Tandem Tslim reviews

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Type1derful

Type1derful

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Relationship to Diabetes
Type 1
I finally had my pump assessment after waiting since pre covid hoooray!! However I did have my heart set on the Omnipod but have found it most likely won’t be suitable for me as my insulin requirements do vary and with pregnancy a possibility in the near future I won’t have much wiggle room :( But at the meeting my Nurse suggested that the Tslim works closed loop with my Dexcom G6 (which I love) I find the Dexcom to be so reliable and really has been a life saver for me. But I haven’t really heard much about the Tandem Tslim pump. I like the idea of the pump adjusting automatically - but find it also a little scary. How do Tslim users find this I assume once you’re used to this function it is amazing ? Pre covid I only really seen the OmniPod or Medtronic so just looking for some information on this pump as don’t really know much about it - any info good or bad welcome!
 
I'm getting the t slim as well at the end of September so I'm keen to learn people's thoughts about it as well. Have done a lot of research and looks like the best of the two options that were available to me. However my CCG won't fund the dexcom so will just have to use it without until things change.
 
We use tslim and dexcom. Currently on the basal IQ setting which helps reduce hypos but will move onto the control iq one very soon which helps with hypers too. It does help a lot but doesn’t eliminate all hypos. We like the system a lot. It’s helpful for us with a kid that we have the follow app and the ability to use Sugarmate for alerts too so that I can deal with night time hypos etc. As you’re already using dexcom it seems the obvious choice.
 
I am in a Medtronic 780 using it in a closed loop so can’t help with the t-slim. I look forward to hearing how you all get on with the t-slim for when I need to do my next changeover.
 
I started on the Tslim on 11 July 22 with Dexcon G6. I have been Type 1 for 46 years. I had AccuChek spirit combo pump for 10 plus years and Abbott's Freestyle 1/2 for around 15 months. For me, jury is still out on Tslim. I have the control IQ version. I do like its ability to reduce/stop insulin delivery to avoid hypos. For me it does not work anywhere near as efficiently to stop highs. I have removed the Dexcon app from my phone. The alarms were both invasive and embarrassing. The Tslim has a hard coded BG target of 6.1 mmol. It ignores the fact that Type 1 diabetics can function effectively with BG in the 4 - 6 mmol range. As soon as the control IQ and G6 sensor predict BG below 6.1 a relentless barrage of alarms start. Company staff coyly refer to this as alarm fatigue. Living with it is something else.
My other major gripe is wastage of both expensive insulin and plastics. My AccuChek had a 300ml cartridge that could be topped up, despite this not being recommended. We live with a difficult condition. Sometimes we have to adapt the tech. The Tslim cartridge is a concealed foil filled with a syringe. Very cumbersome process. It cannot safely be topped up.You need to be very alert to having sufficient insulin for the working day.
The self injection cannula is in my view unnecessarily complicated and wasteful. While it is a technique issue, I find that 1 out of every 2, I inject leaks. I replaced the cartridge and cannula about 4 hours ago. My BG is up to 13. I have just swapped mine back to the old cannula (I have learned to leave the old cannula inserted until I can be sure the new one is not leaking). Since starting the new cartridge I have wasted 20-30 units of insulin trying to first maintain BG levels then to test for leaking cannula and now another 10 units to bring down the current 13 BG reading. EffectivelyI have wiped out a half day worth of insulin and cartridge usage.. I never had failures like this with my previous pump.
Don't let my experience put you off considering Tslim for your own use. Experiences provided here are mine alone. I respect others will view there pump use differently. However, I was unaware of the 6.1 hard coded target, nor the cumbersome and wasteful components. It is unlikely you would be advised either.
 
Welcome @Fackprod 🙂 I have a pump but not the T Slim. What do you mean about the leaking cannula? Sorry if that’s a daft question but I’ve never had that before so can’t visualise exactly what you mean.
 
Fackprod said:
I started on the Tslim on 11 July 22 with Dexcon G6. I have been Type 1 for 46 years. I had AccuChek spirit combo pump for 10 plus years and Abbott's Freestyle 1/2 for around 15 months. For me, jury is still out on Tslim. I have the control IQ version. I do like its ability to reduce/stop insulin delivery to avoid hypos. For me it does not work anywhere near as efficiently to stop highs. I have removed the Dexcon app from my phone. The alarms were both invasive and embarrassing. The Tslim has a hard coded BG target of 6.1 mmol. It ignores the fact that Type 1 diabetics can function effectively with BG in the 4 - 6 mmol range. As soon as the control IQ and G6 sensor predict BG below 6.1 a relentless barrage of alarms start. Company staff coyly refer to this as alarm fatigue. Living with it is something else.
My other major gripe is wastage of both expensive insulin and plastics. My AccuChek had a 300ml cartridge that could be topped up, despite this not being recommended. We live with a difficult condition. Sometimes we have to adapt the tech. The Tslim cartridge is a concealed foil filled with a syringe. Very cumbersome process. It cannot safely be topped up.You need to be very alert to having sufficient insulin for the working day.
The self injection cannula is in my view unnecessarily complicated and wasteful. While it is a technique issue, I find that 1 out of every 2, I inject leaks. I replaced the cartridge and cannula about 4 hours ago. My BG is up to 13. I have just swapped mine back to the old cannula (I have learned to leave the old cannula inserted until I can be sure the new one is not leaking). Since starting the new cartridge I have wasted 20-30 units of insulin trying to first maintain BG levels then to test for leaking cannula and now another 10 units to bring down the current 13 BG reading. EffectivelyI have wiped out a half day worth of insulin and cartridge usage.. I never had failures like this with my previous pump.
Don't let my experience put you off considering Tslim for your own use. Experiences provided here are mine alone. I respect others will view there pump use differently. However, I was unaware of the 6.1 hard coded target, nor the cumbersome and wasteful components. It is unlikely you would be advised either.
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Thanks for your views. It’s good to hear from both sides. I have never used a pump before so I don’t really have any other pump to compare too but out of the options available to me I must say that the Tslim does seem like the better option (for me) . Also issues with leaking is something that has concerned me but with the Dexcom alerts I suppose that this will prevent too long a time without adequate insulin. I hope that you work out your niggles with your pump! I was also unaware of the target of 6.1 thanks for letting me know
 
Fackprod said:
My other major gripe is wastage of both expensive insulin and plastics. My AccuChek had a 300ml cartridge that could be topped up, despite this not being recommended. We live with a difficult condition. Sometimes we have to adapt the tech. The Tslim cartridge is a concealed foil filled with a syringe. Very cumbersome process. It cannot safely be topped up.You need to be very alert to having sufficient insulin for the working day.
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Are there not alarms to set to tell you that you have X units left?
Sure if this is the case then prefill another cartridge ready to go in when needed.
Fackprod said:
The self injection cannula is in my view unnecessarily complicated and wasteful.
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Why use them? There is a choice of cannulas that do not have self serters
Fackprod said:
I have wasted 20-30 units of insulin trying to first maintain BG levels then to test for leaking cannula and now another 10 units to bring down the current 13 BG reading. EffectivelyI have wiped out a half day worth of insulin and cartridge usage.. I never had failures like this with my previous pump.
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Surely if you change a set before a meal you will know quickly enough you have a problem and can change it out? Obviously if the cannula is leaking the stench of insulin is obvious so why mess around just change it.

I have had numerous problems with medtronic sets same as you so am using a different set now, so perhaps try that and see what happens.
Fackprod said:
. For me it does not work anywhere near as efficiently to stop highs. I have removed the Dexcon app from my phone. The alarms were both invasive and embarrassing.
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Err why don't you just turn off the alarms?
 
Yes, I have turned off alarms to the extent possible and set the remainder to vibrate. The flashing light warnings cannot be disabled.
Leaking comes from around the cannula base and the sticky pad that adheres to the skin. I have been pumping for over 10 years with extremely limited insertion problems. The Tslim device is overly engineered in my view. I have a scheduled meeting with a company rep coming up to review technique.
I use Humalog short acting insulin. I have never been aware of any oudor and certainly not at a strength that I could use to detect a leak.
Pre filling a cartridge for use later has its limitations given the rest of the process involved in filling the tubingvand inserting the cannula. To change the cartridge or the tubing/cannula independently of each other will waste significant amounts of insulin. The setup is designed to be changed together.
This forum has the benefits of sharing views and experiences. My ears are open with this pump.
 
@Fackprod Have you tried different cannula types, and without the inserter, as mentioned above? Is the leaking when you bolus? Can you slow the bolus speed and/or split the bolus into two (done a few minutes apart)?
 
Fackprod said:
Leaking comes from around the cannula base and the sticky pad that adheres to the skin. I have been pumping for over 10 years with extremely limited insertion problems.
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That sounds as if a change of cannula is needed so if you use a straight cannula try an angled cannula instead.
I have my Dex set to alarm at 5 and 10 on both phone and receiver. I have the alarms turned off at night on the phone and also have the rapid rise turned off on the phone.

So assume you can have the alarms set differently to what's on the pump.
I'm wondering why you have so many alarms going off though? Have you set your basals correctly so you do not spend so much time out of range?

Might be worth perhaps doing a full basal check to see what is going on.
 
Inka said:
Welcome @Fackprod 🙂 I have a pump but not the T Slim. What do you mean about the leaking cannula? Sorry if that’s a daft question but I’ve never had that before so can’t visualise exactly what you mean.
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I’m pretty sure it’s what John ‘Pumping Insulin’ Walsh calls ‘tunnelling’ - where insulin is able to leak up around the outside of the cannula to the surface of the skin rather than remaining down where it was delivered.

I’ve had it a couple of times in my 2+ years, but not for about a year now.

At one stage I got into the habit of checking the infusion site when I had any unresponsive highs for that telltale insulin smell.

The minimum 10u tubing fill winds me up a bit too. Even if you only want to fill the cannula the pump wants you to do an (unnecessary) 10u tuning fill. I would never waste that insulin I just bolus a .8u cannula fill and mentally knock it off my IOB.

It’s a shame that the Vari-soft (self inserting) sets for tslim don’t *quite* fit my old Silserter - despite being very obviously almost identical. But I’m used to the Mio-style Autosoft 30s now.

The tSlim and G6 is the best kit I’ve used and gives me better results than I’ve ever had, with less effort.

Inevitably there are frustrations and irritating quirks, but I’d thoroughly recommend it.
 
Thanks for most helpful reply. I have never heard of tunnelling. Sounds possible. Insulin seems to build like a boil under the sticky pad. Pump excess insulin and put pressure on the pad and eventually insulin will oozes out of the weakest area. I will consider this possibility more closely.
 
Very helpful post. Thanks for all the different views. It is one that my team suggest.
 
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