I was first diagnosed with Type 1 Diabetes in 2020 when I was in my early forties. It came completely out of the blue, and deeply shocked me. The biggest shock came when I arrived home in the evening of my diagnosis and had to inject myself with insulin for the first time. Initially, as someone who hates needles, I could’t bring myself to do it. I realised, though, that this was now going to be a necessity for the rest of my life.
Over the next four years I became accustomed to injecting myself multiple times a day – morning and evening with Levemir, a long acting insulin, and with Novorapid and subsequently Fiasp every time I ate. This is a very common way to manage Type 1 Diabetes, and is often referred to as multiple daily injections (MDI). I took pride in the precision and control I achieved through this method—diligently counting carbs, adjusting doses for exercise, and keeping a close eye on glucose levels. My results were good—exceptional, even—and, although I was aware in insulin pumps, the thought of switching to a pump felt unnecessary, perhaps even risky. I worried about handing over some control of my diabetes management to an algorithm, fearing that a pump would interfere with my carefully maintained balance. But a conversation with my endocrinologist changed my perspective and made me consider the potential benefits of automation.
Initial Reservations About Moving to a Pump
The biggest hurdle for me was the concept of relying on an algorithm to manage my insulin needs. Would a machine understand the nuances of my body as well as I did? My endocrinologist, however, was persuasive. He explained that a hybrid closed-loop system could relieve some of the mental burden associated with managing diabetes. With such a system, I wouldn’t have to manually adjust my basal rates as often, and I might sleep through the night without waking up to address high or low blood sugars. It wasn’t about giving up control, he argued, but rather about sharing the workload with a system designed to keep me within target ranges automatically. He encouraged me to meet with my diabetic nurse to explore the options.
Meeting with My Diabetic Nurse
When I met with my diabetic nurse, she introduced me to several pump options that were available through the NHS. We discussed the Omnipod 5, Tandem T-Slim with Control IQ, CamAPS FX with Ypsopump, and the Medtronic 780G. She explained the features of each, their compatibility with continuous glucose monitors (CGMs), and how they could potentially lighten the mental load of daily diabetes management. While each pump offered some form of hybrid closed-loop technology, each came with its own set of strengths and challenges. I, somewhat surprisingly, quickly came to the conclusion that perhaps I should, after all, opt for an insulin pump. The question then was, which would work best for me and my needs?
Key Considerations
I approached the decision with a clear set of priorities. I wanted a pump that would help me maintain tight glucose control, aiming for levels as close as possible to non-diabetic ranges. Given that I enjoy swimming, running, and sailing, I needed a system that wouldn’t hinder my active lifestyle. Additionally, integration with my existing data setup was crucial—I use xDrip4iOS to display glucose levels on my iPhone and Garmin watch through Nightscout, and I wanted to maintain this visibility, even if it meant considering a switch to an Apple Watch.
Weighing the Options
I decided to carefully review each of the options on offer to see if one or other of these would be suitable for my lifestyle.
Omnipod 5
The Omnipod 5 immediately appealed to me for its tubeless design. As the only pump without tubing, it seemed ideal for my active lifestyle, allowing freedom during swimming and running without having to worry about tubing getting in the way. The Omnipod 5 also integrates directly with the Dexcom G6 and, as of 2024, the Freestyle Libre 2 Plus, making it a versatile option.
• Pros: Tubeless and waterproof; freedom of movement; seamless integration with Dexcom G6 and the upcoming option for Freestyle Libre 2 Plus.
• Cons: While it’s great for daily use, it lacks the deep integration with xDrip4iOS out of the box, requiring additional setup for some of the third-party apps I currently use.
Tandem T-Slim with Control IQ
The Tandem T-Slim has earned a reputation for accuracy and predictive adjustments. Its Control IQ algorithm is designed to prevent highs and lows by making real-time changes to basal insulin, working in tandem with the Dexcom G6. The touchscreen interface and compact design make it user-friendly, though it’s a tubed system, which posed a concern for my more active pursuits.
• Pros: Customisable glucose targets, strong integration with xDrip4iOS, Nightscout, and Garmin.
• Cons: The tubing could be cumbersome during sports, and while it’s effective for maintaining good control, it lacks the tubeless freedom of the Omnipod 5.
CamAPS FX with Ypsopump
The CamAPS FX with Ypsopump offers a highly adaptive algorithm that adjusts to individual glucose patterns over time. It’s controlled through a smartphone app, giving users flexibility in adjusting settings and monitoring trends. For someone like me, who is detail-oriented, the ability to fine-tune the algorithm was appealing.
• Pros: High adaptability; excellent for those who want to target near non-diabetic glucose ranges; control via smartphone app.
• Cons: As a tubed pump, it’s less convenient for my active lifestyle, and its integration with xDrip and Garmin is not as seamless, often requiring workarounds.
Medtronic 780G
The Medtronic 780G offers a well-regarded SmartGuard technology, which adjusts basal rates automatically and can deliver correction boluses. It’s designed to keep glucose levels as close as possible to 5.5 mmol/L. The Guardian 4 CGM integrates directly with the pump, offering a streamlined experience. However, the proprietary CGM means limited options if I wanted to stick with my Freestyle Libre or Dexcom.
• Pros: Robust closed-loop system with automatic corrections; designed for those looking to maintain tight control.
• Cons: Tubed design can be restrictive; limited third-party integration, making it difficult to continue using xDrip4iOS or Nightscout for data visibility.
Choosing the Omnipod 5
After weighing up the pros and cons, I settled on the Omnipod 5. Its tubeless design suited my lifestyle, allowing me to continue my activities without having to disconnect from the pump. The ability to use either the Dexcom G6 or Freestyle Libre 2 Plus gave me flexibility, and its future compatibility with the Libre sensor made it a forward-looking choice.
While the NHS will eventually cover the cost, I am currently on a waiting list. To avoid delays, I’ve decided to self-fund the Omnipod 5 until I reach the top of the list, allowing me to benefit from its features right away.
Transitioning from Freestyle Libre 2
Since the Omnipod 5 requires a Dexcom G6 or the newer Freestyle Libre 2 Plus for automated insulin delivery, I needed to decide which sensor to use. The Dexcom G6 offered zero calibration, seamless integration with xDrip4iOS, and the ability to see my glucose levels on my iPhone lock screen and Garmin watch. In contrast, the Freestyle Libre 2 Plus has a longer wear time of 15 days, but integrating it with xDrip4iOS would have required a third-party transmitter.
After careful consideration, I opted for the Dexcom G6. While it requires more frequent changes, it integrates smoothly with the Omnipod 5 and fits well with my existing setup, making it easier to monitor my glucose trends and maintain the tight control I aim for.
Conclusion: A Balancing Act Worth Embracing
The decision to transition from MDI to an insulin pump was not made lightly. It required a willingness to embrace change and let go of some of the control I’d held tightly for years. Yet, the Omnipod 5 offers the right balance between freedom and precision, allowing me to maintain my active lifestyle while benefiting from the automation of insulin delivery. The transition to the Dexcom G6 complements the Omnipod 5 by keeping my data accessible and visible across my devices.
For anyone in a similar position, wondering whether a pump might be right for them, my advice is to think about what truly matters in your management. Whether it’s freedom of movement, seamless integration with technology, or reducing the mental load of diabetes, there is likely a solution that can make life just a bit easier. As I continue this journey, I’m hopeful that the Omnipod 5 will not only improve my diabetes management but also enhance my overall quality of life.
