Which pump should I choose? How do I choose? Oh let me count the ways…

Which pump should I choose? How do I choose? Oh let me count the ways…
Which pump should I choose? How do I choose? Oh let me count the ways…

I’ve seen this question asked many times across multiple different versions of social media. And I think at its heart it misses the point. I think at the core, in basic functionality, all pumps are essentially equal, in that they all provide basal and a variety of bolus capabilities, and have different reservoir capacities. All are just a different form of insulin delivery device. Like a pen or a syringe is. 

Where they vary is in the increments in which they can deliver insulin and the number of time slots that can be used for basal rates. If you are extremely insulin sensitive, you might, for example, require a pump that can deliver insulin in 0.025u increments, and if your basal requirement is very up and down you may need 48 slots in 24 hours.

In order to work this out though, you need to look at what you do now and do some observation. It’s worth doing a basal test to see how up and down you are on long acting insulin, which should give you an indication of how you will need to break down your basal rate on the pump. Most people are fine with 24. Does your basal rate change multiple times a week and will you need to take this into account and have multiple rates set up?

You’d also need to review how you bolus. Do you only ever need one or two units for a meal? Then you might need to have more flexibility in the size of the increments that the pump delivers, for example, the Omnipod goes down to 0.05u while the 640G goes down to 0.025u. If you only work in small numbers, smaller increments are better.

Then you need to consider how important tubeless is. Are you really averse to that tube? Does it frighten you? If you really are that bothered, then in the UK at least, you’ve currently only got one choice. You’re going Omnipod.

Do you use a lot of insulin and need a 300u reservoir? Then you’re looking at Medtronic or the Accu-Chek Spirit Combo.

Following that, you’re really into what I like to call “add ons”. The things that make each pump stand out, and really, only you can choose between these as to what you prefer.

Do you want CGM as part of the pump? If so then you are narrowed down to the Medtronic and Animas Vibe.
Do you want to be able to remote control the pump? Then you are looking at Accuchek Insight or Omnipod, with some limited remote bolus capabilities from the Medtronic.
Do you want both of the above? Then you will have to select the Medtronic.
Does it need to be waterproof? Medtronic 640, Animas Vibe or Omnipod.
The list goes on. Create this list and ask yourself the questions…

Last year I wrote about what an ideal pump might look like here. What you could do is go through the list, highlight the things you think are best and then look at which pumps offer what you’ve ticked off.

The other thing to be aware of is the user interface. Getting your hands on each of the pumps you are interested in and using them for 15 mins will tell you which of these you like and which you dislike. I’m sure some of them will feel totally alien and some you will click with right away.

Ultimately, the answer will be partly emotional, partly based on features and partly based on what’s available. You’ll have to decide what you’ll compromise in order to get what you need. INPUT can also provide you with a little help.

Me? I’m using a Spirit Combo, as it was what was available not going through the NHS (which was my compromise) and it does a great job. It doesn’t have CGM, But it is a pump. And it gives the basal and bolus flexibility that only a pump can. 

It is the fact that it is a pump that is important, and not the bells and whistles.

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