Tslim insertion trouble

Just switched to the tslim for the better algorithm after being on the Omnipod horizon study for the past two years.
My dawn phenomenon is way better managed but I really miss the ease of insertion of the pods. I hate all the parts of the tubed pumps… but whatever I’ll get used to it.
My main issue is I keep inserting the autosoft 60 and 90 wrong so it’s not actually and and have a huge resulting 350+ BG because not getting any insulin delivered.

Any tips? Help!

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Without watching you install a set it is rather difficult to know what the problem is. Please don’t take offense if you are doing everything right. I’m just sharing my own failures. I don’t think the training showed all the ways one can fail. I have learned several.

I destroyed a few AutoSoft infusion sets in the early days. It was always user error, or as we Air Force types say cockpit error.

I ruined a couple of sets by forgetting to remove the plastic sleeve from the insertion needle. This prevented insulin delivery.

I think as you get use to the procedure of filling the cartridge, filling the tubing and inserting the set, filling the cannula and restarting insulin, you will have better results.

You might want to review Tandems training videos.

BTW - I love the AutoSoft XC sets. They connect/disconnect much easier that the AutoSoft 90.


Thankyou! Cockpit error sounds better than “user” I will tell myself that. I’m sure you are right about the practice makes easier.
My issues are with the 30 the cannula wasn’t going in but laying on top of my skin. So I switched to the 90, so I can’t mess up the angle. Today I had a 90 with a bent cannula sitting on my skin under the tape. So seems I can mess that up too. Will try the other one you suggested next.

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Noticed most of my issue ones are in the stomach or back. Do you find butt and arm to be better? Heard the butt is slower absorption… anyone find that to be true?


I have also, on occasion, had troubles getting a nice, effective insertion of either Autosoft XC or 90.

The whole insertion process must be a bit tricky mechanically: during the “insertion stroke” the surrounding insertion needle and the actual Teflon cannula are moving into your skin at the same rate to the same depth. On the “retraction stroke” the needle is supposed to slide out of your skin without pulling out the actual cannula.

Two things that have helped me that , as I recall, I learned from @Robyn_H on this forum:

  1. Don’t just pull the little green sleeve directly off the needle. Rotate it as you gently remove as if it was threaded onto the needle. This, I think, keeps you from pulling the needle out beyond the cannula before you’ve even begun to insert it

  2. Remove the insertion needle and plastic inserter gently and slowly and try to pull it away perpendicular to your skin (rather than at an angle).

Best of luck!


I hate when this happens because I always seem to be too slow to act and change sets when sugars are going through the roof …


I’m all about varisoft. I insert them manually exactly where I want and at the angle I want. There is a little window where you can see the cannula is in your skin so you don’t have to guess if it’s really in or not. It’s very rare for me to have failures from insertion.


That sounds like what I need, thanks

the medtronic advanced mio is a terrific inserter, it will eventually get to tandem I imagine. I am super sold on this version of Mio.

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Looks like even more waste on inserter.

I want Tandem to do Quick sets!!


I agree with you it is an incredible amount of waste. It is also almost painless. I don’t know exactly how it is done, but honestly it is less painful than inserting a sensor. We all know that is almost pain free. Is crazy.

I also really like the quickset and have used it for over 20 years. So yes I am torn by the waste vs comfort calculation. i hope the company who makes the advanced MIO will solve some of the waste issue when it is adapted to Tandem.

Omen mark of how good it is is that when this entered the market all other set sales declined including the steal sets. They had to discontinue shipping these because they ran out of stock in the production run .

@John_S2 was really close to all the tips.

The thing to understand about the automatic inserters is that the infusion set is made to slip right off the end of the introducer needle. This is great when you want to remove the needle, but problematic if you accidentally dislodge it prematurely. The introducer needle provides support and structure for the soft cannula during insertion. If the cannula is ever pulled so that it extends beyond the tip of the needle, it will simply fold in half when it meets your flesh. For this reason, you want to avoid absolutely any upward force in the direction of the needle.

  1. Yes, twist the blue needle cover. It doesn’t need spun the entire time like a screw, though. It just sticks to the plastic cannula. Twisting it until it spins freely will break that tension, so it slides off easily without dragging the infusion set off the needle with it.

  2. Pull the paper adhesive cover off to the side, unspiraling it around the inserter. DON’T pull it up straight into the air. Again, you risk pulling the set off the needle if you pull straight up.

  3. Don’t tuck the tubing into the half-circle cutout until AFTER you’ve pulled back and cocked the inserter, otherwise it could get snagged and tug on the set.

  4. Keep you fingers clear of the central moving parts during the actual insertion. It doesn’t really hurt to get your finger caught accidentally. The problem is that it stops the needle in it’s tracks, launching the cannula off it’s tip without any support to keep it traveling straight.

It sounds like a lot to spell out, but these are really tiny things that require nothing of you but a little awareness.


Hope this helps…

The bent cannula happens when the needle is not protruding from the cannula when it hits the skin, or you pull out the needle after insertion before making sure the site is secure on the skin.

This causes the cannula to bend and the needle either catches it or poke through the cannula. It can also bend when the site adhesive is lifted off the skin after its inserted.

Key fix is to always make sure the cannula is fully seated in the inserter and the needle protrudes. Also make sure the adhesive is secure before pulling out the needle.

After cocking the inserter check three things:
1 - Be sure the needle is protruding 1/8" or more beyond the cannula. Be sure the blue cannula/needle cover sleeve is removed.
2 - Check to be sure the set is fully seated in position with the infusion line in the groove.
3 - Position the infusion line in the groove in the inserter housing.

For the best insertion be sure to secure the adhesive securely on your skin after insertion. Make sure the skin is taught by squeezing a chunk, just enough to to tighten up the skin. Press the inserter solidly on your skin the squeeze the inserter. It is a good habit to hold down the inserter securely on your skin for a few seconds before pulling it out by the white cocking handle. Rub the adhesive down. Note that the adhesive takes body heat and 12-24 to fully cure.

Hint…, If needed use a pair of tweezers to seat the set into position. Push down on the plastic without the adhesive, do not pinch the cannula/needle.

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I stopped using the Tandem pump because of all of the waste and the way the infusion sets are packaged, leading to tubing that doesn’t lay flat and is always curled around itself. I went back to my Medtronic pump, but the 530-531, because the newest pump is thicker than the older model pumps because they now use a AA battery not a AAA! The quick set infusion sets are also very easy to use, to connect and disconnect. It seems these pump companies are making pumping more difficult, rather the easier and not so bulky. The Tandem pump infusion sets are complicated to use and the meter has to be charged daily. Medtronic is making their pumps more complicated to use and bigger and bulkier and their sensor are very tiny, difficult to insert, have to be calibrated twice daily, onky last 7 days, and, in my case, are very inaccurate. However, the Dexcom sensor is great! Easy to insert, very accurate, doesn’t need to be calibrated, and lasts 10 day- I love it! Living well with Type 1 for 56 years.

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I used the 50x,51x and 52x Medtronics pumps for 30+ years. Switched to Tandem 2 years ago. Agree that some features were better with those older Medtronic pumps!!! But the auto basal adjust T-Slim with Dexcom is worth it, with less alerts and less interaction, once settings are fine tuned.

Had some initial problems but adjusted how I did the steps, and no longer have issues. But there was a learning curve.

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Have you tried the TruSteel? I love the Tslim with Control IQ, but had too many issues with bent cannulas. Switched to the TruSteel and haven’t had any infusion site issues since. It still has too many parts and steps and takes too long to change, but hopefully Tandem will improve the infusion sets over time. Control IQ makes the pump worth it.


I tried equivalent from Medtronic pump before switching to Tandem.

I only had 1 or 2 AutoXC bent cannula, but since pinching up skin before release, NO BENT CANNULAS. Now 2 years using Control-IQ with great results.


@Luvsangels Thanks for your note- good to hear the good stuff. My dawn phenomenon is handled sooo much better on Tandem auto- I think your right, I’m in the learning curve and just got learn thru these mistakes.

Same to you @SheilaW - thanks for sharing that it’s worked out for you

I couldn’t manage the AutoSoft either, maybe because of minor neuropathy in my fingertips, I really don’t know. My trainer had someone drive to my house with an assortment of devices and Tru-Steel was the answer. No problems since. I didn’t even need training - watched a video, got it to work the first time.

LOVE Control IQ. My control has improved so much that retinopathy healed, my ophthalmologist said she couldn’t see any evidence of it in the last scan. Then she took snapshots of the pump, the insertion site and said she’d be talking to her patients’ endocrinologists asap.


We need more doctors like her.