Talk to me about the t:slim

Diabetes Technology
1

I want opinions from real-world users before I talk to a rep.
I have what I think is a complicated situation and I need direction.

Truly, the only reason I’m considering changing pumps is so that I can test different lengths and angles of cannulas. And maybe the fact that it will work with my Dexcom (I hope, but more on that below).

I’ve been on Omnipod for over 4 years now, and its the first pump I’ve ever used. I love not having tubing. I’m plenty used to being careful at not ripping the thing off. There are still accidents, but such is life as a diabetic. I’ve been using Dexcom for almost the same length of time. I have the G4 with Share, but can’t use the Share since I’m an Android user (someone tell me they’re working on fixing that though? I don’t keep up with the news). And I would love for my husband to be able to see my blood sugar levels with a glance at his phone too. But this is all beside the main point.

I have problems with sites. I was on MDI for ten-ish years and used ONLY my stomach (didn’t really know better and wasn’t taught). So when I place a pod there, absorption rates are pretty low and I struggle with staying in range. I’ve been using the sides of my upper thighs. When I can find a good spot, they work well, but those sites are harder and harder to find. I have three scars from site infections - in the “sweet spot” of my right thigh, upper left stomach, and back of my left arm. So those sites and the tender areas around them are out of commission.

I’m not skinny. I have a solid layer of fat. My doctor doesn’t seem to think the length of needle makes a difference, but is willing to give me whatever length I want. I don’t particularly relish adding to that fat layer, but I don’t truly understand where insulin is best absorbed - not in diabetics in general, but in ME personally.

So right now I’m using the Omnipod for boluses and Tresiba for basal. That helped my absorption rates a bit for a couple months, but they’re getting worse again. I hover in the low 200’s. I can’t pick out patterns. The Dexcom software can’t pick out patterns either, fwiw.

Changed pod at dinner last night, a little after 7 pm. I took 2 units of insulin at 9 pm last night when my pump didn’t suggest I take any, bg was 203 with insulin still on board. At 9:57, my bg was on the RISE at 257 so I took 4 more units (I think only 2 were suggested, but knowing myself, knowing the highs I’ve been having during the night, I bumped it up to 4). I also threw my Dexcom off the bed in a fit of rage. And it still took until 2 am to get down CLOSE to range (which i keep at 70-170 for my rapidly declining sanity). Then it hovered around the 170 mark all night, spiked again after I ate breakfast this morning (two eggs and coffee, same as always - bolused 11 units for that!), bg still 219 at 9 am, so another bolus of 4 units and Dexcom reflects I’m finally trending back down into range. Highish range, not mid-range, or near 100.

Guess what. It’s almost time for lunch! Hahaha! :cries:

I’m sure you can see this is causing me a ton of stress. We’re trying to get pregnant, which is why I want my blood sugars under better control (and they’re truly not TERRIBLE, my a1c is in the upper 6 range but seeing these high numbers day in and day out scares and worries me). The example above is a DAILY thing for me. I can’t tell you the last time I’ve been in range ALL DAY. Maybe last week sometime?? I change pods, I rotate sites, I’ve switched insulins (from Apidra, which seemed to cause more site irritations and was the cause of the three I mentioned above, to Humalog). The only thing that hasn’t changed is the cannula. So here’s the big questions (sorry it took me so long to get to them, thanks for sticking with me on this!):

  1. Do you think different angles and lengths of cannulas will even make a difference?
  2. Will tandem allow me to do a test run for a couple weeks so that I can try different cannulas and see if any work better for me?
  3. Can you still use the t:slim with Dexcom G4 if you have an android device?
  4. Important but only tangentially related - does anyone know of some dermatological procedure that can break up scar tissue and perhaps help with absorption for us diabetics?

I’d like to hear specifically from people who had issues on Omnipod and switched to t:slim. Its a big expense and a lot of effort to go through for something I’m not even sure will work. I’m not interested in Medtronic at this time, sorry. Nothing against them, but I prefer to stick with Dexcom, so the t:slim seems the way to go. Learning to manage a tube would be a challenge, but if I can get better control, it might be worth it. I’m not super committed to Omnipod - I had a bent cannula the other night, bg in the 400’s, insulin oozing out everywhere, and it didn’t alarm :angry:.

Like I said, stressful. For some reason, my job stress seems manageable, the stress of ttc seems manageable, but my blood sugars drive me absolutely bonkers when they don’t respond to insulin (hence the rage throw of my poor Dexcom. Sorry, Dex, it wasn’t your fault!!).

I hope someone out there can help with some advice. I have an endo appointment July 19th and I’d like to have a direction to go in by then. BUT if you think I’m being completely ridiculous, please provide a powerpoint presentation with logically bulleted points and cute cat pictures to ease the way. :smile:

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Wow that is a lot. lol.

So we have not used omnipod. In terms of other pumps, with many you have a choice of infusion sets so for a given pump you may be able to choose:
90 degree straight vs 45 degree angled
plastic flexible cannula vs steel
6 mm vs 9 mm
23 inch tubing vs 46 inch tubing
These are ones we have looked at and other pumps perhaps more.

The Tandem has publicly stated in their “pipeline” the updates which will provide greater and greater integration with the Dexcom. This was a significant factor in us (recently) choosing to go with the Tandem t slim X2. We have been using the Dexcom CGM for many years and are very happy with the accuracy of the Dexcom.

The G5 does work with Android. The Android app was released maybe 2 weeks ago or so? It is available for download on many Android devices although not all. Check Dexcom website to see if your OS/device is listed.

The share works great for a second person to be able to see your BG.

The newest Dexcom G5 transmitter has backfill capability so you are much less likely to get “gaps” in your graphs of BG values.

In terms of sites, an Endocronologist should be able to help you find many more places to put either an infusion set or the CGM. The FDA has certain approved sites for each and many people find many other non-FDA approved sites to work for them as well. Probably best for a discussion between you and your doc in relation to which ones would work best for you.

In terms of an extra layer of fat and canula depth, this also is a good discussion with your Endo. If you switch from say the 6mm to the 9mm canula it could change your insulin absorbtion or maybe not. Best to discuss with your Endo but you would have some choices in the infusion set and perhaps find one that really works ideal for you.

When trying to bring down high BG, I find that sometimes an increased temp basal can be extremely effective in conjunction with a bolus. Perhaps the reason for the increased BG is something pulling you up? (Stress, sick, hormones, could be many things). In which case the bolus might bring you down and the temp basal keep you down. Certainly always different for different people in different situations. But bolus + temp basal is often effective for us.

We do find breakfast very easy for a huge spike. Biggest way we have found to avoid that is a 30 or 45 minutes pre-bolus depending on the foods being eaten.

Lunch is a problem if breakfast was a problem. They are just so close together. So I like to focus on getting breakfast fixed before trying to make long term lunch changes. If breakfast was bad than I know lunch will be and just have to get past it. But I would stay focused on getting breakfast better and then start working on lunch patterns.

Tandem t slim with G4 is only the older Tandem. The current Tandem is the G5 and we are waiting on integration to happen. The G4 and G5 have different communication frequencies and protocols so are naturally incompatible.

Would your insurance cover the t slim? The cost was actually much much lower than I had expected.

Good Luck. Stick with it. Sounds like you are actually in really good shape and looking to improve even further.

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THANK YOU. I guess I didn’t even think to check the Dexcom site, assuming I would have seen talk of the update here in the most recent discussions. I still only have the G4, but at minimum, even if I don’t decide to switch to the t:slim, I think a G5 update might be in order. My phone is listed and I think my husband’s phone is listed as well, have to check his model when he gets home tonight!

I guess I didn’t go into depth about my conversations with my endo about my sites already. I don’t know of any other places to stick a pod that will work, FDA “approved” or no. I’ve tried the back of my hip and lower back area, but I get occlusions every time, without fail. Not sure why. I rotate my dexcom sites on my hips and sometimes my lower stomach. And endo doesn’t think the length of needles and canulas matters, as I mentioned, which is why I said maybe I just don’t understand how insulin is absorbed, etc. My endo doesn’t actually have diabetes, which is also why I’m here on this site. She would send me to the diabetes educator to talk about pumps & sites. I’m open to learning, but not sure what else there is to know.

Insurance covers DME at 80/20, but I haven’t called them about a new pump yet. Thankfully we’re in a position where the money isn’t a huge concern right now, as long as insurance picks up their part! And like many of you, I’ve already met my deductible for the year (cough-March-cough).[quote=“Tim35, post:2, topic:62327”]
In terms of other pumps, with many you have a choice of infusion sets so for a given pump you may be able to choose:
90 degree straight vs 45 degree angled
plastic flexible canula vs steel
6 mm vs 9 mm
23 inch tubing vs 46 inch tubing
[/quote]

I’ve looked at those, but again, just don’t know which my body will prefer. Must test! Although I think I would prefer the shorter tubing length. 23" seems really long to me!

True, and that sometimes works, but again, then I’d start running into problems with site absorption. And stacking. I’m trying to focus on better application of the insulin that goes in. I can throw insulin at a stubborn bg all day, but if its not absorbing and my bg stays perfectly level (which it does, just at 230 instead of 140)…then what’s the point?

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i have never used Omnipod. I’ve been on the T-Slim 5 months-my first pump. I was worried about getting used to tubing but it honestly hasn’t been a problem at all. I’d say it only took a few days before I wasn’t really aware of it. The pump is small–fits easily in a pocket or in my bra.

As far as length of tubing, I use 23" and it really isn’t that long. It allows you to put your pump in different spots. But I’ve not used the pod so I’m sure it will seem different to you.

I tried every insertion set Tandem makes before I settled on one. My trainer gave me samples of each to try. My trainer seemed to think it is normal to try different ones.

It’s worth a try. I think Tandem has a 30 day return policy but you should ask them to be sure. I could be mistaken.

5

I used the Omnipod for five months back in 2012. I had problems with getting consistent absorption. I had BG control trouble with every fourth or fifth pod plus I had many pod-change highs. When I returned to my tube pump, my control returned. I also experimented with several different infusion sets. I ended up going with a 90 degree set at 6 mm depth with a teflon cannula. I successfully used that combination from 2012 through most of 2016 when I changed pumps again.

Are you confident that your basal dose of Tresiba is set well? The basal rate is fundamental to good pump therapy. If the basal is set too low, meal and correction doses can seem to do little or even nothing. Perhaps you and your doctor can consider some formal basal testing. I like Gary Scheiner’s protocol; he addresses both pump basal and MDI basal testing.

It helps a lot if you start a diabetes log to keep track of your insulin doses, meals, exercise, and any other things you think affects your blood glucose levels. A log will give you some perspective to see past the minutia and view the larger factors at play.

6

I get your frustration. It looks like you are putting a whole lot of thought and surveillence into your blood glucose control. As someone who has a CGM and has used a t:slim my advice would be to go back to MDI, using the same fast acting insulin as you would in the pump, and gain stability before again going back to any pump. Even on MDI there are so many data points to consider when troubleshooting but add a pump to the mix and the complexity expands significantly, as you are finding. With MDI you can focus on right drug, right dose and right time and then when that’s nailed add pumping challenges such as lipodistrophy, optimal cannula lengths for best absorption, micro or burst delivery, silent occlusions and such. You’d lose the ability to fine tune your basal, moment to moment, but from your narrative it doesn’t look like basal is the issue. Best of luck!

7

I suggest that you join the Tandem tSlim Pump group on Facebook (Tandem tSlim Pump | Facebook) to ask your question and you’ll find some users who have switched from the Omnipod.

On my blog I have published a couple of reviews of the Tandem X2. I struggled with false occlusion alarms for several months, but they have been eliminated by always keeping my pump in a case. Basically I am very happy with the X2. You can find some of my posts here: T:slim X2 | Search Results | Test Guess and Go

Diabetes Mine published a good update on Tandem today: Tandem Diabetes Care: Staying Alive and Focused

Infusion set types are a very individual matter. In 13 years of pumping, I have always done well with manually inserted angled sets and have never found a 90 degree set that works well. Other people have different experiences. I have never minded tubing and have always thought that the size of a tubed infusion set is much smaller than an Omnipod.

Good luck getting the info you need and making the right decision for you.

8

I’ll add one more little bit to the idea of your issue with scar tissue and lack of good places to inject/pump. With MDI the research is coming in pretty solid that the nano pen needles (4mm & 32 gauge) work just fine for all body types. And you can inject, 90 degrees, almost anywhere they are so short. Now, I wouldn’t try my forehead but I’ll inject in a whole lot of places that would have been impossible with say, a pump, or 8mm needles.

1 Like
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A few of us have been discussing the mystery of frequent occlusion alerts with Tandem pumps.
That discussion is here:
https://forum.tudiabetes.org/t/t-slim-or-t-flex-and-occlusion-alert

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Thank you, I do have those for my Tresiba dose. I manage to move that around a bit more than normal, but still haven’t attempted any injections in my legs with those.
I get what you’re saying about MDI too, and it’s something to consider, but calculating the correct bolus is hard for me. I went back onto MDI last fall for several weeks but I just couldn’t stand the meter I was using, an Accu-Check, and as far as I’m aware, its the only other one that tallies your insulin needs for you. It was so clunky and awkward and those strips were huge! lol

Tubed pumps boggle my mind, honestly. When I first wrote this post, I was set on getting a t slim. Two nights ago, I was determined I would never go on a tubed pump. Even on the “short” 23" tubing, it just seems like an awfully long way for the insulin to go. It seems strange to me.

Yes, the size is a plus for me, however I doubt it will fit anywhere in my bra. The Dexcom barely fits sometimes. Too bad there aren’t more women’s clothes with acceptable pockets!

Another thing I’ve been wondering about is the “dual wave bolus” that I read about. That’s exactly what I’m doing on Omnipod, only manually! Bolus for my meal, eat, an hour later still high, bolus more. Another two hours later, still too high, bolus more!

I managed to get an earlier appointment with my endo, so I’ll see her tomorrow instead of waiting until the 19th. I sent her a frustrated email and she made some suggestions and things she wants to test. Hopefully we’ll figure something out. A new pump is kind of last on the list, last resort type thing for me right now.

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Can you expound? Perhaps it is possible to address your specific concerns in this area.

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I’m used to Omnipod. No tubing. Or injections, where the insulin goes straight in.
Sending this precious, lifesaving liquid so far through a tiny tube where anything could go wrong on the journey just strikes me as strange. I know tubed pumps have been around decades longer than Omnipod, so I know its silly.
It feels like it should take longer to get your bolus. Or that its counterintuitive to what I need. (more more more insulin bolus bolus bolus!)

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The tubing could hold anywhere from 10 to 20 units. Making a pretty big guess for different types/sizes. Point being if you are dosing 3 units, the insulin which is going into your system is not “at that moment” coming directly from the pump reservoir but rather from the tubing closest to your infusion set.

Sorry if that was blatantly obvious and you were referring to something else.

If it is just a “comfort level” then you may have to do whatever works for your personal comfort zone. But if any specific questions that can be concretely addressed then…

14

You fill the tubing and the cannula when you first put on the infusion set. So the insulin is sitting in the cannula ready to enter your body. It doesn’t have far to travel.

It is an adjustment getting an tubed pump, whether you are going from an Omnipod or no pump at all. But for me, I was a quick adjustment. There are lots of hints on line as to various ways to wear it and I haven’t been limited at all.

15

There may be many reasons for sticking with a tubeless pump, but this isn’t one of them. It’s the exact same concept as a hospital IV, which are relied on for lots of life-saving liquids (including insulin).

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I’ve been pumping 17.5 yrs, started on Jan 1, 2000 with a Medtronic. Moved to a Deltec Cozmo (My favorite by far), then Animas Ping (hated it, occlusion alarms every few hours for no reason at all), back to the Medtronic and now on the third month of the t:slim.

I am in the process of writing a review of the t:slim, but will jump to the heart of your concern. I have several user interface complaints about the t:slim that have caused me a couple of very high sugar episodes, and the load process is very tedious along with taking more insulin than the other brands. But my biggest gripe has been the quality of the t:90 insets. They are the same as the Animas versions and nearly the same as Medtronic’s but the lack of adhesive is abysmal. My sugars have not been this bad since I was first diagnosed in 1987. And now that I hear Tandem is going to a proprietary connector ala Medtronic, it appears that going with another supplier of infusion sets will soon be out of the picture.

If Tandem would raise their quality control of Unomedical’s product, they could match Medtronic on the infusion sets. But it remains to be seen if they even acknowledge that they have a problem on their hands.

At the present time, I can’t recommend Tandem given my experience with all of their infusion sets, especially the t:90 which I have been using since I started pumping.

Addition: About an hour before I wrote this, I changed infusion sites. The t:90 sets, like their Animas cousins are self contained, with the tubing wrapped around a pod injector. Unlike the much better designed Medtronic version which has tubing separate and a separate plastic delivery tool, these have a tendency to pull the set up off of the needle, and you end up with a kinked cannula. And even when you are EXTREMELY careful, pushing it back down, praying to the infusion gods, you will get this. I caught it three hours later as my sugars approached 400 and I was ready to throw the t:slim at the wall. Note that the t:slim sounds no occlusion alarm, yet it doesn’t deliver insulin. No idea where it goes when the pump is supposedly pumping its guts out to deliver 20 U of insulin via bolus twice in 120 minutes. Again, I am no fan of Medtronic for a number of reasons, but I cannot recommend Tandem due to their infusion set designs and quality control of the adhesive.

I’m running about 60-75% “spoilage” where I throw the set out because I can’t use it. Even when Tandem gives you 3-4 as replacement, the costs are outragious. And if you pay much for insulin, the overhead of Tandem vs Medtronic is about about an additional 20-25 wasted units per load.

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