My ten year old son, diagnosed with type 1 diabetes six months ago, is doing pretty well on Lantus with Humalog, but he wants to go on the pump. We have been to a preliminary meeting and have looked at three different pumps briefly (Animas, Paradigm and Deltec Cozmo). Both the Paradigm and Deltec have blood glucose meters that transmit blood sugars directly to the pump. We are trying to determine the best way to go about choosing the best pump for us, and our doctor’s office has said all are good.

Their promotional videos were not helpful. Neither of the videos for the Paradigm or Deltec had information about their new pumps, so still feel in the dark. What are your recommendations as to how to research these pumps? How do we compare one to another? Are there any studies out on which ones have been most reliable? What other pumps are available?

The best way to compare the insulin pumps is to actually try them out using normal saline or insulin diluent (it stings less). Sometimes the pump companies will loan a pump to the patient or to the doctor to lend to patients to wear for a few days. You can also refer to the information on pumps available on this website.

Another way to compare pumps is to speak to a pump trainer or pump representative and ask them to point out the differences between the different brands of pumps comparing their brand to other brands. In the long run, it probably makes no difference and is best to go with the brand you doctor says gives the best patient support in your area.

TGL
Additional comments from Lois Schmidt Finney, diabetes dietitian:

Ask the pump reps if you speak to any families who have similar-aged children using that model of the pump or ask the pump rep if you can try one out for a month. They should be willing to let you do so. I think you would not go wrong with any of them. Which one does your child like the best since he will be the one wearing it?

LSF
Additional comments from Shirley Goodman, diabetes nurse specialist:

It looks like you are taking time and looking at your options for insulin pumps. In the United States, there are currently the three companies you have looked at plus another company out of Korea. Over the next year, there is likely to be at least one other company with distribution of pumps in the US.

In deciding on a pump, I would encourage you to look at the current feature each pump has, if there is any feature that you and your child would find most helpful since there are differences (e.g., the capacity of the reservoir of the Deltec is 300 units while the MiniMed 512 is 180 units of insulin or that the 512 is able to receive glucose values from a meter via radio-frequency now, but the Deltec infrared downloading meter/pump is not currently on the market), and if there is any financial difference for your family in the pump or its supplies.

I am unaware of any independent data that shows one pump to be superior to another. Both Deltec and MiniMed have informed their customers that they will provide upgrades in the pump system (sometimes at a cost). Additionally, with a 4four year warranty, many customers can anticipate that they will be able to submit to their insurance company in the near future (four years)for a new pump with the newer technology.

SG
Additional comments from Dr. David Schwartz:

I am sure clinicians have their biases about various pumps. I think I do, too, but please do not lose sight of the fact that an insulin pump, no matter the manufacturer, is simply a device to provide insulin. It is a sophisticated device and an expensive device, but simply a tool. It is important to recognize that it is not an “artificial pancreas.” Your son must still check blood glucoses and adjust insulin dosing based on his carb intake and perhaps make adjustments based on glucose levels. The principle behind “pumping” is the same as the plan you basal/bolus are using with his Lantus and insulin lispro Humalog. Indeed, some would argue that you are already (essentially) doing what a pump does. but at the cost of needles and syringes and insulin rather than paying $5500 for a pump.

That said, there really are few basic differences between the various pumps. The difference is in the “extras.” There is little basic difference between a Yugo and a Mercedes or a Suburban and a Corvette — all are tools to transport you over the road. But the differences are styles and extra features. If you work on a farm, a Corvette is of little use. If money is tight, a Yugo is very economical. You find the car that is right for you; you find the pump that is right for you. As you have probably seen, each pump has some features that are positive and some that are simply pretty darn cool. Having a pump that communicates with a meter is really cool, but you can manually enter the data and use a different meter. The new Paradigm and the Deltec Cozmo if not already can preprogram in “correction formulas” and insulin-to-carb ratios so that the pump can “suggest” insulin bolus adjustments, but the pumps do not simply give the suggested insulin. You must confirm or override. After all, the pump does not know that you are about to play tennis or ride a bike or take a test.

I like the Animas a lot. Solidly made. Very water tight. Easy to program. Can dose down to 1/20 of a unit of insulin. Such a good pump that Paradigm and Cozmo copied technology from Animas to upgrade and make their pumps. And then improved upon it. The very convenient thing about Cozmo and Paradigm is that they use regular batteries that you can buy anywhere; no special “electronics” batteries. The inconvenient thing about Paradigm is that it holds half as much insulin as the other pumps. For a smaller child not receiving a lot of insulin, that may not be an issue.

I prescribe all the pumps. My approach with my patients is that I introduce or explain pumping to them and review various features (both good and bad about each of the pumps using my biases, of course). The families then make a decision based on lifestyle issues. I know I did not make a decision for them.

I do hope that I unmuddied the water a bit. After all, you may be happy to just keep Lantus and Humalog. With that, a final anecdote: one of my nurses had a daughter with type�1 diabetes who was placed on an insulin pump by a former colleague. Her control was pretty good, but during the summer, she decided to go back to shots because of all the swimming she does. She loves being pumpless again. She found that when her glucoses were high, she not only worried about that and tried to correct it, she always had to confirm that the pump was working and potentially troubleshoot issues: battery; kinked tubing; other pump problem. Now with shots, if her glucose is high, she simply takes a correction shot. Done.

DS
Additional comments from Delaine M. Wright, Clinical Exercise Physiologist:

The Insulin Pumpers website at is one of my favorite resources for patients and families who are in the process of considering pump therapy. There you will find links to the websites of the most popular insulin pumps. The websites of each pump company should contain the most recent, detailed information about their latest models. The insulin-pumpers website will also connect you and your family to other parents whose children are pumping. Like your healthcare team, and as a pumper myself, I also agree – there are many great options for people and parents interested in pumping insulin. The important thing is that we do have a choice.

DMW
Additional comments from Dr. Larry Deeb:
For me it’s service. Who will replace a pump today when it breaks? Who will
go to a patient’s house tonight with a replacement? Who let a child “drown
a pump” at diabetes camp and brought him a replacement, arranged to have the
broken one repaired, etc. so he wouldn’t be without a pump? Those are the
questions.

LD
Additional comments from Dr. Alan Schorr:

The pumps available in the US are the Animas IR-1000, the Deltec Cozmo,
the Paradigm 511 and 512, the Medtronic 508 and Sooil company pump. The
Disetronic line is shut down for the next 12 months due to
FDA irregularities with their paperwork and operations. I would check the
various company websites and ask your physician to speak with
individuals who are using those pumps. There are no studies comparing the
various pumps.

The decision to use one pump over another is purely individual. The
features that you may like usually makes the decision. However, you should
look at the service that the company has provided in the area, the number
of clinical personnel available (not sales but individuals who are solely
in the region to help with clinical issues). Then I would ask to speak with
the various reps in the area. Most of them will come to you to discuss the
pump. I would realize that their job is to sell the item, but ask the
hard questions, make them answer the clinical issues, find out if
something goes wrong, the time frame that it will take to get a new pump.
If my pump fails, do I receive a new pump or a refurbished one? That is a
key issue.

All the companies will be upgrading their pumps within the next six months
and probably every one to two years thereafter. What is the policy
regarding upgrades? Can I get the new features? Is my pump waterproof or
just water-resistant.? How many complaints have there been regarding pump
failure, battery issues, length of battery life, leaking, FDA complaints,
etc.? All these things should be considered.

There are various data management systems at your disposal, and you might
not want the direct readings to the pump. The Cozmore, the Deltec
pump with the meter attached will not be available until early next year.
The Paradigm 512 is available now, but several of my patients have
indicated the meter may not be the greatest. However, they like the pump
itself.

There is a great deal of work involved but it will be rewarding as the pump
will be able to control his glucoses better than any conventional
regimen. Good luck and ask the hard questions. Whoever gives the answers
will generally get your business.

ABS