WilD

Got diabetes? Need advice? Of course you do! And you came to the right place: Ask D'Mine, our weekly Q&A hosted by veteran type 1, diabetes author and community educator Wil Dubois.

Today, Wil goes deep into a question many of us insulin pumpers have asked, about refurbished insulin pumps. Read on to learn whether he thinks there's any reason for concern...

{Have diabetes questions of your own? Email us at AskDMine@diabetesmine.com}

 

Bonnie, type 1 from New York, writes: Being a Medicare recipient, I am obligated to receive only refurbished pumps, and have received refurbished Medtronic pumps for years with no trouble. Historically, I did not need replacements, but now I'm going through 1-2 per year. I suspect, and would like to know, if refurbished pumps are less accurate and less durable than a brand new pump. I currently wear a 523 Revel. I soon will get a replacement (refurbished) but I feel that response is not as good. I have more problems with high sugars that occasionally will not come down despite double infusion given. I am an old CDE so know carb counts, etc. I looked online to see if refurbished Medtronic pumps have poorer functional statistics, but struck out. What are your thoughts?

Wil answers: The world is changing, and we may very well be moving into the era of the refurb thanks to all the moves to contain costs for medical care. But my first thought is that you've been lied to in the past. As I can tell, historically, Medicare was perfectly happy to pay for brand new insulin pumps. Well, some brand new pumps, anyway, and not just from Medtronic. But that wasn't a Medicare decision; it was a Medtronic decision. Med-T didn't want to sell new pumps to Medicare at the price point Medicare required, so Med-T's solution was to sell Medicare folks refurbished pumps.

I guess I'm OK with that, but Med-T has a bit of a reputation for placing the blame for their "business decision" on the government, and I'm not OK with that. In my book, that's playing dirty pool.

Anyhow, you asked about accuracy, so let's get to that.

My first ever Apple device was an iPod Touch that I bought to run the iBGStar meter. Sadly, my insurance wouldn't cover the strips. Then Apple changed their connectors, and the iBGStar has pretty much disappeared from the scene. I think D-Advocate Scott Johnson has the last one left on the planet. But anyway, being both cheap and poor when I got my first Apple, I decided to get a refurb. (It was in my hands two days after I ordered it, having traveled in that time from the middle of nowhere China to the middle of nowhere New Mexico, a feat that still amazes me.) Years later the iPod's case has many dents in it and the screen has black zones where the liquid crystals have ruptured, but the damn thing still works fine. And many people buy refurb'd phones. And cameras. And TVs. And stereos. And it's not just electronics; old cars get rebuilt with new engines. Hell, even old airplanes get new engines and fly on.

And why shouldn't they? It's cheaper and it's better that anything made gets a second life with a new owner than ends up buried in a landfill somewhere, right? And beyond the money savings, many people actually prefer to buy a device that's already "broken in." Hey, if it hasn't failed yet, and it's been given the once-over by the experts, it might be a safer bet than something fresh off the assembly line in Mexico, right?

Still, are there things that just shouldn't be refurbished? Like things our lives depend on? After all, who wants a refurbished pacemaker? Uh... and what, exactly, happened to the previous owner of this pacemaker?

Insulin pumps might seem to fall into that category. But maybe they're more like an iPhone or more like a pacemaker? I guess it dependsRefurbished Insulin Pumps on what the refurb entails. If it's just been cleaned up and the scratches buffed out, well, that's not much of a refurb, is it? But if the device has been cleaned, checked, tested, and any questionable parts replaced, if it is refurbished in the true meaning of the word—returned to "like new" condition with a re-set warranty—then why not?

I've visited Med-T a time or two, and I vaguely recall being shown the refurb process on one of those visits. The details have escaped me, but I recall being impressed by how complete and thorough the process was. And don't forget, Med-T is refurbishing these pumps themselves, and that means they are liable if something goes wrong. On top of that, a Medicare pump has to last five years, not the four most commercial insurance requires (because Medicare might get lucky and you could die in five years, given your advanced age, and then they wouldn't have to buy you another one). So if Med-T isn't pretty sure the refurb'd pumps will hold they will end up losing money, something companies like Med-T really hate to do.

So given all of that, how do I personally feel about the idea of wearing a refurbished insulin pump? The idea doesn't bother me. If I were paying for a pump out-of-pocket and was offered an identical model that was refurb'd but cheaper, I'd snap it up in a second. Why should I spend public money any differently than I spend my own?

In fact, come to think of it, I've actually worn a refurb'd insulin pump. When Cozmo upgraded to the Model 1800 they did it by having all of us who were in-warranty with the older model send our "new" pumps back in to trade for refurb'd models with the new operating system loaded onto them. I never had a lick of trouble with that refurb'd pump. On the other hand, I've had five brand-new Med-T pumps in a row fail on me, along with one brand new t:slim.

So weird stuff happens to pumps. New, old, and, I imagine, refurb'd. But I suspect that if there were widespread problems with the accuracy of refurbs from Med-T (or anyone else) there would be a lot of background chatter, and I'm just not hearing that. In terms of durability, I'm not sure if being worn for a while by someone else matters as much as you'd think. I know a lot of folks wearing pumps that are years out of warranty and are doing just fine. This is some tough gear.

But regardless of all of that, you're having some issues you were not having before, and want to know if the pump might be responsible. So here's my idea for some mad science at home to double-check the function of your pump. Go get some graph paper. Not the crappy quarter inch stuff they use in elementary school, but the college physics kind with the wee, teensy, tiny little squares. Next, take an about-to-be-retired infusion set and snip the connector off the tube with some scissors so that you have a tiny garden hose leading from your pump.

You know, you might want to take a bolus first, because you're going to be unhooked for an hour or so.

I'd cut the hose about 12 inches from the pump. Make sure there are no bubbles at all in the hose. Then do a series of boli onto the graph paper. Maybe a dozen or so at half a unit, a dozen or so at a full unit, a dozen or so at 2 units, and so on.

Are your bolus blotches the same size? For your larger boli, do the same thing with a syringe. Do the blotches look about the same from the pump and the syringe? (Bear in mind accuracy in small doses with a syringe can be tricky, but this is still a good "control group" to make sure the pump isn't wildly off.)

If your pump experiments don't show any trouble with the machine, I think you can relax about the pump. But you still have a problem to solve. Next I'd look at your infusion sets. If you're using 90s switch to angled sets for a while, or vise-versa. This will help rule in (or rule out) absorption issues. You should also try some undiscovered regions on your body for your next set. Long-term pumpers are at risk of wearing out the main sites for infusion sets.

Oh, and speaking of long-term, if no one has said it for a while: thank you for your service to us all by being an "old CDE!"

 

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 

 
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Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.