My first pump

I was just outfitted with my first pump 2 days ago. I went with Tslim X2 with Control-IQ. So, I have questions and come here seeking knowledge.

Maybe I went into this without understanding the dynamics of how the pump really works or maybe I have unrealistic expectations but, OMG, I am so stressed seeing my numbers after I eat! They are HIGHER than when I was injecting 6-8 times daily. Is this normal or should I be looking at other data to see that this is the correct treatment modality for me?

I have my first cartridge and tubing change tomorrow. I am mildly concerned. Is it normal to discard this much insulin? I currently have 145 units of insulin in the cartridge. It seems like such a waste. And, lets face it, insulin isn’t cheap. I have a $90 month co-pay.

I had 1 hour of training on this thing so I’m sure there is A LOT I don’t know. The clinical educator at the endo office could not get the Tslim to pair with my phone and connect to the TConnect app. Then again, he was genuinely confused when I asked him a question re: the pump and FOTF. He asked me what FOTF was. Makes me think maybe I should seriously consider getting my certificate in Diabetes Education. I called Tandem and they got me paired up to the app and running. The endo educator told me there were only three things I needed to know about/use on the pump. Oh boy. I feel woefully underprepared.

Last night, I told the pump the amount of carbs to bolus for my meal. The screen said “bolus infusing” and I put the pump in a shirt pocket (I stole hubs shirt…it’s huge on me. He’s a 5x but it had a pocket!). I checked after my meal and the pump said “Bolus not delivered”. IDK why. I really wasn’t sure what to do. My BG was already rising from the meal and wasn’t sure if I put the same number of carbs in the pump if it would cause a low or if IQ would adjust, so I told the pump 8 carbs less than I actually ate. What do you folks do when you encounter such issues? Why wasn’t the bolus delivered? What do you do if you forget to bolus before the meal?

I would appreciate any tips, tricks, advice that you, the community, has to offer this newbie. It’s silly things that trip me up…like getting dressed this morning. I had to laugh at myself holding the pump in my mouth because I had no where to put the thing! I looked ridiculous. I’m sitting here on the computer with the pump laying next to me on the couch. I didn’t think about the need to find pants and shorts with pockets. Duh. I guess I will have to alter my work uniforms too. They have pockets but I already carry three devices in my pockets for work as well as pens, markers, highlighters, scissors, etc.

I will stop here. It’s supposed to be a post, not a novel.


I’m going to throw a few things out there, but the biggest thing is to not worry yet. There’s going to be a period of adjustment while you figure out what your settings should be. Your Endo took a guess based on how much long-acting you were using, but our basal need vary throughout the day and with experience and data, you’ll be able to adjust your settings.

Can’t offer you any settings adjustments yet, but I will mention that Control-iq seems to work best when you lower your correction factor. It helps the system curb highs and prevent lows better. I would start out by adjusting it 5% lower right off the bat. Such as, if you currently have 1 unit:50mg/dl programmed, I would change it to 1:47.5 . You can see, it’s a small change. It’s not going to matter much in the long run if you overshoot your target BG by 2.5mg/dl, but it empowers the system significantly. You may ultimately make much larger adjustments, but that’s a good place to start.

Also, you don’t have to change your cartridge at the same time as your infusion set. Insulin does degrade in the cartridge, though. Most users report zero issues with a week of use, though. What you do is just insert a new infusion set and remove the tubing. You probably want to save it somewhere clean, like in a ziploc bag. Plug in the old tubing that’s still connected to your cartridge. Now go into the load screen and do nothing but click on the “fill cannula” option.

Options > Load > Fill cannula > All deliveries will be stopped. Continue? âś“ > Start > âś“ in the top right corner > Resume insulin now? âś“

You likewise don’t have to change your infusion set when you change the cartridge. That’s why you want to save the unused tubing.

I’m with you on the insulin is money thing, too. There is actually about 15 units of unusable insulin left in every cartridge. This is a complete renegade move and you’ll have to decide if it’s worth it to you, but a lot of us actually suck that 15+ units out with the syringe and add it to a new cartridge along with fresh insulin. Insulin degrades, though, so this move has mixed feelings. Personally, I don’t have any issue doing it.

Also, the pump doesn’t have to live in a pocket. My preferred location is right between my breasts. I can clip it to the bridge of my bra if I’m wearing one, or to the neckline of the tank I’m usually wearing wearing if not a bra. You can also clip it onto the waistband of your bottoms. You can buy or make waist pouches, garter belts, arm bands, etc… Another lesser known option: Get yourself some baby socks, readily available at the Dollar store, and a safety pin. Pin the sock inside any clothing item that doesn’t have a pocket, and slip your pump into the makeshift baby sock pocket. Works best without the case on it.


I consider it a waste and I have never discarded my current insulin reservoir when changing an infusion site unless the reservoir was empty. You can prep a new infusion set by skipping the “Change Cartridge” step in the “Load” menu. Just disconnect your old set, connect your new one and select “Fill Tubing”. At least that’s what I did for my last site change.

Check the “History” section on your pump for error messages that might give you a clue as to why the bolus was not delivered. Also, double check your “Insulin on Board” (IOB) to double check how much of the bolus was delivered.

You can enter a bolus by simply specifying how many units of insulin you want to deliver. Figure out how many units you wanted to deliver to cover your meal, subtract any that may have already been delivered, and then just bolus that number of units. You do not need to specify carbs when you bolus.

The pump will treat it as a “correction” bolus, but that’s OK. This way you avoid double counting the carbs.


This may be of no use to you, but I had problems figuring out how to remove/relocate the metal clip on the back of the t:slim case. The link below is to a post I made that points to the (slightly outdated) Tandem training video about how to do this. If it helps, great. If not, just ignore.

Training info about Tandem pump case & clip

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Just thought of another forewarned newbie thing. When you do change your cartridge, don’t panic when it shows you an unusually small amount of insulin. It makes a general guess, and will say something like “120+” or “180+” until the pump delivers ten units of insulin. After it’s delivered those 10 units it will give you a better approximation, but it’s still a rounded value. It doesn’t start counting down in single units until you get down to the bottom of the cartridge.

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There seem to be a lot of women with youtube sites about living with diabetes. Usually they will have a video talking about how they work with their wardrobe to carry a pump. You might look around for them to see if anything they suggest could be of use to you. The link below is just an example to give you an idea of what sort of content I’m talking about.

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If you had referred to it as somewhat similar to “Dawn Phenomenon” chances are he would have had a better idea what you were talking about. Just because it’s discussed in the Diabetes Online Community (DOC) does not necessarily mean it’s a term your medical support folk will know about.

Of course, someone is going to post a reply telling me that FOTF is different from DP. OK, fine. But my guess is that it’s related. I would also guess that the way you’d want to deal with it is to bolus for it before you get up. :man_shrugging:

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Really? Out of curiosity, what were those three things? :confused: :upside_down_face:

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  1. How to bolus for a meal
  2. How to load new cartridge/prime tubing
  3. How to find home screen/unlock screen.

I understand that most medical staff have never heard of FOTF…I am a nurse and know that it was never in any textbook I had. But, the DIABETES EDUCATOR??? So now I wonder if it is something that isn’t brought up in the Diabetes Educator Certification class. And what else isn’t brought up? I’m seriously thinking I should take the course just to see what they do teach.

OK. I have no idea how to make setting changes or what my settings are. All I know is that my target BG is 112. IDK if that is a preset standard number or if the endo educator programmed that number in. I also see that IQ does not dose additional insulin unless I am over 150-155. I did not get any insulin the past 2 nights because my BG was in the 130s. Prior to starting a pump, my morning sugar was 110s to 130s. I have been 140s to 150s the past 2 mornings. Post meal, my sugars were <170 just about 100% of the time. Since pump, I am seeing 170 to 200+. I guess my A1C will be going up.

I guess I will have to look at videos. I hate watching “educational videos” because people speak too slowly. I always hated classroom learning for the same reason. Guess I need to get over myself, put on the big girl panties and suck it up.

I just called tandem because I got a message that my pump stopped delivering insulin. They explained it to me and it’s working again. But they offered to have one of their local educators reach out to me to set up a session. I am taking them up on it and I will make a list of questions. :slight_smile:


My suggestion here is meet with a pump trainer not a CDE. My CDE had never worked with a Tandem pump so she sat in on my training session with the pump trainer. I have meet with my pump trainer a few times over the years.
Once just to go over how to set up computer to pull reports. This was before being able to look at pump settings on my phone. I have also meet with them on infusion set issues.
And I am sorry but the first lesson is really just getting the pump fired up and working. There is no training on what the pump can actually do. I mean who was taught back in the day about extended bolus during your first session?
So first off, welcome to the pumpers club. And I hope you didn’t think it was the cure for all that causes you problems with your diabetes. It took me about 6 months to finally start feeling ok with it but that was 20+ years ago and things are a lot easier now.
And sorry about the post meal surprises. But that and overnight were the main reason for me to finally switch from 5 shots a day to a pump. I so wanted to have a baby. And thankfully the pump and a lot of hard work made that possible.
Hang in there. It will get easier. And remember what works for me might not work for you. Each of us is an experiment in the making. But I do really suggest asking for a one on one session with your pump trainer, not the sales rep. They have all the tricks that they have learned from others over the years.
Good luck! And I will say, this system has made my life so much easier. I really don’t think much about my diabetes throughout the day! And after 50 years, I am so ready for easier!


I don’t see a pump as a cure or fix for this. My endo recommended a pump to control lows and she said it would improve my A1C more. My A1C has been 6 to 6.3 over the past 6 months. She is claiming an A1C of 5.7 is achievable. I don’t know what extended bolus is or what the benefit is. Hell, I don’t even know what all of the icons on the home screen mean.

I am currently in You Tube hell trying to find info.

Oh my goodness. This is why I despise most endos. The whole system is broken. They can’t live with us to make the immediate, necessary changes, yet they don’t teach us how to self-manage.

Personally, I think you would benefit greatly by reading something like Pumping Insulin by John Walsh and Ruth Roberts. It’s pretty much the pumpers handbook, and will be the best way to educate yourself since your management team is lacking. You might even be able to find it in your library.

It’s pretty obvious your basal rates are too low. I think it’s normal for them to start low and increase it as necessary, though. Doctors are much more afraid of lows than highs. It isn’t a problem so much in the short term, but if they make you wait much more than a week to adjust your settings, it IS a problem.

We can help you right now with your morning sugars, though.

Did they not teach you about sleep mode? Sleep mode was designed to give the pump tighter control while you’re inactive and fasting, because there are no other external factors to screw with your insulin needs. It will aggressively adjust your basal to keep you between 112-120 all night. You can turn it on by clicking Options > Activity > Sleep: START. The regular Control-IQ algorithm won’t resume until you follow the same pathway in the morning and click “STOP”. While you’re in that activity menu, though, you’ll see an option for “Sleep Schedules”. You have two different setting options, such as one for weekdays and a different one for weekends. Go ahead and set up a schedule now that will turn Sleep mode on and off for you automatically. I would highly suggest you set a time that begins about 2 hours after you usually finish your evening meal and extends to your typical breakfast time (this will also help cover dawn phenomenon and FOTF).

Unfortunately, your pump is going to struggle to achieve that goal just yet because your basal rate is inadequate. I’m not comfortable advising you to change that, but you may call and ask your endo or educator to increase it for you, or you can take it upon yourself to raise it. It’s generally accepted that 5% changes are safe and acceptable. You run no risk of severe hypoglycemia with just a 5% change if you’re already running high.

The one thing I WILL help you with now that will make your nighttimes better is getting your correction factor down. This is the setting that enables control-iq to influence your BG. The higher the number, the slower and milder the changes. The lower the number, the faster and more extreme the changes are. (Edited, because I suck at proofreading. Thanks @irrational_John ) Too low is a bad thing, though, as it will overcorrect at both highs and lows, leaving you on a wicked roller coaster ride.

Too change it, you need to learn about your “personal profiles”. This is where all your background insulin settings are. You can have up to six different profiles, because our insulin needs aren’t the same everyday. You might need/want a different profile for high activity days, sick days, weekends vs weekdays, etc… It’s fine to start with just one, though. You don’t know yet when that particular profile isn’t working for you until you have more time with it. (Personally, I have 3. My regular profile, one that delivers extra insulin for sick days, pms, etc…, and 1 that delivers less insulin for really high activity days when I otherwise might fight lows a lot.)

Click on Options > My Pump > Personal Profiles.

The first item on this list is “pump settings”. There’s nothing too important in there other than it lets you customize how much insulin is delivered if you “quick bolus”, which I’m guessing they didn’t teach you about either. I have mine set to 0.5 units. If you hold the silver button until it beeps or vibrates (depending on your sound settings), you will see the Quick Bolus screen pop up. Every further click of the button will tell the pump to deliver some insulin. Since I have mine set to 0.5 units, if I want to deliver a 2.5 unit bolus, I would click the button 5 times. The pump will then repeat 5 beeps or vibrations back at me and I will long press the silver button to confirm. It’s easier than it sounds. Do it a few times watching the screen and you’ll catch on quick. This allows for discreet bolusing without even removing your pump, because you don’t actually have to see or touch the screen.

The second item on the list will be the only basal profile you currently have set up. It should say “on” next to it. Go ahead and click on it. If you scroll down to the second page, you can rename that profile to something more helpful. I would suggest “starter”, because you want to save the initial settings your doctor gave you.

Now scroll back up the first page and click “duplicate”. This will initiate a new profile great you can tweak without affecting your doctor’s settings. Click the check mark to confirm you want to do this. I would call it something like “testing”.

Click anywhere in the box labeled “timed settings”. This is the heart of your pump. I’m guessing you only have 1 segment at the moment, starting at midnight. Eventually, you will want to add other segments where you need different amounts of insulin, such as a higher one in the early am to account for dawn phenomenon, and then a reduced one the after the DP passes and you don’t need the extra. You can see right in that 12:00 am box what the basal rate, correction factor, insulin:carb ratio, and target BG are set at. If you want to edit it, click on that box. Click on “correction factor”. Whatever that number is, reduce it by 5%. You can use a calculator if you want, (current correction factor value) x 0.95 = new correction factor value. Once you enter the new value, click the ✓ to confirm. Click the check again to save the new timed segment information.

Now, you need to actually turn your new “testing” profile on. Click on “testing” (or whatever you named it), and then click on “activate”. ✓ to confirm. You’re now running your newly adjusted profile.

Note, I feel comfortable guiding you on this because it’s a SAFER option than the inadequate starter settings your doctor set you up with. It will make Control-IQ better at preventing both highs and lows. I also think it’s an option most professionals, except the very best, ignore. Generally, they only change insulin values, even though it’s only one of many factors that influence pumping. You should confidence to make small 5% changes, and see for a week or so how they work for you.


I also often feel that way. Have you tried just speeding up the video?

It’s easy enough to do with YouTube videos. I created the screen shot below using YouTube in a desktop web browser because that’s how I usually use YouTube. But you can do essential the same thing in a slightly different way if you are using a YouTube app.

The Tandem video screen shot below is for “How Control-IQ Technology Works on the t:slim X2 Insulin Pump”. To play the video faster I first click on the “options” gear wheel :gear: in the video’s lower right hand corner. Then I select “Playback Speed” to get list of speeds to choose from.

Here’s a link to a Tandem vid about setting up personal profiles.

Getting Started with Personal Profiles on the t:slim X2

Editing your pump settings is not that hard to understand, but it can be a tedious process. Just something we all have to deal with. :man_shrugging:

This video discusses creating the very first profile on the pump. Since your trainer already set that up, it is too early for you. But it will you point you towards how to view or edit your profile on your pump.

I suggest before you change your profile settings you first duplicate (copy) them into a profile with a different name. This saves the old settings for future reference. It also makes it easy to switch back to the old settings should you want to.

Always look at the date of any tutorial material you come across. In my experience the older Tandem stuff can be out of date. As it updated the pump’s software over time, Tandem also changed the pump’s menus. Older educational material may still be of use to you, but it won’t necessarily match the screens of the t:slim x2 you are using. You’ll need to allow for that.

Tandem also has a collection of user guides & Quick Reference sheets in PDF format which you can refer too. For example, here is a link to the quick ref for t:slim x2 user profiles.

As with the videos, keep in mind that some of the material may be out of date compared to the version of the pump you are using.

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My endocrinologist was not familiar with the term. When I explained to him what it meant, he recognized the phenomenon, just not the name.


Nice to know that I’m already (self)trained. :roll_eyes: :upside_down_face:

I guess I just have a different perspective than many others. My first pump was a MiniMed 507 which was delivered to me along with supplies in December 1996. Included with it was a book containing a number of articles about using an insulin pump. After reading through some of the articles and the pump’s documentation, I took a guess at a basil rate, filled a cartridge with insulin, slapped in an infusion set and started using the pump.

A week or three later I went in for an appointment with the educator at the office of the doctor I was seeing then. She was surprised when she found out I was already wearing/using my pump. That was how I first found out that folks are supposed to be “trained” to use a pump.

Oh, well. :man_shrugging: She handled it well which I am grateful for in hindsight. :wink:

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I wish I could have read information like this when I started the CIQ. Robyn_H - thank you for sharing. :slight_smile:



To go in a slightly different direction, I’m curious how much use you are making of your Dexcom G6 CGM. Were you using a G6 before you got the t:slim x2 pump? How do you view your CGM data? Is it just via the t:connect app or can/do you also use the Dexcom app to monitor your G6 sensor?

All I recall you saying about t:connect is pretty much the excerpt below.

Are you uploading your pump’s data to t:connect? Have you signed in to Tandem’s t:connect web site?

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If you don’t know this, I suggest not using the pump. Could be very dangerous.

Get a pump trainer and start over.

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