TSlim vs Medtronic vs other for upgrade

[thefloatingkudu]

Hello all!

I'm (finally) getting my pump upgrade after 4 long years on the Medtronic 670G, however I'm not entirely sure which pump to opt for going forward?

Current pump use: I use the 670G but I don't use it in auto-mode due to the nightmare that is the guardian 3 sensor. So I use a dexcom g6 or g7 linked to my phone and then do everything on the pump manually. This works really well and I can maintain a healthy BG, but it would be nice to sometimes be able to rely on automation. The issue with the medtronic sensors is (a) the need to calibrate, (b) the fact they are so unreliable, and (c) (maybe this is vapid of me) they don't look as 'sleek' as the dexcom products.

So for my next pump I'm leaning towards the t-slim as it integrate with dexcom and allows me the freedom to chop and change between auto and manual. I was wondering what peoples experience of the t-slim + dexcom are and whether they would recommend this pump? From doing a bit of research it seems like a great option, the only drawback being the reduced extended bolus ability and the fact that it only makes one correction an hour in auto mode (compared to one every 5 minutes for new medtronic). It also has a slightly higher BG target than the medtronic which isn't ideal as I shoot for lower than that.

Same question for latest medtronic pump - how have you found it? Are the sensors any better now?

Any thoughts/advice/musings would be really appreciated 🙂

Thanks in advance!

 

[rebrascora]

I will tag @everydayupsanddowns as Mike used the Tslim in closed loop with the Dexcom G6 I believe and Sue @SB2015 as she uses the Medtronic 780 looped with the guardian 4 sensors. I believe both really love their respective systems.... so not sure how helpful that will be to you in making a choice between them, but they will be able to talk specifics that they like and dislike about their system.
I also have a friend who isn't on the forum and she just upgraded from the 670 (which had her tearing her hair out) to the 780 and absolutely loves it, so don't let your poor experience of the Guardian 3 with 670 put you off sticking with Medtronic.

 

[novorapidboi26]

Just because of your personal experience with the guardian sensor, you may as well go for something that works with the dexcom....


Unless you think the guardian 4 might come with improvements of course.....lol

 

[Thebearcametoo]

My teen uses the tslim with a dexcom. We started with basal iq which helped present hypos by stopping basal when he was dropping. Now we’ve upgraded to control iq where it predicts highs and automatically adds insulin too. All you have to do is put the carbs in. It works well the majority of the time. As you’re already using dexcom it seems a sensible option.

 

[SB2015]

Hello all!

I'm (finally) getting my pump upgrade after 4 long years on the Medtronic 670G, however I'm not entirely sure which pump to opt for going forward?

Current pump use: I use the 670G but I don't use it in auto-mode due to the nightmare that is the guardian 3 sensor. So I use a dexcom g6 or g7 linked to my phone and then do everything on the pump manually. This works really well and I can maintain a healthy BG, but it would be nice to sometimes be able to rely on automation. The issue with the medtronic sensors is (a) the need to calibrate, (b) the fact they are so unreliable, and (c) (maybe this is vapid of me) they don't look as 'sleek' as the dexcom products.

So for my next pump I'm leaning towards the t-slim as it integrate with dexcom and allows me the freedom to chop and change between auto and manual. I was wondering what peoples experience of the t-slim + dexcom are and whether they would recommend this pump? From doing a bit of research it seems like a great option, the only drawback being the reduced extended bolus ability and the fact that it only makes one correction an hour in auto mode (compared to one every 5 minutes for new medtronic). It also has a slightly higher BG target than the medtronic which isn't ideal as I shoot for lower than that.

Same question for latest medtronic pump - how have you found it? Are the sensors any better now?

Any thoughts/advice/musings would be really appreciated 🙂

Thanks in advance!

Guardian 4 is reliable, and requires one Bg per week. I am happy to bolus from sensor glucose for all meals, so my only other tests are for rare hypos.

I found the switch from AccuChek to Medtronic 780 very hard just because it was a change of manufacturer, so slightly different language, and it was difficult for me to hand over the responsibility of managing my diabetes to the system, albeit with some input from me now and then. Now I am very happy with the looping system. I would not want to go back to a system that doesn’t loop. Happy to answer questions.

 

[Sally71]

My daughter has had the T-Slim for nearly 3 years and we love it. We had Basal IQ for the first two and a bit years, both of us being a bit resistant to change, but thankfully switched to Control IQ at the beginning of December and it’s been amazing. HbA1c has gone from being consistently 49-53 to 41 now (I didn’t think it was possible to get her much below 48 without being hypo half the time) and time in range has gone from 40-70% to an almost unbelievable 92% yesterday (didn’t think that was possible either!). And we can pretty much just leave the pump to get on with it, apart from putting carbs in and a very occasional correction dose it just sorts itself out, and we can go several days at a time without getting any Dexcom alerts at all. (Having said that we are getting some low alerts while I’m typing this, but oh well, nothing’s perfect!). We find Dexcom to be extremely reliable too, it is possible to calibrate it but we have never needed to and were advised not to unless it goes ridiculously far out. We rarely finger prick any more as it is always very close. I certainly don’t miss studying CGM tracks every day to try and spot patterns and see if anything needs adjusting.

If you have done a bolus it won’t do another one automatically for at least an hour, to give the first one chance to work, but it’s changing basal rate constantly, and the basal graph downloaded from the pump now looks like the New York skyline instead of a series of flat plateaus!

We’ve never used Medtronic so can’t comment on that, but we’d highly recommend the T-Slim. The consultant we saw yesterday reckons it’s the best system available at the moment so that’s another vote for it!

 

[everydayupsanddowns]

Just because of your personal experience with the guardian sensor, you may as well go for something that works with the dexcom....


Unless you think the guardian 4 might come with improvements of course.....lol

Nice to see you posting again @novorapidboi26 🙂

 

[everydayupsanddowns]

I was wondering what peoples experience of the t-slim + dexcom are and whether they would recommend this pump?

Good luck with your choice @thefloatingkudu

I don’t think you could predict with any certainty which hybrid closed loop algorithm would suit your diabetes better - I know enough people on the MM780 who love it to believe it would be a great option.

I had a bit of a wobbly time with G3s needing calibration when I was towards the end of my time on the MM640G - actually on balance, Enlites were probably better for me!

I think tSlim and Dexcom G6 is probably the best kit I’ve ever had to manage my diabetes - and my results have never been better (I’m back in the 5% club, with not many hypos).

Having run Smartguard on the MM640G, and both Basal IQ and Control IQ on the tSlim (updating the software on the pump via home download is a brilliant asset) I would make the following observations, based only on my experience and how my diabetes is behaving at the moment…

Smartguard was noticeably better at dodging hypos. It acted much earlier, and had a minimum basal suspend of 30 minutes. Control IQ only fully suspends at 15 minutes before a predicted hypo, and I find Dex (while generally excellent) is pretty laggy and runs about 10 minutes behind ‘now’ plus it only updates every 5 minutes - so depending on the nature of the drop it can just sneak past one data update, and then it’s a full 5 mins before action is taken. More than once by the time Control IQ suspends I am already below 4 according to fingerstick. Consequently I have a Dex low alarm at 5.2 to get early warning and preventatively treat. The downside of this is more alarms, and more alarm fatigue. With smartguard I’d often only know it had silently sorted out the potential low after it was already fixed! This does happen with C IQ, but not as often. Especially not in the daytime.

Control IQ restarts insulin more readily than Smartguard did. This has the benefit of virtually eliminating post-suspend highs (where the suspend was longer than needed) but it means I get more double-dips, especially as I don’t really trust the suspend to work on its own so I treat in parallel. And when a Control IQ sees the rise of the treatment it can annoyingly add a bolus dose which then turns me back round hypo-wards again.

And none of these settings or limits are adjustable, of course.

On the plus side Control IQ bases its adjustments on your current active profile, so you can adjust that which in turn does affect C IQ’s tweaks.

Plus tweaking and amending my basal profile regularly (at least every 4-6 weeks, often more) is important to give C IQ a fighting chance.

Another plus is ‘night mode’ which works amazingly well for me. I get almost no alerts or alarms at night on the tSlim, and almost always wake up 5.5-6.5 with a flat line for the preceding 3-6 hours.

In short, I have great results with it, and it mostly suits me really really well… but diabetes is still annoying and frustrating at times, and I need to work much harder to try to keep my hypos / low BGs down (probably 1.5x or 2x the number of events than I had on Smartguard)

Sorry! That ended up being a bit of a novel!

 

[SB2015]

One things that is worth noting in the comparisons that you read.
Medtronic used the term Smartguard for their earlier pumps linked to a sensor but in manual mode, with auto suspend and alerts.

They then used this same term for when the 780 is being used in a closed loop with either the Guardian 3 or Guardian 4 sensor. The 780 can also be used in manual mode with alerts and suspend features, as before, but this is no longer referred to as Smartguard. It didn't bother me as I had not used a Medtronic until I went on to the 780, but does cause some confusion at times.

I have had to get my head round ways of doing things that I did on my Combo in a different way. Instead of reducing the basal, which is now auto adjusted throughout the day, I set a temp target when I want a bit less insulin. Instead of using extended bolus, I give the initial dose and then let the pump fort out the extension through its basal adjustments.

I think each pump has its quirks. The Automated basal adjustments every 5 min are great and I have learnt to let Hermione (my pump) get on with what she is doing. She gets in a bit of strop on occasions but is generally pretty reliable.

 

[thefloatingkudu]

Thank you all for the thoughtful and detailed responses - I really appreciate it.

Have to admit that going back to closed loop is a bit of a leap of faith for me because I've become so used to manually managing everything and SmartGuard on the 640 was ok but I didn't get on with it so well.

It's difficult isn't it because you have to lock in to your decision for such a long time! On balance, I'm leaning towards the T-Slim for the next round as all feedback I've heard has been very positive, but will take everything that has been said in this thread onboard while I mull it all over 🙂


PS: @SB2015 I love that you have called your pump Hermione! Anything to do with it being a wizard?

 

[everydayupsanddowns]

PS: @SB2015 I love that you have called your pump Hermione! Anything to do with it being a wizard?

I‘ve named all mine.

First was my Minimed Veo ‘Artoo’ (R2P2, Replacement To Pancreas #2, with MDI being #1).

Next was my MM640G ‘Threepio’ (Third Pancreas Object).

And now my tSlim HAL (Hybrid Automated Loop)

 

[Sally71]

You don’t have to loop with the T-slim, if you’re happier doing it all yourself then it will run quite happily as a basic pump with no sensor interface. But like you say, you’ve at least got the option. I’m told that if you have sensors linked but turn control IQ off you’ll get the sensor readout on the pump but it won’t do anything with the information.
My daughter’s current pump is named Marvin (after the paranoid android in Hitchhiker’s Guide to the Galaxy) (thanks to @everydayupsanddowns for the inspiration for that one)
And all the sensors are named Dexter
Marvin and Dexter do a very good job between them!

 

[SB2015]

S: @SB2015 I love that you have called your pump Hermione! Anything to do with it being a wizard?

Yes indeedHermione is a bit of a Wizard with all that she does for me. I also have an image of her being a bit of know it all, in white ankle socks with Clark’s Rosamund sandals (for those that are old enough to remember them) and her hair in a long plait. She is always hanging around and sometimes just wants lots of attention. A somewhat irritating friend on occasions.

 

[Finn]

I named my T:Slim Pip. Pip the Pump.

Dexcom (for the short period I had it before also getting the pump) was named Connie (DecCOM turned into Connie).

Before that, FreeStyle Libres 2 & 3 were both named Libby (from Libre). 'Libby' was used to refer to both the sensor and the reader ('I need to change Libby today' (the sensor) and 'have you seen where I left Libby?' (the reader)). We used her name a lot when discussing readings ('What does Libby say?' and 'Libby says xx, but fingers say xx.')

 

[Pumper_Sue]

It's difficult isn't it because you have to lock in to your decision for such a long time! On balance, I'm leaning towards the T-Slim for the next round as all feedback I've heard has been very positive, but will take everything that has been said in this thread onboard while I mull it all over 🙂

Do make sure you have a good look at the cannula's provided with the Tslim, others have found them quite limiting in choice and some difficult to insert if you have manual dexterity problems. I had to decline the Tslim due to this.

 

[ISCA]

NEW PUMP UPGRADE……ANY ADVICE??

Dear All,
The information above is very interesting.

For my new pump I have been offered the choice of-
Medtronic 780G, closed loop system with a Guardian 4 sensor

MiniMed™ 780G system | Medtronic Diabetes

Our most advanced insulin pump system. Automatically* adjust insulin delivery and corrects glucose levels every 5 mins, 24/7with no fingersticks*†.

www.medtronic-diabetes.com

Tandem T Slim X2, closed loop system with Dexcom G6

Welcome | Air Liquide Healthcare United Kingdom

www.airliquidehealthcare.co.uk

Ypsomed, closed loop system with cams APS and Dexcom G6 (requires an android phone for the app)

I have happily used Roche Insight pump, and Libre freestyle for a long time now, but I also like the idea of the loop systems on offer.
I know that I now have to get my head around all of it!

My first question is,
are the Libre 3 and/or Dexcom G7 sensors and functionality now available on prescription?
I think I would benefit greatly from the full use of looping.

There are lots of FORs for all three systems, it seems to me.

As for the Against.....
It looks like I will have to update my android smartphone in any case.
But apart from that It seems to me that the cons of
Medtronic is the size
Tandem is the regular hassle of self filling & priming the insulin cartridge. Also the tethered battery charging
Ypsomed is the limited pump functionality and requirement to have the phone very close by for the loop to work.

So your comments, to help my choose, would be most welcome.

Many thanks ISCA
p.s. It looks like I will also have to give the chosen pump a name too!

 

[SB2015]

NEW PUMP UPGRADE……ANY ADVICE??

Dear All,
The information above is very interesting.

For my new pump I have been offered the choice of-
Medtronic 780G, closed loop system with a Guardian 4 sensor

MiniMed™ 780G system | Medtronic Diabetes

Our most advanced insulin pump system. Automatically* adjust insulin delivery and corrects glucose levels every 5 mins, 24/7with no fingersticks*†.

www.medtronic-diabetes.com

Tandem T Slim X2, closed loop system with Dexcom G6

Welcome | Air Liquide Healthcare United Kingdom

www.airliquidehealthcare.co.uk

Ypsomed, closed loop system with cams APS and Dexcom G6 (requires an android phone for the app)

I have happily used Roche Insight pump, and Libre freestyle for a long time now, but I also like the idea of the loop systems on offer.
I know that I now have to get my head around all of it!

My first question is,
are the Libre 3 and/or Dexcom G7 sensors and functionality now available on prescription?
I think I would benefit greatly from the full use of looping.

There are lots of FORs for all three systems, it seems to me.

As for the Against.....
It looks like I will have to update my android smartphone in any case.
But apart from that It seems to me that the cons of
Medtronic is the size
Tandem is the regular hassle of self filling & priming the insulin cartridge. Also the tethered battery charging
Ypsomed is the limited pump functionality and requirement to have the phone very close by for the loop to work.

So your comments, to help my choose, would be most welcome.

Many thanks ISCA
p.s. It looks like I will also have to give the chosen pump a name too!

I am glad that you have added in the priority of naming your pump whichever you choose.

On a more sensible note
As far as I know the sensors that enable looping are not the usual ones available on the NHS, but some have managed to get funding for the specific sensors needed in order to loop.

I use the Medtronic 780 and self fund the Guardian 4 sensor In order to loop. I was an accuchek user before this and found the switch difficult initially, but I had only ever used a combo. It also took me a while to trust the system to do what I had been doing for so long, and it took me a while to stop interfering with the pump. Now I would never want to go back to using a system that does not loop.

You mention the size of the 780 As an issue. It is comparable to my old Combo so that has not been an issue for me. I am not sure how it compares to the Insight. I like having a tubed pump which I can put wherever I want to in order to suit what I am wearing And my tubing is long enough to allow me to choose a variety of positions for it. In bed I just chuck the pump in the bed and can move around as I wish and the pump just stays put. Any questions come back to me.

I can’t comment on the other pumps but know that @everydayupsanddowns usea the t slim In a hybrid closed loop. I am not sure about others.

 

[Sally71]

We get the G6 on prescription but I think we were lucky. Refilling to me looks a lot more of a faff than the Combo we had before, daughter has taken it all on herself though and seems to get the job done quickly enough, I guess it’s like anything, once you’ve done it a few times it’s not so difficult. Charging isn’t a problem, it charges up quite quickly and lasts several days on a charge, Tandem recommend that you just put it on charge for a top up every time you have a bath or shower, as you have to take the pump off then anyway. The cable is a normal usb one like a phone charger, so if you have a power bank you can charge it on that if necessary, it drains it far less than a smartphone does!

 

[everydayupsanddowns]

I agree about the tSlim charging @Sally71

There are lots of ways to make that effortless. I’ve only ever charged mine about once a week! I let it run down to about 20%, then either charge it overnight or whenever I’ll be sat still for a while (working or watching TV).

The reservoir fill isn‘t much more faffy than any other pump I've used tbh. And takes the same amount of time.

 

[Sally71]

Just don’t do what my daughter did when she’d only had it for a couple of months… I told her about top up charges but she wouldn’t listen and always ran it down to almost nothing, then one evening turned the low battery alert off but forgot to plug it in and it died sometime during the night; if it did do a final urgent alarm she just slept through it. Went to school the next day, didn’t often have breakfast and that was when her OCD was bad so we had other things to worry about rather than food, then only realised she had a problem after she got to school and started getting Dexcom high alarms from her phone. Tried to do a correction dose and then found out that pump was dead. Went to medical room; luckily someone had a phone charger that fit it so they didn’t have to ring me, but she was then stuck in the medical room until it had got enough power in to last the day. Conversation with first aider went something along the lines of: “So this little machine keeps you alive, and you didn’t charge it up?” “er… yes.” “You’re an idiot!”
Ever since then I think she’s always kept the cable and a power pack in her bag, and has used it in class a few times, people seem to find it highly amusing when she plugs herself in!