My t:slim Adventure by SugabeticMe

This November will mark my 4 year anniversary with the t:slim – and also will mean my pump will be out of warranty. I’m currently mulling over and deciding whether to stay with Tandem or to move on (and backwards) to another pump company.

I have honestly researched all of the pumps on the market for the US right now, and it just seems that going to another pump other than Omnipod would just be taking a step backward. MedT is out automatically because their pump has a proprietary CGM, and seeing as how I love for all of my reports to be in one place, they’re not a contender (currently). And, due to my insurance plan, I cannot afford the Omnipod pods on a monthly basis, so they’re also out.

I have deeply thought of Animas, but they seem to be stagnant in their design. And, hello, if I go with them, I’ll be getting a pump design that is almost 8+ years old. Not something I’m fond of doing, especially since the Vibe has been on the market for 5-6 years, integrated with G4 (though poorly integrated in my opinion) and by the time I can upgrade, the talks of the G6 will be in the works. They’re still on my radar, though, as I trust their pump. It’s a pain in the butt to upload and scroll, but it’s a good backup thought.

I’ve loved/hated having my t:slim over the last 3.5 years. It seems to be the one I keep going back to though simply because the convenience for both day-to-day and uploading is the easiest I’ve ever used by far. It seems my “issues” that I have come in the summer months though, so we’ll see how this year fairs out. If I can go through without any unexplainable events, then it will probably seal the deal for me.

I just hope and pray with all of my might that if I upgrade (to the one with newer software, not the one with G4 though), that it will last me a while without having to get replacements. I’m currently on my 6th t:Slim and I hope that the trend doesn’t continue if I stay with them. I like the company and I think they have a good thing going for them. But just like any product, it has it’s greatnesses and it’s weaknesses. It’s just deciding on whether the greatness outweighs (in my mind) the weaknesses I’ve experienced and have the potential of experiencing again.

Oh, to ponder the thoughts….. *sigh*

(sigh)

It finally happened.

After seeing posts from others and sharing with some how I hadn’t had any issues with my t:slim’s battery door and being in awe and wonder of how some people can go through them so fast, it happened.

It was like the pride of the possibility of either having an invincible charge port door or having the super ability to be unknowingly very careful was gone. Poof.

But, I digress. I’ve joined the ranks of those who have had to replace their charge port doors now.

Everything’s all good now though. I noticed the barely-hanging-on door Monday and called it in to Tandem, and they promptly sent me two complementary doors. You just pop the old one off and pop the new one on. Which, I have to say, the new ones look to be built sturdier, so hopefully they won’t wear has fast.

And so goes another day in this little adventure with my t:slim.

Hi guys!

I’m back! Sort of…

I’m copying over some posts from my Sugabetic.me site over to here in efforts to have sort of a “t:slim adventure diary” or sorts. Crazy, maybe, but hey. oh well, right?

So, bare with me for a bit.

-Sarah

I’m one who likes to take things apart and see how they work. I’ve done it with the Omnipod pods (both older and newer generation) and also the Asante Snap pump body. Granted, I haven’t done this with any other pump seeing as how they cost several thousands of dollars, but I am sure they are cool on the inside too.

Now, with the Tandem t:slim, I’ve been intrigued as to how the “micro-delivery” pump action works, since it’s different than other standard piston style pumps in that it doesn’t push from the bottom of the cartridge up, but rather a small bit is vacuumed into the mechanism to the bag and then pushed up into the tubing – a safety feature that allows you to only be subject to 0.3u of insulin at the time verses, say, 20-300u. So, true to form, I took a cartridge apart to see how it actually works. Granted, I’ve taken several apart just to see the bag on the inside, but never to actually see the mechanics of the pump itself. So, for those of you who are just as excited about this stuff as I am, here you go:

So, basically, there’s two little pieces at the end of the piston rod that when pushed in, push air or insulin into the tubing and the space between the two parts of the piston rod is eliminated. When the piston rod is pulled back, the space between the two parts fill with insulin as it is pulled apart and then the insulin is moved back into the area under the tubing to be pushed up into the tubing when the piston rod is pushed back again. It’s a rather genius idea. And the parts? They’re interlocked in a sort-of T pattern. How awesome? Now whether or not that is where they get the ” t: ” part in everything, I’m not sure, but I know that the one little piece looks very similar to the “T” button on the pump, which is just.freakin’.COOL… like, COOL doesn’t describe it… it’s WICKED AWESOMENESS.

Of course, if you want to see Tandem’s official video, you can go here.

I don’t know why this stuff excites me the way it does. To others, this may not be that cool and they’ll think I’m totally off my rocker, but this stuff, to me, is super awesome and gets me fired up. I like to know they how and why of things, not just that it is what it is. So, High-5, Tandem developer people. You’ve made this inner tech geek VERY happy. Of course, it would REALLY blow me away if I could see the inner workings of the pump, but you know.. I don’t want to ruin this $7k piece of life-saving beautifulness.

Since starting back on the t:slim, I wanted to make an effort to try to solve some of the “issues” I had with the system. Not that they’re major issues per se, but things that sort of bugged me.

The biggest thing was how it just didn’t seem to deliver insulin or, for whatever reason, didn’t seem to do well in heat. That, I think, was all attributed to those bad cartridges I had. Since changing out to new ones, I don’t have issues with unexplainable highs any longer. As far as my whacko BG’s, that seems to now be fixed, and I can joyously use the pump (knock on wood) with no problem.

My next thing was more of an annoyance, but it bugged me even still. Now, I have figured a work-around for it. It was the insulin level calculation. If you’re new to the t:slim, you will notice that if you fill it with, say, 250 units, the pump will only register 200 in the history section. If you fill your tubing and cannula, you’re likely to only need 18 units for that and then maybe a half-unit for cannula fill. That, coupled with that the pump automaticallyhides 20u, you’re still left with 10 units unaccounted for. Every time, I would assume that I should be showing 212u by the end of the process, but I would inevitably only show 200. That part bugged me to no end…. it seemed as if 10 units was going unaccounted for each time. So, what did I do? I figured out it’s calculations. The pump takes what you fill it with and subtracts 50u and then whatever you use or don’t use during prime/fill is just left as extra, apart from the 20u cushion. *NOTE: The following is NOT recommended by Tandem and I’m only telling you what *I* do, not what YOU should do. If you do, do it at your own risk.* So what did I do about it?? Since I want my pump to read 200u at the end of each fill, I put in 250u from the syringe. I let the pump start it’s prime and get it’s bubbles out, all the while, I have my Inset set turned upside down in the cap of the Inset top to catch extra drops. I continue to let it prime until it’s primed out 28u exactly. I have tried going to just 25u and it still registered 200. I went and let it fill all the way until the pump stopped (I think 29.8u is the automatic stop?) and then it registered less than 200, so for some reason 28u is the magic number. Now, the problem is, you have 10u of insulin that has pumped out into this Inset cap. You can either choose to discard it (which is what you would have done anyway if you had left it in the pump) OR (and again, this is NOT endorsed so if you do this, you are doing it at your own risk) you can draw it back up, and place it in an empty insulin bottle that you’ve removed as much as possible of the old insulin out of. This may not seem like much, but if you change your cartridge out every 3 days, by the end of the month, that’s 100u of insulin you can put into the pump and use at least 50 of. I wouldn’t recommend putting it back into the bottle you drew it out of initially just because it *may* have been contaminated going through the pump cartridge and tubing, but maybe keeping it in a separate bottle marked somehow could help you save on insulin. Granted, doing that may not be worth it, but if you’re tight on how much insulin you get per month, it may help. For me, I just let it fill to 28u to calm down my OCD brain. I haven’t yet tried saving the insulin yet, so I have NO idea if it will affect the insulin’s potency, though I can’t see how it would anymore make it contaminated than when you draw up air and put it into the bottle of insulin.

Speaking of priming, there’s a big thing about the bubbles. For me, I simply use insulin that has been out since it was opened. I never put it back in the fridge so I never have to worry about it warming up again. For me, this caused LOTS of champagne bubbles every single time. Now, I slowly draw it up, get rid of as many bubbles as possible, and when I fill the cartridge, I don’t just press the plunger in as fast as it will let me. This causes bubbles again. Think of it this way, as a visual representation. When you’re filling the syringe, if you get a bubble and press all of the insulin back into the bottle fast, you get a lot of bubbles in the vial, then it’s almost impossible to get the insulin back into the syringe without getting bubbles back. BUT, if you push the insulin back in slowly to get the bubble back into the bottle, more than likely you won’t get bubbly insulin in the vial thus getting bubbly insulin into the syringe when you pull back. Applying that same logic to filling the cartridge, filling it sloooow and steady reduces the amount of bubbles I get each time. I know this is crazy, but sing the birthday song if you’re filling it with 300u. Since filling it at about that rate, I’ve been able to reduce the amount of bubbles I get when priming.

My other pet-peeve that used to bug me (and still sort of does) was that the system does not reverse correct. If your BG is below your target but above 70mg/dL, the t:slim does not subtract out insulin from the bolus so that when your BG normalizes, you should return to your target. Instead, the calculation brings you back down to where you were. The problem with this is that it also does not subtract out IOB.So, say you’re 79 and with 1.2u IOB and you’re going to eat a 27g carb snack. You know that if you don’t subtract out that IOB, you more than likely will go low. I didn’t want to start doing this, but honestly, for the time being until they fix it, it makes the most sense. If you enter 69 as your mg/dL, it WILL subtract out the IOB and also subtract out a correction amount :

See the difference? If I had let it calculate based on just my BG of 79mg/dL, I would have been given a calculated bolus of 2.73u. However, by simply fibbing and saying my BG is 69 mg/dL, the pump corrected and suggested a dose of 0.9u. That’s a LOT less insulin to say 1u lowers my BG by 56 mg/dL, and if given the dose based off of my actual BG, that was 1.7u too much (approx).  So, as a suggestion, if you’re at risk for going low based on your IOB, enter a 69 mg/dL or whatever number that is close as possible under 70mg/dL that you’re comfortable with. Again, I don’t *like* doing this just because I can’t stand to have incorrect data in my records, but until they fix this, it’s really all you can do apart from doing your own math and changing the suggested amount (which I used to do, but now I’m too lazy and don’t care).

This is all I can think of right now, but it’s a lot in terms of how I’ve learned to live peaceably with my t:slim… okay… well, I’ve always LOVED it, just not everything about it. Keeping these things in mind help me get past what I don’t like about it and just simply see it for what I do like about it.

My endo appointment went well this morning. Although I won’t know my lab results until the end of the week, I did get more out of this appointment than I have in the past. He took more time to examine my numbers and look over my graphs and charts. He viewed my report from my retina specialist as well. He looked in my eyes an insanely long amount of time (okay, maybe not that long, but it seemed that way to me. From what he could tell, he couldn’t see any swelling, so I’m super happy about that. My appointment with the retina specialist is in a month, so we’ll know more then, but otherwise, he wants me to keep everything the same as nothing really seemed to need to be changed…. except my morning BG spikes, but those can be explained by the wonderful thing called PMS.

Now, we wait until the lab-work to come back. I’m anxious to see what my a1c is, and I also asked him to check my Vitamin D levels as well. I know I probably need to be on something anyway seeing as how I’m both diabetic AND have hypothyroidism, but I’m curious to see what it comes back at.

One thing we talked about was my t:slim pump. Back in October, he had taken me off of it for an “undetermined” amount of time due to the unexplained highs (which I now firmly believe were cartridge-lot-related). Then, when the eye thing happened and since I had been using it for a week prior, I stayed on it until I met with him today to look at my numbers. And as far as he sees, there is no reason why I have to stay off of it. In other words, I can continue to use it if I want to. In other words,

….there are no words. Just happy dancing.

Three weeks ago, I began what I thought would be just a break from my Minimed pump / CGM combo. I was constantly getting frustrated with CGM sensors not lasting the full 6 days (usually only about 4 days) and knowing that my records were going to be all messed up. I have to hand it to Medtronic though, they stuck it out with me the entire time and without hassle replaced boxes of sensors and even my serter. But with all of the trying and trying and trying, I just couldn’t get them to work. So, I wanted to take a break. Being overwhelmed with that and just everything else, I just didn’t feel like I could troubleshoot anymore. Now, I’m not saying their product isn’t good, because I know a LOT of people who use it and have had a lot of success too, but I’ve learned one thing – there is a lot of truth in the fact that not every device “fits” everyone, and no, they don’t all work the same. Thus, my theory that everyone should get to “date” pump systems before locking in needs to be a must. And I don’t mean just over the weekend. I mean like, for a whole month or two.  I just think with all the scar tissue I have and the sensitivity to the tape the Enlite has, it’s just not worth trying to make it work right now. So yes, in essence, it’s me, not them.

When I got frustrated, I switched back to using my Dexcom. Granted, it’s a pain in the butt to keep up with, but for me? The accuracy over the duration of wear time is much better. It wasn’t untileverything happened with my eye that I realized just how important it was. I’m not saying it is super accurate, but I’ve been able to depend on it more than the pump CGM, and right now that matters a heck of a lot more than whether it’s integrated or not. Plus, I have no tape rashes or burns from the Dexcom, so that’s a huge plus for me.

Also, at the time, I had a fling. No, not that kind of fling… a pump fling. Knowing how I am about wanting to switch up pumps between the Medtronic and my t:slim, I had actually planned on going through maybe two cartridges in my t:slim pump at the end of March. I don’t know if the battery works the same as most computer batteries, but with those, if you don’t use them, the batteries mess up, so every now and then I wanted to be able to use it so that just the lack of use didn’t mess up the battery. So, when the eye thing happened, I was on the t:slim. I was not having any issue at all with the pump like I had before, so I am not attributing what happened to that, but I am telling you that because when I spoke with my endo, he told me to “keep everything to the same” until I went for my appointment… which will be next week. So, for 3 weeks now, I’ve been using my t:slim pump. Much longer than I expected, but I have to say, I haven’t had the issues with random, uncontrollable highs that I did before. In fact, it’s been quite the opposite. My control has improved. I still wonder if the cartridges I had were affected by the recall, but that the lot numbers were too “young” to be considered in it (my lot numbers were in the 300′s, the recalls started in the 800′s). I’m not going to lie, I’m sort of hopeful that maybe that was the case and now the pump will work just fine.

And, as an update to the whole eye thing, I have good days and bad ones. For the most part, if I can keep my blood sugar as steady as possible and without any major swings (like, no arrows on the dex, and no BG’s above 180-200 for a period of time), my vision is pretty well clear. But if I have a period of time were my BG has run high for a while or if I have major swings (like when I went from 220′s to 70′s within an hour and a half), my eye is pretty well good for nothing for a while. It’s amazing me how things work and affect us all. If anything, this has taught me, as I said before, it’s not about what you use to control your diabetes, as long as you’re using it the best you can and doing the best you can.

Anyway, that’s sort of a rundown of what’s been going on. I know it’s probably confusing when I just throw stuff out there at random without any true point or purpose other than to just get stuff out of my head, but that’s sorta what I started blogging for anyway.