How do you sleep with your Tandem Tslim

Type 1 and LADA
1

I had a scary experience the other night. I accidently bolused myself while sleeping. I woke up with a 43 bg. I had an appt earlier in the day and I put my pump cgm alerts on vibrate. I forgot to turn the vibrate off and restart the sound alarms. I will never again do that again. Around 2 am I bolused( Yes, I checked to see if I did or an auto bolus) In about 1.5 hr. I dropped to 43 and was awakened by the Tandem low 55 alert. I summarized that I rolled on the pump and somehow, I did it. What I do now:
Make sure the pump is off whenever I touch it
I use my phone more to check readings
I used a form fitting sleepwear that keeps the pump in place.

I remember someone else posting something like this before. I will report this to Tandem.

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2

What are you going to report to Tandem?

You can look at the pump’s complete history log for that time period to verify how the bolus was given. Control IQ software doesn’t auto bolus during sleep schedule, and it undercorrects by default. Basal IQ never auto boluses.

If you bolused while asleep, you goofed. To err is human. So is blaming equipment for mistakes. I’ve done both, but never the same twice. :face_with_open_eyes_and_hand_over_mouth:

  • If you have Basal IQ software, maybe you entered BG wrong.
  • If you have Control IQ, maybe you ignored the pump recommendation.
  • If you have quick bolus enabled, maybe that’s the problem. (Disable it. )
  • If your pump screen timeout is set to 120, shortening that will make it harder to do anything half-asleep.
  • Maybe you unlocked at night when you didn’t need to. The only reason to unlock at night is to bolus. You don’t need to unlock the pump to read the current number, see the trend, IOB, last bolus or the current basal rate. (Press where the pump fill status bar is. )

I don’t have AC, so depending on the weather I have my pump in the pocket of an inside-out pocket T, in a belt pouch, or an arm band. That makes the pump hard to access and put back, and if I did, I need my glasses to read those silly small numbers, which means turning on the light, making it hard to get back to sleep. All that make it hard to accidentally bolus at night.

So I use one of the always-running apps on my phone - XDrip+ which connects direct to the G6, or the Tandem connect app. They both have large numbers that I can read without glases and the screen brightness turned down. (I hope the new Tandem app will allow the the phone bolus feature to be disabled. )

I prefer Xdrip+ to the Tandem app, a memory hog that doesn’t need to run continuously. I use airplane mode at nght. There’s nothing I can do for anyone not in my house that can’t wait until morning. I have a smart speaker the bedroom to make calls out and broadcast to other rooms.

I recommend XDrip+ to any Tanden pump or Dexcom G6 user with an Android phone. A smaller app, a much better display and better alarm capability than Dexcom or Tandem apps and it has historic and statistical displays that are more readily useable than the Dexcom receiver or T:connect web.

My XDrip+ low-low-low alarm is a loud audio file that says " Hey Google, call < number>. This is a recording. I need medical assistance at < location> and am unable to speak. This is a recording . My name is < name> . I’m at < address>. I may be in hyopglycemic shock, and may need glucagon or injection or glucose infusion. Break through the rear door for easiest access. " The message repeats without a break for 2 minutes.

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3

I made this a habit from the start:
Press button on top, then hit 1-2-3 to wakeup pump.
After done, hit button on top again to lock screen again.

This may be something the trainer suggested. Now its a habit and takes just an extra second.

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4

In all my years with a pump, I have never had this happen. I always have my pump in a case that hooks to the waist band of my pj’s. I am a side sleeper so I just move it to under my belly button so I am not rolling on it.

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5

Using Medtronic (in the past) and Tandem (currently) I’ve bolused in my sleep plenty of times - normally I think it is just the recommended correction dose.

I don’t think you have any ground to stand on as far as reporting it goes. Their equipment worked correctly.

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What I would report is the ease of bolusing while sleeping via sleep movements. As a consumer, I would think they would be interested in user interface experiences.

7

The closest I’ve gotten is “beep beep beep “ bolus has not been delivered!

I think I must have somehow hit 1-2-3

You could ate a more complicated passcode to reduce the chances of it happening again.

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8

I just did that. Lol

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You believe that Tandem might be interested enough to do something.

My experience reporting documented pump and app anomalies to Tandem and Dexcom is that they don’t make changes unless the FDA makes them do it. That requires the FDA receiving more than a few reports of the same issue, some with serious outcomes.

Report suspected adverse events for human medical products to the FDA. That eliminates the possibility of internal reporting at the manufacturer delaying the event being reported to the FDA.

https://www.accessdata.fda.gov/scripts/medwatch/

If you feel unsafe using the pump until it’s more secure from accidental boluses, there are 2 features of the pump that together could prevent the experience you had:

  • Options/Device Setting/Screen Timeout, and
  • Options/Device setting/Security PIN.

Setting the timeout to 15 seconds will kick you out of entry mode unless you are actively entering a value. That will require you consciously deciding what exactly what changes to make before you enter a screen to make them. If you are sleepy, it will time out unless you are pressing soft buttons no slower than 1/14 seconds.

The security setting is designed to protect pump wearers from accidentally entering entry mode. It locks the device requiring a numerical code to unlock it.

But I’d just advise that you be careful to practice after every entry action, to press the Tandem button and the power button until it becomes an automatic reflex.

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10

I am using both methods. Thanks.

11

You’re welcome.

I’ve gotten help from reading other people’s shared experience here and it’s only fair to pay it forward.

Every problem and question that someone has, will eventually be encountered by another. Forwarned is forarmed.

I know that my responses sometimes seem dismissive and are always long-winded, but I want them to help any person with a problem understand what’s happening and its relative importance, not just “fix” a problem.

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12

In response to the initial question: at first I would sleep (unclothed) with the pump by my pillow and the connecting tubing coming up near my head. I never slept that well, having to wake up enough every time I turned to reorganize everything.

I now wear the pump in a pouch that I got from Tandem that. Now the problem is it buzzes when I’m lying on top of it and it loses connectivity with the CGM.

But at least I’m not worrying about self-strangulation!

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13

I don’t have the auto bolus activated for this very reason. My scary experience was the night I groggily woke up to find my pump was not delivering insulin because it was caught up in some step of loading the cannula that I could not immediately get it out of. I called Tandem, who insisted it must have been something I’d done, not something the pump would have done itself. Seemed like a whole lot of steps to have happened by lying on it. Was finally able, fiddling with it while talking to him, to get it to return to normal delivery, and hadn’t been long enough to cause a problem with my control. But I do now pay more attention to having it on the home screen when I turn it off, to at least require that push before it gets to any operation. Even turn it on again to do that if it has gone off on its own. (No, I hadn’t been loading it just before bed, but not impossible that I’d gotten there accidentally.)

Still hard to imagine lying on pump to press the 1-2-3 in correct order, but I’m assuming I did.

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14

That is awful and I am sure scary. Where do you keep your pump when you sleep? I put mine under my pillow which works well most of the time. It can be startling when it vibrates with an alert.

15

In top pocket of sleep wear. Since using the security pin, I am feeling more comfortable and I am very cautious that that I turn it off. (make screen inactive)My timeout screen is set to 15. I am a hard sleeper so I need it near and a little hard of hearing.

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16

Are you saying you sleep bolused or the pump bolused somehow when you leaned on it?

I noticed while awake once that after I put my pump back into my little waste pouch/ belt it actually got into the bolus menu because it must’ve pressed on the pump and I had not shut the screen off, so I always make sure to shut the screen off before putting it away.

Once while I was sleeping I woke up at around the normal time I would and I noticed that there was some huge bolus that was written into the pump bolus menu, but I didn’t do it and I have no clue how that could’ve happened. My max bolus is 4 units and top button bolus is off. So I don’t think it would be possible for it to give me a large bolus accidentally unless there were a major malfunction.

I have never mistakenly bolused in this fashion ever while asleep so I don’t think I did it myself. And I sleep alone so no one else did either.

It’s scary to think that could’ve happened just by me leaning on the pump if I had forgotten to shut the screen off. I sleep with it the same way I have it when I am awake it is in a softy flannel belt and a little pouch with a zipper pocket. I sleep on my side or my back so the pump should not be having pressure on it depending on which side I’m on but I guess it could happen shifting in my sleep and it rolled around etc.

This is one reason I will never use my phone to bolus.

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17

I feel the opposite is true.
If you are using your phone to bolus, you can lock your pump with a passcode. Then it’s a lot less like to accidentally do anything and it makes bolusing in your sleep less likely too, because it requires a bit of thinking to get past the code.
I’ve bolused in my sleep a few times. Usually when I’ve been not sleeping enough.
I also keep my max bolus number set at 8 units.
Using my phone to bolus makes it safer. It has more steps and security features to get around in order to deliver.

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18

I never lock my phone with a passcode. I have had bad experiences with passcodes and would not lock my pump with one if that is even possible.

But we all have to do what we feel most comfortable with. The sensitivity of mobile devices is too much and it’s easy to touch something not even realize you’re doing it plus the connection to the pump could fail and make mistakes- just seems like there’s more chance for mistakes to be made I’m not talking specifically about sleep bolusing. I assume you mean when you’re half asleep- I guess that’s what people mean here I’m not sure.

I guess you could have them with either one. I don’t know what happened with that huge bolus but the only thing I can think of is that either I pressed on it when I was sleeping or I had set a temp basal rate after waking up briefly and put it into the bolus menu instead of the basil temp basil maybe. It still seems crazy though because I don’t think the numbers as I recall were similar to what I would do for the that. Fortunately it never happened again.

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If you decide to do the bolus feature on your phone, it requires you have passcode turned on the phone.
You can use face recognition, but there has to be something for safety reasons.

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I use fingerprint on my iPhone SE 2nd gen.