Author Topic: Tubed or tubeless?  (Read 798 times)

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Offline nytquill17

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Tubed or tubeless?
« on: 22 March 2018, 06:59:26 PM »
Hi all! I know this is a question we have gotten a few times before on the forum, but now it's my turn to ask anew ;) (and we may have members with new/different experiences since the last time it came up)


So! I may be joining you pump users' ranks within the next few months. My clinic is very keen to get me onto a pump, and luckily for me my new province of residence has a special funding program that covers all T1s for pumps (1 pump every 5 years plus $200/month for supplies). So it's looking feasible financially and I also have competent and comprehensive support.


At my appointment today, we did some discussing of options, and currently there are 2 available to me: the Omnipod, or the Medtronic Mini-Med 630G. I got to see and handle both and practice using an inserter set for the Medtronic. I also have a demo pod to try on but I haven't used it yet. So basically it boils down to what do I want: tubes or no tubes? Naturally I have been scouring reviews (including YouTube reviews) for the past few hours trying to suss out which way I might lean. As my CDE said to me, pretty much everybody likes the one they've got, whatever that is, which suggests that neither is drastically better or worse from the other.


I'm interested in hearing from people with more pump experience than I - anyone, but especially if you've had experience using both!


My initial thoughts are something like this.
OmnipodMedtronic
No tubes - set it and (mostly) forget it. Does have tubes which will have to be managed for things like changing clothes, showering, using restroom, etc.
Pod is kind of bulky (though smaller than they used to be!), looks like it might be easy to bump/hard to find convenient sites where it wouldn't rub on clothing (need to save arms for Libre sensors!)Infusion set is really small and discreet (and so far not uncomfortable to wear) BUT you have to find "somewhere to put the pump" for every outfit/activity
No concrete plans for closed-loop system, although partnership with Dexcom suggests something in the works.Beginnings of a closed loop system available on the next model due out (in the US this year, probably another 2-3 years in Canada). I would be able to upgrade (not for free, but at reduced cost) to a newer model from same manufacturer before the 5 years are up should I want to switch over.
Failure at any point in the delivery system (occlusion, kinked cannula, random mechanical/electronic misfire) means inserting a whole new pod (filling with insulin, etc.). Easier/less wasteful to deal with delivery issues that only require new tubing/infusion set/site


So it's really kind of a toss-up for me. And both of course have other pros and cons, failure rates, alarm issues, adhesive, annoying menus, things like that, that didn't stand out to me so far but I'm interested to hear if there are any "little things" I'm not thinking of that have a significant impact on QOL!
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline sedge

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Re: Tubed or tubeless?
« Reply #1 on: 22 March 2018, 09:40:42 PM »
Well the Medtronic currently used in the UK is the one that pairs up with a Dexcom - but the Dexcom and sensors are not currently as easily available on the NHS as the pumps - you have to be at imminent risk of very severe hypos or other pretty uncontrollable conditions in order to qualify in the first place - a special case has to be made for you in order for funding to be applied for, and that's no guarantee of the purse holders agreeing.  I think it's the Medtronic 640, cos the 630 was a special model specially cos the FDA didn't agree to the 640.  They always take longer by insisting on far more human trials than any other country.  Having been the guinea pigs - it has been a resounding success with or without a Dexcom - so that's fine, no probs.  It also has limited 'communication' from the matching meter and that is what you haven't mentioned at all.

The bolus wizard that calculates your bolus or correction dose taking into account the IOB - is on the Medronic pump itself and so though the meter picks up the BG from the meter, the calculation and ANY delivery (even if done by mental arithmetic or guesswork) has to be done via the pump itself so even if it's buried next to your skin in multi layered Arctic wear - you cannot bolus/correct unless you get it out and use it.

I don't know what/how the Omnipod works but I'm sure @himtoo will respond as soon as he sees the question.

It's the fact it sticks out so far - and that's dodgy with me, that has always put me off them - hell I even ripped out a Libre sensor in my arm on the edge of a door - and that hurt a lot more than 'ripping out' a 'normal pump' one - cos the pump cannula bit inside the body is flexible and the Libre one ain't and their sticky just refuses to budge on me, whereas the outside edges of a tubed pump cannula lift up a tad sometimes, to give you a start where to pick at it and get hold of it, to remove - the Roche ones don't seem to leave a completely bald patch or remove the top layer of tanned skin either, not leave adhesive on my skin, the couple of Libres I used left a circle like old fashioned Elastoplast used to, which I then had to work Vaseline into to get it off, also a round paler patch on my arm.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

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Re: Tubed or tubeless?
« Reply #2 on: 22 March 2018, 10:58:56 PM »
The one serious attribute I like in my pump is the ability to dose via the handset without hoiking the pump out of my clothing.  I rarely wear a dress, but sometimes at formal do type occasions i.e. weddings etc.  it's handy not to have to fish in your underwear in public to get a pump out.  So I guess I might plump for the Omnipod given the two choices you've been given.  I saw Mike's pump (EDUAD) when we met up last Autumn, which is a Medtronic and it's quite a bit bigger than my tubed pump.  Not entirely enough to put me off, but I do like doing stuff on my handset.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline nytquill17

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Re: Tubed or tubeless?
« Reply #3 on: 23 March 2018, 12:27:45 AM »
Yes the Libres do stick quite firmly on their own! I buy ring-shaped "fixtapes" to put down overtop just to help protect the edges of the sticky a bit to make sure I get the full 2 weeks' wear out of the thing, but I suspect that I could get away just fine without!

Thanks for the info, Sedge. I had seen that the Medtronic has a remote meter and didn't think about whether it actually WORKS or not. Good to know!

Having looked around a bit more before posting this, it appears that the 630G has an improved remote bolus ability to what you're describing. It also integrates with a proprietary(?) CGM (Guardian/Enlite) rather than Dexcom directly. Seems that it has already incorporated the auto-suspend feature if the CGM detects a low, although it doesn't have the full closed-loop capability of also increasing dose if CGM detects rising BG the way the new model will. Important details to track down, though!
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline sedge

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Re: Tubed or tubeless?
« Reply #4 on: 23 March 2018, 12:19:47 PM »
Don't think ours increases, only suspends.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline nytquill17

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Re: Tubed or tubeless?
« Reply #5 on: 23 March 2018, 12:37:33 PM »
It'll be the 670 that increases. It's out on trial I think in the States right now, due for a commercial release very soon if it hasn't already. I've seen some reviews online of people using one, apparently the "automode" (closed loop) isn't too brilliant because of all the safety regulations they've had to adhere to. Things like it doesn't let you pick your own target BG but has a pre-set, unchangeable target of 6.0 (a lot of people would prefer theirs at 5.0, apparently!), pre-set sensitivity factor, pre-set minimum and maximum basal rates it can deliver automatically, and so on. And everything depends on communicating with the proprietary CGM sensors which are less well-rated than Dexcom (and wouldn't work with the Libre anyway, obviously, which is the only CGM my insurance will cover for the over-25 set!)

My feeling is that this model is essentially the road test for closed-loop systems and that as they become more commonplace the regulations will allow a bit more flexibility and user input than they do now. In other words, I'm not chomping at the bit to be an early adopter in this case, but I suspect that in a few years' time we'll have a closed loop system to really be interested in!
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Pattidevans

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Re: Tubed or tubeless?
« Reply #6 on: 23 March 2018, 01:24:31 PM »
There are a number of Patients/carers who are busy perfecting closed loop systems, some with great success I believe.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Liam

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Re: Tubed or tubeless?
« Reply #7 on: 23 March 2018, 02:55:00 PM »
I've only ever had my vibe (tube pump) but I've never fancied the omnipod myself. I just don't trust myself not to knock it off. Just a bit too big for me.

I think we all love our pumps when we get used to them.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline Alan

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Re: Tubed or tubeless?
« Reply #8 on: 25 March 2018, 03:14:29 AM »
I can't offer any helpful suggestions. Just mentioning when I saw the topic title I was wondering why we were discussing car tyres on the forum...
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Slow Cooked Beef Brisket)
Born Under a Wandering Star (Surviving Long-haul Flights in Cattle Class)

Offline sedge

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Re: Tubed or tubeless?
« Reply #9 on: 25 March 2018, 02:32:11 PM »

Nah Alan - pushbike ones!  LOL


That's why you need the pump to go with them.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline everydayupsanddowns

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Re: Tubed or tubeless?
« Reply #10 on: 26 March 2018, 10:33:11 AM »
Just for clarity on a few details here...

Well the Medtronic currently used in the UK is the one that pairs up with a Dexcom - but the Dexcom and sensors are not currently as easily available on the NHS as the pumps - you have to be at imminent risk of very severe hypos or other pretty uncontrollable conditions in order to qualify in the first place - a special case has to be made for you in order for funding to be applied for, and that's no guarantee of the purse holders agreeing. 

It isn't Dexcom. It is Medtronic's own 'Enlite' sensors with a Guardian transmitter. This is a minor, but quite important distinction, partly because the US has historically had quite a difficult time with the older Medtronic CGM (sofsens etc) and even their early Enlites didn't have as up to date a transmitter as used here which affected BG accuracy. As a consequence, Medtronic CGM has an absolutely terrible reputation in the US, which is slightly unfounded with the newer tech. My experience of the Guardian 2 is excellent, and tracking is significantly closer to my BG meter than Libre on almost all sensors I have used. Dexcom have a great reputation for restart-ability for self-funders, many people regularly getting 14-20 days. I restart all my Enlites and almost always get 12 days (they are officially licensed for 6 days). On rare occasions I can get a second restart. My longest sensor ran for 21 days! But 11-12 is my expectation.

Quote
I think it's the Medtronic 640, cos the 630 was a special model specially cos the FDA didn't agree to the 640.  They always take longer by insisting on far more human trials than any other country.  Having been the guinea pigs - it has been a resounding success with or without a Dexcom - so that's fine, no probs.  It also has limited 'communication' from the matching meter and that is what you haven't mentioned at all.

The difference between the 630G and 640G (G standing for 'guardian') is to do with the glucose suspend. Medtronic is the only currently available official tech where the linked CGM can affect insulin delivery. For the 630 and 640's this is about hypo prevention AKA 'low glucose suspend'. On the MM640G the pump watches CGM and *predictively* suspends basal insulin (and any extended bolus delivery in progress) if sensor glucose is heading to be below a person's 'low limit' within 30 minutes. On the MM630G the suspend doesn't happen until the low limit has been reached. It's a minor difference, but means that 630 users have to rely on more alarms to take action, while 640 users can let the pump do it's thing silently and keep them out of bother. Typically I lose 90% of my hypoglycaemia when wearing a sensor linked to my MM640G.

Quote
The bolus wizard that calculates your bolus or correction dose taking into account the IOB - is on the Medronic pump itself and so though the meter picks up the BG from the meter, the calculation and ANY delivery (even if done by mental arithmetic or guesswork) has to be done via the pump itself so even if it's buried next to your skin in multi layered Arctic wear - you cannot bolus/correct unless you get it out and use it.

No. I'm afraid that isn't right at all. I've tried a number of times to explain this, but I cannot have been clear.

The full bolus wizard IS on the pump itself exactly as you say.

BUT...

If you want to manually do a straight bolus of however many units (in 0.1 increments) you can EITHER use the pump OR deliver the bolus from the Contour NextLink 2.4 BG meter.

Additionally you can predefine up to 5 'fancy' boluses which can be picked from a menu. (eg 8 units delivered as a dual wave 60:40 over 2 hours). The snag with these is that they are fixed. You have to know all the details - amount, split and duration - when you define them. I've always found this makes them rather useless so haven't used them... but for example... if I were getting married in a fancy frock and knew that most likely *that* sort of meal needed a blah dose delivered over that period then I could dose that from the BG meter WITHOUT having to fish the pump out, and just make the carbs in the meal fit the predefined dose (like many of us used to do in the old days!)

So there IS some remote bolusing from on the MM640G (I would need to double check about the MM630G as it isn't available here).

But you are quite right that the full bolus wizard, with automated correction calculation and/or offset of correction based on IOB is only available on the pump itself.

Not sure if that it at all understandable?

Here's the 'manual bolus' process:


Incidentally the linked BG meter can also be set to automatically transmit all BG readings to the pump - so that they are always there waiting for you if you are using the full bolus wizard on the pump itself.
Mike

Type 1 since: 1991 Last HBA1c: 45 (6.3%)  Total Chol 5.0 (1.9HDL / 2.8LDL / Trigs 0.7)
Pumping NovoRapid in a MiniMed 640G
Blogging at: www.everydayupsanddowns.co.uk

Offline everydayupsanddowns

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Re: Tubed or tubeless?
« Reply #11 on: 26 March 2018, 10:38:17 AM »
It'll be the 670 that increases. It's out on trial I think in the States right now, due for a commercial release very soon if it hasn't already. I've seen some reviews online of people using one, apparently the "automode" (closed loop) isn't too brilliant because of all the safety regulations they've had to adhere to. Things like it doesn't let you pick your own target BG but has a pre-set, unchangeable target of 6.0 (a lot of people would prefer theirs at 5.0, apparently!), pre-set sensitivity factor, pre-set minimum and maximum basal rates it can deliver automatically, and so on. And everything depends on communicating with the proprietary CGM sensors which are less well-rated than Dexcom (and wouldn't work with the Libre anyway, obviously, which is the only CGM my insurance will cover for the over-25 set!)

My feeling is that this model is essentially the road test for closed-loop systems and that as they become more commonplace the regulations will allow a bit more flexibility and user input than they do now. In other words, I'm not chomping at the bit to be an early adopter in this case, but I suspect that in a few years' time we'll have a closed loop system to really be interested in!

The MM670G has been out in the US on general release for about a year now I think. Gary Scheiner wrote a review here: http://integrateddiabetes.com/670g-and-me-insights-and-incites-on-medtronics-latest-system/

I have no idea when (if?!) it will be released in the UK. I don't think there has ever been a time when we've had the same pump here as our cousins have over the pond, but there's a first time for everything. Rumours were that the MM670G might arrive here 2018-2019ish, but they don't currently have a CE mark for it, so can't do anything until that process has completed.

In the meantime, literally hundreds of people in the UK are 'looping' with the OpenAPS system(s) as part of #wearenotwaiting
Mike

Type 1 since: 1991 Last HBA1c: 45 (6.3%)  Total Chol 5.0 (1.9HDL / 2.8LDL / Trigs 0.7)
Pumping NovoRapid in a MiniMed 640G
Blogging at: www.everydayupsanddowns.co.uk

Offline himtoo

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Re: Tubed or tubeless?
« Reply #12 on: 26 March 2018, 12:34:09 PM »

Hi @Nyt !!

I have only ever used the omnipod so am unable to comment on the medtronic.

I really like the fact that i put the pod on and pretty much forget that it is there. it is fine for showering and swimming.
I have ripped 1 pod off in 30 months which works out at 1 lost pod in 300 pods ( so faR)
i have had 2 pods fail with an alarm ( kink-- in the cannula ).

I have also had a few ( 3 0r 4 ) incidents where my BG is rising unexpectedly so I have done a change before the 3 days has finished. ( but I read about all pump users having to do set changes because of rising bloods -- ok they don't waste any insulin which does happen with the omnipod )  but you don't have to fill the pod with 200u unless your daily usage is at 60u per day -- I know of pod users that only put the 85u minimum in.

as for siting the pod i use the outside of my arm , the underside of my arm , my upper abdomen , lower abdomen , thighs , upper bum ( just around lower back ) and recently have sited on my forearm ( after seeing some other peeps using forearms on instagram.

as for siting Libre -- i have started seeing some people siting on their upper chest and reporting excellent results compared to Bg tests. (very close comparison )


you should check out www.pimpmydiabetes.com for any colourful covers for the pods , sets , libre patches etc etc.
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6) 04/18 46 (6.4)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline sedge

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Re: Tubed or tubeless?
« Reply #13 on: 26 March 2018, 01:17:48 PM »
Mike - you probably did make yourself perfectly clear - much more likely that I simply didn't remember quite honestly - and I know when you told us how much could be done remotely, I did tell the personnel at 'my' clinic that Medtronic had a lot more 'remote control' than before and Kim - the DSN/Nurse manager - said she'd 'have to investigate'.  I don't get to see her now, she seems to spend a lot more time managing than DSN-ing so no longer get the latest news on what the Trust are planning for us all in future.

Paul - I think you'll find that there is little soft flesh -other than the actual breasts! - on the upper chest of a lady - under them the ribcage is too close to the skin and also the bones above the boobs. (is that the top of the ribcage? - but swiftly followed by the collarbone anyway!)  How far above the nipples do you mean?  LOL
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline himtoo

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Re: Tubed or tubeless?
« Reply #14 on: 26 March 2018, 02:06:38 PM »
the images i have seen on instagram were about where the top of the bra angles across the chest.
also seen them on thigh and stomach ( i know libre don't recommend )
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6) 04/18 46 (6.4)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014