780G v T Slim, opinions?

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AaronH83

AaronH83

Well-Known Member
Relationship to Diabetes
Type 1
Hi, so some background. I was diagnosed 6 years ago following a dose of sepsis which almost killed me and then 6 months after that I ended up being hospitalised with DKA. Doctors reckoned the sepsis went through me and killed my beta cells leaving me T1 (I suppose technically I'm LADA).

Anyways, I've been pushing to get sent on a DAFNE class since my diagnosis to try get as much education as possible. I've taught myself to carb count and learned to adjust my ratios and basal, I've also had to go back to the hospital to ask to be changed insulins as Novorapid wasn't working well for me. I was finding I was injecting and nothing was happening for hours, then I would crash. The nurse changed me to Fiasp which has been great for me, whilst keeping me on Lantus as my basal. I also started using the Libre after 2 years of fingerpricks and then moved onto the Libre 2, using it with Diabox and G:Watch as a sort of pseudo-CGM.

I've finally managed to get a date for a DAFNE class and I will be pushing to get a pump as soon as possible after. I do meet all the NIICE guidelines, I check sugars at least 4 times a day and carb count, I work varied shifts and my job is extremely varied. I could be sat doing paperwork one minute and then an alarm sounds and I have to be able to respond immediately. I also play some fairly physical sports with full contact.

There are 3 pumps available at my clinic, the Medtronic 780G, the T Slim Tandem, and the Omnipod. I've been doing my research and I've spoken to representatives from all 3 companies, and I've discounted the Omnipod as I don't think it's suitable for me, my lifestyle and my job. This leaves me with the 780G and the T Slim.

Having looked at the two, I think I prefer the Medtronic, I feel the sensor integration and closed loop system would be the best option for me. That, along with the ability to use Fiasp in it, filling reservoirs from a vial. It would also mean instead of needing to be prescribed pens I could ask for syringes in the event I had a pump failure, to administer Fiasp. There's also a hard polycarbonate case available which would negate the risk of damage whilst I'm playing hockey. The issue is, I think the Guardian sensors are only prescribed on a case by case basis, which leads me to the T Slim.

The T Slim has a choice of software, I believe one is a closed loop system and the other is a basal rate adjustment system. It also integrates with the Dexcom G6 which is now being covered on general prescription in NHS England. I'm in Northern Ireland, but I expect the health trusts here to follow suit. I'm led to believe the T slim only gives the choice of Humalog or Novorapid in prefilled cartridges though. The Guardian sensors do seem pretty expensive to self fund, so unless the hospital grants me a prescription for them I may have to go with the T Slim.

Does anyone have experience of both pumps? Has anyone gotten the Guardian sensors on prescription? Is it possible to use Fiasp in the T Slim in the event I have to go with it? In the event of a pump failure, is there much between both companies customer service? I know Medtronic are based just over the border in southern Ireland so it may be quicker for me to receive a replacement 780.

I'm sorry for the long-winded post, I'm just trying to go into an appointment with my endo with as much information as possible to put my point across. My DSN has already told me I meet all the requirements for a pump with the exception of having done a DAFNE class and they pushed very hard to get me into the one I'm going to, which is the first face to face one since COVID hit.
 
AaronH83 said:
It would also mean instead of needing to be prescribed pens I could ask for syringes in the event I had a pump failure, to administer Fiasp.
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I think you'd still want a basal wouldn't you? (But yes, for the bolus I can see being able to use the same vials would be convenient.)
 
AaronH83 said:
Hi, so some background. I was diagnosed 6 years ago following a dose of sepsis which almost killed me and then 6 months after that I ended up being hospitalised with DKA. Doctors reckoned the sepsis went through me and killed my beta cells leaving me T1 (I suppose technically I'm LADA).

Anyways, I've been pushing to get sent on a DAFNE class since my diagnosis to try get as much education as possible. I've taught myself to carb count and learned to adjust my ratios and basal, I've also had to go back to the hospital to ask to be changed insulins as Novorapid wasn't working well for me. I was finding I was injecting and nothing was happening for hours, then I would crash. The nurse changed me to Fiasp which has been great for me, whilst keeping me on Lantus as my basal. I also started using the Libre after 2 years of fingerpricks and then moved onto the Libre 2, using it with Diabox and G:Watch as a sort of pseudo-CGM.

I've finally managed to get a date for a DAFNE class and I will be pushing to get a pump as soon as possible after. I do meet all the NIICE guidelines, I check sugars at least 4 times a day and carb count, I work varied shifts and my job is extremely varied. I could be sat doing paperwork one minute and then an alarm sounds and I have to be able to respond immediately. I also play some fairly physical sports with full contact.

There are 3 pumps available at my clinic, the Medtronic 780G, the T Slim Tandem, and the Omnipod. I've been doing my research and I've spoken to representatives from all 3 companies, and I've discounted the Omnipod as I don't think it's suitable for me, my lifestyle and my job. This leaves me with the 780G and the T Slim.

Having looked at the two, I think I prefer the Medtronic, I feel the sensor integration and closed loop system would be the best option for me. That, along with the ability to use Fiasp in it, filling reservoirs from a vial. It would also mean instead of needing to be prescribed pens I could ask for syringes in the event I had a pump failure, to administer Fiasp. There's also a hard polycarbonate case available which would negate the risk of damage whilst I'm playing hockey. The issue is, I think the Guardian sensors are only prescribed on a case by case basis, which leads me to the T Slim.

The T Slim has a choice of software, I believe one is a closed loop system and the other is a basal rate adjustment system. It also integrates with the Dexcom G6 which is now being covered on general prescription in NHS England. I'm in Northern Ireland, but I expect the health trusts here to follow suit. I'm led to believe the T slim only gives the choice of Humalog or Novorapid in prefilled cartridges though. The Guardian sensors do seem pretty expensive to self fund, so unless the hospital grants me a prescription for them I may have to go with the T Slim.

Does anyone have experience of both pumps? Has anyone gotten the Guardian sensors on prescription? Is it possible to use Fiasp in the T Slim in the event I have to go with it? In the event of a pump failure, is there much between both companies customer service? I know Medtronic are based just over the border in southern Ireland so it may be quicker for me to receive a replacement 780.

I'm sorry for the long-winded post, I'm just trying to go into an appointment with my endo with as much information as possible to put my point across. My DSN has already told me I meet all the requirements for a pump with the exception of having done a DAFNE class and they pushed very hard to get me into the one I'm going to, which is the first face to face one since COVID hit.
Click to expand...
Can’t speak about tslim/Medtronic, but to clarify, dexcom one is now on tariff equivalent to libre. I would check if you will get funding for dexcom g6 (which is needed to loop). It looks like funding for cgm is becoming more available generally but worth making sure in the same way as guardian
 
Tslim you fill the cartridges with insulin and change the cartridge & cannula every 3 days. They don’t support fiasp and it would invalidate the warranty on the pump if you had problems caused by the insulin but there’s no practical reason why you couldn’t fill the cartridge with fiasp. The algorithm may not work the same so it may be worth running it without basal or control IQ which defeats some of the benefits of closed loop but it may be something you can get around with timing of your dosing etc. https://support.tandemdiabetes.com/...What-insulin-can-I-use-in-the-t-slim-X2-pump-

Dexcom one has been approved but that doesn’t support the control algorithms so you would need to see if they would fund the G6 on a case by case basis.
 
I have been on the tSlim for a couple of years. Initially on basal IQ (predictive low glucose suspend), but then upgraded to Control IQ (hybrid closed loop).

A couple of clarifications from what you’ve said so far...

The tSlim reservoirs aren’t prefilled (don’t know who told you that!). It is licensed for Humalog / NovoRapid, but with your clinic’s agreement you may be able to try it with Fiasp and see how it works. A possible snag might be the Duration of Insulin Action which is fixed at 5hrs with Control IQ, but having said that my experience of the Tandem closed loop algorithm is that it expects corrections to work more at a Fiasp pace than a NR pace. (I tried Fiasp for a while before switching back to NR).

Control IQ needs Dexcom G6, which *should* be available under new NICE guidelines, but you may have a bit of a battle on your hands if your CCG try to push Libre2 or Dex One as cheaper alternatives. The same would also be the case with Medtronic G4s.

Tslim (with control IQ) and 780 are both hybrid closed loop, but the algorithms are different. Might be worth delving into the detail to what you can tweak and what you can’t between the systems. Both potentially work excellently, but you might prefer the system of one vs the other.

Customer support from both companies has been excellent for me. Some have found Medtronic’s a bit patchy of late, but that was never my experience.

Any specific questions, I’m happy to share what I’ve learned.
 
Thank you so much everyone, these are the little bits of information that are so valuable to making a decision and I really really appreciate you all sharing
 
Bruce Stephens said:
I think you'd still want a basal wouldn't you? (But yes, for the bolus I can see being able to use the same vials would be convenient.)
Click to expand...
Oh yeah, I'd still carry a Lantus pen in my kitbag just in case, which would be a box every 5 months. I have a fairly good stock of Lantus in the fridge as it is too.
 
@AaronH83 have you spoken to your diabetes team about having a pump?
Meeting the guidelines is only one of the hoops you need to jump through. The most important being convincing your team and CCG that you would benefit from a pump.
It is great that you have a place on the DAFNE course as this is often one of the hurdles. I believe there are a few reasons for this: to ensure you have the necessary knowledge of carb counting because you need to be more precise with a pump; to prove you are willing to put in the effort to be able use the features of the pump; and for your diabetes team to see you in that learning environment.
The criteria you have mentioned do not explain to me why a pump would be better than MDI. Have you thought about why the ability to vary your basal would be beneficial or why smaller bolus doses would help? It is useful to think about this to build your case why your CCG should invest in you.
 
helli said:
@AaronH83 have you spoken to your diabetes team about having a pump?
Meeting the guidelines is only one of the hoops you need to jump through. The most important being convincing your team and CCG that you would benefit from a pump.
It is great that you have a place on the DAFNE course as this is often one of the hurdles. I believe there are a few reasons for this: to ensure you have the necessary knowledge of carb counting because you need to be more precise with a pump; to prove you are willing to put in the effort to be able use the features of the pump; and for your diabetes team to see you in that learning environment.
The criteria you have mentioned do not explain to me why a pump would be better than MDI. Have you thought about why the ability to vary your basal would be beneficial or why smaller bolus doses would help? It is useful to think about this to build your case why your CCG should invest in you.
Click to expand...
As stated I've spoken with my nurse and endo and my dietician (who is also T1). The endo said I'd have to do DAFNE first, my nurse said I'd benefit from it and a pump. My dietician said given the stresses of my work and the variety of my shifts (earlies, straight days, long days and nights as well) she fully believes I'd benefit. My job is extremely variable. No two days are the same and it is incredibly difficult for me to dose for at the moment with fixed basal and variable bolus. I could spend an entire morning doing paperwork and then all hell breaks loose in the blink of an eye and I have to be able to respond. Currently this results in me running high at work. I'm often 10mmol or more solely trying to keep from hypoing during response.

The ability of the closed loop system to detect a pending hypo and cut insulin delivery or give more in cases of miscounted carbs is something that would make my life better health-wise. I've also noticed with the Libre 2 that I tend towards dawn phenomenon during the night. The ability to have variable basal rates is something that would help immensely with this. I feel the pump/sensor combo would bring me to more time in range during my working hours and also when at home.

My endo has also suggested that I change jobs. That's not a consideration I'm willing to make, I've worked damn hard to get into my chosen career. I told him it's like me telling him to give up medicine. Currently I'm recovering from a hip issue and work have accomodated me in a more admin based role but I will have to go back out to response at some point as that is my role.

I understand you have your doubts about my reasoning for wanting a pump but I genuinely have looked at the pros and cons. I have tried everything suggested to me by my diabetic team at the hospital in the 6 years since diagnosis and it was them who made the suggestion that a pump would be beneficial.
 
AaronH83 said:
Does anyone have experience of both pumps? Has anyone gotten the Guardian sensors on prescription? Is it possible to use Fiasp in the T Slim in the event I have to go with it? In the event of a pump failure, is there much between both companies customer service? I know Medtronic are based just over the border in southern Ireland so it may be quicker for me to receive a replacement 780.
Click to expand...
Yes you can use Fiasp in the Tslim. None of the pumps have been tested using Fiasp so we use it off licence 🙂
It took 6mths for moronic to replace my faulty pump and then the new pump was also faulty. My experience of their customer service has been appalling so far and I can't wait to change pumps.
 
I am a 780 closed loop user and love it. I would definitely not want to go back from this. The pump support I have had has been excellent and they patiently helped me transition from my old Combo pump and get used to the new pump.

Any issues around faulty sensors have been dealt with promptly, with a replacement provided within 24 hours anywhere in Europe.

The consumables I order have to be okayed by my DSN which is understandable as they are paying for them but I just ensure that these are ordered in good time.

No complaints so far and very pleased with how it works and how little I have to think about my diabetes now.
 
Hi @AaronH83 I am on exactly the same insulin as you, moved from Novorapid and wouldn't want to go back. And I have just raised the pump matter with my team, seeing my nurse next week.

I also play contact sports (rugby) and have a very active lifestyle, at least 1.5 hours walking a day and in the gym or at a fitness class when not a rugby. So I need a pump suitable for all of this. I work from home so that's not an issue, for me its my basal requirements they change so much, even if I do exactly the same things, I think it is based on my mensural cycle, which are also random (not fixed time frames) so I am having to change my levels on at least a weekly basis, and I have days working out what the right level is, a few days okay before it changes again.

My nurse said Tslim and Control IQ, I have also been looking at the omnipod and the Medtrum as if I could have one that works with a glucose monitor I think that would suit me best.

Did you get a sample omnipod? it's really compact. Can I ask why you don't think this would be suitable?

There's so many options and information.,
 
AaronH83 said:
Hi, so some background. I was diagnosed 6 years ago following a dose of sepsis which almost killed me and then 6 months after that I ended up being hospitalised with DKA. Doctors reckoned the sepsis went through me and killed my beta cells leaving me T1 (I suppose technically I'm LADA).

Anyways, I've been pushing to get sent on a DAFNE class since my diagnosis to try get as much education as possible. I've taught myself to carb count and learned to adjust my ratios and basal, I've also had to go back to the hospital to ask to be changed insulins as Novorapid wasn't working well for me. I was finding I was injecting and nothing was happening for hours, then I would crash. The nurse changed me to Fiasp which has been great for me, whilst keeping me on Lantus as my basal. I also started using the Libre after 2 years of fingerpricks and then moved onto the Libre 2, using it with Diabox and G:Watch as a sort of pseudo-CGM.

I've finally managed to get a date for a DAFNE class and I will be pushing to get a pump as soon as possible after. I do meet all the NIICE guidelines, I check sugars at least 4 times a day and carb count, I work varied shifts and my job is extremely varied. I could be sat doing paperwork one minute and then an alarm sounds and I have to be able to respond immediately. I also play some fairly physical sports with full contact.

There are 3 pumps available at my clinic, the Medtronic 780G, the T Slim Tandem, and the Omnipod. I've been doing my research and I've spoken to representatives from all 3 companies, and I've discounted the Omnipod as I don't think it's suitable for me, my lifestyle and my job. This leaves me with the 780G and the T Slim.

Having looked at the two, I think I prefer the Medtronic, I feel the sensor integration and closed loop system would be the best option for me. That, along with the ability to use Fiasp in it, filling reservoirs from a vial. It would also mean instead of needing to be prescribed pens I could ask for syringes in the event I had a pump failure, to administer Fiasp. There's also a hard polycarbonate case available which would negate the risk of damage whilst I'm playing hockey. The issue is, I think the Guardian sensors are only prescribed on a case by case basis, which leads me to the T Slim.

The T Slim has a choice of software, I believe one is a closed loop system and the other is a basal rate adjustment system. It also integrates with the Dexcom G6 which is now being covered on general prescription in NHS England. I'm in Northern Ireland, but I expect the health trusts here to follow suit. I'm led to believe the T slim only gives the choice of Humalog or Novorapid in prefilled cartridges though. The Guardian sensors do seem pretty expensive to self fund, so unless the hospital grants me a prescription for them I may have to go with the T Slim.

Does anyone have experience of both pumps? Has anyone gotten the Guardian sensors on prescription? Is it possible to use Fiasp in the T Slim in the event I have to go with it? In the event of a pump failure, is there much between both companies customer service? I know Medtronic are based just over the border in southern Ireland so it may be quicker for me to receive a replacement 780.

I'm sorry for the long-winded post, I'm just trying to go into an appointment with my endo with as much information as possible to put my point across. My DSN has already told me I meet all the requirements for a pump with the exception of having done a DAFNE class and they pushed very hard to get me into the one I'm going to, which is the first face to face one since COVID hit.
Click to expand...
Hi, If you don't mind me asking, which clinic in Northern Ireland do you attend? I haven't heard of anyone being offered these range of options over here. Thanks
 
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