Passionate About Pumping
by Cathy Miller MPH, RD, LD, CDCES
The first time I saw the the Tandem T slim X2 pump with basal IQ demonstrated at a conference, I said to myself, “ I’m in love” and that love affair is still going strong! What do I like about the Tandem pump? For starters, it has a touch screen and software updates (like your favorite phones). It also has an integrated Dexcom 6 sensor which is one of the most accurate sensors on the market (MARD 9%). It has a basal suspend feature which turns off your background insulin 30” before it predicts your blood sugar will go under 80 and resumes it automatically when your blood sugar starts to rise.
Those features alone would have kept me happy for a long time, but technology improvements never seem to slow down and Tandem wasn’t just enjoying their previous accomplishments. In January 2020, Tandem released its latest software pump update, called T slim x2 with Control IQ. It’s a closed loop system which will give you extra background (basal) insulin when your sugar is above 160 and a bolus when your sugar is above 180. It also decreases your basal/background insulin when your sugar is less than 112 and shuts off your pump when your sugar is less than 70 (this is an over simplified explanation). It also has a special sleep and exercise mode. The sleep mode keeps your blood sugar in a tighter range and assumes you are not eating in the middle of the night. The pump will give you extra basal insulin when your sugar is over 120. The exercise mode keeps your blood sugar a bit higher to prevent post exercise hypoglycemia. You also no longer need to enter your blood sugars into your pump. The pump knows your sugars. All this equals more time with your blood sugar in range and less you have to do!!
To me, anything that can improve the quality of life for people with diabetes makes me happy. Are you starting to see why I’m in love and why I wanted to be a pump trainer? While this pump may seem like its the diabetic version of a self driving car, you still need to bolus for your carbs. The main difference is that if you over or underestimate your carbs, the pump is going to do its best to keep your blood sugars in range by adding or stopping insulin delivery. This is always a good thing!
Since becoming a diabetic educator in 2006, the best control I’ve seen for my type 1 patients is when they use a pump. Insulin sensitivity is improved with pump sets. Insulin can be given whenever carbs are eaten rather than just at meals. If they understand how to use the pump features and put in carbs when they eat them, the change in their blood sugars can be remarkable!
Sensor Savvy
The Dexcom 6 is a wonderful way to see your blood sugar 24 hours a day (on a screen) with surprising accuracy (MARD of 9%) without finger sticks. You can wear the sensor for 10 days before changing. What you may not know is how to prevent a sensor failure. A sensor failure is when the Bluetooth on your receiver is interrupted and no longer transmits your blood sugars to your pump or receiver. Since the sensor can now be replaced in less than 5”, this often confuses the Bluetooth in the receiver and results in a lost sensor or sensor failure message. To avoid this, go to stop sensor in your pump when completing a 10 day session. Replace your sensor. Wait for a full 15” after replacing it before you push start sensor. This allows your pump to find the new sensor. Other ways to avoid lost sensor messages are to make sure your pump face is facing away from your body and is on the same side of your body as your gray transmitter. Dexcom understands that it takes time to learn a new technology and therefore will replace a few sensors when you are first starting out.
To be able to see continuously how your blood sugars respond to foods, exercise, stress, insulin injections, sleep, and hormones is priceless to people with diabetes and leads them to feeling empowered.