Switching to the t:slim Insulin Pump.
This will not be a post about what insulin pump is better for YOU. I’m not a soothsayer (though every time I say that word, the mental image of a knight slaying a dragon made entirely out of teeth is hard to shake), so keep in mind that this post doesn’t include as many facts as it does opinions. Also, don’t take any of this as medical advice, because I’m not a doctor. I can’t even drive a stick shift. Consider your sources, please.
Securing my bias lens even further, please read my recent disclosure about my agreement with Tandem.
All that official throat-clearing out of the way, let’s do this. Because I switched insulin pumps for the third time a few months ago, and it’s been a good change for me. (If you want to read more about the how and why of switching this time, that’s in the disclosure post.)
Get Off My Lawn Stuff (Known Formally As “Cons”)
I did multiple daily injections to administer my insulin for seventeen years, and switching to a Medtronic insulin pump back in 2004 was jarring because it was a big change to my daily routine. Going from carrying syringes to wearing a device 24/7 was a switch. But even after adjusting to the Medtronic pump, every subsequent change to my hardware, however small, felt like a big deal. Switching to the Animas pump was hard not because the pump was that different, but because the clip was different in the most infinitesimal ways. It drove me bananas making the adjustment. It took a good month to adjust to how the Animas pump clipped to my clothes. Big deal? No. Big difference? Nope. But big adjustment? Hell yes. Any insulin pump that I wear is with me all day long, in every imaginable situation, and every single human factor of anything must be taken into account.
When I tried out the t:slim a while back, just to see how I like it, four things struck me as annoying: the process of filling/priming the pump, the luer lock/pig tail system, the assumed fragility of the pump, and the pump clip. The technology was new and exciting, but I kept hitting myself in the face with it … metaphorically.
Back when I tried the pump, you had to install an empty cartridge and then fill it once it was loaded into the pump, but updates have made it possible to pre-fill the pump cartridges, making the process slightly less annoying. The time it takes to prime the tubing is longer than that of the other tubed pumps, but I usually change my pump out after a shower, so it’s not inconvenient to spend an extra minute at the bathroom counter while the tubing fills. An odd quirk is the recommendation that the pump be tipped up with the tubing facing up and the tubing extended while it filled, but this made sense to me and I actually started doing it with my Animas pump when I filled it, too. (Brings any air bubbles to the top of the cartridge and pushes them out.) Overall, the prime/fill process is a little cumbersome and at first it drove me up a wall, but now I’ve adjusted. Ish.
The luer lock is not new (Animas has a luer lock system) but the lock itself being two inches (or so) away from the pump itself has made for some awkward under-the-dress-or-shirt lumpy bits. It’s not the biggest deal, but for the first week or two, this change was frustrating and I felt like my tubing had becoming a permanent, and migratory, third nipple.
But the pump seems a little more delicate than other pumps I’ve used before. I’m not easy on technology, and many of my daily activities usually include interacting with my five year old daughter, traveling, and changing my clothes in a closet that is tiled and the tile in our new house is apparently impossibly hard. (Using the 42″ tubing for my infusion sets makes my pumps into yo-yos.) Every medical device I’ve ever owned has hit the floor multiple times either in the bathroom, the kitchen, the airport TSA lines, etc. I do not go gentle into … anything. In my short time with the t:slim, I’ve scuffed the ever loving hell of of the edge of the pump. For a few weeks, I thought this pump was more fragile than others I’ve had in the past, but it turns out (after inspecting my stash of medical devices) I’ve destroyed the edges of every pump, ever. So the fragility of the t:slim, in my case, is assumed. And I remain a bull in a diabetes closet.
The last frustration I had with the t:slim when trying it out and then switching was the pump clip. See the previous paragraph for my brutish behavior when it comes to devices, but I felt like the clip couldn’t stand up to my clumsiness and awkwardness. This was a deal-breaker for me when I tried the pump, as I need to be able to wear it effectively. BUT WAIT! This particular con turned into a pro, so I’ll lead with it for the next section, which is the PROS section of switching.
Stay On My Lawn Stuff (Known Formally As “PROS”)
So the clip – THE CLIP! A solution was found, but not a medically blessed one, so don’t make any fast moves without consulting with your doctor, and your neighbor, and the post office lady, and god. But there is a clip that I bought on Amazon that, when applied strategically to the back of my t:slim in such a way that does not cover up any pertinent medical information (like the phone number for Tandem Care, etc.), it fixes the pump clip conundrum for me completely. It’s totally a “to each their own” sort of gig, but I love wearing the pump in a streamlined, secure manner like this, and the wearability is completely badass.
Another thing I really like about the pump is how updated and streamlined it looks. These things cost, what – $5,000? – and they should damn well look like they cost a pretty penny. I like that my insulin pump looks like the sophisticated medical device it is supposed to look like. Sure, looks don’t trump functionality, but it doesn’t hurt that this pump works well and also looks smart. Call me superficial. Go ahead.
With that sexy look comes functionality that I had been craving (which makes it sound like a delicious grilled cheese sandwich, in which case … hang on … brb). I wanted a pump that did what I needed it to do without having to press 10,000 buttons along the way. Like the temp basal feature. Temp basaling (a verb, to be sure) is my favorite way to combat lazy, slow lows that don’t necessarily require a snack but do require some kind of gentle intervention. For example, if I’m 70 mg/dL and trending flat with no IOB before bed, I may do a temp basal for 30 minutes in order to bring me back up into the 85 mg/dL range. Setting up a temp basal on the t:slim is extremely easy and takes a matter of seconds. I appreciate that.
Integration is a plus with this pump, although integration is a frustrating topic all on its own because companies never seem to be on the same page for long enough. (Project Odyssey might help change that, allowing software updates to replace hardware ones, i.e. downloading updates from your computer to your pump, and I’m excited to see that move forward. More on that once there’s more on that.) But as it stands now, the t:slim is integrated with Dexcom G4 technology. I am pro-options and prefer that patients have access to what they want, so I tried out the integrated system to get a feel for how the technologies worked together. Overall, the user interface for CGM is really nice and a huge upgrade from other systems I’ve seen (CGM results are on the home screen, trend arrows are there, too, and the X axis is more than an inch long). The CGM alarms on the pump are loud enough to hear while I’m sleeping, and the hypo repeat option worked irritatingly well on the overnight (stupid lows). The integration seems solid and streamlined.
But … I like Dexcom Share. And having Share as an option is essential for me, with my work and travel schedule, so I decided to bounce between the G4 and the G5 technology in whatever way fits best week-to-week. In order to Share while using the t:slim as my primary CGM screen, I need to use my G4 receiver for cloud uploading. That’s clunky (and also required me ordering a G4 receiver since I had already updated my previous G4 receiver to the G5 technology … see also: regret) and the G4 receiver I ordered is borked, so I switched back to G5 for the time being in order to continue Share. This is a long, kind of boring paragraph, the point being that the integration is great, but Share options suffer, so know what you’re getting into and also what you expect.
One other point re: the t:slim with G4: When I decided to go back to G5, it took a full 24 hours for the home screen on my t:slim to stop showing the CGM graph. I was confused as to where the option to “turn off CGM” was on the pump itself, but it turns out that the screen automagically reverts to regular t:slim mode once the 24 hour window is up. Useful.
Also (unrelated), the little “change sensor” icon on the screen looks like a bottle of champaign and a clock, making it seem like New Year’s Eve on your pump for 24 hours.
I also like how quickly I can take a bolus. The audio bolus is loud (and the disco boobs are in full effect for those sorts of moments, so turn that shit down if you’re feeling demure), and I’m a big fan of the audio bolus. The bolus screen is different on the current iteration of the t:slim than the one I first tried out, allowing me to put in a number of units without forcing me to enter a BG or carb amount. I know I should be taking advantage of all the options available to me on this technology, but sometimes I just want to take a unit of insulin and not jump through a dozen hoops en route to bolusing, so streamlining this process is a plus.
These are just some first impressions, but there’s always a learning curve with new tech. As the weeks go by, I’ll have experience with the more advanced features and will have tinkered around extensively with the device, but at first glance and first few weeks, I’m deep into techno-joy once I stopped being scared of the change itself.
Kind of like this:
It feels like a device company has taken my diabetes experience and given it an overhaul. One that was sorely needed after almost 30 years with type 1 diabetes.