Tag Archives: Tandem Diabetes

My Review of the Tandem t:case

Posted on by

On the surface it seems that designing a case for an insulin pump should be an easy task. The new t:case for Tandem t:slim pumps demonstrates that it is actually more complicated than that and that it might be impossible to design one case that will make everyone happy.

Two weeks ago the news spread like wildfire around the Tandem community that we could finally order the long-awaited t:case. A limited selection of colors was offered at that time, but the full spectrum (Black, Blue, Olive Fatigue, Pink, Purple, and Turquoise) is now available on Amazon. Some colors are in stock with others back-ordered until August 5. The Tandem online store continues to show most colors as “Coming Soon” but keep checking. The introductory price of $19.95 is guaranteed until August 31 after which the price may increase to $24.95.

The previous t:clip case was available in fun mix-and-match colors. It looked great, but had major problems with a top heavy design and the tendency to fall off user waistbands. The clip was too bulky for pocket use although some women liked that it was easy to attach the pump to their bras. Frequent breakages and replacements were common. I personally hated this case. Some users liked the t:slider case and I used the removable part of that case in my pocket.

The t:slider case has not been available through the Tandem online store for many months and the remaining stock of t:clip cases shows availability only in Flash Green and Sunset Orange. Leatherette cases are still offered and include the t:flip, the t:holster, and the t:wallet.

One thing I like about Tandem is the importance of design. The t:slim is a sleek and modern pump and I don’t think that Tandem would be satisfied with a case that wasn’t equally attractive. I also think that after the track record of the flawed t:clip case that it was important to “get it right” this time.

So did they get it right?

Yes and no.

The Yes:

The case is made out of what seems to be a very strong plastic and there is no flimsy clip or hinge to break. I think that the case will be durable and provide excellent protection for my pump.

The cutouts make a lot of sense and allow the user to charge the pump and change cartridges without removing the case. (That is good because it is not easy to remove the pump from the case.) My photo below shows a view of the back of the case with the many cut-outs.

The removable clip allows the pump to be worn in a vertical or horizontal orientation. For those  who carry the pump in their pocket, the clip can easily be removed. However, it is so low profile that you won’t be bothered by just leaving it on. The clip is made of stainless steel and seems unlikely to break or bend.

The No:

In my opinion Tandem made a mistake in how the clip attaches for horizontal wear. Those who wear the pump horizontally usually do not want to remove the pump from their waistband to see the screen or program pump functions. Therefore it makes sense for the pump to be oriented upside down so that when it is lifted up it is right side up for the viewer. The t:case orients the pump so that it is upside down when the user lifts it up. This is a big problem for those who are using the t:slim G4 for their CGM data and for those X2 users who will soon be able to see their Dexcom G5 data. Another annoyance about this clip position is that the tubing comes out at the bottom of the pump which increases the opportunity for tubing to hang down below your clothes and to jump out at doorknobs.

The Meh:

The t:slim screen is turned on and off by pushing the silver T:button at the top of the pump. My guess is that I push that button 30 times a day. For unknown reasons Tandem added a plastic cover over this button on the t:case. Previous cases just have a cutout. Unfortunately I found that the button cover made it difficult to turn on my pump. Sometimes it worked the first time; other times I had to push the button 4-5 times. I have arthritis in my hands and am unwilling to tax my joints just to turn on my pump.

Fortunately this was a problem easily fixed. The photo below shows my X-ACTO knife solution.

I found the clip to be quite secure when wearing the pump horizontally, but as I explained above, lifting up the pump to an upside down view doesn’t work for me. IMO the clip is slightly too short when wearing the pump vertically and is not as tight on my waistband as I would like. But it is okay and I know to be careful.

Tasks like removing the pump from the case and changing the clip orientation are not straightforward and no instructions are provided with the case. Fortunately there are instructions available on the Tandem website but that link is not included with the case.

User Feedback on Facebook:

“After wearing my pump all day in the new case, I have to say, I really like this new style case…ALOT! “

“I love my new (pink) case so much I now also have a black one and a purple one on backorder lol”

“Okay, so I may be the odd person out, but I’m not feeling the new case. I don’t like the clip…”

Addressing the cover on the silver T:button — “I’ve found mine getting easier to press- although it’s possible that it’s just my hand getting stronger”

“I just received the new hard case they have designed. No more plastic clips!! Has a metal clip and you can change the cartridge without taking the pump out of the case. I love it!”

“Anyone else annoyed that the pump is upside down with the new t:case when you look at it?! Why didn’t they put the clip on the other side?!”

Addressing the clip placement for horizontal use — “My understanding is they took in feedback from a lot of pump users so either no one thought of that or there were technical limitations that prevent it or they ignored the user feedback.”

“I love it! It’s way more comfortable to wear, and it doesn’t dig in like the old style did. And best of all…it isn’t top heavy anymore!”

“I really still don’t like it. I can’t put it in the center of my bra, which is where I normally wear it, and it won’t stay on my waistband. Putting it in my pocket makes my pants slide down and/or the tubing hangs out.”

“Just got the new clip for the pump but it didn’t come with any information on how to put it on can anyone help me out with this??”

“How do you flip the metal clip on the new case?”

“It is great. I can use the clip on a pair of shorts or put it in the pocket of my trousers without removing the clip.”

“My new T:case came…. WHEEEEE!”

Summary:

I am happy with my t:case. It is compact, functional, and attractive. Although I think the clip design makes a horizontal orientation an unlikely wear for me, I am satisfied to use it vertically or in my pocket. I have previously written that my problem with false occlusion alarms on my X2 was solved by using a case. Whether it is a temperature issue or the cutout for the vent holes, the cases have completely eliminated my alarm problems.

I think that no one could create a case that would please everyone. We each have unique needs and opinions. The t:case is mostly a win for Tandem, but IMO the horizontal clip position is a big problem—especially for integrated CGM use. I know that Tandem had many customers test drive the case and I wonder why the horizontal wear issue was not fixed. Also, did they consider older and disabled users? If it were not for my X-ACTO knife, I would not be able to use this case because of the difficulty of using the T:button. And I am not really that old or very disabled….

Here is a short instructional video about the t:case. I am currently using a black case but also ordered a pink one. In terms of color, I think that the video depicts the color of the cases much better than the Amazon photos.

 

Please note that this post discusses the t:case for the t:slim, t:slim G4, and t:slim X2 pumps. The t:case 480 is for t:flex pumps and is available in black and purple. The t:case 480 only allows a vertical orientation because of the larger insulin cartridge.

A 5-Month Review of the Tandem t:slim X2

Posted on by

I began using the Tandem t:slim X2 insulin pump in mid-December. In February I wrote a mostly-favorable review of the pump, but indicated that I was struggling with user-error problems and occlusion alarms that stopped insulin delivery. In March I wrote a post indicating that I had found a solution to the false occlusions, but it may have been a premature claim to success. I am now 5+ months into using the pump and thought I’d give an update on my experiences.

Overall Satisfaction:

I am happy with my Tandem pump.

The things I liked before I still like. I enjoy the contemporary looks of the pump and the touchscreen menu navigation. I appreciate being able to fine-tune settings although I don’t always take advantage of that capability. I like being able to easily see my Insulin on Board with one button push. I like that I can see the pump screen when outside in bright sunlight.

I have trained myself to avoid most of the user-error problems that I previously discussed. After filling the cannula of a new infusion set, I patiently wait until I arrive at the screen to resume insulin. I still get occasional Incomplete Bolus alarms when I put in a BG number to see if I need a correction. If I don’t need a correction I often forget to back out of the bolus menu and end up with an alert. I now get an A+ in remembering not to detach my pump in the middle of a bolus. It has been an adjustment moving from the fast bolus delivery of Animas pumps to the delayed delivery of a t:slim, but I have adapted.

Still Annoyed:

I still hate the pigtail on the pump tubing. It often makes the tubing stick out of my pocket which is unsightly and a doorknob risk. I also dislike how long it takes to fill a cartridge. I know that the X2 is faster than the original t:slim, but it is not a one or two minute task as with previous pumps.

Tandem recently announced that it will convert the luer lock connector at the pigtail to a proprietary connector called the t:lock. The purpose of this change is to reduce the time and insulin required to fill the cartridge and tubing. The downside of this conversion is that only Tandem proprietary infusion sets will be compatible. For me that is no problem because I use Comfort Shorts, a Tandem-supported set. I also understand that this change should help Tandem’s financial bottom line and I can’t oppose that. Some t:slim users, particularly those using non-supported sets such as the Cleo, Orbit 90, and Animas Inset, are enraged that Tandem is going the Medtronic route of proprietary sets.

I continue to dislike the Min Basal alerts. They happen a minute or two after I have set a temporary basal of zero and are annoying. I suspect that the alerts are the pump sensing the basal amount rather than the result of what I have just programmed. So maybe it is a safety issue. But it’s still annoying. If the pump questioned my temp basal amount right away, it would be better than interrupting me a few minutes later. At least this alert doesn’t stop insulin delivery, so it stays in the “annoyed” category.

Avoiding Occlusion Alarms:

When I wrote my initial review of my t:slim X2, I was unnerved by the fact that I was experiencing weekly occlusion alarms that resulted in a stoppage of insulin. Having pumped for 12 years with no such alarms, I knew that they were false and related to the pump not my infusion sets. In March I wrote a blogpost describing what I thought was a workable solution to the problem. I began using a Nite Ize clip and keeping the pump out of my pocket. The blogpost of course jinxed me and I had 3 occlusion alarms the next week. However, in fairness to Tandem, those alarms all happened with the same infusion set and maybe it was a site problem.

When I flew back to Minnesota in mid-April, I set off the TSA metal detector. As a PreChek traveler I am used to never declaring my pump and speeding through security. The downside of the Nite Ize clip is that it can’t be removed and ensures an airport pat-down every time. Because I set off the metal detector on my only other flight with the t:slim, I am afraid that the pump itself might have enough metal to always alarm, but I hope not.

I decided to remove the Nite Ize clip which wasn’t tight enough anyway. I wanted to go back to carrying the pump in my pocket and knew that doing that without a case was a recipe for occlusion alarms. Meanwhile a Tandem tech suggested the removable part of the t:slider case for use in my pocket. He indicated that the occlusions were a temperature problem and this case would resolve that. It is essentially a t:clip case without the annoying clip. I have used this case with my pump in my pocket for 6 weeks without a single occlusion alarm. For working out I put the pump in a Running Buddy Mini case on my waistband.

I made one other change that might be responsible for eliminating occlusion alarms. Rather than follow the Tandem instruction video for filling my cartridge, I do two things differently. After pulling air out of the cartridge with the insulin-filled syringe, I do not release the plunger as instructed. I hold it tight so that the air stays at the top of the syringe as I remove it. Then as directed I hold the syringe with the needle up and tap it so that all air moves to the top. At this point, I reinsert the syringe into my insulin vial and slowly push the air bubbles back into the vial. When there are no more air bubbles, I pull in enough insulin to measure my desired amount. If I see more air bubbles, I repeat the process. This eliminates the messy loss of insulin when shooting the bubbles out into the air.

I have not done a scientific test to determine whether it is the new case or the alternative method of filling the cartridge that is working for me. All I know is that with the combination of the two changes, I have not had a single occlusion alarm in 56 days.

Please note that the t:slider case is sold out according to the Tandem store although I wonder if the tech reps still have access to them. A new case to replace the t:clip case is in the works but I don’t know when it will be available.

Wishes:

One change I would like to see is the ability to customize the preset temporary basal setting. It always reverts to 50% now and 50% over 2 hours. That is a preset I never use and I override it every time. I would like the option to program my own preset or to at least show the last-used setting. This should just be a software change, so maybe it could be a future fix.

I anxiously await the software update to integrate my Dexcom G5 into the pump. Because it looks as though CMS will not allow the use of a smartphone with sensors purchased under Medicare (stupid for sure!!!), it would be nice to have my CGM as part of my pump even if I have to carry the Dex receiver also. I haven’t heard anything on when this update will be released.

My Favorite t:slim Hack:

I live in an older house and have few electrical outlets in convenient locations. Many people charge their t:slim pumps while showering. Our bathroom has only one outlet that is overused with hair dryers, a straightening iron, razors, and electric toothbrushes. I can sit near an outlet in the family room while watching TV, but then it is a PITA to unhook myself when I get up to do something. Charging in the car works fine when I remember to do it.

My newest solution is to use an Anker PowerCore back-up battery which I bought this winter for hiking. After owning it for a month or two, it dawned on me that I could use it to charge my pump! I keep a compatible cord attached to the Anker device and just plug in when needed. I can tuck the charger in my pocket or waistband and move about the house as needed. The charging is just as fast as from an outlet.

A great solution to a minor problem.

Conclusion:

I am satisfied that I chose a Tandem pump in late 2016 and think that I would make the same choice again. The only serious problem I have had with the pump is false occlusion alarms and that has mostly become a non-issue. The constant rumors about Tandem’s financial status are concerning, but my fingers are crossed that the company will overcome its problems and remain an innovative player in the diabetes tech world.