I am about to start using an insulin pump after 10 years on MDI. I’m interested in getting feedback from all you pump aficionados out there as to what I can expect, learning curves, issues etc. I have been on a CGM for 10 years - currently using Dexcom G7. I admit to being a little apprehensive so I appreciate all your thoughts.
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I forgot to mention I will be using the Tandem Mobi pump
I’ve only used Omnipods, so I don’t have any great insights about the Mobi. The number one thing in my opinion for any pump is to dial in your basal program(s) as solidly as possible. That should be the building block you can go back to and rely on when/if the Mobi is not doing it’s Auto-mode thing to your satisfaction. I use the Omnipod on “Auto mode” most of the time, probably 75-80%. But whenever I switch into “Manual mode” (which is the basal program that I entered into the pump) I always feel pretty confident that I know how that basal will work for me. It’s a nice feeling and it took a lot of trial and error to get there.
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It’s kind of funny how I started using a pump nearly 3 years ago. I was interested but did not think I would be covered under Medicare as aa type 2. I had a conversation with my endo and told him I leaned towards the Tandem X-2 with C-IQ. I liked that it was intergrated with the Dexccm G6 which I had been using for several years.
Well he put the order in and just before Christmas a box appeared at my house with pump and supplies. There is a 30 day grace period which expired before I could get training. Thankfully I liked the pump.
I did spend that month wearing the pump with a piece of string trimmer line to mimic the tube and infusing site. My trainer thought that was pretty clever.
We set the basal, units/g carb and correction the same as my MDI. The basal rate was fine as C-IQ will adjust up or down based on Dexcom data.
Both U/g and correction had to be tweaked. On MDI I had an HbA1c of 5.5% with the pump it was 6.0% flat for a year. Then I returned to the mid 5% range.
Since then I had chemo, surgery and immunotherapy all of which has caused BG instability. I wouldn’t call me brittle but definitely not my former normal.
This pump is the best fit for me. I fudge the U/g a bit by either overriding the recommended or increasing grams of carbohydrate higher. I tend now to get a postprandial spike 3 hours after eating and will do corrections higher than the correction factor set in the pump.
One thing you will have to learn is which infusion sets are best for you. Hopefully your trainer will give you samples of all the types available.
The MOBI if I understand correctly does not use the cartridge with a bag like the X2, but more like a motorized syringe type reservoir like Medtronic. Some find this easier to fill.
You will need to get used to the new normal, but will find the 3 day cycle an improvement over doing MDI every day.
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This is very important (and I confess that I’m a bit lax about this).
Because infusion sites can “go bad” so that you’re not getting sufficient (or any) insulin, it’s important to have an alternative insulin source available (I use a half-unit insulin pen). I experienced this problem this morning—BG starting climbing by 10s out of the blue—and dosed with my pen before I changed my Omnipod. I also gave myself a small bolus with the pump to boost the basal dosing. (Thanks, @Eric!)
Remember…”when in doubt, change it out”!
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That is a rule of thumb we can all get behind! There are always some Murphy’s Law issues at play with infusion sites. With the recent heat waves I experienced a variety of pod failures on 6 pods over 45 days. Another good rule of thumb is to always have a syringe and fast acting insulin (or pen and tips) handy to get back under control if the pump infusion site is in doubt or has failed.
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Good luck with your first pump! 
Your trainer should give you plenty of good info! Some other tips:
- Beware of doorknobs – my #1 way to rip out a perfectly good infusion site.
- Limit scar tissue by rotating your infusion sites and trying to stay on the replacement schedule.
- If your site hurts, you notice bleeding, or you rub the site and can smell insulin, then it’s probably time to change early! Same thing if you notice a BG rise out of nowhere or unresponsive highs – like @CatLady said, “when in doubt, change it out!”
- I’d recommend getting used to the pump without using the AID system (Control IQ) if possible. Especially while figuring out the right basal rates. Once basal rates are solid, then Control IQ will be able to work with more accurate info! (When you get there, beware that Control IQ will auto-bolus when it thinks you’re going to go high. The number of times I’ve treated a low only to have the “sudden rise” be bolused back down into another low is a lil infuriating. One day I’ll write a letter to Tandem.
)
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Thank you all so much for your feedback. I really appreciate them all!! Wow it’s clear there is such a lot to learn!! From all your comments, it’s obvious this device will take some time to master. Hopefully in a few weeks - after I’ve completed all my training sessions - I will be a little more knowledgeable and confident in its use.
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@funk I hesitated to respond because others here use Tandem’s, and I’m on Omnipod Dash. Regardless, I think you’ll find pumping quite freeing when compared to MDI. I could go back, even prep to every time I take a trip, but I don’t think I’d like it. As with most things new, you’ll probably stress over the details of filling, placement, etc. But after awhile it becomes the norm. The one thing I don’t care for is the waste stream involved with the consumables (infusion sets, tubes, the pumps themselves with Dash, applicator, etc.); it would be great if the manufacturers could find a way to re-cycle the plastics more. Best of luck and, please, let us know what you think of the MOBI!
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There are many youtube videos by Tandem and users you might find useful. Here is one example.
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Thank you for forwarding this. I have watched several of these and they have been quite helpful. I have been on the pump for almost a week now and have stumbled through a couple of insertion set changes. Today I am trying the adhesive sleeve for the first time with the shortest length of tubing.
The whole experience has definitely been a learning curve but the educational staff have been very helpful and I love how my time in range is improving.
The only thing I am really struggling with is the Control IQ algorithm. Most of the time the Control IQ status says “on” and even when I bolus for food, it takes forever to change to “active”. (I’m assuming I understand the difference between the two.) So even with enough IOB, my BG levels go way up and don’t start dropping for ages. Sometimes it’s a couple of hours before they drop and I bolus again out of sheer frustration.
Can anyone advise if I am doing something wrong or if any of my settings need adjusting?
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It is on all the time (unless you turn it off manually), but it won’t give you any boluses if you have taken a bolus within a certain period of time. Your settings probably need adjusted before assuming it’s a problem with ControlIQ - such as making sure you have the correct insulin:carb ratio, correct correction factor, accurate basal rates (although that one’s not as important as the first two).
Also - if you have not, READ THE MANUAL. It is really helpful.
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Thanks Allison. I am currently making my way thru the Mobi manual so I will step that up and finish it sooner. I have a call with my educator today so I will discuss the need to adjust the other settings you mentioned. Thanks for this feedback!
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I’m pretty sure “On” means that Control IQ is on but not making any changes to your programmed settings – you’re just getting the unchanged basal rate you entered in the system (“Maintains” in the image Allison shared). “Active” would mean that it’s making changes to your settings – for example, increasing your basal when you start trending high after a meal, or decreasing or suspending your basal when you start trending low.
As for post-meal highs, did you notice the same CGM pattern when you were doing MDI? In some cases absorption through a cannula can be slower than through a syringe, I’ve heard. Or the 4-hour IOB that Control IQ assumes might be wrong. I know that my IOB is more like 5 hours, so I can’t always trust Control IQ when it says I don’t have any IOB, and I’m sure folks have the opposite problem too. Hopefully one day we’ll be able to override some of the Control IQ defaults.
I hope your trainer also had some good ideas about what might be happening!
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I did notice this sometimes on MDI but not very often. I thought it was because of what I was eating, ie the type of carbs. Starchy carbs (pasta etc) are harder to dose for. But I also never manually calculated how much IOB there was when using a pen so I just didn’t have that info. It’s great to see that on the app dashboard!! Since then it has been a lot better. I had one other bad day when my BS hovered around 300 for about 11 hours (with plenty of IOB) and all I ate that day was 1/2 cup of tuna salad (tuna, low fat mayo, apple, celery, sweet relish) and a piece of cooked chicken (no skin). I was pretty frustrated that day too and eventually changed out my infusion set, which did not make a difference. They finally dropped to normal at bedtime.
Interesting point about the absorption rate thru the cannua vs syringe. My IOB is also 5 hours. That appears to be controlled by the algorithms.
My trainer suggested I bolus a little sooner before eating, as much as 30 mins if my levels are higher than normal, 15 mins if normal. (I used to inject when I started eating.) So that may have made the difference as everything is a lot better now.
Thanks for your feedback. Much appreciated.
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Yes, that has helped me so much too! In all my years before my CGM I totally ignored the “15 minutes before” advice. And now that I can see the data and the difference, I can’t go back!
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I’ve been using Tandem pumps for the last 7 years, and in that time I have gone from MDI micro-managing my day to "what?, I should probably see what my sugars are doing"on CIQ. That said, my A1c in that time frame has gone from low 7s to 5.4 and my sanity has returned along with a sense of normalcy of being just like the pancreas- normies.
When I started on CIQ I tried to “manage” it. I personally found through trial and error that if my base numbers were good ( ICF, Basal, Carb & Target) even if I had several “time zones” where the base numbers were different and I let CIQ do its thing with minor corrections from me and occasional pre-boluses for meals my numbers stayed consistent after the first 3 to 4 weeks. I also set a high BG threshold of 165 and a low threshold of 85 on the CGM portion of the pump to alarm early so CIQ would react sooner and I would also have more time to make corrections if needed.
The first 3 to 4 weeks were not great. Week 1 I tried to correct CIQ. What a disaster. I ended up having to go back and reset the algorithm to zero and start again. Week 2, I gave CIQ a lot of leeway to learn me. More than I would normally give myself. I had a lot of highs and as many corrections when I hit 165. At the 3 week mark , things started to improve, and at the 4 week mark I rarely made a correction unless I overate.
I’m looking forward to getting a Mobi later this year, so I’m following your adventures with great interest @funk . I hope you and your trainer are able to get everything with your pump to your satisfaction. I will say from experience though that sometimes the less you fiddle with it, the better the results. Set your numbers and let them be for a quarter and see how things go before you make changes. Then slowly start your fine tuning.
I hope you enjoy your new pump! My first pump freed me from me. Now I enjoy life again and don’t worry so much about my numbers.
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My trainer said exactly the same thing - let the pump get to know me and don’t try to manage it the way I did with MDIs. Great advice but I admit it’s hard to give up the control. But I am getting better at it.
I am thinking of tightening my range similar to what you did - Mine are currently set at 70-180 and I think I would rather see a faster response to higher BGLs. When I make this change, does it matter if you use the G7 app or the Mobi app to make it?
Today is the beginning of week 3 for me so I am hopeful things will improve. I don’t like to make too many changes at once - that way I can see if that particular change helps or not.
I have been re-reading all the past comments and am now understanding things I was not sure about when I first read them. That is reassuring to me!!
So thanks to all and I look forward to continue being educated by all of you !!
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On the x2 model the G7 is integrated into the pump as software, which is where I made my changes. The Tandem app just mirrors whats on my pump.
I suspect your set up is slightly different since the Mobi doesn’t have a screen and everything is driven through the app. The manual should be able to tell you. They are great about illustrating how to make changes to all the minute settings if you care to drill down that far.
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Yikes! That is not great advice. This pump does not “learn” - if you are seeing a trend in which things are not going right, you need to make changes.
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