Australian Insulin Pump Choices
April 2021 update
Here’s the latest run-down. The structure of this article has subtly changed from previous versions, and there is a bunch of updated data in here.
There are currently 6 pumps that can be purchased new through private health insurance:
There are also some older pumps in use, such as:
As usual I’ll run through them all with brief descriptions. Then I’ll mention other pumps we’re aware of which are not available at this point. Including at least one we’re expecting this year!
A note about “closed-loop” systems referred to below: those are systems which use your CGM data to dynamically adjust your pump’s delivery of insulin. These are not the mythical complete “artificial pancreas” replacement, but they do add a lot of automation to help you manage your diabetes. For information about the open protocol closed-loop systems, see my separate page on the Australian options.
The hurdles for pumps to be sold in Australia
For new pumps to be available in Australia, the first hurdle they need to pass is registration with the Therapeutic Goods Administration (TGA), after which doctors and suppliers are legally allowed to talk about them.
The next hurdle is generally getting listing on the Federal Department of Health’s Prostheses List so they’re eligible for supply by health insurance. The Prostheses List was last updated in March 2021. The next updates are expected in July and November.
Pumps available new in Australia
The following pumps are available new. Usually they’re bought through private health insurance, where they’re classified as prosthetic devices. Not all private health policies cover 100% of the cost: check with your own insurer as to coverage. But if they cover “insulin pumps” then they’ll cover all of these.
This pump is a relatively old design, but it has proven itself as a reliable performer over the years. The Combo system is comprised of a “Spirit Combo” pump along with a “Performa Combo” BG meter which is used as a remote control so the pump doesn’t have to be brought out of your pocket in normal use.
Mind you, that Performa Combo does insist on a fresh fingerprick for each bolus decision. Although when used with AndroidAPS the meter is replaced by a Bluetooth connection to your phone so the meter’s no longer required.
The Spirit Combo can hold up to 315U of insulin, and the basal rates can be set to 0.01 U/hr increments in 1-hour blocks.
The pump has a luer-lock connection for its infusion sets, so the currently-available (through NDSS) sets it can be used with are:
- Accu-Chek FlexLink (teflon)
- Accu-Chek Rapid-D (steel)
- Accu-Chek TenderLink (teflon)
- Medtronic Silhouette (only 17mm version, but same as TenderLink)
- Medtronic Sure-T (steel)
- Medtronic Quick-set (teflon)
- Orbit soft (teflon), micro (steel)
- Cleo 90 (teflon)
The Spirit Combo has an IPX8 waterproof rating. Some people do take it swimming, although the manual’s official advice is quite conservative:
Avoid contact with water. Check daily that your Accu-Chek Spirit Combo insulin pump is not chipped, cracked or damaged in any way, and that the battery cover and the adapter are correctly closed. If the pump is chipped or cracked, water, dust, insulin, or other substances may enter your pump and lead to malfunction. Before any contact with water, disconnect and take off your pump.
Disconnect and remove your pump before taking a bath, or going into a whirlpool, shower, or swimming pool. Avoid exposing your pump to high humidity, such as in a sauna, as this could result in damage.
I have spent years using the Combo. It’s been a very reliable pump for me. I’ve always taken the cautious line that I take the pump off before head into water, but have faith that it will probably survive if I fall overboard when working around water.
The Combo can be used with the AndroidAPS closed-loop system. This is not actively supported by Accu-Chek, but I’m sure most of Accu-Chek’s sales today are due to this compatibility.
This tubeless patch pump has multiple components, starting with a cannula patch onto which the pump clips. The cannula is 90˚ teflon with two length options. There’s a disposable 200U reservoir (which includes the battery for the pump body).
The pump body nominally lasts 4 months. The Aviva Solo handset has an integrated BG meter (although you can enter corrections using a BG value you’ve retrieved from another meter or CGM). Because the pump body lasts for 4 months, when you buy the pump each year you will receive three bodies. Plus if it’s the first year you’ll receive a handset.
The Solo has buttons each side, which can be pressed together in patterns to administer simple boluses even without the handset.
The 9mm and 6mm teflon cannulas, and 200U reservoirs (with battery) are available through NDSS.
The Solo pump is not waterproof: you are expected to remove it (leaving the cannula patch in place) for swimming and showers. This is primarily because the battery has to use a “zinc-air” chemistry to get enough capacity, and without access to air the battery stops working. There’s a small vent on the outside of the pump, that if you covered with tape would kill the pump.
The pump’s ingress-protection rating is only IP22.
The Solo is not currently compatible with any closed-loop system.
Tandem t:slim X2
This pump is a small pump with a touchscreen interface. The aluminium case is very robust, and gives it a slight heft in your hand. The internal battery is recharged by USB (typically topped up at least every few days).
The insulin reservoir can hold up to 300U. The basal rate can be set with a tiny increment of 0.001 U/hr in 16 arbitrary time blocks. However, the minimum basal rate is 0.100 U/hr (or 0), and this can cause issues for some paediatric use as this minimum also applies to temporary basal rates.
Note that even if your basal rate is 0.6 U/hr, that minimum 0.1 still applies to any temp basal. Thus the lowest TBR you’d be able to apply would be 17%. Not 10%. If your basal rate was 0.3 U/hr you’d only be able to drop to 34%.
Note that Apidra insulin is not compatible with the Tandem reservoirs (it’s not officially listed for pump use in Australia, but is sometimes used in other pumps). Apidra fails catastrophically in this pump.
Fiasp is officially not supported in the t:slim either, although some people apparently do use it successfully.
The Tandem reservoirs are compatible only with the Tandem t:lock infusion sets. The older reservoirs that could be used with any luer-lock infusion set have been discontinued. The Tandem infusion sets are:
- VariSoft 30 (teflon: same as Medtronic Silhouette, Accu-Chek TenderLink)
- AutoSoft 30 (teflon)
- AutoSoft 90 (teflon: same as Medtronic Mio, YpsoPump Inset)
- TruSteel (steel: same as Medtronic Sure-T)
These are all available through NDSS.
The t:slim X2 is rated as IP67 waterproof, which is not quite as robust as the IPX8 rating of most other current pumps. See this article for a discussion of waterproof ratings. Mind you, the IP67 rating does still allow for short-term immersion in water up to a metre deep.
A touted feature of this pump is the ability to update its firmware at home via USB without having to have the whole pump replaced/serviced, and this has already been used to add features to the pump at no direct cost during its 4-year warranty period. Yes, “free” upgrades (although there may be costs involved in getting doctors to sign off on it).
Apart from any minor updates, there are three major revisions we’re aware of:
1. Dexcom G5
The initial version of the pump acted as a Dexcom G5 CGM receiver. This seems to be the version that resulted in the December 2020-April 2021 suspension of its TGA registration. This version is no longer available new. And once you update your pump to a later version, you cannot go back.
This version changed the CGM to use the Dexcom G6, and won’t connect to G5. It uses this to not just auto-populate the bolus advisor as with G5, but also to implement low-glucose suspend.
This is the version of the firmware currently supplied with the t:slim X2. It was released in the US in August 2018, so there’s a lot of user experience with it online already. The firmware was updated apparently in response to the TGA suspension.
Basal-IQ suspends basal deliveries if your BG is below 3.9 mmol/L, or predicted to go below 4.4 mmol/L within 30 minutes, and should resume when it knows you’re coming back up. If it’s been suspended for 2 hours then it will resume for 30 minutes.
This is the next version, that at the time of writing isn’t quite here yet. It received TGA approval in late 2020, and over the last few months AMSL have been training staff and diabetes educators in its use. So we should expect it to be rolled out at some point soon.
Control-IQ implements a closed-loop system where the pump not only decreases insulin supply (not the brute-force suspend used by Basal-IQ) if you’re heading low, but also increases it if you’re running high. It still needs you to manage it, but it does a lot of the moment-to-moment decision making for us.
It also links to the t:connect phone app via Bluetooth, allowing viewing and uploading of pump data (but not yet control of the pump) without getting the pump out of your pocket. That should hopefully become available in Australia at about the same time as Control-IQ.
Control-IQ was released in the US at the end of 2019, so again there’s a lot of user experience with it online.
The t:slim X2 pump is not compatible with any external closed-loop system. Obviously Control-IQ is its own closed-loop system.
The YpsoPump (from Ypsomed) is a tiny unit which links to the Mylife app on your phone via Bluetooth. Currently the app has a one-way connection: it needs the user to use the pump’s touchscreen to issue boluses, but does most of the the rest of the management and connection from the phone (including carb/bolus calculations).
The first of Ypsomed’s major upgrades is supposed to be rolling out any day now. Mylife Assist integrates their phone app with the Dexcom G6 CGM. In fact it communicates with the G6 independently of the usual Dexcom G6 app.
We’re told to expect the Mylife Dose upgrade in mid-2021. It will allow us to bolus directly from the app without needing to lay a hand on the pump. To support this in-warranty pumps will be exchanged for versions with new firmware.
Ypsomed are also developing the Mylife Loop system in conjunction with TypeZero (now part of Dexcom) and a date of 2023 has been mentioned. TypeZero are the company behind the algorithm in Tandem’s Control-IQ closed-loop system.
The reservoir holds up to 160U of insulin, and the basal rates can be set to 0.01 U/hr increments in 1-hour blocks. The pump uses three types of infusion set:
- Orbit soft (teflon)
- Orbit micro (steel)
- YpsoPump Inset (same as Medtronic Mio, Tandem AutoSoft 90, and Animas Inset II)
A 2018 article on this site talks about the Orbit infusion sets.
The reservoir is smaller than in some other pumps, although 160U is enough for many people’s requirements. But the reservoirs are quick and easy to swap in, so I think the 160U limit is unlikely to be a problem for many people.
Plus the reservoirs are glass (unlike the plastic of other pumps) and as such are approved for longer-term insulin storage. The tested and approved use includes the ability to pre-fill reservoirs and keep them in your fridge for up to 4 weeks.
All these are available through NDSS.
The YpsoPump is rated at IPX8 (the manual describes “immersion to a depth of 1m for up to 60 minutes”, and says that “for water sports that cannot comply with these specifications (e.g. diving)” we should disconnect.
The YpsoPump cannot currently be used with any external closed-loop system.
The Medtronic 770G is a development from the earlier 670G. It runs a closed-loop algorithm using the Medtronic CGM to try to control both highs and lows.
The looping algorithm is the same as the 670G, with the same fixed 6.7 mmol/L target. But it will be software-upgradeable to the enhanced algorithms of the 780G pump which is in use in Europe.
Note that while the 770G promises to be upgradeable, there are conflicting reports from Medtronic as to whether the upgrades will be free or not (unlike with the Tandem pump).
The 770G does have a few extra features over the 670G, such as:
The CGM uses the same Guardian3 sensors, but a new transmitter which uses Bluetooth (like the older Guardian Connect transmitters, but not apparently not identical).
It has Bluetooth integrated into the pump. This is used to link the pump to your mobile phone (with the CareLink app uploading to Medtronic’s cloud servers). No longer do we have to choose to either have the CGM connected to the phone or to the pump. We finally get to see it on both!
The CGM is managed by the pump though, which then reports the results to the phone. This is different to the way the Dexcom CGMs can talk to pump and phone independently.
The pumps are shipped with Accu-Chek Guide BG meters (instead of the Contour Next Link 2.4). These will apparently eventually be replaced with Accu-Chek Guide Link meters which are intended to connect to the pump via Bluetooth. The plain Guide meters will link to the MySugr app on phones.
The 770G can use either 300U or 180U reservoirs. Although the manuals only mention the 3ml reservoirs, the 1.8ml ones are still available through NDSS (and are required for some of the older Paradigm pumps).
The infusion sets are common across all the Medtronic pumps in this list. The available sets are:
- Mio (teflon: same as Tandem AutoSoft 90, YpsoPump Inset)
- Sure-T (steel: same as Tandem TruSteel)
- Silhouette (teflon: same as Tandem VariSoft 30, Accu-Chek TenderLink)
- Quick-set (teflon)
The 770G is described as coming from the factory as waterproof, able to be underwater to a depth of 3.6m for up to 24 hours. This is still IPX8. It’s the same rating as the older 640G and 670G pumps, and in fact the design of the pump body is unchanged.
However the manual does note that the waterproofing can be compromised by bumps/scratches and especially cracks in the pump. Many people over the years have reported their Medtronic pumps drowning due to cracks they hadn’t noticed before they got wet. So user beware!
The 770G cannot be used with any external closed-loop system, but it has its own hybrid closed-loop system built-in.
This pump originally integrated with Medtronic’s Guardian2 Link CGM, but also supports the Guardian3 Link that was introduced with the 670G.
However, it’s mainly used these days without CGM. Medtronic is pushing new customers who will use CGM towards the 770G.
If a 640G does have CGM connected, it can use that data for “SmartGuard” which is their predictive-low-glucose-suspend (sometimes referred to as a “hypo minimiser”).
The pump is supplied with a “Contour Next Link 2.4” BG meter, which links wirelessly (not using Bluetooth) to the pump.
The reservoir and consumables are the same as the 770G.
The 640G has the same waterproofing as the 770G/670G/etc.
The 640G is not compatible with any closed-loop system.
Official info: Medtronic
Other pumps in use in Australia
While not available new, the following pumps are still in use by many people.
The 670G pump was Medtronic’s first closed-loop system. The pump acts as the receiver for the Guardian3 Link CGM, which it needs for the closed-loop functionality.
The pump is supplied with the same linked BG meter as the 640G. The meter, pump, and CGM sensors communicate via a radio protocol which is not Bluetooth.
The Guardian3 CGM has sensors that last for 7 days, and require calibration within every 12 hours.
The basal rates can be set to 0.025 U/hr increments in 30-minute blocks.
The reservoir and infusion sets are the same as the 770G, and are available through NDSS.
The 670G cannot be used with any external closed-loop system, but it has its own hybrid closed-loop system built-in.
With its CGM the 670G is able to have the same SmartGuard function as the 640G, as well as having “auto mode” which is their closed-loop system. Note that it is a first-generation looping system and lacks many of the configuration options and features of the open protocol loop systems (such as the inability to customise the target BG level) although it is approved by the regulators and available without you having to assemble it yourself.
Peer support (via Facebook): Medtronic 670g and 770g Support Group Australia
These were Medtronic’s earlier generation of pumps. The consumables (reservoirs and infusion sets) are still used with the current 770G.
The “Veo” 554 and 754 pumps were the last versions of these, but the earlier 522, 515, 722, and 715 look very similar.
The reservoir in the 554 can hold up to 180U of insulin, and the 754 can hold up to 300U (or use the 180U option). The basal rates can be set to 0.025 U/hr increments in 30-minute blocks.
The pumps support Medtronic’s old “Enlite” CGM system (uses the same sensors as the Guardian2 CGM, but a different “MiniLink” transmitter) and they have a primitive low-glucose-suspend function (which suspends when you get to the boundary point, not when the pump predicts you’re soon going to get there).
These pumps were originally rated with IP67 dust/waterproofing, but especially given their age I would not regard any of them as waterproof today.
The reservoir and infusion sets are the same as the Medtronic 770G, and are available through NDSS.
The latest firmware versions of these pumps are not compatible with any external closed-loop systems. Older versions with firmware up to 2.7A are “loopable” and supported by all three opensource closed-loop systems (OpenAPS, Loop, and AndroidAPS). As are many other older Paradigm models.
DANA R and RS
The DANA R and RS pumps look almost identical. The main differences are the R’s use of Bluetooth 2 rather than the lower-power Bluetooth LE of the RS, and a correspondingly-worse battery life (approximately a third of the lifespan).
The pumps have a 300U insulin reservoir, and basal rates can be set to 0.01 U/hr increments in 1-hour blocks.
They use DANA-specific infusion sets (including a teflon one made by Ypsomed and equivalent to the Orbit Soft set). The Orbit micro steel cannulae (available on NDSS without tubing) can be used with the DANA tubing if you need to use those. For a long time there has been talk of “Inset” infusion sets for the DANA, and these are now reaching the market in some parts of the world. We’re yet to see if they reach Australia.
The special batteries for the pump are supplied in each box of reservoirs. The supplier (Managing Diabetes) has ceased sales of the RS (apparently largely due to their exhorbitant costs for importing the special Lithium batteries in today’s economy) but is still supporting current users with consumables via NDSS.
The upcoming DANA-i (see below) looks like it will be their replacement product, but there’s no sign of it yet.
Both the R and RS pumps are supported by the AndroidAPS closed-loop system.
V-Go: a non-T1D pump
The V-Go is available in Australia, but is designed for use in Type 2 diabetes, not Type 1. It is a simple mechanical (spring-driven) device for 1-per-day use, with a fixed infusion rate. I have previously written about the V-Go.
Other insulin pumps
That’s it for the current Australian pump options, but there are some other pumps around the world which Australian folk keep asking about.
This is Medtronic’s touted next closed-loop pump. It’s still being trialled at some locations around the world, but in fact it’s hit the market in Europe. It apparently has Bluetooth for connecting to your phone, but the thing most people talk about is a more-advanced closed-loop algorithm than the 770G. The 770G pump seems to effectively be an early release of the hardware for it.
Some features include a new CGM which only needs calibration on the first day of a sensor, and a BG target adjustable between 5.6-6.7 mmol/L.
This is the next pump from SOOIL. It has TGA approval for supply in Australia, but did not reach the March 2021 update to the Prostheses List that controls which pumps will be funded by private health insurance.
It uses the same reservoirs and infusion sets as the DANA RS, but uses a standard AAA battery. It is a bit bigger and “chunkier” than the RS pump though. The pump does also have a few technical advances over the RS other than just a new battery, such as a new Bluetooth 5.0 module with increased range.
The DANA-i has apparently begun delivery to some customers in Europe and in NZ already, but it’s a waiting game for all the pieces to fall into place for Australia.
But note that the official position from AndroidAPS is that there are no plans to support the DANA-i at this point. SOOIL is focussing with this pump on supporting commercial loop providers rather than the opensource systems. In Europe this pump is supported by the commercial CamAPS FX looping system and by Diabeloop. But there’s no sign of these systems for Australia yet.
This tubeless patch pump is available in the US and Europe. It is planned to be launched in Australia in 2021.
Because it is the pump, reservoir, and infusion site all combined into one disposable unit, there are a few differences in operation from traditional pump.
The internal reservoir is filled with a syringe prior to insertion, and it auto-inserts a teflon cannula after application. There are no cannula options: it’s a very short 6.5mm cannula at an angle. But the pump can be worn during swimming/showering/etc. If the pump detaches, it can’t be re-attached. Every 3 days a whole new pump is required: the only permanent piece is the PDM (“Personal Diabetes Manager”) handset. Every month a new box of 10 pumps.
Errors occur at times with all pumps. With the OmniPod some can be resolved via the PDM, but some need to you remove the pump. In some error conditions the pump will alarm loudly, and the only recourse is to remove the pump and break the kill-switch panel (normally against your skin) with a nail/key/pin to silence it.
Unlike other pumps (including the Solo patch pump) there are no buttons on the pump itself. The only way to deliver insulin is using the PDM.
There have been two major versions: “Eros” and “DASH”. The difference between these is the computer chip and the radio used to talk to the handheld PDM.
The original Eros pumps used 433 MHz radio. These received TGA approval for Australia in 2012, but were never sold here. Mainly because the economic model simply hasn’t fit the pump funding model used in Australia. This would shift most of the cost from your health insurance (which normally funds pumps) to the NDSS which supplies pump consumables, and no-one was able to work out a compromise.
That TGA approval has now been dropped.
The newer pumps use Bluetooth to talk to the PDM (which is a locked-down Android device). These received TGA approval for Australia in 2020, and Insulet Australia Pty Ltd claims that the OmniPod will launch in Australia in 2021. How the funding model will work is unknown at this point, but apparently negotiations are underway.
When can you get it?
We don’t know.
Because funding arrangements are still being negotiated, no-one is able to talk about sales yet.
You can register your interest on a form at the OmniPod website. And this page will of course get updated when new information comes in.
I’m sure Insulet is hoping to get it into the July update to the Prostheses List. But the next update after that will be in November (which is still “2021”).
The Eros pods can be used with external closed-loop systems (Loop and AndroidAPS) using a RileyLink/EmaLink/OrangeLink radio bridge (these replace the PDM). But Eros will never be supplied in Australia.
As well as operating as a standalone pump, the DASH will be used by Insulet’s future Omnipod 5 closed-loop (which used to be called Horizon) as well as Tidepool’s future commercial closed-loop version of Loop. No sign of either of those for Australia yet.
This patch pump from Korea got some press in March 2019 when it got “Breakthrough Device” designation from the US FDA. It is apparently reaching the South Korean market now, but it’s a long way from other markets.
Apparently research and testing is continuing with a version that integrates a POCtech CGM sensor as well as infusion cannula into a single unit for closed-loop operations.
This pump is used in Europe, but not available here (although it was registered with the TGA back in 2015, as well as added to the Prostheses List). Like the other Accu-Chek pumps it has a remote handset/meter which links to it via Bluetooth.
The pump needs its own collection of Accu-Chek infusion sets (the end of the pump is actually part of the infusion set tubing).
It uses the same cartridges as the YpsoPump, but the pre-filled NovoRapid/Fiasp “PumpCart”s used for it in Europe are not yet available in Australia. Accu-Chek originally planned self-filled reservoirs for the Insight (and the menu asks you if you’re using self-filled or pre-filled) but the self-filled ones never reached production. The YpsoPump’s reservoirs can be used in the Insight (they are standard PumpCart format) but I’m sure Accu-Chek wouldn’t like you spending money on someone else’s consumables for their pump.
The Insight is supported by the AndroidAPS closed-loop software, as well as the commercial Diabeloop.
This tubeless patch pump from China has had TGA registration for some time, but does not seem to be on anyone’s marketing plans. Note the approval covers the pump itself, not their associated CGM system. Reports from overseas users characterise it as a relatively primitive device (especially its controller device).
Currently I do not expect to see the Medtrum reach the Australian market.
A patch pump from the Netherlands, Kaleido has a similar form factor to the now-defunct Cellnovo system, but also allows you to use longer tubing for flexibility in how you wear it. It’s the pump Diabeloop in France initially chose for their DBLG1 closed-loop system.
Currently I do not expect to see Kaleido reach Australia.
This is not an actual pump yet, just a planned product that occasionally gets mentioned online. All we’ve seen are various prototype mock-ups. Here one is shown alongside the t:slim X2.
It apparently has a traditional “piston style” reservoir holding 200U, and no screen. It’s built to be controlled from Tandem’s t:connect app via Bluetooth. It would have the Control-IQ loop software inside it, and talk to the Dexcom G6 CGM. It would use the same infusion sets as the t:slim, and presumably new options with super-short tubing will be introduced. It’s designed to be small enough to be stuck to your skin beside the infusion site (see the earlier image of the similar Kaleido pump).
The latest rumours are of Tandem possibly introducing this in the US in late 2021 or into 2022. After it finally appears in the US we’ll eventually find out if there are any plans for the rest of the world.
This is another not-an-actual-pump-yet. BetaBionics have been working for years on a “bionic pancreas” closed-loop system, and have conducted a number of trials in the US.
There have been two basic designs investigated: an insulin-only pump, and a “dual-hormone” (glucagon and insulin fed to two infusion sites). Insulin to push your BG down, and glucagon to bring it up: just like an actual pancreas.
BetaBionics did a lot of work with Zealand Pharma who developed dasiglucagon, an artificial glucagon which is stable in liquid form (unlike the regular glucagon in injection kits). Dasiglucagon has also recently reached the US market in a ready-to-inject emergency pen form.
Of course in the years all this dual-hormone development work has been going on, other single-hormone closed-loop systems have developed too. While iLet trial participants have commented about how easy the system is to use, I haven’t yet seen clinical results any better than achieved by today’s single-hormone systems.
There are no signs yet of when an iLet product might actually appear.
Terumo (a brand many people associate with syringes and needles) also has an insulin pump, but only within Japan.
The “MEDISAFE WITH” is a patch pump, and will be used with the Diabeloop closed-loop system.
I’m not aware of any plans for this pump outside Japan.
That’s it for now
But I’m sure this page will get updated in the coming months…