Picture this: It’s Friday night. You’re at a restaurant for dinner with a bunch of your friends. You’re craving something delicious after a hard week.

You decide to go fancy and order some surf and turf with vegetables and cheesy cauliflower mash. The group orders some oysters to share. Your mouth is watering.

Low carb, right? Your starting blood glucose is 104 mg/dL. 1 unit of insulin is taken for the veggies.

You go to bed at 11:30 PM with a blood glucose of 135 mg/dL. Nothing to worry about, right?

You wake up at 4:00 AM and your blood glucose is 265 mg/dL for no good reason. What went wrong?

Enter: Bolusing for high-fat meals.

How Fat (and Protein) Affects Blood glucose

I won’t nerd out and go all biochemistry on you, but for simplicity, fat has no real impact on blood glucose levels in isolation. 

What it does do, however, is delay gastric emptying, aka slows digestion. This can occur over a period of HOURS.

Why this matters: You are likely NOT consuming fat in isolation (if you are, more power to you). Instead, in this scenario, you are consuming it concurrently with protein.

**We interrupt this section for a quick word on protein.**

When consumed with carbohydrate, protein can augment the way the carbohydrate affects your blood glucose, though minimally. Unless you consume an excess amount of protein, you likely won’t notice much of an effect at all. When protein is consumed in the ABSENCE of carbohydrate, however, it will break down the excess into glucose during a process called gluconeogenesis.

On average, each excess gram of protein will break down into roughly 0.6 grams of glucose.¹  

Now, imagine the meal above. If you are eating 50-plus grams of protein, that potentially has the effect of 30 grams of carbohydrates on your blood glucose.  

**Back to your regularly scheduled program.**

The effect of the glucose from the protein won’t be seen immediately. It may take an hour or two to even notice any increase in blood glucose. Now, add fat to the equation, which will slow the increase in blood glucose even more. Then a CGM graph will reveal a steady increase in blood glucose levels over a period of many hours.

Let’s set this scene up again:

• high fat, high protein, low carb meal
• if we assume 50 grams of protein, it could impact blood glucoses similarly to about 30 grams of carbs
• fat slows digestion, so the ~30 grams of carbs aren’t even seen in total until hours later
  

How Do We Solve This? 

There are two real options to consider, one of which is more sensible: 

1. Set an increased basal rate for two to eight hours after the meal
2. Set an extended bolus to cover the meal for two to eight hours…

 **Disclaimer: The two- to eight-hour range is NOT a range set in stone – you will need to experiment with what works for you and what does not.**

While the first is simpler, it is not optimal because:

1. Basal rates fluctuate through the day and night, so the amount of insulin to be increased is not consistent
2. There is a max rate of basal one can receive per hour, and your needs for the meal may exceed this rate.
   

Thus, let’s talk extended boluses!

What is an extended bolus?

The t:slim X2 Insulin Pump’s extended bolus feature allows the user to take an amount or dose of bolus insulin over a longer duration of time. Novolog peak quickly (between 30 min to 3 hours) last approximately two to five hours, their effects on lowering blood glucose may be out of the body too early to help avoid this delayed increase in blood glucose. Additionally, their peak may be too soon and lead to hypoglycemia...BEFORE the effect of the high fat meal kick in!

However, with an extended bolus, pump users can take some insulin up front and then have the rest administered at a consistent rate over whatever time period they choose. For example, one could take 20% up front and then 80% over four hours.

Ideally, this strategy can be used to combat the delayed blood glucose increase by allowing users to have a higher amount of insulin active when their blood glucose starts to rise, and ideally blunts that possible spike or prevents it from even happening.

Read more about the Extended Bolus Feature: [Hyperlink https://www.tandemdiabetes.com/blog/post/general/2016/11/23/extend-your-holiday-meal-coverage-with-the-extended-bolus-feature]

What Percentages Do I Need to Use? 

This, my friends, is the beauty of diabetes: There is no “one size fits all.” There is no right answer. What works for me may not work for you and vice versa.

There are, however, some tips for success you may want to consider:

1. Track, log, or journal about how each attempt goes! It takes work, but it may help you get closer to the ideal up-front percentages, extended percentages, and ideal time frames that work for you.
2. Alter ONE variable at a time! If you change more than one variable at once, such as time frame and percentages, and it works, you won’t be sure which variable caused the success. Changing one variable at a time takes longer, but it can help you better identify what works and doesn’t work for you.
3. If something doesn’t work as expected once, don’t give up. We all know about diabetes, what works one day may not work the next – despite everything being same – so try not to get discouraged. Think of it as a learning experience.
   1. Note: If your strategy repeatedly doesn’t get you the results you need, then it may be time to try something else.

Bonus Question: What if I Ate Carbs with a High Fat Meal? Does that Change Anything?

Answer: Yes and no. The carbs will raise your blood glucose as anticipated, but the fat may prevent your blood glucose from dropping as easily.

Why? The delay in gastric emptying is almost like a consistent flow of glucose being released in the blood over many hours. OR, you could choose to see it as the fat making one more insulin resistant.

Either way, the end result is the same: elevated blood glucose levels for many hours, requiring more insulin than usual to bring it down.

Author Bio: Ben Tzeel has lived with type 1 diabetes since 1999. He has a master’s degree in nutrition from the University of North Carolina at Chapel Hill and is a registered dietitian. He is a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association, is a published fitness model, and writes about exercise and nutrition. 

Ben Tzeel was compensated by Tandem Diabetes Care for his contribution on this topic. However, he created the content and it is based on his personal knowledge, experiences, and observations.

¹Oexmann MJ. T.A.G.: A Diabetic Food System. New York, NY: William Morrow & Co.; 1989.

f you’ve never used the extended bolus feature before, talk to your healthcare provider about strategies for using it to make this holiday season a little easier to manage. This information is a summary only, if you’d like to learn more please reference your pump’s User Guide for further information.

From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

IMPORTANT SAFETY INFORMATION

By Kerri Sparling

When I received the email from Tandem Diabetes Care that my Basal-IQ feature training was available, I was in the car with my husband and our two kids, headed up to Acadia National Park in Maine for a week.

“The update for Basal-IQ just landed in my inbox! I have to watch the training videos!” I said to my husband. We were about 45 minutes into a seven-hour drive with our kids in the backseat.

“Awesome!” 

Only I was still in the car and had to wait seven hours before I could watch the videos. (Knowing that the Basal-IQ update was just a training module and email launch code away from being siphoned into my insulin pump made the drive feel even longer.)

The first time I updated my Tandem t:slim X2 Insulin Pump from home, it was to integrate with the Dexcom G5 Mobile CGM System. The update was simple: I received an email code, plugged in my pump, and downloaded the software update. It was awesome having my G5 data streaming to my t:slim X2 Pump…then Dexcom came out with the G6 CGM System.

But you know what? My pump wasn’t outdated. 

Instead, it was updated. 

The process for updating this time was a little bit different. Several days earlier, I received an email from Tandem telling me that the update was available and that my doctor needed to provide a prescription for the update. I signed into the t:connect® Patient Portal to start the process for my endo to sign off on the request. In my case, this took a few days, but once the ball was rolling, things progressed smoothly. Once the prescription request was completed, I received an email with a link to training videos for the Basal-IQ update. (That’s the one that came while we were driving.)

Now? All I needed to do was find some space to update my pump in peace. My kids like to hang out and be close (read: on top of me), so finding some uninterrupted time to watch the training videos for Basal-IQ was a challenge. Once we arrived at our lodging for the week, I realized there were bunk beds in the apartment. Which is why I spent some time hiding on the top bunk of the bunk beds, where no one could physically reach me, watching the online training videos. 

The videos were very clear and concise, and once they were completed, I had a good sense of what the Basal-IQ Technology was going to look and feel like on my t:slim X2 Insulin Pump. The quizzes I had to take at the close of each module helped reinforce what I had learned. Hitting “Exit” on those videos triggered the email from Tandem to arrive, providing the details on how to update my pump and also the necessary Update ID Number. 

From the top bunk, I disconnected my insulin pump from my body and plugged it into my computer which was connected to the internet. After entering the Update ID Number into my pump and clicking through a few confirmations, my pump started to download the software update. 

“Hey mom! Are you almost done fixing your pump?” my daughter yelled from the other room.

“Almost! Just a few minutes!”

“Okay.” A brief pause. “Will you be able to see your Dexcom on your pump again?”

I stopped for a second, trying to find a way to explain how my CGM works, how Basal IQ works, how diabetes still requires work, and how my pancreas doesn’t exactly work to my 8-year-old daughter.

“Yes…that’s the idea. And when the Dexcom is talking to my pump, my pump will be able to use that information and hit pause on my insulin if it sees that my blood sugar starts to run low, too.” 

Her little face appeared around the door, peering up at her mother, perched in the top bunk with a bunch of technology glowing around her. “For real?”

“Yeah, for real.”

“That’s cool.” Another pause, followed by a confused query, “Are you going to sleep in the top bunk tonight, mom?”

“No, I’m not sleeping up here. Just hiding for a few more minutes.”

It took about 10 minutes for my pump to complete the update, and after I loaded up a new cartridge and infusion set, I was good to go. (Because software updates are awesome and useful but I can’t let the hardware go unchecked – I have to make sure my CGM is communicating properly and that the bits and pieces of my pump and infusion set are working right.)  I lean heavily on temporary basal rates to help take the edge off dropping blood sugars, so I was excited to see Basal-IQ Technology make that move for me. 

And it only took a few hours to test my IQ (so to speak). 

Later that afternoon, after updating to the Basal-IQ Technology, I was on a hike around Jordan Pond in Acadia National Park with my family. The hike is a few miles long, and I didn’t notice until about 45 minutes into it that my pump had already shut off twice, without my assistance, helping me keep by BGs in check. My blood sugar remained solid and stable, with the Basal-IQ Technology and exercise working in tandem with one another.

Of course, I am still responsible for keeping tabs on my blood sugars and maintaining control of diabetes. Technology is moving forward quickly but still haven’t freed up all the space in my brain that’s dedicated to diabetes. But with technology like Basal-IQ in my management toolbox, I feel like the mental burden of diabetes is a little bit lighter…which makes it easier to drag around ponds and up mountains and on hikes. 

From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

Important Safety Information

We’re excited to announce FDA approval of the t:slim X2™ Insulin Pump with Basal-IQ Technology, a predictive low glucose suspend feature designed to help reduce the frequency and duration of low blood glucose events (hypoglycemia) using best-in-class glucose sensor data. We’re here to answer some frequently asked questions about our announcement. Please note these answers are intended for our customers in the United States.

How Does Basal IQ Technology Work?
Integrated with the Dexcom® G6 Continuous Glucose Monitoring (CGM) System, the Basal-IQ feature helps reduce the frequency and duration of low-glucose events by predicting glucose levels 30 minutes ahead and suspending insulin if they are expected to drop below 80 mg/dL. Insulin delivery resumes once glucose begins to rise. We have a few more details for you here: www.tandemdiabetes.com/products/t-slim-x2-insulin-pump.

What’s so great about Basal-IQ Technology?
A pivotal study showed the use of Basal-IQ Technology on the t:slim X2 Insulin Pump demonstrated a 31% relative reduction in time spent below 70 mg/dL when compared with a CGM-enabled pump without Basal-IQ Technology. Importantly, this marked reduction of time spent in low glucose was accomplished without any increase in the rate of hyperglycemia. Participants in the study overwhelmingly described the system as simple to learn and use.¹ It is also approved for use by children as young as 6 years old.

"Being a person with diabetes complicates all aspects of my life. The t:slim X2 with Basal-IQ eased some of these burdens. During my time in the Basal-IQ PROLOG study, the feature shined overnight when I could see it suspended and protected me from lows." - Elena E., Clinical Study Subject


Pinsker, et al. Exceptional Usability of Tandem t:slim X2 Insulin Pump with Basal-IQ Predictive Low Glucose Suspend (PLGS): The PROLOG Study. Poster presented at: American Diabetes Association 78th Scientific Sessions. June 22-26, 2018. Orlando, FL.

"My 13-year-old son manages his care quite well, but his schedule with gym class after lunch often causes his BG to drop. When this happens, his class time is interrupted. With Basal-IQ during the PROLOG study, Russell spent more time in class and less time taking care of his medical needs." - Kathleen B., Mother of Clinical Study Subject

When will Basal IQ Technology be available?
On August 16, we announced we began sending emails with update instructions to in-warranty t:slim X2 Pump users in the United States, who now have the option to add Basal-IQ Technology free of charge via remote software update. Emails contain the link to the new patient portal and instructions about the process, and will be sent in batches. We anticipate that all emails will go out by the end of August. If you customers can't wait for an email, they can learn more about the process and how to get started here. (Just know that all will still get the email later, even if they start the process sooner.) https://www.tandemdiabetes.com/products/x2-update

Will Basal IQ Technology work with the Dexcom® G5 Mobile CGM System?
The t:slim X2 Pump with Basal-IQ Technology is only compatible with the latest Dexcom G6 CGM, allowing the system to predict and help prevent lows with zero fingersticks.*

What does iCGM mean?
Essentially, it’s a faster pathway to deliver new CGM technology. iCGM classification designates approval for integration with other medical devices, such as insulin pumps, based on a series of special control requirements. Dexcom G6 was the first CGM device to receive iCGM classification from the FDA earlier this year, and Tandem is the first company with a pump approved with iCGM compatibility. The classification of the Dexcom G6 CGM sensor, combined with our Tandem Device Updater, allows us to offer our Basal-IQ Technology with Dexcom G6 CGM integration without a new submission to the FDA. We are excited about the potential for an exciting new wave of future innovation for the diabetes community.

Oh no, I just ordered Dexcom G5 Mobile CGM Sensors!
We realize some customers will be affected by the timing of their CGM sensor orders, and we are exploring options for customers who will have Dexcom G5 Mobile CGM supplies when the software update rolls out. We’d like to note that eligible t:slim X2 Insulin Pump users will be able to take advantage of the Basal-IQ Technology software update, free of charge for some time. The no-cost eligibility is determined by our release date in 2018 – not your download date – so it’s possible to align your update with your next sensor order.

I have Medicare, can I use Basal-IQ Technology?
The t:slim X2 Pump is covered by Medicare, but the Dexcom G6 CGM system is not. The t:slm X2 Insulin Pump can be used with or without the Basal-IQ feature or CGM. Because Basal-IQ Technology relies on Dexcom G6 CGM data, anyone who uses Medicare benefits for CGM supplies should not use the feature unless Medicare changes its reimbursement policies. We will be working with Dexcom and the Centers for Medicare and Medicaid Services (CMS) on this challenge, but we don’t know if/when this will happen.

I have a regular t:slim® Insulin Pump or t:slim G4™ Insulin Pump, how can I get Basal-IQ Technology?
We offered an upgrade program for t:slim and t:slim G4 Insulin Pump users to access the updatable t:slim X2 Insulin Pump from October 2016–December 2017. Currently, we have no plans to have another upgrade program. If anything changes in your insurance coverage during your warranty period, please let us know. Our insurance verification team can look into your options. They can be reached at (877) 801-6901, Monday-Friday between 6 AM and 5 PM PT.

What about Canadians? We’re waiting for a new option up here!
It is too early for us to speculate about plans or timing for availability of the t:slim X2 Insulin Pump with Basal-IQ Technology outside the United States. In February, we announced our submission of a medical device license application to Health Canada to market the t:slim X2 Insulin Pump with Dexcom G5 Mobile CGM integration. We plan to launch that pump in Canada in the second half of 2018, subject to regulatory approvals.

For additional product and safety information for our customers in the United States, or to begin the order process, visit www.tandemdiabetes.com/tslimX2
or call (877) 801-6901, Monday-Friday between 6 AM and 5 PM PT.

Chloe was an ice skater before she began living with diabetes. And even though all she could do was cry after she was diagnosed, now she says that not much has changed in her life since then.

“Now, my advice to others with diabetes is, don’t let diabetes get the best of you, because nothing has really changed,” Chloe said. “You are still free to do what you want to do and follow your dreams.”

Chloe skates almost every day during the school year, for two to three hours per day. She also travels out of her home state of Colorado for competitions twice a year.

“Diabetes has taught me that I need to always try my hardest in skating, and that I can push through everything that goes wrong with my diabetes when I’m on the ice, and skating has taught me that I don’t need to be ashamed of my diabetes.”

She shared that the biggest challenge she faces as someone with diabetes is that it makes her feel different from everyone else at school and at the rink.

“It can sometimes make me feel like I am all alone in this, even when I know that I’m not,” said. Chloe. “I have coaches and teammates, and their role in my life with diabetes is to support me, lift my spirits, and make sure I am safe when I am on the ice. I share with them everything about diabetes that I can, and when my teammates are in a hotel room with me for our travels, I am able to show them what it’s like to poke my fingers and change my infusion sets so they know more about what it’s like for me.”

These teaching moments may have contributed to her desire to be a pediatric endocrinologist.

“I hope one day to help other people with diabetes,” Chloe says.

In the meantime, she will continue to learn through her own experiences. She’s adapted to life as an athlete with diabetes by listening to her body and putting technology to use.

“I feel and decide if I need to treat a low or if I need to give a correction for a high blood sugar. I carry my CGM on the ice too, and every once in a while, I check it to see if I’m trending down and need to change my basal rate. My blood sugar varies quite a bit between practices and competition because of adrenaline. Usually, I go quite high during practice, but then tend to drop low afterward. Sometimes, though, it is the opposite, and I have to aggressively treat a low in order to continue practicing.”

Chloe shared that for her preferred treatment plan she prepares for treating low blood sugar in the rink by making sure she has Smarties and peanut butter crackers in her skate bag, "So I can quickly get off, treat, and get right back on the ice,” she said.

Chloe hasn’t always used an insulin pump. Like most, she started using multiple daily injections when she was first diagnosed, but had the opportunity to use a Tandem pump when after participating in a market research study.

“I loved it as soon as I saw it and used the features,” she said. “I also liked that I wouldn’t have to use long-acting insulin, and I could bolus more without having to poke more needles into me. Only one every three days! I got my t:slim Pump just five months after my diagnosis.”

It is not uncommon for active people to ask questions or worry their pump will get in the way of their activities, or that they might hurt their pump while doing the things they love to do. There isn’t much extra space in a skating costume…

“I wear it in a belly band designed for carrying insulin pumps,” Chloe said. “It keeps the pump safe and cushioned and allows me to tuck in some tubing so that it doesn’t get caught on anything. I also can program my pump right through the window without even having to pull it out of the band!”

Chloe’s diabetes packing strategy includes:

• one pump site change for every travel day
• one extra full vial of insulin
• one extra CGM sensor
• syringes
• plenty of snacks for treating lows

Be sure check out Tandem’s list of essentials that might be easy to forget if you have limited time to pack.

Chloe also makes sure to contact TSA Cares before traveling to make sure she can get through airport security quickly.

Planning to travel by air with your insulin pump? Click here to download our air-travel note to carry with you and share with the TSA or airport representative. We hope this will help make the path through security smoother for Tandem pumpers.

From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

Important Safety Information

We’re thrilled to announce the t:slim X2 Insulin Pump with Basal-IQ Technology has been granted FDA approval. This latest release from Tandem Diabetes Care helps pump users take charge of diabetes management by predicting and helping prevent lows.

Benefits of the system include:

• The ability to predict low glucose levels 30 minutes ahead of time and suspend insulin delivery to help reduce the frequency and duration of low-glucose events. A pivotal study of Basal-IQ Technology showed a 31% relative reduction in time spent below 70 mg/dL when compared with a CGM-enabled pump without Basal-IQ Technology.¹
• Integration with the new Dexcom G6 Continuous Glucose Monitoring system, which delivers continuous glucose readings to the t:slim X2 Insulin Pump to aid users in making in treatment decisions without fingersticks for mealtime dosing or calibrations*.
• FDA approval for automated insulin delivery for pump users as young as 6 years old.
• A simple-to-learn interface that operates without constant user input or the use of complicated modes. In a clinical study, 91% of participants found Basal-IQ Technology easy to use.²

If you have an in-warranty t:slim X2 Insulin Pump, you will be able to access the remote software update with Basal-IQ Technology free of charge when it is available. This update will require a prescription and online training which will be managed through a simple to use online portal. You will receive an email when the portal is available. No action is required at this time. Click here to learn more about the process.

Time for a new pump?
If you don't currently use a t:slim X2 Insulin Pump and would like to start the process, visit www.tandemdiabetes.com/getstarted or call us at (877) 801-6901. 

*If glucose alerts and CGM readings do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions.

^1. Forlenza GP, Li Z, Buckingham BA, Pinsker JE, et al. Predictive low glucose suspend reduces hypoglycemia in adults, adolescents, and children with type 1 diabetes in an at-home randomized crossover study: Results of the PROLOG trial. Diabetes Care. 2018 [In Press].

^2. Pinsker, et al. Exceptional Usability of Tandem t:slim X2 Insulin Pump with Basal-IQ Predictive Low Glucose Suspend (PLGS): The PROLOG Study. Poster presented at: American Diabetes Association 78th Scientific Sessions; June 22-26, 2018; Orlando, FL.

From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

Important Safety Information

It's Summer and there are so many great opportunities for fun with people who understand diabetes! Using the T1D Camp Finder Tool, powered by Beyond Type 1 and the Diabetes Education & Camping Association (DECA), you’ll be able to find diabetes camps that are happening all across the globe.

Find out when camps are happening, what activities they offer, and the cost to attend. Just click on the location you’re interested in and the information is at your fingertips!



Beyond Type 1's diabetes camp webpage has more info and stories about camps for people with type 1 diabetes!

If you know about an event that isn't listed, you can contribute to the map by emailing the Beyond Type 1 Team at: hello@beyondtype1.org.

Your t:slim X2™ Insulin Pump was designed to give you quick and easy access to both basic and advanced functions you can use in your diabetes management.

After you complete a task with your pump, tap the Tandem logo to return to the Home Screen. This takes you straight back home, eliminating any additional taps before your desired next step. From the Home Screen, you have immediate access to your continuous glucose monitor (CGM) data (if you have a CGM sensor session going) and your insulin on board.  

Editor's note: This blog was written prior to FDA approval of the t:slim X2 Insulin Pump with Basal IQ™Tecnnology announced 6/21/2018. The Basal-IQ feature helps reduce the frequency and duration of low-glucose events by predicting glucose levels 30 minutes ahead and suspending insulin if they are expected to drop below 80 mg/dL. In-warranty t:slim X2 Pump users in the United States are now able to add this feature free of charge via remote software update.

By Diabetic Danica

When you’re connected to a medical device 24/7, you grow “attached” to it - not only physically attached, but emotionally too! I have been an insulin pump user for 11 years, and I have only ever used an Animas insulin pump. So when I heard that Animas was officially exiting the insulin pump market last year, I knew I would have to face a very big change. It is crazy to think that a device you have used every single day for more than a decade will soon be a thing of the past. However, I was happy that the warranty left on my current pump gave me some time to investigate my options before making a decision. When I choose my next insulin pump, I’m committing to it for up to four years, so it is very important to me that I make the best decision.

When Animas decided to exit the insulin pump market, they chose Medtronic to support current Animas customers through the end of our warranty. However, it is important to remember that we do have options. We do not have to simply switch to whatever pump company Animas has selected at the end of our warranty. There are different pumps that offer different features, and it is important to do our own research into what pump would be best for us. In the U.S., there are basically three insulin pump options out there.

Omnipod differs the most from my current pump, as it is a tubeless pump that stores the insulin in a patch-like pod that is controlled by a remote PDM (Personal Device Manager). I was able to get a demo pod to try out, and I came to the exact conclusion that I had expected: the pod was simply too large for my taste. I also worried that I might accidentally leave the PDM at home and not be able to bolus when I’m out and about. My pump is important to have with me at all times, so I don’t mind it being attached to me! Having tubing does not bother me.

This left me with options from two other companies, Medtronic and Tandem Diabetes Care. To me, the biggest difference between the two is their Continuous Glucose Monitor integration. I am a loyal Dexcom CGM user. I absolutely love my Dexcom CGM and personally feel it is the best CGM on the market. I’m hesitant to use anything else.

The Tandem t:slim X2 Insulin Pump is currently integrated with the Dexcom G5 CGM, which allows me to dose my insulin using CGM data alone without requiring a separate fingerstick. While Tandem pumps don’t automate insulin delivery today, I like that the potential is there because the t:slim X2 Pump is capable of remote software updates as they are approved by the FDA. There’s obviously no guarantee, since there are a lot of steps involved in getting something like automated insulin delivery approved, and Tandem has also been transparent that there may be a cost for some software updates, but it does make the 4-year commitment feel a little less scary. Additionally, I like the look of the t:slim X2 Pump. It’s significantly smaller than the Medtronic pumps, and I like the simplicity of the touchscreen. I want a device that does not overcomplicate my diabetes life. I love that you can see both the Dexcom trend graph and insulin on board right on the home screen. I also like the ability to enter numbers on the screen instead of scrolling. It sounds silly, but Animas requires scrolling and I waste a lot of time. The t:slim X2 Pump has a keypad and you just type on it.

Figuring out which pump to switch to can seem overwhelming. It is a lot to think about, but overall I am excited to embark on a new insulin pump journey. Who knows how much the insulin pump market will change as I wait for my Animas warranty to expire? I will miss my Animas, but I’m also excited to try something new! Technology is developing fast, and my goal right now is to stay informed of my options and make the right decision for me when the time comes.  
From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

Important Safety Information

Every day, Tandem insulin pump users are doing their part to reduce, reuse, and recycle. Having chosen the only rechargeable insulin pumps on the market, our customers have kept an estimated 2,327,595 disposable batteries out of landfills since the first t:slim Pump shipped in 2012.¹ Nice work!

Rechargeable batteries have a much smaller environmental footprint thanks to their reusability. Not only do they last longer over time, but also – thanks to trade-in programs for the high-tech devices that use these batteries – the heavy metals find their way into landfills less often than their disposable counterparts.

At Tandem we also have several ongoing recycling programs where we work with vendors who specialize in each particular waste material.

Instead of contributing to the problem, the good news is that we can all make a difference right now by replacing single-use batteries with the recyclable, rechargeable kind. By using rechargeable batteries, you not only save money, but also ensure that fewer batteries get into landfills. 

Additional reading:
In honor of Earth Day in 2016, we asked 1,456 of our customers how and when they preferred to recharge their pumps.

¹Estimation since Aug 31, 2012 as of April, 1 2018, assuming 20-day battery life of disposable batteries when used in other insulin pumps. Data on file.

We're growing our software team! Tandem engineers take an innovative, user-centric approach to the design and development of products for people with diabetes, and we are looking for people who are passionate about making the lives of people with diabetes better. Before you look further into careers at Tandem, we thought you'd like to hear from some members of our team. Manager of Software Engineering Dave Nguyen and Software Engineer Jason Guzon share their experiences in this department. 

Q: What are your favorite things about your job?

Dave: When I started working at Tandem in 2009, I wanted to work on something meaningful, while developing cutting-edge technologies and learning from smart people. Working at Tandem has fulfilled all of those goals and allowed me to grow as a person and an engineer. Being able to innovate and change the landscape of insulin pump therapy fulfills my creative needs. I also really enjoy getting customer feedback and hearing about how Tandem’s products incorporate into their daily lives.

Jason: I love writing software, and at Tandem I get to write code that helps make people’s lives easier.


Jason Guzon, Software Engineer

Q: What are some of the challenges of your position that you enjoy most?

Dave: Being at Tandem allows me to work on hard problems with a small and dynamic team. Everyone has more responsibility, but also more freedom.

Jason: Designing new features, learning new technologies, and exploring software behavior are some of the challenges that push me to learn and grow as a programmer. Tandem has also provided the opportunities for me to improve myself in many other areas including writing, interviewing, and product management.

Q: How does Tandem’s focus on the customer impact your job?

Dave: Because we focus on the customer here at Tandem, it allows the R&D department to really develop the best products possible. We don’t cut corners and we always listen to what the customers have to say to improve their experience the best we can.

Q: What sets Tandem apart from other companies?

Dave: Tandem’s culture is incomparable. The work/life balance is amazing, and my work attire consists of shorts and t-shirts. Not much has changed culturally, since I started at Tandem back in 2009 during its startup days. Working on software in the R&D department at Tandem allows you to learn a lot of really cool things. Since we are using the latest technologies to try and solve problems in different ways, everyone here is constantly learning and growing. 

Jason: When I interviewed at Tandem, I was fresh out of college, but when I stepped into the building, I knew that I needed to work here. From my research, I knew that Tandem created top-of-the-line, high-quality products, and from the remote-control helicopters, mini foosball table, and random objects hanging from the ceiling, I could tell that these engineers knew how to have fun. The the t:slim® Insulin Pump broke ground in innovation with its touchscreen, easy-to-use interface, rechargeable battery, small size, and sleek design. Our second-generation pump, the t:slim X2™ Insulin Pump with Dexcom G5 Mobile continuous glucose monitoring (CGM) integration and capability to get software updates remotely, provides a pipeline of opportunities for engineers to learn and to shine.

If you thrive in a casual environment that inspires collaboration and innovation apply today!

Find out about careers at Tandem here. 

The AutoSoft™ XC infusion set is the t:lock™ equivalent to the Inset™ infusion set formerly distributed by Animas.

As a reminder, the new t:lock design reduces the time required to fill infusion sets by 30 seconds and lowers the amount of insulin used in the fill process by 4.4 units. The design itself looks, feels and functions in a very similar way to the traditional Luer-lock connector.

We are very excited to offer another option for patients when it comes to infusion sets.

CLICK HERE to see a complete list of Tandem’s infusion set products.

The t:connect® Diabetes Management Application is our fast, easy way to access and save data from pumps, supported glucose meters¹, and Continuous Glucose Monitors.

We are pleased to announce an enhancement to our Therapy Timeline report. The Therapy Timeline will now include Dexcom® CGM readings when a CGM enabled Tandem pump is uploaded to t:connect. Best of all, no additional action is required, CGM data will automatically appear in t:connect when the pump data is uploaded.



Patients who regularly log in to review data spend more time in range,² and sharing reports before appointments with healthcare providers can help to make the most of time spent with a physician. To encourage this habit, we send monthly reminders to our customers about the benefits of uploading.

With the new t:connect HCP Portal, clinicians can now upload, view, and print this data from one user-friendly webpage.

Don’t have a t:connect account?
Healthcare providers interested in the HCP Portal should reach out to their local Tandem representative or give us a call at (877) 801-6901. Or visit our website for more information.

New Tandem pump users should follow the steps in our Get Started Guide. 

¹ The t:connect Application is compatible with the following meters: OneTouch® Verio® IQ, OneTouch UltraMini®, OneTouch Ultra® 2, FreeStyle® Lite®, FreeStyle Freedom Lite®, ACCU-CHEK® Aviva, ACCU-CHEK Compact Plus.
² Data on file. Tandem Diabetes Care, Inc. 

The blankets are soft and warm. You’ve just flipped your pillow to the cool side. It’s time to sleep. Or relax. Or to snuggle. Until… 

BEEP BEEP BEEEEEEEEP!! 

Nothing ruins the mood for sleep (or otherwise) quite like a loud pump alert. If you’re dealing with some ill-timed alerts, you have options. Thankfully, there are plenty of ways to reduce the inconvenience while making the most of your Tandem pump’s features.

Let’s take a look at some common alarms and alerts.

The Alarm: Auto-Off Alarm (aka Alarm 7).
Why it’s important – The reason for this alarm is sound: it’s a safety precaution to prevent insulin delivery in case someone is unable to interact with the pump due to a severe low blood sugar.

When it can be inconvenient – Ever eat an early dinner and then sleep in the next day? Your auto-off alarm might go off in the morning, depending on when you last looked at your pump screen and how long you slept.

What you can do – The default is pre-set for 12 hours, but you can customize this setting and adjust the alarm to go off anywhere between 5 – 24 hours, or the alarm can be turned off completely. But if you decide to turn this alarm off, make sure you check with your healthcare provider. Safety first.

See Auto-Off Alarm in your User Guide. 

The Alert: Site Reminder
Why it’s important – Time flies, and it’s easy to forget to change your site within 72 hours. But, leaving the infusion set in for over 3 days can lead to decreased insulin absorption and could cause high blood sugar. That’s why we designed this reminder to help you get the most out of Tandem pump therapy. At the end of the infusion set change process, after your fill the cannula, your pump will ask if you want to set a Site Reminder. You can customize this alert to go off any time 1 – 3 days after the site change.

When it can be inconvenient – If your site change is at 9:00 a.m. and your alert is programmed to remind you three days later...during your big presentation.

What you can do – Go on…customize it. Make sure you take note of when you’re changing your site, and be sure to program what time you want the reminder to pop up. Make it your own and take back the beep!

See Setting Site Reminder in your User Guide. 

The Alert: Incomplete Bolus Alert
Why it’s important – Distractions happen. Life doesn’t stop while you’re trying to pay attention to your diabetes. This alert occurs when you navigate to the bolus menu and then put the pump away without executing a bolus. Ninety seconds later, you’ll receive an Incomplete Bolus Alert. We designed this feature for those times when you’re interrupted mid-bolus and never have a chance to complete it.

When it can be inconvenient – If you legitimately decide you don’t want to bolus but forget to cancel it out... at the movies.

What you can do – If you decided not to deliver a bolus, make sure you tap the T button to return to the home screen before putting your pump away.  It’s that simple.

See Incomplete Bolus Alert in your User Guide. 

The Alert: Incomplete Temp Rate Alert
Why it’s important – If you set up your temp basal rate before you headed out to the gym, or to help mitigate some downward facing Dexcom CGM arrows, you want to know if it didn’t get done. We designed this alarm as a friendly reminder for those times. This alarm occurs when you remain on the temp rate page for 90 seconds without completing the process.

When it can be inconvenient – When you decide against setting a temp basal and forget to clear the screen? Yeah, then.

What you can do – Tap the T button to return to the home screen before putting your pump back in your pocket. Home screen again for the win!

See Incomplete Temp Rate Alert in your User Guide. 

And finally…

CGM Reminders.

Why CGM Alerts are important.

CGM reminders are important because they alert you to blood sugars that are out of your customized range. These alarms give you a head’s up on the blood sugars that might be coming, building in response time to prevent a sticky high or a dangerous low. These alarms help you stay between the threshold lines, giving you a chance to keep your blood sugars in range and your diabetes more on the mental back burner.

See chapter 26 in in your User Guide for instructions on how to customize your CGM settings.

And remember, if you have any questions about the alarms and alerts you experience most, our tech support team is here for you 24/7. Please call 1-877-801-6901 anytime to ask them about your pump features.

From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

Important Safety Information

Full manufacturing operations have begun at our new facility in San Diego!

In support of our growing operations, the 50,000-square-foot space doubles our previous manufacturing capacity for both insulin pumps and cartridges and expands warehousing for additional infusion set supplies related to the launch of our new t:lock™ connector.


Our cartridges are produced using high-volume automation. They are produced in a clean room controlled environment with line capacity for producing 1 million cartridges per year.


This is a close up look at the automation, specifically the assembly of the  tubing and infusion set connector to the cartridge.


Cartridges are installed into our cartridge test system where each and every one is tested for quality.


In the pump assembly area, pumps are run through the equivalent of one month of customer use to ensure they are ready to go. 


Pumps sit ready to head to their new homes!

Alcohol affects everyone differently, so you should always monitor your blood glucose when drinking to learn how alcohol affects you. There are a few things to consider beyond just the carbohydrate content of your favorite drink. 

Safety first!
Alcohol can cause flushing of the skin, nausea, increased heart rate, and slurred speech in anyone. These symptoms may be confused with or mask the symptoms of low blood sugar, so it’s important to make those around you aware of your diabetes when you are drinking. Always wear a medical alert piece of jewelry that says you have diabetes.

Compromises Liver’s Response
While moderate amounts of alcoholic drinks may cause blood sugar to rise, excess alcohol can actually decrease your blood sugar level - sometimes causing it to drop into dangerous levels, especially for people with type 1 diabetes. This is because alcohol interferes with the liver’s efforts to release glucose. For example, if your blood sugar is trending low, in a normal situation your liver would kick in to help bring it up. However, after ingesting excess alcohol your liver might not have the ability to help increase your blood glucose.

Carbohydrate
Alcohol itself does not contain carbohydrate, but mixers can contain large amounts. Beer and sweet wine contain carbohydrate and may raise blood sugar. It’s smart to avoid alcohol with added sugar (sweet wines or liqueurs) and sweet mixers (regular soda, fruit juice, or margarita mix).

Other
Remember, there is no specific diet for diabetes, but an overall healthy eating pattern is important for everyone, and eating well is important to manage your blood glucose. Alcohol stimulates your appetite, which can cause you to overeat, and on top of that may affect your judgment or willpower, causing you to make poor food choices. With calories already in most alcoholic drinks, frequent drinking makes it more difficult for people who want keep their blood sugar under control and/or lose excess weight.

Craving for more? Check out the complete Carbohydrate Counting series:
Carb Counting #1: Food & Blood Glucose
Carb Counting #2: Nutrition Labels
Carb Counting #3: Other Influences
Carb Counting #4: Alcohol

The material provided is for educational and training purposes only, is general in nature, and is not intended to replace the medical advice of your doctor or healthcare provider. You are encouraged to seek advice from a competent medical professional regarding the applicability of any recommendation with regard to your symptoms or condition. It is important that you do not reduce, change or discontinue any treatment without first consulting your healthcare provider.

From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

IMPORTANT SAFETY INFORMATION

 

Diabetes is complicated, but managing data shouldn’t be.

Compatible with both Macs and PCs, and accessible by both patients and providers, the t:connect® Diabetes Management Application is a fast, easy way to access and save data from pumps, supported glucose meters¹, and Continuous Glucose Monitors. 

April 2018, we announced an enhancement to the Therapy Timeline! It will now include Dexcom® CGM readings when a CGM enabled Tandem pump is uploaded to t:connect.

Patients who regularly log in, and review data spend more time in range, ² and sharing reports before appointments with healthcare providers can help to make the most of time spent with a physician. 

But, don't take it from us! We asked Kerri Sparling, creator and author of Six Until Me, one of the first and most widely-read diabetes patient blogs, and mother of two. Even with all that Kerri has going on, Kerri finds time to upload her data.

Q1. How often do you upload/sync data to t:connect? 
I upload at least once a month, but am trying to do it every two weeks as part of my diabetes New Year resolutions. Since I use my Dexcom 24/7, I feel like I’m getting a good sense of my trends on a day to day basis, but there’s something very powerful about seeing 30 days of data, all color coded and presented in an organized way that keeps me from feeling overwhelmed and instead inspired by the data.  

Q2. What features on t:connect that you use the most? 
The dashboard is the feature I use most, because it gives me a global snapshot of where my management is, and helps me set quick goals on where I want to focus.  

Q3. How do you and your physician share and use the data to make treatment decisions?
I have shared the dashboard with him during our visits so we can start our appointment knowing where my management style stands.

Q4: What else do you like about t:connect?
Honestly, I like that plugging my t:slim X2 into my computer to download the data also charges my pump. Managing my data is a decision I benefit from twice…and that’s a rare thing. 

As Kerri mentioned, with the new HCP Portal, clinicians can now upload, view, and print your data from one user-friendly webpage.

Note: Don’t forget to protect your t:connect password. Treat it like your other important passwords!

If it's been a while since you uploaded, here are simple steps to upload your data today: 

1. Plug in your pump or BG meter to your computer. 
2. Open the t:connect Uploader and click Start Upload. Upload times will vary depending on the number of records since your last upload. 
3. The “Upload Successful” message is displayed after the data has successfully been transmitted. 
4. Click View Reports or Save Reports to be taken directly to the t:connect Application.

Don’t have a t:connect account?
New Tandem pump users should follow the steps in our Get Started Guide. 

Healthcare providers interested in the HCP Portal should reach out to their local Tandem representative or give us a call at (877) 801-6901. Or visit our website for more information.

¹ The t:connect Application is compatible with the following meters: OneTouch® Verio® IQ, OneTouch UltraMini®, OneTouch Ultra® 2, FreeStyle® Lite®, FreeStyle Freedom Lite®, ACCU-CHEK® Aviva, ACCU-CHEK Compact Plus.
² Data on file. Tandem Diabetes Care, Inc. 

From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

IMPORTANT SAFETY INFORMATION

The Balance of Protein, Fat, and Carbohydrate
The balance of protein, fat, and carbohydrates in a meal has an effect on post-meal blood glucose.

• Protein - If eaten in large amounts (more than 15-20% of calories), may cause an increase in post-meal glucose.
• Soluble fiber - Slows digestion. Glucose released from carbohydrates will reach your bloodstream slower and may delay glucose response.
• Fat - Does not convert to glucose, but may slow digestion of carbohydrates and the release of glucose if eaten in large amounts.

Glycemic Index System
The differences between carbohydrate foods can be described in relation to their glycemic index. Simply put, this index, which goes from 100 to 0, indicates how quickly a food raises blood sugar levels. Glucose is rated at 100, and the closer to 100 a food is rated, the more it affects blood sugar levels.

Those foods with a low glycemic index (55 or less), which includes most vegetables, don’t raise blood glucose in the way those with a high index (70 or higher) do—foods such as white bread, potatoes, and pasta.

The system ranks carb-containing foods according to their effect on blood glucose and maintains that equal amounts of different carbohydrates can have different effects.

Glycemic Load
The Glycemic Index System ranks foods based on how quickly they're digested and get into the bloodstream. Glycemic Load takes the Glycemic Index System one step further when it considers both the glycemic index of a food and the amount of carbohydrate in the portion of food eaten. The glycemic load is calculated by multiplying the glycemic index value by the number of grams of carbohydrate, then dividing by 100. Using cooked carrots as an example, 1 cup of cooked carrots provides about 10 grams of carbohydrate, and the glycemic index of cooked carrots is 49. That makes the glycemic load of a cup of cooked carrots about 5, since 49 x 10/100 = 4.9.

In general, a serving of food with a value of 1—10 is considered to have a low glycemic load, 11—19 a medium glycemic load, and 20 or higher a high glycemic load. The table “Same Carbohydrate, Different Glycemic Load” shows the glycemic load for a variety of portions of foods.

Usually, you don’t just eat one food by itself — you eat a whole bunch of foods together. The glycemic load of a portion of a single food or of a meal (with a mix of foods) may be a better predictor of after-meal blood glucose level than the carbohydrate content of the food portion or meal. You can add a particular nutrient to a meal and affect the Glycemic effect overall. As a general guideline, the more fiber a meal has the better. The same foods can have a high glycemic index, but an overall low glycemic load, making it better for you than it originally might have appeared using only the Glycemic Index System.

For example, adding peanut butter to a smoothie can help delay the absorption of the high Glycemic Index fruit and juice components.

According to the American Diabetes Association (ADA), the use of Glycemic Index  and Glycemic Load may provide a modest additional benefit over that observed when total carbohydrate is considered alone.

One of the most notable differences between insulin pump therapy and multiple daily injections is the ability to deliver an insulin bolus over an extended period of time. By using an extended bolus, you can choose to only take a certain percentage of your insulin up front (high GI portion of your meal) and have the rest delivered over an extended period of time (for food with protein, fat, and fiber). This allows you to better match your insulin dose to your food intake and provide a great deal of flexibility and control when eating.

Learn more: Extend Your Meal Coverage with the Extended Bolus Feature

If you don’t already have a Tandem pump, we have a free demo app that will let you try out our pump interface on your Apple or Android mobile device. You can experiment with pump settings, personal profiles, and practice using the Extended Bolus Feature. You can download the app from here. 

Craving for more? Check out the complete Carbohydrate Counting series:
Carb Counting #1: Food & Blood Glucose
Carb Counting #2: Nutrition Labels
Carb Counting #3: Other Influences
Carb Counting #4: Alcohol

The material provided is for educational and training purposes only, is general in nature, and is not intended to replace the medical advice of your doctor or healthcare provider. You are encouraged to seek advice from a competent medical professional regarding the applicability of any recommendation with regard to your symptoms or condition. It is important that you do not reduce, change or discontinue any treatment without first consulting your healthcare provider.

From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

IMPORTANT SAFETY INFORMATION

Nutrition Facts labels for packaged foods are regulated by the Food and Drug Administration (FDA) to reflect new scientific information, including the link between diet and chronic diseases such as obesity and heart disease. Labels are designed to make it easy for consumers to make better informed food choices. They are the most reliable and easy-to-use resource for estimating the carbohydrate in foods.

For counting carbohydrates, the two most important and useful items on the label are:

• Serving Size
• Total Carbohydrate

“Total Carbohydrate” should be the main focus – NOT just the Sugars. Total Carbohydrate reflects all sugars, including sugar, starch, fiber, and sugar alcohol.

The “Sugar” listed under Total Carbohydrate is very misleading; all carbohydrate (sugar and starch) is included as part of “Total Carbohydrate.”

Be careful, it’s easy to confuse the weight in grams of the food item with grams of Total Carbohydrate.

A Word About “Net carbs,” “Impact Carbs” and “Active Carbs”
These terms are NOT regulated by the FDA. They have often been created by food manufacturers to appeal to the low-carb diet market. In these cases, manufacturers have subtracted all fiber and sugar alcohol from the Total Carbohydrate to make it more appealing to the consumer.

It is recommended to use “Total Carbohydrate” unless otherwise recommended by your healthcare provider.

Fiber - Includes all soluble and insoluble fiber. According to the Academy of Nutrition and Dietetics:

• If food (i.e. 1 cup of broccoli) has 5 or more grams of fiber per serving, subtract half of the grams of fiber from the Total Carbohydrate when you are calculating total carbohydrates for insulin dosing.

  Sugar - Includes all naturally occurring and/or added sugars and is included in the Total Carbohydrate value

• Do not discount a food because it is high in sugar. Some healthy foods, such as fruit and milk, have naturally occurring sugars.

  Sugar alcohol - Reduced calorie sweeteners such as mannitol, sorbitol, and xylitol. According to the American Diabetes Association (ADA):

• If a food has 5 or more grams of sugar alcohol per serving, subtract half of the amount of sugar alcohol from the Total Carbohydrate when you are calculating total carbohydrates for insulin dosing.

15-Gram Carbohydrate Choices
The 15-Gram Carbohydrate Reference Guide serves as an easy-to-remember resource, because each food item represents a 15-gram carbohydrate choice. 15 grams is not a suggested portion, but a resource for estimating carbohydrate using easy math.

Please refer to the “ADA Exchange list for Diabetes” for a complete list: https://www.uaex.edu/publications/pdf/FSHED-86.pdf

The t:slim X2 insulin Pump uses the settings in your active Personal Profile (your individualized settings for basal rate, correction factor, carbohydrate ratio, and target BG) to calculate the recommended delivery for food boluses and correction boluses based on your target BG. When a total carbohydrate is entered during bolus programming, your Tandem Pump will calculate a recommended bolus.

Carbohydrate counting and insulin pump therapy together match insulin more precisely with carbohydrate ingested than multiple daily injections. It allows more flexibility with food choices and meal timing.

If you don’t already have a Tandem pump, we have a free demo app that will let you try out our pump interface on your Apple or Android mobile device. You can experiment with pump settings, personal profiles, and some practice blousing. You can download the app from here.

Craving for more? Check out the complete Carbohydrate Counting series:
Carb Counting #1: Food & Blood Glucose
Carb Counting #2: Nutrition Labels
Carb Counting #3: Other Influences
Carb Counting #4: Alcohol

The material provided is for educational and training purposes only, is general in nature, and is not intended to replace the medical advice of your doctor or healthcare provider. You are encouraged to seek advice from a competent medical professional regarding the applicability of any recommendation with regard to your symptoms or condition. It is important that you do not reduce, change or discontinue any treatment without first consulting your healthcare provider.

From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

IMPORTANT SAFETY INFORMATION

This past August, a group set out to complete the North Coast Trail – a trek around the northern tip of Vancouver Island. A place only accessible by boat, home to the densest population of black bears and cougars on the continent, and known for its knee deep mud, vertical climbs, and ankle tweaking cobblestone beaches. Each of the trekkers lives with type 1 diabetes. We talked with Tandem pumper Geneva Boliek-Poling about her experience.

Q. What was the catalyst that pushed you to apply for Connected in Motion's Adventure Team?
I saw a post on their Instagram feed calling for applications. It sounded crazy and wonderful and beyond my reach, so I tucked it away in my mind as something to daydream about.

A few weeks later, my long-term relationship came to an end and I needed an outlet for all the emotions that come with a breakup. Diabetes had lodged itself so deeply in my identity and it was such a private aspect of my life that I never felt like it could be a part of my relationship. It sounds selfish, but I wanted to do something that was just mine. Diabetes became my ticket to this incredible adventure.



Q. Had you done any diabetes programs before this?
This was the first. Before the trip I knew only three people with diabetes. I was 17 when I was diagnosed and never had a diabetes camp experience.

My mom and dad have been my main support from day 1 and they are my go-to when I feel overwhelmed. They have a hard role because they’re my parents and they of course worry about me a lot, even more than I worry about myself. So when I decide to go out and do crazy adventures like the NCT, I know they’re thinking of the risk. But even so, they’re supportive and have helped me make my wildest dreams a reality regardless of diabetes.

But, I underfed the community aspect of my diabetes. Until now.

Q. How did you prepare for the trip physically and mentally?
I was worried that I would be discouraged by how difficult training would be, so I didn’t really train for backpacking specifically. I relied on being in shape from my habit of running every day.

Anytime I have a big event or trip coming up, I go into planning overdrive. I make lists and sub-lists and sub-sub-lists outlining everything I might need because I’m paranoid about forgetting something important like my insulin or underwear. For this trip I tried to think of all the possible scenarios and variables so my packing list for diabetes supplies was thorough.  I had more sensors than I should need and extra infusion sites, etc. I ended up needing them!

My pump site knocked loose on the trail while I was hauling myself up a slippery climb. Thankfully I had packed enough extra sites to do a quick change right here on the beach. After that, I had to rethink where on my body I would put my new site because the 65 liter pack strapped to me hit all the spots where I usually stick it.

If diabetes has taught me anything, it’s that you can’t predict the future. You can be as prepared as you like, but there will always be some unpredictable occurrence that you haven’t dreamed up in the planning stage. Adapting to the environment with the gear I had was an important lesson.

Q. How did you need to adjust your insulin needs for the days on the trail?
The days on the trail I ended up using 10% of my regular basal rate. After the second day, I set a Personal Profile just for the trail. We were burning through carbs like crazy, so if I had stayed on my normal basal rate I would have been hypoglycemic the whole time. It was surreal to need so little insulin for meals and snacks – for the week of the hike, I felt like I didn’t have diabetes! It was a difficult part of reentry in to my normal lifestyle after the hike when I had to switch back to my previous rate.

I switched to an insulin pump after four years of using multiple daily injections because I wanted the ability to have nuanced control over my insulin intake, and this was a good example where the pump features helped.

Q. What is the biggest challenge that diabetes brings to your life?
The biggest challenge for me is when I have to stop what I’m doing based on what my blood sugar is doing. The challenge is accepting that sometimes I must defer to my diabetes because the consequence to ignoring it is unacceptable. My diagnosis made me respect my own existence much more than I had beforehand.

Over the years, diabetes has become such a normalized part of my routine that it’s almost profound how little I think about it sometimes. It’s affected my daily life so much that it becomes my normal.

Diabetes wasn’t even the hardest part of the trail.

Q. What was the hardest part? 
I was in a lot of pain from a knee injury that got worse throughout the trip. On the very last day of our hike, I was in tears for the last few miles from the pain. I think some tears came from the sorrow/joy/satisfaction of completing the trail. When we reached the parking lot at the very end, I don’t think I had ever felt such a weird combination of relief and emptiness.

Out there I learned we had purpose. The accumulation of all the small things added up: The moments where you’re laughing uncontrollably with the person hiking behind you. Or watching the sunset and everyone is quiet. Or eating dinner all together while your socks dry by the fire. It was in those little moments that I was struck by the impact of what we were doing.

The trail taught me that diabetes isn’t a roadblock, but a stepping stone. I wouldn’t have hiked the NCT if I weren’t diabetic. Without diabetes, I wouldn’t have the same appetite for pushing limits.

Q. What’s different about life after the trip, than before?
I have WAY more mental endurance. “One step at a time” had a literal meaning on the hike, but it’s translated into difficult days with diabetes management in a mental sense.

Interview and photos by Blair Ryan.

From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

Important Safety Information

This year in July, Logan’s 10^th anniversary of this diagnosis with type 1 diabetes will happen during the annual Children with Diabetes Friends for Life Orlando Conference in Florida.

Logan has attended the conference since 2015 and has worked hard to give back ever since. In 2016, Logan’s fundraising supported a “Mickey Bar” afternoon where all the event participants are treated to chocolate covered ice cream bars shaped like Mickey Mouse. The last two years he delivered speeches about why it’s important to support Children with Diabetes, and how to win fundraising contests along the way. Logan and his family are often contacted about guidance on fundraising strategies and his contributions earned him the “Unexpected Hero” award which he accepted at the 2017 Friends For Life Banquet.

As a special challenge for this milestone year along his journey with diabetes, Logan chose to run at the annual Walt Disney World Marathon Weekend to support non-profits that have supported him in his journey with diabetes. Logan ran the 10K for Children with Diabetes and the 5K to fundraise for JDRF. He raised over $24,000 ($18000 for CWD and $6000 for JDRF) and was the youngest runner on both teams.

In these races he ran alongside many of his peers with diabetes, sharing their diabetes management strategies along the way.

Here is Logan lined up at the start of the 10K. 

Logan took a quick break for some carbohydrate during the 10K run with fellow runner with type 1 diabetes, Stella Hogan, as Vice President of Education and Programs at Children with Diabetes Laura Billetdeaux smiles from behind.

"During my 5K and 10K runs, my t:slim X2 Pump integrated with Dexcom made it easier for me to run more and stop less. It was so much better than last year when I had to take out my phone or stop and test." said Logan.

Logan received registration for the 2018 Friends For Life Orlando conference as a Christmas gift. Since December, he met a personal goal to fundraise for a giant party at the conference to celebrate his diaversary. There, he will bring together his friends with diabetes who live all around the country.

Logan with his JDRF teammates and fellow Tandem pumpers Emma Kleck and Lauren Dahlin after the 10k that day. Emma did the half-marathon on Saturday, and Lauren did the full marathon Sunday. 

Logan at the finish line for the 5K. 

We love seeing our customers giving back to this community and nothing motivates us more than seeing our pumpers push their limits for a good cause. We are so proud of Logan!

What’s your journey with T1D like? Share pictures and stories with us via community@tandemdiabetes.com. We’d love to hear and share.

From time to time, we may pass along: suggestions, tips, or information about other Tandem Insulin Pump user experiences or approaches to the management of diabetes. However, please note individual symptoms, situations, circumstances and results may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information linked below before using a Tandem Diabetes Care product.

Important Safety Information