My Tandem:X2 experience: CIQ versus HAL 9000

Continuing the discussion from Tandem decision:

So a few people on the other thread asked how it was going since I made the decision and started on the Tandem, but after trying to respond there it felt like I needed a new thread. I wanted to write the review that I would have liked to encounter when I was researching this and never quite found. There are a lot of reviews out there—the pump and CIQ have been out for several years after all. But what you’re really seeking is to somehow get a sense of what it feels like to live with this thing you’re going to be wired to 24/7/365 for years. And it’s hard to get that kind of gestalt from reading about how this or that function performs, or lists of discreet pluses and minuses. So this is my attempt to get at that.

I look at it like this: a system like this is kind of an act of communication between the designers and the patient/user. For me, with the 670G—my first and rather disastrous experience with an AID pump—that communication went like this:

Dave: “Open the pod bay doors HAL!”
HAL 9000: “I’m sorry Dave. I’m afraid I can’t do that.”

And like this:

“No 9000 computer has ever made a mistake or distorted information. We are all, by any practical definition of the words, foolproof and incapable of error.”

And like this:

HAL 9000: “This mission is too important for me to allow you to jeopardize it.”

So that fed into my apprehension about AID in general, and why I procrastinated about getting a new pump for well past the warranty expiration. Actually ten years if you count the fact that after giving up on the 670 I went back to my old Paradigm, my first pump, that I got in 2013.

But this has NOT been my experience with Tandem CIQ. With the 670, it seems like the MT designers understood their task to be to redesign the traditional pump from the ground up, with a view toward making the user’s experience to be a set-and-forget black box they wouldn’t even have to think about 90% of the time. But in the execution that meant locking away all the controls and leaving you staring at a blank wall when you needed to modify it to fit your own metabolic needs.

Tandem on the other hand seems to have started from a much more humble place. Like they looked at the manual pump with its programmable, if fixed, basal rates and instead of proposing to replace it wholesale, said “What if we just added a layer of programming on top of what it already does so the CGM can adjust things where necessary and otherwise leave well enough alone.” Like they realized there would be a human in the circuit who also might have a sense of what their own body was doing, and they realized it would be advantageous to let them sit in the pilot’s chair on the flight deck rather than manacling them to a seat in the passenger section.

My old pump just could not get ahead of my DP, even thought that early a.m. rise was as predictable as clockwork. There must be SOME way to tell it that’s going to happen, isn’t there? “I’m sorry Dave. I’m afraid I can’t do that.” Whereas with the Tandem it has my early-a.m. basal rate in it, transferred from my manual pump, and it can just let that rate do its thing, or it can give it a bump or pull it back a little if the data and algorithm indicate that will smooth my ride. If I’m not satisfied I can raise it myself and then that will be the baseline CIQ is working from thereafter.

For another example, bolusing. At first I kinda got the assumption that there was a hard-wired requirement to always enter a carb value and have the pump do all the calculations to set my dose. Now I’ve gotten lazy about that stuff—I have a pretty decent sense of how I’m going to react to most foods and can make a pretty good seat-of=the-pants estimate of what I’m going to need. But NBD, I thought, I can deal with carb counting. Only then I accidentally touched the “Units” field while setting up a bolus and realized, “Oh, I can just put my own number in!” Turns out all the fields are like that. BG auto-populates from your CGM, but you can tap it and put your own number in if, say, you’ve just done a finger stick but haven’t recalibrated yet.

And none of this requires you to quit out of CIQ mode. So if you’re off, your pump is still going to be tracking your BG and evaluating whether you need a nudge up or down while your meal is metabolizing.


In short, it feels like a smart BG assistant, not a little robot that’s completely uninterested in your feckless input. In short, it feels like the people who programmed it were very much aware of the user as a participant and collaborator in the process. That impression that it starts from a position of valuing and accommodating user preferences and input is a huge difference from my apprehensions and goes a long way toward mitigating the few irksome things I have encountered.

Just my perspective. Hope others find it useful.

EDIT: I don’t know anything about the Medtronic 780G and don’t mean this to be a comparison. I’m only using my experience with the 670 as a point of contrast to explain what’s so drastically different about CIQ and why I like it as much as I do.


Very good and well thought out review. I never wanted HAL 9000 to control my insulin delivery.

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Great term!!

Some folks name their pump, in a similar way of thinking of it as an assistant.

Good luck with continued great results.


So happy to read this! Unfortunately, I’m a geek through and through and jive best with the tech specifics. It’s how I talk and think. It’s nice to see a different perspective.

Just out of curiosity’s sake, and for the full review (since you only talked of the positives), what are the negatives? I love my T:slim, but mine is by far the micro-usb choice! Usb-C was already around when the pump was developed, and so much more capable and user-friendly.


The new version will be wireless charging so they will skip the c. I was hoping there would be some other charging ability because carrying around a wireless charger is irritating. I realize that I hardly need to charge away from home. And the new pumps will be charge faster and last longer.

I intend to get a mobi next and it’s supposed to be charged when you change out your set. Hard to believe it can run for 3 days and then charge for 5 min, but I guess we will see if it ever hits the market.
Charging is the least of my worries.

I was asked to do a clinical trial with a new version of CIQ that is an algorithm that doses for food with no input. I didn’t have the bandwidth to get to the site so I declined.
I hope they don’t take away the control I have now because I’m a micro dozer and I can correct before my pump gets to it.

The CIQ is a great back up for me but I’m still faster and also more on top of it still at this point.


It looks like you are getting a great first couple of weeks with your Tandem! I love the HAL 9000 comparison :rofl: :crazy_face:.

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I’m guessing that this system would increase insulin as BG rises after eating. Yeah, I’m not comfortable with that.

To which I’m not unsympathetic. I’m something of a tech geek too. I spent most of my career as a web and interactive developer, including a lot of UX stuff, also worked for a biotech instruments firm, so the nuts and bolts matter to me, but the question of what the app communicates to the user is also critical, and I’m sensitive to the ways that can get lost in the design process especially if it’s heavily engineering-led. The Tandem really feels like the product of a user-forward rather than programmer-forward design process. I’ve been on both kinds of teams so it’s something I pick up on pretty rapidly.

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Well, a couple of things. Bluetooth dropouts are more frequent. I was surprised by the caution to wear the thing on the same side of your body as your sensor with the screen facing out. Wut? They say, “Cuz your body can block the Bt signal.” Srsly? I don’t have that problem with my phone as receiver. But sadly it is a thing. I’ve always kept my pump in my t-shirt pocket when I go to bed, but after getting jerked awake with “Out of range” alerts a couple of times I now have to leave it out so I can move it close to the arm with my Dexcom when I roll over. Had an (embarrassingly loud) OOR alert yesterday at a baroque music concert because the signal apparently couldn’t reach from my arm to my jeans pocket.

Set change process is kind of a PITA, as I expected, but this last time I managed to do it without spritzing insulin all over my laptop—progress! Software-wise, I accidentally hit “Fill tubing” while I was just setting up, still attached to my expiring set, and away it went. I hit the “X” to stop it, but there didn’t seem to be any way exit out of the option; it was just “Continue?” or nothing. Just had to wait until it timed out on its own. That seems like something that should be locked out until you’re at that stage in the process, as opposed to allowing you to go ahead and give yourself a 17.8u bolus without meaning to. Also had some similar glitches around finding I’d somehow skipped the “Fill canula” step without intending to. Just learning-curve stuff really, but I knew this was going to aggravate me. Heck, I still found the Medtronic process could get bollixed if I wasn’t focusing, and that was much simpler.

Speaking of which, DAMN I do miss those Mio Advance insets. I was surprised at what a difference those made when they came along, and it really feels a step backward using the older-style spring-loaded thwacker that Tandem uses. It’s much more awkward when you’re tying to use hard-to-reach real estate, and the tubing wants to get in the way, and the alignment of the trigger indents is 90° away from how I want it in order to get the clip facing the way I want. I did ask my trainer about the inset situation, and yup, as you’d expect Medtronic has an exclusive arrangement for the Advance, so Tandem can’t use it. She said they’re is working with some other company on their own improved version but who knows when that will be available.

Otherwise, just little stuff that involves adopting a new routine here and there. Recharging the battery, f’rinstance. I do have one of those extension batteries for my phone so I’ve been using that to avoid being pinned down to an AC outlet. Remembering to plug it in while I’m in the car.

But all more than compensated by the overall feeling that I made the right choice. One of the worst things about this disease is what I call “T1 Claustrophobia.” Finding yourself stuck with a regimen that just isn’t working out, it’s screwing with your quality of life and you can’t easily change it. Kind of a derivative version of getting the DX in the first place. I was in that place with the old R/N regimen, when the whole basal/bolus thing came in and I’d heard about it but couldn’t get my (HMO) doc to let me try it (YDFLNCA*) or give me a referral to a specialist (because HMO). Also experienced it when I tried the Assante Snap pump and was suffering from incessant occlusions, and again with the 670G after six months—I’m tethered to this goddamned thing 24/7/365 and it sucks! Well, I mean every regimen has stuff that’s going to be irksome compared with, y’know, having a functional pancreas, so it’s a question of degree really. But that apprehension is what held me back from making this change for years. “The devil you know” syndrome. Kinda why I wrote this post: the review for the me who was leery of going through all that again.

Having made the decision, I mentally prepared myself for an extended process of acclimation, based on past experience. “Give it some time, remember your first pump—took weeks to get it dialed in” etc. Instead, I felt like I was 90% there within the first week. First couple of days even. So this thread is kinda my attempt to send that message back in time to myself, in the form of anyone else coming from a similar place and having similar apprehensions.

*You’re Doing Fine Let’s Not Change Anything.


Are you using the Tandem XCs? I found them easier to align and get attached.

I miss the Medtronic Quicksets and Tandem would be perfect if they could work. But the XCs are next best in my opinion.

AutoSoft 90, I believe. Basically the old-style MIO with Tandem-compatible connectors. It’s too bad these things can’t be some kind of generic with universal connectors.

I use the XCs, they are similar to Auto 90, but many think XCs are better, easier to connect.

If interested, you could ask Tandem support for samples.

Tandem use to use Luer lock connectors but changed to a proprietary connector. Probably to stop the loss of sales because people were using Medtronic sets.

I really don’t see any advantage to the new connector over luer lock.

Thanks for all that! I think it’s important to highlight the bad alongside the good so nobody gets suckerpunched down the road. I agree with so much of it, but honestly kinda forgot because I’ve just learned to live with those things.

The 90-drgree rotation of the autosoft sets’ triggering mechanism to the tubing release mechanism used to annoy the ever loving “urine” (because apparently the p word that ends in -iss is a bad word now???) out of me. I got around that by actually following the fill instructions. Go figure… I usually insert the set first, remove the tubing, connect to cartridge, fill tubing, then finally reconnect and prime the cannula. That’s what the instructions USED to say. Now, if I’m planning an awkward placement, I connect the entire infusion set and inserter setup to the cartridge, fill it completely, insert it wherever I can reach, and then just don’t plan on disconnecting it ever for those three days. It’s really not been a big deal this way since the pump can go in the shower and whatnot and it’s doesn’t have to be disconnected to charge, but it’s definitely an annoyance that one shouldn’t have to juggle.

Tandem’s new set in the works is pretty cool. They acquired Capillary Biomedical in 2022, which is 2 years after the video I’m gonna link was made, and it was already in clinical trials at the time, which should mean a speedy rollout. (Well, as speedy as things go in the medical world.) The entire video is worth a watch, but you can jump to the 22:25 and 27:00 timestamps to see the cannula and inserter. It’s a very different beast than what we’re used to now.

The Bluetooth does dropout sometimes, but usually reconnects on it’s own without me doing anything. It’s this unique to the T:slim? I figured that was an inherent problem with all Pump/CGM systems since it’s so easy for our body to get between the 2 devices. I actually do wear mine screen facing in, though. The only time it’s really an issue is if the pump gets under me in the water bed. Bluetooth does not like water!

Have you discovered that all the sounds/vibrations are customizable, except the critical low alarm? Options> Device Settings> Sound Volume>. There you can adjust the volume or set things to vibrate instead of making any noise so there’s no more embarrassing concert experiences. Be warned, though, vibrations use a lot more battery power than audible beeps. I usually only charge once every 7-10 days, but go through battery like water if I forget to turn vibrations off.


Yeah that’s what I was doing with the previous pump and I think I’ll take your tip and go back to it. Just wasn’t sure if I was going to hit some snag in the process.

Yes! I actually have tweaked some of those, but I guess I’d left the loss-of-signal one on the default. Loud!

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Thanks for that video! I liked the developer’s comment about what a PITA these idiotic proprietary connectors are. “Great for the pump manufacturers, terrible for everyone else.” That multi-port approach is also fundamental to the new Medtronic extended-duration inset; I recall seeing a thing about it a few months ago. That one’s already on the market, but it wasn’t compatible with my old pump so I was out of luck there anyway. The Advance set is a lot better than the older MIO, but it looks like we’ll leapfrog that with the the Capillary Biomedical one when it comes out. Couldn’t find any info on that, but SOON please!

This is quite exciting. The use of an angled cannula with the addition of 3 small side ports as well as the main insulin distribution at the tip sounds like a real improvement.

I watched the whole thing and learned more about set failures causes in the 1st half than I ever knew.

I recommend everyone who is pumping or thinking about it to watch the whole thing.

I wonder how close this set is to be approved and released. Surely before the cure in 5 years :stuck_out_tongue_winking_eye:. Yuk yuk.


Exactly! They’d better hurry, it won’t be much use after that.


And just to reiterate, having done it AGAIN, it is TOO doggone easy to forget you have to manually “resume insulin” after a set change. I’m used to “fill cannula” being the final step in the process. I don’t know how I’m going to train myself otherwise. Shouldn’t “resume delivery” pop up as a dialogue at the end of that process?

You would think so, and have you experienced the bolus incomplete because you didn’t lock the screen?

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