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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.

T:slim with clip

A photo posted by Kerri Sparling (@sixuntilme) on

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.

The temp basal rate to gentle smash a low is my favorite. #diabetesgram

A photo posted by Kerri Sparling (@sixuntilme) on

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.

CGMed. #slightlylatergram

A photo posted by Kerri Sparling (@sixuntilme) on

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.

A photo posted by Kerri Sparling (@sixuntilme) on

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.

A photo posted by Kerri Sparling (@sixuntilme) on

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:

View post on imgur.com

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.

29 Comments Post a comment
  1. I’m buying that clip TODAY because one thing you wouldn’t find out for several months is that the tSlim clip is a wimpy piece of garbage. Thanks for posting it!

    02/16/16; 12:08 pm
    • The aftermarket clip fix is a sturdy little sucker. I’m thankful that the Diabetes Fairy (who shall remain unnamed but super-appreciated) brought it to my attention. 🙂

      02/16/16; 12:35 pm
    • Matthew #

      Yeah, the T:clip is certainly prone to breakage (my first one broke inside of a month when I whacked it against the steering wheel getting out of the car), but Tandem has been great about sending out free replacements so it hasn’t bothered me much. They’ve actually gone to sending me two at a time. Of course, if you don’t wear it on your belt the bulk that Kerri doesn’t like is probably more of an issue than the sturdiness or ease of replacement.

      02/16/16; 7:53 pm
      • I didn’t like the bulk and also didn’t feel the pump clipped to my clothes securely. But, as I mentioned, I’m violent with most of my devices. 🙂

        02/16/16; 8:01 pm
  2. Walter #

    This was great. Been on the t:slim for a year. First pump for me and dealing 43 years with this ridiculous disease and single then MDI. Really liked the screen shot of Dex data on t:slim screen. Am a lot jealous. Maybe one day…. I think its cool Tandem is getting access to your user knowledge of diabetic tech.

    02/16/16; 12:13 pm
  3. Sarah #

    Awesome post. Just be careful with the clip – my pump got pulled somehow (magically wrapped around my seatbelt…) and bent open just enough to not be able to be fixed back and was waaaayy too loose for wear.

    02/16/16; 12:37 pm
  4. David Downs #

    Switched to the TSlim G4 after trying the Animas and I will NEVER GO BACK to Animas or Medtronic! Great integration with Dexcom, smooth user interface, good online software to upload and review your data. Killer product. I have the plastic version of the clip sitting at home … I’ll put it on tonight and wave goodbye to the clunky case.

    Now I’m like everyone else and counting the days until the algorithms are ready and I can let great software do the tinkering for me!!

    02/16/16; 12:45 pm
  5. Excellent post Kerri. I’ve got the tslim leather case. Wil Dubois kindly gave it to me and I’ve found that works fine…provided I’m wearing a belt. But that clip looks robust and slim, I’ll keep it in mind for the future.

    Pity that the integration is with the G4, but understandable because of the FDA lag time. I’m hoping that G5 integration or the bionic/artificial pancreas will come along by the time my tslim is out of warranty. Just call me Mr. Optimism.

    02/16/16; 12:46 pm
    • David Downs #

      I specifically chose the Tslim because I love the G4 integration. After thinking long and hard about this, I decided I DON’T WANT to be attached to my phone 24/7/365. I also don’t want to have another reason to look at my phone. I’m definitely in the “keep diabetes on it’s own platform” camp.

      I can see how Kerri misses the Share function, but I don’t use that and likely never will. I’m a happy camper with all my data (insulin, BG, trends, etc.) on one screen that’s already always with me.

      02/16/16; 1:01 pm
  6. Taylor Inman #

    I got the T slim about 6 months before the dexcom integration. Currently T slim has NO upgrade options at all! So I’m stuck with my current technology for a total for 4 years! Absolutely crazy that they don’t allow upgrades – keep that in mind when selecting a pump…you’ll be stuck with G4 technology when there is already G5 technology out there. Who knows, dexcom will probably be to a G10 in the next 4 years!

    02/16/16; 5:49 pm
  7. “a permanent, and migratory, third nipple” <—! You make everything seem like fun. You make this bearable.

    We got the one without the integrated G4. It looks really pretty though.

    Thank you for existing and writing.

    : )

    02/16/16; 8:23 pm
  8. Missy #

    Hey, I gave the tslim and it comes with a case with a clip attached ( I got it New Year’s Day, is this a new accessory?)and I wear it hooked to the middle of my bra and when I sleep I hook it screen pointing toward on my pants at my hip… Have u guys tried that clip?

    02/16/16; 11:28 pm
  9. Donna Lee Ferrara #

    Kerri,

    Thank you for your blog post ~ I really enjoyed it (as I ALWAYS do)…you made me chuckle with the grilled cheese part! 🙂
    I am interested in obtaining the t-slim pump clip you described, but I couldn’t find it on amazon. Could you please send me the link? I would appreciate it. Thank you!

    02/17/16; 9:34 am
      • J9 #

        I just got the Tslim with G4 this week and am having the same feeling about the clip it comes with and the 3rd nipple thing with the pig tail- so frustrating!

        This clip solution seems great, but I was worried about being able to remove it if needed, and if it would affect the warranty, or somehow make Tandem not want to replace the pump if something went wrong. Can that clip be easily removed if needed, and do you know if it is an issue with tandem at all??

        Also, how did you fix the 3rd nipple thing??

        Thanks for normalizing the adjustment experience !

        04/15/16; 10:29 am
  10. Amber #

    OMG! That’s the same clip I use! I’ve tried several (slim pump- bulky clip-NO!). However, the tape from Nite Ize is garbage & unsticks. I use some foam tape from the hardware store, it still comes off when you need it to, but doesn’t unstick!

    02/17/16; 12:09 pm
    • Yours unstuck? I haven’t had that happen yet, but now I’m going to get some backup tape just in case. (I thought the tape was strong! Maybe I’m not as rough on my devices as I thought. 😉 )

      02/17/16; 12:39 pm
  11. Sandy T #

    Oh my gosh, that awful clip! I tried the Tslim. I really liked it EXCEPT for the clip! It dug into me. I mean it was awful. Painful, awful! Whoever designed that thing, clearly never wore it!

    02/17/16; 12:51 pm
  12. Martha #

    The other thing about the t:slim clip is that it is so much bulkier than it needs to be, although using it does protect the pump more than when the pump is naked. I used a minimed for years and I really liked the lowest profile clip they offer. Also, the t:slim definitely gets banged up easier than the minimed. I still like it though. And, yeah, the lack of an upgrade option is whack. I hope that changes.

    02/17/16; 1:51 pm
  13. Leah M #

    Wait–you can fill the cartridge before you put it in? My T-slim is a few years old but even after a software update I can’t do this. Have I missed something? I really hate how long it takes to fill and prime.

    02/18/16; 3:02 pm
    • Someone had mentioned that the pumps shipped after April 2015 didn’t require the cartridge to be pre-filled. I’ll double check that for you and get back to you. (I’m new – still learning the ropes.)

      02/18/16; 10:10 pm
  14. Daisy #

    I’m really irritated that you get a free pump. How did that happen?

    02/18/16; 4:12 pm
  15. I like and dislike that there’s not a “linked” meter with the t:slim. Your bg #s can get lost unless you put them in. But that frees us to use whatever meter we want which is nice (or whatever insurance will pay for), (no more fighting with insurance to get stupid pre-approval, promising to give my first grandchild, etc).

    03/8/16; 4:41 pm
  16. Jim #

    Hi Kerri –

    I got that clip for my T-Slim G4 pump, and it worked great for about 6 weeks then the tape gave way. I guess I’m just really rough on stuff (in general). Anyway, I called Nite Ize for some replacement tape and they wound up instead sending 2 new clips (a replacement and 1 backup).

    While I was grateful, the second one recently just gave way, too, so I ordered some 1/2 inch 3M VHB tape for next time. I really appreciate the recommendation and it’s an improvement over the T-Slim clip. A huge roll of tape is not much more than the cost of the clip in the first place, so it’s definitely worth the investment.

    Thanks again for the recommendation and cheers to you and your baby bump!

    J.B.

    05/23/16; 7:49 pm
    • I wonder if I’m not as rough on the clip as I thought, as I’ve had the same one for several months and have put it through the ringer (beaches, hikes, 6 year old, bras, falling against the bathroom floor, jeans pockets, etc). But I do have a backup clip in case this one gives up. And THANK YOU for the recommendation on the 3M tape – buying some now as a backup for the backup!!

      05/23/16; 8:47 pm
  17. Layne #

    Hey Kerri,

    Looking into a new pump after YEARS upon years with the Animas. I heart (liike really heard) the remote meter functionality and other than Omnipod, haven’t found another pump that does it.

    In fact, I just about lost my sh!t to find out that the Vibe now syncs with a CGM (yay!) but wait?!? No more meter remote?!? Why would they make such an awesome upgrade and leave out probably the best feature of the old pump? I also wasn’t keen on the idea that they didn’t mention this fact to their current customers who were, oh, I don’t know ….. maybe out of warranty but waiting to upgrade bc the Vibe was coming any minute now. No way was I going to the Vibe without the meter remote! Thanks for nothing! /rant

    Just curious if Tandem does have any form of remote system? Maybe through an app? Also, I know you tend to have the low down on what’s coming down the pike…. do you happen to know of any other pumps that are looking to go to remote functionality (via meters, apps, whatever) in the future?

    That is my one deal-breaker as I absolutely hate digging my pump out to bolus.

    Thanks!
    ~Layne

    10/11/16; 12:45 pm
    • Layne #

      Oh, but how I’ve been longing for the “jump to bolus” option because UGH dialing that bolus in at a table with kids, I can’t even tell you how many times I get distracted and my meter times out. Oh well, still can’t do the Vibe without the remote functionality.

      LOL.

      10/11/16; 12:49 pm

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