Review: @TandemDiabetes t:slim X2 Insulin Pump with Dexcom G5 integration

Manny Hernandez with X2+G5

Last year, when the Tandem X2 pump that supports software updates via USB (the only pump to do so) was approved by FDA, and they announced that their first update would support integration with the Dexcom G5 CGM sensor, I signed up for it. I left my clunky Animas Ping behind and became a Tandem pump user.

Recently, FDA granted Tandem approval for the Dexcom G5 update. And today, I am happy to report I am sporting my Dexcom G5 data on my Tandem X2 pump, as you can see above. This post summarizes my experience and feedback during the update process and over the course of the first few days of using the integrated product.

The Update
Upon receiving the instructions with my Update ID (you need one to proceed with the update), I downloaded the Tandem Device Updater:
Tandem Device Updater
After I had the software installed and running, the update literally it took under 15 minutes. This even included completing the recommended safety steps.
Update successful
In (silly) defiance to the recommendation to do the update in connection with a site change, I found myself needing to load the pump as you would have to with a site change. So, while you technically can still continue to use your current infusion site, you will need to go through the process of loading the pump. And since you need to prime by letting a minimum of 10 units flow through the tube, if you do not have at least 50 units of insulin in your cartridges, I recommend you follow their recommendation, unlike what I did… :/
At this point, my pump looked pretty much like it used to before the update… because my Dexcom receiver had not yet arrived, and it took about a week to get here…
The CGM integration
Once my Dexcom transmitters arrived, I was able to continue with the process, and get down to the really exciting stuff.
Entering the transmitter ID is a bit more “fun” than the way you enter it on the Dexcom receiver, where there’s no keyboard. The advantage of a touch screen is that the screen can be turned into a keyboard, only not a full keyboard but more like a phone pad keyboard:
Dexcom keyboard
You are prompted to verify the Transmitter ID (enter it twice), which is different from the Dexcom-only experience too. Not too sure what this does for the process, but not a big deal either.
My anxiety to be done with the rest of the process got in the way, as did my Dexcom receiver freaking out and entering into a loop where it would reboot itself over and over, as if it had sensed that it was no longer going to be with me any more (I forgot to take pictures of the Dexcom receiver acting up, and I had to do some ninja stuff to get the recurring reboot to stop, so I owe you visuals of the Dexcom screens, but I am sure you have seen them before…)
Finally, after patiently waiting for the mandatory two-hour sensor warmup period (which gave me plenty of time to finish the training and configure alarms, etc.) at 11:21, on Sep. 6, 2017, I finally saw my Dexcom G5 data on my Tandem X2 screen! 🙂

First CGM time

The Training
It will take you up to 30 min to complete the Remote Software Update – CGM Integration Tutorial. This is if you are new to the CGM or the Dexcom G5, since it covers CGM basics, how to insert the sensor, snap the transmitter, etc. I liked that it included these types of quizzes to confirm you have retained the key concepts that you’ve learned:
Not a huge deal, but the voiceover used in the tutorial was creepy at times. Also, I think the trainer speaking changes mid-module, which can be a tad disconcerting. Then again, not a huge deal.
Everyday use

After a few days of use, the pump battery has already shown signs of lasting less. This is not surprising, as it now has a Bluetooth radio to feed. But it’s still not necessarily the most fun extra thing to do. To be fair, it’s only one device vs. two (pump + receiver) I have to keep charging.

But the biggest downside I’ve found is that I am seeing the Out of Range icon in the place where you’d see the CGM reading more often than I would have expected, typically no less than a couple of times per day:
Out of Range 2
They indicate in the training that “Brief interruptions of up to 10 minutes [without CGM signal] are normal”. The truth is this doesn’t feel normal.
I have historically worn my pump in one pocket, on the same side of my body where I am wearing my infusion site. And I have my CGM sensor on the other side of the body (typically, both are on my abdomen). If I change my insulin pump to the opposite pocket (the one closest to the CGM transmitter/sensor), normally the Out of Range icon disappears shortly. I get that proximity matters to make sure the transmitter signal can get to the receiver in the pump, but we’re not talking 20 or even feet here, we’re literally talking inches… Although I am working on losing weight, I hope my belly is not the obstruction causing this! 😉
The verdict
I am delighted with being able to see my CGM data on my pump, period: full stop. Is it exactly the way I envision it? No. But it’s a MAJOR step for me, considering my choice of CGM at the present time (the world of CGM is changing rapidly so we will see what the future brings). In the meantime, here are two ideas (for my friends at Tandem and Dexcom) to make the integration better (which I assume they have already thought of):

  1. It would be amazing to offer the option to use a BG readings entered on the pump “side” of the device (while you are bolusing) to calibrate the CGM, or the opposite: offering the option to bolus for a BG being entered as part of your CGM calibration. Neither option is available, and they would make perfect sense. (Update, Sep. 10: Just realized that above target calibration BGs generate this prompt. Love it!) CGM calibration - correction
  2. Something that takes some getting used to is the fact that functions for loading the pump and for calibrating the CGM are respectively further out (in terms of button taps needed) than where they used to be pre-integration. I get that this comes with the territory, but I’d love to see the two companies explore ways to make the user experience a bit cleaner, specially re: calibrations which occur twice a day.

My Animas Vibe #PumpTrial

Since mid-2012, I have received product and supplies gratis from Animas (a Ping insulin pump with monthly supplies). In December 2014, I was provided with the Animas Vibe system, a Dexcom G4 Platinum sensor, and a Diasend kit to evaluate at no charge to me. Following are my impressions about the product as I experienced it. Animas has not seen or vetted this post prior to me publishing it.

Dec. 19 I started a trial of the Animas Vibe insulin pump:

Since the start of the trial I enjoyed seeing a few small things that I had longed having on my pump. But I will start with the bigger things that most PWD who are not on the Vibe may be wondering about.

THE BIG THING: Dexcom-integration
I am fairly open about my personal preference towards the Dexcom G4 CGM given its accuracy vs. other CGM systems in the market. So any pump that integrates with it I favor over others because CGM has been a diabetes technology that has saved my life countless times. While Tandem is on track to integrate with the Dexcom G4 next, and Asante will do so with the G5 further down the road, at this point the Animas Vibe is the only insulin pump that integrates with the Dexcom CGM.

Seeing on the same screen the glucose trend arrows along with the Insulin On Board (IOB): priceless!

A “chubby” downside:
The transmitter you use with the Animas Vibe is the “chubby” G4 (see it on the left, below), not the slim one (on the right, below). Not a HUGE deal… just a HUGE transmitter. Get it? 😉

Update (Jan. 6, 2015):
Heard this from fellow #DOC members, Melissa Lee and Mike Hoskins:

An upside:
As Kerri pointed out, you can pair the same transmitter to your Animas Vibe AND to one or more Dexcom G4 receivers at the same time.

A potential “downside” down the road:
Dexcom has gotten us a bit spoiled in recent months with the release of the Dexcom Share and the 505 algorithm, which increased their accuracy even more (although you can only upgrade the Dexcom receiver, connecting it to a PC).

There’s no doubt that Dexcom will continue to innovate, and by the time the Dexcom G5 is approved, unfortunately it will not be compatible with the Animas Vibe. Dexcom is supposed to submit the G5 to FDA any day now, so I am hopeful that the Animas team is working diligently to keep up with the pace of innovation, in order to make sure that there is not such a long wait for an Animas pump that can take full advantage of the latest in CGM at that point.

Most of the small improvements on the Animas Vibe pump did away with a number of annoying “features” that I could have totally done without, and welcome with arms wide open:

The first one you can witness on the Vine video below… You REALLY cannot blink, otherwise you will miss it:

Basically, with the Animas Ping you have to press the UP arrow all the way to the total bolus you want to administer, which can be fairly annoying if you are giving yourself anything over 1 unit of insulin. With the Animas Vibe, you only need to press the UP arrow once and the calculated amount of insulin gets populated on the Bolus Total screen. Yay to small improvements! 🙂

The SECOND improvement which I was VERY happy to see only becomes apparent when you change an infusion site or a battery. When you do either one of these things on an Animas Ping, your combo bolus default values (duration and Normal/Extended percentages) get reset. I cannot describe how much this “feature” has driven me nuts since I’ve been on the Animas. While, I didn’t have the chance to test it with a battery change, I did see the improvement with site changes. Now, your combo bolus default values do NOT get reset with site changes! Yay to more small improvements! 😀

There’s one lost feature that will be missed by many: the Animas Vibe does NOT have the companion OneTouch that doubles as BG meter and remote. It is a very unfortunate loss that takes value away from the product. Though I can live with this shortcoming, I’ve read about women who wear their pump on their bra or caregivers (parents as well as spouses of PWD) for whom this feature will constitute a deal-breaker. Again, this is an area where I am hopeful the feature will be restored with an eye on innovation not simply catching up.

There’s ONE last small improvement that exposed me to a feature of the Animas pump that I didn’t know about. Ironically it only became apparent as a serendipitous result of remote meter no longer being available: I am referring to the Food database. As it turns out (not sure why it was so, but clearly it buried the feature) the Food database was only accessible through the BG meter remote: you could not access it through the pump. Hence, why I never used it (or even knew it was there, although I did get trained on the pump): I only bolus from the BG meter/remote for BG. For carbs (the place in the navigation menu where the Food database is found) I always bolus from the pump.

There you have it! That’s my experience with the Animas Vibe during my two-week trial. Let me know if you have any questions: I will do my best to answer them. Beyond the Animas, I HIGHLY recommend you read Melissa Lee’s super-thorough comparison of all pumps on the market, that she published a few weeks ago on ASweetLife.

3 Secret Weapons for Nonprofits

As you may know by now, the past seven years I have been President of Diabetes Hands Foundation, a Berkeley-based nonprofit that aims to connect, empower, and mobilize people touched by diabetes for positive change, so that nobody living with diabetes may feel alone.

In the process of growing the organization, we have encountered a number of valuable tools and resources that have been instrumental in support of our mission. I wanted to share three of them that I have been meaning to write about for some time:

1) Techsoup
Nonprofits need software. But software can come in at a steep price, specially packages like Adobe PhotoShop and others that are important as part of creating and maintaining your nonprofit brand. Enter Techsoup!

They aim to connect nonprofits, charities, or public libraries with tech products and services, plus learning resources to make informed decisions about technology. Their free resources are available to all users. Once registered and qualified with TechSoup, nonprofits and libraries can access donated and discounted products and services from partners like Microsoft, Adobe, Cisco, Intuit, and Symantec.

2) Nonprofits Insurance Alliance Group
Nonprofits (as any other business) also need insurance. The Nonprofit Insurance Alliance Group provides a stable source of liability insurance tailored to the specialized needs of the nonprofit sector, and assist their members with programs, tools and training that minimize their risk, protect their clients, employees and volunteers. Not only are they tailored for nonprofits: they are more affordable than other alternatives.

3) Hispanic Foundation of Silicon Valley
One of their programs is the Latino Board Leadership Academy, which is a bootcamp of sorts, that trains Hispanic executives in Silicon Valley to become the best possible nonprofit board members. We came to their 2014 “Nonprofit Match Night” and loved it. Indeed, we recruited one of our current board members that night! They interviewed me about my impressions on the event: