STUDENT CONTRIBUTOR: Liza Khalyavka | Nutrition & Food, Ryerson University
November 25, 2020
Have you ever been told by your doctor with a new diagnosis, and then left their office with a whole bunch of questions about what you can do to help manage your health?
People with Type 1 Diabetes can totally relate to that! Type 1 diabetes is not only hard to manage, but it also requires extra attention to your body’s natural cues; you are literally doing the work of a human organ!
Thankfully, over the past few years, technology has come a long way in the efforts to ease the burden of blood sugar management for T1Ds. This blog is going to focus on insulin pumps and continuous glucose monitors (CGM) by introducing you to what's available and how they compare.
Today, there are 4 different kinds of insulin pumps, 2 different kinds of CGM systems and 1 flash glucose monitoring system available on the market to help ease the struggle of managing diabetes. Let's get into the detail in hope of making it a little easier for you to choose the system that the best fits your goals and lifestyle.
But, first… what are insulin pumps and what do they do?
This conversation can get real complex very quickly, but - to keep it simple - insulin pumps are devices used in blood sugar management strategies that provide life-sustaining insulin. When paired with a CGM - an additional device worn on the body that reads blood sugar levels every 5 minutes - this technology can send continuous and customized doses of rapid-acting insulin throughout your day to match your body’s needs; mimicking how a healthy pancreas works.
The 4 insulin pump companies approved for use in Canada include; Medtronic, Omnipod, Tandem and Ypsomed. Here's a visual of each of the four pumps:
MEDTRONIC OMNIPOD TANDEM YPSOMED
Click HERE to view/print a 'quick comparison chart' showing the pumps & their features.
The Nitty Gritty
Each insulin pump device functions with a specific CGM (continuous glucose model), which was briefly summarized in the chart.
Medtronic can be used alone or with the Medtronic CGM. The CGM collects and communicates by passing the information to the pump. The Guardian Connect CGM also works well with this pump.
Omnipod's pump pods are very popular because there is no tubing. The insulin is held within the pod, itself. Pods pair with an independent CGM made by Dexcom; providing glucose readings around the clock. Users (or caregivers) control the system from a Personal Device Manager (PDM) that also acts as a blood glucose meter. The DASH pods will be available, soon, which can be managed through a smartphone app.
The Tandem pump usually pairs with the Dexcom G6, just like the Omnipod, but other CGM monitors can also be used. The Basal-IQ feature reduces the duration of low blood sugar in your body by predicting sugar levels about 30 minutes ahead and releasing insulin if your blood sugar levels drop below 4.4 mmol/L. Regular insulin delivery resumes as soon as the sensor sugar values are up again.
Lastly, the Ypsomed pump does not come with a CGM but luckily, this company recently entered a partnership with Dexcom to integrate the CGM into the pump. From reading about all these pumps, sounds like Dexcom has become the hot new company, providing their CGM monitors to many insulin pump companies. Every 5 minutes, the CGM transmits your current blood sugar value to a Ypsomed app, where its determined whether insulin should be released or not.
Each pump has their own special functions, with some already having CGM integrated within them, and some having to purchase one externally.
The drawbacks of each pump...
You are probably thinking to yourselves “wow, these pumps each have something great to contribute”, but of course we must consider the downfalls and drawbacks to really see what sets these pumps apart from one another.
Beginning with Medtronic pumps, there are small structural adjustments that need to be addressed, like the text being very small or the attached clip being upside-down. With respect to data, the insulin-on-board (IOB) is only deducted from correction boluses. Overall, this device may be too complicated for some users, having multiple menus, many buttons and confirmation steps.
Molly Johannes spoke about her experience with the Omnipod pump, highlighting one of its biggest downfalls being that it was quite disruptive when it emits continuous beeping noises to alert that action is required. It has been noted that this pump can also leave a bulge on the skin, the boluses cannot be changed without a programmer and the maximum reservoir volume is only 200u. Also, if there is an error with the pod it must be completely replaced, so there’s no chance troubleshoot and keep your old pump; all important considerations to be taken into account.
Next is the Tandem pump. The Tandem Diabetes Care website states that there is a potential risk of the cannula breaking under the skin. Once it breaks, you'll find yourself in a bit of a bind because only a doctor can take it out. Air bubbles in the tubing are also possible, which can reduce the accuracy of insulin delivery. If the pump itself fails, there is a risk of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), due to the pump not properly releasing the required amount of insulin. If this happens, be sure to keep a close watch on your blood sugars until the situation is fixed.
Finally, the Ypsomed pump. There isn’t too much information about this pump, but Frank from Type 1 Writes reviews this pump by sharing that once the infusion is inserted under the skin, there is a feeling of it digging into him. Once he took it out, there were bumps left on his skin, similar to his experience with the Omnipod system. He also added that the Ypsomed pump lacks a built-in bolus calculator, lacking much-needed convenience.
Considering the promises these pumps claim…
Every insulin pump company has a desired goal that they wish to achieve through their insulin pump technology. Taking a look at all 4 options, it's pretty obvious that every pump company is maximizing the use of specific claims in the hopes that they can convince you to be the first in line to get their pump… and they're pretty good at it!
For instance, looking at the "About Us" page on Medtronic's website, they claim that they are trying to transform diabetes care for greater freedom and better health and to make life easier overall. From this, it's clear that they want their pump to be convenient enough that it will not cause extra stress in the lives of people with type 1 diabetes. They also include that that their pump can better your health, which can really only be confirmed once you've already purchased and started to use it.
The Omnipod pump website claimed it takes an innovative approach to continuous insulin delivery, where this pump provides insulin while being flexible and having more freedom than other pumps with tubes, since its small size. Similar to the Medtronic, it wants to achieve freedom... but what does that actually mean? You can interpret this as feeling less trapped by your diabetes or just being free from worrying about those tubes in other pumps.
The Tandem website emphasizes its simplicity and user-friendliness; calling itself a 'modern technology device'. Their use of the word 'modern' is meant to get you thinking that there's no other technology out there as new and fresh as the t:slim X2 pump.
Lastly, one of the first things you'll find on the Ypsomed pump's website is their claim that their system is “easy-to-learn” and “the intuitive insulin pump system”, which basically speaks for itself. Simply reading these two phrases tells us that this company wants their pump to be very simple and user-friendly for people of all ages and life stages, and one that you can rely on to help you manage your diabetes.
The Bottom Line...
Overall, all these 4 pumps claim to improve your mental and/or physical health through the use of their systems that provide “freedom”, making life with diabetes “easy”; positioning their pumps to be the most convenient when compared to their competition.
Contact a diabetes educator for support with choosing the right system for you.