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Insulin Pumps...

This does not replace any medical advice. The following is for your information only. Please feel free to share with your diabetes team but it does not make any changes in your diabetes management without first consulting your diabetes team

An insulin pump is not a cure but another method of insulin delivery. It is a small pager-like device that mechanically pumps set amounts of fast-acting insulin into the patient's body. This is not yet a closed loop system. It is a system that requires the setting of "basal rates" and the calculation of various insulin to food ratios to be used in the run of a day.

Unlike Multiple Daily Injection therapy (MDI), pump therapy does not use a long-lasting insulin but small amounts of fast-acting insulin are delivered throughout the day. For some this leads to feelings of unease as the threat of DKA (Diabetic Ketoacidosis) looms greater. For others it simply leads to feelings of freedom as they no longer are forced to follow the clock. The peaks of long-lasting NPH insulins may have been a problem, or the single basal rate offered by insulin glargine may not match their body's needs.

An insulin pump lets you set a variety of "basal rates" to meet the naturally occurring needs of your body. It further allows you to match insulin to carbohydrate intake rather than having to "feed" your insulin. You now chose to eat, snack or graze.

Pumping insulin is not for everyone. It is another method of insulin delivery. Some do not like the idea of being attached to a mechanical device 24/7 but the freedom, flexibility and tight control often outweighs any of the negative concerns.

 

Please take your time when choosing an insulin pump.  You need to the pump to fit with your needs and your lifestyle. We have a detailed outline of each pump company's current styles and features, as well as opinions for those who are currently using an insulin pump.

The basic insulin pump system currently costs approximately $7000CAD and require monthly pump supplies whose costs can run upwards of $1200 per year. These costs are often, but not always covered by private insurance plans.  In Canada, more and more provinces are also beginning to realize the long term benefits of covering insulin pumps and supplies under their provincial health care policies

 

A continous glucose monitor (CGM)  can be a part of an insulin pump.  These pumps are known as "sensor augmented pumps" (see Animas or Medtronic pumps for details).  CGMs can also be stand alone devices used by both pumpers and those on multiple daily injections.


What does it  all look like?



pump description All together!


 

Today's most popular insulin pump brands

Animas Insulin Pump systems

Animas currently has two pump systems availabel in the US and Canada--The Animas Ping and the Animas Vibe.

Animas One Touch Ping

Animas Ping

Features:

  • Remote bolus
  • Links with glucometer
  • 200 unit cartridge
  • Luer lock connection system for infusion sets
  • Uses AA battery
  • Bolus delivery to .05 units
  • .025 basal rate available
  • eZ bolus calculator
  • 4 custom bolus programs available
  • Temporary basal rates from -90% to +200% for 30 minute intervals up to 24 hours
  • Normal and combination bolus options available
  • Waterproof
  • Uploadable to diasend webbased system
  • Self illuminating
  • High contrast screen
  • Blue, pink, green, silver and black

Animas Vibe

Vibe

Features:

  • 200 unit resevoir
  • Uses AA battery
  • Battery last 6-8 weeks
  • Pump size is 3.25 x 2 x .85 inches
  • Water-proof for 12 feet up to for up to 24 hours
  • Uses luer lock connection infusion sets
  • Bolus delivery to .05 units
  • .025 basal rate available
  • ezCarb Customizable Food Database. Meter-remote can store a customized list of up to 500 foods for easy carb counting on the go.
  • 4 custom bolus programs available
  • Temporary basal rates from -90% to +200% for 30 minute intervals up to 24 hours
  • High contrast, easy read screen
  • Works with DexCom4 CGM
  • Works with Diasend web-based software
  • Choose your own times for your insulin-to-carb ratios, Insulin Sensitivity Factors (ISF) and blood glucose targets in 30-minute increments, up to 12 personal settings.
  • Blue, pink, green, silver and black pump colours
  • Resistant to static electricity and has memory protection in case battery is down for an extended period
  • User-defined timeout setting
  • User-defined occlusion sensitivity
  • User-defined bolus delivery rate

 

Drawbacks as noted by  Integrated Diabetes Services 

  •  Doesn't link with glucometer
  • Uses older generation DexCom technology
  • You have to reprime the pump when you change the battery
  • insulin to carb ratios are in whole number increments only
  • You can't see the insulin cartridge inside the pump
  • extra button presses required with most standard programming
  • You can't recall blood glucose or carb history on pump screen
  • IOB is not subtracted uniformly on all boluses
  • 200 unit cartridge
  • cursor speed can be difficult to master
  • bolus delivery can be too rapid for those using larger bolus amounts.

 

Medtronic 630G

Medtronic 630G

Features:

  • linked to Contour glucometer
  • Remote bolusing from Contour next meter
  • Uses Medtronic patented infusion sets
  • Uploads to Careline software
  • Threshold suspend aka Smartguard technology
  • Suspend on low
  • Black only pump
  • Portrait display
  • Waterproof
  • Predictive alerts
  • Built in CGM using Enlite Sensors
  • Colour screen
  • IOB on home screen
  • Easier pump navigation
  • More alarm customization
  • Improved CGM transmitter

Drawbacks noted by Diatribe.org

  • Cannot be software updated to add next-gen automation algorithms: 640G with predictive suspend (outside the US) or the 670G hybrid closed loop (under FDA review)
  • Upgrade program is expensive for current Medtronic users
  • Current Medtronic users must also purchase new transmitter
  • Not compatible with MiniMed Connect remote monitoring device, no Bluetooth included
  • Only approved for those over 16
  • Slightly larger than previous pump

OmniPod

OmniPodomnipod

Features:

  • Tubeless
  • 200 unit pods
  • 2 AAA batteries
  • Batteries last 4 weeks
  • Automatic inserter with no visible needles
  • Pink slide insert window to ensure the cannula has deployed
  • Strong adhesive
  • Pod has durable, water-proof exterior shell
  • Handheld PDM has built-in FreeStyle blood glucose (BG) meter
  • PDM has large color screen with bright light option
  • Customizable ID screen
  • Test strip port light for low-light conditions
  • Suggested bolus calculator
  • Downloadable data
  • Intuitive prompts
  • Reduced upfront costs
  • Discreet
  • Drawbacks as noted by  Integrated Diabetes Services 

    • Bulky programmer
    • Pod creates a bulge on the skin
    • Must have PDM to bolus or make changes to delivery
    • Cannot program or edit while bolus is delivering
    • Only one canula orientation which may not work for all body types
    • 200 unit pods
    • Pods stop working after 72 hours (plus grace period)
    • dislodged or clogged canula requires complete pod change.
    • No vibrate settings
    • Pod must be suspended to change basal rates
    • Temp basals are limited to 12 hours
    • If you lose the PDM, no boluses can be given.
    • Does not work with a CGM currently

     

    Tandem X2 Insulin Pump

    Tandem Insulin pump

    *This insulin pump is not available in Canada

    Features:

    • Smaller than previous models
    • 300 unit reservoir
    • Full colour touch screen
    • iPhone look
    • Fastest bolus entry
    • Can bolus up to 50 units
    • Site-change reminder w/customizable day and time
    • Graphic on screen history
    • Bolus calculator
    • Temp basal up to 250%, 72 hrs
    • Can set duration of insulin action in 1-minute increments
    • IOB shown on home screen
    • Missed bolus reminders
    • Warns of high insulin temps
    • Uses leur lock infusion sets
    • No batteries required

     

    Drawbacks as noted by  Integrated Diabetes Services 

    • Does not work with a CGM
    • Small buttons can be a problem
    • Pump must be unlocked to do anything
    • Weak vibration setting
    • Extra confirmation steps with all programming
    • Must be recharged 1-2x per week

     

    To see what other insulin pump users feel about their insulin pumps, please click here. To share your opinion, please email us.

     

    Infusion Sets


    90 degree sites...

     

    Cleo


    Disetronic Rapid-D

     uses 28 gauge needle. Inserts at 90 degrees. Multiple base units allow you to change infusion sites without changing tubing. Low profile design makes it very discreet. 


    Inset II or Insets by Animas


    This set has a teflon cannula. It has an all in one infusion set and inserter. It disconnects at the point of insertion. Small, flat infusion set design.  One-handed insertion and hidden introducer needle. Disconnect and connect the tubing at the site. Convenient needle protection after use. Safe to carry without compromising sterility. 23 and 43 inch tubing. 27 gauge introducer needle with 6 and 9mm cannulas

    mio

    The mio™ infusion set

    is Medtronic Diabetes new "all-in-one" design that combines the infusion set and insertion device into one unit. This 90°, soft cannula set is available in a variety of configurations and colors to match your personal body type, preferences, and lifestyle

    Quicksets use a 90 degree insertion. Luer Lock or Paradigm connection. 6 or 9 mm needle. 25 gauge intro needle, 27 gauge cannula.  23, 43 inch tubing lengths.

    30 degree sites


    Inset 30

     by Animas. 

    Pre-fixed 30 degree insertion angle. One handed insertion. Small and flat infusion set design. Ergonomic design with integrated insertion devise and a reversible connector that makes connecting and disconnecting a snap. Transparent window to view the site. Well-protected introducer needle. Disconnect and connect the tubing at the site. Convenient needle protection after use. Quiet release of the insertion devise. Available in blue, pink and grey with 23 and 43 inch tubing lengths. 13mm cannula.

     


          Tenders; Comfort; and

    Silhouettes

     all use a 30 degree insertion.  They have 13mm Teflon cannula. 25 gauge intro needle, 27 gauge cannula.  24, 31, 43 inch tubing.  All have luer lock connection.

    Disetronic offers the MiniTender with a smaller cannula size.

     

    Where do you put an infusion set?


    Just like injection therapy, insulin infusion sites must be rotated.  Site maps such as the one below may help to keep track of insertion sites and reduce the chance of hypertrophy.


     

    You are not limited to using only one area of your body.  Any area suitable for injections may also be used for infusion sets.  Here are just some of the areas that can be used...

     

    The abdomen The thigh

    The arm

     

    How do you change a site?

     
    Site changes should be taught by a certified pump trainer!! Below is a demonstration of how "we" change a 90 degree infusion set. This should be used as a guide ONLY.  It has been brought to our attention that our method and the method described by the Animas website (who distribute this set) are different. They do not require that you pinch the skin for one but it is an old MDI habit that I cannot break especially on a small child with minimal fat. Please remember to go through your trainer and read your manuals before doing a site change. This is only a guide for those who may forget or simply are curious as to what it may look like to do.

    For those who would prefer to insert the site according to the InsetII instructions, here is where we differ. I do not use the automatic inserter built into the site (as you can tell from the instructions below).  The Animas instructions suggest that after you have removed the adhesive backing paper you "Place fingers on lined indentations. Press lined indentations on each side. Pull spring up until you hear a "click" (this is what we do NOT do). Carefully remove the needle guard by gently twisting and then pulling it. Place tubing in the slot so that it is not caught under the devise when inserting. Position InsetII. Simultaneously press the round indentations on either side of the insertion devise to insert it. Push gently on the center of the inserter to secure the adhesive on the skin. Remove the inserter needle by grasping the center and pulling it gently back. Massage the tape thoroughly into the skin and fill cannula."
    Click on pictures to see larger images...

    3 steps to change a site

    Cleaning site with alcoholAdding Mastisol

    Attaching Tubing to pump attaching to pump Pump attached to site

    Remove site backing Inserting an Inset into Leg

    Finishing site

     

    How do you wear your pump? 


    Pump clips....

      (not so traditional method of wearing your pump!)

    Pump Pouches


    supplies

     

     

    Insulin Pumper Testimonials

     

    The following comments are opinions volunteered by people currently using insulin pumps.

     

    Tandem T:Slim X2...There is nothing I can complain about.  I was a Medtronic user for over 15 years and I have better control and regulation with the Tandem.  I LOVE the so easy to use touch screen, the bright display, the ease of use all around...I LOVE even more that unlike my Medtronic, it doesn't alarm constantly.  It can be more exact dosing than the Medtronic, and its small and VERY durable.  I broke/cracked more Medtronic pumps than I can count, but I have not had to return a single Tandme pump due to breaks, damage, or even malfunction, only when I upgraded. (DISCLAIMER...I have no bad feeling nor am I saying anything bad about Medtronic.  I undersand some people love theirs and would never have any different.  I also understand that Medtronic may now offer some of the things it did not when I had a Medtroinc pump.  I am merely just giving my opinion and experience.  Emily H

     

    Animas...Despite little grievances from time to time with time x of the lumps of life span...and getting Johnson & Johnson a bit on the defensive side with my dblogs...their pumps are easy to use (I am self taught) and when you need help...compared to other pump manufacturers...hands down. My only peeve with the Vibe I'm now using...has no remote like the Ping but Dexcom CGM technology incorporated into it is great! I did notice though the other day when I had to SUSPEND pump (using FIASP and having to test out pump settings with this faster but more short lived insulin...so 3 days in I've had a few under 3 lows) that in SUSPEND you cannot access the CGM readings on the Vibe pump.  Luckily I do have a seperate Dexcom receiver so all was good but I doesn't snow IOB like the Vibe does.  Anna

     

    How do you log when using an insulin pump?


    Check out some great log book ideas by clicking here...

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