Switching Systems

Hi folks. I’ve been using Dexcom g6 and Omnipod for two years now. I’m very happy with the system but my Educator would like me to switch to Tandem Control IQ. Just wondering if any of you have done so, and what the pros and cons are for you. I personally really enjoy being tubeless, and I can’t imagine going back to tubes. Please advise. Thanks!

Hi @T1Tenor and thank you for writing in to the forum. Please excuse me for stepping in here as I’ve never used Omnipod. Right now I’m using TSLIM with BASAL IQ, and will be switching to Control IQ soon - my doctor’s preference although not necessity a requirement. I’m finding BIQ extremely helpful with lows and am looking forward to CIQ help similarly with highs. Some people on this forum have reported 90% time in range using it!
That said, keep in mind that once you’ve done your research the decision is yours, not your educator’s - after all, you are the one who will be living with it 24/7, so if you love your pod and being tubeless is a deal breaker, stand your ground by all means. I’ve heard that Omnipod was coming up with what I gather is its own comparable system that may be available next year, so perhaps you can have the best of both worlds of you’re willing to wait. Here’s some info - apologies if you already have it. Dash, Tidepool Loop, Horizon: the Future of Omnipod
Take care!

@T1Tenor Hi Christopher and welcome to the JDRF TypeOneNation Forum! Search through postings, read what interests you and please contribute bits & pieces that may help others on this journey.

Diabetes Educators and trainers provide much worthwhile information and provide some of the best guidance for living with diabetes. It is my opinion [I’m not a licensed medical provider] , but in the end, methods and devices should be your informed decision.

The OmniPod and Dexcom is not a “system”, but rather two separate devices. The only two AIDs, Automatic Insulin Delivery Systems, currently approved by The FDA [there are some effective DYI Systems] are the MiniMed / Medtronic system which is “Non-Adjunctive”, and the more high;y approved Tandem t-Slim paired with the DexCom G6 and using the Control IQ algorithm.

The Insulet Dash paired with DexCom G6 has been through successful trials and may soon be approved by FDA. Also on the horizon for AIDs could be the Abbott Libra 2 CGM paired with Tandem and/or Insulet; plus the anticipated MiniMed 780G paired with a new Medtronic CGM that hopefully will be non-adjunctive.

Hi Dennis. Would you please define “non-adjunctive” - or simply “adjunctive,” and I can figure out the rest😊. I’m not familiar with the term. Thanks.

Dorie @wadawabbit, non-adjunctive is FDA Terminology meaning that a CGM reading does not require another source corroboration, such as a fingrt-stick.

1 Like

Thank you - I can still learn.

I am now off-warranty on my old medtronic pump and have been told I won’t be able to get quick replacement if it should fail. I am also very happily using freestyle libre cgm as of winter 2020. I need to make a decision about whether to buy a new medtronic pump and stick with the 14-day Libres OR move to T-Slim, and integrate with Dexcom cgm, which I’ve heard so many good things about. (I don’t want to use medtronic’s cgm, having tried twice and finding it awful in so many ways). I’ve compared medtronic and tandem online, and love that tandem is smaller and can probably pretty easily get used to the different filling system and charging it etc. My concern is more how intrusive the Dexcom will seem after the ease of the 14-day Libre. Is the Dexcom sensor more like the medtronic sensor (painful and prone to failure, in my experience) or like the Libre (painfree with only worry being an adhesive failure, in my experience)? Any other differences that I should consider? Thanks!

I’ve used Dexcom G4/G5 as well as the G6. I was pleasantly surprised to find how quick, easy and painless the G6 sensor is to insert. The applicator is huge in comparison with the Freestyle, and I literally do not feel the sensor when it’s going in - and I do not misuse the word “literally.” The Freestlye I can feel going in sometimes, but the first few times I inserted my G6 I was skeptical that it had even gone in!
Any device is subject to failure but I’ve found my Dexcom to be very reliable. If my G6 sensor doesn’t last the full 10 days or anything wise goes wrong I can call and get a replacement. The only exception to that may be using a not approved site when you have the issue - otherwise they ask some questions for documentation purposes as I’m sure they did with Medtronic, and send one overnight.
You can request free patches from Dexcom (mashed me wonder why they don’t just include them in the package). I myself use a sensor cover and a Simpatch with a strap, available from Amazon. I may not need it but use it to protect my investment.

Hi Elizabeth @elizabethm, and welcome back.

If you change to a t-Slim, you can continue to use your Libre sensor just as you use Libre with Medtronic. They just don’t pair at this point. I believe that Tandem is now exploring with Abbott the possibility of integrating the Libre 2, approved last month by FDA, into the Tandem Control IQ AIDs.

I don’t expect that you will have difficulty switching to Tandem, I moved over very easily after having used 3 Medtronic models.

For a dry run with Tandem, I suggest that you put the t-Slim simulator on your phone or tablet. Very realistic way to practice.

Thanks, Dorie. Good to know the G6 painfree. (That was a surprise to me with the Libre too, having tried earlier versions from medtronic years ago that were so painful.)

1 Like

Thanks, Dennis. I’ll def try the t-slim simulator as a dry run. I figure I have a few months to make a decision and run down my medtronic supplies.
Are you using the closed loop system now? (Is that Control IQ?) I am a bit of a control freak and that would be a big change for me, but I also have some worrisome lows and would love to be better equipped to prevent some of them. I am sure closed loop helps flatten out the highs, but does it really help with the lows. I know it shuts off insulin, but does it prevent them in the first place? (I know most of this stuff is prob addressed on the Tandem website, but I’d rather hear the good, the bad and the ugly, than rosy endorsements.) Thanks!

Yes Elizabeth, I am using Control IQ. I began CIQ in January 2020 and have found it to be wonderfully effective, and in the six ++ months since then my BGL has been In-Range well over 90% of the time.

As for avoiding hypoglycemic events my term would be awesome - from a few per month, I’ve had only two since January and those were not severe in that I began correction BEFORE my glucose reading got down to 60 mg/dl. The fact that the system anticipates glucose drop is effective.

Useful feature that can be easily set in the t-Slim include both high and low threshold alerts and alarms. I have al alert to notify me whenever my BGL is falling at 2 mg/dl or faster, and on days of bike-riding, gym and other activities I set the pump to notify me when it anticipates me going below 100 mg/dl. When in Exercise Mode, CIQ corrects to 140 mg/dl.

That sounds great. I spend a lot of time in the 50s and 60s and then eating when I’d rather not be.
Can you set your system to not notify you through the night but to just anticipate and act upon info, alarming only if you actually dip below 60 and need to eat? One of the things I really couldn’t stand about the medtronic system (which, in fairness, I tried a long time ago) was all the alarms, keeping me from ever getting a good night’s sleep. Thanks!

Elizabeth @elizabethm, I get a really good night’s sleep. The CIQ begins reducing basal rate no later than when BGL is expected to get below 112.5 mg/dl, and suspends basal completely shortly after that. I’ve also seen my basal reduced, and occasionally suspended at levels much higher than 112.5.

Alarms can not be prevented during the night, alerts can sometimes be prevented from sounding. Because I’ve been extremely brittle for many decades, and can drop suddenly and without my knowing, I have my threshold [during the night] set to notify me when it is anticipated that my BGL will go below 75. My night time alarms/alerts are most often caused by “compression lows” where the sensor gets pinched between a rib and the mattress or against my elbow. I try to avoid this happening by inserting the sensor lower on my abdomen.

Hi Dennis - would you happen to know if the Libre 2 has been approved to be synced with the Tandem Control IQ at this point? My 5 yr-old daughter is doing awful with the DexCom - it’s always off by a lot. She was approved ‘off label’ to get the Tandom Control IQ in Jan (our insurance required that she’s diagnosed at least 6 months). My worry is that the Tandem Control IQ, despite all the praise from our doctor, will only be as good as the CGM its feeding from. Her doc has also thought about switching her to the Libre. thanks for any input!

Angelica @Angelph, at this point, I haven’t seen that the Libre 2 has been approved for Tandem Control IQ use. I agree with with you that CIQ will only be good for your daughter if her CG<M gives accurate readings.

When you say that her DexCom “is always off by a lot”, I need to ask your method for checking accuracy the CGM. Assuming your BG Meter is accurate, it should not be compared with a CGM reading if the CGM has not been at a steady value for at least 20 minutes - better, at least 30 minutes; it is common to have at least 20 minute “lag-tie” between glucose level in the body fluid and blood.
Another way to determine accuracy of her DexCom, is to compare the DexCom Clarity 90 day “GMI” reading [on Overview page" with her laboratory HbA1c result; if the GMI is within 0.5 of the A1c, I would say that her DexCom is providing accurate readings.

Just a thought but I initially struggled with my g6 on my abdomen and moved it to my arm and have been thrilled with the change. In my abdomen I would see a 40pt difference in the morning, I am a back sleeper, after moving to my arm I regularly see only 1 to 2 pts difference in the morning now.

Hi Dennis - these are good points. We currently calibrate the device every morning before we send her off to school, regardless of what her #'s are. We’re also following recent guidance given to us by DexCom representative that we should only calibrate when its off by +/- 20% of the finger prick test. Sometimes her DexCom fizzles out (possibly compression), and her #'s drop to urgent before it stops transmitting a signal momentarily. We usually finger prick just to be sure when it fizzles out like that - is it a real low or just the DexCom fizzling out from compression.
If you’re right about avoiding comparing values when her #'s are trending up/down, that’s a challenge for us. You can see below that she has these wild swings all day, so 20-30 mins of steady #'s is a luxury we don’t encounter. Below is her reading for the past day, and below that is her past 7 day averages from Clarity.The nutritionists and RN’s at her Endo are constantly making changes every 3 days to her ratios. I’d like to believe we’re doing our best to stick with them. At school, they dose her after lunch to avoid having her crashing at recess right after. Thanks so much for your feedback! I would’ve responded earlier, but I’ve been struggling to reset my password here, I need to get in touch with JDRF.