50 Comments
If you have never used an insulin pump with automated insulin delivery (also known as a hybrid closed-loop pump), what are some of the reasons you're reluctant, or obstacles you’ve encountered? Please select all that apply.
You must be logged in to post a comment.
when theese things first became available, I wwas doing fine without them !!! so why add problems and devices to complicate things ?? I went from pee sticks to finger sticking when insurance covered cost… I got first CGM [ G6 ] 2 years ago [and dont fully trust it ] …. 70 years T1D…..
I’ve been on the Medtronic pumps for over 20 yrs. great tech and support
T1 for 50 yrs
Luddites just may be the most comfortable people on earth. 🙃
The constant refilling and site changes…doesn’t seem worth it.
To start, I like to be in control and I have done very well. Second, from a liability standpoint, who is responsible if the machine incorrectly gives my body too much insulin based on algorithm that was developed/trained/tested on people that weren’t me.
I’m unique and my needs are very, very, different. I don’t need the added worry cause insulin is deadly.
I don’t want to risk my life on a new device with the stated objective of controlling me rather than me controlling it.
I agree…. we are not all the same !!!
I think I use too little insulin to be able to use an automated system easily….a few hours in the evening with no basal delivery and generally around 12 Daily Total units. I diluted the insulin in my first insulin pump back in 2000 but I’m not really thrilled with the idea of returning to that although I’m sure small children still dilute. Also, I have tight control now and apparently the current automated delivery systems have a wider range of flexibility that I think would bother me. I would love to hear from people who use small insulin doses AND are on an automated insulin delivery system.
Just a small diversion. Did you see Katie Bone, 15 yr old T1D, win the women’s American Ninja Warriors last night? Go Girl !!!! Yeah!
She was wearing an Omnipod and a G6 Dexcom sensor on her arms.
I’ve been on a Pump for 25+ years, now using Tandem CIQ w/Dex 6, have eliminated almost ALL lows below 80 and even got to an A1c of 5.4 but always in Low 6
I am very happy with MDI using the InPen. The pen gives me all the data a pump does. Calculates dose, IOB etc. I do not trust a pump to make decisions for me. And the big reason for me is that I am sick of being attached to a device.
I have high insulin resistance, so I use too much. I’d have to change it out a couple times a day. It wouldn’t be efficient for me.
I chose “Something else” because I use an insulin pump that offers automated insulin delivery, but I do not use the hybrid closed-loop because my blood sugar ran too high when i tried it. Setting just my basals and then inputting my bolus at meal times works much better for me. If/when the FDA allows for lower settings on the hybrid closed-loop systems, I might be willing to try it again.
Non FDA cleared DIY systems do allow to set any target the user wants.
I don’t like the automated feature as it keeps me a little on the higher side than I like. I like to be at 80-90, not 110-120.
Something else – I use an automated system, but the sensors are not nearly as accurate as advertised, or as accurate as is needed for the type of control I aim for. I end up doing most of the corrections myself even when on the automated system.
It is integrated with the Dexcom CGM, and my glucometer output is frequently as much as 40 points different from the CGM. That might cause me to receive insulin when I do not need it, or not getting insulin when I do need it.
Yes! For the first 24 hours after I put on a new CGM sensor, finger prick and CGM readings can be dangerously different. Plus now that I’ve fine tuned the MDI, I get good, consistent results without a lot of effort.
thats what scares me !!
Like others, the “closed loop” runs me too high – even the target bg is too high for me. I use the TandemX2 with BIQ integrated wqith my Dexcom G6. I also appreciate – and use – the temp basal function often. I would lose that with CIQ. L:ike Nilla Eckstrom (I think?) I like to be between 80-90, with maybe up to 120 after I eat.
I currently use one but having the CGM talking to the pump has been cost prohibitive in the past.
My private insurance carrier will not cover either a CGM or pump, but I am now receiving my CGM from the Veterans Administration and am exploring receipt of a pump from the VA.
My spouse has been skittish about me getting a pump. I think I’m finally at the place where I need to keep my bg TIR steady to support my kidney transplant.
read all the comments first … and others on this site !! some good and some not !!
There are many reasons, as well as “something else.”
My arthritic fingers do not serve me well with a cell phone. I have trouble putting the needle covers back on to my insulin pen needles. If I had to take care of all the fine muscle issues associated with setting a pump up, I would probably require assistance.
I am also not drawn to the issues I hear about tissue damage at the infusion sites, or knowing whether everything is seated properly and the insulin is actually flowing.
Finally, I just have some kind of negative karma with electronics. I have worked as a lab biochemist. Somehow, I find the weaknesses of every machine in the lab. (the ideal industrial beta-tester)
Having said that, what I hear about the numbers achieved with the tandem CIQ gives me pause to consider.
Good reasoning !!
I want an AIP that I can set my own targets and settings that I know will give me enough insulin.
A DIY hybrid system, like AndroidAPS, allows its user to set any target and many more settings. The drawback is that such freedom is not easy to manage and wrong parameters may make control worse.
I am on the Omnipod 5 but I don’t use it in the auto mode. I tried it, but their algorithm is terrible and the requirements for my Dexcom to connect with the pod don’t work for me. So I just use the manual mode. I now only use the pump for my basal anyway because I have switched to using Afrezza inhaled insulin for my meals/highs.
I use the Tandem t slim X2 pump that has the option of CIQ but don’t use it much unless my bg is going down. It usually runs me too high so I just make corrections etc myself. My TIR and A1c are fine. 68 years T1D.
I stand by this answer: THE INSULIN IS TOO SLOW! It’s not the device, it’s the insulin. Pre planing my bolus is the most difficult part. Busy father and full time employee makes meal planning a challenge. Also I was on a pump for many years and I DO NOT miss the complexities of a pump in general. Tubes, pods, filling, priming, batteries, occlusion and other alerts, lypohypertrophy, etc…
Using inhaled insulin is easier, more flexible, and I don’t have to preplan my dose because it works so dam fast! Basal insulins are significantly better and I took a shot and LOVED IT! Very stable.
Bottom line, I have as good if not better control than when I was on pumps w/o the complexities from being on Pumps.
Get me an algorithm and system that will predict when I’m going to eat and gets me to 90%+ TIR (90-130) and I’ll consider a pump.
Otherwise, inhaled insulin, CGM, longer-acting basal for life! 😊
Good for you!! sounds like you have a good handle on it !! how many years have you had T1D and what is your age ??
Not available in Canada yet
Pregnancy
Try it! The user can monitor closely and, if uncomfortable with what the pump is doing, disconnect. My A1c went from 7.3% to 6.8% after a year of getting used to the automatic delivery of basal and corrective doses.
I do MDI. For the last 7 years my A1C has averaged around 4.8. I have no reason to believe that a closed loop automated system could do that well.
For the last 5 years, the highest HbA1C I’ve had was 5.3. For the last 3 years the high, low, & average have been 5.2, 4.7, & 4.9. I’m not willing to go to an AID that sets a target of 6 to 7.
I don’t want to change from the Omnipod Dash to Omnipod 5 because the minimum target blood glucose is level is higher than where I like to keep it. My A1C is currently 5.0.
On tslim, I’ve found that the Dexcom CGM is way too slow on picking up my lows as well as rarely registering as low as my glucose meter (out if parameters). I’m going to give CIQ a try when I get my new pump, hopefully this week. We shall see. My last A1c was 6.2 and I’m usually in the upper 80’s-more 90’s time in range. I’d love to not have to think so hard though.
Using the Medtronic 770G system found the algorithm was great for preventing hypoglycemia, but was too slow and not aggressive enough for lower glucose levels. Some of the reasons include the speed of insulin and rate of detection of glucose by the CGM. For one prone for hypoglycemia, has unawareness (especially a child), or lacks skill in carb counting any algorithm is a good deal. Right now with pens and the Libre3 due to retirement (cost) it’s going well but plan on a pump again and will definitely give it a try.
Following others who have posted similar responses: I’m on MDI and doubt that regulators will allow target ranges to go low enough to achieve sub 6.0 A1C (I’m no more than 5.3 normally). Cheaper, more efficient to be on MDI for me, but glad hybrid closed loop works for others.
I have been wanting to get on a hybrid pump system for a few years now. When I went on the OmniPod , they said that since it goes through the pharmacy, the warrenty rule (5 years) wouldn’t be a problem. Well, my insurance won’t switch so I’m stuck with this one even though an automated pump would help regulate me much better.
The upper and lower limits, and target range, are all too high for me! I need to customize, which isn’t allowed.
I’m using the FreeAPSx system with my omnipod dash pods! I’m loving it – no PDM necessary, all controlled through my iPhone, and it has taken such a mental load off of managing my diabetes.
I use as Tandem X2 Pump and a Dexcom G6 Sensor. I believe Control IQ is too slow to respond. Exercise mode is useless, along with the Extended Bolous, only get 3 hours max. Not good when eating Fatty stuff or Grazing at a Wedding. (Dual wave for those Metronic Pumpers) Not being able to set a long temporary Basel. Very difficult when told to fast for at least 6-12 hours.
The need for better CGM accuracy is a big consideration for me. Also my control is pretty good right now (a1c in the low 6 range). Although I am tempted by the sleep and exercise modes which would be very helpful since I’m getting back in to exercise. So…I keep sitting on the fence…
That T1Ds on this site report report achieving consistent normal blood glucose levels using pumps makes them attractive to me. I rarely get below 6.0 on MDI. Pump disincentives are cost and the extra time it takes to use a pump.
Just waiting for more data. I am scheduled for a closed loop system in September ’23. Have to determine the cost yet. That may be a determining factor.
Financial issues prevented it period. However, I have fundamental issues with pump tech.