One Year Later….

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It’s been one whole year since I received my Tandem t:slim insulin pump. It’s not been all rainbows and unicorns, that’s for sure, but I am very blessed to have this pump. I want to make it work so badly – both out of loving the interface of it and the looks (I mean, come on… I can change out clips to fit my mood and not be bound by one pump color? Score!) and the simple fact that my insurance paid a butt-load for this little piece of machinery and I feel it’s my duty to do my part.

So far, since my last restart (shhh! Don’t tell my endo yet!), things have been going well. I’ve been taking some new tips into consideration when setting it up and it seems to be helping. I still can’t get over the loss of 40-50 units per cartridge change, but it’s something I’m going to have to suck up and get over until they can improve this in the pump.

I’m hoping that maybe it was just a rocky start with the pump and that things will go smooth from here on out.

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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.)

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

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 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. **********

The Forbidden

When I switched over to the Tandem t:slim insulin pump, I knew I would have to switch insulin as well from Apidra back to Novolog, which was fine with me. I had used Novolog successfully during my pregnancy with a bit of extra work. So, I started t:slimmin’ with Novolog and things worked out great.

But if you know anything about me, it’s that I’m a curious cat. As it is told in the Tandem t:slim manual, it is only approved for use with Humalog and Novolog, not Apidra. Why, I’m not sure, but I was told that it’s simply because they didn’t use Apidra in their testing trials. And LOTS of people were not aware of this before switching over or starting on this pump, and had lots of trouble with occlusions and such, which promptly disappeared as soon as they switched to one of the approved insulins. So, I wanted to try it for myself. Glutton for punishment, some would say, and yes… I guess you could say that…but…

Apidra Tslim

 

I did it anyway. And I have been for the past month. I don’t know why I’m able to use Apidra and others aren’t, but I’ve been working on a theory….

One thought is that the heat from charging the t:Slim damages the Apidra since it’s not stable in heat. I have been charging my t:slim about twice per week, and when I do, I place it on a refrigerated (NOT frozen!) cool pack for the time that it takes to charge. Whether this is the “cure” for it or not, I don’t know, but I’ve been successfully using Apidra for the past month with no issues.

Another theory I have is geographic location… or sea level…or atmospheric pressure…. maybe that’s what I’m thinking… I don’t know.. I’m not a scientist (though I would LOVE to be one) but something else has got to be happening for others to have such an issue and not having success with Apidra in the t:slim. I really hope this can be figured out. I think the t:slim is a great insulin pump and could be used by a lot of people (well, a lot MORE people) if Apidra was a good, stable option.

What’s the point of this post? I’m not quite sure. Other than to be another testament to just how much of a diabetes geek I am. :)

I Heart t:slim!

So, yesterday, I was able to see hands-on a demo t:slim insulin pump.  We went over the functions of the pump and how it works, and some of the cool features it has over other available pumps.

When the rep pulled it out, my jaw literally dropped. I could not believe how tiny the pump is! It’s slim and sleek and all sorts of awesome.  I compared it to the size of my Animas Ping and it was like – whoa. Super thin. Then, I compared it to my Verio meter – it’s a bit thicker, but not by much.

 

I didn’t get any frontal pictures, just because there are so many out there available now. What I was really looking forward to seeing was if it lived up to it’s name and their slogan. Well, color me happy because it is SUPER slim and certainly lives up to it’s name.

So what about this “touch simplicity”?

I have to tell you, while it doesn’t have the super responsive feather-touch sensitivity as an iPhone would, it’s is very easy to touch the screen to get it to do what you need it to do. While I know that’s not the slogan’s meaning, it was a concern for me. But, once I got to touch it and play around with the menus, it’s not that much different at all. I liken it to the touch-responsiveness of the Kindle Fire. I did keep laughing at myself though because I wanted to scroll with my finger instead of touching the up or down arrows to scroll through the history screen!

The pump does live up to the slogan though. It is so easy to use this pump, and having the touch screen does make things so much faster and easier. I loved that all I had to do was touch a few places and a bolus was delivered. No scrolling up, missing the mark, scrolling back down, etc. It just a simple tap-tap-tap and your’e done.

The thing I’m most excited about is the different profiles  and not just different basal rate profiles. This is the most ingenious thing ever in my opinion because someone FINALLY realized, “Hey, if they need to change their basal rates, wouldn’t they be sensitive/less sensitive to the other insulin factors as well??” Super smart, Tandem!

Oh, and the T button (the ONLY button!) on the top/side not only wakes the pump, but can be used for an audio/vibrate bolus. {Yeah, so! What’s so special about that? All pumps do that now.} Except (from what she told me) it can be set to go in increments of units OR carbohydrate! So, no more doing the math to figure out how many units you should need for “x” amount of carbs while trying to keep the pump hidden away. Just press it how many times you need to to increase the number of carbs you’re eating and it does the math for you! HOW TOTALLY AWESOME!!?? The only time I can figure that would be an issue would be if you’re needing to do a correction… then you would have to do some serious math to convert the BG overage to what would be equal to carbohydrates and then deliver the bolus.

I am super stoked about this pump. I am eligible to get one after December 14th, and I cannot wait. (Read: I’m such a nerd that I have a countdown clock going… T minus 31 days!) This is the first time in a long time I’ve been so excited about pump technology. I would gladly trade in every one of my pumps to get this one if I had to. I know, a pump is a pump is a pump – in the end, they all do the same function. And while each pump has their own niche and ways to trump the other, the end decision is going to need to be based off of what you like/want the most out of the pump you choose. If you want something that’s all connected with CGM and meter and all that jazz – then the Revel would probably be best. If you want a color screen, but prefer to have tactile buttons as well as a remote to bolus with so your pump can stay tucked away, then the Animas Ping would be better. If you want small, sleek, color screen and touch-ability, then the t:slim would be a good choice. They all perform the same basic principle and that’s to deliver insulin. As for me, I want the t:slim. It’s like a Kindle, Omnipod, and Ping had a baby.

Besides, did you really think this technology geek wouldn’t want it??