Feature Wish

I wish, in the easeness of the pump, that when duplicating the profiles, you could choose to have it duplicate as-is, or simply duplicate and adjust up or down by percentage all of the factors. So if you chose to increase all factors by, say 15%, not only would your basal rate increase, but so would your I:C ratio and insulin sensitivity factor.

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There are times when I am really insulin resistant, and times when I’m insulin sensitive (thank you, Mother Nature). Then, there are also those times I’ve filled the cartridge with the “bottom of the bottle” insulin that isn’t as potent as when the vial was first opened. I wish there were a way other than setting a 72hr basal rate that I could just easily copy a profile and have the pump automatically adjust the basal rates, IC ratios, and insulin sensitivity factor based on that percentage increase or decrease.

The whole idea behind having profiles in the first place was to have one central location to change any and all factors without going to multiple menus. When adjusting for varying sensitivity, wouldn’t it also make sense to be able to temporarily switch all contributing factors in the world of insulin delivery?

I mean, the set up is pretty darn easy as it is anyway, so this isn’t a complaint at all. It’s so much easier to switch a profile than it is a basal rate THEN everything else individually. I could easily do the math myself, duplicate the profile, and just adjust everything in the profile except the time slots. Just thinking maybe it would be one more way the t:slim could be that much easier to use.

Or, just have two options for temporary use: Temp basal and Temp profile.

Clothes

The hardest thing I’m learning to live with now is where and how to wear the t:slim. The t:clip case, as I’ve mentioned, is not the best made thing in terms of where the clip is placed, but it is a good protective case. For the most part, my pump stays clipped inside of my pants pocket or waistband. Other times, it’s in the side area of my bra under my arm (which is when I’m super thankful for the slimness of the pump because unlike the other pumps I’ve worn, I can barely feel it there, and it doesn’t look too much like an extra boob).

This summer, I went shopping at my local Belk store to hopefully find some shorts that fit my odd-shaped body. Jean shorts are too thick to adjust the waist in and for the most part, they stick out too far in the back. I also hate having to wear a belt, so those are out of question for me. So, I tend to go towards the Bermuda-length fabric (non-print) style with the no-gap waste band. These, I can wear for weekend and work, so I’m all for.

But the main thing I love about these? They have a decorative “coin” pocket. Nothing much can fit in them unless they’re made to carry a few dollars or a credit/debit card, but it just so happens that my t:slim fits PERFECTLY into this pocket! So I can wear the pump “naked” in the pocket and no one sees a pump clipped to my side.

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Breakfast’s a Witch

I’ve done very well so far on my t:slim with lots of tweaking here and there. I’m actually excited about using it again.

But there’s one thing that gets me… every.single.day.

The b word.

Breakfast.

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Without fail, my BG will be great until an hour or so after I eat. Everything looks great, I’ve prebolused at least 20-30 minutes ahead, my meal doesn’t spike with in 30 minutes after eating like usual.. and BAM! It hits. I end up correcting every time, so I’m thinking I need a higher insulin-to-carb (IC) ratio in the morning for breakfast than any other meal.

It seems that I’m slowly ironing out the bumps here and there. But it’s also as if I get one ironed out and another one pops up. But that’s life, right?

Cartridge Changeout

IMG_5576Last night was change-out night. I had 33 units left in the pump, but I could tell the site wasn’t working quite as well. (Not to mention, the 300+ bg sorta gave it away too.) And it was a good thing, because the pump site area was a hard lump when I pulled it out, so it was good that I did.IMG_5577

So, spurr of the moment, I decided to make a video. I’ve done this before, but I decided to do another one for the blog. 🙂

The Clip

Oh the t:slim’s clip. Sure, shortly after the initial setup was released that included a very bulky t:case and t:slider (which I do use sometimes, but not very often at all), they came up with the t:clip. A slider case with a clip attached. This was a great improvement over what they had… but it’s still lacking in my opinion.

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Really, it’s just one complaint. The clip doesn’t clip the pump far enough down to make it a steady hold. I’m constantly making sure my pump isn’t leaning forward or about to fall off of my pants/skirt/whatever. And it’s absolutely terrible for those of us who wear the pump clipped “between the girls”.
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So, please Tandem.. redesign the clip. Below, I’ve attached a photoshopped clip to include a redesign that I feel would work. You would still have two pieces (great for those who like to mix/match still too!) but the connection would be more towards the middle, allowing the smaller piece to be longer and thus the clip being able to be higher.

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The Weekend

weekendThe weekend was pretty rough, with no rhyme or reason to most readings. On the “purple” day (which was actually Saturday, not Friday… my Dexcom had the wrong date when I uploaded it), I woke up with a high BG and simply could not get it down. So, I changed out my cartridge since it had been since Tuesday that I had it in there, and my BG plummeted by 4pm. It’s not been bad since, even through my son’s birthday party yesterday.

I’m constantly tweaking things in the pump as well as around that I do (like no eating-meals/snacks-too-close-together) and watching how the insulin affects me so that I’m not overbolusing/stacking if I do eat a meal then decide to add a bit more on for dessert. I still worry that charging more than once or twice during a cartridge use will cause the pump to heat (thus causing the insulin to go bad). I may be completely wrong, but it’s still something in the back of my mind. I’m going to try giving it one good full charge and see if I can get at least 4 days out of a cartridge (since Novolog is approved in insulin pumps for up to 6 days, that way I can change out my infusion site in the middle of the wear time).

Overall, I’ve been happy with the t:slim again. I’ve still got some things I need to work out, but it’s been a good choice so far.  

Day Two

Day two has passed with similar results as day one, though I did have a few highs in there… which are to be expected since, well, you know… I am diabetic.

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Something my endocrinologist said to me stuck with me when I went for my visit last week. When discussing bolusing for supper, he told me that I probably needed to be “combo” bolusing anyway because, physiologically, it makes the most sense in order to mimic a healthy pancreas. So I’ve been thinking…. Did my endo actually make sense? Did he actually suggest something beyond his usual “lets just adjust your basal and see how that works”???

Since then, I’ve been using the “Extend” feature in the pump. Depending on the meal, I deliver a percentage immediately and the rest is delivered over a period of time that I set. So, for things like pizza that we had last night, I did a 30% up front and 70% over 3 hours. It worked then, so we’ll see the next time we have it (which is typically Wednesday nights). And, instead of only doing it for supper as he suggested, I’ve also been working with lunch too, though not quite as much of an offset. I’m learning how my body needs the insulin delivered, and the t:slim makes it easy.

My next mission is breakfast. Unlike lunch and supper, breakfast hits my blood sugar like a ton of bricks. So I need to figure out how to handle it.

First 24 Hours

Technically, it should say 36, but we’ll roll with 24 for now.

I have been doing a LOT of changes. Basal rates, insulin-to-carb ratios, lots of temporary basal decreases. It’s been so WEIRD how my insulin needs change between the t:slim and the Omnipod. I’ve been watching it like a hawk. Bolusing before meals, combo bolusing meals that usually give me trouble, spacing meals out evenly… because for once… it seemed to finally work. I owe that to Tandem’s delivery system I think because of the way it delivers. Does this mean every day will be all rainbows and unicorns? Nope. It’s already proving that to me this morning. BUT I do believe that maybe I honestly do have a lot of work to do. Accomplishing what’s happened was no easy feat, and I realize it won’t happen all of the time, but IF I can somehow get close to it on a daily basis and figure out how my body works enough to make it happen, I’ll be a happy camper.

Before it went away, I snapped a picture. I’m hoping this will give me the encouragement to stick and work with the t:slim diligently. My first 24-hr “no-hitter” in ages…..

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The Restart

I have had a Tandem t:slim insulin pump since December 2012. After just a few months of using it, there became things I liked and disliked, with the dislike list growing. Being a person with many insulin pumps, I decided to abandon the t:slim and use another one.

Lately, I’ve been thinking differently. Maybe it’s not just the pump, but the operator too (in other words, ME). My husband ( a tech guy ) has a saying when he’s irritated with people who think it’s the equipment that’s wrong without it being used properly. He calls it an ID-10-T problem. If you look at it fast enough, you’ll see what it means.

Also, at my most recent trip to my endo’s office, my endo’s nurse did something that struck me. I had been on the Omnipod for the summer months, but she assumed I was on the Tandem t:slim since I had just gotten it back in December. When I told her about the summer pod break, she had a look as if she was irratated with me. She’s never had that before in all the years and all the pump change-ups I’ve had.

So it got me to thinking… maybe I’m a bigger part of the problem than I realize. And, instead of boring people with a timeline on my main diabetes blog, Sugabetic.me, I thought I’d write out my own personal thoughts, victories, frustrations, etc with just the t:slim on here. I know it’s probably confusing, and it’s totally okay if you don’t want to follow. This is here really just for my reference  as I make this journey once more.

******Disclaimer: Any thoughts, views, and treatment options that I choose to talk about here are strictly for my own personal use. I am not a doctor nor do I pretend to be one. Nothing written here is intended to be in any way, shape, or form a suggestion as to options for your treatment. Always check with your health care professional before making any changes to your health care options. Thank you. **********

My Pros and Cons of the t:slim.

I’ve been reading and studying my reports and it seems that I only needed to adjust insulin-to-carb ratios for my day-to-day issues. And, while I’m thankful that Tandem has the ability to show me things I need in their reports like Insulin-On-Board action and all, the system is really messed up for me right now. I’ve asked that my pump be replaced to see if that’s the issue (which I strongly feel that it is), but they won’t yet, so I hooked back up to my Ping. I know having a pump is a big deal, but for me I’ve grown to know how to read and interpret my reports to make my therapy decisions, and so I rely heavily on their accuracy of data recording.

As much as I want to really like and even love the t:slim, I just can’t right now. They have a lot of things to work on and improve first. That doesn’t mean I want to abandon it – because I don’t – but I’m tired of running up against something else every week or so that I don’t like. So, for pros and cons sake ( I guess this was a long time coming), here’s my list view for the t:slim (remember, I’m not comparing it to any other pump – I’m looking at it for what it’s features are):

Pros:

  • Touch screen – super easy for fast operation of the pump
  • Small – It’s so much easier to hide when it’s “naked” and not in a case than any other tubed pump I’ve used.
  • Customizabe – You can have it be as simple or as complicated as you need to be, with personal profiles that can just be duplicated to start a new one and make small changes without having to start from scratch.
  • Chargeable – No battery needed. Just plug it in.
  • Future – It was the pump used for the Artificial Pancreas trial, so that makes me hopeful. I’ve also seen a screenshot of what it would look like with Dexcom integration, and that is SUPER cool.
  • Software – When t:connect worked right for me, it was awesome. It was sleek, cool, and very VERY informative.
  • Reservoir Size – while I wouldn’t use 300u in a 3-day span, I know others who do, so it’s good to have that option out there. Besides, I’ve been able to get a good 6 days out of one cartridge fill that way. ;-)
  • The screen has an instant view of most everything I need. IOB, Insulin remaining, Date/time, and battery charge.

 

Cons:

  • Logging – If you enter a carb entry into the BG section by accident in the pump, even when you press “back”, it’s saved as a BG. There have been many times I’ve done this, so my report thinks my lowsest BG is 16, when it should have been 16g of carb. And there’s no way to delete it.
  • Software – It’s on the fritz for a lot of us. For some, it works fine, for others, it doesn’t. I was one who it worked great for.. and then it went screwy after I put the pump into sleep mode. Now, all of my bg readings are entered as-is, but all bolus and carb information is recorded in quadruplicate. (Is that a word? It just looks so weird!)
  • The clips – Oh the clips. I still cannot figure out why it seems the clip is in the middle of the case. One of the things Tandem spoke about as to why the connector is not on the side of the pump but rather in the “pig tail” is because people complained that they hated the “stump” connectors on their pumps…. well, now, with the t:clip, the whole end of the pump stands just as far above the belt as the other pump “stumps”, so it seems a bit redundant…. and irritating. And good luck getting them to clip firmly to anything but a belt too. My pump has fallen off or on the verge of it so many times because of the way the clip is designed.
  • No prefillable cartridge – Let me explain this one. Yes, the pump has a cartridge, but it’s a bag that’s inside of a plastic piece that’s snapped onto the pump that you inject the insulin into. I have no way to check for air bubbles other than making sure there aren’t any in the fill syringe…. and this just throws my OCD all out of whack. I like to see that before I place a cartridge into a pump that there are no air bubbles. Granted, the system is supposed to have some mechanism that pushes air out, but still… like I said… OCD-brain. I mean, who all of you have gone and filled a cartridge, and emptied it back into the insulin bottle just to get rid of a bubble hanging around the plunger and not seen all of the micro-bubbles that come back into the mix???
  • (Currently) No reverse-correction for lows – this is not news if you’ve been reading my blog, so I won’t go over it again.

 

And these are just me, but I’m freaked out by the screen. I feel like I have to baby it. I’m scared the pump will drop and it will shatter (as I’ve seen other’s do). Also, did you know that you are not supposed to have the screen pointed towards you when you clip it in or place it in your pocket (or wherever)? Yeah. So, I’ve almost always put my pump inside of my pocket and clipped it there, screen facing my leg… and it bugs the ever-living crap out of me that I can’t with the t:slim. (Well, I’m sure you can, but the book says youre  not supposed to so… I guess if you accidentally bolus yourself it’s your fault for having the pump clipped towards you and not away.)

All of these won’t fit everyone. Some people may see my cons and not think they really are cons for them. And that’s cool. While I think the t:Slim is awesome and the iPhone of insulin pumps, I also feel like I have to baby it somewhat. I’m sure I don’t and it’s just my paranoia, but I’m constantly in preparation for the OHSHIP moment when this pump could go on the fritz or I get clumsy and I do something that renders it useless. Yep, total paranoia that I know probably isn’t warranted, but even still… I’m just freaked out by it and not comfortable. As cool as it is, it’s not an iPhone that if I drop mine and destroy it, I can order another one on eBay to replace it for a couple hundred bucks.

Where am I going with this? I don’t know… by now it’s a complete ramble. So I’m ending this post…as I’m sure it’s not helping anyone at all.