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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