Changing from Medtronic to Tandem tslim

My father and I (he turned TD1 after a few years using oral medication in his 60’s I am TD1 since late teens) usually use Medtronic pumps, but recently he changed to Tandem and using Dexcom which can have a big difference from blood tests no matter what the ads say! I do blood tests at least once daily and more if Dexcom shows high or low.

I am almost out of warranty with Medtronic and considering Tandem, but my dad’s blood sugar some times gets off track and he can’t use temporary basal with the CQ or whatever the automated version of this pump is that relies on Dexcom. I like the synchronization for bedtime, but is it difficult to turn off CQ or whatever the name is during day time? He got trained but he doesn’t understand the pump and I am hesitant to use :thinking:

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Hi @eroig13 ! You might recall from your own first days - or weeks - on a pump, that it can take some time to get proper settings in place: it may be your dad has not found his yet and needs to work more closely with his endo.
I’m wondering if your dad would benefit from additional training? I switched from Tandem to Omnipod last year, and even with reading the manual; watching the online videos and passing each test; and my session with a trainer - there were still some things I had questions about so I was contacting her for a while. If he feels the need he should call and ask for more so he gets the understanding he needs.
I think most people find Dexcom to be fairly accurate - but for a CGM that’s a matter of percentages (± 15% of acceptable) rather than straight numbers: so if Dexcom reads 250 and fingerstick is between 200-300, it’s considered accurate although you may want to use the fingerstick reading to decide how to respond. Dexcom does tend to show false lows the first 24 hours or so. I don’t know if that has changed with the new Dexcom 7 but if so that will be great when it can be paired with pumps.
Turning off CIQ is an option but if he needs to do it for the same time period each day - say overnight - that may indicate some programming changes are in order. I would suggest he first work with his endo to make sure good settings are in place: and his trainer to increase his understanding of the system, so he’s getting the full benefit. Then if it turns out he needs to turn it off for a time he’ll have gone through the process of elimination.
All the best to your dad and you!
PS - if you’re thinking about switching I would suggest starting out in plain old manual mode before starting on CIQ. Although you’re not new to pumping, seeing how it does at its mist basic level might help you with fine-tuning the “smart features.”

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This is a two part response to your questions, Edith; this first Part is about selecting a replacement pump and the second Part responds to your current situation.

Edith @eroig13, when a pump is out-of-warranty or soon will be it can be difficult to choose if it is better to stay with a familiar type device or switch to another brand; you are fortunate in a way that you are in position to see how the Tandem compares with the Minimed [sold by Medtronic]. My Tandem t-Slim x2 with Control IQ [CIQ] technology is beyond the 4-year manufacturer warenty and I’m studying my options. I suggest that you make yourself aware of your choices. I’m impressed vy the recently FDA Cleared MiniMed 780G with "Smart Guard, using the new Guardian 4 CGM; I’m waiting to hear user reports of the Guardian 4 to see if it is significantly better than the previous Medtronic attempts. The 780G system can make BOLUS adjustments as frequently as every 5 minutes thus reducing higher BGL; I am also waiting to hear how well it does in avoiding low BGL.

The Beta Bionics iLet with controlled Loop technology using Dexcom G6 was also recently FDA Cleared for use; don’t confuse the iLet with the other, really awesome Beta Bionic 2-hormone pump which is still being tested. This system mostly eliminates carb-counting and only requires the user to enter meal type such as breakfast, lunch, supper and whether the meal is usual size, smaller size or larger size. Thehnology?? I had an interesting phone call with the developer’s representative.

Do your research. Recently posted in this Forum are Topics about the iLet and the 780G with links to manufacturer information and FDA important information. Another source of trusted and impartial information about diabetes and technology is the diatribe foundation;

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I find that if blood glucose is 100 and Dexcom show 60 it’s unacceptable and doesn’t help. I do enough blood tests to know it’s ok as long as it doesn’t have low or high number. If it does then blood test and calibration is needed. His pump beeps many times and unfortunately Medicare paid for one training session. He can contact trainer back, but it takes 24 hrs.

Thanks Dennis for the information. Unfortunately I am under a commercial insurance and have to limit myself to the pumps they approve. In the case of Medtronic, I started with them in 1998 and have tried 3 different cgm and they are not close at all. Dexcom is not perfect, but I ended up not using the cgm from Minimed and loosing money. I am scared, but have serious scary lows that scare my family so I need a CGM that works with pump. Omnipod is another option for my insurance, but not sure about the co payments of supplies etc :pleading_face:My dad is talking about going back to shots. That may be option for me too if tandem doesn’t work well with Dexcom. Is there a way to use the control IQ only at night?

Edith @eroig13, This is Part Two of my observation to your posting. I’m only offering my non-professional thoughts based on personal experience.

  • Recall that the Dexcom CGM is not measuring blood glucose, but rather is measuring body glucose level [BGL] by analyzing interstitial fluids in the body - blood glucose level and body glucose level are not frequently the same number. All CGM cleared for use must meet a higher accuracy rate than BG Meters are required to meet. The Dexcom G6, the first device ever FDA APPROVED for insulin dosing proved to be extremely accurate; there isn’t any BGM approved for insulin dosing.
  • Tandem/Dexcom CIQ [Control IQ] system, when properly used eliminates the need for “Temporary Basal” by automatically adjusting the profile basal rate settings as frequently as every five minutes. The only limit on increasing basal flow is the value the user entered [up to 9 units per hour] when setting up profiles.
  • Getting off track, and we ALL know “going off track” is a guaranteed part of living with T1D, can be somewhat limited by CIQ. When BGL climbs as high as 160 mg/dl and is expected to climb higher [observe the predictive G6 arrow] the t-Slim will calculate and deliver an “automatic” correction - the weakness I think is that automatic corrections are limited to “one per hour”. These corrections are also limited by values the user entered in various Profiles. I encourage that multiple Profiles be used for differing days.
  • The Tandem CIQ requires that we effectively use each of the three operating modes. Each “mode” has differing characteristics, including target and automatic-bolus features. A handy table is on page 307 of the User Manual.

Edith, it is “simple” to turn CIQ on and off BUT it is strictly manual and one needs to remember to do it. Options >>> My Pump >>> Control IQ - then there is a toggle switch directly above where you entered your current weight. And mentioning user weight, this is a critical value for the automatic insulin adjustments. Recall that the Tandem “sleep mode” of operation suspends the automatic-bolus feature.

I too had three MiniMed pumps that would operate with Medtronic CGM before I switched to Tandem, but the Medtronic CGM were notoriously inefficient so I didn’t throw my money away. I began using CIQ the month it became available and it has helped hold my TIR at 90% or higher - even during the month I spent with the coronavirus.

I omitted adding OmniPod 5 to my list of options. Usually this device is sold mostly through drug stores, no long term commitment, and is covered by many prescription drug plans. Some good reports of the OmniPod are posted in this Forum.

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Frequent alerts are annoying, I agree. If he’s getting them around the same time all the time he probably needs to make adjustments to his settings. I’ve found that a small adjustment to my basal rate or carb ratio did the trick, although there are other background settings he might need to tweak.

Were they different from each other, or different from a fingerstick? I know it’s unlikely you wore multiple sensors at the same time but now and then people do to compare say a Freestyle with their Dexcom or Medtronic, so I thought I would ask. Unfortunately Medtronic’s CGMs are particularly and notoriously problematic.
You’ve been doing this a while and I have too (60 years on insulin this year!) but here’s an article about reasons for differences - I find it’s helpful to have a reminder of things to check. That’s not to say every or any CGM will work for a person - in some case they just don’t - but this might help the process of elimination.
A pump is an investment: and with the exception of Omnipod which has no commitment since it’s disposable - you’re in for the long haul with other pumps. I think you can go back to your old one if the new one isn’t a good fit , but your doctor must make a case with insurance and you still might be out of pocket at least for the pump if not the supplies. I wish you could try them on advance - take one for a test drive as it were - before committing, but you can’t do that with medical devices.

You mean different profiles for different days to include sick days, high activity days, weekends etc?

Yes Edith, that is what I was trying to say; although now that I’m getting older my high-activity days are getting less frequent.
I very, very rarely have a “sick day” but the Profile I had on my pump for “Sick” came in very handy when I had the corona virus last year - that Profile kept me in-range at almost 90% for that month.