Say you’re ready for a new insulin pump, or a continuous glucose monitor (CGM), 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.
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, maintaining a healthy insulin level without the users having to do anything, after initial programming. (Already on the market, the MiniMed 670G Insulin Pump System and the Tandem Control-IQ are hybrid closed-loop systems, meaning that they can automatically adjust certain features of its insulin delivery based on CGM readings.)
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.
Type 1 diabetes is an autoimmune disorder in which the immune system attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the pancreas produces little or no insulin. Type 1 diabetes is also characterized by the presence of certain autoantibodies against insulin or other components of the insulin-producing system such as glutamic acid decarboxylase (GAD), tyrosine phosphatase, and/or islet cells.
When the body does not have enough insulin to use the glucose that is in the bloodstream for fuel, it begins breaking down fat reserves for energy. However, the breakdown of fat creates acidic by-products called ketones, which accumulate in the blood. If enough ketones accumulate in the blood, they can cause a potentially life-threatening chemical imbalance known as ketoacidosis.
Type 1 diabetes often develops in children, although it can occur at any age. Symptoms include unusual thirst, a need to urinate frequently, unexplained weight loss, blurry vision, and a feeling of being tired constantly. Such symptoms tend to be acute.
Diabetes is diagnosed in one of three ways – a fasting plasma glucose test, an oral glucose tolerance test, or a random plasma glucose test – all of which involve drawing blood to measure the amount of glucose in it.
Type 1 diabetes requires insulin treatment for survival. Treatment may also include taking other drugs to prevent kidney damage or to treat diabetes-related conditions such as high blood pressure.
How much will it cost, and how much will your insurance cover? Medicare and some private insurers 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. 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.
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 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.
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.
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.
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.
Sometimes you want to share information with your healthcare team. Does the system generate reports your doctor can use?
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?
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, 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 times a day or who have a history of hypoglycemia (low blood glucose), 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 for CGMs or this one 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.
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