Tslim x2 pump starting next week

Status
Not open for further replies.
setebaidw&11

setebaidw&11

Member
Relationship to Diabetes
Type 1
Hi All,

Having had T1D for some 40 years, I’ve hit a wall with how hard I can change and implement my efforts to keep diabetes in a good place … now for my new phase on the Tslim pump alongside the dexcom cgm.

I’d like to hear from you, if you have the same pump/cgm combination, to share on the following areas if you’re happy to share your experiences:

-comparing hypo awareness to the predictive alert of the cgm/pump (I’m curious how long it takes to sync up with the body).

-what is it like sleeping with the pump attached?

-what precautions do I need for travelling abroad? I’ll be travelling via Ryanair to Austria later in the year and coming back via train.

-how secure are the cgm and pump during exercise ( I am a keen road cyclist, wall climber and runner).

-are there any good accessories to make carrying a pump around better (keeping it at the right temperature, making it wearable via clips etc, personalising it, making it secure)?

-good things to tell curious children (I work with children and have two wonderful nephews who always ask about my Libre monitor).

Look forward to hearing from everyone who can share some experiences/information!
 
Hi, I'm T2, your questions are well outside what I know about, but there's a forum thread for pumping and technology which might be a useful resource.
Hopefully there'll be some more knowledgable folk about soon to look at your questions.
Hope it all goes well for you with the new pump, Sarah
 
I can certainly answer the sleeping question cos I've had a tubed pump for 12ish years now, and still wear my birthday suit in bed (TMI). El Pumpo roams free, if it gets in the wrong place and digs in me, I just go Owww! and move it. Have to remember to find it and pick it up when I get up for the bathroom or in a morning - but with the ones I've had/still have, all Roche - when I forget it it swings free still attached to the cannula clunks against me and I go Oh bugger and grab it.

It's not heavy enough to pull a cannula out, cos their cannulas stick to me like the proverbial to a blanket. The Tslim pump is very small in comparison to an AccuChek Combo, so weight shouldn't be a prob - but I have no idea whatever how well the tubing attaches to their cannulas or how well they stick.
 
Thanks for the tag @Bloden and welcome to the forum @setebaidw&11

Yes I‘ve been using the tSlim with self-funded Dexcom G6 sensors since the summer of 2020. There are a few things that drive me crackers about it (there always are with any diabetes device!), but my results are better, and I think on balance it’s proobably the best combination of kit I’ve used so far.

There are a couple of posts on my (much neglected) blog, one a guest post from another user which might give you some thoughts

Every day ups and downs, a diabetes blog

Because no two days with type 1 diabetes are the same. Except when they are. The ups and downs of life with T1D.
www.everydayupsanddowns.co.uk www.everydayupsanddowns.co.uk

setebaidw&11 said:
Hi All,

Having had T1D for some 40 years, I’ve hit a wall with how hard I can change and implement my efforts to keep diabetes in a good place … now for my new phase on the Tslim pump alongside the dexcom cgm.

I’d like to hear from you, if you have the same pump/cgm combination, to share on the following areas if you’re happy to share your experiences:

-comparing hypo awareness to the predictive alert of the cgm/pump (I’m curious how long it takes to sync up with the body).
Click to expand...

Control IQ looks 30 minutes ahead and responds to try to keep you in range. It bases some of those adjustments on the profile you have active at the time (eg basal rate and insulin sensitivity), but the target values themselves are preset and not user-definable.

From the manual:

Control-IQ technology adjusts insulin delivery in several ways to help keep your actual glucose value within the target range. It will decrease or suspend insulin delivery when predicted glucose values are below a preset treatment value, increase insulin delivery when predicted glucose values are above a preset treatment value, and automatically deliver a correction bolus once per hour, as needed. The automatic correction bolus is based on a predicted senor glucose value. There are maximum insulin delivery limits based on your Personal Profile settings. These different insulin delivery actions are described below. Each of the insulin delivery adjustments occurs in different ways depending on whether you are using the Sleep Activity, using the Exercise Activity, or neither. For more detail on how insulin adjustments are made for different activities see Sections Control-IQ Technology With No Activity Enabled, Control-IQ Technology During Sleep, and Control-IQ Technology During Exercise in this chapter.

Personal Profile Basal Rate Delivery
When the predicted CGM value is within the treatment value range (6.25 mmol/L – 8.9 mmol/L), the pump will deliver insulin at the rate determined by the active Personal Profile settings.
All Personal Profile settings must be completed in order to use Control-IQ technology. See Chapter 5 Insulin Delivery Settings for more information about Personal Profiles.

Decreased Insulin Delivery
When Control-IQ technology predicts that your glucose value will be at or below a preset treatment value (6.25
mmol/L) 30 minutes in the future, the rate of insulin delivery will start decreasing to attempt to keep the actual glucose values within the target range. The following diagrams depict how the pump uses 30 minute predictions to gradually decrease insulin delivery compared to the personal profile basal rate. The diagram on the left depicts the prediction, the diagram on the right depicts how the insulin and CGM readings might look if the CGM graph continued on the trend.

Insulin Decreased or Delivering 0 Units per Hour
Control-IQ technology can reduce the basal delivery to a percent of the basal rate in addition to completely suspending. When Control-IQ technology predicts that your glucose value will be lower than a preset treatment value (3.9 mmol/L) 30 minutes in the future, insulin delivery will decrease and may set the basal rate at 0 units per hour if necessary to attempt to keep the actual glucose values within the target range. Manual boluses can still be delivered when Control-IQ technology is decreasing or suspending insulin. The following diagrams depict an illustration of when Control-IQ technology might set the insulin delivery rate to 0 units per hour, and when it will resume at a decreased rate after the 30 minute prediction is above the target glucose value.
⚑ NOTE
When Control-IQ technology sets the basal rate
to 0 units per hour, bolus deliveries will continue. This includes starting a new bolus and any remaining bolus from an extended bolus delivery.

Increasing Insulin Delivery
When Control-IQ technology predicts that your glucose value will be at or above a preset treatment value (8.9 mmol/L) 30 minutes in the future, the rate of insulin delivery will start increasing to attempt to keep the actual CGM values within the target CGM range. The following diagrams depict when Control-IQ technology might be increasing and delivering at the maximum increased basal rate.

Maximum Insulin Delivery
When Control-IQ technology predicts that your glucose value will be above a preset treatment value (8.9 mmol/L) 30 minutes in the future, but the maximum rate of insulin delivery has been reached, Control-IQ technology stops increasing the insulin delivery rate. The maximum insulin delivery rate is a calculated value that is dependent on an individual's Correction Factor setting (found in the active Personal Profile), the Total Daily Insulin estimated by Control-IQ technology based on actual total daily insulin values, and the current insulin on board (IOB).

setebaidw&11 said:
-what is it like sleeping with the pump attached?
Click to expand...
Like you I was a bit worried about this before starting, but actually it ended up being a complete non-issue. I just clip it to whatever I am wearing, or it nestles alongside me.

setebaidw&11 said:
-what precautions do I need for travelling abroad? I’ll be travelling via Ryanair to Austria later in the year and coming back via train.
Click to expand...
Airport security is far more familiar with diabetes tech than you might think. Often it’s recommended to take a letter from your DSN that explains your need to carry insulin etc. Never put insulin in the hold (too cold, it could freeze and become useless). Most device manufacturers say archway metal detectors are fine, but that you shouldn’t put a pump or CGM through a full body scanner, so ask nicely, but firmly for a swab/pat down
setebaidw&11 said:
-how secure are the cgm and pump during exercise ( I am a keen road cyclist, wall climber and runner).
Click to expand...
This seems to depend on your skin type. I find once adhesive has fully cured (takes about 24hrs for me) I can be pretty confident that my tech will remain secure
setebaidw&11 said:
-are there any good accessories to make carrying a pump around better (keeping it at the right temperature, making it wearable via clips etc, personalising it, making it secure)?
Click to expand...
You don’t need to worry about temperature - insulin is only in the pump for 3 days, and is perfectly fine out of the fridge for 28 days.

Some people like spibelt (especially during sport). The tSlim has a skin/clip that comes with it that you can try to start with.
setebaidw&11 said:
-good things to tell curious children (I work with children and have two wonderful nephews who always ask about my Libre monitor).
Click to expand...

I generally opt for something along the lines of ‘robot pancreas’ and/or ‘I’m a cyborg’ :D
 
If you’re worried about the dexcom when climbing etc you can get patches that cover it. But they are very sticky and pain to remove. We use the ones from type one style. It’s worth getting something like apeel to help remove them if you use them as it melts away the adhesive but it skin safe. For normal day to day stuff the adhesive on the dexcom is plenty. My kid likes to wear the patches though and it helps him to feel proud of his CGM.

For the pump you can unclip it for things like climbing but otherwise using joggers belt bags etc works well. We have some lycra waistbands made by diabetes supply I think it was. You can specify size or pockets and get one or two pockets so you can hold your phone too as you need that close by for the dexcom to pair with. Lots of sports clothing has built in pockets for tech these days so you may find you’re covered already.

Hypos and alerts well it varies as to how quickly it picks it up as it depends on the cause but being able to see the trend is very helpful. You’ll have a lot of data from the dexcom so will be able to tweak basal etc. it may take a while to get everything set right as it’s only as good as the input you give the algorithm. It can be helpful to wear the dexcom for a week or so before you get the pump so you have good data for setting the time blocks.
 
everydayupsanddowns said:
Thanks for the tag @Bloden and welcome to the forum @setebaidw&11

Yes I‘ve been using the tSlim with self-funded Dexcom G6 sensors since the summer of 2020. There are a few things that drive me crackers about it (there always are with any diabetes device!), but my results are better, and I think on balance it’s proobably the best combination of kit I’ve used so far.

There are a couple of posts on my (much neglected) blog, one a guest post from another user which might give you some thoughts

Every day ups and downs, a diabetes blog

Because no two days with type 1 diabetes are the same. Except when they are. The ups and downs of life with T1D.
www.everydayupsanddowns.co.uk www.everydayupsanddowns.co.uk



Control IQ looks 30 minutes ahead and responds to try to keep you in range. It bases some of those adjustments on the profile you have active at the time (eg basal rate and insulin sensitivity), but the target values themselves are preset and not user-definable.

From the manual:

Control-IQ technology adjusts insulin delivery in several ways to help keep your actual glucose value within the target range. It will decrease or suspend insulin delivery when predicted glucose values are below a preset treatment value, increase insulin delivery when predicted glucose values are above a preset treatment value, and automatically deliver a correction bolus once per hour, as needed. The automatic correction bolus is based on a predicted senor glucose value. There are maximum insulin delivery limits based on your Personal Profile settings. These different insulin delivery actions are described below. Each of the insulin delivery adjustments occurs in different ways depending on whether you are using the Sleep Activity, using the Exercise Activity, or neither. For more detail on how insulin adjustments are made for different activities see Sections Control-IQ Technology With No Activity Enabled, Control-IQ Technology During Sleep, and Control-IQ Technology During Exercise in this chapter.

Personal Profile Basal Rate Delivery
When the predicted CGM value is within the treatment value range (6.25 mmol/L – 8.9 mmol/L), the pump will deliver insulin at the rate determined by the active Personal Profile settings.
All Personal Profile settings must be completed in order to use Control-IQ technology. See Chapter 5 Insulin Delivery Settings for more information about Personal Profiles.

Decreased Insulin Delivery
When Control-IQ technology predicts that your glucose value will be at or below a preset treatment value (6.25
mmol/L) 30 minutes in the future, the rate of insulin delivery will start decreasing to attempt to keep the actual glucose values within the target range. The following diagrams depict how the pump uses 30 minute predictions to gradually decrease insulin delivery compared to the personal profile basal rate. The diagram on the left depicts the prediction, the diagram on the right depicts how the insulin and CGM readings might look if the CGM graph continued on the trend.

Insulin Decreased or Delivering 0 Units per Hour
Control-IQ technology can reduce the basal delivery to a percent of the basal rate in addition to completely suspending. When Control-IQ technology predicts that your glucose value will be lower than a preset treatment value (3.9 mmol/L) 30 minutes in the future, insulin delivery will decrease and may set the basal rate at 0 units per hour if necessary to attempt to keep the actual glucose values within the target range. Manual boluses can still be delivered when Control-IQ technology is decreasing or suspending insulin. The following diagrams depict an illustration of when Control-IQ technology might set the insulin delivery rate to 0 units per hour, and when it will resume at a decreased rate after the 30 minute prediction is above the target glucose value.
⚑ NOTE
When Control-IQ technology sets the basal rate
to 0 units per hour, bolus deliveries will continue. This includes starting a new bolus and any remaining bolus from an extended bolus delivery.

Increasing Insulin Delivery
When Control-IQ technology predicts that your glucose value will be at or above a preset treatment value (8.9 mmol/L) 30 minutes in the future, the rate of insulin delivery will start increasing to attempt to keep the actual CGM values within the target CGM range. The following diagrams depict when Control-IQ technology might be increasing and delivering at the maximum increased basal rate.

Maximum Insulin Delivery
When Control-IQ technology predicts that your glucose value will be above a preset treatment value (8.9 mmol/L) 30 minutes in the future, but the maximum rate of insulin delivery has been reached, Control-IQ technology stops increasing the insulin delivery rate. The maximum insulin delivery rate is a calculated value that is dependent on an individual's Correction Factor setting (found in the active Personal Profile), the Total Daily Insulin estimated by Control-IQ technology based on actual total daily insulin values, and the current insulin on board (IOB).


Like you I was a bit worried about this before starting, but actually it ended up being a complete non-issue. I just clip it to whatever I am wearing, or it nestles alongside me.


Airport security is far more familiar with diabetes tech than you might think. Often it’s recommended to take a letter from your DSN that explains your need to carry insulin etc. Never put insulin in the hold (too cold, it could freeze and become useless). Most device manufacturers say archway metal detectors are fine, but that you shouldn’t put a pump or CGM through a full body scanner, so ask nicely, but firmly for a swab/pat down

This seems to depend on your skin type. I find once adhesive has fully cured (takes about 24hrs for me) I can be pretty confident that my tech will remain secure

You don’t need to worry about temperature - insulin is only in the pump for 3 days, and is perfectly fine out of the fridge for 28 days.

Some people like spibelt (especially during sport). The tSlim has a skin/clip that comes with it that you can try to start with.


I generally opt for something along the lines of ‘robot pancreas’ and/or ‘I’m a cyborg’ :D
Click to expand...
Helpful insight into what I asked, thanks for your efforts and time . Really helpful to tap into ‘field’ knowledge alongside clinic advice… much appreciated
 
Thebearcametoo said:
If you’re worried about the dexcom when climbing etc you can get patches that cover it. But they are very sticky and pain to remove. We use the ones from type one style. It’s worth getting something like apeel to help remove them if you use them as it melts away the adhesive but it skin safe. For normal day to day stuff the adhesive on the dexcom is plenty. My kid likes to wear the patches though and it helps him to feel proud of his CGM.

For the pump you can unclip it for things like climbing but otherwise using joggers belt bags etc works well. We have some lycra waistbands made by diabetes supply I think it was. You can specify size or pockets and get one or two pockets so you can hold your phone too as you need that close by for the dexcom to pair with. Lots of sports clothing has built in pockets for tech these days so you may find you’re covered already.

Hypos and alerts well it varies as to how quickly it picks it up as it depends on the cause but being able to see the trend is very helpful. You’ll have a lot of data from the dexcom so will be able to tweak basal etc. it may take a while to get everything set right as it’s only as good as the input you give the algorithm. It can be helpful to wear the dexcom for a week or so before you get the pump so you have good data for setting the time blocks.
Click to expand...
Great- the Lycra waistbands seem like a great fit so I’m borrowing from my partner to road test as she is a runner. The climbing really does suggest time without pump as I often up facing the wrong way or inverted … more through haphazard excitement than intent .

How far away has reliable readings from cgm been available to phone? What is the relationship between pump-phone-cgm (do I need my phone as well as the other two?) @everydayupsanddowns
 
setebaidw&11 said:
How far away has reliable readings from cgm been available to phone? What is the relationship between pump-phone-cgm (do I need my phone as well as the other two?) @everydayupsanddowns
Click to expand...

I use my phone as a back-up display for when my pump is just a bit of a faff to get to (or I happen to have my phone put at the time).

Continuity of contact with the phone is helpful, because it allows you to get the analysis/reports from Dexcom Clarity, and also to use Dexcom Share if that’s helpful for you. The app has to be running all the time though. The sensor stores 3 hours (I think??) of historic data, so short interruptions are fine, but I’ve had a rare occasions where the app has closed overnight and I‘ve lost several hours of data (though had them on my pump).

The phone antennae seems a little more reachy than the pump. I can have my phone on charge a few metres away and it will stay connected as long as I’m in the same room. Pump connection seems most reliable if the pump is clipped to my belt on the same side as the arm with the sensor.
 
Thebearcametoo said:
For the pump you can unclip it for things like climbing but otherwise using joggers belt bags etc works well.
Click to expand...
I too am a climber. Unlike running and cycling, my levels rise when climbing due to the adrenaline and the short climbs so I keep my pump attached.
I now have a patch pump but when I had a tubey one, I would just clip it to my waistband and make sure it is snug with regard to my harness. On one occasion, I knocked it with my hand on a big overhang. The waistband clip came undone and the pump was hanging but the cannula remained firm. My belayer was more concerned than I was.
I find having a pump fantastic for climbing - I increase my basal before starting which stops my BG level raising. As a result I have been able to climb for longer at higher grades.
 
helli said:
I find having a pump fantastic for climbing - I increase my basal before starting which stops my BG level raising. As a result I have been able to climb for longer at higher grades.
Click to expand...

How interesting! I would have thought the exertion involved in climbing would mean you would be wanting to reduce basal so as not to go low. The adrenaline must really be something! I wonder if bouldering would be different?
 
everydayupsanddowns said:
How interesting! I would have thought the exertion involved in climbing would mean you would be wanting to reduce basal so as not to go low. The adrenaline must really be something! I wonder if bouldering would be different?
Click to expand...
You can think of climbing a bit like HIIT very adrenaline because you are not climbing non-stop like you would be if cycling.
Routes tend to be 10 minutes of high exertion followed by 30 minutes of belaying my friends.
Even when bouldering it is stop start because you take it in turns to try the routes ... and they are shorter.
 
I am using a Medtronic pump so a little different and as @Bloden said I am using a closed loop so some of the work I used to do is done for me. For what it is worth here are my responses to your original questions

comparing hypo awareness to the predictive alert of the cgm/pump (I’m curious how long it takes to sync up with the body).
With the close loop most hypos are dealt with by the pump noticing the drop and switching off the basal insulin in good time. This doesn’t deal with me getting carbs wrong at a meal or forgetting to change my carb ratios with the change in weather. The time lag for the alarms is about 10 minutes, which Inhave moved from 4 to 3.5 to let the pump deal with the mild ones.
With this system I have gone from daily hypos to perhaps one per week usually down to my miscalculating carbs.

-what is it like sleeping with the pump attached?
Like @trophywench I have always had a tubed pump and apart from forgetting to pick it up when I go to the loo in the night it doesn’t cause any issues. It copes with me turning over but on odd occasions one of us lies on it with an ouch.

-what precautions do I need for travelling abroad? I’ll be travelling via Ryanair to Austria later in the year and coming back via train.
Some airlines will let you have an extra bag in the cabin, but may ask to see your letter. I carry double the number of cannulas, sensors, stuff as well as my back up stuff in my hand luggage. I don’t mind losing a case with clothes etc but don’t want to be without my diabetes stuff.

-how secure are the cgm and pump during exercise ( I am a keen road cyclist, wall climber and runner).
I put an extra tegaderm over my sensors when swimming just to be safe, but apart from that I just stuff my pump where it is most convenient . I tried Hidnbelt but found that uncomfortable and just stuff it in my bra.

-are there any good accessories to make carrying a pump around better (keeping it at the right temperature, making it wearable via clips etc, personalising it, making it secure)?
I usually stuff the pump away, but occasionally put it in a back pocket, and regret it when I go to the loo….
I cracked one when it fell out onto the floor.

-good things to tell curious children (I work with children and have two wonderful nephews who always ask about my Libre monitor).
When I go into schools I refer to my pump as my pancreas. I also make sure I eat something whilst with them and get absolute quiet when I do the bolus so that they can hear the pump doing the delivery.
When I was teaching Maths I used to finish the lesson before lunch with their calculating my carbs and my insulin dose which they liked. I was on MDI with half unit pens so we had discussions about rounding, and when to do this. (I flummoxed the DSN with discussions about when I would round on the DAFNE course which was relevant then as my doses were so tiny, and at the time I was trying to get things ‘right’)

Enjoy yourself
 
Status
Not open for further replies.
Back
Top