By Beth Michaels, in-house Dietitian
In this article we're going to do a comparison of insulin pumps and provide information to help you make a decision about what might work best for you.
Insulin pumps are small computerized devices that serve to deliver short or rapid acting insulin to the body incrementally throughout the day. They work through an infusion set, which is changed every 3 days or so, in which a catheter is inserted under the skin and left covered and sealed.
This catheter then extends through a tubing, which is connected with a reservoir of insulin that is released according to the pumps programming. The reservoir has a sort of plunger or ‘pump’ that must be told what to do by the wearer.
For example, if a person consumes 15 grams of carbohydrates, the pump doesn’t ‘know’ this unless the person enters that information or the amount of insulin they require based on that information.
Insulin Pumps: Factors to Consider
There are many different kinds of insulin pumps available and just like when choosing a house, a vehicle, or clothing items, there is no one ‘best kind’ for everyone as they all have different advantages and disadvantages. Some of these are more important to certain people than others, so it’s important to consider the factors that are most important to you.
Here are some variations to compare as you consider the pump that will be best for you:
Health insurance may cover much of the cost, but there are often co-pays and deductibles.
Size, weight, appearance
No pump-wearer is trying to make a fashion statement, but for some, having a bulky or obvious pump is more troublesome than a small, discreet or even cool-looking pump.
Ease of use
Some features make pumps more user-friendly than others. Playing around with buttons, screens, menu items and so forth, can give you a better feel for simplicity in day-to-day use.
Battery type and life
Pumps have different charging options and duration between charges.
Infusion sets and tubing
Most pumps have tubing that connects the reservoir to the pump. Patches or pods are tubeless and offer a tangle free option and stay stuck to the site until it is changed.
Those who are highly insulin resistant or use more than 60 units/day will want to ensure they have sufficient reservoirs to avoid having to change cartridges on a daily basis.
The ability to set multiple dosing and variable rates is very beneficial, especially in those who use large amounts of insulin and are more ‘brittle.’
Basal range, delivery, and increment
People who are extremely sensitive to insulin may require doses of less than 1 full unit.
CGM and meter integration
If a pump integrates data from glucose meters or CGMs this eliminates the need to manually enter glucose values and ensures a correct reading. Some pumps have meters integrated into the remote controls that program the pump.
Pumps have alarm systems for obstruction, over-delivery, near-delivery, and many other factors. Volume and intensity of vibrations are points of consideration.
Sometimes it’s hard to know whether your pump is right for you until you’ve actually used it for a time. Many pump manufacturers offer a 30 day money-back guarantee, but check before purchasing.
Memory and reporting
All meters have different data managing systems and generated reports–some are more helpful and understandable than others; most are compatible with Windows and Mac.
Special features (colors, software download, waterproof etc)
Several other bells and whistles offered by pumps should be taken into consideration when making a decision based on what is most important.
Realistically, most people end up with the pump their insurance company covers.
5 Popular Insulin Pumps
While there are far too many pumps and features to cover in a single article, five of the most popular pumps and highlighted features are as follows:
Long-established, large reputable company
Not water tight
Low contrast LCD screen
Integrated Enlite CGM system (data display on pump screen)
CGM system must be purchased with pump ($)
Connect feature for sharing CGM data (even on smartphones)
On-board insulin only subtracted from correction bolus
Quick and easy bolus programming
Slow bolus delivery
Easily downloadable to online program
Customer service complaints
Very specific Insulin to Carb ratios (.1 g increments)
No food database available
Generates insulin/carb/BG statistics
Alerts difficult to hear
Syncs with Dexcom G4 (CGM) integrates with web-based software
No data averages or statistics generated on screen
Re-priming with battery change
Very bright full color screen; easy to read
Insulin to carb ratios whole numbers only
200 unit cartridge limit
AA Batteries; last 6-8 weeks
Cursor screen complicated
Cartridges easy to fill
Extra button presses when programming
No air bubbles
Does not sync to meter
Strong metal clip
On-board insulin not subtracted from bolus
Reduced up-front costs
Bulky programmer and pod ‘bulge’ on skin
Discrete size (smaller than other pumps)
Cannot program while bolus is delivering
No tubing (more freedom to move around, no ‘lost’ insulin)
Cannot enter boluses or make setting changes without programmer
Max reservoir 200 u
Temp basal and boluses can be customized
Dislodged cannula or disconnection requires complete reservoir replacement
Freestyle meter built into programmer
Not covered by 3rd party payers
Large color screen with full-sentence text
Insulin to carb ratios whole numbers only
Only one cannula type
Automated cannula insertion minimizes pain and lipodystrophy
Must suspend when changing basal settings
Bright full color TOUCH screen
Small buttons…difficult to navigate
Modern, “techy” appearance; compact
Unlock procedure required to perform programming
Graphic on-screen history display
No integrated clip
Carb counting calculator
Tubing connector unattractive
Web-based downloadable software
No meter link option
Calculate bolus up to 50-60 units
Cartridges hold 300-480 units
Charging required 1-2x/week
No in-warranty upgrade policy
Roche Accu-Chek Combo
Full pump programming via linked meter/remote via bluetooth
Must use linked meter to check BG and perform bolus calculations (cannot enter manually)
Bolus adjustments in percentages
Need computer software to change certain temp basal parameters
Bright full color meter screen
Smart scrolling speeds
No clip (must use case)
3 programming options (based on user capability)
Cartridges challenging to fill without bubbles
Holds 315 units insulin
Must stop pump to change cartridge
Sensitive occlusion detection
Can only link 1 meter per pump
History displayed as graphic reports on meter screen
Bolus calculations complicated to set up
Can use rechargeable batteries
Must enter cartridge fill amount manually
You can also find a more detailed side by side comparison here.
One last point–word of mouth may be one of your best assets.
If you know anyone who has a pump or has had one, or even better, has tried multiple types, set a date to meet up with them and ask some questions.
To provide a comparison of insulin pumps, much of the information available is from the manufacturer, which is obviously a bit biased. We all know some things look better ‘on paper’ than they are able to deliver ‘in practice.’
Your doctor and/or diabetes educator likely has experience with patients using several of these as well so be sure to ask them too!