Tandem t:slim X2 Insulin Pump - 2 months later

So I’ve been on the Tandem for just shy of 2 months now. My sugars are definitely improved…got my first A1C under 8 in over a year (7.5%) and that’s with my continued disordered eating issues (I restrict/“binge” (I think) on and off and jump from diet to diet).

Sleeping is a lot better, not as many lows.

So a lot of checks in the pro column. For the con column, exercise has gone down the drain for me. I am an EXTREMLY active person, but find it exhausting to try to exercise with this pump. I have to wear a belt to keep it on, and despite trying many, I hate them all. I hate having to unplug for the shower or swimming, so my pool days have dwindled to nothing, and sometimes I don’t bother working out because of the shower annoyance. Psychologically, I hate the tubing. I drop the thing constantly and that sucks.

Another reason I got this pump was my Omnipod would only work consistently on my stomach, which I was way overusing. So far, I have been able to use my stomach and upper buttocks/lower back so that’s one more site. I used my mid buttocks and it didn’t feel great and the tubing constantly got pulled when I had to use the washroom. I currently have it on my leg, and it’s painful to sleep on that side and I’ve been running high the entire time, except for when I suddenly go low (if I try to exercise).

These downs might seem like I should just have an attitude adjustment, and trust me, I’ve tried. I will also continue to try. I’m also nursing a knee injury, but that still doesn’t stop me from biking, rock climbing, kayaking and going to the gym, so it’s more the pump than anything.

I want to be so happy about this pump, and I’m going to keep trying to get there, I mean I used all my savings to get it, even with my Uncle helping out, but yeah, the reality is none of these systems are perfect, none make me a non-diabetic, I’ll always be somewhat moody over T1D, but I’ll also always keep trying.

Just sharing my thoughts and feelings. I’ll see how I feel at the 6 month mark. Hopefully better.

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Maybe an upgrade/trade-in offer will be availabke for Mobi.

*(https://investor.tandemdiabetes.com/news-releases/news-release-details/tandem-diabetes-care-announces-fda-clearance-tslim-x2-insulin-0)

From article:
UPDATE: Tandem [announced]
on Feb. 16, 2022 that it had received FDA clearance for its mobile bolusing feature for both iOS and Android, and it’s expected to launch in summer 2022.]
*

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I’ve been tempted by the idea of changing from the Omnipod for the same reason; I’m running out of places to put it. I’m back to stomach too. I don’t think I’d last through the tube thing, I’m not going to be happy wearing a belt.

It’s incredibly, annoyingly, frustrating. Some things get better, some times get worse. The more we try the more we fail. I remember all the years I didn’t give a damn and that was easier.

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Thanks for the update. On the exercise thing, have you thought about just leaving the pump at home when you go for an exercise? I know everyone is different, but for me it’s not a big deal to not have my pump with me when I’m working out.

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Looks like the pod. I wonder if it’s waterproof. I’ll take a read later today, thanks for sharing.

I think that might be too long without it. I usually go to the gym for 1.5HRS and it’s about 10 mins drive either way, then shower too without pump. Might work, but I’d be pretty nervous.

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We should have a short acronym for the acknowledgment that every diabetic is different - maybe EDID?

Given EDID, I have gone for a day without my pump when I’m biking. My endo suggests I wear it all the time, so I’ve been trying to, but in terms of control it doesn’t make much of a difference (for me).

I guess you are willing to take some advice, given your response to @eric 's question. So my suggestion: try it and see what happens.

No doubt, the pump is a pain when exercising, and I get away without having it for long periods of time when I’m exercising.

Nervous is good - it means you will pay attention to the results. Maybe this will be helpful, maybe not. Are the risks of the experiment acceptable to you?

e

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I’ve mostly seen YDMV for “your diabetes may vary.”

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Oh yeah. I always carry pens in my bag anyway for back up, and I am very open to experimenting

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I could understand not wanting to go without some form.of glucose monitoring when exercising, but not going without a pump or giving up swimming.

If it were me I’d be more worried about going low during exercise than not having enough insulin. I needed to snack before exercising long before I had type 1 throughout getting certified as a lifeguard and scuba diving. If I were still diving that would have me completely removing the pump and CGM and using MDI and BGM during the diving part of a trip. But not for casual surface swimming.

Active exercise lowers BG. All a pump could do is lower it more. Exercise profiles for a Tandem purposely raises the BG control range, gives less insulin prior to exercise, and the pump always reduces delivery if you drop low or quickly so you don’t drop low too quickly to react.

Disconnection for exercise is the same as for bathing. That should not be a problem once you do it enough times to learn the knack and swimming just requires waterproof overpatches to keep the cannula and CGM sensor in place.

Take along glucose tabs to use if you feel s low coming and do a correction if needed after you reconnect the pump.

Regardless, check your BG before driving home.

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I’ve always wanted to scuba dive! Do you do it anymore?

Actually, for me, depending on what exercise I do, sometimes it can raise at the gym (very annoying). I wouldn’t feel comfortable going anywhere without both insulin and glucose. I’ve had a few scenarios happen that have ingrained this in my head: a couple lockdown situations where I work, where I’d have to hunker down for hours, got stuck in an elevator once for 2 hours, etc. Weird things like that where I thought to myself I will never not have my D supplies with me in case this happens again! I even take my purse with me going to take the garbage down in my building!! I just never know.

My Tandem at first gave me peace of mind at the gym because it accounts for highs and lows while I’m not paying attention, but I still went low at the gym even in exercise mode. I’m still figuring it all out and it’s frustrating and taking a huge mental toll on me for me for some reason. Still holding out hope that in the end it’ll all be worth it.

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No I do not scuba anymore. I gave it up when I didn’t believe that it was safe for my partners and didn’t believe they were attentive enough to notice if I passed out underwater .

Passing out was my fear for years. If I knew then what I do now, I would have done it longer.

Newly diagnosed as type 1 in the 1970s (they didn’t have LADA yet), and newly married I wasn’t getting much enjoyment from inland cold water diving (murky with 3 foot visibility ) and couldn’t afford more than one Caribbean trip per year.

If you were ever considering scuba, don’t delay . Reefs are dying worldwide . Diving dead ones is as unsatisfying as touring melted glaciers. Dead animal (natural history) museums are more interesting, at least they have animals to see.

As far as BG rising during exercise, it can’t rise more than the carbs in your system and bring high isn’t a problem unless it’s above 250 mg/Dl for hour’s.

I wasn’t suggesting you go anywhere without all your kit. I carry all my “if the pump or CGM fails and I get trapped in a well where Lassie can’t get immediate help” stuff in a belt pack everywhere . I could survive for 3 days with it, longer with the water and food that is in my car.

Keto test strips can tell you if you’ve been too high too long. These are cheap, under $10/100. You probably won’t be high enough long enough to need them frequently, so get them in sealed ten packs That way some will be good for 2 years not just 3 months.

Hypo symptoms at the gym means you weren’t high enough before you started OR you normally run high and your BG dropped rapidly.

I’m assuming your have Control IQ. You should start an exercize profile at least 90 minutes before going (or disable it and run on just basal until you disconnect.)

You don’t want the sw to drop your BG to a level where your circulating sugar isn’t enough to meet a demand surge.

The harder you work out, the higher you need to be in advance, or the more measured quick carbs you need to take throughout the session.

Ideally the hardest workout you do shouldn’t drop you below 120 at the end. 200 isn’t nearly as dangerous as 70 is.

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The following is a long thread to read through but Daisy Mae, an avid swimmer, worked through a lot of pump issues.

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Some people arrange it to have 0 remaining IOB before exercise, and also suspend the pump to prevent insulin delivery. (Rather than starting with really high BG and lots of carbs in the belly.) But it depends on the intensity and duration of the exercise. At a moderate effort my BG slowly falls, but when working hard near my limit my BG rises from the stress. So we all have to run the experiments for ourselves to see how our own bodies handle our style of exercise. Folks here will offer suggestions, but if your CGM is working and you have insulin and glucose that you can get to if needed, there’s no danger to trying different things to see what works for you. You’ll get it figured out with practice. Kind of like learning to drive a car, it’s clumsy and stressful in the beginning, and pretty automatic after a while.

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I think my problem is I don’t have enough consistency to see any solid patterns yet. Sometimes I go high, sometimes low, exact same workout. Times vary, also what I’ve eaten, when. Last time I ran into an ex at the gym and I think the stress of that sent me skyrocketing lol, but a lot of factors. Hopefully I’ll figure it all out one day…

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I’ll have to look up those numbers because I’m Canadian, eh. Ketone strips…I have them, but have only used them in DKA.

Scuba :diving_mask: sounds amazing. I’ll definitely look into it.

Thanks!

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The first column is A1C the second column is milligrams per deciliter the third gram is mmol. I carry around this truncated version of a longer list because this is the only range of values I care about.

If I’m outside that that range, as far as I’m concerned, I’m too high or low.

250 mg/dL is 13.9 mmol. the upper range line on a tandem pump is at 180 mg per deciliter or an mmol of 10.

For amazing driving you have to go to Australia or Fiji where the cost of getting there is high enough that casual tourists aren’t breaking off pieces of reefs with their fins.

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This is what I try to make every day look like, but its hard to do with gastro problems ,CGM sensors that fail and bad sites.


Too often they look like this

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I’m surprised to hear that you consider below 120 mg/dL / 6.7 mmol to be too low. My endo best likes me to be in 80-120 mg/dL except for excursions.

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As @psfud123 observes. Do it now.

The DAN rules require a physician to sign off (not an NP, not a PA), they also require a BG before the dive of at least 150mg/dL (i.e. 8mmol/L, 8mM), and a max of 250 (14); I hate that part, but I follow the rules (I don’t think I would actually dive at 14 and I have aborted a couple of dives because I was too low).

With conventional pumps - they didn’t consider the Omnipod - they say to disconnect the pump before the dive, reconnect after. I wouldn’t do that either; when diving I swap to using a long-acting insulin because I’ve heard too many stories of non-Ds being accidentally left in the water for hours. I don’t have any endogenous insulin production so things start to go seriously wrong 2-3 hours after a pump failure. Long acting insulins avoid that problem and then it’s hypothermia that kills you if you get left behind.

FWIW if you do it the Omnipod is a blessing; during training, if it is done in a swimming pool, you can just wear it; pools don’t go beyond 25ft (8m) and then only if they have a dive (as in high-diving) pool. Repeated immersion at any depth will kill a 'pod; the pod is vented (you will learn the importance of that if you learn to scuba dive). Anyway, if you do it you will learn all of this (scuba is an OCD).

Watch out for places with real diving; I know that Dressel in Cozumel run their “open water” qualification dives at a location which approaches 60ft (20m) in depth. I’ve dived with a pod on (actually delivering basal until I learnt better) at that depth and the thing starts beeping after about 30 minutes. There are tricks to make a pod last longer at depth - it is vented, so it works at any depth - but they are just not worth it. This is why I swapped to Lantus on diving vacations.

Like @psfud I’m probably not diving anymore, but not because my buddy is inattentive; she is my wife (I wouldn’t dive with anyone else) and she is very attentive. Find a good buddy, marry them.

Yes, yes, yes. The first time I did any scuba I was recently diagnosed, a T1D of only a couple of years age, and my curious parents decided to go to Kenya. Now the diving was, well, for a 14 year old, weird, interesting and slightly scary, but the Kenyan national parks we were staying in (primarily the Tsavo) were utterly, unutterably, amazing. No longer. See it before it is gone, it will never come back.

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