I started using a brand new-to-Ireland pump, the Tandem T:Slim insulin pump with Control IQ, on July 6th. Then, on the 16th of July, I went on holiday to America, where I travelled to six cities in three weeks, got home for a night but the next day flew back to the US for another 5 days due to tragic circumstances. So, me and my pump have not had a typical beginning, and I’ve spent very little time thinking about my diabetes or doing anything with it. However, this insulin pump has played a blinder in letting me do what I needed to do without spending much time thinking about diabetes.
Note 1: Insulin Pump uptake is very low in Ireland; in 2016, less than 7% of adults with diabetes used them and approximately 30% of children used them despite the device being best practice for this age group. Access to Insulin Pumps is severely restricted as only one-third of diabetes clinics offer them as a treatment option. This is one of the Diabetes Ireland Advocacy Group’s topics highlighted in the 2022 and 2023 Pre Budget Submissions.
I’m not new to insulin pumping; I've been a pumper user for over 12 years; I’m also not new to Closed Loop Pumping as I moved to a Medtronic Paradigm with DIYAPS LOOP in 2018. I decided to move away from the DIY technology because it’s labour-intensive to maintain by updating the software and rebuilding the system every so often. I chose the Tandem system because I wanted to stick with my current glucose sensor, which works really well for me and the YpsoPump system is not available just yet.
The First 12 Hours of Tandem doing it’s thing.
So on Wednesday the 6th of July, I started using the Tandem T:Slim pump with Control IQ, and overall, I’m very impressed with it; however, there is room for improvement from Tandem, more on that later. First, I’m pausing to reflect on how changing diabetes devices has affected me over the years.
Changing diabetes devices
Changing diabetes devices used to be difficult for me; I used my first glucose meter for six years. Yep, the exact same one for 6 years. AND, Not realising that I had to change the lancet in the finger pricker 😱Changing to a different meter the first time was painful bureaucracy, but thankfully, that had changed.
Now, I'm more open to new devices and reflect on the improvements each device has brought to my quality of life. I remember the first time I took insulin through my first pump. There was no stabbing, no striptease to expose tummy flesh, just press some buttons and voila! Eight years later, I remember the first time I took insulin using an App on my phone - no rooting around in my pocket for my pump, no unclipping or clipping it from my waistband - Woah!
Back to New Pump Chapter
But back to my old pump versus new pump story. Using DIYAPS Loop, my time in range was usually between 70%-85% without much effort from me. However, there usually isn’t a lot of variation in my day-to-day routine, and when there is a variation, I fail miserably at carb counting. Exercise was also a major, MAJOR issue for me too, even with DIYAPS.
I felt that moving to a new pump with less control over the parameters would mean that my HbA1c would increase and my time in range would decrease; however, that has not been the case. Yes, my estimated HbA1c has increased slightly, but my Time in Range has increased, not decreased. My time in range is an impressive 79%, with 0% time in low or very low range, within this period of complete upheaval, and all I can say is I’m very grateful to this technology for taking care of me when I wasn’t in a frame of mind to do it myself.
About the Pump
There are quite a few things I like about Tandem, but there are a couple of things that are very annoying about the pump, and there are things I miss about DIYAPS, so, taking inspiration from the format Pumps and Pricks review of A Year of Medtronic 780g, I shall list them off.
Note 2: I’m fairly certain that these results could be achieved with the Medtronic 780g and the YpsoPump Loop (when it gets approved here).
What I love about Tandem T:Slim Control IQ
No software self-building/updates maintenance
Only those who are using DIYAPS will understand this one. The results are amazing with LOOP, but I would still have a lot of highs, especially when I didn’t update the programme regularly. So I don’t miss this at all.
The Size
It’s quite small, but I don’t think it’s as small as the YpsoPump though.
No more batteries
I love that I don’t have to have AAA lithium batteries anymore and can charge my pump using a USB cable while I’m in the shower or sitting at my desk. And it doesn’t require suspending insulin delivery to do so.
The Review Software
Tandem’s t:connect software doesn’t seem to be available yet in Ireland or the U.K. so that’s a huge pity and also a concern as the remote bolus feature was launched in July in the US. My diabetes team set me up with Glooko as a way to review charts. Tandem uploads to Glooko and Dexcom can connect to the Glooko App via Bluetooth. I can also input food, exercise, note and other details through the Glooko App.
What I dislike about Tandem T:Slim Control IQ
The cartridge change was finicky in the beginning and still nerve-wracking
I completely messed up my first set change and had to do another one the next day when I figured this had to be the problem. I find it difficult not seeing the insulin fill up the cartridge. I know that part of why the cartridges are designed the way they are makes the pump size smaller but filling the cartridges is fiddly at first. I’m used to it now but not complacent.
With regards to the Tandem insets, I find them great. They’re the same as I used before with my Animas pump and very similar to the Medtronic Mio Advance. I really didn’t like Medtronic’s reusable inserter at all when I used it. I found I ended up with a lot more site occlusion with it.
The Review Software
This one is part of my Like’s list too, the reason being that the pump must be connected to my laptop to upload to Glooko and doesn’t sync via Bluetooth. So I haven’t been using it at all, which means this will probably not be done until my clinic appointment is imminent:-S
The pump screen keeps 24 hours of glucose trends, just like the Dexcom App so I still use the Dexcom Clarity App to review glucose levels beyond that time frame when I’m curious to review or to see time in range.
Glooko Diabetes Management App
Some of the alerts are redundant and Annoying.
All the alerts that you would find on the Dexcom App are part of the Tandem system too. However, I frequently get alerts saying that I had a low or high glucose level two, three or even five hours ago, which makes no sense to me and is completely redundant. But not a big deal to live with at the moment.
Aligning sensor and pump to the same side.
I found that I do have to wear my pump on the same side of my body as my sensor, and this is tricky for this lefty. But I’m not that upset about it, so I’ll live with it. Just occasionally annoying.
What do I miss from DIYAPS IOS Loop system?
Pre-meal target button
I really struggle with the pre-meal bolus. I just never remember, and I always find the carb count easier when I see my food in front of me. DIY LOOP was great with this because with one tap of an icon on the app and I activated my pre-meal BG target.
All on my phone
I was used to doing all I needed to do with my insulin pump during the day from my LOOP App, and it was really discreet as well as convenient. With Tandem, for the moment, I have to root out my pump to bolus and to see what’s going on. However, I don’t miss this as much as I thought I would. I was never without my phone in my pocket or my RileyLink attached to me somewhere. So I’m free of two devices and it’s liberating until it comes time to bolus and I am “losing” my phone (What did I do with my phone, anyone?).
More Information
If you would like more information on how to access Insulin Pump Therapy in Ireland, Click here.
If you want to know more about what an insulin pump is and how it works, click here
And , if you think you would like to explore if an insulin pump is for you, here’s another post I wrote in February 2022 that might be helpful.