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For anyone taking long-acting and short-acting (pre-meal) insulin, an insulin pump offers freedom from all of the hassle of injections.
If you decide to eat a little more, or do some unexpected exercise, you can just push a button to administer more or less insulin. And the pump’s continuous background drip of insulin mimics the action of a healthy pancreas, so your blood sugar levels can remain much steadier.
Traditionally, insulin pumps were stand-alone devices. But in recent years, they’re increasingly connected to a continuous glucose monitor (CGM) to create a more automated glucose monitoring and insulin dosing combo marketed as a “closed loop system.”
What’s a “closed loop” for diabetes?
Insulin pumps are increasingly being combined with CGMs to create “artificial pancreas” or “closed loop” systems that automate blood sugar monitoring and insulin dosing.
Read all about the development of this so-called artificial pancreas technology here.
Whether the pump is connected to a CGM or not, the person wearing it still plays an important role in determining how much insulin they need and when they need it, especially around meals.
But no worries — modern pumps are very intuitive and easy to use. And there’s no age limit on using a pump; they are used by children, all the way up to older adults.
Read on to learn about current insulin pumps in the United States approved by the Food and Drug Administration (FDA), some older models still in use, and a glimpse at next-gen insulin pump technology that’s on the horizon.
Benefits of an insulin pump
- offers flexibility by being able to adjust insulin rates based on time of day, or circumstances such as exercise, sleep, insulin resistance
- lets you set temporary dosing rates based on weekdays or weekends, or specific durations of time
- does away with the need for regular injections with a syringe or insulin pen
- stores dosing data that provides more information for you and your healthcare providers to use in optimizing your diabetes management
- modern pumps include a food database to help with carb counting, and a dose calculator to help you do the necessary math
- you can get creative and decorate your pump to make wearing a medical device less drab
Drawbacks of insulin pump therapy
- expensive, not always accessible or covered by insurance
- technology can fail and leave you unprepared if you don’t have a backup plan
- you may encounter skin irritation, cannula (insulin tube) blockage, or sites on your body that don’t adequately absorb insulin
- pumps can sometimes fall off or get knocked off the body
- can present a feeling of being tethered to a device
- you can experience “device fatigue” where you feel burnout from the alerts and alarms
Here is a rundown of the existing insulin pumps on the market in the United States (listed in alphabetical order) and what they offer to people with diabetes:
Tandem t:slim X2
The X2 is the latest iteration of the signature touchscreen insulin pump from California company Tandem Diabetes Care, first introduced back in 2012. The X2 has built-in Bluetooth connectivity, and received FDA clearance in 2016. It was launched to market the following year.
Tandem’s t:slim X2 is a traditional tubed insulin pump, meaning insulin is delivered via a long plastic cannula connected to the body via an infusion set. What makes it stand out from competitors are the color touchscreen display and innovative insulin cartridge design. Tandem’s cartridge uses a bag of insulin rather than a clear, hard-case reservoir inside like most of the other tubed pumps.
What’s also unique about t:slim X2 is the capability to update the unit remotely from home, a first in the diabetes pump world. This means users can update the pump’s features just by plugging the device into a computer and connecting to Tandem’s updater site, rather than needing to buy a whole new expensive piece of hardware.
The latest iterations of this pump bring more closed loop capabilities: either an auto-insulin shutoff feature known as Basal-IQ, launched in 2018, or their more advanced Control-IQ algorithm, launched in early 2020, that auto-adjusts insulin delivery to offset high blood sugars.
Currently, this pump only works with the Dexcom CGM, but Tandem has agreements for future integration with other CGMs, including the Abbott FreeStyle Libre flash glucose monitor.
Medtronic Minimed 670G and 770G Hybrid Closed Loop
Medtronic has been a long-time leader in tubed insulin pump technology. They are also the only company that manufactures both a pump and a CGM.
In fact, Medtronic is the oldest pump company on the market, beginning with their acquisition of Minimed back in 2001. Their traditonal horizontally-oriented pumps looked similar to pagers, but those older iterations have now officially been discontinued and replaced with the “6-series” that have a more modern look and vertical orientation.
Their Minimed 670G was FDA-approved in 2016 as the first-ever “hybrid closed loop system” that can automatically monitor glucose and adjust basal insulin doses, approved for use by people 14 and older with type 1 diabetes (T1D). Thae 670G monitors glucose using Medtronic’s Guardian 3 CGM and automatically adjusts basal insulin to keep users as close as possible to the fixed target blood sugar level of 120 mg/dL.
It has the ability to predictively alert users to impending low blood sugars, and can adjust insulin accordingly or shut off background insulin if the user reaches a low threshold. It was dubbed a “hybrid” closed loop upon launch because it does not take over glucose control completely as is expected from a full artificial pancreas.
You can read about users’ experiences with the 670G in our review here.
In 2020, Medtronic launched the 770G. With the same form factor as the 670G, this newer model adds Bluetooth connectivity so that it can work with smartphone apps. Importantly, this system is FDA approved for adults and kids as young as 2 years old right from the start — instead of starting with adults and doing pediatric studies later, which is traditionally the case.
This 770G version is also the platform that will be used for the company’s future tech, which is a more advanced and personalized closed loop system. This is the pump that Medtronic is now selling as it’s most current model in the United States, and updating those who have been using the earlier models.
Omnipod tubeless patch pump
The only full-featured tubeless insulin pump on the market is made by the Boston-area company Insulet Corp.
First launched in 2005, this system has gone through a few iterations before the Omnipod DASH system was released in 2019. Insulin is delivered via a small pod with an adhesive back that’s stuck onto your skin, that is controlled via wireless connection to a handheld PDM (Personal Diabetes Manager). The DASH model has built-in Bluetooth and touchscreen PDM with color display.
The newest Omnipod also no longer houses a built-in fingerstick glucose meter as earlier models did.
Omnipod doesn’t currently allow for remote control of insulin delivery via a mobile smartphone app. But that is coming soom in the newest Omnipod 5 model (formerly known as Omnipod Horizon), which will be Insulet’s first closed loop tech that works with the Dexcom G6 CGM. That is expected in late 2021 or early 2022.
While insulin pumps have largely been aimed at the T1D population of people on intensive insulin therapy,
Beyond the above-mentioned pumps, there are two other pump devices aimed specifically at the type 2 population:
This simple, daily-use disposable “patch pump” was launched back in 2011, and in 2019 announced a milestone of 20 million devices sold.
The stick-on patch unit (with no plastic tubing) holds one day’s worth of fast-acting insulin, and is preset to deliver one of three fixed basal (background insulin) rates for the day.
Despite the large user base, the manufacturer Valeritas filed for bankruptcy in 2020 and sold the V-Go to Denmark-based biotech firm Zealand Pharma, which also has a rescue glucagon pen now available in the United States.
Through the V-Go product page, you can find more information about this device and how to begin the process to buy one.
Omnipod U-500 Pods
Omnipod-maker Insulet has been talking about its interest in offering a higher-concentrated insulin delivery device aimed at the T2D population for a number of years now.
The new pods would use Eli Lilly’s higher-concentrated U-500 insulin, which would make the tubeless pump a real option for patients who need large amounts of insulin, which is the case for many people with T2D. This remains in development as of 2021 and there is no official timeline on when this might become available.
Medtronic’s 780G model
The 780G model is known as the Advanced Hybrid Closed Loop (ACHL), and it’s currently pending review before the FDA in mid-2021.
It looks the same as the 670G and 770G, but it will also include advanced features:
- an auto-correction bolus every 5 minutes to help keep users in optimal range and auto-adjust for missed meals
- adjustable glucose target between 100 to 120 mg/dL (compared to the current fixed target at 120 mg/dL)
- built-in Bluetooth for data-sharing and remote monitoring
- over-the-air software updates (similar to Tandem’s) so users won’t have to buy a whole new device each time an improvement is available
Medtronic is enthusiastic about customers being able to easily upgrade to 780G and newer features remotely, rather than requiring a new hardware purchase. FDA approval is expected in the second half of 2021, with a launch following that.
t:sport mini pump
A new Tandem mini pump in the works is known internally as “t:sport,” though that may not be the official brand name when it hits market. It will be a hybrid of sorts, roughly half the size of the existing t:slim X2 pump and without any display screen at all.
Notably, this will be a patch pump with no tubing, that includes a side-button to administer a quick insulin dose directly from the device itself. The t:sport will stick to the skin with an adhesive, but unlike the Omnipod, would be detachable for short periods of time.
The hope is to give customers a choice of how they want to use it: either via smartphone app, or a separate receiver device. Tandem had originally planned to submit this to FDA for consideration by mid-2020, but delays due to the COVID-19 crisis have pushed that timeline back.
While these insulin pumps are no longer made or sold to new customers in the United States, many are still circulating, used by die-hard fans and in some cases, do-it-yourselfers who’ve hooked these older models up to their own homemade connected systems. Many people still get these insulin pumps to use, despite not being able to buy them directly from manufacturers or most third-party suppliers.
Medtronic’s earlier Minimed pumps
In its heyday, the Minimed 530 was monumental because it did what no other insulin pump had done before: It automatically suspended insulin delivery if you crossed a certain low glucose threshold. Medtronic snagged FDA approval for that Low Glucose Suspend (LGS) or threshold-suspend feature in September 2013 and it remained available until October 2018, when Medtronic discontinued it and earlier “5-series” pumps in favor of the newer 6-series devices.
The discontinuation of those classic Medtronic pump models that looked like colorful pagers marked the end of an era. The Minimed Revel and Paradigm designs, as well as the 530G (with auto-shutoff for low blood sugars), are actually still widely used but are no longer being manufactured or sold by the company. The supplies are becoming more difficult to find as time moves forward.
One of the oldest brands of pumps was Animas, which hit market in the early 2000s and became part of pharma giant Johnson & Johnson. The popular Animas Ping and Vibe insulin pumps were the latest in a long line of their tubed insulin pumps through the years.
Unfortunately Animas was shut down October 2017, after J&J announced it would be closing its pump division for good.
The company stopped manufacturing its devices and transferred remaining customers to Medtronic for supplies and pump support up until 2019. Some people are still using Animas devices, but with different infusion sets and supplies obtained through third-party vendors.
Another longtime insulin pump manufacturer was Roche Diabetes Care, with its Accu-Chek pump line. In 2003, Roche acquired Disetronic and used that as base technology to eventually rebrand and launch the Accu-Chek Spirit pump in 2006.
That evolved through the years, but Roche eventually stopped selling this pump in the United States in early 2017, and transferred all remaining customers to Medtronic for support and supplies. Like Animas in 2019, customers were then forced to switch pump brands or go through third-party suppliers to continue using the unit. While Roche hasn’t shut the door on eventually bringing a new pump back to the U.S. market in future years, there’s no guarantee.
The future of insulin pumping definitely appears to be connecting these devices to CGMs for improved blood glucose control. This of course has pushed to the forefront the issue of device interoperability and do-it-yourself (DIY) technology.
Behind this evolution has been pressure from the patient community rallying behind a #WeAreNotWaiting mantra — pushing to get innovative technology out more quickly and allow data and device integration.
Many of the folks creating DIY connected systems are using older, discontinued insulin pumps such as the Minimed Revel and Paradigm models. Despite an FDA warning and mainstream media concern that surfaced in 2019, thousands of people are now safely and successfully using these homemade systems.
Meanwhile, FDA has published new interoperability protocols to help the established medtech industry create products that are more “modular” and can work together safely and seamlessly. For insulin pumps like the Tandem t:slim X2, that means gaining a
This is important to keep in mind when shopping for new insulin pump technology.
This can be a tricky question, because when it comes to diabetes technology the cost often varies based on one’s insurance coverage.
Generally, you can spend thousands of dollars on the initial purchase because you’re buying a new device along with that first set of supplies to use it. The starting cost can be anywhere from $3,000 to $8,000 depending on the device, and monthly supplies can also add up quickly. Most companies do offer payment plans, too.
Keep in mind, this is just the first-time buy and doesn’t include the needed pump supplies — including infusion sets, tubing, cartridges or reservoirs for insulin, as well as adhesives wipes for site prep. Of course, you’d also need to purchase the insulin to fill the pump and any separate CGM supplies that you might use alongside this pump.
Even with insurance, it can cost hundreds of dollars per month to afford an insulin pump.
Most private insurance companies cover insulin pumps under the durable medical equipment (DME) portion of the policy. You’ll need to work with a doctor to get a prescription and Letter of Medical Necessity confirming your diagnosis and medical need.
The paperwork can be somewhat daunting, so most insulin pump companies offer help in the form of dedicated insurance service teams that work with patients to apply for coverage.
The terms of coverage vary(‘Your Insurance May Vary’ is a well-known mantra in our Diabetes Community), and your choice of covered device may be limited because some insurance companies have “preferred” deals with certain pump makers.
This became quite controversial after Medtronic signed an exclusive deal with United Healthcare (UHC) in 2016, locking their members in to that brand of pump only.
A similar deal followed in 2019 for the latest Medtronic tech approved for children. While UHC and Medtronic insist that exceptions can be made in certain cases, many plan members found they weren’t able to obtain a non-Medtronic pump of their choice. Fortunately as of July 1, 2020, UHC began offering a choice by expanding their coverage to include Tandem pumps along with Medtronic’s.
Health insurance hurdles can definitely add an additional layer of difficulty in trying to decide which insulin pump is your best choice.
This really depends on many factors, both personal and institutional. So many different things go into one’s choice on a big diabetes device purchase like this, ranging from the specific features you prefer, to how it works with other technology and smartphones, and whether it includes tubing or is a tubeless patch pump.
Access and affordability are also huge factors that make this decision for many people, because insurance plans don’t always like to cover expensive medical devices like these or they have specific criteria that must be met in order to buy a particular insulin pump.
Talking to your healthcare professional about the different options and what might work best for your diabetes management is always advisable, as well as reviewing credible and reliable information online about how the various technologies work.
User reviews can also make a big difference in deciding on which insulin pump may be right for you. You can start by checking out our product reviews here at DiabetesMine on Medtronic, Omnipod and Tandem pumps.
For some PWDs, the tubeless Omnipod is an easy choice because it’s the only patch pump currently available in the United States. But for those who don’t care about wearing tubing, the more modern-looking Tandem t:slim X2 is appealing to many because of its color touchscreen and its connectivity to the Dexcom G6 CGM. Yet, the long-term sustainability of a company like Medtronic brings market recognition and many healthcare professionals continue turning to that brand.
As the saying goes, it all depends on you and what’s important for your life with diabetes.
Insulin pumps can be a great option for both adults and children with diabetes. They offer a ton of flexibility and features to help you optimize your glucose control. But that doesn’t mean an insulin pump is the only option or the treatment that works best for everyone. Here’s a guide to making your own decision whether to pump or not.
Modern pumps have multiple features that can allow for more customization in how you manage diabetes, as well as the different supplies that you use. While these are costly gadgets that insurance isn’t always eager to cover, insulin pumps are helping many PWDs live healthier, less burdensome lives.