Had the t slim just over 6 weeks and I don't like it. Have issues with filling it as there are so many fiddling bit to manage compared to Accu Check Insight. Twice of which one is now 3.30am changed site and cartridge and blood sugars have risen in 6 hours to 26.3.....site changed and tubing checked. I have never in 15 years of having a pump known such wastage and poor control.
TSlim issues
- Thread starter TSP70
- Start Date
I also found my T-slim very fiddly and frustrating after Accu Check. It was so much easier to pop in the pre-filled glass vial of insulin. Because I have problems with my fingers, I actually asked to have T-slim changed to an Ypsomed but the 'system' doesn't allow. Now I tend to fill the cartridges when I have plenty of time and put the 'spare' in the fridge.
I found that the teflon cannulas kinked for me, so I changed to TruSteel infusion sets (after advice from this site). I am more comfortable with TruSteel.
In Response
Well-Known Member
- Messages
- 3,487
- Type of diabetes
- Type 1
- Treatment type
- Pump
Take care with this. My understanding is that the cartridges are not designed for long term storage so the advice was not to pre-fill cartridges as it can affect the insulin.
I am sure it will be fine if you fill one cartridge when you have time between set changes but building up a supply in your fridge will mean the insulin sits in the cartridges for too long.
Oh, thank you. I have been wondering but crossing my fingers. From now on, it will be one cartridge at a time.
- Messages
- 9,037
- Type of diabetes
- Type 1
- Treatment type
- Pump
- Dislikes
- Hypos, rude people, ignorance and grey days.
It's incredibly hard transitioning from one pump to another and the differences are more apparent when faced with more obstacles, just to start off why are changing your set at 3.30am is it because you've gone high and alarms ? What cannula sets are you using ?
Getting used to something does take time and patience, as t1d's we want instant relief but a new pump will bring new challenges, it took me a while to get used to my T Slim, I use trusteel sets as didn't get on with the mios/teflon sets, had many fails but I don't with trusteel as I manually insert the steel tip, a set can last me 3 days, yes the change is fiddly but with time/practice it does get easier, the benefits though with T Slim are great, more stability, better sleep quality, these far out weigh the negatives but that's only happened over time.
Yes my sugar was 26+ !!! It's the cost to the NHS which I find hard too with all the different buts and plastic and packaging they said it's environment friendly as no batteries however uses more plastic packaging than anything in 47 years of T1 diabetes. It was the best of a nit so good choice. I work in primary school and sometimes have to deal with challenging behaviour! Anything too big was not practical that could be visible. I have left a message for the team to call as not good today.
- Messages
- 9,037
- Type of diabetes
- Type 1
- Treatment type
- Pump
- Dislikes
- Hypos, rude people, ignorance and grey days.
If it's any consolation I was hypo for about 2 hours during the night, went to bed high, took a correction and from 3-5 was low... so having a hyper night you have my sympathy..
What sets are you using and do you know what caused the 26+ reading ?
What sets are you using and do you know what caused the 26+ reading ?
- Messages
- 9,037
- Type of diabetes
- Type 1
- Treatment type
- Pump
- Dislikes
- Hypos, rude people, ignorance and grey days.
Sorry to add... I have also had my concerns over the amount of packaging/waste from an environmental point of view but have only come to the same conclusion each time, we are keeping ourselves alive, despite the cost/impact, it's the fact that this equipment helps us to live each day is the reason I cannot then expend more mental energy on the environmental impact, in my own small way I collect litter around my village and so I try to balance my reasoning with putting something back, hope that helps..
You mention readings over 26. What I tend to do in a similar situation is to give myself a correction with a pen, and let it work while I change the infusion set.
As far as wastage is concerned, I agree with you. My special frustration was that twice when I had telephoned to ask for infusion sets only, because I still had lots of cartridges, they still sent more cartridges with new infusion sets. On the third time the person at the call-centre listened to me. My consultant agreed that I could change the infusion sets approximately every 48 hours, instead of every three days, because somehow on the third day the infusion sets let less insulin through (even the TruSteel ones).
RobertJ
Well-Known Member
- Messages
- 217
- Type of diabetes
- Type 1
- Treatment type
- Pump
I've been on the T-Slim X2 since late June. There have been some good periods but sadly, so far, my results are worse than when I was on pens.
Although the pump has sometimes been brilliant, when it goes wrong it goes very wrong. I've had a few instances where my levels start going up and no doses will bring them down. A site change always makes this better but I wonder if I keep the pump on too long. Does the insulin go off after more than three days once it's in the pump?
What I find weird is how you can store about 250 units in the cartridge, yet you're supposed to change it once every three days. That's enough insulin to last me five days, and it would certainly be easier if I could do less frequent site changes.
Although the pump has sometimes been brilliant, when it goes wrong it goes very wrong. I've had a few instances where my levels start going up and no doses will bring them down. A site change always makes this better but I wonder if I keep the pump on too long. Does the insulin go off after more than three days once it's in the pump?
What I find weird is how you can store about 250 units in the cartridge, yet you're supposed to change it once every three days. That's enough insulin to last me five days, and it would certainly be easier if I could do less frequent site changes.
It takes time to get used to going from mdi to a pump @RobertJ
Teflon cannulas should be changed every 3 days (or sooner if levels aren't coming down after a correction dose, and every 2 days for steel infusion sets.
You only need to fill the cartridges with the maximum you use in 3 days, plus a bit extra as the pump can't use the last 20mls, so no need to completely fill it.
If a correction dose doesn't start to bring your levels down, always change the insulin and infusion set, and I correct with a pen in the meantime, and also if my levels go above about 14.
Teflon cannulas should be changed every 3 days (or sooner if levels aren't coming down after a correction dose, and every 2 days for steel infusion sets.
You only need to fill the cartridges with the maximum you use in 3 days, plus a bit extra as the pump can't use the last 20mls, so no need to completely fill it.
If a correction dose doesn't start to bring your levels down, always change the insulin and infusion set, and I correct with a pen in the meantime, and also if my levels go above about 14.
Nicola M
Well-Known Member
- Messages
- 695
- Type of diabetes
- Type 1
- Treatment type
- Pump
I think because the insulin in a pump is out of the fridge and generally is kept close to your body so for 3 days it’s kept at around body temperature it does start to go “bad” which is why they say to change your sets or at least they did with me every 3 days. The cartridges are designed to hold a lot of insulin but it doesn’t mean you have to fill it completely to the 250. My pump holds 300 units but I only fill it to about 200 as that’s all I need for 3 days with a little extra just incase. Everyone’s insulin needs are different so some people will need more and some less than what a cartridge holds.
RobertJ
Well-Known Member
- Messages
- 217
- Type of diabetes
- Type 1
- Treatment type
- Pump
Okay, I will strictly adhere to three days from now on. It's a shame how many problems I've had so far with this pump. It's kind of annoying because the benefits are too great to switch back to pens, but it's just not going well enough at the moment.
My average glucose has been stuck on 8.0mmol for about two weeks now. This is worse than most of the year before late June, which is when I started on the pump. A common problem is what I'd call long highs: it goes up then stays there for hours. Today I went for a 10k run, and normally on such a day my requirements would be lower for the rest of the day. However, it went up to 16mmol after breakfast (I must have undercounted my carbs) and three hours later it's still on 12.4mmol. So now I can't have anything else to eat until it goes down, and even then there's the fear it will just spike back up and be high until late afternoon/evening. I have far too many of these days where the graph looks absolutely horrible: just a series of huge spikes.
The NHS is not bothered about this because I'm above the threshold of 70% in target, and I'm told that "as long as it comes down again" it's fine.
The big problem with a pump is you don't know straight away when it's gone wrong. For example, maybe right now something has gone wrong and I need to change the site. But it requires a few hours of results that don't make sense to come to that conclusion. I only changed the site little over 48 hours ago.
Nicola M
Well-Known Member
- Messages
- 695
- Type of diabetes
- Type 1
- Treatment type
- Pump
I'm not as well versed in Tandem although have learned enough about the system from being on these forums. I'm not sure whether you are just on the Tandem or have a CGM but perhaps you would benefit from a CGM that integrates with the Tslim to provide a closed-loop system. I'm a little biased when it comes to this as it works really well for me and I know it isn't available to everyone but just a thought.
I know it is frustrating to be told because you are in range 70% of the time they aren't bothered and they have said the same thing to me, in a way I do get it since my HbA1c in April came out at 40/5.8% with 73% in range, 1-2% above/below range and the rest in "mid-high" range.
Swapping from pens to a pump is hard and unfortunately getting things perfectly right takes time, as long as you are confident your basal rate is correct everything else will fall into place pretty quickly, you may find your carb ratios need changing, since moving to closed-loop mine have changed again baring in mind I've been on a pump now for 8 years.
I know it is frustrating to be told because you are in range 70% of the time they aren't bothered and they have said the same thing to me, in a way I do get it since my HbA1c in April came out at 40/5.8% with 73% in range, 1-2% above/below range and the rest in "mid-high" range.
Swapping from pens to a pump is hard and unfortunately getting things perfectly right takes time, as long as you are confident your basal rate is correct everything else will fall into place pretty quickly, you may find your carb ratios need changing, since moving to closed-loop mine have changed again baring in mind I've been on a pump now for 8 years.
Just recently changed to tslim + dexcom 6 after many years with Roche combo. The Roche much easier to use and their cannula and connections superior to airliquide tandem items. As for refilling reservoir....can't imagine a more ridiculous arrangement! Every change wastes 12 units + that left in discarded reservoir. That's every 2.5 days.
Having to fish the pump out of clothes every time it beeps,if you even hear it, is annoying enough.
Then the screen is so small some will require glasses to read it, by which time the display has timed out!
But, but, closed loop control is the way to go. The tandem will only get better especially when dexcom g7 sensor and smartphone control of bolus is adopted.
My clinic at Scarborough, like I am sure all NHS services in these straightened times have been very helpful. We are so lucky to have such people/services.
Having to fish the pump out of clothes every time it beeps,if you even hear it, is annoying enough.
Then the screen is so small some will require glasses to read it, by which time the display has timed out!
But, but, closed loop control is the way to go. The tandem will only get better especially when dexcom g7 sensor and smartphone control of bolus is adopted.
My clinic at Scarborough, like I am sure all NHS services in these straightened times have been very helpful. We are so lucky to have such people/services.
- Messages
- 9,037
- Type of diabetes
- Type 1
- Treatment type
- Pump
- Dislikes
- Hypos, rude people, ignorance and grey days.
Heya @allerston I also use Tandem but ignore the change cannula set alarm, I change mine every 2.5-4 days later depending on how much insulin is left to avoid wasting it, hasn't been detrimental to my BG levels at all.
Controversial opinion: I change my set ever 4 or even 5 days, 4 years on the tandem and have never noticed any issues with reduced insulin effectiveness. Much to the chagrin of my diabetes nurse.
Have you done any basal rate testing? You can make your own diary or download a form for this. But your diabetes team should have their own process.
Long-acting insulin from injection pens can be quite effective at levelling out high blood sugars across the whole day so I assume this is what you're missing. With a pump this needs to be 'programmed' in.
The pump should manage your levels with more precision and agility but it is fiddly to get your rates rights. If you notice your control is consistently worse on the pump, your basal rates probably need adjusting. This should address the unevenness in your graph somewhat.
How soon are you bolusing before eating breakfast?
