on the pod (only 3 on Medtronic) and the My Records that includes temp basals and when used, but other than that, I find MM much easier to use. (To be fair, it's the pump I learned on!)

    My daughter switches between pod and MM for site rotation. She dislikes arm sites with the MM but prefers them with the pod.

    If you were my daughter, I'd encourage you to TRIAL everything IRL, not just through reading websites.
     
  11. Darryl

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    This is all really helpful, thank you.

    She likes the Dexcom but might be open to the new Enlite (not going back to the sof-sensor though). Her main goal is to have more flexibility on site location, I'd also like the insulin cutoff if possible. We like the idea of getting demonstrations from the pump reps.

    Can I add a few questions?

    About how much does a "site" cost vs. an Omnipod ($35) before insurance?

    What is the difference between a "steel" set and a non-steel(?) set?

    If she wanted to disconnect, would she just bolus an hour's worth of basal, and then disconnect?

    Can any of the pumps be used with any of the infusion sets?
     
  12. Darryl

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  13. dianas

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    I just looked at Animas store and a box of 10 cartridges retails for $36.60 and 10 luer lock infusion sets varies between about $108 and $136.

    Medtronic also has an online store where you can look at their retail prices. Medtronic reservoirs are $38 for 10 and it looks like most infusion sets range in price from $98 to $151 for a box of 10.

    The Enlite sensor retails for $473 for 5 sensors vs $439 for 10 Sofsensors.

    If Leah switches to a tubed pump there may also be a small initial investment for accessories. The pumps ship with clips but sometimes people want something like a pump band to secure the pump under dresses.

    Looks like you found the answer to the steel set but basically a stainless steel cannula vs Teflon catheter. Some people develop a reaction to the Teflon or get a lot of kinking and occlusions so have better luck with a steel set.

    Medtronic has a proprietary connector so you have to use their stuff but the others all use luer lock sets. All the infusion sets are manufactured by one company for the most part so you can get most sets in either a luer lock version or with the Medtronic connector.

    Regarding disconnecting I have personally found it all depends why I am disconnecting and blood sugars at the time. I don't generally replace missed basal for an hour or two but longer time off the pump I need a shot every 3 to 4 hours.
     
    Last edited: Nov 4, 2013
  14. Beach bum

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    Sadly, they don't make this anymore. We had one and it broke and when I went to replace it they said they didn't market them any longer:(
     
  15. Marcia

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    Why use a steel set? Abbey uses them in areas where we had kinks with teflon sets. They work great on lean people. They are comfortable to wear. When not using SureT's, Abbey uses Mio's. Mio's have a self inserter and have 23" or 32" tubing options. She throws an extra one in her bag for unplanned site changes. 32" tubing works well on arm sites (to fish through clothing to a pump stored in pants pocket. You can also choose from pink,blue or clear sites to match your mood. If Abbey disconnects for an hour or more, we only prebolus for lost basal if she is active for that time. (If at a water park, we do not prebolus because she tends to run low. If at the beach relaxing, we would prebolus because she would not be so active.)
    At this time, we are jumping through the necessary hoops to get the Minimed 530g and enlite sensor.
     
  16. MomofSweetOne

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    See answers below.

    No. MM's sets & reservoirs are proprietary.

    One of the things I prefer about MM is the ability to fill the reservoir to full and swap it out when it's at about 5 units or so. I really dislike trying to estimate for the pod how much insulin she might use. The waste probably evens out by the time tubing is filled, but it's just easier. I also like that the MM tells you at all times how much insulin is left in the reservoir, not just when it's under 50 units.

    MM tubing comes in several different tubing lengths. My daughter actually prefers the longest length of tubing rather than the shortest. Something to do with how much the infusion site hurts when it dangles by accident (or dangles less?); not exactly sure, but I know she always wants the longest length.

    My daughter wears her pump clipped most of the time. It goes in a spibelt for going to open gymnastics, PE workouts, etc.

    We've had 4? MM pumps in 2 years. One was replaced because it got wet in an Aquapack fail; it was fine but they wanted it replaced. Another had the plastic attachment for the clip crack. The other failure was bad. It alarmed No Delivery and then I discovered there was insulin around the reservoir & an o-ring coming up around the piston in the reservoir chamber. That happened around 10 p.m., and we had a new pump in our hands before 10 a.m. the next morning.

    Medtronic lets the kids chose to change pump color when replacing a pump; I think I've read here that Animas doesn't? Medtronic also has really fun skins, even ones that you can design yourself. They're extremely pricey compared to Accu-chek's meter skins, but they're very durable. Getting coupons for them is a highlight of attending Expo each spring. In between skins, the pump sometimes wears duct tape (but nowhere near the buttons!)

    While clips, etc. are listed for sale in the store, we've received free replacements each time her clips have broken (we've gone through many). I believe Animas charges for clips?
     
    Last edited: Nov 4, 2013
  17. obtainedmist

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    I'm not sure if this is still available, but it seems there is a reservoir that one can use in Metronic pumps that connects with a luer lock. http://www.youtube.com/watch?v=klkLnhiHeHU
     
  18. missmakaliasmomma

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    I'm one of the people that prefers the teflon sets instead of the steel. That's only because the contact detach (steel) for the ping doesn't seem to stick very well at all. We went through 4 different sets at first before deciding that the regular insets (they have an inserter in it) worked the best for us. My daughter has barely any fat on her so putting a site anywhere but her butt is pretty difficult. We stopped pumping though a couple months ago because of some issues we were having.

    I have to say, I couldn't stand my daughter bathing with the pump on. It has to be pretty annoying. She did it once, so we had to limit the bath time and disconnect. Now on shots, she can stay in there for an hour if she wants
     
  19. hawkeyegirl

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    I don't know anyone who bathes with their tubed pump on.
     
  20. Sarah Maddie's Mom

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    Since the OP is a teen and has been pumping for years your bath time experience with a preschooler might not be all that relevant.
     

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