 Hello insulin users today we are going to talk about tandem control IQ versus metronic 670G. I am Dr. Ergen I'm an under chronologist and I have a huge under chronologist practice and we have a lot of patients on these pumps and I consult them every day about the differences and which pump is the best way to go. So if you guys have used insulin pumps before you will know that there have been a lot of developments in this area. So you may have been using basal IQ with tandem or you may have been using 630G, 640G with metronic. Now they had something called a threshold suspend to prevent a low blood sugar. Now we have closed loop system that actually also help you to prevent high blood sugars. So as you can see here metronic 670G and tandem. They have their own sensors for metronic and for the tandem they are partnering with DEXCOM G6. Now today we are going to summarize important clinical features of these two pumps and that way you can make the best decision. Now remember when you get a pump you're practically stuck with that pump for a long time so you better like your pump and if you don't it will be difficult or at least costly to upgrade or change your pump to a different brand. Now we are going to summarize today how these pumps really operate and how can it be better for you in terms of different features because they're totally differently engineered. The purpose is the same however once you hear the differences you will appreciate the benefit of each pump pertinent to you. So the first one is we are going to talk about how these pumps actually suspend the the insulin delivery when your blood sugar is about to go low. Secondly we are going to talk about what is modifiable and what is fixed in those insulin pumps and I'll explain to you what I mean by modifiable and fixed and thirdly we are going to talk about when does the pump kick you out from the closed loop system and then we will talk about what is a closed loop system and open loop system in a minute but these are the headlines for you that we will go over. So the fourth point we are going to talk about some educational points that you really need to be aware of when you are wearing those pumps and that's also true for clinicians who are watching this if they are treating patients with insulin pumps. Lastly we are going to talk about the sensor differences between the metronic and tandem control IQ. Okay guys tune in and we will go over one by one. Okay let's talk about how these pumps really calculate the automated insulin delivery. Now there are major differences guys. Number one they're both closed loop systems but how they are different we'll talk about now. So basically what happens is the metronic insulin pump adjusts your basal insulin delivery based on the last two to six days. So your pump actually learns from the last couple days of your basal insulin delivery and will continue to adjust your basal insulin based on a set threshold of blood sugar. So basically the pump is trying to keep you at 120 blood sugar and it adjusts every five minutes by increasing or decreasing the basal insulin delivery to try to keep you at 120 milligram per deciliter. Now on the other hand metronic pump does not give you an automatic correction bolus. So as a result it only adjusts your insulin and your threshold is set at 120. Now this can be modifiable which we will talk later but on the other hand patients cannot really manually correct when their blood sugars are high. Now let's look at the tandem insulin pump which uses the Dexcom G6 sensor and normally your doctor your endocrinologist will set up your pump just like they do for the metronic one but pump can also start working immediately if you put your total weight and if you put your total daily insulin use and insulin pump will start from somewhere to start giving you insulin. Now the difference from metronic pump is that as you can see on the screen here it maintains or tries to maintain your blood sugar between 112.5 and 160. So as long as your blood sugars are between 112.5 and 160 your pump really does not adjust your already set basal rate. Now of course both pumps give you insulin based on a predicted blood sugar in the future not only the blood sugar currently. So that is the benefit of closed lip systems that when your insulin changes you actually see the result you know later not immediately. So as a result making changes for the future blood sugars really make a difference. Now as we said the metronic pump is set at 120 the tandem pump is set at between 112.5 and 160 and this is modifiable in certain settings which we'll talk about but primarily if you're using tandem pump that's what you're set up it's what your pump is trying to keep you at between 112 and 160. Now what happens is that there are multiple different layers of blood sugar goals and thresholds here and your tandem pump will act accordingly. So what happens is that if you if your tandem pump thinks that your your blood sugar is going to be less than 112.5 in 30 minutes it starts reducing your basal dose and if it starts going down below 70 if it thinks that you are going to be below 70 very soon then actually totally shuts off your basal insulin. Now the same thing happens with metronic and with the metronic though it shuts off basically whatever the low thresholds that you set anytime you're 20 above that as a safety feature your insulin will go down or will shut off and the good thing about metronic pump though if you want to change your your low setting your low glucose threshold you can change it anywhere from 50 to 90. On the other hand with the tandem pump it is actually cannot be modifiable and it's only at 70 and tandem pump predicts or the dexcom predicts actually that you're going to be below 70 then your pump will be shut off. In the metronic again it shuts off when it is 20 above so you can actually basically make your pump shut off if you set your low threshold all the way up to 90 your pump will actually shut the insulin off at 110. So you have to be careful about that because if you set that way you may end up with high blood sugars in metronic pump setting sometimes if you do not set it right. So these are the important features now the tandem also will give you you know more insulin if you if it predicts that your blood sugar is going to be more than 160 versus that happens with more than 120 with metronic pump so the metronic pumps tries to keep you a more of a narrow range right around 120. How successful that is that's that's debatable but the goal in the metronic pump is basically your your blood sugar to be 120. Now with the tandem pump unless you're 160 you are not going to get more insulin or predicted blood sugar has to be more than 160. Now if you are though the good thing about tandem pump that is not present in the metronic pump is that you actually get a bolus dose if your blood sugar is predicted to be more than 180 which metronic pump does not do. Why is it important to get a bolus because bolus is as you can understand from the name it's a big chunk of insulin that is given to try to bring you down fast however when you do basal adjustments only the reaction is a lot slower. So if you guys are driving German cars you will you will see that there's a sport mode sport plus mode when you change it your car suddenly gets the speed. So bolus is like that when you give the bolus suddenly your insulin goes up and and then your blood sugar can come down quite fast and most of the time that's what you want you don't want to stay at 200 for two three hours before you come down you want to bring it down very fast without crashing of course. So the good thing about these closed loop systems they can give you a bolus with with tandem not with metronic but with tandem you can get a bolus and if your blood sugar is predicted to go too low then it's going to shut the insulin off so it's not necessarily a dangerous thing and then tandem pumps are designed very carefully considering the safety so I think that's a good plus feature that you are getting a bolus if you didn't bolus right let's say you gave a bolus for your carbs which is required for any pump closed pump open pump doesn't matter for any system you still have to give a bolus in this case if you are giving a bolus but your blood sugar is gonna go to more than 200 anyways the tandem pump will be able to give you that extra push-off insulin that will keep you within your goal. Alright so with that being said we are going to move to the second point which is what is really modifiable in your pump. So when we talk about what is modifiable if you know what pumps and if you guys are really hands-on with your pump or at least you have an idea about what is an insulin carb ratio what is sensitivity what is basal rates what is active insulin time you should be able to differentiate and I will tell you clinical pearls in terms of why these modifiable factors can actually be important. So let's talk about insulin carb ratio that is modifiable in both pumps and I'm glad that is because everybody's insulin sensitivity is different and insulin carb ratio has to be set by the colonization and the patient together so as a result I think it's good that both pumps metronic and the tandem allows you to modify the insulin carb ratio now when it comes to sensitivity factor in metronic you cannot really adjust your sensitivity because basically metronic pumps are almost using like artificial intelligence to understand what your sensitivity is to insulin and your basal rates are all not changeable so sensitivity factor is not changeable when metronic versus in tandem pump that is definitely modifiable and I think I favor that better so that you have better control now basal rates also is not modifiable in metronic 670G system on the other hand in tandem that is also modifiable so your colonization will set your basal rates in both systems metronic will operate in the already present system that is set by your colonization your endocrinologist if you're not in the order mode which is closed loop system so if you are in the order mode on the other hand the pump will calculate your basal requirement based on the last two to six days of your insulin use now that is not totally outside your hand or your colonization hand because bottom line it is still using your preset insulin settings but if you're in if your metronic pump thinks that you're actually basal rate is not enough based on the sensor readings for example you go to bed and your blood sugar is 120 and you end up waking up with 180 blood sugar then your pump will realize that actually your basal rate is not enough at bedtime and if it keeps happening every night then your metronic pump will think that you actually need more basal insulin at night so as a result when you're in a closed loop system while monitoring your blood sugars at the same time your metronic will be able to adjust your basal rates based on the learned basal rates by the pump so as a result the pump basically takes full control of your basal insulin delivery with the metronic