Monday, January 27, 2014

Review: Tandem t:slim Insulin Pump.

I wanted to give myself a few weeks of living with it before I shared my thoughts on the t:slim insulin pump I'm now wearing. I've had time to do several cartridge changes, program boluses of all flavors, experience some alarms and alerts, download my data a few times, and basically just see how this tech fits into my activities (and outfits).

You may not have the patience to read everything I'm going to write about this pump (I get that; do your thing), so here's the GIF short-hand. It's going to be about 90% this:




And the remaining 10% somewhere around this:




My insulin pump experience includes four years with a Cozmo, and four years with an Animas Ping, plus a few weeks of trying out the Snap, so keep that in mind as my frame(s) of reference.

I realize no insulin pump is "perfect" and probably none will possess all of the things I like (and none of the things I don't), but the t:slim gets preeeeeetty close, for me.

Let's get the less favorable qualities out of the way first:
Nothing to see here; everything's normal

  • While it's advertised as a pump that can hold 300 units, I don't see a way to actually get to use all 300. When I tried to fill the t:slim's cartridge with a full 300 units (it may have been more like 302), it caused an error that rendered the cartridge - and its insulin - unusable. I called customer service when the error came up, and they said that particular message code appears when the cartridge has been overfilled, and that I wouldn't be able to use that cartridge. Whoops! (Sidenote: some suggested I could draw the insulin back out using the syringe I filled it with, but I hesitated to do so. I'd rather play it safe than use possibly contaminated insulin; that's just me though.) The t:slim still holds more than my Ping did, though, so I can live with it.
  • The tubing prime when starting a new cartridge - OH MY does this process seem ridiculous. Having grown used to the < 30 seconds a prime took with the Ping, and the .5 seconds it took to prime tubing with the Snap - this step feels painful. And not only does it take a long time - think minutes, not seconds - I was instructed to sit not only the pump, but the tubing upright during the prime to avoid air bubbles. Considering I use 43" tubing - it's a sight to behold, and a task I've assigned to my kitchen cabinet knobs. (See right.) 
  • When my t:slim was shipped to me, they asked what kind of infusion sets I wanted and we decided I'd try some Cleo sets. Unfortunately I had quite a few issues with using these - I've sent back the unopened boxes to swap back for Insets - among them, an airbubble that would get stuck where the "pigtail" meets the luer lock of the tubing. However when I switched back to Insets, I couldn't see that bubble anymore, so this may be a non-issue for me going forward.
  • There are what seem to me to be an exorbitant plethora (I like big words as much as I like GIFs, okay?) of confirmation screens. I'm aware that this was due to FDA's concerns about a touch screen on a medical device (think about how many people butt-dial on their phones; now imagine butt-bolusing), but it's still a concern from a usability standpoint. It annoys me.
  • The "manual bolus" option - that is to say, a way of telling my pump to just administer a certain amount of insulin, not associating it with carbs or a BG - is non-existent on this pump. While there is a workaround that involves programming 1g of carb, and then overriding the units of insulin from there - it seems a silly thing to have omitted.
  • The lowest profile clip they offer, which is also the clip that now comes with the pump when you order it (the "t:clip"), is not as low-profile as I'd prefer. Again, I'm used to Animas' clip, which was so nice! And when clipped to the top of my pants, more of the Animas pump would be "below the line", so to speak, than the t:slim and its case.
  • And finally, the way it delivers insulin - with this "bladder" that I'm not able to see, within the cartridge - is something new to me. I'm going to need some time and an accumulation of good experiences before I can develop full trust in how reliable and accurate this is. 

There are a few other small things, but they may just be things I need time to get used to, rather than downsides of the pump itself. It's also worth mentioning that during my first few days with the t:slim, my blood sugars were running higher than I expected them to. But, once I switched back to Inset infusion sets from the Cleos, things seemed to even out for me. It could be coincidence and due to some other factor, but it happened, so it's worth noting.

Onward.

Here are my "Oh, HELL Yeah!" items:

  • It feels, looks, and behaves like an insulin pump in 2014 should. How I feel about the way I manage my diabetes plays an important role in my psychosocial health, for better or worse, and things like a touchscreen (no more scrolling - huzzah!) and data displayed in color (with graphics!) please my sensibilities. The screen is bright; the vibrate setting is noticeable but not too vibratey (technical term); the pump's "feel" is solid and sleek. This matters to me.
  • It has a vibrate option, instead of all audible alerts and alarms.
  • There's a touch bolus button, which allows me to program a bolus without ever needing to look at my pump screen - I use this often, and realized after trialing the Snap pump that this was a must-have for me.
  • The "basics" are all on my home screen, or just one tap away: things like my insulin on board (IOB) and time of my last bolus, current basal rate, battery life, insulin left in cartridge and current I:C ratio are all easy and quick to access. 
  • I can plug the pump into the wall, or the USB port on my laptop, or my car,  to charge it. That is so boss.
  • "Personal Profiles" include everything you might want to reset for that time of day - not just basal rates, but also I:C, correction factors, target BG, and more can be tailored in each individual profile.
  • Speaking of personal profiles, you can name the profiles whatever you want. Again, seems small - but being able to have a profile named "Eff Yeah Wknd" makes me smile.
  • I considered listing this as a negative, but I'm actually thinking it should be a plus: the t:slim seems more occlusion-sensitive than other pumps I've worn. This could be good as long as the alarms are actually truthful. 
  • It's water-tight. Excellent.
  • Delivery noises seem much quieter to me. I'm not talking about confirmation beeps, but the actual noise the piston makes when delivering a bolus or basal. Anyone who has used an Animas Ping and spent any amount of time in a library or super-quiet work environment (hey, that's me!) can attest to the loud noises it makes while delivering insulin, and that always bugged me. Sweet relief!
  • I hadn't realized this ahead of time, but the t:slim will alert you if you it thinks a bolus you're creating will cause you to go low. I love a device that can help me out like that.
  • The t:connect software (Mac-friendly - yay!) is very visual and easy to use, and I like not having to mess with a special cable/dongle in order to access my information. Downloading my Ping was always such a clunky process that it deterred me from doing it very often - t:slim is very plug-and-play with any micro-USB cord. My doctor hasn't tried to access my data yet (I've heard there's no provider version; that they'll need my password to access it, which doesn't seem right), but so far I like it for my own use.
  • I've found Tandem's team to be very responsive - customer service has been good, and my local reps have been very accessible, through emails, texts, calls, or whatever medium I might want to use. And when they issued two different voluntary recalls on cartridges - mine were affected - I was alerted by tweets, phone calls, emails, AND snail mail. 
  • Back to those t:clip cases - again, a small thing, but you can totally mix and match colors on these, because the clip is two parts. 
  • One last thing - I'm looking forward to hearing more about the partnership Tandem and Dexcom have forged in order to get an integrated system to market. 

I'd also be interested in hearing what other t:slim users do or don't like about pumping with this particular device, so feel free to comment all over this.

As I said, I'm only three weeks in. Time will tell if this pump is a good fit for me over the long haul, but so far? Thumbs most of the way up.



43 comments:

  1. I'm glad you feel like the occlusion alarm is really sensitive. I've had the alarm go off multiple times and almost every time I've just unkinked my tubing and pressed resume and it's been fine. If it goes off twice in a row I'll change it out. Also, and probably not a problem for those not in a stand on your feet for >8 hours a day profession, but the occlusion alarm happens really frequently with tubing under compression hose, just a fun fact.

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  2. Hi Kim...I'm about 15 months in and generally agree with everything you've written! Love my t:slim - it's a worthy successor to the cozmo!! -ellen

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  3. Wow, thanks so much for this feedback! I just connected with a t:slim rep and have started the process of switching from Medtronic. Question on the manual bolus problem: So are you saying you can't just bolus for say, 2 units, just because you feel like it or know that you may have eaten extra at lunch, for example. You would have to enter a blood sugar or carb amount to bolus?

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    1. Technically, yes you can - you just have to use that workaround that I mentioned to get to the point where you can specify what you want your bolus to be, in units. But no, there is no way to "officially" do it, unless you're using the touch bolus button and don't need a super-specific amount of insulin (i.e. one button press, for me, is one whole unit). Does that make sense?

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    2. Ah, okay. So "touch bolus" could be an option around it. Great review, btw! Very helpful! Also, I adore the cookie monster.

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    3. I am a little confused by this. I can perform a quick bolus, two units at a time (which is programmable to other increments 0.5, 1.0, 2.0 or 5.0) by pressing the silver button on the top. Is the issue that you cannot input a more specific amount? Not sure what a touch bolus is.

      And spot on with the Cleo - yuck!

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    4. Amy - yes, that is exactly what I mean. :) If I wanted to just program, say, 2.55 units without associating it with a BG or carbs, I can't do that (save for using the aforementioned workaround). With the Ping, I could just input a specific amount like that.

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  4. My son's been using it for about 4 weeks and I've been trying to write our/his review. You pretty much write was I was thinking. We haven't had one occlusion alarm, so that's weird. He thinks the delivery noise is loud (he also switched from Animas) and he did get the carb/bg buttons mixed up (while groggy in the middle of the night) and gave insulin for 331 carbs rather than a bg of 331, which I luckily notice half an hour later. He hates the high profile clip but has to use it during PE. He won't even do cartridge changes because they're so ridiculous, I've been stuck with the task every time. Overall, we're both happy with it, no scrolling through numbers makes up for a lot.

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  5. Yep. You nailed it. The whole "you may go low" thing actually bothers me a bit. I know it's all "math-y" and stuff, but if I want to correct a high sugar, and it's night time when I'm far more insulin resistant, and I still technically have enough IOB, I hate having to do a workaround via quick bolus because my pump thinks it's smarter than I am. The priming process is ridiculously long. And the Cleo infusion sets are awful. AWFUL. I almost decided not to pump because they ripped off so much and hurt my skin and kinked a lot. My distributor (not my rep) says a lot of people don't like them.

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  6. Ive been on the TSlim for about 4 months.

    Drive me nuts category:
    1) Air Bubble Paranoia
    2) Incomplete Bolus Alert - When I put something into the calculator, its because I want to see if a correction is necessary. If its not, just let the bolus time out. All those loud beeps aren't necessary.

    Good things:
    1) Touch Screen
    2) No longer asked about why I have a beeper (Although someone did ask about my MP3 player the other day).

    Dexcom integration, please hurry!!!!

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  7. I used Cleos with my Cozmo, and I was never a fan, so I would also recommend the Insets! So far, the t:slim and I have been getting along well for the past 8 or 9 months. I don't seem to have issues with air bubbles like some people do, but on the other hand, if they are very tiny air bubbles, I am not so insulin-sensitive that these would normally cause me any issues. I feel like the primes are long, but I also think my Cozmo primes were somewhat long, because it doesn't always seem that bad to me. Of course, I am frequently multitasking, so while the t:slim is priming, I'm running around doing things. Also, having 10-digit numerical entry with a delete key AND a calculator is fantastic. I am not great at math, so when I know Food A has 12 grams of carbs and Food B has 26 grams of carbs (and there is a train going from Philadelphia to Boston or whatever), I can just enter 12 + 26 and it's there for me. I feel like no pump is perfect for me, and the t:slim has been a great option so far, and WAY better than my other option when I was choosing a new pump last year.

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    1. Yes! Thank you for mentioning that feature - I had forgotten to include it. I appreciate the ability to add when bolusing for multiple things, too!

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  8. For what it's worth, when I upload my Medtronic pump data to Carelink for my doctors to review, I also need to give them my username and password. But I agree, I feel a bit "violated" in doing so, even though I have nothing (in that data) to hide.

    That manual-bolus thing really sounds like a pain in the ass. Does that mean you can't give it a BG and then choose your own correction without adding carbs? Also, I'm curious to know what you think of the reverse-correction "bug", where it won't subtract from a carb bolus unless you're under 70. I know that bothers some people.

    Last question for you -- for those of us unfamiliar with the "Cleo" sets, what are they, and do they resemble a set that another manufacturer distributes? If it causes such problems, I'd be curious to hear what happens with the same set connected to different pump.

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    1. Hi Scott - to clarify, you can specify carbs and/or BG. You don't have to do both. :)

      The reverse correction issue doesn't bother me, but I know is important for some.

      I linked to the Cleo sets above, but here's another: http://www.smiths-medical.com/landing-pages/promotions/md/cleo-home.html They pretty much work with any pump that accepts a luer lock.

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  9. My 13 yo daughter has been on the t:slim for about nine months, came from a Cozmo (she was the last one at her clinic with a Cozmo). We both love it and generally agree with what everyone has said. One thing that does bother me, though this should rarely happen... if you allow the pump's battery to deplete, you have to change the cartridge once it's charging/charged. Waste of supplies, insulin and time. Also, the anchor for the door that covers the charging port comes detached much too easily. She does get fairly frequent occlusion alarms, but they are very easily rectified. Question... Is there a way to turn the pump off? RE Cleos, my daughter has used them for almost five years and we both LOVE them. Love the insertion device.

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    1. Hi Shannon! I remember asking about how to "shut down" the pump, since there's no battery to remove, during training - but I'm afraid I don't recall the answer. A call to tech support may answer this.

      I'm glad Cleos work so well for you both!

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    2. I don't believe there's a way to shut the pump off. I went camping for a few days last summer where I chose to use insulin pens instead of the pump and it was a painful alarming process until the pump died.

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    3. I've taken frustration vacations from the tslim a few times. The first time, I put it in "shelf mode" where you plug it in to the charger, then hold down the button on top until it screams some beeps and goes black. To turn it back on, plug it in and hold down the button until more screaming and the screen lights up. THIS IS NOT AN OFFICIALLY SANCTIONED TANDEM APPROACH. There have been some concerns over data corruption, so shelf mode at your own risk. My other tactic is to just create a new profile with a 24 hr basal rate of 0 and switch that one when I want to take a break. The fully charged battery lasted me well over two weeks last time, and as long as I didn't have the site change reminder set, it stayed blissfully quiet the whole time.

      I'm one of those people who isn't all sunshiney about my tslim. I'm not sure it's always giving me the insulin it says it is. I get cartridge occlusions a lot. But I like it better than any other pump I've used, so I keep going back. It's my insulin infusing version of a bad relationship.

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  10. Hey Kim. I've been using the tslim for 16 months about and I would definitely agree with almost everything you've said.

    To get around the painful priming process I have been reusing my tubing for the life of a insulin vial. It also helps to know I'm not throwing away 43" of insulin every 3 days too. (I'm not recommending this - just stating what I do. If it were to cause significant BG problems I wouldn't do it but I haven't noticed anything yet. Although this could change.)

    One thing that bothered me at first was there was no alarm clock. Silly but I used it to remind me to take other medications on my previous pump.

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    1. Melissa,

      I'm pretty sure you can use the reminders feature to program any alarms that you want. I haven't used it much but it is there. Jason

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  11. Hi Kim,

    Air bubble paranoia (well stated above) became my biggest concern with the pig tail design. I would also add that the extended bolus feature has some limits that are programed into the pump (can't deliver more that 7.5 units per 30 minutes). Has anyone had issues with this??

    Finally, Tandem got really weird when I asked to return the pump and ultimately wouldn't allow me to which was super frustrating. Just be aware that when you sign the assignment of benefits form that you are agreeing to the return policy (30 days from the ship date).

    You review seems spot on.

    Jason

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    1. Is this correct? The maximum extended bolus s 7.5 units over 30 minutes? I am currently using an Animus One Touch Ping. I assume the extended bolus is the same as what Animas calls a Combo Bolus. Generally whenever I use this feature is when I have eaten something not to good for me (especially pizza). I know I shouldn't eat it but can't resist it occasionally. When I need it, then I need more than 7.5 u aver 30 minutes. .

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  12. My daughter (16 y/o, 4.5 months post T1D onset), just started on her t:slim today. Since we have nothing else to compare it to, and are still very much "beginners," it's good to read that most reviewers have positive feelings overall. We'll see how it goes...

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  14. I had a terrible time with the Cleo sets when I tried them, too. I think my dermis/subcutaneous tissue ratio just isn't good for them. I can't use an insulin pen, either, because the needles are too short.

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  15. They were super awesome on the recall I was amazed I only had 2 cartridges affected but they sent me a whole box. It makes me wish my insurance covered them directly and I didn't have to go through a supplier that sucks.

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  16. thanks so much for all this detail. the warranty on our mm is up in a couple of months and after doing the tslim trial at ffl, that's the one L is leaning toward, so it's great to see this real world look at things. L's main concern was the comfort/ease of the infusion set. she's used to mios.

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  17. You can use any luer lock infusion set with the tslim. The non proprietary version of the mio is the Inset... most of medtronics infusion sets are made by unomedical and come in a version for everyone else's pump

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  18. I'm so glad I read your post as I have been having a lot of air bubble issues. Oddly enough, I have had the t-slim since July and have not had a single alarm or occlusion. I say odd, since I have had alarm issues with every pump I have used including Medtronic, Deltec, and Omnipod. I have been using Cleos (mainly because I had a super supply leftover from pre Ominpod days and wanted to use them up). I had the exact same problem you did, the ginormous bubble that sits between the leur lock and the tubing. What I don't understand is if it can use any infusion set with a leur lock why the problem with Cleos? But perhaps I need to do a little experiment and try a different set up. Great blog. I really do love my t-slim and I don't want to give it up because I am not so enamored with anything else on the market. So I hope I can get to the bottom of the air bubble problem.

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  19. Here is another site which covers the air bubble problem:
    http://www.tudiabetes.org/group/tandem-t-slim/forum/topics/how-i-beat-the-bubbles

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  20. If you would like to bolus in units, you can tap on the amount of units displayed at the top of the screen after entering a carb amount or blood glucose and then enter the amount manually. Or if you would like to use units exclusively you can change that option you can do so by going to

    Options>My Pump>Personal Profiles>(Select the profile you'd like to change)> Edit> Bolus Settings> Then change the Carbohydrates to off.

    After doing so your bolus screen should display units instead.

    Hope this helps

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  21. I'm looking into getting one of these in the next few weeks. My biggest concern is not being able to replace the battery if it happens to die while I'm camping or something of the sort. So my question is, have you tested how long the battery life is without charging it at all? How long does it last on a single charge? I'm surprised no one has asked about this yet.

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    1. I've never let it run down to zero battery, but to give you an idea: after 48 hours of use since the last charge, I was down to 80% this morning.

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    2. Also, you can solar-charge your t:slim too, apparently, though I've not tried it: http://www.diabetesmine.com/2014/03/using-the-suns-power-to-juice-up-our-diabetes-devices.html

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  22. How is the bolus delivery time compared to a Ping which has Normal & slow delivery rates? I was playing with a demo unit in the office earlier and programmed a 10 u bolus & it seemed to take forever compared to the Ping. Was this just the demo pump or is it slow? I have gotten into the habit of making sure the bolus is actually delivered. Please confirm, the cartridge is NOT refillable? Any Medicare insurance users out there? Do cartridges, infusion sets & supplies come from Tandem or will I have to go thru a 3rd party medicare approved supplier (Animas dropped all their Medicare patients 4.5 or so years ago just after I started using the Ping system) Final question: Will the pump survive being dropped onto a hard tile floor from waist height-- say 3 feet, if not is this covered by the warranty?

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    1. You are correct that the t:slim delivers boluses much more slowly than the Ping does. The cartridge is not refillable, no. As for the rest of your questions - those would be really great questions to ask of a Tandem rep.

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  23. One thing that it's explained very clearly about a t:slim, you can't use Apidra rapid acting insulin in it. It wasn't tested with it, so it's not FDA approved. But, like yourself trying every possible way to test and stretch the limits of the t:slim when I trialed it. Apidra would gum up the "pig tail" the luer lock connector from the cartrige to the tubing. Boy, I haven' has so many "HI" blood sugars in my insulin pump career. So just a head's up to the Apidra users. ( I use continue to use Apidra in my Minimed pump- works great)

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  24. I just got a Medtronic 530G. So I have less than 390 days to change my mind. I was choosing between t-slim and 530G. I chose 530 because of integrated CGM.
    My question for the group: The alarms on the 530G are very high pitched, and not very loud. There is no volume setting, quiet is all you get. You can chose vibrate WITH NO SOUND, but you cannot have both.

    What is the volume like on the T-slim. Is it adjustable? can you have different "ring tones" for alerts, alarms? Can you have vibrate with sound vibrate only, and sound only? Can you silence almost all alarms if desired?

    SO far this is the biggest concern I have had with the 530.

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    1. Hey there - okay first, do you have a Tandem rep in your area? They can meet with you and show you a t:slim in person so you can hear all of the alarms, etc., for yourself. But to answer your question, you have the options of Vibrate (no sound), Low, Medium, or High and can adjust those for each alarm. (So for example, if you wanted a "low" volume for quick boluses, but a "high" alarm for a low cartridge warning, you can specify that. It's not one-setting-to-rule-them-all, like with some other pumps.) Right now it's just beeps - no choice of "ring tones", no. You can't have *no* alarms, but the vibrate option would make it silent, relatively speaking, if that makes sense.

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    2. If it's not too late Kim, check out the Dexcom cgm which is much superior in accuracy.

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  25. Reading through the list of issues, I wonder why would I consider it over the Ping?
    With Ping priming process is easy, waterproof design is great, air bubbles are no much trouble either.
    Besides, rechargeable battery sounds more like a hassle, considering once a month replacement on Ping.
    Convince me!

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    1. Hi "Anonymous" - you may find this comparison helpful, to understand what differs between the Ping and the t:slim (and other pumps): http://integrateddiabetes.com/insulin-pump-comparisons/

      No convincing needed - choose what works best for you. It sounds like Ping is a good fit for you now.

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    2. Thanks for the link! Will stay with Animas for now ...

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