Please keep us posted. I am very interested in this and trying to explore more options for myself. Thanks for your experiences.
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So far things have gone well with getting the twiist pump starter kit…the box is sitting in my house ready for me. All I need is a CGM that will work with the twiist, either Eversense 365 or Libre 3 plus. It looks like the Eversense sales force is not ready to sell one to me. They have a long winded song and dance about Medicare that has created confusion with me and my endo. She had referrals locally that can insert the sensor but Eversense says they will not do that for Medicare patients.
So I am waiting for Edwards to ship a 90 day supply of Libre sensors once I am allowed to reorder DME sensors. Once I have those in hand I will try to use the twiist pump with Libre 3 plus sensors but wearing Dexcom as a backup because I have not been confident in the libre sensors so far.
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Today I started the twiist pump, so far so good. The startup training was at the CDEs office of my endo’s clinic and lasted about 1 1/2 hours. As luck would have it, my past few nights with the pods were notable for middle of the night lows. Those events got the trainer and CDE pretty excited and contributed to an overall approach of being cautious with the settings. The basal rate, I:C ratio and a few others were about 30% reduced from the numbers I had been using in Omnipod 5. They said their experience has been that users end up with similar reductions so I went with their numbers. They also stressed that my habitual use of Afrezza to speed up correction bolusses would not be wise for a while until I’ve git the twiist dialled in.
As for the CGM, I started twiist using Libre 3+ CGM and plan to continue with Libre until it proves itself either inadequate or adequate. The trainer assured me that obtaining replacement sensors is easy if any don’t last 15 days. I will also be wearing Dexcom G7 for 4 more days until my current sensor runs out.
I don’t have enough time with twiist pump to form an opinion about the settings or dealing with tubing, but hopefully will be fine tuning over the next few days.
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Good luck on the twiist pump start, @John58. You’ve got the right attitude trying to follow the trainer and CDE but I certainly would find it hard to follow their conservative approach. No long-term harm; you will be making changes on your own soon enough!
I use Afrezza for corrections, too. I use maybe 3-5 four unit doses per week. I consider it a mainstay for my control and would find it hard to not use it. I’ll be interested to read more about your twiist experience.
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I had a call back from the local Eversense rep…he offered a June 4 insertion date with a newly signed up clinic in Tacoma able to bill Medicare.
I’ve been putting the twiist pump through it’s paces…it’s been great so far especially in comparison to my last few months on Omnipod 5. I’ve had no problems getting used to wearing a tubed pump. About the only complaint I’ve got is with Tidepool’s mobile app. The only way to see any daily detail with my data is using a laptop, the mobile data is a basic 2 week average only.
I am planning to stay with the Twiist and go with the Eversense 365 sensor sometime this summer, mainly based on my two unsatisfactory initial attempts with Libre 3+. The Libre sensor I am using now seems fine but I suspect I’ll have a better shot at consistently good sensor performance with the Eversense.
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@John58, I apologize if you’ve already answered this; my memory is not what it used to be. I understand you’re on traditional Medicare with a Part D Rx insurance provider. The twiist is not on your Part D provider formulary but your appeal of an initial denial was successful. You have the pump and also the Libre 3+ CGM.
Did you have to make any co-pay for the twiist? What is your current understanding of your responsibility to pay out of pocket for any ongoing twiist and CGM supplies?
I ask these questions because my situation closely aligns with yours. I’m trying to get myself in line to go ahead with the Eversense process. Part of what motivates me is I think the ES 365 holds out the potential to overall much better data consistency than Dexcom G6. I have no experience with the G7. The relief I would sense avoiding “babysitting” a questionable sensor data (10% of data requiring finger stick confirmation) promises a step up in quality of life. In any case, I am most interested in the path you take.
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@Terry Your summary was close! Rather than initially submitting a claim for them to deny I went straight to the formulary exception submittal with my Part D insurer, by obtaining the form, filling in most of the required info, and hand carrying it to my endo with a request that she complete the rest of it and submit with the prescription.
The way I look at the cost, I was hitting the $2100 out of pocket max for Part D about halfway through the year the past few yesrs mainly because of Omnipod copays. Now with twiist, my copay for the “starter kit” (which includes the pump plus a 30 day supply of expendables) was $145 and a 30 day “refill kit” came with a copay of $145. They only use two suppliers (Byram and one other I forgot) so a phone call to Byram with your Part D insurance info might help clarify your copay costs.
A hidden $$ saving is my TDD of Novolog has been reduced by a significant percentage from Omnipod 5 (more info on that later in the month) and I have only had to use Affrezza once for a correction in the first 5 days of using twiist. As compared to the past few months when I was correcting daily or more. So I will save some insulin copay $$ by stretching out my refills.
I’m very happy with the twiist pump and find the AID software (Tidepool loop) to be a perfect fit for me. I speculate that the infusion set used by the pump does a much better job at getting the full dose of insulin into my flesh than Omnipod’s angled cannula, which might explain the reduced TDD.
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That sounds really encouraging. Glad the approval process moved along quickly for you. Hope the transition to Twiist goes smoothly and ends up being a good fit.
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I had my Eversense 365 sensor inserted on Thurs, June 4. The insertion was scheduled for me by the Eversense reps, and the Medicare Part B DME claim was handled entirely by them too. Zero copay. (I have a Premera BCBS supplement). The clinic for the insertion goes by “Eon Care” and apparently is owned by Senseonics, the Eversense company. They seem busy with Eversense insertions, telling me I was the 6th in Tacoma that day .
The insertion takes about 10-15 minutes and was in the back of my upper arm. They closed the incision with steri strips and instructed me to take it easy for 5 days to avoid sweat or stretching to disrupt the healing. There has been zero pain at the site.
Based on my prior experience with the 90 day sensor, I don’t plan to start the Eversense or connect with the twiist pump until about a week after the insertion. Like the Dexcom 12-24 first day inaccuracies, I am planning for about 7 days of healing time for the Eversense sensor to gain accuracy before I calibrate it . I timed it so my current Libre sensor session will have a few days left when I start using the Eversense.
In the meantime, I’ve been happy with the twiist pump but concerned about running Tidepool Loop on it with the Libre 3+ CGM. @Terry To answer your question, the twiist refill is $145 copay on Part D. It is supplied by Byram, who seem OK so far. The contents of a refill are listed below.
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Glad to read that you were able to get the Eversense 365 inserted and get 100% Medicare coverage. How is the incision healing? Have you been able to manage your glucose at a good level post-incision. Did they give you a choice of which arm to use?
I’m still getting my doctor to complete the required forms to Senseonic’s satisfaction. Not sure how long this process will take but I’m motivated to get this thing done!
I had a bad hypo two days ago, attributed mostly to a newly installed G6 inaccuracy and a poor night’s sleep the night before. That prompted me to turn off the Dexcom app just prior to a nap, to silence what I thought were false alarms. I woke up with a sweat-soaked shirt and a low < 50. It was the worst hypo I’ve had in years.
I’m hoping that the ES 365 will prevent that circumstance from repeating itself. Good luck with your new CGM!
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Just keep an eye on making sure your orders are coming regularly! I’ve been using Byram for over a decade. They once didn’t send me insulin for a full year because my prescription had expired. I only realized because my back stock started getting low, which never happens. I had to call them to find out the issue… they never called me about sending them a new prescription. 
Byram’s supply ordering side (like my pump supplies, the only thing I still get from them) is much easier to use than their pharmacy side (insulin, test strips, etc.). For supplies you can reorder and pay and see your order history online, easy peasy. For pharmacy stuff, I only was able to get stuff done by calling their customer service. If they had an online pharmacy portal, I never found it. Eventually I made sure eeeeeverything pharmacy was on auto-order and that they had two methods of payment on file. That helped prevent a lot of the pharmacy issues.
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It’s been so far so good with the Eversense 365. I had one episode of overnight high BG (possibly attributable to the twiist pump pinched tubes but frankly a mystery)…during that extended overnight high the Eversense vibratory alerts failed to wake me up. After that experience I have kept my phone close by at night without silencing it.
One surprising issue I’ve found is the Eversense app drains my battery. Day to day my iphone says the Eversense app used anywhere from 30 to 50 percent of my total battery use each day. I’ve started closing the app during daytime to see if that helps.
As for the twiist pump, I’ve had some infusion site issues and some pinched tube problems the past few weeks. I’ve gotten more aggressive about adjusting my settings, resulting in my Total Daily Dose (TDD) insulin usage increasing and getting closer to the range I was seeing with Omnipod 5. Not sure what to make of that but hoping there is a corresponding reduction of after meal spikes and significant drop in average blood glucose.
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The app opens in the default browser, at least on Android, and you can use the “Desktop Site” button in the (browser) menu to swap to the full display, and the "“Mobile Site” button (which “Desktop Site” changes to) to get back.
I use DuckDuckGo on my mobile; other web-site viewers (particularly Google’s, which has a lot of its own code) may be slightly different. Try an AI search for, “How do I swap to the desktop site from the mobile site.” in your browser of choice. Zoom the browser screen to make it more readable; the screens are about the same resolution in pixels (“Picture Elements”; the smallest block of RGB dots on the screen that the program can change) but the screen is much smaller so stuff is difficult to read.
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I’m not sure what you mean by “closing”. If you mean you are just removing it from the list of apps in the list that allows you to swap between apps that’s just the same as clicking in another window on a desktop computer; it doesn’t stop the app running. Technically it doesn’t on a desktop either but it’s a lot more common there for apps to really shut down when their window is closed.
There’s an option in the operating system (the thing that controls everything on the mobile) to, “Stop.” the application. I don’t know about Apple tech but generally it’s the same as Google’s; on Android, however the specific instructions here will only work on Android:
- Hold the App icon on the control screen (the first screen where you can see all the app sigils).
- Observe: An “App Info” entry on the menu which pops up; select that.
- Observe: “Force stop” on the screen which appears. Click that.
- You will be warned that apps, like children, misbehave. Select “Force stop”.
- Observe: the “Force stop” button [square] is now dimmed.
You need to go back after a while and see if the Eversense app is running again. Some apps will “auto-start”. If it’s doing that I think you can stop it; I believe automagically starting is a “permission” that can be denied. I don’t, at this moment, know how to do that; most of the time I want to do the opposite because Android has a built-in very-hard-to-disable feature that stops an app doing this.
For those people using on-mobile AIDSes, yes, we obviously don’t want to do that because we need the CGM aggregator to be running all the time; that’s why I am more concerned on said aggregator not being stopped by the OS… Fortunately my aggregator, xDrip+, accounts for just 1.27% of the app battery usage. My AIDS (AAPS) consumes 55.25%.
It’s also worth noting that Android and, most likely, iOS, report a percentage of use over time, not the actual use. It’s not clear what the “percentage” is a percentage of so the figure is almost completely meaningless.
This happened again a few weeks ago, with my pump supplies. 
Thank goodness I realized, “I haven’t seen a delivery in a while…” I logged in to see my last order in April had been “cancelled” and never sent because they “don’t have my insurance on file.” No notification otherwise, and it’s the same insurance I’ve had for 6 years. To verify the insurance, I tried the Byram chat, I sent photos of my insurance card, I called Byram twice to get phone numbers for my insurance to call to verify my coverage (none of which went to the right Byram office)… Finally I had to spend an hour doing a three-way call between me, Byram, and my insurance. Oof.
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@John58 Have you talked with other Eversense users about the phone battery usage? I haven’t heard of the issue, but sounds significant, particularly if your a heavy phone user. Also, is it reporting every 5 min like G7’s do or is it every minute? Is it selectable using their app? Just trying to think of solution, but you’ve probably already gone thru that.
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Apple calls it a “force quit” (?). Swipe up on the app and it stops gathering data every x minutes. The twiist app gathers all the same BG data and suffices during day to day activities.
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I have not had a problem with Byram (yet). They have an odd habit though of texting me about ordering a refill about 2-3 weeks before the subject refill is shipped. A little confusing but at least they have both dropped the ball.
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I’m not sure but I thought twiist was akin to O5; no mobile required. In other words the twiist connects directly to the Gx or LibreY and gets the BG from there and then works out how much insulin to deliver.
I wouldn’t willingly swap to another AIDS unless it did that; that is the biggy. It allows us to drop our mobiles into some appropriate cesspit, at least until we eat, and just keep on keeping on.
I get I have to tell the algo that I ate; not doing so is, “Full closed loop.” I’ve tried it yet I don’t think it’s quite there. But I don’t want to have some half kilo mobile relaying my BG from one IoT to another. (I do have that, but I don’t like it.)
So, for me, twiist, despite it’s twisty little tubes all alike, is a real possibility (like Eversense) but it needs to work without my mobile. Fine; I’ll use the mobile to tell it I ate something, but honestly, why on earth would I need a mobile for anything else?
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It’s my understanding the Tidepool loop software resides and runs on the iphone. It’s possible that I am mistaken though.
FYI I am mothballing the twiist as of today and going back to Omnipod 5 and Dexcom G7. Too many hardware issues in my 2 month test run, (mostly infusion sites giving up their grip on the cannula and false blocked/kinked tubing alarms) topped off by a “mechanical failure” in the pump today and a two day wait for a replacement. I have a lengthy trip starting in a few weeks and I don’t have enough confidence in twiist hardware reliability to stay with twiist for the trip. On the bright side, I became comfortable with the Tidepool loop software and found it was working pretty well the past few weeks. It took many tweaks of my settings to get to that comfort level.
Since the Eversense sensor is in my arm I will keep using it as a backup to the G7. But the Omnipod 5 will not read Eversense data so there we are, back at square one.
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