Winning the Battle with Tandem Occlusion Alarms

I began using the Tandem t:slim X2 in mid-December and wrote a product review in February. At that point I was frustrated with what I called #FakeNews occlusion alarms. I described the situation:

“I have used the Tandem t:slim X2 for almost 10 weeks. In that time I have had 9 occlusion alarms resulting in an immediate stoppage of insulin delivery. The first couple of times I panicked at the shrieking pump alarm fearing that something was actually wrong. Nope. Not once has there been a problem that did not disappear by working my way through the menu screens and pressing “Resume Insulin.” The vast majority of these alarms have been while delivering meal boluses, but not all.”

I mentioned that I had tried several recommendations from both Tandem reps and t:slim users on Facebook. Because I was using cartridges for more that the recommended 3 days, I began changing them more frequently. Instead of reducing the number of occlusion alarms, more frequent changes with less insulin in the cartridge resulted in more alarms. I tried carrying my pump in a Spibelt and then a Flipbelt as one D-friend recommended. I found the belts uncomfortable for everyday use and was quick to abandon them when I got an occlusion alarm wearing one.

A Tandem tech gave me a call and indicated that he is convinced that these occlusions happen because of temperature changes. He wanted me to start using a Tandem case to protect the pump from temperature changes when it was taken out of my pocket or Spibelt. He promised to send me a case without the clip so that I could carry the pump in my pocket. Meanwhile I started using the dreaded t:clip case which was bulky and ill-balanced and frequently fell off my waistband. I used the case for a week and hated it despite having no occlusion alarms. I took it off for a day hike and immediately had another lunchtime occlusion alarm.

Very quickly I reached the point that I was going to wear the pump the way I wanted to and occlusion alarms be damned. I wasn’t going to use an uncomfortable waist pack. I wasn’t going to use the t:clip case which ruined the elegant size and looks of the pump. I wasn’t going to change the cartridge every 3 days and waste a ton of time and insulin doing so.

Meanwhile I recalled that both Sarah “Sugabetic” and Kerri Sparling had written about a metal clip that could be attached directly to the pump. I reviewed their blogposts and ordered a Nite Ize Hip Clip from Amazon. I was a little spooked about attaching something directly to the pump, but went ahead anyway. For the first time I felt that I finally had a solution to carrying my X2 that would take it out of my pocket but keep the sleek lines of the pump intact.

I started using the Hip Clip on February 15 and made it 17 days before I had an alarm during a mealtime bolus. Although the pump was on my waistband, it looked as though the tubing was bent over on itself. Not exactly kinked but somewhat bent. I straightened the tubing and resumed insulin with no problems. As of today I have made it 32 days with only the one occlusion alarm.

Meanwhile I have not had to use the bulky Tandem case. I have not had to wear a Spibelt or Flipbelt except when I choose to at the gym. I have continued to use each cartridge well past the 3-day recommendation. (I change the infusion set every 2-3 days, just not the cartridge or tubing.) I have been happy wearing the pump on my waistband and been particularly happy that the pump retains it beauty and small size.

I am wearing and using the pump the way I want to wear it and the way I want to use it.

What has been my solution?

  1. I wear the pump with the Hip Clip clipped to my waistband most of the time. I try to make sure that there is no pressure on the tubing to cause it to bend near the pump and tubing connector.
  2. If I carry it in my pocket (which is easy to do because the clip is so small), I make sure that during boluses I keep the tubing near the pump and pigtail straight.

This solution seems to work for me, but will it work for others experiencing occlusion alarms? Are those of us experiencing the alarms having them for the same reason? I can share my profile: low average daily dose of insulin (<20 units), thin-average build, using manually-inserted Comfort Short infusion sets, carrying the pump in pocket with no case, using each cartridge for longer than 3 days. From Facebook discussions I don’t find a lot of overlap with my profile compared to others. I don’t even know what percentage of t:slim and X2 users experience occlusions because discussions about occlusions primarily attract users having the problem. Many Tandem pumpers report having no occlusion alarms. Some pumpers who report occlusion alarms believe that they are really having occlusions and have been helped by switching type of infusion sets. But that is not the case for many of us.

So for now I have learned to live with and mostly avoid occlusion alarms with my Tandem t:slim X2. IMO there is a flaw somewhere in the design of this pump system because I strongly believe that I should be able to carry my pump in my pocket without alarms. Tandem also thinks so because this screenshot of the t:slim X2 webpage shows a pumper pulling an uncased pump out of her pocket.

On March 8, 2017 Tandem announced that it will soon implement infusion sets and cartridges using a newly-designed tubing connector. The news release states:  “The new design reduces the time required to fill the infusion set tubing by approximately 30 seconds and reduces the amount of insulin used in the process by approximately four and a half units.” There is no mention that the t:lock Connector will reduce false occlusion alarms and it probably won’t, but a girl can always keep her fingers crossed….

In summary, I seem to have figured out how to avoid occlusion alarms on my Tandem pump. Maybe it is the tubing; maybe it is the temperature issue. Whatever. For the most part I’m just not thinking about it. And that’s a good thing.


Please note that this post only reflects my personal experiences. Be sure to talk with a Tandem representative and read as many reviews as possible if you are in the market for a new pump.

8 thoughts on “Winning the Battle with Tandem Occlusion Alarms

  1. I would be angry if I were getting those alarms. I do not know the reason for the occlusion error but frankly, I cannot imagine either the carrying case or the tubing length would matter much. But I am glad you found something that seems to be working.

    • I am frustrated with Tandem, but not angry. Because of changes in insurance I don’t have a lot of recourse and would probably buy the same pump again. The 670G would be enticing for me, but not the 630G. Medicare doesn’t cover Omnipod and I already have a working Animas Vibe. So it keeps coming back to Tandem. Thanks for reading, Rick.

  2. I agree. Pain in the ass. Noted it first with contact detach…now though less still with T90’s if i try to wear pump with out case. I call BS on the temp idea. And the moisture idea is stud chinstrap is supposed to be water proof and no moisture in mine…beside alarmed even when sitting on cool counter. Has little to do with temp or covering for carbs. Though did note seemed to be appriximately 8 hrs after replacement more commonly…but crazy fix i found -was to unclip from site and re-snap into site. For whatever stupid reason this fixed. Though at time’s would not fix (maybe true occlusion i guessed).

    Still unhappy about that added cost! They gave me a free nix of cintact deyach and reservoirs. Yipee.

    May try your clip out! I had one of their clips that busted off that i dremlled smith and that works great as well!

    • Thanks for commenting, Chrystal. Like you, I think the temperature explanation makes no sense. What I really don’t understand is why some of us have the problem and others don’t. IMO the problem will never be solved until that is understood.

  3. Hi Laddie,
    I came across your website tonight and have enjoyed reading about your impressions of the Tandem X2 insulin pump as well as your other posts. It is a curious thing about your occlusion alarms.
    When researching insulin pumps (and patents) last year, I wondered how Tandem could determine the reservoir volume since it was using a fluid bag with “reciprocating draw syringe” vs a syringe driven by a small stepper motor (Medtronic, volume easily based off position).
    I think that there may be an air pressure sensor on the small stud that the bottom reservoir case hole slips over (appears to seal around stud). This pressure sensor probably takes time to equalize and reference itself, hence the guessing upon reservoir replacement. It back calculates the bag volume based on the initial air volume, and changes the bag volume number as the air pressure is reduced.
    So where am I going with this? With a closed container (space around bag with sensor reading air pressure) and changing environmental temperatures, it may be temperature related due to the heated air expansion/contraction confusing the response of the air pressure sensor. Since the issues decreased with the insulin pump being less confined (and more temperature controlled), it kind of makes sense.
    Well, anyway there you have my 2cents. Keep up the great work.
    Cheers, James
    T1 since 1987, lucky to have been always on a Minimed, Medtronic, or Tandem pump

    • Thanks so much for sharing your thoughts and expertise, James. Your discussion of the temperature issue makes sense. I am still of the opinion that if taking the pump out of a loose pocket causes an occlusion, then something about the pump is too sensitive. Unfortunately I’ve recently had a series of occlusions recently wearing the pump on my waistband, so I’m back to square one trying to eliminate them. I’ve filled my last two reservoirs in a slightly different way than the Tandem video suggests and had no occlusions despite putting the pump back in my pocket.

  4. Good point concerning the loose pocket and occlusion alarms. Thinking back, I don’t believe I have ever had this alarm since getting the pump in Nov15 but I haven’t used their filling method to begin with. So maybe your pump is too sensitive to this fault condition…..
    I prefer to do a “wet connect” at the luer connector to reduce bubbles, although it isn’t always successful as there may be a lingering bubble that stays in the luer region.

  5. Pingback: A 5-Month Review of the Tandem t:slim X2 | Test Guess and Go

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