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

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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, February 06, 2013

All thumbs


I’m all thumbs when it comes to running this stupid pump, and it’s causing me no end of trouble lately. For some reason, the shape and size of the t:slim, and the shape and size of my hands, conspire together to create an ergonomic environment where both my thumbs rest on the touch pad.

Like a teenager texting, I pump with my thumbs.

The problem, of course, is that the “keys” are small, my thumbs are big, and I can’t text for crap. The result? Lots of using the “back” button. As in back to change that 100 carbs I just entered into the pump to the 10 carbs I’m actually eating. Back to change that blood sugar of 258 to the 159 it really is.

Of course, if I could get into the habit of holding the pump in my right hand and using my left index finger to enter data, a lot of these problems would probably go away. Or maybe not. Even using one finger, I often hit the number below the one I had intended, a common issue according to one of Tandem’s train-the-trainers who recently visited me at the clinic. Apparently, it’s human nature to try to see the button you seek to press. I have no doubt that in the future our species, in addition to evolving a third arm and hand to hold our Apple devices, will evolve a transparent finger to solve this issue.

And no, before you ask, being all thumbs had nothing to do with my killer low. If it had, the pump logs would have shown it. And if the pump logs are wrong, then the pump is fucked anyway, and we’d be back to square one.

The thumb issue just requires me to be a little more alert whenever I use the pump, that’s all. But I’m guessing that people who have more touch-screen time under their fingertips than I do won’t have any problems at all. Will I adapt? I don’t know. If you are 70 years old, don’t own an iPad, smart phone, or Kindle Fire—is the t:slim the pump for you? Probably not. That said, I don’t think there’s a 70-year-old in the country who doesn’t own one of the three. Oh. Wait. There’s that one guy in Rhode Island. But he’s not diabetic, anyway.

Another thing I wanted to warn you about today is to never try to reprogram your t:slim’s profiles when you are hypo. Yes, in theory the mistakes that got you into trouble are still fresh in your mind, but your mind is not what it should be. You might, for instance, get AM and PM confused and wreck a perfectly good half-functioning profile by making changes to the wrong half of the day. And of course, you couldn’t restore those changes because you hadn’t written them down anywhere, your pump has no memory of the old settings once you change them, and you have no back-up files of previous settings on your computer, as the FDA hasn’t approved any software for your pump yet.

Of course this is all very hypothetical, I’m not saying it happened to me or anything like that.

Oh, and while I’m complaining, I just discovered something else that pisses me off about the t:slim. We made a gluten-free pizza last night. It was perfectly yummy, but it kicked me in the blood sugar just as badly as any other pizza (no fair, as I only had two small pieces). Anyway, like any good pumper eating pizza, I used a combo bolus. On the t:slim pump, this requires you to “flip a switch” on one of the many bolus confirmation screens that stand between your meal and your insulin. Once you do that, after then having to tap “next,” a new screen appears:


It has two buttons: one to tell the pump how much insulin to put on the table, and another to tell it how long to stretch the rest of it out. The default is 50/50 over two hours. My gripe is this: Like the Temp Rate, it doesn’t remember your last setting. It always comes back to the 50/50 two hour. Now in my experience, most folks who use combo boli tend to use the same one again and again. One of my faves is 65% on the table with a two-and-a-half hour run. That’s my go-to combo bolus for most occasions that I like to use combo boli for.

But noooooooo, Mr. Pump, who likes to remind me of every frickin’ thing at every frickin’ step, has no memory for my preferences. What frustrates me so much about this, is that it’s such a little thing for Tandem to have gotten right. And even if there’s a compelling reason why some people would be better off always starting at zero… well, 50/50… then why couldn’t we have had an option like this in the setup menu:

Choose remember last setting used
—or—
Return to default on next use

I know Tandem says they talked to something like 4,000 type 1s in designing this machine. I keep finding myself asking: Which 4,000? Or maybe they talked to the right 4,000—but just didn’t listen to them carefully.

The Tandem t:slim is like a mirage in the desert. It looks like cool, clear water—and then as you get closer it evaporates into smoke and dry dust. They come so close to getting everything perfect, then they fuck it up at the last moment. It just makes me want to scream.

On the bright side, I’ve learned some new things about the profile programming that are done right. First, as you’re getting your settings fine-tuned, if you find that you have a segment you no longer need, you can just delete it. Poof! It’s gone, and the pump simply connects the dots for you between the segments that were before and after the one you just deleted, re-setting the end time of the previous one automatically. Cool beans. Second, you can very easily change the time of a segment by just tapping on the time and changing it. For instance, if you decided you wanted to move a basal step forward in time one hour, thanks to something you noticed while carefully studying your CGM downloads, most pumps would make you add a whole new step to do this. On one popular pump, you can’t even insert a new step, you have to reprogram every down-stream step that follows. Quite the time-consuming and frustrating process.

Oh, and speaking of frustrating, I wanted to give you the epilogue on my last two posts. Tandem hasn’t been sitting idly silent in the shadows. They’ve been very proactive about reaching out to me about the issues. How does their approach compare to other pump companies? Are they doing everything they could? Everything they should? I’ll let you be the judge of that, but here’s where we are to date:

Customer service intervention number one: Shortly after my killer-low post, one of the Tandem brass called me. His first question was, “Are you OK?” His second was, “How do you feel about the way our customer support folks treated you?” We chatted for a time about how bizarre the event was, but he was 100% sure that the pump couldn’t be behind it. It must have been me. Hmmmmm…. I think that’s what the folks at Med-T told me a time or two…Or three… Or four… Or five… And he assured me that they were a different kind of medical device company, by and for dFolks. I’ve heard that before, too. But he said something very poignant, in terms of being confident that the t:slim pumps worked the way they are supposed to. He said “Hell, our children wear these pumps.”

Customer service intervention number two: I got a call from a nice young man at Tandem last week, shortly after the severed lifeline post ran. He was wanting more details about the incident, the lot numbers, have I had any other troubles, etc. I admitted I didn’t know if my pocket-carry method was putting too much of a strain on the connection. He was adamant that it should be “stronger than that,” and that Tandem was keen on trying to find out why this one failed. Did I still have it? As a matter of fact, I do have exactly one-half of it: the cartridge. I pitched the female luer lock with the set. Half was better than nothing and he asked if I’d be willing to send it back so they could analyze it. Sure thing. And he said that while they couldn’t do anything about the forty-two bucks worth of lost insulin, they could send me a whole box of cartridges to help make up for it. Who would say “no” to an offer like that?

But I hesitated.

I hesitated, because I’m not sure I’m sticking with this pump for much longer. But not for the reasons you might be expecting. It has nothing to do with the mystery killer-low, which even I’m not convinced was caused by the pump. Why am I close to throwing in the towel on the t:Slim? You’ll have to go over to Diabetes Mine tomorrow morning to read all about that.

But my mind is not 100% made up yet, and my health insurance plan self-destructs in ten months. I have no idea how well whatever health plan I get next will cover pump supplies. If I do stick with t:Slim I might need every cartridge I can get my paws on. So naturally I accepted the box of cartridges.

Diabetics and squirrels have a lot in common in this regard.


Next time: Bubble-free system, my ass!

3 Comments:

Blogger Bernard said...

For what it's worth Wil I have the same problems hitting the wrong button. About 40% of the time I hit the back arrow button when I meant to hit 9. And I have used touch screens for many years, though I not a teen any more and never could text while chewing gum and walking up stairs.

I think the targets are too small. Apple recommends a minimum target size of 44x44 pixels, that's a square shape. Tandem's are really not high enough, though they're constrained by the vertical height of the screen. Like Dexcom I wish they'd placed the number to the left or right and used the extra vertical pixels to enlarge those buttons. I also wish they had a 00 button in the lower left space which is empty.

I'm with you re who they talked with. I've advised several device makers over the years and I've blogged about diabetes technology for 5+ years. Heck most newbie companies I contact already know about me. So I was a teensy bit disappointed I didn't ever hear from Tandem, I could have given them this advise 2+ years ago.

Oh well. the next one will be much better I'm sure with GPS and a voice interface. Only kidding.

Though I'm really getting tired waiting for that software.

7:04 AM  
Blogger DB said...

Well your phone should be ringing off the hook after this feedback...

Tandem does seem to be working the social media HARD.

One of My beloved Cozmos died last week. Im now down to one... Since Im not a blogger or Diabetes VIP I usually, have a backup plan, which means ordering a replacement pump.
I was hoping I could nurse a year more out of the cozmo so that I could see what else comes on the market. But the Tslim was going to be the go to choice if I had to pull the trigger. With this review, now Im debating just going back to shots....

11:18 AM  
Blogger Skye said...

I just don't understand why they didn't use the entire screen... why there's 7/8" of deadspace on the side with the silly "bit T" button, which I don't ever need because every screen has a back button. And not that Apple should be the gold standard for everything, but there's less deadspace on my ipod touch, with only 5/8" for the button, which makes the ratio of useable to wasted space on the front a lot better in Apple-word than on my pump.

It doesn't bother me that the pump won't remember my last combi-bolus settings, but I've already tripped myself up on twice (in 2 weeks) is that the 'deliver now' box and the 'duration' are right on top of each other, and they light up blue at the same time, which to my brain implies that the duration I'm choosing is for the 'now' insulin, which doesn't make any sense but leads me to swap the % of 'now' and 'later' insulin without missing a beat. Sure, I could actually stop to read the screen I guess, but I kinda don't think I should actually have to....

I mostly like it though, I think. Dead space and stupid luer-lock placement notwithstanding. (Well fine, the lack of downloading software is kind of unsettling, but the lady I talked to yesterday said it should be out by the end of the month for sure so I'm not including that on my list of really weird things.)

3:15 PM  

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