Putting It Away

After this morning’s visit with my endocrinologist, we have decided to suspend my use of the t:slim insulin pump.

I’ve had a good run and a bad run with it, and it seems that maybe this pump is just not for me. I’ve had a lot of issues lately, some that were happening with the old pump that we thought were fixed by the replacement, and some new ones. As of the 7th of this month, I had started on MDI for a couple of days and then a couple of days later, I went back to my Medtronic pump, both with better results than the t:slim. I don’t want to say that the t:slim is a bad pump, because it apparently works great for some. But for me, it doesn’t and it’s just not a good fit right now. I hope that they are able to improve upon their design within the next couple of years, and maybe I’ll go back to it.

As of now, I’m following his orders and staying on the Medtronic Revel. Thank you to all who have followed me over the past couple of months. It’s been a joy to blog about my t:slim adventure for you.

A Few Things

I don’t want to have a blog of complaining, as many would probably think I’m doing, but there are a few things that I both like and dislike about the t:slim throughout my time of using it. These things come out of both just daily use of the pump itself and out of comparing it against other pumps that are out on the market.

Things I like:

Built-in “safety” mechanism whereby you are not exposed to the entire cartridge of insulin, but rather just 0.3 units.

Touch-screen makes for easy input.

Personal “profiles” instead of separate categories for each thing such as basal rate, bolus calculator information, etc. It’s all in one place. Not millions of other places.

It’s tiny. Doesn’t take up a lot of room.

Upload doesn’t require anything special other than a standard micro-usb cord.

You don’t have to upload to see a data-snapshot of how your week or month is going as far as insulin delivery is concerned.

 

 

Things I don’t like and wish could be changed:

The cartridge system. I do not like the “bag” idea as it seems to create more problem than it’s worth. If there were a way to create a better container that would act similar to how an insulin pen cartridge works, that would be better. (Maybe if there were, instead of a bag, a vial with a stopper inside of the cartridge container that would adjust to the amount of insulin? I’m no scientist, but I do believe this system could be improved upon.) It could still be a syringe-type cartridge (similar to how the Omnipod system works, and would be filled the same way as well), but without a piston rod pushing the insulin. The mechanism pulling the insulin out of the top would be similar to how we insert a needle into a vial to remove insulin now, but it would just remove 0.3 units at the time. I think this would cut down on a lot of the problem with the pump not calculating the correct amount of insulin in the pump as well.

Speaking of how the pump determines the amount of insulin, I don’t like it. While I see the need for it to subtract out 20 units for a “cushion”, that’s half of a days worth of insulin for me. Why not, instead, let us fill it, type in how much we put in (say, 200), and let it subtract off 10 units (leaving 190), and then let it subtract out just what we prime, and not another 20 units (thus if I prime out only 15 units, the pump would then show a total of 175 usable insulin units, not 160).

The “pig tail” connector. This thing is cool yet irritating. Bubbles get caught in this thing frequently either due to air in the cartridge bag being periodically pumped out or the connectors not being tightened enough. Problem is, I check my connectors frequently and somehow, they become loose. If there were come way to create a connection directly to the pump cartridge similar to how the makers of the Snap insulin pump have done, that would eliminate not only the pigtail but also keep the original idea of eliminating the bump connection on other pumps such as the Medtronic and Animas brand pumps.

Some have complained about feeling as if the pump doesn’t have consistent basal delivery. While I haven’t experienced this myself, I feel that for those who have, it could be an issue with the way the cartridge and pigtail connector are made. And, if air gets into the pigtail connector, it can affect delivery. So, please, find a way to fix that!

Confirmation screens. OMG, the confirmation screens. I really don’t see where all of these are needed. What if, similar to how a Quick bolus is deivered, instead of having tons of confirmation screens (yeah, like the “Dude, you’re above your target BG!” one? Duh, I know this already), why not, after plugging everything in and receivign the suggested amount, we just press and hold the “T” button for one second and let that take the place of the dozen “Are you SURE you want to deliver this bolus??” screens that are supposedly safety measures because it’s a touch screen pump and the FDA doesn’t want us butt-dialing doses. Pressing the “T” button would be a definite “YES, deliver my bolus” confirmation over a tap on the screen.

 

Bottom line? I like the pump. It’s keeping me alive, and does it rather simply. I just wish there were things I could change about it.

(And, as an additional wish out there… I wish I could just plug my meter into my pump and download every reading into it, so that if I look into the history of the pump for the Summary, you would also have BG averages and maybe even graphs in there as well. Sort of like a portable t:connect.)

Orientation

There are a number of things that I like/love about the t:slim. The orientation is not one of them. Just like most all pumps (except for the Omnipod PDM controller) are landscape oriented, meaning that it is longer than it is tall. While this is okay and probably will be super helpful once Dexcom integration is here, it just doesn’t help the pump sit comfortably in your hand for one-handed operation. Being a mom and everything else that I do, I usually have both hands busy with something, and if I can bolus single-handedly while being able to hold my crying kid, I consider that a huge win. I can usually bolus single-handed now, but I’m reading sideways. If the pump could be portrait oriented, it would be so much easier!! But, of course, this is just a wish. Doesn’t have to be a priority, but I would absolutely LOVE this!! (And once Dexcom is integrated, maybe let those screens be the only ones that are landscape?)

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Smurfing

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There’s a new Smurf… didn’t ya hear?

It’s Pumpa Smurf!

Nooo… not Papa Smurf….

PUMPa Smurf!

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Haha!

I love being able to mix and match the t:clip cases to fit whatever I want it to look like.

Where’s My Insulin?

This is probably going to be my number one complaint of the t:slim pump since my old number one complaint is being fixed soon. This is an issue that I doubt will ever change, though I wish it would.

Traditionally, when you fill an insulin pump reservoir, you fill it to about what you need, and the pump – when it loads the cartridge- will show relatively what you have placed into the pump. If you fill it to the 150u line, then typically, the pump will recognize about 160-140u in that cartridge (because they’re not exact and you are sort of eyeballing what you place into it). The t:slim is a bit different.

Upon loading the cartridge, the system removes any air that may be present in the cartrige. It then tells you to fill it. This is where it gets a bit wonky in the system. You yourself have, for instance, drawn up 200u of insulin for both priming (which it takes about 20u or more to do with the t:slim) and just use, but you also have to account for 20 to 30 units that becomes hidden in the pump. So. Let’s see. You’ve filled it with 200 usable units, but you’re only going to actually have access to about 150 of it after loading and priming.

This bothers the crap out of me. I already feel that it wastes a TON of insulin to prime, almost twice the amount, but to hide 20-30 units as well? I understand why they do it… as it was explained to me that since the system uses a bag, it’s similar to a ketchup bottle or a jelly packet… you can put 100% of whatever into it, but because of the nature of the container, you’ll never get 100% out. But we’re not talking about ketchup or jelly. We’re talking about expensive-as-heck insulin. We’re talking about enough insulin, that over the course of a month, is being thrown away, and enough to keep me a live for another 36 to 54 hours (day and a half to two days). For some, they have to pay out of pocket for this insulin, and to simply have to throw life sustaining liquid out into the trash is simply wrong (though some have found ways around this by reclaiming the old insulin and using it to pre-prime the tubing for the next site change).

I wish there were some way around this. Especially since the pump does not always only subtract out the given 20u, but sometimes more… I’ve had it make 50u disappear before. Honestly, I wish we could load the pump with the insulin and type in how much we filled it with. And, if we filled it with 200u, we could type that in, and the pump would subtract maybe only 10 + how much ever we primed (just say 20u) and then show a total in the cartridge as being 170u. I know this probably wouldn’t happen since it would introduce another layer of human error, but it would help us save a lot on this expensive life juice that we use every day. I mean, really…we’re so blessed to have it, and yet we’re having to throw so much away because of a safety measure…, when the amount being thrown away could save a life.IMG_5858

One Month

It’s been one month since I started back on the t:slim pump. I have to say, it’s been an adjustment from being on the pod for so many months. I can’t believe how quickly I had become “used” to it, but I did. I was worried that I would be bothered by wearing a tubed pump again, but so far, it’s been fine.

I have been keeping an eye on my sugars as well as my t:connect account and things are going just fine with both bolusing and uploading my pump. The problems I had before with highs all day are gone, with the exception that last week was my period and things are always wacky around that time, but they’ve leveled back out and my sugars are back to their more predictable pattern, and the t:slim has been working just fine right along with them. T:connect is working beautifully, no double or triple data in there at all, and that makes me happy.

Earlier this month, I switched over to using my Freestyle Lite meter and it’s been bugging me that I couldn’t upload it. When speaking with my hubby, he made the point very simply that if I had more money in strips than the cable, then I needed to order the cable. I currently have about 3 more months worth of strips left, so indeed, I have more left in strips than it would cost for the cable… so I broke down and ordered one last week. It finally came today and I’m shouting “hallelujah” because my reports are finally looking right since all of the data is there. 

Speaking of t:connect, there are still some glitches in the system, but I’ve heard through a little birdy that there is going to be a software update release next month, so I’m hoping those will be fixed. I’m also hoping they will have the ability to upload the Dexcom for a more complete picture of what’s going on, or at least more types of meters (like the Nano), but that’s not confirmed at all and is (I’m sure) a simple daydream for now, so do not quote me on that at all.Image

I’m so glad that Tandem has come out with more colors of the t:clip during this time as well. I was hoping and praying they would have the teal one voted in as a new color, and it was! So welcome to my new design, complete with teal-clip-cased t:slim!

Also, I may add a page later for questions that you guys can submit to me about the pump or anything diabetes related, so keep an eye out!

Pumping Along

So it’s been almost a week since I received my replacement t:slim and things seem to be going okay with it so far. I have uploaded a few times and all of my records are matching in percentages on the dashboard and the logbook is logging correctly (verses recording boluses and carbs 3 and 4 times over).

We did have a little bit of a hiccup in t:connect that neither I or can the rep at Tandem figure out how it happened, but on Saturday, there was a note added into my account that I had eaten Kashi rice and chicken of some sort… which I didn’t. I didn’t even make a note in there Saturday, and no one has access to my account. In fact, the only reason I use notes anyway is to mark the start of my monthly visit from Aunt Flo or any other wild, out of the ordinary occurrence. When I called, I suggested the thought that maybe I had received a refurbished pump and someone still had access to an old account with that serial number. The rep told me that they had sent out a brand new pump, so no one had ever used it before. So, that makes me feel a lot better knowing it wasn’t just a wiped and reprogrammed pump like other pump companies do. (It also explains why they are a little more rigorous in their questioning whether to replace a pump you have or not.)

Other than that, I’m doing okay with the pump. I’m trying to retrain my thinking on how to bolus in that when you read the screen, the first thing you see is the carb button. Seeing as how the first thing I do is test my BG and enter that into any other pump I’ve ever used, that’s what I’m accustomed to doing, so I end up entering the BG into the carb section. Retraining myself to read and enter information from right to left is odd, but seems to be working so far. And right now, entering the correct information for BG records is very important because I’m using my Freestyle Lite meter that I’ve had tucked away forever in efforts to use up my stock of strips, and I don’t have a meter cable yet (ordered it… it’s on it’s way) to upload that data and get a better picture of things.

Now, if we can just get Dexcom data to upload into t:connect, I’ll be one happy camper.

Out with the old… In with the new!

Sorry for the long hiatus. I’ve been working on trying to figure out why my sugars were so off the charts high, even with increased basals, ratios, and all of that good stuff.

After fighting and fighting with it, I decided to see if maybe my pump was the issue. So, I switched off of the t:slim and put a pod out of my minimal stash on to see if my sugars responded. If not, then I was going to assume that I had one massive cold or other illness about to come. If so, then I was calling Tandem.

Lo and behold, it was the pump from what I could tell. After three bottles of new insulin opened (which one will be wasted by the end of the month), 4 cartridges and 6 sites, nothing made the sugar budge to come down other than running a 40-50% increase of all insulin being delivered (basals AND boluses). Within two hours of wearing a pod, my sugars returned to normal, with no increase of insulin needed.

I called Tandem and explained the issue. Due to them being a new company, they can’t exactly just replace pumps off of suspicion, they need proof. So I was denied a replacement at first. I pressed on, and even had my endo write a note stating that he also felt it needed to be replaced and that the one I had couldn’t be trusted. What finally allowed me to get a replacement was that I had put my first t:slim to sleep earlier in the year (like, around April) when I was going to go off of it until they fixed an issue the pump has with reverse-correction (well, it’s not really an issue.. just a lacking feature that’s being fixed soon) and by doing so, it messed up something in the memory mechanism of the pump. Seeing as how that was the only thing that could be technically proven over the phone, I stressed that even though that was the only thing they could tell on their end, there was no way of knowing unless they had the pump back to inspect it that if by putting it in shelf mode that something else had happened. (So, whatever you do.. if you have a t:slim insulin pump.. NEVER EVER PUT IT IN SHELF MODE unless you’re sending it back to Tandem!)

Yesterday, I received the replacement t:slim. Since I had only been wearing the pod for one day and I’m limited on how many of those I have left, I decided to wait until Friday to put on the new t:slim. Then, today, I started thinking… maybe I need to just suspend the pod so I can use it again if needed, and put the t:slim on. So that’s what I’ve done.

So far, I’ve noticed a few things that my first t:slim didn’t do the same way, so I’m thinking maybe there was something really messed up with it and I didn’t know it. All I can say is that I’m thankful that Tandem did replace it. And, also I’ve bolused for a pretty good sized lunch and it still seems to be working just fine.

(Pic used from my main diabetes blog)
(Pic used from my main diabetes blog)

Replaced

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Due to the fact that I had put my pump to “sleep” back in April when it really shouldn’t have and it messed up quite a few things in the pump, the nice people at Tandem replaced it for me.

So, whatever you do… do NOT ever put your t:slim into sleep mode unless you’re sending it back to the company! Serious damage can happen to the memory of the pump. I had made a post on how to do this in April, and am removing that post as well as the video because it is definitely something you should NOT do just for pump breaks.

I’m currently wearing a pod because I was unsure of 1) if they would replace the pump and 2) how long it would take to get it. Well, the new one was overnighted, and I have until Friday for the pod, so I’ll be wearing it until then. I would switch back now, but I have only a few pods left, and I’d hate to waste this one knowing I couldn’t use it ever again.