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 Asante 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!) pleases 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.

UPDATE SEPTEMBER 2016: To those wondering, two and a half years later, if I'm glad I picked the t:slim... I am. I'm not sure there existed a better option for me at the time I was able to get a new pump (January 2014). That said, I am on my third t:slim as I write this. My original pump, and its refurbished replacement, got to the point that they would not accept a new cartridge installation - which essentially means the pump was rendered useless. Because my pump was still within its four years of warranty, it was replaced at no cost to me. And with my third (current) version, they sent a pump that included updated software.

SO MUCH BETTER.

Here's hoping the updated software continues to solve the "no cartridge for you!" issue my previous t:slim pumps had. After two replacements, it has become more challenging to completely trust this tiny, life-bettering machine on my hip. 

UPDATE TO THE UPDATE, DECEMBER 2016: I'm on a pump break for the first time in 11 years. Details in this post.