tandem tslim pre pump training

EllieM

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So I've had a box with a tandem pump sitting in my bedroom since december and have training with the tandem rep booked for march 25,26.

I have a pre pump training session with my clinic next week, any thoughts on what I should ask?

They want a food insulin diary, which I normally keep on my dexcom G7 app. Two things I already know

1) insulin basals need vary by about 15% according to exercise.
2) correction factors vary according to bg levels.

So should I fast and attempt to get ratios for different times of day? What's the best info for setting up the tandem?

Advice welcomed

(And I don't know whether I should raise my biggest issue with the G7, fails if I put it on my arms and frequent low readings for the first 24 hours ....)
 

Juicyj

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Well done Ellie, I am not sure I would of coped for so long with that sat in the box !!!

They will start you off conservatively with your ratios, so in regards to expectations please keep them very low as it will take a while to get ratios adjusted and tweaked.

The Tandem has an exercise mode so you can switch to that and it allows flexibility with timing then, the tandem's algorithm will calculate your correction factor based on insulin on board/glucose levels and it's predictions as to where it thinks you are heading. There is a setting for this in your pump and again it can be adjusted in different times throughout the day too.

The basal profiles will change over time so you may start with say 4-6 and then add more in where you need to.

It really is slowly slowly to start, but over time with adjustments and the pump collecting more data it really does come into it's own

Good luck with the training.
 

sninge

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Ditto, that is will power having it in your house and not using it, but obviously very wise!
Re the g7, ive only used g6 and libre1&2 but I've found with them 'as well as many others have' that the readings are out for the first 24hrs and to overcome that just insert 24hrs before you start it, you don't want false readings if you are using closed loop!
Definitely don't expect too much, it takes time to work things out but hang in there as its worth it in the end, also be prepared for the endless alarms for the first week or so, also they rarely happen once you get there!
 

Chas C

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Great advice already, all I would add is make use of all the basal profile time settings even if for now they are identical. I find its best to use hourly settings for early to mid morning so you can adjust for any dawn settings changes needed, otherwise I use 2 hourly. The t:slim is great and I hope you can find a way to sort your G7 issues, I think Dexcom have a team now to help users deal with these issues so might be worth asking them. I've been using Dexcom since it was first released and not had any repeating issues, but I had a work colleague and his brother who could not get more than a few days out of each sensor sadly.
 
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Hopeful34

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Sorry for the late reply @EllieM Just to add to what's already been said, if you've got time before your clinic appointment, it would be worth checking your basal rates.
I'd mention the issue with the G7 if it was me.
It's a lot to take in at first when it's your first pump, so be prepared to be frustrated at times, but like most things, it becomes easier the longer you use it. I really like the tslim, and have much more stable levels overnight on it. All the best for your clinic appointment and also your pump start.
 
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EllieM

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Hi @EllieM Just wondered how you'd got on with the pump training? Hope all went well.
Just had two half days with the rep (and a couple of reviews with the dietician).

The team were adamant that I should start with basal IQ before moving to control IQ, so the rep brought me a G6 starter back.

First day was in the afternoon, on my own. (Two others were starting at the same time but were both new to dexcom, so started in morning).
Basically pump basics, filled my pump, inserted cannula, inserted dexcom G6 (so briefly had G6 and G7 on the go at the same time). I was told not to have my morning lantus so was running on a bg of 10ish by repeated doses of humalog.

Monday night was a dream, pump showed several stopped basal doses while the system kept me above hypo territory (just).

Tuesday morning I went up to 10/11 with dawn phenomena plus stress of 1 hour roadworky drive to my local hospital in peak traffic (normally takes 30 minutes).

Went through more pump stuff, signed off on a tandem checklist, went back to dietician to have settings tweaked based on first day's results. (The original settings were based on a 2 day food/bg diary, though I did 6 days).

Tweaks were a mixed bag, leading to good afternoon and evening levels and a miserable night of repeated hypos. I pulled ny G7 off and turned off my phone to get the alerts down to just those from the G6 and pump. Not too worried by this, as dietician will review uploads tomorrow and I am fully intending to put a temporary lower basal level in overnight.


So far things I love

1) bye bye lantus (oh I hated that insulin)
2) no more pen injections and/or forgetting whether you have had your insulin
3) Monday night avoidance of hypos
4) better handling of dawn phenomena and varying daily basal needs
5) not needing to carry my phone all the time


The down side
1) Tuesday night of hypos though am sure this is just a question of getting my rates right.
2) losing connection between the g6 and my pump, specially at night and/or on walks. Doesn't seem to like being in my pocket if I have a coat on over my sensor.
3) finding somewhere to stash my g6 st night


Suggestions, particularly for 2 and 3 , welcomed.
 
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Chas C

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I leave mine loose in bed with me, used to hag it around my neck in yrs past. I turn off the lost connection alarm at night time.
 
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1) Tuesday night of hypos though am sure this is just a question of getting my rates right.
This could also be due to having some residual Lantus left in your body.
Although it appears to run out after (less than) 24 hours, my DSN is adamant that it can still have an affect for 3 or 4 days when starting a pump. So you may not need the temp basal.
3) finding somewhere to stash my g6 st night
Do you mean your G6 or do you mean your Tandem?
When I had a tubed pump, my DSN told me I could leave it loose as @Chas C does. However, I learnt that my gentle tossing in the night would result in a roaming pump which would roam to directly under my hip. Hard bone against hard pump (even with a softish mattress) is not good - it would wake me. I chose to wrap a HidIn pump belt around my upper thigh and stash my pump there overnight.
(Apologies if you meant a G6 reader.)
 
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Chas C

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When I had a tubed pump, my DSN told me I could leave it loose as @Chas C does. However, I learnt that my gentle tossing in the night would result in a roaming pump which would roam to directly under my hip. Hard bone against hard pump (even with a softish mattress) is not good - it would wake me. I chose to wrap a HidIn pump belt around my upper thigh and stash my pump there overnight.
(Apologies if you meant a G6 reader.)
I actually find now (been a good few years) that when I move I move the pump with me, so if I turn over in my sleep I seem to pick up the pump and take it with me. I sleep on a memory foam mattress so pump tends to not cause digging in issues.
 
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EllieM

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Well my DN has told me to adjust my rates again, and it's looking much better now (Thursday evening). Am sure I'll sort the sharing a bed thing with a pump eventually. Am more concerned about the connection loss on walks, if the pump is in my pocket it doesn't seem to connect to the sensor on my arm.

First site change tomorrow am....
 
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EllieM

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Just an update.

Things went crazy on Friday early am and morning, massive rise to 16 after either over treatment of 2 am hypo or rise from delayed absorption of carbs in fatty (roast duck) evening meal.

So I did a site change in the morning, spent some time with dexcom support because pump was showing too little insulin (apparently it isn't accurate till you've given 10 units) and then even more time with them when I found I had my first occlusion !

By the time I fixed that, Friday was a complete write off, and I only had 70 units left in my pump, and I had to do a new change just 2 days later.
Moral, I do need to put 2 ml of insulin in my pump cartridge, even though I'm averaging less than 35 units a day. (Was hoping I would be able to get 2 changes per 3ml insulin cartridge, but this is clearly not going to work. )

Boggling at the waste of insulin and the cost of insulin consumables - $90 (GBP45) for a pump insulin cartridge. Though the hospital is paying, that is a big cost for the state health system. (Edited to add, that's for a pack of ten - I don't feel so bad now).

Getting better at not losing connection at night, and still happy to have a pump. (I reckon the difficulties are just helping me learn).

Still losing connection on walks though. Is it worth putting the pump in an armband or maybe one of these?
 
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Hopeful34

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How are you doing @EllieM?

pump was showing too little insulin (apparently it isn't accurate till you've given 10 units)
Do you mean insulin on board, or insulin left in cartridge? Not heard of this, and just curious.


By the time I fixed that, Friday was a complete write off, and I only had 70 units left in my pump, and I had to do a new change just 2 days later.
Moral, I do need to put 2 ml of insulin in my pump cartridge, even though I'm averaging less than 35 units a day. (Was hoping I would be able to get 2 changes per 3ml insulin cartridge, but this is clearly not going to work. )
I just put in roughly what I use, and if it is going to run low on a very odd occasion, just change the cartridge, not the cannula.

Overnight I clip the pump onto my pyjamas, as I'm too liable to get up for the loo and forget about it, and find it swinging from the cannula in me, which then raises bloid glucose and necessitates a cannula change.

Just bought a Hid-In belt to try.
 
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EllieM

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How are you doing @EllieM?


Do you mean insulin on board, or insulin left in cartridge? Not heard of this, and just curious.
The insulin left in cartridge.


Just bought a Hid-In belt to try.
Well I've bought a comfy belt.


Not having too many issues at night, occasional compression low and signal loss but very livable with.

The going out for walks issue remains real. Only way to maintain a signal appears to be to hold it in my hand.

Wondering if things would be better with dexcom on my stomach? (Was trying to leave real estate free for cannulas (cannulae?) ).

Has anyone tried some sort of arm phone holder?
 

EllieM

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So, another update. Moved to control-iq yesterday. Tandem phone support are awesome, walked me through the update when I found the instructions on the updater weren't showing up properly on my computer screen. (Nothing but praise for tandem support so far).

Basically all good, other than the fact that I changed my dexcom sensor at same time and it was under reading drastically for first 12 hours. All fine now and I will make sure to pre-insert future sensors.

Overnight bgs were magical and system managed to cope (just) when I went for a long walk this afternoon. So far the best spot for keeping connection with my cgm is my bra (sorry if that's TMI and I'm sorry that I don't know the solution for males).

Despite my issues, my TIR is looking good and hypos are greatly reduced.

Feeling optimistic.
 
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Hopeful34

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That's great @EllieM
I mainly wear my pump in my bra during the day as well, and rarely lose connection with the cgm. Clip it to the waistband of my trousers when going to the hospital though.
 
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searley

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Well my DN has told me to adjust my rates again, and it's looking much better now (Thursday evening). Am sure I'll sort the sharing a bed thing with a pump eventually. Am more concerned about the connection loss on walks, if the pump is in my pocket it doesn't seem to connect to the sensor on my arm.

First site change tomorrow am....

When not at work I keep mine in a pocket, on the same side of body as the g6, typically glass out as that the only side the BT signal will travel and never really have an issue.. if going opposite side of body I get some dropouts
 

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When not at work I keep mine in a pocket, on the same side of body as the g6, typically glass out as that the only side the BT signal will travel and never really have an issue.. if going opposite side of body I get some dropouts
Sadly, few women's trousers have pockets large enough for a pump.
When I had a tubey pump, i cut a small hole in a few pockets to feed the tube through but the pump kept falling out.

I also found the bra a challenging location as I am small chested so it made me lop sided (apologies if TMI).
 
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EllieM

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Just updating to say that my dietician has signed me off on monitoring with food diaroes and basically told me to get on with it. (Still need to sort cannulas and insulin scripts with nurse).

So that was 17 days from first start wth basal-iq to being set free with control-iq.

Still got some tweakingof ratios to do I feel but will do so cautiously....

Very happy with pump experience.

I'm still working through my supplies of 3ml cartridges. Do others use 10ml vials? The drawback with the 3mls is that to optimally use them I'd need to do 1.5ml fills of the tandem cartridge, which isn't quite enough for 3 days. 2ml seems to leave me with nearly 50 units wastage, so means I can get 3 fills out of 2 cartridges. (Am a little horrified by the insulin waste involved in pumping.)