Best Inset to use with my Tslim

I am very close to giving the go ahead for a new Tslim, but I am totally new to pumping and have a couple of questions. I currently use the I-Port insulin delivery method. Here are my questions:

1. Is the Tslim a good or bad pump?
2. What is the best inset to use to avoid clogs, steel or soft cannula?

Any information about the Tslim would be appreciated.

Thanks

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Hi Bob,

I have had the T Slim since it first came out and I love it. My A1C is 6.8....before I was on insulin I was a 10.8.

With regard to the pump, super easy to use and few people even realize you are using one...as a working professional an discrete pump was a must. It is really easy to load, change settings, and do quick bolus. Super straight forward to enter bg and carbs.

I use with a dexcom, which I think is just as important as the pump!

With regard to the inset, steel generally is better for clogs. However, I had a bad site infection for leaving a steel set in while at work even though it was getting sore....developed a baseball size cyst under skin and had major allergic reaction... I have since once done soft cannula, but absorbtion is not near as good and sometimes it kinks or does not insert properly....

Hope that is helpful.

MK

I have been on TSlim for 9 months, having converted from MDI and a T1 on insulin for 43 years years. I did a lot of research and even did a trial on the Ping and hated that pump. You have to remember that there is no perfect pump for everyone. The features of one manufacturer's product may be attractive to one are not so with another user. I did a lot of research before I made the decision. My endo is a "Medtronic House" and I told her that the Medtronic was a non-starter for me. She agreed to let me go with the TSLim. I use the Inset 9mm sets and have used nothing else. The Tandem rep and RN/CDE were great. You have to remember that the conversion to any new treatment protocol is not without a learning curve. I had some trouble with the insertion of the sets at first, pulling out, not going in right until I got the hang of it. "Practice makes perfect". After the first three months, no further issues. I would never go back. My endo is now fine tuning my technique at every visit, i.e. having expand my site areas. I love the Inset sets, it's an all-in-one set and is self-contained for disposal.

Thanks for the response Mike. I too have a G4 that I pay for, but I would have it even if I had to beg for money on the street to pay for it, lol.

My concern is that I know the soft cannula will kink and create problems from my use of the I-Port, so I am trying to use the best type of fusion set that will reduce this kinking problem. However, having said that I sure don't want an infection like you referring too. I, like you, use the G4 that is one great device for Diabetics. Do you or anyone else know how to avoid or reduce kinking the cannula. For example, does kinking happen more with auto inserting as compared to manual insertion? Does kinking occur less with 6mm verses 9mm cannula? I blame my kinking on my rock hard abs, lol.

Thanks Kirin for the reply. Is the set your using the Cleo® 90 infusion set?

Hi Bob,

I use the t:slim (for 2+ years now) and love it. I used to use Medtronic and the features of the t:slim made me want to switch.

As for infusion sets, I've had trouble with bent cannulas in the past so I use steel cannulas (Contact Detach) with the t:slim. These work great - no issues with infections. They are not as easy to remove since the cannula does not bend, so you need to pull straight out or risk tearing some skin. I also use the Comfort Short, which is a manual insertion infusion set with soft cannula that goes in at an angle (I think they recommend up to 45 degrees, but don't quote me on that). These also work well for me, but I do find that occasionally when I have it in a place that gets a lot of movement during physical activity, most notably in my flank or upper buttock, I'll have issues later with a bent cannula. It's usually just a slight bend, but enough for me to notice a higher blood sugar. The t:slim also seems to have a fairly sensitive occlusion alarm which can be helpful in these cases.

As for infections, you can get them irregardless of the type of infusion set you're using. You should make sure you're following proper hygiene protocols to prevent any infections. With the steel cannula, you also should make sure you're not reacting to the material - not seeing red, inflamed skin around the site or experiencing itching (at least more than normal). I've been using infusion sets for 15 years and have only had one infection and that was just this past year.

Hope this helps!

Agree with all of the above. Part of the issue of my infection was an allergic reaction...though through extensive testing we could not determine if it was the adhesive or metal....

Auto insertion results in more kinks, though I still use auto....

Thanks for all the responses. You have reconfirmed most of what I suspected about fusion sets since I have been using the I-port for several months now. My next step in my decision to pump or not to pump is what benefits will I get from moving from the I-Port and pen (my manual pump system)delivery to a pump. I currently have excellent result using my manual pump system and G4. For the last two years my average A1C is 5.2%, so I know the pump is not going to improve my A1C level. Of course I do use Lantus once a day, which can be eliminated with the pump, but I don't look forward to pumping all day. Another benefit would be that I could $120 bucks a months for the I-Port I buy since my Medicare Advantage Plan with Humana will not cover them. But I have watched several videos on using a pump and I am not excited about all the time it requires, especially changing the cartridge. I love the prefilled cartridge that the Snap pump used, but my insurance won't pay for it. Right now I just pick up the pen, select dose, insert through the I-Port and done. Best of all when the pen is empty I just get another one and continue on insulin journey, lol.

Since Tandem doesn't offer a free trial for their pump I would hate to buy in to the T Slim and end up giving it away. Bet my insurance wouldn't be to happy about that decision. Like they would really care. Is this a dilemma or what? It's so much fun being a diabetic.

Again thanks

Bob:

I use the Inset infusion sets, 9mm, 23". They are a 90 degree soft canula. I never tried anything else. I tried different lengths of the sets and found that the shortest length worked best for me. I have 1" button holes in each of my front pants pockets, along the front seams. I run the tubing through the holes to my sites. The pump stays in my pocket. There is plenty of slick in the tubing for me to take the pump out and make settings.

I have never had an occlusion in 9 months on the Tandem. I did have several pull-outs of the site when I first started due to my own clumsiness getting the tubing caught on objects. That has not happened since I had my pants modified since everything is inside my clothing. My pump is also safer in my pocket tun hanging on my belt.

I have never tried the Cleo sets. I like the compact size of the Insets I am using. I look for minimum bulk when I travel and the Cleo is larger. I amy ask my endo for a sample on my next visit just to try one, but I really like the Insets.

Oh, I did try longer tubing Insets, but found I had too much slack tubing to deal with and I never needed it so it was not worth the hassle of the slack.

When I change sites (every two days works better for me, but I have gone three days) I pull the site, wipe with alcohol, then put a small dab of Neosporin on the site and cover with a Band Aid. That eliminates any staining of clothing due to any small amount of site bleeding until it heals. Because I am on an aspirin regimen, my clot time is longer. I can usually remove the Band Aid after an hour. I have never had an infection and my endo likes my method.

Bob, best thing to do is ask for an assortment to trial. Different site types will play differently for different people.
I have tied several and like manual insertion slant sets - Comfort Shorts- as I never get a kink when I place them. Have tried auto straight sets - Cleo90- well as auto slant sets- Inset 30 - and have had kinking issues as well as needing more insulin even when they were inserted properly.
Am currently trying Contact Detach which is a steel set and am liking it. Have needed to step down on my basal rates once it got established.
You will not know what will be best for you until you test things out.

And you might also find out that different types of sites will work better in one part of body vs others.