The bottom line here is all the cost cutting in the world cannot make up for COGS that are just too high. Given that Insulet's efforts to lower COGS are directly related to how many systems they sell, it would be foolhardy to cut costs too much particularly with their sales team. For the moment the company has yet to cut their sales team, however should COGS remain too high and sales don't increase to a level where COGS can be lowered some very interesting choices will need to be made.