Insulin Pump Buying Guide 2024

An insulin pump is a device for people living with diabetes that eliminates the need to inject insulin by hand using a needle.

Insulin pumps are about the size of a deck of cards, attach to your body via tube or pod, and deliver insulin under the surface of the skin (subcutaneously). Insulin pumps help to relieve the burden of diabetes management by replacing the need to give many injections throughout the day.

Insulin pumps have been available for over 15 years, but have become more valuable and popular in recent years because the technology has continued to advance.

There are four insulin pumps available on the market in Canada:

• Medtronic 780G
• Omnipod DASH
• Tandem t:slim X2 with Control IQ
• Ypsomed Ypsopump

Two of these pumps – Medtronic and Tandem – are able to automate insulin delivery and reduce the burden of managing blood sugars in target ranges by talking to a continuous glucose monitor. These ‘automated insulin delivery (AID) systems’ adjust insulin delivery rates based on what current blood sugars are and what they are predicted to be in the near future, taking into consideration how much insulin has already been given.

CGMs are an important tool that work alongside insulin pumps to help inform the pump – either automatically or through your own calculations – what actions to take.

Continuous glucose monitors like Dexcom’s G6 and G7, Freestyle’s Libre 2 and Medtronic’s Guardian sensors help to reduce the burden of diabetes management by providing ‘real-time’ information about how things like foods, exercise and stress affect blood sugars without having to poke your fingers all day to get a reading.

The sensors have a flexible filament that sits just below the surface of the skin and measures blood sugars every 1 to 5 minutes. CGMs use a transmitter that sends blood sugar readings to a smartphone or insulin pump using Bluetooth transmission that does not require internet (or wi-fi).

Insulin pumps work by delivering insulin to the body on frequent basis through an infusion set attached to the skin, usually on the belly, lower back, thigh or back of arm.

With an insulin pump, long-acting insulin is no longer needed; instead the pump delivers frequent, small doses of fast-acting insulin in response to the individuals needs and activities.

When eating meals or snacks, the pump user enters in a current blood sugar reading (not required with pumps that integrate with a CGM) and the amount of carbs being eaten. The pump then calculates the amount of insulin required based on settings programmed into the pump (e.g., basal rates, carb ratios, correction factor), and administers it automatically.

Insulin pumps have a changeable reservoir, cartridge or pod that contains enough insulin for a few days use. These need to be filled and maintained by the user who purchases and stores the insulin at home in vials.

Infusion sets come in a variety of sizes and configurations that suit different body types, skin types and preferences. Like CGM sensors, infusion sets are stickers that have a flexible cannula or tube that is inserted just under the surface of the skin. Insulin from the reservoirs or cartridges in the pump flows through the cannula of the infusion site into the body. Depending which pump you use and what kind of infusion set you choose, the infusion sets and reservoirs/cartridges need to be changed every 2-3 days with the exception of extended wear sites from certain brands that last 7 days.

Continuous glucose monitors like Dexcom’s G6 and G7, Freestyle’s Libre 2 and Medtronic’s Guardian sensors help to reduce the burden of diabetes management by providing ‘real-time’ information about how things like foods, exercise and stress affect blood sugars without having to poke your fingers all day to get a reading.

The sensors have a flexible filament that sits just below the surface of the skin and measures blood sugars every 1 to 5 minutes. CGMs use a transmitter that sends blood sugar readings to a smartphone or insulin pump using Bluetooth transmission that does not require internet (or wi-fi).

One of the most interesting and emerging aspects of an insulin pump is the potential for automation. In other words, the ability for a CGM and a pump to connect and automate the dosing of insulin in response to your real-time blood sugar readings.

There are two paths to setting up a looping system: one is Health Canada approved, and one is not. Please remember that this document is meant for informational purposes only and we strongly recommend you speak to a healthcare professional before undertaking steps to setting up a looped insulin pump for yourself or others.

A Hybrid Closed Loop (HCL) system – sometimes referred to as an artificial pancreas or automated insulin delivery (AID) – uses an insulin pump with a continuous glucose monitor or sensor and an algorithm programmed into the insulin pump to help manage blood sugars. This HCL/AID algorithm continually calculates and recalculates how much insulin you need every 5 minutes based on readings from a sensor. These systems will automatically deliver more or less insulin depending on current and predicted blood sugar levels, taking into account insulin already delivered (e.g., insulin on board).

When you use an HCL/AID pump, you still need to enter carbohydrates to bolus for meals and snacks like you would with any other pump, but HCL/AID pumps will continue to adjust your background basal rate and provide auto-corrections to help keep blood sugars in target range more effectively between meals, during exercise and while you sleep.

There are currently two approved HCL/AID systems available in Canada – Medtronic 780G and Tandem t:slim with Control IQ. Making the switch to a hybrid closed loop pump takes some getting used to, but most often significantly reduces the burden of diabetes management and leads to quite a jump in time-in-range.

The Loop App or OpenAPS (artificial pancreas system) is a do-it-yourself automated insulin delivery application that you build and load on an iPhone or Android smartphone. It was developed by a group of highly engaged members of the T1D community who were motivated to build an “artificial pancreas” solution faster than government entities were willing to move.

Similar to using one of the two approved systems currently available, DIY looping automates insulin delivery based on personal settings (e.g., basal rates, carb ratios, correction factor), sensor data, insulin on board (IOB) and carb counts entered. Loop then uses this information to calculate an insulin dose that will bring your blood sugar within a set target range.

• In Closed Loop mode, Loop will automatically control insulin dosing.
• When using Open Loop mode, Loop recommends insulin that you manually accept or modify.

The main differences between HCL and DIY Loop is the level of customization, aggressiveness of targets and the fact that it is not approved for therapy by any government organization. Anyone choosing to build their own DIY Loop app must be willing to take full responsibility for building and running this system; doing so at your own risk.

DIY Looping is currently possible with Omnipod or with older, out-of-warranty versions of the Medtronic pump. Setting up a DIY loop can be a complicated process, and requires extensive research and some technical know-how.

Diabetes Canada recently published a detailed position statement on DIY Looping, which offers an in-depth summary of the risks and benefits as well as perspectives from patients and healthcare practitioners alike.

Insulin pumps can make life with diabetes easier, but they’re not for everyone. Insulin pump therapy is available for children, adults and older adults on insulin with Type 1 or Type 2 diabetes. Talking to your healthcare team (e.g., endocrinologist, nurse, diabetes educator) may help you determine whether a pump is right for you. Doing your own research is also important to make sure you are making a choice that will support your lifestyle.

You may want to consider using an insulin pump if you:

• experience high variability in blood sugar readings
• are unable to meet targets with multiple daily injections (MDI)
• experience delays in food absorption (gastroparesis)
• want to adjust/pause insulin doses when exercising
• have or have had severe reactions to low blood sugar
• have diabetes and are planning a pregnancy
• want to reduce number of daily injections
• want to enjoy an increase in quality of life

‍

Managing diabetes with an insulin pump requires the person living with diabetes to:

• be comfortable with technology
• change infusion sites and refill cartridges or reservoirs that hold the insulin every 2-3 days
• to monitor blood sugars frequently throughout the day; either by finger poke or continuous glucose monitor (CGM)
• enter carbohydrate counts for all meals and snacks
• commit to attending follow-up appointments with an endocrinologist or diabetes educator 3-4 times per year

‍

Some of the benefits of using an insulin pump include:

• only using fast-acting insulin (long-acting insulin is no longer necessary when using an insulin pump)
• lower total daily dose of insulin and help with preventing insulin stacking (when you give frequent bolus corrections in a short amount of time)
• a lot less poking; using infusion sites cuts down on up to 17 extra injections over a three-day period
• more precise insulin doses and delivery based on personalized basal rates, carb ratios, and correction factors
• bolus calculator to help with calculations (you must enter carbs for meals/snacks)
• more flexibility for food choices, portion sizes and timing of meals
• easier to manage planned and unexpected events and/or physical activity
• automation between meal boluses to prevent lows, reduce highs and increase time-in-range
• convenient – integrates well with lifestyle and improved quality of life and sense of wellbeing
• reduced burden of diabetes management

‍

You may not enjoy using a pump if you:

• need more than 100 units of insulin per day
• have a reaction or allergy to adhesives
• are not able to access a continuous glucose monitor (CGM)
• don’t like having things stuck or connected to you
• are intimidated by technology or feel overwhelmed with the process of learning the features and functions of an insulin pump
• are expecting a ‘magic pill’ – the pump will not ‘do diabetes for you’
• experience impaired vision, hearing or dexterity

Most endocrinologists (doctors who specialize in diabetes) in Canada are supported by a Diabetes Education Program (DEP). Diabetes educators working with the DEPs can help people with diabetes to determine eligibility for insulin pumps. Criteria for eligibility includes:

• being enrolled or eligible for provincial healthcare coverage (e.g., OHIP)
• being diagnosed with type 1 diabetes
• being under the care of a physician or nurse practitioner for diabetes management
• completing a pre-insulin pump information session / insulin pump therapy education modules
• Standard of care: attending at least one assessment every three months with their diabetes educator

Coverage for an insulin pump varies depending on the province you reside in. Most provinces have a financial assistance program that covers some – but not all – of the cost of using an insulin pump. Each program has different eligibility rules and requirements, but if you have type 1 diabetes there’s a good chance you will qualify.

Coverage requirements and amounts can change from time-to-time, so we encourage you to review the coverage and eligibility details directly on the official website. You’ll find the links here:

British Columbia (BC)

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

New Brunswick

Nova Scotia

Prince Edward Island (PEI)

Newfoundland and Labrador

Northwest Territories

Yukon

Nunavut

The Medtronic 780G is a customizable tubed insulin pump that is great for people who are looking for a combination of automation and improved glucose control. It is one of two insulin pumps available in the Canadian market that is approved for Hybrid Closed-Loop Automated Insulin Delivery. The Medtronic 780G’s distinguishing feature is its market-leading automation algorithm which acts faster than other pumps to correct glucose levels.

The Medtronic 780G currently only pairs with the Guardian 4 CGM, which requires finger-prick calibration to enter SmartGuard (activate automation).

Disclaimer: pricing is indicative and is subject to change. For real-time information on pricing, assistance programs and offers please contact the providers directly.

Control Unit: $2,994

Monthly Supplies: $225 -$275 through Endor Health

Paired CGM: $385 per 35 days for the Guardian 3 CGM through Endor Health, direct billed to insurance

• Powerful looping algorithm acts quickly to correct high glucose, resulting in market-leading time-in-range numbers
• Real-time CGM data displayed on the colour screen control unit
• Glucometer integration
• Bluetooth connectivity (no internet required)
• Others can view data (parents, caregivers)
• Approved for age 2 years and up
• Updates available as software download

• Control unit is slightly larger than other tubed pump options
• Can only pair with the Medtronic Guardian 3 or 4 CGM
• No remote bolus option
• Menu navigation on the pump can seem overly complex, with many button steps and confirmations required
• Manual process to upload pump data to share with your healthcare practitioner (Carelink / Tidepool)

The Omnipod DASH is the only tubeless pump option available in the Canadian market. Going tubeless has a lot of appeal for folks who are highly active or who value the simplicity and discretion that comes with a pod.

Omnipod Dash does not currently offer Hybrid Closed-Loop functionality that is approved by Health Canada, so Omnipod comes with a trade-off when it come to insulin automation. However it is a trade-of many people are willing to make because of the overall experience going tubeless represents.

Disclaimer: pricing is indicative and is subject to change. For real-time information on pricing, assistance programs and offers please contact the providers directly.

Control Unit: $6,300

Monthly Supplies: $300 per month

Paired CGM: No paired CGM, user can choose any sensor to use alongside

• Omnipod is the only waterproof pump, so is often favored by children and those with active lifestyles
• Omnipod tends to be the most discreet system visually given the small size, lack of tubes and contained nature of the device
• No tubing means less waste
• Auto-insertion functionality minimizes application errors and kinked cannulas
• Glucometer integration
• The PDM has a large colour screen
• The simplicity of the pod system means less supplies to pack when travelling

• The pods can be a bit bulky to wear, and adhesive is often required for the pod to stick a full three days
• No Health Canada-approved integration with CGM
• Cannot deliver bolus insulin without carrying a PDM, which feels like having a 2nd phone.
• Pods have to be changed every 3 days with no flexibility to extend
• Max reservoir holds only 200u of insulin, and the minimum fill is 80u
• Insulin On Board is not displayed in bolus calculation
• Lack of options of where to purchase the pods

The Tandem t:slim X2 is a tubed pump that comes packed with customization and automation features. This pump is a great option for those who want to adopt a Hybrid Closed-Loop system paired with the popular Dexcom G6 CGM. The t:slim control unit is smaller than the competition and has a large touchscreen. The Tandem t:slim HCL algorithm will match the responsiveness of as the Medtronic 780G when optimized, performs very well to improve time-in-range and achieves strong results for its customers. The Tandem t:slim with Control-IQ pairs with the Dexcom G6 CGM, with plans of sending out a software update before the end of the year to integrate with the new Dexcom G7 CGM.

Disclaimer: pricing is indicative and is subject to change. For real-time information on pricing, assistance programs and offers please contact the providers directly.

Control Unit: ~$6,300

Monthly Supplies: $225 -$275 per month

Paired CGM: $329 per month for the Dexcom G6 through Endor Health, direct billed to insurance

• Tandem’s t:slim is the smallest pump with a colour touch screen.
• The menus are easy to navigate and the screen shows all the information you need to know at a quick glance.
• Paired with the Dexcom G6, not having to poke fingers or calibrate the CGM is a major bonus
• The automation increases glucose time-in-range almost immediately and the sleep schedule feature relieves a lot of anxiety of dropping low while sleeping

• Must unlock screen to perform any functions
• No remote bolus option
• Tubing connector can snag on clothing
• May require extra time to update profile settings because basal, bolus and correction factor are in same time slot
• Does not link to a glucose meter
• Priming the pump requires 10.2 units of insulin, and the process can’t be interrupted
• Users report that the cartridge fill process is quite involved and takes a while to get used to

The Ypsopump is a solid tubed pump option for those looking for basic functionality. Its adoption lags behind other tubed pump options from Tandem and Medtronic, with the primary differentiator being that Ypsopump does not connect to a CGM or offer the advanced automation features of its competitors.

Disclaimer: pricing is indicative and is subject to change. For real-time information on pricing, assistance programs and offers please contact the providers directly.

Control Unit: $6,400

Monthly Supplies: $220 per month

Paired CGM: No paired CGM, user can choose any sensor to use alongside it

• The pump is small in size with touch screen and large, easy to see menu icons.
• The self-filled glass reservoirs are easy to fill, easy to use, last longer (up to 7 days) and can hold any insulin.
• The Ypsomed Orbit infusion sets are easy to insert

• No CGM integration or insulin delivery automation
• Icon-based menu requires the user to memorize which icons represent which settings
• Company representation in Canada is behind its competitors

All pumps: 

• Have a bolus calculator (except Ypsomed, which uses an app to calculate boluses)
• Allow for multiple basal rates, temporary basal rates and multiple basal patterns
• Have advanced bolus features
• Keep track of insulin on board (IOB)

‍