Thank-you, Aronld. I appreciate the insights and knowing about Medicare. I appreciate you sharing!
@CarlosLuis I know you’re right for Insulet’s various offerings, one cannula, contained internally. I think similar for other pumps with possible exception of the Sigi. In reading and watching a Youtube video on the Sigi pump (Tandem reportedly just bought them), I thought I read something about potential for different cannulas (cannulae?). With the current Sigi pump design, the “backplate” with a cannula attaches to your skin and the pump, which uses an insulin cartridge, attaches to the backplate. This arrangement could afford to opportunity for different cannula designs (not that it DOES, just something tickling my brain). We’ll see when/if Tandem releases it (BTW it’s a possibility the Tandem version of the Sigi is what Tidepool Loop is hinting at as potential pump partner on Tidepool Loops release. Though the Sigi, my understanding, still has to undergo FDA clearance/approval, possibly some time this year; no small feat!).
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Thanks for your thoughts. My bicycling group scribe would appreciate the use of cannulae for the plural. 
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We need a plethora of cannula choices, a cannulacopia 
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Stop just stop 
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And we need a cannulapedia to understand the different choices.
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It’s been a year since I updated this thread and a lot has happened. As @bostrav59 so presciently put it using autosoft 30 set was a “current” solution. By May '23 I was having a lot of trouble with absorption again. After two failed sets in a row I decided to take a short break and go back to MDI. The short break ended up being the entire summer! And here is the kicker: my control remained just as good on MDI as it was when pumping. I am more active in the summer and that had something to do with it, but I think it has more to do with a raising of my standards of what constitutes “good” control.
By early November '23 control was slipping a bit, and I was sick of rarely getting a full night sleep; lot’s of nocturnal alarms both high and low. I was craving that Tandem Sleep Function! I decided to give tSlim another try. Second AND third sets failed. You could actually feel a dense sort of turgid area of flesh around or in front of the set, like it was trying to corral the insulin and keep it from absorbing. SO I decided to try something I saw mentioned on this site, and so far so good!
I’ve been using the pump for basal insulin only. For meals I use an InPen with Fiasp. I turn Control IQ off for five hours after I inject so it doesn’t get confused (the algorithm needs to know IOB). I do hope this keep working and I do hope my Endo doesn’t throw a fit when I see him next month. Does anybody have any tips for me using this approach?
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No, because it’s exactly the approach I will use whenever the Omnipod 5 arrives in Canada – pump for basal, inject boluses, switch to Manual mode for several hours after an injection or once back in range. It works for a couple of others here, such as @John58.
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TX, guys, I’ll tell endo it’s all your fault 
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If he does, find a new endo!!
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So I went to endo last week and he was not immediately on board with the combo therapy, “not the way I like to do things” says he, and he pushed idea of changing infusion sets every 2 days. Sort of tempting but I told him I don’t want to change what works. He couldn’t argue with 90 day TIR of 92% and SD 34. Or may he could as we will see.
Now the lab had lost my venous A1C so this all went down sober and perfunctory. Then the nurse came in with finger stick result: five point eight. Didn’t expect that. Was flabbergasted. I’m cured. Spent rest of visit in space. Clarity GMI predicted 6.3, and I have been told actual A1C is usually lower - but half a point is a lot.
Endo was tired and seemed more exasperated than pleased with my results. He thinks I need to ease off and he’s probably right. Keeping this kind of control is like living in a video game 24x7x365. It’s all consuming and becomes an end in itself. I say that because nobody really knows how much difference it makes in the long run.
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I had been pumping with a Medtronic 670G and using a Dexcom G6 (of course the Dexcom doesn’t work with the Medtronic pumps so I was adjusting everything on my own). When ControlIQ works, it’s not bad, but frankly, it’s given me no better control (TIR or average blood sugars on a daily or weekly basis) than doing things manually.
The most frustrating part of my Tandem trial, however, is that like you, I tried the Autosoft sets infusion sets. I started with the 90 and have gone to the 30s. I got occlusion alarms and failures with both the AS90s. The 30s worked well until my last site change. It worked overnight brilliantly. I had a training session (cycling), ate breakfast, went a bit high, but started to come down a bit toward lunch, ate a big lunch, and wham, up over 22 (not sure what that is in American measurements; my pump and Dexcom just read, “high.”
While I think Control IQ is probably the best software out there currently, I find it’s insertion devices for infusion sets really difficult to use when injecting on my back and upper butt. Unlike Medtronic insertion devices, you have to pull the needle out manually. If you aren’t exceptionally flexible (Medtronic needles retract automatically), I think this might be a step that can cause bending of the cannula with all the tandem infusion sets. I also find the cannulas a lot less comfortable than the Medtronic cannulas. The issue is not my body or my absorption. I started using the 7 day extended infusion sets with Medtronic (which is nice because I can just choose a good day of the week like a Sunday evening and insert then so I don’t interrupt any social plans/work/etc) and I get the full 7 days and have even gone 8 or 9 days. I also get no scarring or soreness afterward. Whereas I find I’m getting both external scarring and soreness with the Tandem sets (which makes me worry about scar tissue build up over time).
I know the jury is out and that a number of folks say negative things about Medtronic, if you’re having issues with infusion sites, it might be worth it to see if you can at least trial a Medtronic 780G with the extended infusion sets. I tried the Mio sets and those were okay, and prior to that I used the Silhoutte infusion sets which also worked okay, but still hurt more and left more scaring than do the extended sets. The best part of the extended sets is that it’s got a very easy to use injector where the needle retracts automatically. You have to exert slightly more pressure than you do for the Dexcom inserter, but not much more. Because of this (and how easy it is to clip and unclip the tubing to the infusion site), it’s pretty easy to put pretty much anywhere on your body from back, upper butt, all around your abdomen.
So if you want to/are willing to try another system, maybe see if you can trial the Medtronic 870G with the Extended sets and the Guardian 4 sensor. I’ve heard a lot of negative things about the Guardian 4 in terms of the dexterity required to put it on the back of your arm. But some folks seem to have figured out ways to make insertion a bit easier (and the sensor to last for 10-14 days rather than just 7).
I’m still pretty torn about which one I’ll ultimately get. I really want the Tandem to work because I’ve heard such good things about it. But having three set failures in the space of three weeks (with really high blood sugars) is both frightening and it’s really compromised my job/work and my training. Anyway, yet another perspective.
I really hope you’re able to find something that works well without having to make diabetes management a full-time job!.
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Thank you @Dagis20 for reminding us that Medtronic has a lot more insertion set/cannula choices than Tandem. Cannula is THE weakest link in pumping. A downside to Tandem is the proprietary t-lock that “locks” us out of trying the full panoply of sets available.
Abject failure with AS90 sets and limited success with AS30 is our common experience. Not sure the cause of problems is parallel. For me, I’ve decided that any infusion set cannot be relied upon to stand up to repeated meal boluses. It feels like the flesh where the cannula is inserted just reacts poorly to repeated inundations of insulin.
Here’s a project: On MDI, put ALL shots of insulin into same cubic cm of your flesh for 3 days and see what happens. Any Takers??
Since you say you had no absorption issues in the past, give yourself some more time with AS30. Judging the angle of the inserter is key. Maybe use your abdomen only for a while?
Regarding tSlim software, CIQ correction boluses may be too little too late or too much too soon, but when you are not paying attention one can make all the difference. Have you tried Sleep function? It existed as Basal IQ for a year or more before tandem came out with Control IQ. It works in a more subtle sophisticated way, and it keeps your control tighter.
And welcome to FUDiabetes!
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Thanks, Aronld!
I’ve just tried sleep mode and had two fantastic nights! I’m a cyclist and so train for 1-3 hours in the morning and what I’ve done the last two days is just keep sleep mode on all the way through my training so that my blood sugar stays above 6.1, but I can also eat food at 1.5 hours into my ride (which a non-diabetic would have to do). I don’t get an autobolus (and I don’t need it). I really love sleep mode and I might actually keep it on all the time as you’ve suggested.
I think I might have actually inserted the AS30 into a bad spot and then another one far too close. I think I just have to avoid that spot altogether. I will try my stomach. When I inserted the medtronic sets, I got sore. My absorption was fine, so maybe I’ll retry it and hopefully I won’t be sore (also might try to prevent myself from sleeping on my stomach … which my chiropractor hates that I do anyway!!).
I only use about 25 units of insulin a day (I’m not a big guy, 5’8", 138 and then a lot of physical activity), so that might be one reason why I’m able to keep a site in for a while. Maybe it really varies if you have to use more insulin. That makes good sense.
Thanks for the welcome! I do hope things continue to work well with your basal/bolus system! My best to you,
Evan
Just for the record I did not tell you to use Sleep function all the time. Tandem would tell you it is dangerous during exercise. Whatever works, but be careful eh?
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@Dagis20 I’m wondering why you haven’t tried the TruSteel stainless sets. When I first started pumping I tried the AutoSofts and had the same experience as you. I switched to TruSteel 6mm cannulas and it’s been smooth sailing since (10 years ago).
TruSteels are available for both tslim and Medtronic pumps.
Hi Jim_YYC,
I haven’t tried them because I wanted to give the Autosoft30s a fair shot before giving up on them. The last two have worked flawlessly, so I’m actually thinking I may have inserted the last ones too close to a ‘dead spot’ where I don’t get absorption.
The other problem for me is that I am terribly afraid of needles. Although I’ve been doing them since I was 5 years old (I was diagnosed at 3) I still hate them. They actually hurt. Between my fear of them and my ADHD which makes my hands shake a bit (which could be why they hurt when I insert them manually), I don’t like doing a manual insertion. When I went from the Medtronic Silhoutte, which is manual insertion, to the 7 day extended sets, which has an autoinserter, it felt somewhat life changing. I no longer had pain on insertion and lost my anxiety of site changes and of course I only had to change my site every 7-8 days. I had zero issues with the 7 day extended sets with medtronic. I could easily get 7-8 days.
I don’t like the idea of changing my site every two days with trusteel or having to do a manual insert. So I’m really hoping that the autosoft 30s continue to work well for me. I’ve head that Tandem is coming out with a 7 day that will hopefully be available in Canada early 2025. So all of this might be moot in a year’s time!
Of course! Actually, my Tandem rep suggested using the sleep function through my training so that I can actually eat every 45 minutes without getting an autobolus. Getting an autobolus while exercising, while in exercise mode or Control IQ, is exceptionally dangerous. I don’t need any bolus at all if I’m eating. So far, having it on for my training has worked brilliantly. For now, I turn control IQ back on right after the exercise as soon as I am eating breakfast. I have heard of folks running sleep mode 24/7 (and two of the people doing this were training for Triathlons!). But yeah, no worries, I definitely won’t attribute using it all the time (if I do that) to you telling me!
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