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Go Ahead, Pick Your Pump
My plan is to go through life with two things at my side: My wife (‘til death do us part…) and my insulin pump, at least until there’s a cure for diabetes.
Choosing my wife was easy — she was the only woman who was willing to put up with me. Choosing an insulin pump was not nearly as simple. How could I possibly tell which features were important and which were just a bunch of sales fluff? And when I picked out my first pump 12 years ago, there were only two pumps to choose from. Today, there are seven different companies producing a variety of pump models (and one producing a disposable “patch pump”), and more are on the way!
I’m lucky enough to work in a field that allows me to sample just about everything that comes down the research pipeline, so I’ve had a chance to wear every kind of pump out there. And you know what? There is no single pump that is best for everyone. Whether you’re looking to start pump therapy for the first time or are due for an upgrade, selecting the best pump for you is very important. Anything less can impair your ability to achieve the best possible blood glucose control and may create unnecessary costs and inconvenience. So it pays to shop before you buy.
Do your research
So before turning over insurance or payment information to any pump company representative, make sure you’ve done your homework. Contact each pump company and examine the various pumps carefully. (Click here for a list of pump companies.) Review the technical specifications for each. Check out reviews and comparisons made at some of the more reputable Web sites (For links to these reviews, click here.)
In addition, several diabetes magazines, including Diabetes Forecast, Diabetes Health, and Diabetes Positive run objective pump comparisons on an annual or semiannual basis.
Some pump companies (and company reps) will allow you to borrow a pump and wear it with a saline solution in it as a trial run. Take advantage of these opportunities! And try not to be swayed by fancy brochures, flashy videos, or smooth-talking salespeople. I would also be skeptical about comments made by other pump wearers that you meet or come across on the Internet. Very few people have an opportunity to try multiple insulin pumps, so their opinions are usually based on exposure to only one pump type.
And what if you find that you made the wrong choice after the pump has been paid for? Most pump companies offer a 30-day money-back guarantee. Ask your pump company representatives for specifics.
Price. Most insulin pumps cost about $5,000–$6,000. The disposable OmniPod pump costs less up front, but the long-term cost is similar to the others; the Asante Snap costs about $700.
Warranty and customer support. All pumps have a 4-year warranty and excellent 24/7 toll-free support. All pump manufacturers will replace your equipment for free, typically via overnight mail, in the event of a malfunction.
Safety features. All pumps have sensors to detect blockages in the tubing, a low battery, a low insulin level, and any internal problems with the pump itself. All can be “locked” to prevent accidental programming by young or irresponsible pump users. All have multiple systems to prevent accidental over-delivery of insulin, as well as an automatic pump shut-off and an alarm in the event that no buttons are pushed for an extended period of time.
Ease of use. All pumps use onscreen menus and are relatively simple to program. Filling the reservoir (the component of the pump that holds the insulin) and priming the infusion set tubing (filling the tubing with insulin before the infusion set is attached to the body) are tasks that are easily achievable by most people.
Training. The purchase price of all pumps includes comprehensive technical training and a limited amount of as-needed diabetes self-management education.
Small size. All pumps are small and lightweight, about the size of a modern cell phone. The disposable OmniPod pump is somewhat smaller but requires a separate, handheld programmer.
Computer connection. Data from most pumps can be uploaded to a PC for viewing settings and history. Some pumps allow two-way communication for making changes to pump settings.
Power. Most pumps use AA or AAA batteries, which last an average of two to four weeks. Some use lithium batteries, which can last two to three times as long.
Basal features. All pumps permit the user to vary the basal settings (to the nearest 20th of a unit per hour, or less) and enter multiple basal programs. Temporary basal overrides may also be used.
Prolonged bolus delivery. All pumps can deliver mealtime bolus doses all at once or over an extended period of time for foods that are digested slowly.
Backlight. All pumps have a lighted screen.
Programmable reminders. All have optional programmable reminder features to alert the user to check blood glucose at certain times of day or following each bolus dose.
Memory. All pumps store a substantial amount of data regarding boluses delivered, daily insulin totals, and alerts or error messages.
Bolus calculator. All pumps have an optional “bolus calculation” feature that helps the user determine proper bolus amounts based on carbohydrate intake, blood glucose levels, and insulin that is still working from previous boluses.
Some pump companies promote subtle differences in these common features and claim that this gives their pump a “competitive edge.” Typically, these minute differences have almost no significance at all. For example, a pump that offers up to 48 different basal time segments has no advantage over one that offers 24 or 12, since people rarely need more than four or five different basal segments in their 24-hour program. Allowing the user to set up four completely different basal programs is not a major advantage, since few people use more than one (and very few use more than two). A bolus history that holds hundreds of data points is really no better than one that holds a few dozen, since most people rarely look back more than a couple of days. In other words, not every “unique” or “special” feature provides tangible benefits to you, the user.
Ask the following questions when making your insulin pump selection:
Will the pump hold enough insulin to last you at least three days?
Can you see the screen reasonably well?
Will the bolus dose amounts work for you?
Will the “bolus calculator” meet your needs?
Likewise, the time intervals used when setting insulin-to-carbohydrate ratios are highly flexible in some pumps and less flexible in others, and when making adjustments for “active” or “unused” insulin, different pumps handle the data in different ways.
Can you hear or feel the alarms?
Do you require a pump that is fully waterproof?
Do you desire a pump that links with a blood glucose meter or continuous glucose sensor?
Currently, some pumps have the ability to take data directly from a blood glucose meter when performing bolus calculations (thus saving you the time of manually entering the readings). Others can display data from a continuous glucose monitor, but the data is not used to adjust insulin doses.
Is the clip or case easy and convenient?
Can you use your preferred infusion set?
Are there specific safety features that you will need?
Are the size and appearance pleasing to you?
Are loaner pumps easy to get and inexpensive?
Will your insurance pay for a particular model?
When you still can’t decide
Editor’s note: The author’s printer ran out of ink just as the last sentence was printing. We apologize for any inconvenience this may cause. Please direct your questions (or complaints) to Gary Scheiner.
Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.