LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Wednesday, January 02, 2013

t:slim—out of the box and on to the bod

Dare I say it? Using this insulin pump is FUN! Now, some folks will probably regard that statement as heresy, or maybe even a sin. But my diabetes isn’t going anywhere soon, so I don’t think there’s anything wrong with having a good time with it.

And really, if you think about it, diabetes is more of a hobby than a disease. It’s time-consuming, expensive, and frustrating. Everything a good hobby is. Oh, and just like a hobby, when everything works out right, it’s very satisfying to stand back and admire your handiwork.

Exhibit A:

So why not have a good time pumping insulin?

Now, I know that what you’re really interested in are all the nitty-gritty details of the t:slim pump, so I’ll get right to it. I’m sure you’re dying to know if it’s as sexy in person as it looks online. Yes, yes it is. Is the touch screen as responsive as an Apple device? Yep, you bet your boots it is. Does it really fit in the front pocket of your blue jeans like Tandem shows on their website? Damn straight.

But first things first. And I think the first thing most people worried about when it came to a touch-screen insulin pump was an accidental bolus. It’s one thing to butt-dial the LAPD, or some poor citizen in Pakistan; it’s a whole ’nother thing altogether to butt-bolus 120 units of insulin.

Not to worry. Tandem’s got a built-in safety feature that makes Ft. Knox look lightly guarded by comparison. But more than that—the safety feature is actually one of the more endearing features of the pump.

Here’s how it works: To turn on the pump, you must first press the one and only “real” button on the machine. It’s an elongated chrome oval on the top of the pump. This wakes up the touch screen and lets you check the pump’s status without having to do anything else. From here you can see your battery level, date and time, the amount of insulin in your pump—right now I’ve got 110 units still in the cartridge—and your IOB status.

What the fuck is IOB? It’s your Insulin On Board. On board, in this case, means on your body. Well, in your body. It’s the total amount of insulin in play in your bloodstream that can still lower your blood sugar.

I love, L-O-V-E, love this feature. I think IOB is the single most useful pump feature there is, and I can’t believe how long it has taken the rest of the pump market to catch up to where the Deltec CoZmo was back in 2002.

And, unlike some… ahem… other pumps, t:slim tracks all insulin. Every drop. Med-T pumps for years would only count correction insulin when considering the effects of insulin in the blood. Med-T’s assumption was that if you took insulin for food, the food and the insulin cancelled each other out. True. But only in a perfect world. A world in which our insulin-to-carb ratios are exactly correct 24-7, and our carb counting skills are exemplary at every meal, snack, and drink.

That’s not the world I live in. You?

Also, I was spoiled, as my first pump was a CoZmo. I got used to considering IOB when making treatment decisions. Example: It’s bedtime. I’m running sweet, 269 mg/dL, should I correct? If there’s not much IOB, absolutely, I should. But if I just came back from a banana cream pie eating contest (hey, it could happen) and I have 14.8 units in my system with a three-hour run, taking a correction would end badly. A traditional Med-T style pump wouldn’t count all that pie insulin and let me take a correction that would probably kill me.

Of course, the t:slim pump would know I had too much IOB, and would discourage me from taking a bolus, but having the data out where I can see it and think about it is still huge to me. The t:slim gives me both the number of units in play and the amount of time left in its action curve. (Note: the New OmniPod is supposed to have IOB and Med-T has made some changes in this area, too. Apparently the pendulum is swinging my way again.)

Ohmygosh. Sorry. I got waaaaaaaaaaaaay off track there. Back to the anti-butt-bolus feature. So I press the chrome button, and I’m at that home screen I was telling you about. The battery status is at the top left, the date and time top center, the insulin volume is over to the right. The IOB stuff is at the bottom. Across the middle is an archery range: three bull’s-eye targets in a row. The one on the left is glowing bright green and has a “1” in the center.

Faint grey, you can see targets two and three. To activate any of the pump’s features you must first unlock the pump by tapping on these three targets rapidly in sequential order. When you tap “1” it goes grey and the second target lights up:

When you tap “2” number three lights up. When you tap “3” you’re in!

One-Two-Three. Simple. Fast. Fun. I actually love this part, and have yet to tire of it. Each time I unlock the pump, I feel like I’m unlocking the country’s missile defense system. I get a weird testosterone rush out of it.

But for safety, if you touch the screen anywhere outside the lighted target area, the pump shuts off again. Even Jennifer Lopez’s butt couldn’t accidently butt-dial a bolus with this system.

Next week: Pumping with the pump, covering carbs, correcting blood sugar, and other fun with insulin.


Blogger Scott E said...

I know you're talking about a t:slim and I'm focusing on the MedT, but could you elaborate on the way it (MedT) handles IOB ("Active Insulin")? Since I started using one in 2006, it always subtracted IOB from a correction bolus (but not a food bolus) and never recommended lethal amounts. So if I'm 269 and have 6 U on board, it will recommend zero. However, if I'm 269 and about to consume 10 carbs, it'll suggest a full 10-carb bolus (assuming the IOB is for carbs already eaten).

Am I missing something, or is this exactly what you're saying? I kind of like it this way, so if halfway through a meal I've decided I'm eating more carbs than I thought, I can enter it in without worrying that my original meal-bolus will cancel it out.

As I understand, the difference in the way t:slim calculates boluses from other pumps is that it won't factor in a negative correction (for a low) into a carb bolus, so if you're 80 and your target is 100, it won't nudge the carb bolus down to get you back to target.

7:46 AM  
Anonymous Kerri. said...

I live for IOB data. I'm looking forward to checking out your t-slim reviews, Wil. :)

11:37 AM  
Anonymous Anonymous said...

"A traditional Med-T style pump wouldn’t count all that pie insulin and let me take a correction that would probably kill me."

Sorry, I think you're wrong. Medtronic always takes into consideration IOB when giving a correction bolus. That's the whole point behind telling it your active insulin in your settings. It will, however, as Scott pointed out, let you bolus again if you consume more food. But if you have enough IOB to cover a high BG, it will recommend 0.00 units, or a partial correction if enough time has passed.

You might want to double-check.

11:25 AM  
Blogger Andrew Lentini said...

I am curious why you have a picture of the Dexcom CGMS up there in your post at the top. I heard rumors that that CGMS will somehow communicate with the T:Slim...has that happened? Any thoughts on when? Thanks!

7:12 AM  
Blogger Hannah McDonald said...

LOL @ "Each time I unlock the pump, I feel like I’m unlocking the country’s missile defense system."

Bonus points if you say "All systems go!" before administering a bolus.

7:15 AM  

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