Is the Tandem Tslim minimum basal rate too high for kids?

My 8 year old daughter was diagnose June 2012 and wants the Tandem pump. Her Lantus dose is 2 units at bedtime. The minimum basal rate for Tandem is 0.1 units per hour which is 2.4 units per day. I’m wondering if there is a way to make it work, as she will have it for 4 years. Maybe an un-tethered approach. Any thoughts?

I am not a Tslim user but you might be able to use a temp basal (which can be dialed down as far as 0%) every day to make this work. You might set a temp basal at say 83% every 24 hours (83% of 2.4 gives you a total daily basal of 2). Temp basals can be set for 72 hours but setting it every 24hrs at the same time of day might be easier to remember. (This example assumes your daughter's daily basal requirement turns out to be the same as on MDI.)

Thanks for the suggestion. We were told that her basal would be slightly lower on the pump, about 1.8 units per day. So we would adjust for that. 75% of 2.4 = 1.8

The odds are that her insulin needs will soon go up enough to make the Tandem work. IMO though I think that you should wait to buy the t-slim until it is the right pump for her. If you're going to start using the un-tethered approach right off the bat, then it seems to me kind of crazy to get this pump when you won't be using half the benefits of getting a pump. I think it's dangerous to start playing the game of temporary basals every day because what happens when you forget?

Obviously right now the Animas or Medtronic pumps are a better choice for your daughter. However since the t-slim is the coolest kid on the block and it's what your daughter wants, you're probably better off delaying the pump purchase rather than buying another one that she'll have to use for 4 years.

Thank you for your input, definitely something to think about.

I found out that the Tandem pump will not allow a temp basal less than the minimum allowable basal rate of 0.1units per hour.

I have MM pump, and for each 1/2 hour increment on basal, I can choose to set it to 0.0 as the basal rate.
Does the t-Slim allow 0.0 ? I assume .1 is the minimum 'increment', eg .1, .2 , etc. but might not be the minimal value.

So why not just have .1 set for 20 of the hours, and 0.0 set for the other 4 hours ?
If you space out the 0.0, especially if t-Slim can do 1/2 hour increments, it should be ok.

Yes, you are correct, it does allow 0.0. The Tslim can do 15 minute increments, so your idea might work.

For this reason, I would recommend the MM revel or the ping. I realize the t:slim looks cool, and that's something in and of itself. BUT, if I were picking a pump for a kid, I would want to make sure it has the ability to set really low basal rates (both the ping and the revel can go as low as 0.025 u/H for basal, and the Ping even continues to allow these small increments after the 1.0 u/H mark is passed).

In addition (and this is just my opinion as a T1, so take it for what it's worth), if I were picking a pump for a young child, I would stick with something that has a proven track record in the pediatric population. MMs have a proven track record in both adult and pediatric populations, and the Ping has been out for quite some time.

Pumping is great, but it requires a lot of work and you always have to be on the lookout for DKA. Any pump can fail, but sticking with a device that has been on the market for many years will reduce that risk. Kids can go into DKA VERY quickly, and for that reason I would recommend sticking to a pump that has a proven track record. But again, just my opinion. In the end, you know your daughter best and what is going to motivate her. If the "cool" factor of the t:slim outweighs the risks (and it very well might), go for it.

I agree with MBP completely. Chances are that you will need a few different basal rates throughout the day. If the Tslim can only go down to 0.1 U/H, then I think you need to consider another pump. One that will let you fine tune your basals and boluses more accurately.

Thanks for contributing. I actually like that the Tslim has the lowest basal increments of 0.001 per hour. Just trying to get past the initial minimum basal of 0.1 / hour. I do believe that everyone on a pump needs to be vigilant about dka, however, I’m not sure if pump choice plays into dka. We do have a cgm which I think would help considerably. I definitely see the value of proven technology. I also think that medical device technology usually improves at a slow pace, and peoples failure to adopt new technology contributes to the slow down. I like supporting the advancements in new technology. You have some valid points and I really appreciate your perspective. It gives me something to think about.

That is quite good: 15 minutes slot.
Go and set 0 every other slot to get 0,05 /hour units, for example.
The only problem I could see is, for any pump, the risk of occlusions with so a low flow rate.
But tandem has an its own system which garantees more precision that every other pump on market, and it's valuable when you have such high insulin sensitivity.
You have to try and see.

Yes, I totally agree about the pace of technology. I've seen it/lived it firsthand. As an adult, I don't have any issues with supporting new technology if I can. However, the slowness has more to do with the FDA approval process from what I know, not peoples' willingness to adopt the technology once it's out there. Granted, the FDA process is there to keep us safe, so there's that.

Regarding DKA, an occlusion in the line (and failure of the alarm to go off) is just one way it can happen. Pumps can also malfunction and tell you they are delivering insulin when they are actually not. Granted, these instances are rare, but they happen. My endo advised me not to get the Omnipod, for example, because I go into DKA very quickly and the pods are known to be quirky. That said, for someone who isn't prone to DKA and really, really needs a tubeless device, I think Omnipod is a great choice. It's all about individual factors.

My point was only that, IMO, these occurrences are less likely in "proven" devices. I would personally not have any qualms with an adult pioneering a new device, but if it was my kid, I would have second thoughts based on my own experience with T1D, and would probably opt to stick with a device that is more proven/tested in the pediatric population. Again, just my opinion, so take it for what it's worth.

I both appreciate and love to hear what others think. I believe the best choices are made with an open mind, research, and discussions with others interested and/or experienced with the topic. Which is why I am here, soliciting conversation. T1D and pumping are both new.

Very interesting idea and much better than using temporary basals.

I agree that the smallest rate is the most useful, particularly if you are looking for precision. I am pretty obsessive about it but if I'm at 110 and boost my rate by .025/ hour, it'll get the 15-20 points I'm looking for to get me to 90-95. The sensitivity and, for me at least, importance of making these small adjustments, trimming the sails or whatever you want to call it, is something that I haven't seen a lot of in books but seems to me to be a big advantage of a pump and I would want whatever pump has the smallest adjustment parameters avaiable.

Since you mention that your daughter is already using a CGM, I assume that she has a Dexcom. My understanding is that Tandem will eventually pair with Dexcom although I don’t think that anyone has any idea when that will be. Animas will be the first one to come out with the combo Dex pump. Supposedly Omnipod was going to be next, but I read somewhere that they don’t have a formal arrangement with Dexcom right now (but that may have changed. Think it’s been back and forth between those two companies.)

I spoke with a Midwest Tandem rep about the Tandem/Dexcom relationship and he indicated that the companies have a good relationship and are “just down the road from each other.” However, right now there is no upgrade program for Tandem. I assume that will change, but if you buy a T-slim now, you have to assume that your daughter will have this pump for four years.

I just went through a pump-buying decision due to an out of warranty pump. I had pumped with Medtronic for over 8 years and love their pumps, but hate their CGMS. I did have a few years of using a combined CGM/pump device and the integration is fabulous. I’ve been using a Revel pump with a separate Dex for quite a while. I won’t give up Dexcom, but I hate having to carry separate devices.

I ended up going with Animas because of their next pump to be integrated with Dexcom (hopefully 2013). I was told that they planned to file with the FDA in January. The current upgrade program is $99 to upgrade to the combined Animas/Dex pump (the USA version of the Animas Vibe already being sold in Europe). The Animas Ping to me is an OK pump–a step backwards from the Revel IMO and of course very different from the t-slim.

When your daughter adds the pump to a CGM, you will quickly understand how important a combined device is. When I told the Tandem rep that the lack of an upgrade program was a deal breaker for me, he essentially dumped me and I never heard from him again.

Have you ever participated in the forums at Children with Diabetes? If not, I suggest that you post in the Parents of Children with Type 1 forum and ask your questions. I think you’ll get some good answers from very experienced parents.

Good luck on your decisions. No decision will be perfect, but just be educated on what you’re doing. Let us know what you decide. Also remember that unfortunately diabetes isn’t going away and you have time to do your homework.

Wow, lots of info to think about, love it! Nice to hear how you really like the integration of a pump and CGM. Never thought that I would mind them not being integrated, might have to rethink the value in that. I really like the Animas upgrade for $99. Too bad Tandem doesn’t have an upgrade program, as I could see how that might be a deal breaker for some.

I think you hit the nail on the head that there is no perfect pump or decision. I really appreciate your input as you have given me a lot to consider.

I will check out Children with Diabetes, Thanks!

I really like that idea, because right now we keep the Dexcom G4 receiver next to our bed at night. It has a great range. We love it.

Integrated and separate at the same time would be a real plus!