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Posts tagged ‘Tandem Diabetes Care’

Tandem X2 with Dexcom G5 Update

[Please read my Tandem disclosure.  I was not asked to write this post.  But I need to disclose anyway, because it felt weird not to.]

Even though the update email came in a few days ago, I didn’t have a chance to update my Tandem X2 insulin pump until yesterday afternoon.  My original intentions were to sit down (preferably with a cup of tea and my reading glasses, so I could look the part of “focused” which would hopefully, in turn, become real focus) and update my pump in a relaxed environment, but that’s not a thing in my house anymore.  Every time I went to update the pump, the little Guy needed a snack or Birdzone wanted to play Spit (she kicks my butt regularly) or one of the neighborhood kids would roll through the house or the phone would ring or … the list of distractions remains long.

So I had to just sit down at the kitchen table and update the damn thing, house tornado be damned.

It was easy.  Thankfully, because I was only able to keep half an eyeball on the process as it unfolded.

The information I needed – my pump’s serial number and my “update ID number” – was in the email from Tandem Device Updater (if you’re looking for it in your inbox), so once I downloaded the device updater software to my computer, it took just a few minutes to update my pump.  I plugged my pump into the charger and then stuck the charger into the computer’s USB port, followed the prompts, and let my pump get pumpier.

The device updater

I knew the pump was ready to roll once this screen came up –
the update ID from the email went here.

Once the pump was plugged in, this screen popped up.

“Whoa, your pump updates like an iPhone?”  The 13 year old boy who lives down the street asked.

“It does,” I said, watching the blue progress line for the update move across my computer screen.

“That’s cool,” he said.

Truth.  My X2 now grabs Dexcom G5 results and shows them on the pump.  And I’m still learning the ropes with this new update.  In total, the update took about 15 minutes to work through.  I decided to wait until I was ready for a site change because in doing the update, I’d need to swap everything out anyway, and would also have my IOB set back to zero.

I have my iPhone running the G5 app in addition to the pump, and both appear to be working fine.  I was concerned about battery life after making the update, but since it’s been less than 24 hours since updating, I’ll have to come back to that at another time.


Updated!!

What was nice, though, is that my CGM was already up and running on my phone before I updated my pump, so when the update completed on my pump, the CGM results showed up immediately.  It didn’t seem like I had to independently calibrate my pump and my Dexcom phone app.  I’m rebooting my CGM sensor as I type this, so I’ll have a better sense of how this all works in a few hours.  In addition to CGM functionality and battery life, I’m really curious to see what the payment/update reimbursement structure will look like for future updates.  The G5 update was free.

The bottom line, for me, is that updates are available for my insulin pump that don’t require me to wait for a FedEx box to arrive before I can access them, and that’s damn convenient.  Having a pump that can be updated from my house while dinner is cooking (read: burning), kids are running amuck, and emails are dinging makes diabetes fit better into my life … in that I don’t have to organize my life around diabetes.

Blood Sugar Turbulence.

“The captain has the seatbelt sign on.  Please stay in your seats until the seatbelt sign is turned off.  This is for your safety.”

The flight attendants were also in their seats, having suspended drink service.

Turbulence sucks, but it passes quickly … usually.  Unfortunately, on this flight it seemed like it was going to be a 20 – 30 minute wigglefest for the plane.  And also unfortunately, we were at 38,000 feet and my blood sugars appeared to be making the same climb.

I’ve noticed, especially since my pregnancy last year, that I need to change my infusion set at the three day mark, or my absorption goes full crumb (climbing blood sugars, sticky highs).  I was traveling home from the TCOYD ONE conference in San Diego (awesome event –  more on that conference tomorrow) and my “it’s been three days – change your site!” alarm went off the day before.  I was on borrowed time, infusion-set wise.

I meant to change it at the airport but time was too tight.  And I had no intentions of changing it at my airplane seat, but my blood sugars were high, seemingly stuck there, and I needed to swap out that site ASAP.  Who know how long the air was going to be rough, and I could already see that my blood sugars were in garbage mode. So, tucked against the window and using my scarf as a barrier between me and my seatmates, I was able to quietly change out my site.

Covert site change on the plane. #insulincognito #latergram

A post shared by Kerri Sparling (@sixuntilme) on

And yes, the beeps are usually loud an intrusive but the speaker for the X2 is on the backside of the pump – that series of little holes – so keeping my hand firmly over that part made for a subtle set change.  Shrugged my shoulder out of my shirt and popped the infusion set on the back of my arm and I was good to go without even a side-eyed glance from my seat mates.

Stealth set changes at 38,000 feet without going into the nasty little airplane bathroom? And blood sugars that started coming down within 20 minutes of the set change? Check and check. See ya, blood sugar turbulence.

Some t:slim X2 Q&A.

[Disclosure:  I have a relationship with Tandem Diabetes Care that is outlined here.  Bias noted?  Good.  Read on, then.]

I am notorious for holding out on purchasing a new cell phone because I’m convinced that, the moment I hand over my money for Newest Phone it will immediately become obsolete at the announcement of NEWER PHONE.

Which is why I’m so excited about Tandem’s announcement regarding the t:slim X2 insulin pump because the pump software can be updated remotely.  Which means that when new software comes out, I can gain access to it from my house instead of having to wait and negotiate with my insurance company, etc. I wanted to share details on the t:slim X2 and create a sort of blog post clearing house for questions that I have (and that folks in the DOC have asked about), so with the help of the Tandem team and public-facing information (press releases, FAQs on their website, etc), I’ve cobbled together some Q&A hopefully A’s some of your Q’s.

Does the X2 currently work with the Dexcom G4 system?

The X2 currently has the same features as the current t:slim Pump, so it doesn’t work with the Dexcom G4 system. However, the demand will hopefully be high for the t:slim X2 insulin pump when Tandem rolls out the first major software update for G5 CGM integration, so they have an upgrade program in place for t:slim and t:slim G4 customers. (See more below for info on the upgrade program.)

When can users expect the X2 to sync up with the Dexcom G5 system?

The first feature rollout currently planned for the t:slim X2 Pump is expected to be integration with the Dexcom G5® Mobile CGM system, pending FDA approval. FDA submission for this feature is planned for late 2016, and Tandem anticipates availability in mid-2017.

Has the pump body changed at all with the X2?

For all practical purposes, no. The X2 is the same size and shape as the t:slim pump. It has a durable aluminum housing and will be compatible with all accessories designed for the t:slim Pump. (For those who have invested in ten thousand Myabetic cases for their t:slim, YAY!)

Is there a time frame in place for the PLGS ( predictive low glucose suspend) update?

As Tandem continues to build on the t:slim X2 platform after Dexcom G5 CGM integration is offered, the next feature they’re planning to launch on the X2 is a predictive low glucose suspend algorithm. This will be their first-generation artificial pancreas product. The IDE for a feasibility study has been approved by the FDA and the study is scheduled to be completed in August. Tandem expects to file another IDE for a pivotal study in early Q4 and, based on the typical review timing, anticipate that the study will take place in Q1 2017.

The goal to launch PLGS by the end of 2017 remains unchanged. Tandem anticipates a six-month review process for this first-generation pump algorithm because it will come on the heels of an FDA review of the t:slim X2 with G5 CGM integration. The only differing feature will be the algorithm. The X2 plus PLGS, with all the features and benefits of t:slim, will be competitive with other AP pump offerings as it predicts hypoglycemia, which poses the greatest risk for people with diabetes.

The second-generation AP pump algorithm will also be based on the t:slim X2 platform and will include the treat-to-target AP technology that Tandem recently licensed from TypeZero, as well as Dexcom CGM technology. To date, TypeZero’s technology has been used in more than 28 clinical studies with more than 475 people, with data referenced in a number of journal articles. They anticipate that this agreement will allow Tandem to remain on schedule for a pivotal trial in 2017, followed by commercial launch in 2018.

Users will be able to update their pump software remotely with the X2 – what does that process be like for PWD?

Here’s a little testimonial:

For pumpers already on the t:slim, what are their upgrade options? 

Online here: www.tandemdiabetes.com/upgrade

t:slim Pump customers who received their pump on or after July 1, 2016: Any customer who received a t:slim Pump on or after July 1, 2016 qualifies for a new t:slim X2 Pump at no cost. The no-cost upgrade is set to expire at the end of 2016. If folks choose to upgrade after December 31, 2016, they will still have the option for a fee of $399. Interested customers should visit www.tandemdiabetes.com/upgrade and complete the “Get Started” form or contact Tandem directly at (877) 801-6901.

t:slim Pump customers who received their pump before July 1, 2016: Any customer who received a t:slim Pump before July 1, 2016 qualifies for a new t:slim X2 Pump for either $399 or $799 depending on their date of purchase. Interested customers should visit www.tandemdiabetes.com/upgrade and complete the “Get Started” form or contact Tandem directly at (877) 801-6901.

t:slim G4 Pump customers: t:slim G4 Pump customers do not qualify for a free upgrade, but do have upgrade options available to them ranging between $399 and $799. Interested customers should visit www.tandemdiabetes.com/upgrade and complete the “Get Started” form or contact Tandem directly at (877) 801-6901.

t:flex Pump customers: t:flex Pump customers do not qualify for an upgrade to a t:slim X2 Pump, since it is prescribed specifically for its larger insulin capacity. Any change from a t:flex Pump to one with only a 300-unit insulin capacity will required a change in prescription and likely proof of medical necessity for their insurance company.

Note: These t:flex Pump customers could also opt for the 30-day return policy if they bought within the appropriate window and choose a pump with an upgrade path, if their healthcare provider feels this is a better long-term solution for them.

Once Tandem has the Dexcom integration and AP features, will it still allow you to use the Share/Follow apps on your phone?

From what I last heard, Tandem is working on a mobile app for use with all Bluetooth-enabled Tandem pumps, with the goal of providing their customers the option to see integrated pump and CGM information on their pump, their smartphone, or both. Rumor has it that Tandem is also in discussions with Dexcom to determine the best way to integrate pump information from the Tandem App with CGM information from their next-generation CGM display app.

Is there any information on the little asterisk and note in regards to the remote update of software for a fee? Will there be a fee involved to update?

Dexcom G5 CGM integration will be provided to all t:slim X2 Pump users at no charge. It seems that Tandem anticipates that some feature rollouts will be at no cost for in-warranty customers and that they might charge for others. The determination regarding cost will be made individually for each software update.

How can new pumpers/pumpers looking to switch get more information?

Here is the information page on the Tandem website.

New Pumpers, feel free to contact Tandem at (877) 801-6901, Monday-Friday 6am-5pm Pacific Time, or visit the Tandem website at:www.tandemdiabetes.com/getstarted

Pumpers looking to switch, feel free to contact Tandem at (877) 801-6901, Monday-Friday 6am-5pm Pacific Time, or visit their website and fill out the Get Started form.

Open the Door.

For several weeks, I was flipping open the charging port on my t:slim insulin pump and plugging it in while I was in the shower.  But then I noticed the charging port cover was looking a little worse for the wear, and I connected with a friend about best practices.  (“Best practices” standing in for “How the hell do you charge this thing without breaking the door off?”)

Turns out the door swivels.  And swiveling the door keeps it from ripping.

Swivel that door! #tslim

A photo posted by Kerri Sparling (@sixuntilme) on

Well I’ll be (… more careful, more aware, a swivel-er).

(Also, you tell me if “Open the door” as a post title immediately made you think “get on the floor … everybody walks the dinosaur.”

 

[Tandem disclosure]

 

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.

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