Best Insulin Pump : A Comprehensive Guide

Insulin pumps are becoming increasingly popular as a way to manage diabetes, and for a good reason. Insulin pumps can provide better blood sugar control than multiple daily injections of insulin and can be much less disruptive to your life.

If you’re considering an insulin pump, there are a few things you should know. First, insulin pumps are not for everyone. They require a significant investment of time and effort to learn how to use them properly, and they’re not right for everyone with diabetes. Second, even if an insulin pump is right for you, it’s important to understand how they work and what their limitations are. Here’s a quick overview of insulin pumps.

Our Rating of the Best Insulin Pump

1

Tandem T Slim X2

Integrates with Dexcom G6, No calibrations needed, hybrid closed loop system. Touch screen display. Insulin Capacity = 300units

2

Omnipod 5

Integrates with Dexcom G6. No calibrations needed, hybrid closed loop system, Touch screen display. Insulin capacity = 200units

3

Medtronic 770G/780G

Integrates with medtronic guardian sensor 3. At least two calibrations needed a day, hybrid closed loop system, physical buttons, insulin capacity = 300units

How do insulin pumps work?

An insulin pump is a small, computerized device that delivers insulin through a catheter placed just under the skin. Insulin pumps are programmed to deliver small, steady doses of insulin throughout the day (known as a basal rate), and can also give larger doses of insulin at mealtimes (bolus doses).

What are the benefits of using an insulin pump?

There are several potential benefits to using an insulin pump. These include:

  • Improved blood sugar control
  • More flexibility in your daily routine
  • Fewer low blood sugar episodes
  • Reduced risk of long-term complications from diabetes

However, it’s important to remember that insulin pumps are not a cure for diabetes, and they don’t eliminate the need for careful self-management.

What are the disadvantages of using an insulin pump?

There are also some disadvantages to using an insulin pump. These include:

  • The need for frequent blood sugar monitoring (CGMs have largely reduced the burden of frequent checks)
  • The risk of diabetic ketoacidosis if the pump is not used properly (a diabetes emergency plan is required if you are on a pump)
  • The inconvenience of wearing the pump all the time
  • The cost of the pump and supplies

The types of insulin pumps 

ManufacturerMedtronic InsuletTandem Diabetes Care
 
Legacy modelsMiniMed 508, Minimed Paradigm (511, 512, 712, 515, 715), MiniMed Paradigm REAL-time (522, 722), MiniMed Paradigm REAL-Time Revel, MiniMed (530G, 630G, 670G, 770G)Omnipod DASH, Insulet Omnipod UST400, Omnipod ErosTandem T:Slim G4, Tandem T:Flex
Current Model (Flagship)Minimed 770G systemOmnipod 5Tandem T:Slim X2
FeaturesLinks to a CGM (Guardian Sensor 3, Guardian Link 3 transmitter, Accu-Check Guide Link meter, and Test strips). Integrated insulin pump and display screen. Smartphone app (displays your blood sugar trends over time).Links to Dexcom G6. PDM (An android phone displays blood sugars and pump settings). Can link to personal smartphoneLinks to Dexcom G6. Integrated insulin pump and display screen.
Dimensions3.78 length x 2.11 width x 0.96 depth (inches)2.05 length x 1.53 width x 0.57 depth (inches)3.13 length x 2.0 width x 0.6 depth (inches)
Compatible insulinU-100 insulins: Novolog, Humalog, fiaspU-100 insulins: Novolog, Humalog, admelog, fiaspU-100 insulins: Novolog, Humalog
Basal incrementVariable 0.025, 0.05 and 0.1 units0.05 units0.1 units
Maximum basal rate35 units per hour30 units per hour15 units per hour
Maximum bolus25 units30 units25 units
Capacity of the reservoir300 units200 units300 units
Battery lifeAA battery replaceableRechargeable lithium battery (android phone as PDM)The rechargeable lithium battery of the pump can last for up to 7 days (depending on settings)
Basal programmingThree basal patterns12 basal patterns6 patterns
Insulin on boardYes. SmartGuard Auto Mode can only be used for patients requiring 8 to 250 units/24hrsYes. SmartAdjust TechnologyYes. Control IQ and Basal IQ Technology
CGM integrationYes (Compatible with Guardian System, change sensor every 7 days)Yes (Compatible with Dexcom G6 CGM)Yes (Compatible with Dexcom G6 CGM)
Calibration of CGMYes. At least twice a day using the accu-check Guide linkNoNo
Future ModelMiniMed 780GN/ATandem Mobi (tubeless pump), Tandem TSlim X3 (Mobile bolus feature or bolus by phone approved by FDA on Feb 16th 2022)
Major limitationAt least two capillary glucose checks are needed daily. Patients are tethered to a tubing.Restricted to 200units of insulin per dayPatients are tethered to a tubing.
Major AdvantageHybrid-closed loop systemHybrid-closed loop system. Tubeless pumpHybrid-closed loop system

How do I choose an insulin pump?

If you’re thinking about using an insulin pump, talk to your doctor or diabetes educator. They can help you decide if an insulin pump is right for you and, if so, which type of pump would be best. Once you’ve decided to use an insulin pump, you’ll need to choose a pump that’s right for you. There are many different brands and models of insulin pumps available, so it’s important to do your research before making a decision.

Considerations when choosing an insulin pump include:

  • Ease of use: Some pumps are easier to use than others. Be sure to get a demonstration of the pump before you buy it.
  • Cost: Insulin pumps are expensive, so be sure to find out what your insurance will cover.
  • Size and weight: Insulin pumps come in different sizes and weights. Consider how easy the pump will be to carry with you throughout the day.
  • Battery life: Insulin pumps run on batteries, so you’ll need to know how long the pump can run on a single charge.
  • Features: Insulin pumps have different features, such as the ability to give bolus doses of insulin at mealtimes or to suspend insulin delivery when blood sugar is low. Consider which features are most important to you.

Choosing the best insulin pump

When it comes to insulin pumps, there is no one-size-fits-all solution. The best pump for you will depend on your individual needs and preferences. However, there are some factors that you should keep in mind when choosing a pump. First, consider the size of the pump. If you are active or frequently on the go, you may prefer a smaller, more compact pump. Second, think about the features that are important to you. Some pumps offer more advanced features than others, such as bolus calculators and wireless connectivity. Finally, be sure to consult with your healthcare team to ensure that the pump you choose is compatible with your insurance coverage. With all of these factors in mind, you can be sure to find the best insulin pump for your needs.

Tandem T Slim X2

The Tandem T slim X2 insulin pump is a state-of-the-art device that offers users the latest in diabetes technology. The pump features control IQ, which automatically adjusts basal insulin delivery to keep blood sugar levels in target range. In addition, the pump is a hybrid closed loop system, meaning that it can be used with compatible continuous glucose monitors (Dexcom G6) to improve control further.

FeatureComment
Time in range (70-180mg/dl)The control IQ system prevents extreme glucose readings.
Ease of placing pump commands (bolus entries etc)Via a colored and responsive touch screen
Water resistanceWatertight to a depth of 3 feet for up to 30 minutes
Effect of elevation above sea levelInterruption in insulin delivery can occur low atmospheric pressures (mountain climbing above 10,000 feet or take-off during air travel)
Integration with other devicesBluetooth connectivity to phones and CGMs
Tethered TubingTubing may get caught on clothing etc.
Battery lifeIt may require a recharge every 7 days (maximum, depending on usage)
Risk of inadvertent entriesThe unlock procedure prevents accidental insulin boluses

Omnipod 5

The Omnipod 5 Insulin Pump is a small, wearable insulin pump that provides a convenient and discreet way to manage diabetes. The pump can be worn on the body for up to three days at a time, and it is waterproof, so it can be worn during activities such as swimming or showering. The pump delivers insulin through a small plastic tube (cannula) that is inserted just under the skin. The pump automatically delivers insulin based on the user’s glucose levels, and it can also be manually adjusted to provide bolus doses of insulin before meals or snacks. The Omnipod 5 Insulin Pump is an easy-to-use and effective way to manage diabetes, and it offers a convenient and discreet alternative to traditional insulin pumps.

FeatureComment
Time in range (70-180mg/dl)SmartAdjust Technology is a hybrid closed loop system
Ease of placing pump commands (bolus entries etc)Entries via a simple touch screen of a separate handheld android smart device.
Water resistanceWaterproof for depths up to 25 feet for up to 60 minutes. It has IP28 certification
Effect of Elevation above sea levelInterruption in insulin delivery can occur at low atmospheric pressures (mountain climbing above 10,000 feet or take-off during air travel)
Integration with other devicesBluetooth connectivity to phones and CGMs. Insulin pump can be controlled via either an Insulet-provided controller or a compatible phone (using the Omnipod 5 app)
Tethered TubingThis is a tubeless pump. Some users love this feature.
Battery lifeRecharge of lithium battery in Insulet-provided controller or a compatible phone
Risk of inadvertent entriesThe unlock procedure prevents accidental insulin boluses

Medtronic Minimed 770G

The Medtronic MiniMed 770G system is an insulin pump that utilizes advanced features to help people with diabetes manage their condition. The pump is capable of delivering insulin in small doses throughout the day, or it can deliver a large bolus of insulin at meal times. The pump is also able to automatically adjust insulin delivery based on the user’s blood sugar levels. The MiniMed 770G system also features a CGM (Continuous Glucose Monitor) that continuously monitors the user’s blood sugar levels and sends alerts to the pump if those levels get too high or too low. The system also comes with a smartphone app that allows users to track their blood sugar levels, insulin delivery, and other important data.

FeatureComment
Time in range (70-180mg/dl)SmartGuard Automode is a hybrid closed loop system. The patient will, however, be kicked out of the auto mode to the less desired manual mode if they fail to calibrate the CGM (extra finger-stick glucose checks)
Ease of placing pump commands (bolus entries etc)Hard tactile physical buttons and a complex menu (learning curve)
Water resistanceWaterproof for depths up to 12 feet for up to 24 hours (when the reservoir and tubing are properly inserted)
Effect of Elevation above sea levelInterruption in insulin delivery can occur at low atmospheric pressures (mountain climbing above 10,150 feet)
Integration with other devicesBluetooth connectivity to phones and CGMs.
Tethered TubingTubing may get caught on clothing etc.
Battery lifeStandard AA battery life
Risk of inadvertent entriesThe unlock procedure prevents accidental insulin boluses

The Verdict

Tandem T Slim X2

The Tandem T Slim X2 is arguably the best hybrid closed loop system on the market. It integrates with the Dexcom G6 CGM (the current gold standard of continuous glucose monitoring) which means no fingersticks. The control IQ keeps you in range.

tandem t slim x2

Omnipod 5

The SmartAdjust technology is Insulet’s new hybrid closed loop system which is fully integrated with Dexcom G6. It is the third hybrid-closed loop system on the market and remains untested over an extended period. It remains to be seen if it produces control similar to the Tandem T Slim X2 pump.

Omnipod 5

Medtronic Minimed 770G

Although the medtronic Minimed 770G is an excellent hybrid closed loop system. The need for multiple calibrations (fingersticks) reduces its ease of use in real-world practice. Most patients who quit using this pump cite incessant alarms and requests for multiple finger sticks. We will not recommend this pump to most patients interested in insulin pump technology.

Medtronic Minimed 770G

Selecting a personalized insulin pump

We have developed this simple tool to help you select the right insulin pump for you. There are three simple questions. Are you willing to check your blood sugar twice a day? Do you prefer a tubed or tubeless pump and finally, how many units of insulin do you require a day. This tool is based on a well thought out algorithm based on feedback from patients, diabetes educators and diabetes care specialists.


choosing the right insulin pump

Insulin Pump Recommendation Tool

Provide three responses and get a personalized feedback in less than 5 seconds. 


Not at all Likely Extremely Likely

Who can get an insulin pump?

Based on the current medicare guidelines in 2023, patients with type 1 diabetes mellitus and type 2 diabetes patients on an intensive multiple daily insulin injection regimen qualify for insulin pump therapy.

The decision to use an insulin pump as part of diabetes management is an individual one, and should be made in consultation with a healthcare provider. However, there are some general guidelines for who may be a good candidate for an insulin pump:

  1. Type 1 diabetes: Insulin pumps are typically used by people with type 1 diabetes who require insulin to manage their blood sugar levels.
  2. Intensive insulin therapy: Insulin pumps are generally used for people who require intensive insulin therapy, which means taking multiple daily injections of insulin or using a basal-bolus insulin regimen.
  3. Self-management skills: Insulin pump therapy requires a high level of self-management skills, including the ability to perform blood glucose monitoring and calculate insulin doses.
  4. Motivation and willingness to learn: Insulin pump therapy also requires a high level of motivation and willingness to learn about the device and its use.
  5. Financial coverage: Insulin pumps can be expensive, and may not be covered by insurance or other healthcare plans. People who are interested in using an insulin pump should check with their insurance provider to see if it is covered and what the cost may be.

In addition to these general guidelines, there may be specific medical considerations that need to be taken into account when deciding whether insulin pump therapy is appropriate. This includes factors such as pregnancy, age, and other health conditions.

It is important to note that insulin pumps are not appropriate for everyone with diabetes, and not everyone will benefit from this type of therapy. Your healthcare provider can help you determine if insulin pump therapy is right for you, and can provide guidance on how to use the device and manage your diabetes effectively.

What does a hybrid closed-loop insulin pump mean?

The term “hybrid” in the context of the hybrid closed loop insulin pump refers to the combination of a continuous glucose monitor (CGM) and an insulin pump. The system is considered “closed loop” because the CGM and insulin pump are integrated and work together to automate insulin delivery. However, the system is not fully closed loop, as it still requires some manual input from the user.

The system is also referred to as an “artificial pancreas” because it mimics the function of the pancreas in delivering insulin to the body. The hybrid closed loop system uses the CGM to measure blood glucose levels in real-time, and the insulin pump uses an algorithm to calculate the appropriate amount of insulin to deliver based on the glucose levels, rate of glucose and the estimated insulin sensitivity factor of the individual.

Benefits

The hybrid closed-loop system has several benefits over traditional insulin pumps, including:

  1. Improved glucose control: The hybrid closed-loop system can help to maintain stable blood glucose levels, which can reduce the risk of long-term complications associated with diabetes.
  2. Reduced risk of hypoglycemia: The algorithm used by the hybrid closed-loop system is designed to minimize the risk of hypoglycemia by automatically adjusting insulin delivery based on glucose levels.
  3. Flexibility: The hybrid closed-loop system allows for more flexibility in daily activities, as the system can adjust insulin delivery based on changes in activity or food intake.
  4. Ease of use: The hybrid closed loop system is designed to be user-friendly and easy to operate, with a simple interface and automated features.

Limitations

The hybrid closed loop system also has some limitations, including:

  1. Cost: The hybrid closed loop system can be expensive, and may not be covered by insurance or other healthcare plans.
  2. Training: The system requires specialized training to use effectively, and may not be appropriate for individuals who are not able to learn how to use it.
  3. Maintenance: The system requires regular maintenance, including changing infusion sets and sensors, which can be time-consuming and require additional supplies.

New Insulin pump therapies in 2023

Medtronic’s diabetes program has faced significant competition in both the insulin pump and continuous glucose monitoring device sectors. Current generation hybrid closed loop systems such as the Tandem T slim X2 and Insulet’s omnipod 5 are fully integrated with the current gold standard for continuous glucose monitoring (CGM), that is, Dexcom G6 (soon to be G7).

The major limitation to Medtronic adaptation by patients and endocrinologists alike has been its reported lack of user-friendliness. But for the need for repeat calibrations of its continuous glucose monitor, the current Medtronic minimed 770G (with guardian sensor 3) would have been ideal for diabetes management(1). The need for capillary glucose checks (a minimum of twice a day) serves as a major barrier to its adoption.

The reason for switching from capillary glucose checks (finger stick checks with a meter) to continuous glucose monitors was primarily to reduce the discomfort and cumbersome nature of finger stick monitoring. For most patients with diabetes, a hybrid closed-loop insulin pump system that requires repeat glucose checks at odd hours (for example, during sleep) can lead to significant stress and discontinuation of therapy.

In practice, there are patients on minimed 770G pumps who refuse to use Medtronic’s guardian sensor 3. Indeed, these patients may prefer to use either freestyle libre 2 or 3 (from Abbott) or Dexcom G6 with their Medtronic 770G pumps since these CGM devices do not require cumbersome calibrations.

It can be postulated that Medtronic is losing its market share in the hybrid closed-loop insulin pump space due to this obvious limitation.

Consequently, Medtronic has submitted its next candidate for an integrated insulin pump-CGM system (or hybrid closed loop pump) to the US FDA for review. When approved, the Medtronic Minimed 780G insulin pump integrated with the Guardian 4 sensor may potentially become a significant addition to the armamentarium for diabetes care. Interestingly, the problematic guardian series of sensors have been improved in the Guardian sensor 4.

Reportedly, the Guardian Sensor 4 will require a single calibration on the first day of use, with no need for further calibrations during it’s 7 day lifespan. This may potentially reignite interest in the minimed series of hybrid closed-loop insulin pumps(2).

References

  1. Collyns OJ, Meier RA, Betts ZL, Chan DSH, Frampton C, Frewen CM, et al. Improved Glycemic Outcomes With Medtronic MiniMed Advanced Hybrid Closed-Loop Delivery: Results From a Randomized Crossover Trial Comparing Automated Insulin Delivery With Predictive Low Glucose Suspend in People With Type 1 Diabetes. Diabetes Care. 2021 Feb 12;44(4):969–75.
  2. Medtronic announces latest data on MiniMedTM 780G system with the newest GuardianTM 4 sensori at American Diabetes Association 82nd Scientific Sessions [Internet]. Medtronic News. [cited 2022 Dec 5]. Available from: https://news.medtronic.com/Medtronic-Announces-Latest-Data-on-MiniMed-TM-780G-system-with-the-newest-Guardian-TM-4-sensor-at-American-Diabetes-Association-82nd-Scientific-Sessions
  3. American Diabetes Association Professional Practice Committee; Summary of Revisions: Standards of Medical Care in Diabetes—2022Diabetes Care 1 January 2022; 45 (Supplement_1): S4–S7. https://doi.org/10.2337/dc22-Srev

Disclaimer

The opinions expressed here represent the views of a practicing hormone specialist (endocrinologist) and must not substitute the advice of your health care provider. This blog post is written for a non-medical audience interested in learning more about hormonal disorders. The author has no commercial conflicts of interest to declare. Also, read our privacy policy.

This was first published on March 23, 2022 and Last Updated on March 31, 2023 by MyEndoConsult

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About the Author MyEndoConsult

The MyEndoconsult Team. A group of physicians dedicated to endocrinology and internal medicine education.

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