How to Pick an Insulin Pump or CGM


Say you’re ready for a new insulin pump[1], or a continuous glucose monitor (CGM)[2], or both. How do you choose the right ones? There are a lot of them out there, and you will likely be living with your choice for four or five years.

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Remember there is no rush. Diabetes devices are like smartphones, with new ones coming out all the time. Whatever you buy, something better will come out in a year or two. For example, advanced CGMs and pumps will soon work together to function almost as a bionic pancreas[3], maintaining a healthy insulin level without the users having to do anything, after initial programming. (Already on the market for a few years, the MiniMed 670G Insulin Pump System[4] is a hybrid closed-loop system, meaning that it can automatically adjust certain features of its insulin delivery based on CGM readings. The Dexcom G6 CGM[5] can communicate with a variety of devices, such as the Tandem t:slim X2 insulin pump and certain fitness trackers.)

That said, you might want features that are coming but not quite here. Purchasing decisions are complicated and require some research. Here are some things experts advise you to think about and do.

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How to pick an insulin pump or CGM: factors to consider

Price and insurance coverage

How much will it cost, and how much will your insurance cover? Medicare[7] and some private insurers[8] cover CGMs if your doctor documents need. What will your out-of-pocket cost will be, not just for the original product, but for replacement sensors?

Insulin pumps are typically more expensive, and insurance coverage varies. Sometimes free or low-cost pumps and supplies are available through various programs[9]. Infusion sets, syringes and batteries will need to be replaced. Ask about the cost of those and how much insurance will pay. You also have to consider the costs of the insulin, since pumps are made to be used with costlier rapid-acting insulins.

Features[10] 

How much information do you want or need? Some CGMs report a record of your glucose levels over hours. Most keep track of which way your glucose level is heading. Some have alarms that you can preset to warn you of impending lows or highs. Some allow you to enter insulin taken, carbs eaten, blood glucose levels, exercise[11] and other health events.

With insulin pumps, users need to learn how to program their basal and bolus rates and doses and work with their device to keep their blood glucose where they want it. Health professionals usually help with those settings initially. Some pumps and monitors may have more features than you want or can use.

Ease of use 

How often do sensors, cannulas or infusion sets need changing? How easy are they to change? Some CGMs require fingersticks for calibration every 12 hours, but many no longer do. Some are waterproof. Some have rechargeable batteries and some don’t. Each brand has a different sensor life, sensor size and insertion system. Some easily and unobtrusively clip to your clothes while others look more like medical equipment. All require programming, but some far more than others. Consider how tech-savvy you are and how much work you’re willing to put into your learning curve. Here is a primer on living with an insulin pump[12].

System support 

Telephone support is usually available 24 hours a day from manufacturers, but you’ll want to find out how that works for your system and what help they can provide.

Too many alarms or not enough 

Systems may have alarms for low or high glucose, rapid changes in glucose, battery life, insulin remaining in cartridge, missing calibration data and more. Some find the alarms intrusive and stressful, but many systems allow you to program which or when alarms will go off.

Reporting abilities

Sometimes you want to share information with your healthcare team. Does the system generate reports your doctor can use?

Child-friendliness

Is the system child-proof? Child-usable? How easy is it for you to monitor your child’s status when you’re not right next to him or her?

Getting help with your decision

Unless you’re a whiz at both technology and diabetes, consulting with experts will get you a better tech fit than going it alone. Fortunately, everyone wants to help you, especially the device makers.

• Most people start by asking their endocrinologist, diabetologist or primary-care doctor what he or she recommends. Your doctors may or may not be experts in tech, but they can refer you to a diabetes educator[13], nurse or physician’s assistant who is knowledgeable about device support. Does your doctor collaborate with patients by looking at CGM reports and/or helping calculate basal rates and bolus amounts? If so, does he or she have a preference for particular products and types of report?

• Talk with your insurance company about what they will cover. Devices are expensive, and they all need various parts and attachments that can also cost money. Often, an insurer like Medicare will only cover certain people, like those who need to monitor their blood glucose four or more time a day or who have a history of hypoglycemia (low blood glucose)[14], or those who inject insulin four times a day. Patients have to ask.

• Contact the manufacturers of the devices. Ask them what information they can send you. Find out if there are company salespeople in your area who can show you their product and answer your questions. If they can’t send someone, that’s an argument for avoiding their pump or CGM, because you will need support after you buy it.

Keep in mind the company will be trying to sell you something. Have a list of questions for them to answer, such as “Tell me about your company’s support system for customers?” and “How much will this cost me?”

• Every manufacturer has a website for their product, and there are resources like this one[15] for CGMs or this one[16] for insulin pumps that compare various products.

But websites aren’t enough. It’s absolutely critical to get hands-on experience with the device, usually in presence of an educator or doctor. Play with it. Can you use the touch screen easily? Can you understand how to program it? Can you read the graphs and the numbers? Can you attach the infusion sets and wear the device comfortably?

Much depends on what you can afford and what your insurance will cover, so don’t hesitate to ask questions about prices. Thousands of patients with diabetes are finding their lives and health improving dramatically with the use of technology, but finding the right equipment for you can make the difference in how much benefit you get and how much hassle you have to endure.

Want to learn more about insulin pumps and CGMs for diabetes? Read “Type 1 Diabetes Insulin Pumps | What Are Pros and Cons for Older Adults?”[17] and “CGM for Diabetes Management.”[18]

Endnotes:
  1. insulin pump: https://www.diabetesselfmanagement.com/diabetes-resources/tools-tech/type-1-diabetes-insulin-pumps-pros-cons-older-adults/
  2. continuous glucose monitor (CGM): https://www.diabetesselfmanagement.com/managing-diabetes/blood-glucose-management/cgm-diabetes-management/
  3. bionic pancreas: https://www.diabetesselfmanagement.com/diabetes-resources/definitions/artificial-pancreas/
  4. MiniMed 670G Insulin Pump System: https://www.diabetesselfmanagement.com/blog/10-diabetes-technologies-watch-2019/2/
  5. Dexcom G6 CGM: https://www.diabetesselfmanagement.com/blog/dexcom-g6-the-future-of-cgm-is-here/
  6. sign up for our free newsletter: https://www.diabetesselfmanagement.com/newsletter/
  7. Medicare: https://www.medicare.gov/coverage/therapeutic-continuous-glucose-monitors-cgms
  8. insurers: https://integrateddiabetes.com/cgm-insurance-coverage/
  9. various programs: https://www.jdrf.org/t1d-resources/living-with-t1d/insurance/help-with-your-diabetes-prescription-costs/
  10. Features: https://www.diabetesnet.com/diabetes-technology/meters-monitors/continuous-monitors/compare-current-monitors
  11. exercise: https://www.diabetesselfmanagement.com/nutrition-exercise/exercise/
  12. primer on living with an insulin pump: https://healthprep.com/articles/diabetes/what-is-an-insulin-pump-and-how-to-use-it/
  13. diabetes educator: https://www.diabetesselfmanagement.com/about-diabetes/diabetes-basics/certified-diabetes-educator/
  14. hypoglycemia (low blood glucose): https://www.diabetesselfmanagement.com/managing-diabetes/blood-glucose-management/what-is-hypoglycemia-symptoms-treatments/
  15. this one: https://integrateddiabetes.com/continuous-glucose-monitor-comparisons-and-reviews/
  16. this one: https://integrateddiabetes.com/updated-insulin-pump-comparisons-and-reviews/
  17. “Type 1 Diabetes Insulin Pumps | What Are Pros and Cons for Older Adults?”: https://www.diabetesselfmanagement.com/diabetes-resources/tools-tech/type-1-diabetes-insulin-pumps-pros-cons-older-adults/
  18. “CGM for Diabetes Management.”: https://www.diabetesselfmanagement.com/managing-diabetes/blood-glucose-management/cgm-diabetes-management/

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