AskNadia: Which Insulin Pump & CGM Should I Get

Hi Nadia,

I was recommended to look for an Insulin Pump. The doctor asked me to contact different pump manufacturers. The first ad I saw was for the Dexcom CGM. The contact was aggressive, and she is making arrangements to get one. I know this is not a pump, in my mind, it would help.

The doctor gave me two brochures one for Tandem and the other for Medtronics or something that sounds similar. What is the best process to go forward? I want to get this within this year. Would the Dexcom purchase affect getting an insulin pump?

Thanks,
Sonny

Hello Sonny:

Going on an insulin pump is a big decision. Research shows the tight blood sugar control minimizes hypoglycemia and hyperglycemic episodes. If you are a type 1, a large body of evidence also indicates that tight control reduces heart disease.

The Case for Tight Blood Sugar Control

The Diabetes Control and Complications Trial (DCCT) started in 1983 and ended in 1993. This 10-year study showed that tight control, injecting more frequently can delay diabetes complications.

Interestingly enough, participants in the early study are still being followed, and research continues to support early and tight blood glucose control, proving its benefits in preventing diabetes complication.

Before we talk about the different insulin pumps and Medicare coverage, I want to go over a quick review of how the device works.

Insulin Pump Basics

The insulin pump is a medical device that delivers insulin through a cannula (plastic tubing) over a 24-hour period. This method of insulin delivery is referred to as your basal insulin. The idea behind the basal insulin is that it will deliver background insulin all day long preventing glucose, blood sugars from going too high and minimizing low blood sugars by dialing in just the right amount of background insulin.

Once you and your healthcare professional have figured out your basal insulin, you will learn how to give yourself an injection which is referred to as a bolus when using an insulin pump to dose insulin. Learning your carbohydrate insulin ratio can make a difference in your overall blood sugars.

The three insulin pumps manufacture are:

Tandem, Insulet and Medtronic.  All three pumps are covered under Medicare.

If your physician has written you a prescription for an insulin pump, I am assuming that you meet the other Medicare criteria including the C-Peptide test.

C- Peptide Review

The C-Peptide test measures the amount of insulin your pancreas is still producing. To qualify for Medicare coverage, your C-Peptide test needs to be ≤ 225 mg/dL, demonstrating a low insulin production.

Medtronic is the oldest insulin pump company on the market. They have the largest insulin pump, users. Their Paradigm Revel System combines their insulin pump and CGM.

Tandem ’s insulin pump is small, sleek and a less bulky device than the Medtronic pump. The touchscreen design makes it more intuitive to navigate for people who are accustom to using a touchscreen phone.

Both the Tandem and Medtronic have a built-in bolus calculator which takes into account the basal insulin in your system and any other boluses, helping you calculate how to correct dosage if necessary. These two pump reservoirs hold 300 units of insulin.

The OmniPod provides a tubeless insulin pump that also works with the Dexcom CGM. It holds 200 units of insulin and is popular amongst pumpers that do not want to deal with tubing that is attached to a cannula.

Look at this insulin pump comparison chart to view the different features for all the pumps.

Join the Insulin Pumpers Group to read what other pumpers experiences are with the different insulin pumps. Reading and learning how they are different is one thing. However, reading someone’s personal experience will most likely help you pick the best insulin pump taking your lifestyle and insurance into consideration.

CGM

The continuous glucose monitor offers great feedback on which way your blood sugars are trending. A helpful feature when you need to dose more insulin to prevent a high blood sugar or avert a low blood sugar by omitting an insulin injection.

The CGM is approved for both Type 1’s and Type 2’s living with diabetes.

The FDA has approved the Dexcom CGM G5 and Abbott’s FreeStyle Libre, as devices that can replace blood glucose finger pricking tests.

There are 4 Continuous Glucose Monitoring Systems in the market; Abbott’s FreeStyle Libre, Dexcom’s G5 and soon to come G6, Medtronic’s MiniMed Paradigm® RevelTM System and the new, soon to hit the market, the implantable 90-day Senseonics Eversense.

 

Accuracy Test for CGM

MARD (mean absolute relative difference) rates the CGM accuracy with the lowest number being most accurate. PubMed states that “MARD Values Are Not Always a Reliable Indicator of CGM System Accuracy.”

For what it is worth, there is a 4.8% difference from the most accurate to the least accurate CGM.

Dexcom has the lowest number meaning it is considered the most accurate CGM on the market by the MARD accuracy standard.

You can compare the three-continuous glucose monitoring system in this chart.

There is a Dexcom CGM closed Facebook group. I would post any questions you have on the glucode monitor there. The feedback you receive will be from CGM users and parents.

Medicare Catastrophic Coverage

Your Medicare coverage should not affect your purchase of a pump after you have personally paid 5,000 dollars. The Medicare catastrophic coverage should end the gap in coverage. Once you start your Medicare prescription drug program which includes catastrophic coverage, your standard co-payment applies.

After paying $5,000 out-of-pocket in 2018, you should be out of the coverage gap. Once you get out of the coverage gap (Medicare prescription drug coverage), you automatically get “catastrophic coverage.” It assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

Medicare has provided a pdf to clarify the Medicare coverage for diabetes supplies and services. I will post next week in my column.

Wishing you the best in health,

Nadia

Source:

BMJ
DCCT

CMS.Gov

Medicare Catastrophic Coverage

MARD

 

Columnist Nadia Al-Samarrie, “Named Best Diabetes Blog for 2017 by Healthline” release her book Sugar happy

 

If you would like to pre-order my new book “Sugar Happy- Your Diabetes Health Guide in Achieving Your Best Blood Sugars and Letting Go of Your Diabetes Complication Fears” launched on April 6th and pre-orders ranked #7 on the Kindle top 100 new releases. This book is for both Type 1 and Type 2 people living with diabetes. It is meant to be a guide, allowing you to look up the topic of interest.

For a limited time before the June 3rd release, I am offering the Kindle version for 99 cents.

Disclaimer:

Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professional’s therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.

AskNadia and receive her unique perspective on your question.

My Story

About Nadia:

AskNadia (ranked #1 by Google), named “Best Diabetes Blog for 2017 by Healthline and one of the top 50 diabetes influencer’s blog that is a must follow, and with 23 nominations, Nadia Al-Samarrie’s efforts have made her stand out as a pioneer and leading patient advocate in the diabetes community.

Nadia was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview, now Diabetes Health magazine.

 

Nadia has been featured on ABC, NBC, CBS, and other major cable networks. Her publications, medical supply business, and website have been cited, recognized and published in the San Francisco Chronicle, The Wall Street Journal, Ann Landers advice column, former Chrysler chairman Lee Iacocca, Entrepreneur magazine, Houston News, Phili.com, Brand Week, Drug Topics, and many other media outlets.

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