T:Slim X2 – early thoughts, incl Basal IQ

After almost 5 years on the trusty Animas Vibe, I was fortunate to move to the Tandem T:Slim X2 insulin pump in April 2019. I’d been hankering after it for some time, mainly because it incorporates Dexcom CGM and is beautifully slim – designed to fit the small Levi’s waistline pocket.

My comments are those of a relatively inexperienced pump user, but these are my personal pros, cons, plus some tips to avoid pitfalls.

First the good stuff

  • No more huge lumps and bumps in pockets – and it sits far more comfortably in a bra than other chunky dinosaur pumps!
  • As with the Vibe and Dexcom G4, there’s no need to carry a receiver or phone if using Dexcom G6 with the T:Slim. My preference is to carry as little diabetes kit as possible. (NB ditching the phone will encourage less use of social media, so is welcomed by my other half!)
  • Basal IQ is AMAZING! It kicks in whenever blood glucose is dropping fast, not only when it’s nearing 4mmol, thus avoiding so many unexpected hypos. With fewer extreme lows, I’ve even regained – albeit intermittently and just now and then – some hypo awareness, which I’ve not had for decades. Control IQ (for managing highs) will hopefully arrive via an online link some time in 2020.
  • No need to wait the usual 4 years for pump updates – an outstanding 5* unique feature for me, particularly as tech developments are now arriving fast and furiously.
  • The screen is legible in sunlight – the Vibe was DREADFUL as a CGM receiver and was for me, a keen walker with poor hypo awareness, a significant safety hazard when outdoors.
  • The touch screen navigation, with speedy access to all pump functions is great. No more scrolling down several menus on the Vibe for different functions. The touch is sensitive and works really well.
  • Temp Basal rates can be set in very precise minute by minute segments starting at 15 minutes, I’m using this repeatedly to really great effect. Slight drawback: the max is 250% which is insufficient for me if I’m fighting a stubborn high.
  • Basal profiling is very comprehensive: using a copy and paste-like feature, it’s super simple to create profiles with different carb ratios etc.
  • Insulin delivery is very slow. I often found boluses hurt with the Vibe, even using short cannulae on the slow delivery option. Tslim is totally pain free.
  • I rarely use a bolus calculator, but the screen design for this feature is extremely neat and user friendly.
  • Finally, the design is elegant, even beautiful – the B&O of insulin pumps! This really matters to me, as does the great choice of pump skins available from PumpPeelz.

And the less positive stuff

  • The cartridge fill is very fiddly, you have to withdraw air bubbles from the flexible plastic ‘insulin sack’ with a syringe (part of the consumables) before injecting the insulin into the vacuum you’ve created. All a bit of a faff. I’m now totally competent, but it took a few weeks practice to feel this way. The flexible sack was apparently designed to allow a much slimmer pump profile.
  • As my insulin sensitivity is high (12-18u Total Daily Dose) the 300u cartridge and the minimum ‘fill’ is far too generous. Minimum recommended fill is 95u but if following the 3 day change, I’d have to throw away many precious insulin units if recommendations were scrupulously followed (conversations with T:slim users in the USA indicate many people use the same cartridge for 6-7 days to avoid waste!). In theory, I’ll need to order double the amount of insulin using this pump, though my needs are low, it shouldn’t cost the NHS a great deal I’m told! In practice, I do regularly move my steel set after 2-3 days and keep using the insulin up and I’ve not had any problems so far (I keep a very close eye on CGM fluctuations which might indicate lack of insulin potency).
  • Every bolus initiates a buzz and soft vibrate, followed by a second buzz on completion of delivery, meaning you can’t bolus silently if you notice BGs rising at the theatre, a concert or other very quiet environment. A bizarre feature IMHO, presumably included to reassure. I’m HUGELY embarrassed by any noise during performances and may even consider removing the pump if I’m performing myself. Unfortunately my ears are sensitive and this feature can’t be silenced, but it is pretty quiet so hopefully it’s only me that’s bothered by this!
  • For me, the pump alarms too much! I only use the vibrate alarm, but for example, it buzzes when insulin is low, when the battery needs charging, when occlusions occur – which happens frequently. I press ‘Resume Insulin’ and it’s always been fine, so not sure what that’s about….! I’m told the mechanism is just very sensitive, but it’s annoying.
  • The tubing has a ‘pig tail’ – see top photo – that can cause a lump under tight clothing if not carefully placed.

And a few tips:

  • I’d strongly advise ensuring you put T:slim back to sleep after any procedure. Being slapdash about this, I’ve had many false alerts saying an action hadn’t been completed when I’d not been aware I’d started anything. Seems very easy for buttons to get pressed when putting pump back in its hiding place!
  • When replacing the cartridge, be super careful not to mix up the newly filled with the empty one. I once put the old one back on the pump – doh…🤦‍♀️

So I’m really loving my T:slim X2 and will update when I’ve tried Basal IQ in the coming months – and Control IQ in 2020.

                                                         My fab PumpPeelz!


Positives of living with diabetes

I get very sad reading so often about the possible long term detrimental effects of diabetes, as well as the everyday things that can – if we let them – bug us and get us down.

Am posting this as it’s one of the most wonderful, life affirming statements I’ve found online and I hope that others will grab these positives and hang on to them throughout their lives with diabetes! 💙☺️💙

#DUKPC Professionals ✨Wishin’ & Hopin’✨ 

Have you ever wondered what would make the job of diabetes professionals easier, more fulfilling, help them achieve better results, or just make their lives more comfortable?  Or more fun?  Yes, me too – here’s a selection from the wish lists of some who attended the Diabetes UK Professionals’ Conference in Manchester this year!

“I wish every person with diabetes who wanted to see a psychologist (and equivalents) could access one. It baffles me why this isn’t already the case, given that the every decision to engage in self-care starts and ends with a person’s thoughts and feelings….PWD have access to every other member of the MDT….psychological skills are the missing pieces of the self-management jigsaw.” Dr Jen Nash, Clinical Psychologist, living with type 1 and recovered emotional eater  

“I wish that reimbursement for diabetes technology for those with type 1 in the U.K. was more freely available and that there was more focus on type 1, giving patients more choice.” Karen Baxter, UK Manager, Dexcom 

“I wish I could help those who want just one day’s break from living with diabetes 24/7.” Mark Evans, University Lecturer & Honorary Consultant Physician, Cambridge (@MEvansCambridge)

“I wish more people with diabetes had access to psychological and emotional support – people need to realise that diabetes is not easy to live with and these things are as important as the latest medicines or kit.” Simon O’Neill, Director of Health Intelligence and Professional Liaison, Diabetes UK (@simoneill)

“I wish everyone with type 1 diabetes could be seen by a team specialising in type 1 diabetes.” James Shaw, Professor of Regenerative Medicine for Diabetes & Hon Consultant Physician, Newcastle (@nucDIABETES) 

“I wish that we could genuinely have an honest debate about where the NHS is heading without political dogma or evangelism.” Dr Partha Kar, Consultant Endocrinologist, Portsmouth Hospitals NHS Trust & Associate Clinical Director for Diabetes, NHS England (@parthaskar)

“I wish that people with diabetes wouldn’t go it alone – they should ask for help (from peers, family or healthcare professionals.” Dr Sophie Harris, Innovation Fellow & Honorary Diabetes Registrar, Health Innovation Network (@sophiehampon)

“My wish is for our staff room to be filled with rescue puppies for a fun-filled break!” Laura Cleverly, Staff Nurse (@ninjabetic).    NOTE: After much jest with Laura on Twitter post publication of this, I’d like to remind folk of the well recognised benefits of animal companions for people of all ages and backgrounds, indeed some hospitals use them to improve patients’ emotional health and wellbeing, so a great idea Laura and thanks for your contribution! 🐶

“I wish hospital Trusts would fund more diabetes specilalist dietician posts.” Julie Taplin, Chair, British Dietetics Assn Specialists Group 

“I wish those stopping or never starting a medication that’s actually been prescribed for them would be completely open with their doctors – this makes consultations so much easier and helps build a good relationship.” Philip Newland-Jones, Consultant Pharmacist in Diabetes & Endochrinology, Southampton (@PNewlandJones)

“I wish I had more time and opportunity to hear the views and experiences of the widest possible cross section of people living with or affected by diabetes or the risk of diabetes. And if I’m allowed a second – that we could fund more superb research projects than we can currently afford to!” Chris Askew, Chief Executive, Diabetes U.K. (@ChrisAskewCE)

And finally, having thought about what might make my volunteering role better…. I wish all people diagnosed with any type of diabetes could see the benefits of attending self management courses, connecting with peers and getting inspired to take control of and embrace their diabetes as an integral part of who they are, without it taking over but just being a part of themselves they love, cherish and care for 💙. Lis Warren, Jurassic Type 1 (i.e. living with it for 52 years) and manic diabetes campaigner. 

Radio Harrow broadcast

Harrow Radio broadcast an hour-long programme in October 2016 featuring 4 local people who have type 1 diabetes including (L-R) their presenter Pierre Petrou, James Byers, myself and Matt Pulford.  Not quite a blog, but it was great fun taking part and fascinating to hear how we each manage and see things things differently….  In January 2017 the programme was shortlisted for an award – results to be announced in March 😀🤞

Have a listen here! img_3437

A day in the life

5am     Got up for the loo.  Arghh, noticed my continuous blood glucose monitor (CGM, which is integrated with my insulin pump) is reading 14mmol and has been at that level for 2-3 hours.  Aching and exhausted – suspect a virus is cause of unexpected high, which can signal an infection (or one coming – it’s like having a crystal ball!).  Press buttons for a quick infusion of 0.7ml insulin to nudge number down.  (My pump corrections calculator suggests more, but am trying to stay above 4mmol to regain awareness of low blood sugars (hypos), so err on the safe side.) Continue reading A day in the life