Tim, I’ll try to explain it the best I can. When you need to do a bolus, you enter the bolus function of the pump. You then have 3 options for the bolus, either units, carbs or bg value. When you go into the bg section, you have to manually enter the bg level, the pump does not pull this information automatically from the sensor readings into that field. When I did my calibration earlier today, my bg was 118, my target that my pump is programmed with is 100. Right after I got the calibration confirmation screen, it then took me directly to a screen that told me my bg was higher than my target and it automatically calculated the correction bolus, so all I had to do was press the confirm bolus button a few times, I think it’s 3 screens of confirmations before the bolus starts. I don’t understand why this feature isn’t working when you go into the manual bolus screen through the bg option. I believe my Medtronic 723 and 530 pulled this info from the sensor readings into my manual bolus, I can’t remember if this is correct.
@Jason99 - Nice detailed description!!! I do not believe we have yet entered a calibration into our pump. That aspect had slipped my mind until reading your post. So we have not yet been in the same situation. Since pulling the Smart Phone into the picture (quite some time back), all calibrations are typically done on the Smart Phone and we have just continued doing so even with the X2/G5 integration - guess out of habit but also I think it is slightly easier on the Smart Phone?
Anyway…
What I glean from your description is that whether entering the BG calibration into the X2 pump or copying the BG from the one cgm X2 screen to the other bolus X2 screen, the X2 system apparently has the requirement for a human intervention with the entering of the BG as part of the bolus process.
I am wondering if this could be due to a limitation of the FDA approval on the Dexcom G5? The FDA has approved the G5 for fingerstick replacements but not for automatic bolus whereas with the Medtronic, their current sensor has been approved for the reverse which is approved for automatic bolus but not fingerstick replacement. I don’t have the exact FDA approval phrasing in front of me but as I recall that was the gist of it.
Perhaps?
Tandem is planning on using the Dexcom G6 as the cgm system for the Predictive Low Glucose Suspend (PLGS) update for the X2. One would assume that Dexcom will be requesting an FDA approval for the G6 to not only include the fingerstick replacement as the G5 does but also to include an approval for automatic bolus. That should completely open the door to allow the Tandex X2 (with the PLGS upgrade) to auto-populate the BG field even if it is not yet completely automatic.
Or I could be way off track as some of this is pure guess work.
Tim, I think your spot on with every aspect. I’ve had the G5 connected to my iPhone and Apple watch since I got the G5 and Tandem pump in February. I’ve been with Medtronic most of my life, but when the pump trainer informed me that they had no smartphone integration with their new 630g I immediately returned it. My 530g had that integration and the ability to alert my fiancé if anything was wrong. This feature had saved my life in the past. I looked elsewhere and really liked where Tandem was going product wise. I’m very happy with my X2 and Dexcom team so to speak. We’ve finally reached the stage in diabetic technology that was promised to me when I was diagnosed in 1983.
I just assumed it would auto populate too. This takes away a big part of why I wanted Dexcom values on my pump.
The coverage of the Dexcom G5 was based on the receiver being categorized as DME. Without a DME designation there is currently no coding category for CGMS. This is a blogpost that I wrote in January that describes the approval of the G5 in January and it gives a link to the CMS ruling with the DME explanation.
Longterm Medicare needs to address digital medical technology without requiring everything to fit neatly into their DME definition. Here is a link to an article addressing the problem:
It’s encouraging that the GAO is realizing that CMS policies are inadequate and need to be changed and updated. Unfortunately, nothing like that is going to happen with this current administration and more so with the vile subhuman that is currently in charge of HHS. At least there are people standing up and saying that CMS rule changes need to happen for the benefit of all their patients. Thank you Laddie
Ok - I changed my mind on why the requirement to manually enter the BG. Perhaps somebody who used the Tandem t:slim G4 with the Dexcom G4 integration can confirm, but I would suspect this is similar behaviour on the Tandem X2 as on the Tandem G4.
I was checking timelines and I am pretty sure that Tandem submitted the upgrade for the X2 to have the G5 integration BEFORE the FDA decision to allow bolus to be direct from the G5 without a fingerstick required. So if that was so, then Tandem was not able to take advantage of that decision and had to build the X2 software upgrade (at that point in time) to be similar to the G4 in that a human had to be involved. It could not be perceived as a bolus directly from the G5 as that had not yet been approved by the FDA.
Tim, this makes a lot of sense. I don’t have anything constructive to add except you’re on fire with this stuff. Thank you
I’m someone who would also want to keep using my receiver. The reason I still carry it is because it handles alarms better (and more reliably) than my phone. The phone drops connections more often, and the battery lasts only 24 hours, so I don’t trust it for alarms. I don’t know how much I will trust the pump to handle alarms until I’ve seen it in action.
Also I keep my pump in a spibelt, and don’t have easy access to it while driving. When I do long drives, I prop the receiver up in my cupholder. 
Frankly the only reason I wanted the integration with the Dexcom was so that it would prepopulate my BG, which sounds like it doesn’t do so… I’m not sure I’ll update anymore. 
@daytona - It sounds like you did not run the X2 update yet? I believe the email says the code is good for 60 days. So you don’t have to rush it. You can take some time to think it over.
The biggest question I would have (which perhaps Tandem Tech Support could answer or maybe not) would be if you decide NOT to run the X2/G5 update now, would this impact your ability to run the next update that Tandem is planning to release for the X2? Which is the Predictive Low Glucose Suspend (PLGS) currently planned for launch summer of 2018. (Realizing that most things slip but still…)
In any event - 60 days to mull it over.
I am still working with Dexcom Tech Support on the receiver issue and have not given up hope of Dexcom making it all work out.
Ok, is it just me, or does the X2 not have good reception from the G5 as the Dexcom receiver and smart phones do?
I wear the X2 in my spibelt on the opposite side of my torso from the G5. And I’m losing signal pretty often.
If I move it closer, the signal improves. But I don’t think my body would block the signal enough to affect it.
This means I MUST carry my phone with me at all times to keep a constant connection.
The X2 will fill in the blanks from the phone nicely. But I didn’t want to have my phone with me all the time!
The X2 should be backfilling the gaps directly from the transmitter - not related to whether or not you have the phone. 3 hr max backfill.
It would actually be interesting if you could determine if the phone itself is causing any interference. Not really sure how you would go about such a thing though…
My X2 is frequently losing its connection to the transmitter. So much so, that I’m sure I wouldn’t want to rely on it when next summer’s predictive suspend update comes out.
The bad connectivity is certainly not distance related, after all, the pump is rarely more distant from my transmitter than the length of the tubing. It feels more like it doesn’t do well when other Bluetooth devices are nearby, even if they aren’t actively being used - eg. an iPad sitting near my hip seems to correlate with connection problems.
My biggest gaps are when I wake up in the morning. But this happened this weekend when I was out in the middle of a field, and no cell phone, etc (I live out in the country, fairly rural.)
I can swap my router result enough and turn off the lower frequency band.
I haven’t had any signal dropouts, I’m very concerned about the battery life of the pump now. I fully charged my pump less than 24 hours ago and I’m at 50% already. I’m lazy with charging this thing, meaning I don’t top it off when I’m in the shower. I usually end up charging it when I’m sitting on the couch and notice the battery meter is low. I can’t believe how the G5 integration is sucking so much battery life out of my pump.
@Jason99 - I would suggest to call Tandem Tech Support. The battery should not drain that fast. I don’t have the manual in front of me but from memory, I recall it saying the battery on the X2 without cgm integration should last 7 days and WITH cgm integration it should last 5 days.
It sounds like you are so not close to that as to likely needing the internal battery of the X2 replaced (under warranty).
Tim- I finally did call them, and I asked if they’ve been getting any calls about excessive battery drain. They had me upload my pump data to t:connect, because they can see a lot more data on their side about the pump than we can. The tech support guy, could see what time and date I charged the pump, and to what battery level. He told me I needed a replacement pump because he didn’t like what he was seeing with the battery activity. Same thing is going on today as well. This was not happening before the update last week. I wonder if there’s a glitch in the software. Occasional when I update my iPhone, some bizarre problem will show up after the update. Now, when I plug my Apple headphones in, all volume ceases to come out of the phone. If I’m listening to music and a call comes in, I can’t hear what the person is saying. Anytime I use my headphones, I have to restart the phone before and after I use them. This is the type of technology stuff that drives me crazy. Tandem stood behind their product and overnighted another pump to me, which all we can ask for.
@Jason99 - Hopefully the new pump will hold the battery charge for days as it is supposed to even with the cgm integration.
I can double check on our X2 but I don’t think we noticed a difference in the battery drain. What you had described was pretty much “in your face” so if it was that bad, I am sure we would have noticed.
BTW - I would be interested to know if the replacement pump arrives with the X2/G5 update already installed or if it is base X2 configuration when you get it? (just curious).
Tim, the pump would go from 100% to 45% in less than a day. Then, it stays on that 45% and doesn’t change. I did ask Tandem about the software on the replacement pump. I was told that the pump will ship with the latest software already installed, so all I’ll have to do is enter my Dexcom ID info into it. We’ll see. My only gripe with Tandem replacement pumps is that they overnight it by UPS, but don’t use the guaranteed by 10:30am service. Even though it is overnighted, it will arrive by the end of day, which is like 8pm.
Sounds like they didn’t hesitate on sending the pump. So that is good!
I noticed a ‘slightly’ higher battery drain. But this was to be expected.
Nothing I am worried about. But it does put a little more pressure on me to get a battery backup to keep with me. A simple rechargable battery for charging phones, etc. should work fine. I couldn’t imagine it taking much t charge the X2, even a few times.