First Day in Tandem T:Slim X2 Rocky Start

I just thought I’d share how my first day on the Tandem T:Slim X2 went in case it’s at all helpful to others/if you know something I don’t that may have made it more successful. It was a bit of a rocky start.

I started out by turning CIQ off and setting a 0% temporary basal due to forgetting to not take my AM Lantus dose. Oh well, that’s ok! Still have time to bounce back.

The day went mostly great - I went high a few hours after lunch, but that’s part of the reason I went on the pump and I knew it would take a bit to learn exactly how to use extended boluses. Manually bolusing to correct worked fine.

The trouble started after dinner, around the same time I turned CIQ back on. I bolused too low for my meal, and started chasing that high. I got an alert saying the insulin delivery was stopped due to occlusion. I had read here that people often get false occlusion alerts, so clicked through and tried to bolus again. It worked! Maybe? My blood sugar was still rising.

I bolused again for the new higher blood sugar. That worked with no reported occlusion. Blood sugar still rising. Not sure if an actual occlusion or a pita bread related issue. Going with pita bread as the pump told me the insulin was delivered and I’ve seen pita bread issues in the past.

An hour later, still rising, still oscillating between corrections being delivered and occlusion alerts. I decided to just give it up and go to injections for the night. No glaring issues with the site when I pulled it out in the morning, and I was able to keep the same tubing and cartridge today so no issue there.

I learned/reinforced a few things: don’t test a new site with a tricky meal, think twice before slamming injections when possible, and give yourself some grace.

Today has been a bit better! I went a little high this morning, but know I want to play around with my basal rate to help combat my feet on the floor issues. I’m hoping I get it all figured out soon!

1 Like

Keep the faith. Early days can be frustrating, especially since it’s your first pump and you have no clue what your settings should be… but once you get your settings worked out, it’s an incredible system!

2 Likes

Agree with @Robyn_H its a good system and you’ll get it figured out.

2 Likes

I had similar issues and I went from Medtronic pump to tandem so it should have been seamless. However it was not.
My carb ratio was the same and most of my hourly basal rates. My insulin sensitivity needed to be greatly reduced. Not because I am less sensitive it it but because CIQ is too slow for my comfort.
Increasing the sensitivity makes it more aggressive in keeping you from going high.
As long as you are not going low you can change it to suit you.
Also I keep mine in sleep mode a lot. From 730pm till 9 am.
Of course because it allows you to stay lower that way. I average 95 while in sleep mode and 120 when it’s off.

2 Likes

Thank you! This is actually my second pump, but it has been ten years of MDI in between the two so still a steep learning curve. I’m excited to get it all figured out!

Good tip - I’ll keep an eye on this. Thank you!

what is ‘sleep mode’? Is that a CIQ function, that is not available to a BIQ Tandem user (like me)?

1 Like

Yes, it is part of CIQ.
It has a tighter range to target, since generally factors like food, exercise/activity, stress, etc are not impacting bgs.

When a Sleep Activity is enabled, the treatment values are lower and narrower since there are fewer variables that affect glucose values during sleep, for example you are not eating or exercising.

When Control-IQ technology predicts a glucose value less than or equal to 112.5 mg/dL, it will start to decrease basal insulin delivery and will stop basal insulin delivery if the predicted glucose value will be less than or equal to 70 mg/dL 30 minutes in the future.

1 Like

Have you considered trying sleep mode for overnight? It will try to keep you in lower range. You can set up schedule for when it is on/off. Some people use it on all day/night. It helps start off the day in better range.

1 Like

Thank you for the tip, and yes! I do have sleep mode enabled, but have it end right as I get up for the day. Do you think overlap of sleep mode into when I’m up and out of bed could help with the feet on the floor blood sugar rise?

I ended up just bolusing a unit before I stood up this morning like I used to do with MDI and that seemed to do the trick, but it would be nice to have something less hands on taking care of the issue.

It depends. If you have very predictable/routine schedule, the full unit correction might work faster than basal increase. Try it both ways and see which you like better.

Many use sleep on 24 hours, including me, but I first tried it only at night.

1 Like

New tech is always so frustrating. I do not envy you.

1 Like

Note that in sleep mode CIQ will not do automatic correction boluses.

2 Likes

This is super helpful! I’m hoping to maybe start on a T:slim by the end of the year - long time Omnipod user, and not looking forward to tubing, but I feel like my control is much better on a pump. Omnipod’s cannula’s don’t agree with me anymore.

1 Like

Tubing is occasionally a PITA, but 99% of the time you don’t really notice it. I was much more worried about it when I was thinking about starting to use a pump than I needed to be. Everyone differs of course.

The Tandem tsport (patch pump) is suppose to launch in 2021(pending approval), you might take a look. On the Tandem conference call this week, they indicated they are still on track to release in 2021.

2 Likes

Yeah…I’m more concerned with my toddler accidentally yanking things out.

1 Like

I have a 3-year-old who has never touched my tubing, accidentally or not. It generally does not hang outside clothing much if at all. (I am also planning a switch to Tandem, though from Medtronic, another tubed pump.)

Really? That’s encouraging!

My children are now trained not to touch my tubing.
My significantly less responsible door, drawer, & garage handles will grab the tubing(!!) are much less sensitive to the impact! :rofl:
With a background in product design, I am very impressed at how solid the set adhesive sticks, & how the tubing stretches before set actually pulls out.
The greatest frustration is with myself that I mismanaged tubing exposure & the drawer handle was able to grab the tubing.
I think the flexibility offered by a tubed pump, is better than tubeless; but I confess I am ignorant of a tubeless design, I was initially opposed to the extensive medical waste & cost of the disposable pod. - Peace.

1 Like