Hi Everyone,
I’ve been wearing the Tandem Tslim pump for about 8 months now and was just told that you should suspend insulin delivery on the pump when you disconnect to take a shower. I was only disconnecting and not suspending insulin, any thoughts on preferred method?
Thank you.
I think they want you to suspend if you’re using Tandem CIQ so that the algorithm doesn’t give you an automatic correction or adjust basals while you’re disconnected and then use that history when making future adjustments. For example, if you disconnect without suspending and your pump gives you an automatic correction it’ll count that correction as part of your IOB even though you didn’t get that insulin. Then even if your BG keeps going higher, because of your (inaccurate) high IOB the pump won’t make any more adjustments for a while because it thinks it already did it’s job.
If you suspend delivery then CIQ has to wait until you resume delivery to make adjustments.
Since I’m not currently using CIQ on my tandem pump I don’t suspend my insulin when I’m only going to be disconnected for a short period of time. I give myself a bolus that will cover 30 min of my usual basal before I get in the shower and then disconnect my pump without suspending delivery. Haven’t had any issues.
Also, the other problem I think is that I’ve heard showers can cause insulin to get in your system extremely quickly, which could cause hypoglycemia if you don’t need to kick in immediately? I don’t have a pump but that’s just my limited knowledge from being on a pen
Update: I was wrong! It’s literally only hot showers, baths, etc. sorry
You should suspend delivery whenever you disconnect the pump. Otherwise, it will continue dripping insulin out the tube, which is a waste, and it’ll think that insulin has been delivered to you, which will throw off its calculations.
When you disconnect, especially for the shower, you should also use the little plastic clip (it comes in a plastic baggie inside the box of infusion sets) to cover the insertion site. It clicks in where the tubing connector goes, and it prevents water, dust, etc. from getting in and clogging the cannula.
If you have insulin in board and do not suspend while disconnected, later calculations will be off as the system thinks the insulin went into your body rather than the bathroom sink.
@DFBB ,
Diane, someone has feed you hogwash. I have been pumping for almost 25 years with Animas & Tandem pumps & various Dexcom models starting 6 weeks after my first pump.
From the very beginning and with each training session my endo has me attend for each new style pump, the discussion and rationale is
PUT THE TANDEM PUMP ON CHARGE WHILE YOU ARE IN THE SHOWER.
DON’T SUSPEND OR TRY ANYTHING CUTE TO SAVE INSULIN OR OUT THINK THE PUMP.
THE CIQ ALGORITHM WILL CATCH THINGS UP IN ABOUT AN HOUR.
IF YOU ARE ON 3 UNITS PER HOUR AND TAKE A 30 MINUTE SHOWER, YOU WASTE 1.5 UNTS.
So, bottom line, put the pump on charge and plug back in after your shower. If you are rushed, you don’t need to remember to switch anything back. The only issue is assure any bolus or extended bolus is not in progress when you disconnect.
Welcome.
Thank you for your replies, I feel I have so much to learn, great to get the advice of other T1’s.
I never disconnect my pump when I shower. I have had it in the past where I would forget to turn it back on when I’m finished. I cannot disagree with the previous answers They are correct. But there are a lot of things in life that I do not follow the technical process. What works for you might not work for me and what works for me might not work for you. Just my thoughts.
Have a good day Dwayne.
I’m afraid you’ve had some misinformed trainers, @987jaj.
Showering is a good time to charge the pump (although I just plug mine in whenever it’s down to about 50% and I expect to be sitting close to an outlet for half an hour or so, watching TV or whatever).
But my trainers have been emphatic about suspending delivery every time the pump is disconnected (shower or otherwise). It’s not “out-thinking the pump.” It’s that the pump has no way to know that you disconnected it. So it thinks you’re still getting whatever it delivers, whether that’s your regular basal insulin or a correction bolus.
Also, there is absolutely no reason the pump can’t charge while insulin delivery is suspended.
From page 104 of the Tandem t:slim X2 user guide
When you need to disconnect your pump from your body, stop insulin delivery. Stopping insulin delivery tells the system that you are not actively delivering insulin, which also stops the automated insulin dosing feature so that it does not continue to calculate insulin delivery adjustments.
Sometimes you do have to out-think the pump, too. Because you know things it doesn’t know. It’s good to trust the pump, for the most part. Relax and let it do its job. But the algorithm isn’t perfect, and there are a lot of things that happen that it has no way to know. It doesn’t know how much you’ve exercised, or how many calories you’re getting from things that aren’t carbs, or if you miscalculated the carb count, or if the canula fell out, or if you left it disconnected, or if the CGM readings are inaccurate, or any number of other things. It’s up to you to be aware of things, and to learn when the pump needs a bit of extra guidance.
To expand on the above:
The pump knows (1) how much insulin it’s delivered (2) how many carbs you have entered (3) what the CGM reports. That’s it. That’s all it knows. It then calculates how much insulin to give you based on those three things and your current settings (carb ratio, correction factor, etc.).
If any of those three things are inaccurate, the pump will make the wrong delivery decisions. Sometimes when I insert a new Dexcom sensor, it reports a false low. The pump then lowers or even stops my insulin delivery based on that inaccurate reading. I have to turn off Control IQ for a few hours, calibrate the sensor, wait for it to get on track, and only then turn Control IQ back on. Otherwise, I end up with a really high blood sugar because it takes several hours for the CGM to correct the readings. Sometimes when I eat a meal that’s high in fat, my blood sugar goes high because I entered the right number of carbs but my digestive system is breaking the fat down into additional carbs. The pump’s correction boluses aren’t enough and I still feel full. So I need to carefully give myself an extra bolus to correct for the additional calories I’m still digesting that the pump doesn’t know about. If the cannula comes loose, the insulin drips away instead of being delivered and my blood sugar goes high. Sometimes I don’t notice that until the pump alarm tells me that I’ve gone too high and automatic correction boluses (and/or increased basal insulin) aren’t working. I have to replace the cannula, but then the pump’s Insulin On Board calculation is off because I didn’t get the insulin it thinks I did. So I need to do a manual bolus to make up for it, and it still takes time for things to get back to normal because the IOB will remain inaccurate for hours after.
All of which is to say the pump and its algorithm aren’t perfect. There’s a lot that it doesn’t know. And if you give it the wrong data, it’ll make the wrong decisions.
Case in point: If you disconnect from the cannula to take a shower and you don’t suspend insulin delivery, the insulin will drip out instead of being delivered, the pump’s IOB calculation will be off, and it will make the wrong delivery calculations.
Granted, in most cases, that’s probably going to be a small thing. If you’re in the shower for half an hour and your regular basal rate is 2 units/hour, then that’s only 1 unit off. You’ll maybe run a little higher for a while, but eventually the numbers will even out and it won’t matter.
Sometimes, though, the pump will attempt to deliver a correction bolus while you’re in the shower, and it has no way of knowing that the dose is going down the drain. And then its calculations will be off for several hours.
So, in most cases, it probably doesn’t make a significant difference whether or not you suspend delivery for half an hour. But there’s no benefit to not suspending delivery during that time and not only are you wasting at least a small amount of insulin, you’re risking the pump being inaccurate for hours. It’s best to follow the guidance of the official instruction manual and just suspend delivery for a while.
As for charging the pump: If you connect the charger, the pump will charge. Regardless of whether or not delivery is ongoing and regardless of whether or not the tubing is connected to the cannula.
Thank you, I appreciate the info.
@WearsHats , either I miss wrote your something got lost.
[1] Show time is a good time to disconnect & charge.
[2] There are clinical studies reporting pumpers failing to “turn back on” and needing external assistance. So, leaving pump on is a SAFETY actionability, not out thinking the pump.
[3] User guides get revised. What is the date on the back of the edition you are quoting? It doesn’t match my training and updated UG of 30 August 2022.
I started pumping after years of MDI on an Animas with Dexcom 7STS shortly afterwards some 20+ years ago. Been on CIQ since January 2020. Professionally, started in EMS as EMT/paramedic/RN in ambulance & in EMS education. Switched to Hospital in coronary care & neonatal ICU. Then retired after teaching nursing for 27 years while keeping a pinky finger in EMS education. I was also the nursing faculty member of the information technology team.
Bottom line, without discussing your clinical uniqueness with your Tandem CDCES trainer, you endo’s pump team, you, etc. a clear answer is missing.
Agreed. Shower is a good time to disconnect and charge. Sure. A lot of people do that.
But you don’t have to be disconnected while charging, so some people find other times to charge. (You technically don’t have to disconnect while in the shower, either, since the pump is waterproof, but it’s a lot easier to do so.) Any time the pump can be near an outlet for half an hour or so (whether or not it’s connected to the cannula and pumping) will do. For me, it’s easier to keep the charger near the couch and plug in while I’m watching TV. For others, it may be best to charge the pump while sitting and working at a desk.
I’m not sure I’m reading you right. But if you mean that people forget to turn the pump back on, that’s why the t:slim has an automatic alarm that reminds you to do exactly that.
(You’re the one who used the phrase “out thinking the pump.” I only used it in response to your earlier post.)
The user manual I linked and quoted above is version 7.4, from January 2022. It’s the top result on Google. But you’re correct that there’s a newer version, 7.6 dated August 2022, listed on the Tandem website. Let’s see what that has to say.
Chapter 9 (page 139):
When you need to disconnect your pump from your body, stop insulin delivery. Stopping insulin delivery tells the system that you are not actively delivering insulin, which also stops Control-IQ technology so that it does not continue to calculate insulin delivery adjustments.
So… It still doesn’t look like “hogwash” to me.
Agreed. Shower is a good time to disconnect and charge. Sure. A lot of people do that.
But you don’t have to be disconnected while charging, so some people find other times to charge. (You technically don’t have to disconnect while in the shower, either, since the pump is waterproof, but it’s a lot easier to do so.) Any time the pump can be near an outlet for half an hour or so (whether or not it’s connected to the cannula and pumping) will do. For me, it’s easier to keep the charger near the couch and plug in while I’m watching TV. For others, it may be best to charge the pump while sitting and working at a desk.
GOOD POINT about disconnecting. I charge on the road many times. Charging cord in USB and pump sits in cup holder. As for shower time, unless you are using 43" tubing, it is difficult to bring a 120v AC line into a shower and still have someplace to hang the pump.
I’m not sure I’m reading you right. But if you mean that people forget to turn the pump back on, that’s why the t:slim has an automatic alarm that reminds you to do exactly that.
(You’re the one who used the phrase “out thinking the pump.” I only used it in response to your earlier post.)
RIGHT. Some people turn ALL ALARMS possible OFF, including the one suspending would catch. This is the rationale for keeping it simple.
The user manual I linked and quoted above is version 7.4, from January 2022. It’s the top result on Google. But you’re correct that there’s a newer version, 7.6 dated August 2022, listed on the Tandem website. Let’s see what that has to say.
Chapter 9 (page 139):
When you need to disconnect your pump from your body, stop insulin delivery. Stopping insulin delivery tells the system that you are not actively delivering insulin, which also stops Control-IQ technology so that it does not continue to calculate insulin delivery adjustments.
So… It still doesn’t look like “hogwash” to me.
My clinical team taught me using the literature and individualization of pump management to meet the individual needs of a pumper. The “avoid” turning off to shower was the endo, pump training nurse, Tandem nurse trainer, & Dexcom clinical trainers.
I still agree with the KISS, keep it super simple, principle to avoid mistakes.
Hi again @DFBB . There has been quite a bit of passionate discussion on the topic and helpful information from the manual as well. But when all is said and done we have to listen to our own body; so I would just suggest this: if you find your numbers are rising too much (as you see it) after your shower, I would suggest suspending while you’re in - and don’t forget to stay back up afterwards. As below, the pump doesn’t know where any insulin on board is going while you’re disconnected, and it may think you have more in you than you do when you go to bolus later or take a manual correction. The difference may be negligible if your showers are quick, but they could be large if you linger longer.
On the other hand, maybe the hot water drops you while you’re in there, and when it rises later you’ve got a bit of a cushion so it doesn’t go as high as it would otherwise. So see what works.
Why would you want insulin delivered while it’s not connected to you?
Hi I’m not sure if anyone has suggested it yet but I just turn off Control IQ and charge my pump while I shower. That way my pump won’t bolus when I am not connected. It works out great.
Thanks again for all the responses and advice. As a relative newbie with the tandem pump it’s great to hear how others have experienced things.
Hi Diane,
While I understand the reasoning for suspending the insulin, I don’t suspend my pump because I am in the shower for such a short time that the difference in the amount of insulin accounted for by my pump is minimal. When I used the algorithms I did suspend it, but without the algorithm I haven’t found the need.
I simply adjust my dose when necessary. If I am running high, I will bolus before I get in the shower and reconnect right away when I get out. If I am low, I sometimes stay disconnected a little longer after I get out of the shower. If my blood sugar is in range I find that reconnecting when I get out of the shower does not require any correction.
This works for me, but remember that everyone is different. So, what works for me might not work for someone else. You really have to do a trial and error to figure out what works for you.
Pam K.
T1D 58.5 years and counting!
My husband disconnects, charges the pump, and suspends his insulin deliveries since he, ahem, seems to take a long time in that shower! His trainer said the longer length of the shower can definitely mess with the algorithms (why waste the insulin?). We actually just installed an updated outlet with USB outlets so he can just plug the pump in more easily, rather than using the big wall wart. He keeps the cord in the bathroom, and it’s good for my Fitbit charging too!