#1166 Pump and CGM Overview - Part I

April 2, 2024Scott Benner

Scott and Jenny look at the pumps and CGMs available on the market.

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Scott Benner 0:00
Hello friends and welcome to episode 1166 of the Juicebox Podcast.

In this two part episode, Jenny Smith and I are going to do an overview of every insulin pump and CGM that we were able to find on the internet. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget to save 40% off of your entire order at cozy earth.com. All you have to do is use the offer code juice box at checkout. That's juice box at checkout to save 40% at cozy earth.com. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please take 10 minutes to complete the survey AT T one D exchange.org/juice. box you can help type one diabetes research by taking those 10 minutes and answering those simple questions. T one D exchange.org/juicebox. If you're looking for community, check out the Juicebox Podcast group Juicebox Podcast type one diabetes on Facebook, it's a private group with over 48,000 members. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us met. This episode of The Juicebox Podcast is sponsored by the insulin pump that my daughter wears Omni pod learn more and get started today with the Omni pod dash or the Omni pod five at my link Omni pod.com/juice Box. Today's episode of The Juicebox Podcast is sponsored by Dexcom makers of the Dexcom G seven ng six continuous glucose monitoring systems dexcom.com/juicebox. The I have a list here that I think covers most of like what's available. I mean, and couple things that are in development. So we'll kind of pick through it and see what we can find. I have to admit, we are recording. This is not the thing I usually do. Because this seems very close to like a blog post meant to get you to click on it. But you don't I mean, right

Jennifer Smith, CDE 2:49
with all the clicks to the sites to go check it out here. Go look here, go look at this. Yeah,

Scott Benner 2:54
it felt like it always has felt like a blog trick to get you to click as far as I'm concerned. But I keep hearing from people over and over again who think like, I'm getting a pump. I know I am. But I don't know, the first thing about it would be nice if somebody just laid them out for me. And I thought well, we can do that for sure. So yeah, yeah, yeah, absolutely. I'm going to avoid the idea that this feels clickbaity to me, and we're just going to do it because it seems to be necessary. Okay, so I guess we should yeah, God, please do what you gonna do? I

Jennifer Smith, CDE 3:23
was gonna say to and this, I think this is it, maybe it will come up. But I think what I saw when you when I perused your juice box, and I looked at what people were commenting about this and listing some of them. I know, some of the questions that came up are big ones that aren't specific to brands, but they're specific to another topic that I think is important, unless you've already discussed it with somebody. And that's about the aging population. Oh, I did see that as well. Yeah. Right. And also have and what might be available and who can take over. And then another angle of that. I think that none of what we're going to talk about even addresses at all. Is those with some type of either dexterity vision or hearing issues. No one is addressing that. Yeah. Okay. All right. Just that was a second thought. As I was looking through this, I was like, it's not part of this, but it kind of, ya

Scott Benner 4:19
know, we'll find a way to talk about it for sure. And dexterity. Okay. At this point, there are kind of two different kinds of insulin pumps, right. I'm ARE WE ARE THEY JUST automated and manual? Is that the easiest way to think about it? I think that's the easiest way. Yep. All right. So let's start with manual pumps, meaning they're not hooked to a continuous glucose monitor for reasons of making insulin dosing decisions. Correct? Yes, you

Jennifer Smith, CDE 4:45
can use them separately at the same time, but they don't I guess they don't talk to each other. That's the easiest way to describe manual you are manually telling the pump what to do, and then it does it

Scott Benner 4:58
and they're all gonna have Have like Bolus calculators. So they take your settings, you know, hopefully you put it in with your physician and probably fine tune on your own as time goes on your insulin sensitivity, your carb insulin to carb ratio and your Basal rate, most

Jennifer Smith, CDE 5:15
of them, some of the manual ones that we'll talk about. They don't have like ratios in them. They're a very set unit kind of delivery. That makes it really, really simple for those who don't want the extra level of navigation. So we'll go through them all.

Scott Benner 5:36
Yeah, well, why don't we just start with the one you're wearing? That'll be the easiest. So are you wearing Omni pod dash today?

Jennifer Smith, CDE 5:44
I am wearing an omni pod dash today. Yeah,

Scott Benner 5:47
Omni pod is a sponsor of the podcast. I just want to say that upfront, but this conversation should not really delve too far in any of our opinions, just what it does and what it doesn't do. So Omni pod is a tubeless insulin pump. Which I guess the best way to like help you visualize that if you haven't seen it is that everything you need to get your insulin is within this one device that adheres to your body. So it's not connected by tubing or wiring to a controller or to where the insulin is. Everything's self contained. I guess that's the best word right? self contained, right? Yes. Yes. For your money. What is it? Why are you wearing it? I guess why did you choose it over something else? The Dexcom g7 is sponsoring this episode of The Juicebox Podcast and it features a lightning fast 30 minute warmup time, that's right from the time you put on the Dexcom g7. Till the time you're getting readings, 30 minutes. That's pretty great. It also has a 12 hour grace period, so you can swap your sensor when it's convenient for you. All that on top of it being small, accurate, incredibly wearable, and light. These things in my opinion, make the Dexcom g7. a no brainer. The Dexcom g7 comes with way more than just this. Up to 10. People can follow you, you can use it with type one, type two, or gestational diabetes, it's covered by all sorts of insurances. And this might be the best part, it might be the best part alerts and alarms that are customizable, so that you can be alerted at the levels that makes sense to you. dexcom.com/juicebox links in the show notes links at juicebox podcast.com, to Dexcom. And all the sponsors. When you use my links, you're supporting the production of the podcast and helping to keep it free and plentiful. diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email. It's a big button that says click here to reorder. And you're done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the Dexcom G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 888-721-1514. Or go to my link us med.com/juice box using that number or my link helps to support the production of the Juicebox Podcast.

Jennifer Smith, CDE 9:04
So years ago, when I started first using an insulin pump, I was an animus user, which is not even available here any longer. But it was a tube pump. There were no tubeless patch kind of pumps at all on the market. And I'd started doing a lot more exercise, not exercise, I guess triathlons, right where you're in and out of the pool and doing other things and moving on. And I was tired of the disconnection but at that point there was there was just nothing I could do about it. So I had I ran into actually somebody at a weekend conference. They had sort of like a little Expo and I ended up talking to a young woman who was part a of a medical supply distribution kind of company, and she had type one and she was like, You know what, you just wait a couple of months. I'll get you connected with This, you know, representative for him from insolate. She's like, I guarantee this is probably what you're looking for. And so that was a 2005 is when mipad first became available, I mean, it's not the dash obviously the dash is kind of one of the more recent updates to the system, but that's why I chose it. I chose to switch from a tube pump because of the things that I was doing in terms of my lifestyle, and it just met my needs much better. I thankfully at this point, I don't have any issues with adhesive stuff I did. The cannula seems to work really well for me. In fact, I actually have more issues finding the right kind of cannula on a tube pump, kneepads, cannula has never been a problem for me with the angle that it goes in at. Whereas on tube pumps, I actually have to do the best with the steel cannulas. Okay, so that's my n of one as to why so

Scott Benner 10:55
let's see, you can fill an omni pod between 85 and 200 units of insulin. It lasts for 72 hours with an eight hour grace period. Right? What's the lowest Basal rate you can set with it?

Jennifer Smith, CDE 11:09
Point 05. And I believe with the more recent you can also set a zero with a dash, I believe with a dash you can set a zero. Okay. I think that was the I think it was an adjustment from what was called the arrows, which is either phased out or is being phased out or whatever was the previous to the dash. That only allowed a delivery of point 05 was the lowest that you could actually go, oh,

Scott Benner 11:37
yeah, the only pod dash will be able to deliver a 0.0 Basal rate, okay,

Jennifer Smith, CDE 11:43
which for those you know, when you're looking at delivery rates, or insulin needs that are really really teeny tiny, you might have somebody who has several hours that they can go without any insulin dripped in as a Basal delivery, and then they might need a pulse of point 05. And then it might be a couple hours again, have nothing. Some of the little kiddos that I work with have sort of an off on it's like 0.05 0.05 to get that in between rate.

Scott Benner 12:14
I guess people honeymooning as well might need that but little kids actually seems where, where it would make most sense to me. There's a controller that comes with it. And that's where you do all of your good Cynthia's put in your, um, having 40 carbs, this kind of stuff, I believe, Omni pod has approval for a phone controller just isn't out yet. Is that right? Yeah. And I mean, that's it right there. It's tubeless. And it's wireless. That's how I listen, my daughter has been using an omni pod since she was four. So that would have been 2006. Maybe. And I mean, I came to a very similar conclusion, I went to an insulin pump show at the hospital, felt like it felt like a baseball card show for insulin pump. And I looked at all of them and not knowing anything about diabetes. My daughter had only had it for two years, maybe at that point. It just the concept of it not being tethered to something seemed attractive to me. I didn't have any of those other big thoughts. I didn't know enough about diabetes at that point to have those big thoughts. I just was like, this isn't attached to something. This makes more sense to me. Right. And me, she's been using it ever since. So that's it for me. I mean, I don't know, like, what people want to hear about these things. Yeah, it's a tubeless pump bit. You can swim with it. It's got a you know, you can go in the tub, you can go in a pool, it keeps delivering your Basal insulin when you're active. You know, I think the high side of not having a tube pump is that you don't have to disconnect for activity or for bathing or for swimming, things like that. And I think the biggest reason for that is oftentimes people forget to put their two pumps back on after things like that. They

Jennifer Smith, CDE 13:57
can Yeah, absolutely. Yeah, I mean, the manual really is. It's like an easy way of doing injections, right? There's a lot less of the people call it poke the pokes or whatever. Obviously, you only put one pad on every two to three days it lasts like you said 72 hours, but plus that eight hour but some people do find that they might need to change it more frequently than that. But even with that, it's only one poke every two to three days comparative to all the injections. So that's another reason a lot of people might go to a pump to begin with. And then you know, the manual ones again, they really are just, you fill it with insulin you put it on, you are the driver of all of your insulin while the Basal does go in automatically at a set rate. Every Bolus that you take you're you're determining that the pump is not helping you outside of just the calculations with dose settings that you have. Yeah. Today's

Scott Benner 14:55
episode of The Juicebox Podcast is sponsored by Omni pod and before I Tell You About Omni pod the device, I'd like to tell you about Omni pod. That company. I approached Omni pod in 2015 and ask them to buy an ad on a podcast that I hadn't even begun to make yet. Because the podcast didn't have any listeners, all I could promise them was that I was going to try to help people living with type one diabetes. And that was enough for Omni pod. They bought their first ad. And I use that money to support myself while I was growing the Juicebox Podcast, you might even say that Omni pod is the firm foundation of the Juicebox Podcast. And it's actually the firm foundation of how my daughter manages her type one diabetes every day. Omni pod.com/juice box, whether you want the Omni pod five, or the Omni pod dash, using my link, lets Omni pod know what a good decision they made in 2015. And continue to make to this day. Omni pod is easy to use, easy to fill, easy to wear. And I know that because my daughter has been wearing one every day since she was four years old. And she will be 20 this year, there is not enough time in an ad for me to tell you everything that I know about Omni pod. But please take a look. Omni pod.com/juice box, I think Omni pod could be a good friend to you. Just like it has been to my daughter and my family. With all the manual pumps, your settings are in there. So if you tell you know if you tell it, my settings are one unit covers 10 carbs, and I say oh, my meal is 30 carbs, it's going to give you three correct it's not going to back insulin off in the form of basil or make extra boluses or anything like that if your blood sugar should get higher, that's all in sort of the automated side. And honestly, for years, that was the selling point for an insulin pump, you get it in so you don't have to do as many injections and you can manipulate your Basal insulin now because because of manual pump, all these pumps are handling fast acting and slow acting needs in the form. It's all in the same insulin, of course, but you know, you're not injecting a Basal insulin and that injecting your meal insulin like you would with MDI,

Jennifer Smith, CDE 17:12
that's a really important piece to make sure to have, I guess clarify because some people aren't given enough information upfront. And that's not that's not I think disclosed well enough. When you start on a pump, your Basal insulin that you might be using of whatever the various long acting's are at this point, that will sit in the refrigerator in case of a pump failure. But your Basal insulin No longer will be injected?

Scott Benner 17:39
I remember being confused about it. Yeah, yeah, first happened. Now other companies that I think of is kind of the mainstream companies tandem Medtronic, did they make specifically manual pump? Or do they just make an automated pump that you can run manually? Like, do they have any pumps that aren't manual? Do you know I'm saying there aren't automatic. So years

Jennifer Smith, CDE 18:01
ago, absolutely. All the pumps were manual prior to automation coming into the picture with a connection of the pump to some type of a CGM system, right. But I Medtronic, I mean, like I mentioned, animus Deltec. I mean, there are a whole host of insulin pumps that were all manual driven pumps. And at this point, now, there are a couple of other companies that do do manual pumps that have no connection at all, just kind of similar enough to the dash, med tronics, pumps, all of them can be used in manual mode, right? The current ones that are on the market, absolutely. You don't have to use it with the algorithm, if you choose not to, or your life situation dictates that that's not appropriate at this point. So I guess, does that answer what you were

Scott Benner 18:49
I know, you can put a Medtronic pump into manual and you can put a tandem pump into manual but did they make a second? Is Omnipod the only one that makes a here's a pump that's manual. And here's a pump that's automated, like because there's on the pod five?

Jennifer Smith, CDE 19:02
That's a great yeah, I believe you're right. I believe so. Yes. Okay.

Scott Benner 19:06
Because on the pod has on the pod five, which is an automated system. Yes. But I'm just looking at like our list of manual pumps. And I'm realizing I don't see any strictly manual from those other what I think of as the other two big pump companies. Right. Oh, that's interesting. Okay. I

Jennifer Smith, CDE 19:23
never thought about that either. I guess that that is that is true.

Scott Benner 19:28
Listener sent these to me. So there's something called a secure pump simplicity. But that's not that doesn't deliver basil, right? Like that's seems to me to be like a an injection. Like it's a replacement

Jennifer Smith, CDE 19:40
for injections. And really what it provides is, for those who are less than eager to do so many injections a day or it's really become a point of their diabetes management. That's that's not working well, because they're either forgetting or they just don't really want to this past essentially allows the user to deliver a specific set Bolus, with the little Yeah. pinchable bolt Bolus delivery, right on the device. So

Scott Benner 20:10
this was kind of interesting. It looks like it looks like a giant pill shape. It's pretty flat. And then there's two buttons on either side and you squeeze the buttons together, and it gives you two units. Right?

Jennifer Smith, CDE 20:19
Correct. It's empty yet. Yes. 100. And it's a set you you can't change that.

Scott Benner 20:24
Right. So but I could go like two units, two units, two units, if I wanted to,

Jennifer Smith, CDE 20:28
I do believe so. The other interesting thing is that it comes with, I can't remember what your initial supply order is, you do fill it with insulin, just like you would fill in Omni pass 100 units. Yeah, correct. But then it also has an inserter. And the inserter actually is a device that you keep, which I think is quite an interesting concept. Because a lot of people actually dislike all of the discarded plastic that goes into a lot of our diabetes products. So this actually has an inserter that you keep. And it's just the patch. Part of it that gets discarded. Yeah,

Scott Benner 21:08
I'm just looking here, I'm all on their website, but can be worn worn for three days, water resistant, 200 units. This is funny, it takes less than 30 minutes of training. And how much of the training is how to squeeze the button? That's got to be 10 seconds? What's the rest of it? It's probably

Jennifer Smith, CDE 21:27
kind of fill it with insulin. I would expect that's all

Scott Benner 21:29
Yeah, this is not. I mean, we're trying to list them all. But this is not a I mean, this is not a apples to apples comparison. Obviously it doesn't, it doesn't deliver Basal insulin, you can't do 1.5 or point five, you can't do anything but two units direct. So this, this feels to me like they saw a market of people who were just not injecting because they didn't want to inject and thought maybe this would help them okay,

Jennifer Smith, CDE 21:53
correct. And if they were, you know, if the majority of your time you're taking your basil, but where your excursions are happening are around food or stress or whatever, and you're just not willing or you just continued to forget to bring your your insulin pen or whatever along. This takes care of that. So now you're you're really decreasing their time out of range by just providing a product that allows an easy Bolus

Scott Benner 22:19
okay seek your CE qu our simplicity three day insulin patch if you're interested All right. What is Zealand pharma making? Let's see what this thing is. Vigo

Jennifer Smith, CDE 22:29
that's an interesting one. You go oh, the like Yeah, like that, like Vigo from the creepy like Ghostbusters. Oh,

Scott Benner 22:37
I thought I was gonna say Viggo Mortensen. But that's, oh, he's a good after one of our final years not the point. Okay.

Jennifer Smith, CDE 22:46
V dash g o v go.

Scott Benner 22:48
I don't know, the first thing about this. Tell me about why look at it. Yeah, the

Jennifer Smith, CDE 22:51
interesting thing about it is again, I think it's a marriage of a manual path pump kind of like Omnipod. And then the secure because it does deliver basil. And it allows you boluses. But again, there's set parameters. So your basil is, if I remember correctly, your basil is increments of a certain amount each and every day. And I think they have either 2030 or 40 units if, if that's correct, and it's a set incremental. So this doesn't allow, like Omni pads dash allows you to set a higher Basal at a time of day where you need more, and a lower Basal delivery at a time of day when you need less. This pump is just a set based delivery. So if you needed let's say 24 units in a 24 hour day, that would be one unit per hour and you can't change that rate. Alright,

Scott Benner 23:45
I'm looking at it here. It's also filled with you 100 rapid acting insulin worn for 24 hours. It's showing me the little thing just like you said, like you put it on, it gives you a steady 24 hour delivery of insulin in place of Basal injections. Correct and then delivers a Bolus of insulin with meals or snacks with a click of a button. One click equals two units, two units. Yep. Okay, so this is basically the seat cure. But what else Basil, basil, but not manipulatable it's just gonna give you whatever it says correct,

Jennifer Smith, CDE 24:16
whatever it is, whatever you determine with your clinician, you know, clinical team, essentially, you need this much base baseline insulin. This is the so like I said, it's kind of this weird in between but again, for for someone who really doesn't love the shots component and may also have maybe a lifestyle or a job that is really difficult just schedule wise to remember to bring their Basil with them all the time or whatever. I mean, really, because our baseline Basal injected insulins at this point, they don't go up and down based on our physiologic need either. It's a one injection it goes in it covers baseline, this is essentially doing the same thing. It's just you don't have to remember to take A via injection.

Scott Benner 25:01
It's basically you're injecting once a day, because you're poking yourself the once and then, but you're still limited to squeezing the button for two units, correct? Yeah. So let me let me ask you a question. Cuz I'm not denigrating anything, but I look at these and my brain goes to why would I just not worried different pump? Like, where would you suggest this for somebody,

Jennifer Smith, CDE 25:22
if I were still working more heavily in the type two population, I probably end depending, you know, there are quite a number of people with type two diabetes who would want more, they would want more of just manual because that's what they're doing. Or they would want an automated system, if they're already using insulin, knowing what the automated systems can do. Okay. But then there are, you know, certainly people like I think about, again, as I mentioned early on, maybe somebody who is in the later stages of life, and may need something that is just a bit more simple. Not necessarily it is easier, but I think it's the simplicity of it makes it less cumbersome. You know, somebody can say I always have this for breakfast, it always takes two or four units. Great. That's a quick, easy, I don't have to do any calculations, I just know that I'm eating the same meal, and I can dose the same way. The same thing with the Basal insulin. Maybe their lifestyle just doesn't really dictate a need to go up and down and they do pretty well on their flat injected basil. Great. A system like this might work really lovely and maybe less cumbersome. Even for a caregiver. Yeah, of someone who's older to navigate to

Scott Benner 26:36
guess we're also eliminating you needing to use a phone or a controller or something like that for people who don't have that kind of oh, okay, so there's the need for it. Okay. It's not a mass market appeal idea, though. No, no. Okay. That

Jennifer Smith, CDE 26:48
the man I would say not the market that I heavily work in, you know, the the people that I heavily work with would definitely I don't think I have one person that I send this to, right but there is if I was still working clinically, again with both you know, kind of

Scott Benner 27:05
cases Yeah, yeah. Okay. Is what's this? Is it soil? S o il Do you know that one? We I think it's we'll we'll Dana diet. diabetic

Jennifer Smith, CDE 27:16
care? Yes, Dana. Diabla. Care. Oh, yeah.

Scott Benner 27:19
What is that one?

Jennifer Smith, CDE 27:21
So that one actually, again, is a little bit more of a manual. Obviously, it's in our manual kind of comp category. I believe this one has more of a pump. If I remember correctly, this one has more of the typical pump body. It reminds me more of a more of a Medtronic yeah dial if you're aware of the Medtronic body of the pump and this one's tubed this one is to

Scott Benner 27:49
correct and yep, by the way, I don't know who their marketers are but on the front page it says it is real which makes me feel like you're going I can't believe you've and found us Wow, well you heard is true. We do make this insulin. Anyway, I found that funny. Okay, so but it's this is again just like simple buttons. And what does it I'm looking at it right now

Jennifer Smith, CDE 28:15
buttons and if I can't remember is this the one well this is a has a specific there's one that has a cartridge that is prefilled

Scott Benner 28:25
even their website is dicey. Sorry, guys. It's no icon based interface makes the pump intuitive and easy to program and easy to learn is less expensive compared to other insulin pumps half the size and weight twice the outcome that's not specific about anything that it does. So I go down to his technical specifications, Bolus increments. point 05 point 1.5 Or one okay, it's got four basil increments you can choose from, it can do an extended Bolus. Dual pattern Bolus bays that's that's okay. That's Bolus features think

Jennifer Smith, CDE 29:04
it's got a small I think it can go from Bolus doses of half a unit all the way up to is it 40 or 50 units.

Scott Benner 29:13
So I just missed the boat. I'm sorry the Bolus features Bolus features increments. point 05 point 1.51. Bolus duration says 12 seconds per unit it takes the pump in extended Bolus 30 minutes to eight hours and it doesn't dual pattern Bolus now Basal delivery rate point oh four units and hours minimum basil delivery rate every four minutes above point 09 And our basil increments point one or point oh one an hour. That's the increments it moves in changes per profile up to 24 temporary Basal rates one to 24 hours for different profiles. It just doesn't really it holds 300 units of insulin says it's waterproof that's got that IPX eight rating button lock mode. But there's no real like, like, it doesn't tell you on the website specifically how to how it's used. And there's so many different products on this website.

Jennifer Smith, CDE 30:15
Why we have it under the manual category? Yeah. Because it also as none of the rest of these do, I think a missing piece that we didn't say, I think it's just assumed none of them connect with a CGM. Yeah. Right. So none of these actually have that piece to them. Yeah. Not that you can't use them at the same time. It's just that they don't talk to each other.

Scott Benner 30:37
Do you want to go check it out? Absolutely. Do you know, but I just wanted to make sure that the ones that were out there that were the people knew about we talked about, but I mean, switching gears to automated now. I think of them as the big three, right? Like on the pod, tandem Medtronic and now the fourth one beta bionics the eyelet is coming, but it's, it's different. So we'll we'll talk about what all that means. Yes, but let's start back at Omni pod because we started there the first time on the pod five is an automated system. It currently hooked up with Dexcom G six. They have I don't know if you know this, they're in LMR on g7. limited market release on G seven. Yeah, actually,

Jennifer Smith, CDE 31:22
I did know that only because of a client that I work with. So

Scott Benner 31:27
So that's, that's coming. I'm gonna guess that. Literally, you could be listening to this right now. And Omnipod five works with g7. Because this is something people will again, limited. Yeah, but I'm gonna guess that the release gets bigger. Pretty soon after we make this ish. I would hope so. Yeah. So Omnipod five is the and just think of the way we describe the dash. It's a the same exact physical appearance. And, but it's married to a CGM that is now telling you, hey, this is your blood sugar. And it's making decisions about basil, and trying to bring down high blood sugars based on your CGM data. So why don't you talk about Omnipod five a little bit because I know you can speak very clearly about how it works. Absolutely.

Jennifer Smith, CDE 32:15
So Omnipod. Five is its algorithm essentially is an adaptive, which means that it adjusts your overall background insulin need over the course of a couple of pods, based on total daily insulin use. So it does not work off of a set Basal. So what you may have been, may have come from with your manual pump. If you were using that prior, it in no way delivers in the same way you're used to your manual pump delivery, it doesn't give you more at a certain time of day, it doesn't give you less based on physiologic need. That's not how it works. It also has an adapted corrective nature. So based on the predicted glucose 60 minutes out into the future, and each new glucose value coming in from your CGM, the algorithm takes a look at the trend up or the trend down and either suspends your insulin, it doesn't temporarily decrease like some of the other automated systems, it will either suspend based on a drop that dictates is going to get lower than it wants you to be. Or it may on a rise in blood sugar based on insulin on board and what it deems you're needing insulin to be, it may actually give you a bit more automated insulin than your set Basal that he has figured out.

Scott Benner 33:42
So And interestingly enough, these all the next ones we're talking about all do this, you could just switch the Omnipod five into manual mode, and you'd be using it just the way dash works. You

Jennifer Smith, CDE 33:54
could the biggest difference. I think that again, from a clearer of a clarification standpoint is that with the dash pump, manual pumps allow you to set a target that all the calculated boluses are going to aim for that target for that Bolus, right? Yeah. When you're using Omnipod, five, its lowest target whether you are in automated, or in manual mode is 110. Okay,

Scott Benner 34:23
so if I set it lower, how low can I put the dash for target?

Jennifer Smith, CDE 34:28
Oh, that's a good question. I think you can set it. I'd have to look it up. Yeah, but I think it's at least ad.

Scott Benner 34:36
Back when Arden was just doing a manual pump. I never really considered what the pump told me I would just Bolus but I take your point. So if you if your blood sugar's 150, and you say to it, hey, I want to Bolus here because I don't want to be this Hi. Omni pod five is going to shoot for 110 Where is that? You could shoot lower? Okay,

Jennifer Smith, CDE 34:56
correct. Exactly. I know it's much lower because I have He used a manual pump for both of my pregnancies. And the target is definitely much lower than the automated systems would allow the approved automated systems. I'd have to go back to the manual, because I don't honestly remember what the lowest is. Yeah, definitely. No, it's under 100.

Scott Benner 35:16
Yeah, no, okay. Yeah, if we can find it and throw it in, we will at the end, sure. But just the idea is very, is the idea, which is you can target lower with Dash, okay, so on the pod five, has got like an exercise mode, it has a lot of these pumps are going to have this stuff, right, like you put this in. And if you're going to be active, and we'll shoot for a higher target to try to keep you from getting low while you're being active.

Jennifer Smith, CDE 35:40
Oh, I was gonna say as we're talking about targets, that's another piece that is great. While the lowest target is 110, you can have target 110, you could target a 120, you could target a 131 40 a 150. So that's a really nice piece is that you can actually determine what do you want the pump to shoot for? Right? Right exercise mode, the target or activity mode, the target sets it at 150. But the other piece, just like all other manual pumps also have a correct above feature. So depending on where you have that correct above target set, the pump may not give you extra insulin unless you're above that target, to then get you down to the actual target you're looking for. So I know Omnipod five, a lot of people just have it set a 110 target and correct me above 110. So it's always really aiming tight, hard at that 110. However, with somebody who might have a lot more sensitivity, a little bit more variable rate variability, or might need some adjustments that tells the system don't give me a lot more on rises when I'm being active. Because I don't want to drop so then you can adjust that correct above like up to I believe it's 180 so that the system can't really decide to give you some extra unless you're climbing or predicted to climb above.

Scott Benner 37:04
Yeah, I think you used the word earlier, too, that I thought it was important because you you avoided saying learn because I think some people think, Oh, this thing learns. And if it does not do that, it doesn't work like aI like you are imagining it doesn't say, oh, yesterday, we were really high. So today I'm going to you know, it says it basically it looks at the the insulin usage and then sort of makes predictive decisions after that based on what's happened on the on the last pod to this pod. Correct? Again, it's just something worth saying because I do think some people think, oh, I'll just wear this thing for a week or two, and then it'll just magically understand what to do and do it. And that's not the case. And

Jennifer Smith, CDE 37:43
I'll tell you that that's a that's it's great that from what you clarify there, because I think there are a lot of people initially who may have had a system, like segment adjustment in a manual pump that gave more insulin at a particular time of the day. And again, I've had the question enough, well, why isn't it learning that I just need more insulin at three or four o'clock in the morning, because the system doesn't learn, right? It adapts to a certain base delivery. And that's what it's always going to drip in. Once you start rising, it's adapted correction is also going to help overcome that. But it's going to take a little bit more time than your adjusted basil in the manual profile. It's just not the same thing. And

Scott Benner 38:29
I want to say that I know about Omnipod five that the way you set it up is very important to your initial success, sincerely, and so much so that I have like I have a small series about it. They're called Omni pod five pro tips. But if you're going to start an omni pod five, please listen to those three episodes before you set it up. Because you're because if you come in with poor settings, the results you get back are going to be very confusing to you. And you're going to be left thinking this thing doesn't work. And you know, your settings are wrong. And this is not just from the pod five either it's for it's for tandem. It's for Medtronic, it's for all these systems. Yeah, your settings. And I

Jennifer Smith, CDE 39:05
would say that if you come in without optimized settings, will it adapt? Eventually it will adapt as you make adjustments to some of the things that do go into that total daily insulin consideration for it to adjust from eventually you will get there, but it will be a faster. Oh, I like this. Yeah, if your initial settings that you give it to work with are

Scott Benner 39:30
correct, yeah. And just for clarity, they're like, the idea here is if you come in and say I don't know, my total daily Basil is 10. And my total daily insulin is 20. And it's really, I don't know, 15 at the end and 40 or something like that. That thing's trying to do what you asked it to do, but you didn't give it enough firepower. And then you're gonna go in and go and you're going to Bolus more like you're gonna be like Bolus Bolus Bolus and eventually it's going to look and go wow, the total aliens on when we set up was 35. But I'm singing we're really using more like fifth See, and then you'll have a smoother thing. But you don't want to wait all that time to get to that, you know, if you don't have to what else needs to be said about Omnipod? Five, anything.

Jennifer Smith, CDE 40:07
I think the bigger things about Omnipod. Five are things that people are already in the know of. But for those who are wanting to learn about pumps, it does have an app for the Android users right now. So you can control it that way versus the handheld controller. And I think that's a piece that people would want to know that right now, unless you're an Android user, you will have your phone with you for all of your CGM alerts and alarms. And you will have your controller with you, which allows the system to give you a Bolus or to add corrections. I think another piece of that is to understand your controller does not have to be on your person for the algorithm to run. Yeah, pod holds the algorithm and communicates directly with the CGM that you have on your body. So if you forgot your CGM at home today, or not your CGM, I'm sorry, your controller at home today, and you went to work, you're not gonna be able to Bolus the algorithm working? Correct. The algorithms still gonna keep working. It's gonna keep you safe. You'll be able to see your CGM values on your phone or your app, but you won't be able to Bolus but that's I think it's a piece that still a lot of people are. They're concerned I have to carry around this extra thing. Well, not all the time.

Scott Benner 41:27
Yeah. And I and it's a big deal, actually. So to bring that up is smart. And the I think, again, they have I think they have the go ahead for the app. Yeah, for the iPhone device. app, it just hasn't come out yet.

Jennifer Smith, CDE 41:42
So one lovely thing about the iPhone app that I it's not part of the Android app is the iPhone app is going to have a frequent, like a food list. So you can actually have foods in there look up foods from a database, and that populates right into your carb calculator. Oh, which is a really it's a fantastic feature. If anybody is an age old Omnipod user like myself, it usually it used to have in the really old controller. Remember, it had a food diary that you I mean, it didn't go into your calculation, but at least you could look up if you had no idea what was in a croissant. Right, it was in there. And

Scott Benner 42:24
now I'm going to just say Apple this that and it's going to put it into the calculation through the iPhone app. Oh, that's cool. I didn't know that actually. Jenny Okay, tandem T slim x two that's the most that's the newest version so there's some might be some of you out there still using Basal IQ which is tandems automated pump that is just basically taking basil away to stop a low correct it was a like a speed bump has tried to stop you to get low but they pretty quickly came out with control IQ after that, which is another automated system that's making decisions about restricting and adding insulin. Yep, this one works with G six G seven and something else does

Jennifer Smith, CDE 43:05
G six G seven and do they have libre libre

Scott Benner 43:10
I'm looking right now. I think it's libre eight. Libre two? Libre two? Yes, G six Dexcom G six Dexcom g7 libre two, we're currently we're

Jennifer Smith, CDE 43:18
trying to Yeah, so the control IQ algorithm is different than what we just talked about with Omnipod. Five. For many people, I actually really like the control IQ algorithm. I think it's quite lovely. Because as we talked about settings initially getting started on a system. When you use Control IQ, it utilizes every setting that you put in when you enable control IQ. So if your base Basal profile is well set, and it works for you, but you just want that handholding kind of that Butler behind the scenes helping you out with things riot, control IQ, you can change a Basal at 3am to give you more, you can change it at 3pm to give you a little bit less, that's your active time of day or whatever control IQs algorithm will work off of your settings.

Scott Benner 44:10
Okay. So great old school like a manual pump, tell it from this window in this window here, I want my basil to be one. But in this window, I want it to be point eight, and then the but the algorithm still continues to work off those numbers.

Jennifer Smith, CDE 44:22
Correct. So and so it's it's still aiming for the same target, it's still got that 110 target that it is aiming for all the time. But for many people because of the fact that the set Basal profile is your own known amount of insulin, the way that the algorithm works, it tends to work better for some people again, this is where your lifestyle and what you know about yourself and everything kind of comes into the picture. I've seen it personally and you know, the women I work with in pregnancy. I've seen it actually work pretty nicely in pregnancy because we can dictate settings and still have the protection pain of not being too low, right? It does have automated Bolus in normal control IQ mode. As the blood sugar rises, it's either going to temporarily increase Basal insulin. If it looks predictively like the blood sugar is going to get to 160. But if it's rising faster, and the prediction is that your blood sugar is gonna get up to the 180 it's gonna give you automated correction boluses so, there's another little feature to it that's a little bit different for

Scott Benner 45:32
the Omnipod five, okay, to pump cartridge,

Jennifer Smith, CDE 45:36
yep, the to pump the cartridges and it's an interesting cartridge. It's that like, actually, like most people have used tube tops before the cartridge is like, you know, a cylinder sort of that you fill with insulin. It's either plastic, or like a hard plastic control, like you or the tandem T slim pumps have actually like a little balloon kind of like gets filled with insulin, you can't see it, it resides inside of a plastic kind of cartridge holder. But it also is, you don't see the insulin inside of your cartridge. Some people who came from Medtronic and we're very used to seeing see

Scott Benner 46:12
it, okay. So that's a difference. So it's a cartridge with a balloon inside of it. And they come pre filled, they

Jennifer Smith, CDE 46:19
do not come pre fill you fill it yourself. Oh, okay. Yes. And it, it's not advised to use a Piedra insulin in the control like you are not control IQ the T slim, mainly because of crystallization of that type of insulin. So either Novolog or human LOGG. I have had people using like the faster the more Ultra rapid, like fast and whatnot, but just not a pizza. Okay.

Scott Benner 46:44
It's interesting. I don't think a pager is cleared for Omni pod either. But Arden has been using it for 10 years. And it's also Omnipod you have to fill yourself he comes with a you pull out the insulin from the vial and then you inject it into the Omni pod and it's got its own little tank inside of it. And actually, I didn't we didn't mention this, but the only pods like disposable when you take it off the whole little pot just got done. Yeah, yes. Whereas I'm guessing I'm just gonna keep refilling my mighty slim

Jennifer Smith, CDE 47:14
as you get a new little cartridge each and every time you they are disposable. So you don't keep reusing that same exact

Scott Benner 47:23
thing. Gotcha. Do you know what it holds how much they have a

Jennifer Smith, CDE 47:27
200 and a 300. Pump. So they've got two sizes similar to Medtronic. Medtronic has the smaller fill and the larger fill pumps as well. So this one does,

Scott Benner 47:36
too. So if I wanted to next to the hill 300 units, I'd actually have a larger device.

Jennifer Smith, CDE 47:41
You'd have a the actual pump itself.

Scott Benner 47:45
Yeah. Okay. And then of course, you're going from the pump to an infusion set. And so your infusion sets on you somewhere. And then there's tubing from that, that goes back to the pump, and then that pump has to stay with you obviously, because the minute you just kick from it, you don't have access to the shoreline. Okay, correct. But the controller is on the pump itself. Well,

Jennifer Smith, CDE 48:07
that's another neat feature of the control IQ or the tandem pump is that yes, your controls are are on your pump itself, right. But you also have the app, the app now allows you to Bolus do extended boluses with the newest update. So the app on your phone drives the pump as well. So if you really are somebody who doesn't want to ever pull your pump out or or you know you have it like shoved way down in your pants early, it doesn't look nice to dig in your pants. You don't have to

Scott Benner 48:37
he's never seen me dig in my pants Jenny's very

Jennifer Smith, CDE 48:41
efficient your bra I know a lot of women like when I wear a tube pump I actually used to wear it like on the side of my bra because it was easy to clip in there but then to pull that out business meeting digging down your

Scott Benner 48:52
shirt just pulling your sleeve aside excuse me I'm gonna have I'm gonna have a muffin in a second we we win the break so that makes it really nice now listened plenty of people I've heard from love the tea StarMax to these things are all they're never always going to be right for everybody. Right and we say it's like your lifestyle or buy but some people are just gonna like it or not like it for some reason. So I've heard people say like, oh, I'm the pot is too big, or but I've also heard people say I don't care. I'm not wearing tubing, you know, like it's just it's, it's what works for you. Anything else about tandem that we haven't said the

Jennifer Smith, CDE 49:27
software is you don't have to, like essentially get a brand new pump. Whenever something gets updated or upgraded in it a new feature or whatnot. It is a software upgrade to the device, which you know, you get I don't know exactly the how it works, but it's a code your doctor signs off of it, you get it, you essentially sign in, do a little bit of like online training for it and then you download it right to your pump, which is quite nice rather than having to wait for something in the mail.

Scott Benner 49:54
Nice. Alright, let's move to Medtronic. Now Medtronic has, I have to admit I don't know a lot about eyelets but there's a 637 70 and 780 G. These are, by the way US companies that are US pumps. I should also say that Medtronic is the sponsor of the podcast, not for their pumps just for their company. But let's I just want to say that. So what is the difference here 630 G is what the

Jennifer Smith, CDE 50:17
630 The 670 was really the more automated okay of them. When you're looking at like coming from manual upgrading to some type of automation, there was a suspend feature, much like Basal IQ, if you consider it that right, where it just did a predictive suspend prior to the low or a suspend on a low type of feature. Then we moved into the 670. The 670 gave some true automation with CGM data, right, some increases and decreases to the baseline Basal delivery. Again, med tronics automated systems work similar to Omnipod fives automation, it's an adapted insulin delivery based on total daily insulin view over a couple of days. So and it continues to adjust that. It's not AI, it does not learn, but it does adjust based on your total daily needs. So the newest is of course, there 780. There 780 takes it up a step from the 770 in that it has auto Bolus correction. Similar to what I mentioned about control IQ as blood sugar predictively is going to get higher, it may auto correct rather than temporarily increasing your Basal. And a lot of people actually find that the 780s auto Bolus Correct. Works pretty swiftly. Yeah, in comparison to the other systems that have been, you know, looked at. It works pretty darn nice.

Scott Benner 51:51
I've heard a number of people using the seven ATG who are like I like it, and I'm having good results with it. Now this only works with their CGM, though, right their guardian sensor,

Jennifer Smith, CDE 52:01
correct in their newest is their guardian for sensors, which from the handful of people that I've worked with using it do seem to say that it is a nicer sensor more more often that it's consistently accurate a little bit, I guess nicer to use, essentially, it still has all the taping requirements. I think that's the biggest thing that people don't like, who continue to use their sensors, with good accuracy and whatever they are getting. It's that their sensors require a lot of like, taping down to hold them in place. And people don't like the all of the additional adhesive to get it to stay on your body.

Scott Benner 52:44
Gotcha. It's a weird, I mean, the design is interesting. It looks like Uh oh, gosh, I don't think they're gonna like this. It looks to me, it looks like a tick. It looks like it's got like a big round body and it bites you on one side. Like, does that make sense? We

Jennifer Smith, CDE 52:57
call it a BS bot.

Unknown Speaker 52:58
Oh, no kidding. I

Jennifer Smith, CDE 52:59
didn't know. It's like the it's like the abdomen kind of part of the back end of like, a beach, or like a ticket? Actually.

Scott Benner 53:08
I know it's not, they're probably like, Oh, great. I'm glad we bought ads with you. But no, but it's, it looks a little weird to me. But

Jennifer Smith, CDE 53:15
the part that actually when the front end of it as if it's like the head area of the bog, let's call it right. That's the part that has the center and kind of gets inserted. But unless you tape down that butt area, it flops around and it's going to come out interesting. Okay, so the sensor also is not the sensor itself, but that little that little rounded, but area, it actually gets charged. So that piece Oh, much like the Tran let's call it the transmitter on the G six, right, we have to save that part. That's the same thing with the Medtronic sensors is that piece gets charged. And all that gets really thrown away as the little sensor that you pop under the skin.

Scott Benner 53:56
Oh, I see how. Okay, that makes sense. And this is again is another it's to pump. The tube pump. Yeah. I mean, honestly, in the space of automated what's available right now on the pod is the only two books one right the rest of them have tubing. It is

Jennifer Smith, CDE 54:12
the only tubeless currently on the market. Right? Yeah, yeah. So in terms of everything and automation. Yes, yeah.

Scott Benner 54:20
Now, do we have time for you to talk about the beta bionics I letter? Do you want to stop here and we'll do it next time we come back.

Jennifer Smith, CDE 54:28
I would say we should stop here because that's a great one to like, get into and yeah, I only have about four or five minutes.

Scott Benner 54:34
That's fine. Then we'll talk about fun stuff like personal fun stuff when we say goodbye to the peoples. All right, cool. I'll see in a bit for the next part. My pleasure.

A huge thanks to us met for sponsoring this episode of The Juicebox Podcast. Don't forget us med.com/juice box. This is where we get our diabetes supplies from you can as well use the link or call Call 888721151 for use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. A huge thanks to Omni pod, not just my longest sponsor, but my first one Omni pod.com/juice box if you love the podcast and you love tubeless insulin pumps, this link is for you. Omni pod.com/juice box, you can use the same continuous glucose monitor that Arden uses. All you have to do is go to dexcom.com/juicebox and get started today. That's right, the Dexcom g7 is sponsoring this episode of The Juicebox Podcast. The Juicebox Podcast is full of so many series that you want and need afterdark s Gutten Jenny, algorithm pumping bold beginnings defining diabetes the finding thyroid, the diabetes Pro Tip series for type one, diabetes variable series mental wellness, type two diabetes pro tip, how we eat oh my goodness, there's so much at juicebox podcast.com. Add up into that menu and pick around. And if you're in the private Facebook group, just go to the feature tab for lists upon lists of all of the series. always free. Always helpful. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

Scott Benner 1:21:04
it feels like it almost feels like it's coming from the back of your neck. I don't know. Like another way to say that. But yes, yeah, way more talk about how people's voices sound and most people care about I'm gonna say, so I'm gonna let you go now. Most people are like, I have a thought. I don't even bother to think if it's right. And then it comes out of my mouth. That's talking, you people are overcomplicating this, right. So

Kim 1:21:30
when you do it for your living, you know, you have to take care of yourself.

Scott Benner 1:21:35
Yeah, no, it's it's a crazy thing. I usually record every day of the week. So even like getting sick. Like there's sometimes I feel myself getting sick and I'm like, oh, no, no, no, no, that can't happen. Today, Oh, no. You know when that can happen later when I'm dead. Not now. I'm gonna be time for this. Like so. Yeah, I got sick during the remastering of the Pro Tip series. And I have to be honest, the opens are great because that because my voice was like

Kim 1:22:01
extra. Yeah, yeah. Yeah. I just

Scott Benner 1:22:06
had to record in like shorter bursts. And then then breathe and then record and then edit it together. So anyway, thank you can I really appreciate you having this conversation with me? Thank you very much. A lot of fun. Oh, good. I'm glad. Hold on for me one second. Sure.

A huge thank you to ever since CGM for sponsoring this episode of the podcast. Are you tired of having to change your sensor every seven to 14 days. With the ever since CGM, you just replace it once every six months via a simple in office visit. Learn more and get started today at ever since cgm.com/juicebox. A huge thank you to one of today's sponsors, G voc glucagon. Find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juice box. They spell that GVOKEGL You see ag o n.com. Forward slash juice box. If you're living with type one diabetes, the afterdark collection from the Juicebox Podcast is the only place to hear the stories that no one else talks about. From drugs to depression, self harm, trauma, addiction, and so much more. Go to juicebox podcast.com up in the menu and click on after dark. There you'll see a full list of all of the after dark episodes. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com