Evaluating Diabetes Technology: The Pros & Cons of Different Devices, with David Ahn, MD
Download MP3Hi, everybody. And welcome to this edition of the Taking Control of Your Diabetes podcast. I am one of your hosts, doctor Jeremy Pettis, joined as always by my good friend and colleague, doctor Steve Edelman. And if you are just tuning in, Steve and I are both living with type 1 diabetes since we were 15 years old, just separated by about 25 years. And both endocrinologists at the University of California, San Diego, where we do research and see patients.
Speaker 1:And of course, Steve founded Taking Control of Your Diabetes, in 1995 to empower and educate all of us living, with diabetes to take control of our diabetes. So welcome to the podcast. And this, episode today is kind of broadly on diabetes technology with a specific focus on kind of the new insulin pump, what we call hybrid closed loop systems, primarily for people with type 1 diabetes, but also could be for type 2. And this is such an important topic because we say this all the time on this podcast, but things are changing so quickly. And especially with technology, we were just musing that we could easily do this, you know, podcast once a month and have some kind of very valid update on this topic because things are changing so rapidly.
Speaker 1:So, Steve, say hi, and then introduce our extremely, special guest. Special guest. Yes. Thank you.
Speaker 2:Yeah. Yeah. Well, hello. Welcome everybody. Well, today, you know, we're talking about technology, and we have David on with us.
Speaker 2:David, just like yourself, Jeremy, did his specialty training at UCSD and, did his fellowship with us, and that was way back 10 years ago. And, since always well, David always had an interest in technology. Mhmm. And he even helped TCOID get our first technology blog, and now is, in practice in Orange County at Hogue, and now is pretty much an international expert on technology. And now although he doesn't have type 1, he seems to know know that.
Speaker 2:He doesn't look like a type 1. That's for sure. And, we yeah. We're glad to have him here today to talk about, CGMs and their partner device, the insulin pumps, to develop a hybrid closed loop. And there's a lot of advances.
Speaker 2:So, David, why don't you say hi, and, we'll start.
Speaker 3:Yeah. So thank you for having me on the podcast. Yeah. I'm an adult endocrinologist, chief chief of diabetes services at Hoag Hospital in Newport Beach, California. I've been really blessed in my career, really passionate about diabetes technology, have some social media accounts, and, it's been really fun.
Speaker 2:Yeah. And you're chief of 1. Right? You're the only person your division?
Speaker 3:Essentially. Essentially.
Speaker 1:Thanks, Steve.
Speaker 2:Well, he he yeah. You do others.
Speaker 1:And, yes, and and Dave and I, actually, we did our our fellowship at the same time. You say way back when, but we were, like, I was 1 year, I think I think.
Speaker 3:Yeah. Yeah. You were 1 year ahead.
Speaker 1:Yeah. So
Speaker 2:Yeah. You
Speaker 1:know, tell us.
Speaker 2:Let's start off with talking about CGMs in particular. There's been a lot of changes. So let's just start off with the the Dexcom G7, and we'll transition to the, the Libre.
Speaker 3:Yeah. It's it's been a big upgrade over the g 6. Came out, about a year ago. It has a much more convenient form factor all in one, piece. There's no separate transmitter anymore.
Speaker 3:It has a 12 hour grace period, 30 minute warm up, so it's just pretty awesome.
Speaker 2:Yeah. And what about the Libre 2 and, the 2 plus and then the 3?
Speaker 3:Yeah. The Libre 3 has been out for about a year and a half. It's the smallest form factor on the market. It's really impressive if you see it. And there's recently, the Libre 2 plus actually got approved.
Speaker 3:So they kinda brought back an oldie, but they added, pump integration. So it actually integrates with the Tandem Control IQ pump, and it will eventually integrate with the Omnipod 5 pump as well. So, they kinda have those 2 products on the market, Abbott does.
Speaker 2:And and you mentioned on on the TCOD Live that we just taped. For those of you listening, you could watch that on our website. It's it's there forever. The the fact that it's a little bit more accurate, and now that it's gonna be telling the pump how much insulin to give us, too much or too little, it's it's pretty important to have those numbers as accurate as possible.
Speaker 3:Yeah. Right now, we're kind of in, like, the murky part of the product lineup because there's the Libre 3 and the 2 plus are kind of both new at the same time. The 2 plus, is a little bit more accurate. It doesn't have interference from vitamin c like the, like the Libre 3 does. But the Libre 3 plus will probably be out by the end of the year, and that will just Once that's out, I think the Libre 3 will go by the wayside, and everybody will just, all the Abbott users will be on the Libre 3 plus.
Speaker 2:But you don't have to swipe the 2 plus. Correct.
Speaker 3:So even though the 2 the 2 requires swiping, the 2 plus does not if you're using automated insulin delivery.
Speaker 1:And it's it's a big deal because, you know, again, as we're talking about, this this represents the first time that a pump can have multiple CGM options. It historically has been if you wanna use this system, you have to use this sensor. And there might be times where somebody can't use a particular sensor. They might have issues with the adhesive or whatever it might be. So moving towards, in general, the concept that, you know, these things don't always have to be locked in, that you pick your pump, you pick your CGM, and you get on kind of the best system for for you.
Speaker 1:So maybe talk a little bit about that, like, evolution, how that's happening.
Speaker 3:Yeah. It it's a really exciting time. Like you just mentioned, the Tandem pump is the first to actually integrate with, like, 2 different competitor sensors. It integrates with the G6 from Dexcom, the G7 from Dexcom, and the Libre 2 plus from Abbott. And that's really exciting because certain sensors don't work for certain people.
Speaker 3:They have preferences. And, also, maybe your preferences change during, change over time. I feel like we're we're kind of hitting this era where CGM is almost gonna be like your watch or your shoes, where you might have your your daily driver your go to, but that doesn't mean you can't swap it out for a special occasion. Or maybe over the summer, you know, you're gonna be swimming more, so you wanna switch to an Eversense or traveling and you want less supplies or, you know, you you're not tied to one specific product. You can change it every prescription.
Speaker 1:Yeah. So I think we'll save the Medtronic sensor from when we talk about the the Medtronic pump. The other sensor we should definitely mention is the Eversense. And we've talked about that a bit at TCOID and actually filmed with David. David came down and actually did the implant in in Steve's arm.
Speaker 1:So you can see that on our video vault. But essentially, this is a small little sensor, that is implanted in somebody's kind of, upper arm and it can stay there for 6 months now. They're trying to get it to up to a year. You still have to wear a little patch over it that transmits the data, But this is a great option again if somebody, you know, doesn't want to have this thing kind of showing all the time, if they have adhesive issues. It does not integrate with any pumps yet, but hopefully that's coming soon.
Speaker 1:So anything you wanna say, guys, about that particular sensor?
Speaker 2:That was that was good, Jeremy. You you got that down. The, it it currently, you have to calibrate it once a day, and they're working on once a week calibration, and it would last 1 year. And it uses a different technology than the the diff the other sensors, so you don't get compression lows. And so it's got it's got a different form factor, and this is for people who don't wanna deal with prescription refills, the, you know, the pump the patch CGM falling off and getting have to get another one.
Speaker 2:So it comes down to choice. And like you said, some people that are more athletic may be interested, but it just it's just an individual thing. So, yeah, they're they're catching up on the on the connectability with insulin pumps as well.
Speaker 1:I'd say on the backdrop of all this is just a recognition by, providers, by people in academia, by by payers that CGM matters. And it doesn't necessarily mean that you have to be on insulin, but for all people with diabetes, we're moving towards this is just the way that we, you know, measure blood sugars. And I always talk about Steve when we first started talking about CGM at TCUID, that there was people couldn't get it. You know, even type ones, it was so difficult to get on it. There was a lot of anger.
Speaker 1:Now it's it's, you know, Medicare is saying as long as you're on some form of insulin, it can just be basal insulin, you can get it. But I would say it's not that far off that it's gonna be people on just pills and and such and such that we just get it out there to more people.
Speaker 2:Yeah. Well, on a side note, David, I saw in some of your notes for our tcod live, You said that people with type 1 are pissed that nondiabetics are using these devices now and, for weight loss programs, all kinds of other issues. What what give us a one liner on that.
Speaker 3:Yeah. I think it's been a real match point, or kind of point of frustration for patients online that I've seen. A lot of people get really upset. I think it's kind of like, why are you taking this thing that is, like, my medical disease that I'm like, it's my burden, and why are you kind of making it cool? You know, maybe it's a little bit of, like, an appropriation argument.
Speaker 3:I you know, maybe as someone without type 1 diabetes, I am not as sensitive to that. I I think sometimes when I hear that kind of sentiment expressed online, I almost feel like it's like it's like the hipsters when your, like, favorite band becomes popular or when your, like, team wins a Super Bowl and, like, everybody else wants to be a fan and jump on the bandwagon. I think, I do think there's a little bit of that. It's like, this was our one cool thing. Why are you taking it away from us?
Speaker 3:Yeah. But, I'm curious to I mean, maybe your guys' perspective is different.
Speaker 1:You know, we haven't talked about this at all. Like, you know, for me, if people, you know, are paying for it it's not like they're stealing it from people with diabetes. They wanna use it for whatever they're doing. That's fine. I will say I get irked a little bit when we have people, god bless them, without diabetes that try a CGM just to see what it's like, and they'll come back and say, like, oh, I learned so much.
Speaker 1:Like, I realized that my blood sugars, like, really spike after, you know, I eat my cereal in the morning. I'm like, boo freaking who? You know?
Speaker 2:Up to a 120 milligrams per deciliter.
Speaker 1:Rocketed up to 118 and, like, you know, like, oh, man. That Well,
Speaker 2:there's a good friend, of ours, Jeremy of mine. His name is Phil Sutherland, and he runs a company called SuperSapiens. He also, is in charge of the Novo Nordisk cycling team of all type 1 athletes. And, they used CGM to help extreme athletes like Jeremy and myself Mhmm. Know when to fuel Yep.
Speaker 2:And improve their performance. And they apparently had 3 athletes in the Winter Olympics, that used the Supersapiens device to train. So that is ongoing, and they're gonna transition to helping people with prediabetes. And that makes sense because you can really change your behavior, looking at the data from the CGM. So, yeah, as long as there's not a shortage, you know, let's not talk about Ozempic and and people hoarding that.
Speaker 2:That's a whole different category.
Speaker 1:Stop talking about those losers without diabetes. Let's get back to the real topic here. So CGM's important. There's options. Yeah.
Speaker 1:So let's go into now these hybrid closed loop systems and you'll hear AID for automated insulin delivery or hybrid closed loop. It always means these kind of these systems that are starting to automate insulin delivery based on what your CGM is saying. And there's really 4 devices that we have now that these really kind of come out in the last couple years, you know? So it started with Tandem. We're gonna go through these 1 by 1, but Tandem Control IQ, then we have the Omnipod 5, then we had the eyelet, and now we have the new, Medtronic 780 g.
Speaker 1:And they all have their advantages and disadvantages. And we should kind of say that off the top that people like, it's maybe one of the number one questions I get. What's the best pump? And that's about a 45 minute answer because they all do a good job in controlling your blood sugars. So it becomes less about what's best for my blood sugars and more about, you know, how does it interface with my phone or not?
Speaker 1:Do I want to have tubing or not? More of kind of these quality of life types of things and less about the blood sugars. And I think that's good news. It's just that they're all doing really well and you just gotta you have choices.
Speaker 2:Yeah. And I I would say as, as someone that is in clinic seeing patients like both you, David and Jeremy, that it has changed clinic 500%. So, you know, I had clinic this past Tuesday. I had residents there in training, and every single patient was on a hybrid closed loop. Every single patient had time and range well above 70, and very importantly, very little lows.
Speaker 2:And in the olden days, when you guys were fellows, we see a type one with a good a one c. They had tons of lows. And it it is really, to the outside observer, pretty boring. You know, we talk about their favorite Peloton instructor and what their family's doing. I've seen these patients for a long time.
Speaker 2:But you have to admit, it has really improved the care of people with type 1.
Speaker 1:Mhmm. I mean, because any difficult patient, you just send to me, and you just see all of the the easy peasy ones. So maybe, David, talk talk about the Tandem and specifically with, like, a note on, you know, why somebody might choose this. What are some of the advantages you think of that particular system?
Speaker 3:Yeah. The Control IQ algorithm, which powers, the tandem pump, it's, it there are a couple benefits that are unique to it. So first off is it does give auto correction boluses, whereas some of the other systems do not. And, so, what happens is every hour, it will give you if it detects that you're running high and projects that you're gonna be too high, it will give 60% of a calculated correction bolus. And, and I think that can be really, really helpful for people that tend to struggle with carb counting or making sure they're taking enough insulin or just people that forget to bolus, because that happens all the time.
Speaker 3:And, so, I think that's really nice. Kind of along those lines, it also is the most straightforward algorithm, in the sense that they're pretty public about how it thinks and how it works. So if you're the type of person who likes to do little things around the edges, like take Afrezza on top or, you know, do shots in addition. There are kind of ways you can tweak the algorithm a little bit or kind of work around the edges, like I said, to to to get tighter control. So those are the things that I I like about it.
Speaker 3:Also, it it's the only pump that has, currently, that has smartphone bolus capabilities. So you can actually give yourself mealtime or correction boluses using your smartphone. Now Omnipod should have that really shortly, but as of today, only available on tandem. Mhmm.
Speaker 2:And it holds 300 units. Mhmm. And I know you, Jeremy, you like the touchscreen part of it as well. Yeah.
Speaker 1:I like the rapid bolus button, the silver button that you can use to do kind of a rapid bolus that many people don't actually know about, but they find that really easy. And we mentioned it integrates with multiple CGMs, which is nice. You mentioned that the cell phone and so a good option, but tell us about the Mobi, which is another Tandem product. And so how is that a a spin on the how are they different?
Speaker 3:Yeah. So it's really exciting. The the Mobi just came out, or it's just available now. And it's essentially what I call, like, the Tandem Mini. Right?
Speaker 3:So if you think back to the iPhone Mini or the iPad Nano or whatever, it's basically a really tiny version of a tandem pump. There's no screen, and it's a it's about the size of maybe, like, an AirPods case. And, and it's fully controlled by a smartphone. There is a silver quick bonus feature button, so you'll like that, Jeremy. And it's so small that you can actually wear it on the body.
Speaker 3:So it there's an option where you can get an an adhesive sleeve that it can slide into and just be worn directly on the body. It does have tubing, but it's very short. There's a 6 inch, tubing set that you can use as an option. So for people that do like to keep it on the body, or maybe like in a bra or something like that, you can still kind of have it with very little tubing. And, and it kind of has close to a tubeless feeling to it.
Speaker 3:So it's kind of like the more mobile version or the more, maybe sporty version, hence the name Tandem Mobi.
Speaker 1:So if you don't already know, TCOID is guided by the belief free to everyone around the world, and it always will be. If you wanna help us continue to educate and motivate people living with diabetes and their loved ones, please consider liking, sharing, commenting, or subscribing to our content wherever you may find it, including our website, tcod.org. Thanks so much.
Speaker 2:Yeah. I have one quick question, and you may never even had this question in your life. But for people listening, how would you define the word algorithm? Because we use that word a lot, and some folks may not know what that is.
Speaker 3:So an algorithm is a word that, yeah, I think we people use it a lot these days. But it basically is the programming that the engineers have put in to help, you know, the brain behind these systems make decisions. So in the end, all these systems are doing is essentially running a program or a calculation, you know, frequently. Right? Every minute, it might be looking at your CGM and projecting where your blood sugar is gonna be.
Speaker 3:And what it decides to do in response is programmed in by the developers. And so that algorithm is basically dictating how it responds and how it decides to give you more insulin, less insulin, and so on and so forth.
Speaker 1:Yeah. I was just gonna add to that where we're at in terms of what these systems can do. And, again, getting back to people saying what is better. We really don't have any, like, head to head trials of these systems to get approved. All these systems have shown their system versus, you know, a CGM alone with a pump, like, you know, that they're not communicating.
Speaker 1:And in general, these these systems can improve people's a one c's by, you know, 0.4, 0.5 percent, meaning going from 7.5 to 7 and and reduce their their time in the the hypoglycemic range. And that's important context to know. A lot of people will still think, well, just put me on the system and, like, I don't have to do anything. You still have to interact with these systems. They can still definitely help, but this isn't like, you know, diabetes has been cured by by any, you know, stretch of the imagination.
Speaker 1:So being realistic with your expectations, knowing what you're getting into is helpful. And knowing that compared to not being on these systems, they all do make your blood sugars better. But we don't know which of these algorithms per se is kind of the best.
Speaker 2:Yeah. What someone said to me once, you know, who has the best algorithm? I have no clue.
Speaker 1:Yeah.
Speaker 2:And, you know, it's it's very private information for the most part. But if you look at the studies that David and Jeremy and I see at national meetings and journals, it it comes down to they put a group of people on these devices. They look at their time and range beforehand and their time below range, and, of course, the a one c. But it it comes down to time and range and time below range. And these all these systems seem to get people 70% or higher
Speaker 1:Mhmm.
Speaker 2:Depending on the population, the duration of the study, the different algorithm. And, remember, the goal is above 70%. Mhmm. And one thing I said on the on the live program that's that's on our website now is that, you know, these systems all work well, but 20% of that, 30% of your success is based on you. You know, do are you eating the right foods?
Speaker 2:Are you reading the right amounts? Are you counting the right carbs or inputting the right amount of data? Are you taking your insulin early? Are you are you doing your settings correctly? You know, you know, exercise settings so you're avoiding the highs and the lows.
Speaker 2:So, you know, it as Jeremy said, you know, it we all have to learn our the system that we picked.
Speaker 1:Alright. So Tandem has their kind of their original one with the, you know, kind of traditional tubed pump. And then the Mobi, which is more like a patch pump, which brings us to the Omnipod, the Omnipod 5. So tell us what that pump is and some of the advantages.
Speaker 3:The Omnipod 5 is is, you know, the best known tubeless option. It is, up until the Moby, really the only patch pump option on the market. It holds 200 units because it's born on body, so it holds a little bit less insulin than the tandem, the the full size tandem. And it introduced its version of automated insulin delivery in the Omnipod 5. This is an algorithm that, does microboluses, meaning when it detects your running high, it gives you a little bit more insulin.
Speaker 3:It ramps up the basal rate, essentially, fairly aggressively to help bring you back down into target range. And, I think people really love it. Kind of its biggest claim to fame, really, is the fact that it's tubeless. And it's waterproof so you can or water resistant so you can go swimming with it. You can take it to the beach, and it's very popular.
Speaker 2:Yeah. Well, yeah, the it's interesting that, all these algorithms are different. And I know the Omnipod relies on heavily on how much insulin you're using in the last 5 days, but heavily weighted on the last 1 or 2 days. And that's very important on how aggressive the algorithm is. So it's constantly learning you how much insulin you need, and also there are other settings that are extremely important.
Speaker 2:So, yeah, every pod itself has the little microchip in the computer in it. It seems like a shame you gotta throw it out every every 80 hours, which is 3 days plus 8 hours. But it's a different form factor. It doesn't hold as much as you said. Yeah.
Speaker 2:And you have to control it with a a device that is like a defunct Android phone, but soon it'll be, you know, hooked up to the iPhone.
Speaker 1:Well, that that is important. Maybe we could talk about that now, these settings that people will say, well, if it's always adjusting my basal rate or giving me these micro, you know, boluses, Do I have to put in a basal rate? Do I have to put in a card ratio sensitivity factor? How do you explain that, David? Or do you just kinda wait until somebody picks a pump and then go through that or what?
Speaker 3:Yeah. I think each each system does require a little bit of a different approach. So it does kind of originate, I think, from where, a patient starts in terms of their pump. But I think a lot of it also depends on their making sure their baseline settings are right. Right?
Speaker 3:You wanna have a decent sense of what your true basal requirement is. You wanna have a decent sense of what your carb ratio and correction factor is on pen therapy, because that serves as a really good anchor point and starting point. Now you may may tweak it. You may make your CAR ratios or sensitivity factors more aggressive, especially on Omnipod 5. That tends to help.
Speaker 3:But I think, oftentimes, a lot of patients don't even know what their baseline basal rate is and it really helps to have have some understanding of what your baseline settings are.
Speaker 2:Yeah. That's a great point because when someone transitions to a pump, the best thing to do for them first is to get them well adjusted on their multiple daily injection regimen. Make sure on the right basal and the bolus. And I know with the the 780 g, when I tried it, giving them the total insulin that I would use per day on average was extremely important on a way to get going on the system.
Speaker 1:Alright. So marching through Omnipod, you know, tubeless, great for people, different reasons, people in the water, like, whatever. And it's just nice not to have tubing. Next, we have the eyelet, which is probably the most different in terms of the algorithm, I suppose. We keep using that word now.
Speaker 1:So, David, tell us about what the eyelet is and what it does.
Speaker 3:Right. The eyelet is kind of the most by design, it requires the least amount of input. So even for the, you know, physician or trainer, setting it up, really, the only variable you can adjust is the weight. You just put in a patient's body weight to start. No total daily dose.
Speaker 3:No carb ratio. No basal rates. So it just makes things extremely simple. And for patients then, when they're dosing, that same simplistic philosophy applies. Because instead of dosing and using a bolus calculator where they put in their carbs, all they do is announce their meals.
Speaker 3:They say, I'm eating breakfast. I'm eating lunch.
Speaker 2:Out loud? Out loud?
Speaker 3:No. Through the through the nice touch screen.
Speaker 2:Bullhorn. I'm eating a big meal.
Speaker 3:So, you know, you just announce whether you're eating the meal, and you can say, I'm eating a bigger dinner than normal, a lighter dinner than normal. But that's it. And so it and even if you wanted to, you can't even do correction boluses. And even if your doctor wanted to, there's no settings to change. So in a way, it's like this black box, but it that that can be such a great strength because, you know, so many people with diabetes are struggling with burnout or they can't carb count or they, you know, they get over anxious.
Speaker 3:And so sometimes not being able to control things and taking away all the levers can help.
Speaker 1:Mhmm.
Speaker 3:But that also is maybe its downside is that some people may miss those levers or kind of wanna have those options.
Speaker 1:Yeah. This, generally, we found is is for the person that, yeah, wants to be as hand off hands off as possible, doesn't wanna, you know, tweak things. For all these systems, they tend to do the best when you're honest with them, and the iLet, I think, is is a it's particularly important for it because the only thing you can really do, is announce meals. So sometimes people will have a tendency of my blood sugar's 220, I'm just gonna tell I'm eating to get more insulin to bring me down. But then that messes up everything because it, you know, thinks that you're really sensitive to insulin because it sees you kind of, you know, crashing and you haven't actually eaten, and then you're kind of, you know, trying to play catch up.
Speaker 1:So the more that you can just, you know, for all these systems, enter your your meal or your carbs and then kind of let it do its thing as much as possible. It tends to do better, but that takes, you know, patience and it can be, you know, frustrating. So just something to keep in mind too.
Speaker 2:It's like it's like having a partner. Always be honest because this your relationship will work better. But just to give the listeners an idea of the settings that people have to think about on hybrid closed loop systems other than the islet. You ready for this? Your basal rate, your carbohydrate to insulin ratio, insulin sensitivity factor or correction factor, your target glucose, duration of insulin action, and the glucose safety threshold value.
Speaker 2:Those and there's probably more. So these are all settings that could take the time of a 2 or 3 podcasts that people need to know about their system that will help improve their performance and their time and range.
Speaker 1:Mhmm. So, yeah, islet is a is a really good option. Something that, you know, is is still fairly new. We found in our like I mentioned before, we did the clinical trials that the people that did best going onto the islet tended to be people coming from multiple daily injections. The people coming from hybrid closed loop systems already kind of missed, in general, like, the ability to change basal rates or carb ratios, which is funny.
Speaker 1:Right? Because as somebody with type 1, I'm constantly complaining about all the crap we have to do. But then if somebody told me I couldn't do that, I would be a little frustrated. You know?
Speaker 2:So can't do a correction bonus. Yeah. You'd say, jeez. That's not good. Right?
Speaker 2:Because we're so used to saying, I'm high. I wanna correct it.
Speaker 1:Yeah.
Speaker 2:But I've heard with the eyelet, you just gotta be a little patient, and it will bring you down.
Speaker 1:Exactly. Alright. So 4th and, final, do you wanna tell us maybe, Steve, tell us about the Medtronic because you just
Speaker 2:did a little trial. Well, I'll give you the whole history in 30 seconds. They came out with the 6 70 g in in 2019, I believe it was. 2016. Yeah.
Speaker 2:Earlier than that. First hybrid closed loop, it had lots of issues. Sensor wasn't accurate. You had to calibrate 2 to 4 times a day, and a lot of people did not like it. But kudos to them.
Speaker 2:And then they developed different iterations of the 6 70 6 770. But we wanna talk about the 780 g, which is now approved in over a 100 countries and available in the US. And, I'll let you jump in there in a second, David. But I did try it for 3 weeks, and it kept me in range, very impressively.
Speaker 1:I think they gotta change their their naming system. Like, all of a sudden, just call it, like, the tomahawk. You know? Like like, 6 I mean, come on. 780?
Speaker 1:It gets confusing. But, anyways, 7 80 g is where we're at.
Speaker 2:Okay. The tomahawk. That's a big stake that you're supposed to share with someone at Ruth Chris. Yeah. And, you know, I I being an Omnipod user, I was I'm used to the easy form factor.
Speaker 2:But besides all the tubing and the infusion sets and that, that you would use with any tube pump, it did keep me in range. It had aggressive autobolises, modulating basal rate. And I I would say that during exercise, it kept me in range. I it just puts you at a a higher target, although I did set it early. And very impressively for me, it was able to keep my blood sugars down after eating, because I do have gastroparesis, and it just kept I noticed that one of the downloads I was looking at all night long after a large pasta dinner, it was just cranking away auto bolus more frequently than every hour.
Speaker 2:And it kept me in range, and my time in range was well over 80%. And I tried not to, like, try extra hard. I tried to just live life normally. The sensor is the biggest difference. The it's called the generation 4, and it lasted 7 days, required one calibration when you started up, but no other calibrations on subsequent sensors.
Speaker 2:And so it was, I would say, as you mentioned earlier, Jeremy, they they seem to have come back, and they're trying to get a better reputation for their products, And it's based on their sensor. And I think, David, you have a few things to say about what's coming from Europe in maybe 1 or 2 years, their newer sensor.
Speaker 3:Yeah. So I agree. I've heard great things about it. I think, you know, the loyalists that have stuck by Medtronic this whole time, I think their patience has been rewarded, and it's a really good system.
Speaker 2:All 2 of them.
Speaker 3:And, but the biggest limitation right now is the Guardian 4 sensor. It's just it has the same form factor as the previous Guardian 3 even though the technology of that around it is much better. There's 0 calib 0 calibration system. It's more accurate. But I think what, you know, will really move the needle is when they get which is their next generation CGM approved in the United States.
Speaker 3:It is approved now in Europe, but it's a much more traditional form factor. To the naked eye, it just looks like a like a Libre 2 or a Dexcom G7. And I think that will really help, bring Medtronic, you know, their sensor technology up to par. Although, it does still have a 2 hour warm up and a only a 7 day wear period.
Speaker 2:We are we are so spoiled. Oh my god.
Speaker 1:Yeah. So I think, you know, if you're out there listening and you're thinking, you know, maybe I wanna try one of these systems or maybe I'm thinking about, you know, switching, how on earth am I going to decide? Well, it's important to keep in mind that, you know, most of these systems have like a trial period. It's usually about a month and that's, you know, supposed to be risk free. So if you do try, let's say, the Tandem, you don't like it, turn it back in, try something else.
Speaker 1:Don't feel like you have to stick with it because then you can get locked into some of these, you know, warranty programs and it can make it more difficult to try to switch if you do it later. So, you know, it's great to have all these options, but we're getting to the point where it can be a little overwhelming.
Speaker 2:Yeah. And I think you're right, Jeremy. I mean, you will not know if it's really for you until you try it.
Speaker 1:Mhmm.
Speaker 2:So that's a great point. I know David mentioned earlier, some of these companies have free trial periods. And, yeah, I know you're you're gonna be trying the 780 g, and we're both gonna try the eyelet. And, you know, I'm I'm not a tubing guy, but I did enjoy my experience, trying the other pumps. I tried the Tandem.
Speaker 2:I liked it very much. And, you know, it it also helps us providers as living with type 1, give a little bit more information to our patients if you've tried it. Yeah. So, David, have you tried them? And you put I hope you didn't put saline in yours and say that you really tried it.
Speaker 3:I did back when I was a fellow. And, yeah. You know, obviously, I'm not gonna share war stories because my stories are, you know, minimal compared to you guys. But I will say I was very surprised by how annoying going to the bathroom was, you know, pulling down your pants. And, also, when lying down and sleeping, you feel like a, you know, a dog on a walk with the leash wrapped around your stomach.
Speaker 3:So that was really eye opening and gave me just a glimpse of what people with type 1 diabetes are going through, but a small glimpse because I didn't have to deal with the blood sugars. Right? So yeah. But I I think to your point, I think, it's really I would even say for many of you, you you know, the natural recommendation would be talk with your endo, talk with your doctor about it. But now there are so many other resources available.
Speaker 3:Social media has really good people. You can follow, learn people's experience. TCOID has a bunch of material. So, you know, you may, unfortunately, know more about some of the newer technologies than your doctor. Hopefully, you don't and you have a good endo who stays up to date, but maybe you don't.
Speaker 3:And, you know, really advocate for yourself because there really are good resources available online.
Speaker 1:I was just gonna say, you know, thanks, David. That's so important. That, you know, I will try the 780 g soon. And then after that, I will try basically every system out there. And people always say, you know, doctor Pettis, what pump are you on?
Speaker 1:And I kinda hesitate to answer because I don't want them to think that that's the best one. But right now, I'm actually on shots. I'm not on one of these systems. And there's, you know, a number of reasons for that. I just felt like I needed a pump break.
Speaker 1:I was worried about some kind of absorption issues. And I'll go back on one of these systems. But I'm just making this point because, you know, if you're doing well on whatever you're doing, God bless you. You know, there's all these options out there. We just want you to know about them.
Speaker 1:But even if you're on shots and you're doing fine, I think sometimes type ones get browbeaten like, oh, you're not on like one of these systems. You have to. You're a bad diabetic. It's all about personal choice preference, how to make this crappy disease a little bit easier, really.
Speaker 2:Yeah. Yeah. And and, David, you know, in closing, you said one of the most important things is you have to be
Speaker 1:your own advocate. Why why did David say that? I thought that's that's an important stuff. I thought Well, you're whining
Speaker 3:I'm the gas.
Speaker 2:Shots, and you're and you're feeling guilty about it. Well, you know what? I said that because David, you know, said, you have to be your own advocate.
Speaker 1:Mhmm.
Speaker 2:And that's one of the premises of TCOIDs. You know, you gotta be smart, be persistent, and you are your own best advocate.
Speaker 1:Mhmm.
Speaker 2:So, that's that's a great way to end.
Speaker 1:Well, any closing thoughts, David, or things you wanna leave people with?
Speaker 3:I mean, I I feel like the theme is really choice and empowerment. So, yeah, I I think that was kind of the whole theme. So I don't have any profound closing thoughts. Just, yeah, be your own advocate, do your research, and, try things out. You really don't know until you try it.
Speaker 1:Well, Steve always says every day that you're his favorite fellow. So I'm just glad to, you know, have you here, and you guys can be reunited.
Speaker 3:Thanks for having me.
Speaker 1:All right. Thanks for listening everybody. Be sure to like us, subscribe, share with your friends. Again, we do this completely for free. So we rely on you to spread the good word of what we're doing here at TCOID.
Speaker 1:So thanks for listening.
Speaker 2:Thanks, everybody. Thanks, David.
Speaker 3:Thanks for having me.
