Tandem t:slim X2 from a teenager's perspective
First off, here is some background information. I am 13 years old and I have been using the Tandem t:slim X2 insulin pump with the Dexcom G6 continuous glucose monitor for around six months now. The pump is pretty small (measures 2 x 3 x 0.5 inches and weighs 4 oz), has a touch screen, holds up to 300 units of insulin, and is connected to a detachable infusion set by some pretty strong tubing. The t:slim X2 can be paired with the Dexcom, which allows the Basal IQ feature. The pump can also be used by itself without pairing to Dexcom if that is your preference.
Oh yeah, and I’m using these things because I’m a Type 1 Diabetic, diagnosed about nine months ago.
Now, I know a lot of kids use the Omnipod pump, which is tubeless and sounds really awesome, especially now with the Tidepool loop coming up, but I am a gymnast. A male gymnast who lands on my upper arms on the parallel bars and sweeps my legs across the pommel horse. I train over 20 hours a week, which is plenty of time for the higher profile of the Omnipod to get in the way and get knocked off. So I went with the t:slim X2 which has a smaller and flatter infusion set. So far it has not gotten knocked off yet!
Anyway, here are my thoughts and opinions about the t:slim X2 insulin pump. Keep in mind that I have nothing to compare it to because it is the only one I have ever used.
Infusion Set
Tandem has several different types of infusion sets to choose from. I use the Autosoft 90 which has a 90-degree cannula (small tube that goes under your skin to deliver the insulin). My endocrinologist recommended this one because it goes straight in, and she says it doesn’t kink as easily as the other ones that have angled cannulas. And she’s usually right – I haven’t had a cannula kink yet.
The infusion set is changed every two or three days, and the process is pretty simple. There are lots of good YouTube videos to watch for this so I’ll focus on other points.
I usually feel a little bit of pain when the infusion set gets inserted, but that can’t be helped. After all, there is a needle involved and I don’t have a high tolerance for pain. A good comparison would be that it hurts about the same as inserting the Dexcom G6, which apparently a lot of people have said does not hurt at all.
My skin is pretty sensitive, so I had worried about my skin reacting to the adhesive. To my surprise, it’s actually not irritating. It feels fine most of the time except for the very occasional itch. And it’s pretty easy to peel off without turning my skin red.
I do notice that the cannula causes a little bit of swelling and irritation by the end of the third day. After I remove the infusion set, there is a little bump at the site that is sore when I push on it (kind of like a small pimple or bruise), but this goes away pretty quickly. I guess this is inevitable though since it’s normal for the body to react to a foreign object that is stuck under the skin.
Disconnecting from the Infusion Site
I can disconnect and reconnect from my pump at the infusion site. There is a piece that clicks in and out pretty easily. This is really helpful because whenever I go to gymnastics, I can disconnect the pump and tubing from the cannula. This stops me from getting my basal, but it is probably not a good idea for me (or anyone) to flip or tumble with a 4oz aluminum device hanging off of me. The size of the infusion set is really small so when I am disconnected from the pump, I forget that it’s there. I just have to reconnect every hour or so to give myself a small bolus to make up for not getting my basal. For showering or swimming, I also disconnect from the pump.
Tubing
The tubing comes in a few lengths, 23, 32, and 43 inches. I use the 23 inch. Overall, I’m fine with the tubing of the t:slim X2, but there are a few nuisances. One is that it’s curly and long, so sometimes it gets tangled up weird and can just be bothersome. The tubing can also randomly get stuck on things, like on doors or drawer handles. One time it even got caught in my friend’s seatbelt! Sometimes when it gets caught on handles and I keep on walking (unaware that it’s caught), the tubing pulls on the infusion set, making it sting. But somehow, the tugging hasn’t snapped the tube or yanked the infusion set out. Additionally, the tubing can get tangled when I’m sleeping at night, and I haven’t figured out a good solution to this yet.
Basal-IQ
Basal-IQ is a great feature of the t:slim X2. The Basal-IQ technologyis a program that predicts and helps prevent lows. If my blood sugar is dropping and the program thinks I will go below 80 in the next 20 minutes, Basal-IQ will turn on and suspend all insulin deliveries from my pump until it detects that my blood sugar has stopped dropping. This includes my basal insulin deliveries and extended boluses (if I have one going at the time). It will also warn me about bolusing any more insulin while it’s on. This aspect of the pump has helped a lot.
Before I had the t:slim X2, I was on Lantus, and having to treat lows throughout the day numerous times because my basal requirement during the day is much lower than during the night. So essentially, I was getting a little bit too much basal during the day and having to make up for it by munching between meals. When I got my pump, I was able to program in different basal rates for different times of the day, but my basal requirement during the day was still less than the minimum dose that the pump could deliver. (Minimum basal rate that can be delivered is 0.1U/hr.) With Basal-IQ though, the pump shuts off and resumes the basal delivery as needed so the number of lows I have had to treat has gone down quite a bit. And my low alarm only rarely goes off during class now. Yay!
There are a few frustrating aspects of Basal-IQ, though. For example, when I am high and in the 200’s, I will do a correction or go for a walk/run. When my blood sugar starts dropping, Basal-IQ will turn on when I hit 150 for some reason, making me plateau out around there. If Basal-IQ weren’t so anxious, I would have been able to come down to a better range. Another weird thing Basal-IQ does is that sometimes it doesn’t turn on at all! This doesn’t happen too often, but it really gets on my nerves when Basal-IQ will turn on at 150, and then later that same day, not turn on when I am actually going low. This isn’t logical, Basal-IQ!
However, no technology is perfect, and Basal-IQ is in general a really useful feature of the t:slim X2. I can override Basal-IQ and resume insulin, or even turn Basal-IQ off completely, so I have learned to just go with the flow and manually adjust as needed. Overall, though, I think Basal-IQ has had a positive impact on my blood sugar to help minimize risk of severe hypoglycemia.
Control-IQ
I am looking forward to when the Control-IQ update comes out later this year. This feature allows the pump to automatically increase basal insulin and deliver a correction dose when it senses that blood sugar is increasing or very high, essentially creating a hybrid closed loop system.
User Interface
I don’t really have much to say about this, other than that the layout of the t:slim X2 is fairly straightforward and not hard to navigate. The way the CGM graph and other information is displayed on the screen is pretty self-explanatory. The t:slim X2 has a sleek looking touchscreen, which is easy to work with.
Temporary Basal
This is a feature that allows me to increase or decrease my basal rate temporarily for a specific amount of time. I can increase it to up to 250% of my current basal rate or decrease it down to 0.1U/hr. I actually really like this feature because if I’m going high, I can increase my basal rate which tends to work better than correcting. If I am running low, I can decrease the basal rate. With my workouts and growth spurts, this feature lets me adjust as needed temporarily without having to change the settings.
Extended Bolusing
I had a lot of trouble bolusing for high fat and/or high protein foods when I was using an insulin pen, and the fat and/or protein would always come back to haunt me. With the t:slim X2, I can do extended boluses. This feature lets me bolus a percentage of the insulin up front and give the rest of the insulin slowly over a certain amount of time. This really helps when bolusing for high fat and/or high protein foods (such as pizza!) that absorb really slowly and causes a delayed rise in blood glucose hours later. Everyone is different, but I have it worked out so I can now eat pizza without worrying about going high later.
Insulin On Board (IOB)
The t:slim X2 keeps track of how much insulin I have in my body based on the fact that insulin is effective in the body for a few hours. It displays how much is on board in my system and for how long it will remain there. This feature does not take basal into account when estimating IOB. Also, I think it doesn’t take extended boluses into account until the extended bolus is actually finished, but I am not 100% sure, so don’t quote me on that. I like this feature of the t:slim X2 because when I am about to go to the gym or run around with my friends, IOB helps me determine if I need to munch something before I start my activity (if there’s a lot of insulin on board). Moreover, this helps me when I am deciding how much to correct if I am high. It has kept me from rage bolusing on many occasions.
Profiles
The t:slim X2 allows many sets of profiles with different basal rates, insulin to carbohydrate ratios, insulin sensitivity factors, and target glucose levels for different times throughout the day and for different days. For example, I have low basal rates during the day, higher basal rates during the night, and higher insulin to carb ratio in the morning when I am more insulin resistant. I also have different insulin to carb ratios for before and after workout meals. I don’t do this, but I can also have different settings for workout days and non-workout days if I choose to.
Battery
The pump has an integrated rechargeable battery. The pump has to be hooked up to an Android charger cable as opposed to using AA or AAA batteries. The battery is supposed to last five days, but I seem to always have low-ish battery (40-60%). I have the same problem with my phone, so this might just be me. Tandem recommends charging the pump when you unhook it for a shower, but I always forget. I usually end up recharging when I am doing homework, playing video games, or practicing piano, and it only takes 10-15 minutes to completely juice it back up. I can see how the battery might be a problem if you want to go on a camping trip in the middle of nowhere for several days, but a good portable charger should take care of it.
In conclusion, I have been very happy with my Tandem t:slim X2 insulin pump. It has really changed how I am able to manage my blood sugar. Best of all, it has allowed me to be more adventurous with eating and better at correcting a high because I am not having to think twice about whether or not I want to stick myself with a needle (have I mentioned my low pain tolerance?) Keep in mind again, though, that I am a relative newbie to type 1 diabetes and the t:slim X2 is the only pump I have ever used.
Matthew is a relatively newly diagnosed 13 year old. He is an active teenager who practices gymnastics around 20 hours a week, plays piano and also runs an instagram account to help bring awareness around life with Type 1 Diabetes to his friends and family.