I'm Twiisting!

Tips, Tech & Gear Pump
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Long time no write! Sorry about that!

I finally decided to give up LOOPing and go with Twiist since it is an FDA Approved verion of LOOP. I love it so far!

Eversense 365 was recently approved to integrate with it, so this past Tuesday I had it inserted. The numbers are incredibly accurate even a few days in! Like within 20 points of a finger stick!

Now I’m just waiting on a firmware upgrade the company is pushing out for the E365 to make it compatible with the Twiist. They said they are slowly releasing it so support calls aren’t quite so inundating as they are still being trained. I’ve heard of several who have done it themselves and said it wasn’t so bad of a switch over.

I absolutely HATE the Libre 3+ because it is either accurate and works well or it isn’t. There is no way to calibrate it at all! And it only has one channel, so no way to get realtime data up to nightscout or any 3rd party. Nightscout Pro has found a work around by reading data from Tidepool, but I’ve found that the data gets delayed to tidepool sometimes up to 20-25 min, so not good for treatment at all.

Ask any questions and I’ll try to answer when I can.

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Slightly off topic since you aren’t going to be using the Libre 3+ any more but there are apps which will lurk on the “notifications” and extract the BG figures. I assume twiist does keep the 'phone app up-to-date and that the forked twiist TidePool does issue BG alerts in the standard way. I don’t know if there are such apps for Apple.

Do you know how many channels there are on the EverSense? It looks like the Android solutions either read the BG notifications or use a patched ESEL (the EverSense Android app):slight_smile:

Yeah; lack of direct calibration in either xDrip+ or AAPS is currently annoying me with the G7. Yep, I can send calibrations to the G7 but it frequently ignores them and it seems to continue the service disruption for maybe several days! I’d much rather do what I was doing originally with the G7 which was to never calibrate; it would settle out eventually. Even better I’d like to be able to program a temporary BG reading offset (extending into the past) to avoid AAPS over or under-bolusing and, better than that, have xDrip+ or AAPS do the calibration dynamically!

Eversense 365 is certainly one possibility for me, given that AAPS already supports it. twiist not so since they don’t seem to want to deal with Medicare. It’s a pity because it might be better for me because it is a tubed pump (more site choice), certainly cheaper; it could save me almost $2000/year compared to the Omnipod because Omnipod is disposable and ends up on Part D.

How do you find the canula/tube stuff? I hadn’t realised that some tubed pumps (specifically iLet) don’t use “generic” catheters but I think twiist does (from a quick Google).

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Hi, @bpollina. What set up did you use with your former Looping? Did you use a Libre CGM? Omnipod? I’m interested in the Twiist system but I need to overcome two hurdles before I can make the switch. First, there must be an accurate and consistent CGM. I’ve read many criticisms like yours and I would feel stranded if I couldn’t calibrate an obviously inaccurate CGM, especially if the inaccuracy persisted. The Eversense 365 seems to be the answer. That takes care of the first concern for me.

The second is for the Twiist to become eligible for Medicare Part B, DME coverage. I’ve talked with customer service people about this issue and they remain noncommittal about their corporate intention about this. Their celebrated “pharmacy benefit” is not a good benefit for me. It would leave me paying 20% of the price, at least. That is only if my Part D insurer includes Twiist in their formulary. This year, the Twiist is not in the formulary.

Despite that, I’m interested how the Twiist/Eversense 365 performs for you. In the meantime, I’m in the 10th year of Loop DIY with a MiniMed 722 pump and Dexcom G6 CGM. It’s giving me good results yet I would like to switch to an FDA approved system like Twiist when I can.

Good luck with your new system. I’ll be looking for your updates!

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It’s not good because the pump is simply a Part B pump; it isn’t disposable, unless somehow twiist give one out every 364 days, maybe? This is where my $2,000 figure comes from; I am using a disposable pump, the Omnipod, and it costs me deep in the purse. Still cheaper than private insurance…

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I’m loving the Eversense 365! Waiting on that firmware update and then I can use the Twiist with it.

Not sure how many channels, but I know you can use both the Eversense 365 aop as well as Twiist at the same time. Twiist uploads everything to Tidepool, but it is delayed. Eversense uses a private cloud only and can only otherwise write to Apple Health, but that has a 3 hour delay.

I came from the Omnipod Dash, which I absolutely LOVED as it was tubeless. The only problem Ihad with that is that it only holds 200 units of insulin, so I was changing it every 40 hours or so, so I had to have my endo write for changes daily.

The Twiist is 300 units, so it lasts nearly 72 hours! I Really hate the tubing, though. I found a specialized case that uses a double sided tape to emulate an omnipod, but there is no easy way to keep the tubing from getting in the way. LMK if you wuold like that information and I can dig it up.

The Twiist uses Leuer Lock but it is special in that not every infusion set works with it even if leuer lock. People are having problems ordering from competitors because they don’t have license agreements with those companies. They are saying that they are creating their own in house but don’t have an eta just yet.

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I absolutely LOVE Twiiist and once integrated with E365 I think it will be nearly perfect!

The Twiist pump uses an old version of LOOP that was approved by the FDA. It doesn’t have a whole lot of the bells and whistles as the latest LOOP versions have, but I noticed that I didn’t use those features anyway,

For me, the biggest things that made me want to try it were 300 unit cassettes and that they have 24/7 USA based support which has been excellent! They don’t just read a script. They actually know their product!

They use Preccription vs DME side on purpose because that way there is no lock in period, and nothing has to be proven that you normally have to do to get a pump. For example, I’m an insulin dependent Type 2 and the pump itself is only approved for T1. My old endo was skeptical at first, but the rep was able to call him personally and assure him that since it is prescription, so long as y insurance covers it (which it did) that no one verifies T2 vs T1 and it goes through just fine!

The welcome kit they give you has the pump, 2 sets of 2 batteries with separate chargers (one for home an done for work) and the needed supplies. Re-order kits only come with the supplies. It carries a 1 year warranty on everything, and I’ve already had one cassette leak and fry my pump, and I had a new one in 48 hours since I missed the FedEx overnight cutoff. if you don’t like it, you just don’t re-order the refill kits. You could even do 30 days and no harm no foul.

From what I understand, there is even a program for people with insurance that helps with the welcome kit being a set price. Not sure if that works with Medicare or not though.

It technically works with E365 now, but you have to have a certain firmware version that E365 is rolling out slowly for it to work. When its available to you, you get an alert in the software and it shows up in the Apple store. Mine hasn’t happened yet.

Right now the company trainers are being trained as is the customer support team. I believe the official launch is like 2/18 or something close. But those wo are tech savvy enough have switched over and are loving it!

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Just to let everyone know, here’s my progression in E365:

This past Tuesday I had it inserted. Took 10 min for the procedure itself. The rest of the 40 min appointment was programming my phone and activating the sensor and being trained. They allow up to an hour. It was done by a Nurse Practitioner who was trained by the company. She said that this is all she does for my old endo’s office and the endo clinic at Washington University in St. Louis. She has done over 200+ of them and has only had about 2 that she wasn’t able to find and remove. You can use an ultrasound machine to find them, but it is a medical device, so most that have this issue tell her to leave it in. It’s not even 1/2 a cm long and very small.

The first 24 hours are a warm up phase.

Wednesday I had to do 4 calibrations 2 hours apart minimum throughout the day. you have up to 36 hours to get then in by hitting a “delay” button, but I chose to do it the same day.

Thursday I changed the double faced tape thingy and it ripped off the tegederm bandage as well as the steri strips, so I had to re-dress everything. Thursday was just one calibration,

Friday it pulled everything off again, but it was healed well enough that I just used the 2 sided tape thingy. Then its daily calibrations for like 5 days and then on it is once per WEEK for the rest of the 365 days!

They company recommends changing the double sided tape daily and charging 5-10 min when you do so, but the batteries last up to 48 hours depending on how many vibrations you have during that period. It is a micro usb cord, but it is an industrial strength cord that is also warrantied for a year, so if it goes bad, they will overnight you a new one. They recommend using their cord and charger so you know you have a good medical grade one vs cheap charger and cord,

So far my numbers have been within 20 points of finger stick or better! And there is no compression lows either, so you can sleep on that side if you want!

It is also water resistant to 3 feet, so you can swim with it and shower with it if you want to.

Hope this helps some.

If you have any further questions, please ask.

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It’s nice to read a detailed summary of Eversense 365 installation experience.

I’ve tentatively learned more about the Medicare DME vs. pharmacy benefit for the Twiist. Will wait for other sources to confirm but this seems credible to me.

Here’s Sequel’s (twist manufacturer) FAQ about durable medical equipment status:

Will the twiist Pump be available through the DME channel?

To make the twiist™ AID System the best access experience for providers and people with diabetes, we are focusing on making it available exclusively through the pharmacy channel. We are not currently planning to make the twiist AID System available through the DME channel.

Various AI/google searches show that Twiist’s controller expected lifetime is 3 years. I know that Medicare’s DME duration starts at 4 years. So, it is not a “patch pump” per se, but not DME either.

I now think that my chances of using this pump are very low unless I can find better economic access.

Glad that it is working for you!

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I’m curious about the infusion sets and the tubing etc for the Twiist…are they sold as Pharmacy benefit or from a DME supplier? (I’ve never had a tubed pump, total rookie with all the details). Are they an expensive item over the course of a year? If you disconnect the pump to shower or swim etc., what is entailed in reconnecting afterwards both in time/hassle and supplies used?

Thanks for the info! Hope the 365 sensor continues to work well for you.

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The refill kit contains everything you need and is prescription side only.

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My endo suggested I try the Twist at my last appt back in Nov. I went through all the sign up stuff, got a call from a rep two weeks ago. But I’m retired, on Medicare + Supplement, and somewhere along the line I checked online and sure enough: not covered. I think this is noted somewhere on the Twiiist website as well:

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I have heard that some medicare plans are not covering it. It’s all dependent on the formulary.

On a good note, I finally received the Eversense 365 update! Super easy to do. Did my 4 calibrations and I was able to successfully delete the Libre 3+ (good riddance!) and pair the Eversense 365 and I’m off to the races!

I just have to do daily calibrations for a week then weekly thereafter until the remainder of my 365 days of wear!

I still have to charge every 48 hours (they suggest every 24 while showering. Takes 5-10 min) and change the double sided tape thingy daily, but that’s easy. They give you enough supplies when you get inserted for a year!

Total cost for E365: $30 office visit and no charge for the E365 itself! Yes!

Total cost for Twiist pump and refills: $0 copay! Yes again!

Today marks 7 days exactly since insertion. Wound is all healed up. Accuracy is within < 10 points of a finger stick! I’m loving it! I’m so glad I did this!

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This is excellent news! I’ve been using twiist since August. The tubing was a hassle for a month. Now I don’t notice it. The cassette change still takes forever. I’ll add that to my first-world problem list. Time to start badgering my Endo for E365. Thank you for letting us know that it’s working for you.

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Every day it gets more and more accurate. So long as you are steady it’s surging < 5 to 10 at most compared to a finger stick. I use the Accu check guide because that’s what my insurance covers . They recommend contour next one but it’s not required and neither integrate with the software anyway so it really doesn’t matter .

I’m so glad to be done with Libre 3+ which either worked or it didn’t but you can’t calibrate it at all !

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I have been on the twist about two months. I had a Libre 3+ CGM for over three years and was happy with it. It was usually within 20 points of the finger prick READING. So I don’t feel the need to calibrate it as it seems to be accurate or close.

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I have Medicare and Medigap through Empire Plan. My first kit of twist was free, but they do that for everybody. Now it’s 60 a month co-pay..

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Still going strong. I like how the transmitter only takes 5-10 min to charge. The tape is super easy to change as well. No sticky residue. Readings are super accurate and virtually no compression lows even if you sleep on that shoulder!

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Come on. Someone had to do it!

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As of this moment my AARP Medicare Rx Preferred from UHC (PDP - i.e. Part D) lists:

Omnipod Dash: Tier 3: $406.75 for the first 90 days; the “supply limit” is one per day so I assume that the unit is per-pod and checked for 10 pods (for one month). This works out as $1,300 per year (including the full “deductible”. The cost after deductible is $299.10, I pay 16% for Tier 3.)

Twiist starter kit: Non-formulary, limited to 1 every 273 days, requires prior authorisation. “Raw” cost is $538.48 but the cost does apparently count towards the Part D deductible which (for me) is $130. Back calculating my plan covers 58% of the cost (I pay 42%) after the deducible, basically $226.10.

Twiist refill kit/infusion set (also non-formulary) $2082.24/month (according to UNH…) This doesn’t seem to make any sense; I assumed 10/month on the basis of changing the infusion set every month but it’s coming up with $300.49 initially, which is exactly the same as the starter kit. Looks like the prices are bogus.

The Twiist costs are pharmacy dependent, home delivery is not available.

My insulin (Lyumjev) is coming in at $35/month, Fiasp is slightly less ($33), Humalog is $32. So that alone knocks $420 of the out-of-pocket-max ($2,000) however it doesn’t count towards the deductible.

So, yeah, Twiist is available on that plan but only with prior authorisation; who knows whether that would fly?

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