The Best Insulin Pump?

Review Standard Options and Exciting New Features Before Deciding

The list you'll find further down reviews the various bells and whistles you can find on insulin pumps.  The best pump is one that meets your needs. Check off or circle the options you think might be important to you.  Then compare them to the types of insulin pumps available on the  market (insulin pump manufacturers/distributors listed here). All    insulin pumps, properly programmed, can help you sleep in, miss meals, etc and manage food like Pizza and Chinese in ways you can't with a syringe. If you're already sure of the brand you want, just skip ahead to insulin pump distributors. 

Standard Insulin Pump Features:

First off. Don't be swayed by marketing. Manufacturers all claim they have the " best insulin pump". But keep this in mind.  All newer insulin pumps should offer you these features listed directly below. So none of these items are perks. They're standard.

• Numerous basal profiles. Meaning you can store basal signatures or profiles for your day off, your menstrual cycle, your night shift etc. Just a beep or two to access the stored profiles.
• Temporary basal rates. So you can tell the pump to give you less of your normal background insulin when you're shopping like a mad woman (or man) and don't want your sugars to drop.  Low sugars impair your ability to spot a deal. (yes, yes. . . also good for sports etc).
• Standard, extended and combination meal bolus options. 
• All insulin pumps can be programmed to meet your lifestyle - not just those that say it in their advertising. 
• All pumps go through regulatory testing so should all be safe, reliable, accurate and durable. So don't let those words sway you if you see them in pump advertisements. All insulin pumps are safe and accurate not just the "best insulin pumps".

A few suggestions:
When looking for the " best insulin pump " . . .

• Speak with your diabetes educators.  They may have insight into "glitches"  that are not placed in advertisement materials. They all advertise they are the best insulin pump. But, there may be "old" issues with some insulin pumps that are well known to educators but not generally published (like Minimeds old pumps zeroing out the basal rates with minimal static electricity). There might be "new" pumps that are showing some unexpected perks or problems. Who knows. It's a big expense so check things out thoroughly when looking for the "best insulin pump".
• Physically hold all the pumps you are interested in. You'll be intimate with this thing. You must be comfortable with it.  I did not like the feel of one insulin pump because I wondered what body part I could hide it on. But I only figured this out by holding it, not by looking at the picture. Contact the representatives. Make them work for their money and come show you the pumps so you can decide the best insulin pump for you.
• Try doing meal boluses on all of the pumps as if they were hooked up to you. There is no feature you will use more than the meal bolus.  The best insulin pump for you is one you can easily bolus with. I remember trying the quick boluses on a few new pumps and deciding that I liked my old pump better.  Interesting. One pump's buttons were too hard for me to press.  Someone else liked it just for that reason alone. Most insulin pumps offer you two ways to do a standard bolus. You can give it immediately without using any calculator (this is the fastest) or you can go through the screen and use the calculator. Be sure that they are both easy for you! Particularly the fast bolus method - you want to be able to bolus easily (and quickly at times)  through your clothes without always taking your pump out. O
• Ask to speak to some users you have the same model you are considering. Ask these insulin pumpers  what they liked the most; what they liked the least and what would they change if they could. See if their answers make a difference to your decision. Remember, what is important to those pumpers may not be important to you. 

The Best Diabetic Insulin Pump:
Options, Options and yes  . . . more Options!

Which insulin pump options matter to your lifestyle? Check it out.

Check out the list below. Decide on the best "features" for your life. That will help you determine the "best insulin pump" for you.  Print this out and circle the things that matter in your search for the best insulin pump. If I've goofed or missed some great feature that you find helpful, please drop me a line here and let me know.

1. Customer support. Be sure to ask about it. A pump might last you 8-10 years!

   The best insulin pump should last. You need customer support to help with that. Do they have: 

   • Payment plans. Do they have them or do you need them?
   • Direct contact with insurance company? Will they take care if it all after you get the physicians prescription? Will they help advocate for your insurance company to cover the insulin pump if you've been told there is no coverage?
   • How quickly can a damaged pump be replaced? What is their policy for shipping - overnight? How long does it typically take for someone to receive a replacement pump?  What is their policy for pump replacement? Will they replace your pump with a new one or a new "refurbished" one. (You'd rather not have refurbished but they won't tell you this unless you ask).  
   • 24 hr help lines - do they have one?
   • Return policy. Can you get your money back in 3 months if it turns out this is not the best insulin pump. Or you decide you don't like pump therapy? GET IT IN WRITING.
     
2. Size, shape, look, feel and weight of pump. Most are small - less than 2" by 3". Shape and depth can vary. Choosing a pump based on size and shape is really quite a personal thing.  One of the smaller pumps is a bit thicker and so I don't like it. But other people don't mind the thickness because the overall width and length is less. At the diabetes center in which I work, we advise people to contact all the pump representatives and have them make home visits. That way, each and every  detail of the pump can be seen and explained. .When comparing weights, be sure to see if the weight is listed without insulin or with insulin. Compare apples to apples. Is the best insulin pump the lightest? Some pumps are 10-20 grams lighter than others.  It may or may not matter to you.
   
3. Size of insulin reservoir. The long cartridge that holds insulin in the pump can come in different sizes - 1.5 mL, 2.0 mL or 3.1 mL (approx). Generally speaking, if you use small insulin doses and maybe only 20-40 units per day, then it won't matter which one you get. However, if you use 50 plus units per day you might find the best insulin pump for you is one with a larger reservoir eg. 3.1 mL.  Ask the pump representative to explain how you would go about changing the infusion set if you still had insulin in the reservoir. Mine is easy and wastes no insulin. I don't have to refill the reservoir. Others might not be (I'm thinking of some of the  Minimeds here).  
   
4. Pre-loaded insulin reservoir. At this time (Jan 2006) there is only 1 insulin pump that allows for the insulin pen-fill vials to be used directly in it. For many, this option alone made it the best insulin pump. This is the D-TRON pump (now known as the Accu-chek D-Tron and marketed by Roche-Disetronic). However, this pump is no longer sold in Canada and the U.S. but is available elsewhere.
   
5. Time to deliver a unit. You don't see this mentioned much but it is a biggee. Would be for me anyway. Some pumps deliver a unit in 1 second and other pumps like the Paradigm do it in 30 seconds. Uhgg. A bolus of 4 units would take 2 minutes. By that time I might be eating something else or I might change my mind and want to give another unit. (I do this frequently - change my mind after I give a bolus and add in another half unit or just keep eating cookies, one after the other err. I meant I always stop at two. ) But, I'd have to wait for the first bolus to finish. Problem.  I might get busy and forget. If you think this is a concern, ask about how long it takes to deliver one (1) unit as this might suddenly change your mind about the best insulin pump for you.
   
6. Blood Glucose Meter Options. 
   I have an old H-TRON pump which does not communicate with any glucose meter. Still, I love pump therapy. Newer pumps might have some of these options for glucose testing.
   1. Glucose meter attached to the insulin pump? (eg. Cozmore)
   2. Meter attached or part of the hand held device? (eg. Omnipod)
   3. Separate glucose meter that communicates with the insulin pump? (eg. Minimed, and perhaps the newer Animas might).
   4. Option for Continuous Blood Glucose Monitor. At first glance many would say that this makes for the best insulin pump. But read on . . .  One of the Minimed pumps can have a continuous blood glucose monitor built in. You must use different  tubing and sets. You'd have two cannulas in your stomach. One for the insulin pump and one for the continous blood glucose monitor. The tubing sets are pricey (here in Canada about $50 each and they  last for 3 days). So you are not likely to use this option all the time. Also, it reads sugar from interstitial fluid, not blood. If you're interested in my experience with a continuous blood glucose monitor, see here and scroll down to number 27.   
      
7. Standard Luer-Lock? The luer-lock is where the tubing connects to the pump.  If it is "standard" it means it will accept all the standard infusion sets out there on the market. This is a good thing. Some pumps, like some of the Paradigms, can only use "proprietary" infusion sets. This means infusion sets that are made just for the Paradigm pump and just by Minimed. Of course, they generally cost more. And if someone comes up with a new cool set, you can't try it on your Paradigm. Although, I have heard someone is coming up with an adapter to put on the Paradigm to overcome this problem. Perhaps the newer models won't be proprietary. Regardless of the pump, ask is it uses standard infusion sets or not. The Omnipod requires no infusion sets as it is "cordless". See number 16 below under "disposable". I'm a bit biased. I think that the best insulin pumps have standard luer-locks. 
   
8. Software and Programming. All insulin pumps are programmable. But some have more bells and whistles than others. Is the pump with the most options the best insulin pump? I don't think so personally. A lot of people may never use all the options. In fact, some people are so busy trying to use all the options that they have not taken the time to use the most basic and beneficial feature - setting a basal rate to suit their bodies. This is key.  However, some techies feel the best insulin pump is the one with the most options. Regardless, here are some software/programming options that either are or shortly will be available. 
   • Program boluses and basal rates directly into the pump or
   • Program into a palm device or
   • Program into a cell phone device or
   • Program your pump through your home computer.
   • Meal bolus calculators (This takes more time to use so those experienced in calculating insulin to carb ratios might not find this useful. However, others find this most convenient. You don't have to use the calculators if they are on the pump.)
   • Correction dose or insulin sensitivity calculators. (How many correction doses will it allow if you have more than one? Remember, your correction dose might change when you get onto the pump. You might only need one.)
   • Create your own database of carb containing foods.
   • Have carb content determined after entering foods. For those who don't like to generalize or read labels, I suppose this might be the best insulin pump. Might.
   • Multiple basal profiles - eg. one for days off etc.  (All newer pumps should have this. The older H-TRON does not).
   • Remaining insulin on board calculations. Hmmm.. . . there is controversy about using this. For some people it may be most helpful in avoiding piggybacking too many insulin doses in a row. For others, I have seen it result in high sugars because it offers you a meal bolus dose with the "remaining' insulin subtracted.   Of course, you don't have to use this feature nor do you have to use the suggested bolus on the screen.  Talk with your diabetes educator about the usefulness of this feature for you.)
   • Optional self set alarms -(they all have safety alarms, low insulin alarms etc). However, some have alarms you can set to remind you to test 2 hr after giving a bolus or set alarm to wake you up at a certain time etc.
   • Enter quick tips and reminders - eg. sick day guidelines.
     
9. Remote control ability.  Palm devices or cell phone devices might have remote control ability so you don't have to touch your pump to deliver a bolus. The newer pumps as pushing towards being the best insulin pumps on the market by offering these devices.An older Minimed model had a key chain like remote you could use to program a bolus. 
   
10. Kid friendly bonuses. The best insulin pump for an adult is not necessarily the best insulin pump for a child. Consider some of these questions. 
    • Can you name the pump? The Cozmo and Cozmore allow kids to program in names for the pump. Some kids would say this alone makes it the best insulin pump. Good thing I don't have that option on my pump. I'd waste time just being silly with it. I'd probably print up a birth certificate too - why not make it like a "build-a-bear"? 
    • Can you program in music for the alarms? 
    • Can you change the look of it? Some come with peel and stick designer faceplates. I  currently have a blue tartan face on mine. It used to be happy face one but I got tired of my pump smiling at me. If this is important, ask the pump representative when you talk to them.  I didn't know the option was available for my pump until a rep graciously gave me some. I'd never seen them in that pump's  literature. The best insulin pump for kids is definitely one they bond with - looks help.
    • Lock out software - sometimes you don't want kids playing with buttons. Can the buttons be disabled to prevent this?
    • Can the pump give basal and boluses in small increments. Eg. 0.025 or 0.05  units per hour for basal? This same feature might be important for adults whose daily insulin needs are less than 30 units per day. Most new pumps allow for 0.05 units/hr but do ask if this is important. In the past, some pumps had been marketed to people with type 2 diabetes and only allowed for larger increments. 
    • Can you choose or customize your own alarm sounds beyond the boring basics?  Ask to hear the options if this is important. Kids like this. 
      
11. Waterproof; water resistant or water tight? There's a difference. Most are okay  if you drop them in the toilet and  pick them up quickly (eww!).  But, most are not okay if you want to wear them swimming. If you are an avid swimmer then the best insulin pump for you may have to be waterproof.  Otherwise, just take it off for the swim like the majority of folks do.
    
12. Upgrade-able?  Some companies will allow you to upgrade  to the newest model pump (eg. a whole new pump) for a fee whereas other pumps can be upgraded with  simple software upgrades (like the Cozmo).  Software upgrades are faster and less expensive. They might even be free. Ask  about upgrade abilities and fees as this might determine if it's the best insulin pump for you.  That can make or break your opinion about the best insulin pump. 
    
13. Battery type and life. Are the batteries easy to find in the store? How long do they last? Some last 2-3 weeks while others last up to 2 months. (My old H-TRON has batteries that last 3 months! At the time, I felt that made it the best insulin pump. But I can't buy those batteries off the shelf).  Another question: does the data stay in the pump when you change the batteries - of course this is essential but some Minimed/Paradigms had been zeroing out the basal rates if it took longer than 60 seconds to change the batteries. Always have batteries on hand. 
    
14. Reversible display -  So no matter where and how you where your pump you can always read the display without it being upside down. Not a big deal for most I would think. But, all of our needs are different. 
    
15. Accessories - most pumps come with optional accessories that you can purchase eg. leather cases, Velcro waist bands etc. But do check out all the available accessories for the pump you are considering. You may see something that is only available for one pump. But, an accessory may not be the best criteria to choose the best insulin pump by.
    
16. Cases - Most pumps come with a clip case that will  rotate 360 degrees -  but double check. This seems like such a small point but really, if you wear it 24 hours 7 days a week, the case can be a major issue.  I do recall someone being . . . errr. .. ticked because the pump case would not accommodate this person's clothing. I believe this was an older pump. But clearly, this person did not feel they had the best insulin pump based solely on how they had to wear it.  Play with the pump in the case and on on your clothing.  I know some pumps are small but when in their carrying case they are not so subtle. Cases matter. Having said that, it doesn't mean the best insulin pump is the smallest.
    
17. Disposable. Right now, (jan, 2006) I only know of 1 disposable pump. The Omnipod. And it is currently not available in Canada as of Jan, 2006. The pump - a white small pod - sticks to the skin. It has a built in cannula so no tubing is required. It communicates wirelessly with a hand held palm device. You use the palm device to tell the insulin pump when to give you boluses and how to program your basal rates. 
    
18. Cordless - eg. no infusion set. For example, the Omnipod as mentioned above.  Animas is working on one but I don't know when that will be released. At first thought you might think the Omnipod is the best insulin pump, but do consider that you will have a harder time concealing this little "Omipod" insulin pump under your clothes.  It is about 1.5 by 2.5 by 0.7 inches and sticks to your skin. Still, it might be the option for you.

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