Review - The T:Slim X2 Insulin Pump

It's been a long time in the coming, just how long? You'll need to read through some of my blog posts from the summer of 2021 to get an idea. However, let's not dwell on time frames and fighting for funding. The title of the blog should indicate that I'm going to tell you all about the T:Slim X2 pump. I'll try! 

The above image was taken a few moments before I began writing - I'm almost at 48 hours on this pump, now and it was handed to me, fully charged. It was suggested that the battery would last between 5 and 7 days for normal pumping (not looping) and that seems correct, right now. I think most of us could cope with one "big charge" of the battery every week or so. Although, the suggestion of charging it for 10 - 15 mins each day seems like a good one. Perhaps it's worth popping on charge while you take a shower or a bath, with the pump unplugged from you at that stage. I'm happy with a rechargeable battery, rather than a disposable one, as it seems more planet friendly and a once per week charge or a few mins each day is not going to disrupt my life.

The pump feels very smooth, almost slippery, to hold. It's made from aluminium and it feels very strong and well manufactured. It's also a very small and light weight pump. If you've ever used a Combo, it's smaller than that. How about one of the Medtronic bricks? It's much lighter and thinner. I actually have some pocket space again! 

How about usage? The image above shows the home screen and the numbers 1, 2, 3. To unlock the pump you tap the numbers; 1, 2 and 3. That's not your PIN! If you want that second level of security then you can add a PIN in your pump settings. I like this form of unlocking, it prevents accidental unlocking and the tapping of functions. If you do leave it unlocked and randomly tap an area of the screen which is not a pump function then, after 3 taps, the pump will recognise that you're not purposefully trying to activate a function or setting and it will lock itself again. You can manually lock the screen by pressing the T button on the top of the pump - that's your on and off switch, in effect. Yes, the pump does still carry on pumping when you press the T button to turn the screen off.

The screen, just like any mobile smart phone - you tap to navigate around but there is no swiping or scrolling, just the tapping of arrow buttons to move up and down the pages or to go back and forth between options. And the display? It's bright and this is my first, albeit tiny, gripe; There is no obvious way to reduce or increase screen brightness. During the evening, I'd like the option to reduce that just a little so it's a bit kinder on the eyes. It is only a minor gripe and in comparison to my old Combo screen it is far superior and easier to look at.

Is it loud? Oh, yes! Fortunately, there ARE options for volume! From high, medium and low volumes on all the important pump functions - and if low is still too much then you can set it to vibrate instead.

There is wizardry in the form of a bolus wizard. I'm delighted to report that it's really very good. It'll take into account your insulin on board (IOB) and your target blood glucose along with your carb to insulin ratio before delivering a bolus. I've used it for every meal, every snack and every coffee for the last 2 days and my time in range has been 99% and 94% for those days.

Insulin to carb ratios and basal rates should be set up before you begin pumping. It's very easy to do those things, you'll probably learn how in your pump start up appointment and they can be adjusted by you at any time.

Temporary basal rates can be set, extended boluses are an option - standard stuff, these days, but they're very useful features and certainly ones that I use from time to time. How about stopping insulin delivery? Because, you know, you might have a hypo sometimes. Easy! it's just a couple of taps away. Insulin can be suspended for a minimum of 15 minutes or you can specify an amount of time in that menu.

Insulin? Ah, yes, that's pretty important. You'll need to draw up your Banting Juice in a syringe and inject it into the cartridge, doing all the air bubble avoidance and removal things. It's a little bit fiddly because the pump and carts are so small. If you have issues with your grip or a visual impairment then you might need to seek assistance at this stage. Also, it's a NovoRapid or equivalent insulin only pump. So... yeah, no Fiasp or Lyummy! *cough, cough*

How about the Infusion sets? AutoSoft 90 was provided and I think they'll be the best option for most people. Other sets are compatible and there is a steel option so, find the one which works best for you - YouTube is your friend, here.

What else? There is s belt clip and a cartridge removal "tool" although, you can remove those with a coin if you'll do what I'm very like to do and lose the tool. You might also get a lot of "suggestions" for places to shop for belts, pump stickers, etc. But! I don't mind a little spam if it comes with a free pen and a ketone check monitor.

So far, I'm very happy with this pump. It is a million miles better than the Combo and I really loved that pump, too. However, it's early days, problems might happen later on and I'll report back if they do.

Thank you so much for reading this blog. I do appreciate your visit and your support. As you might know, I LOVE COFFEE! So I've teamed up with a thing called Buy Me A Coffee. If you enjoy my content and appreciate the time it takes to create such things then you can buy me a coffee! If you leave your Twitter @ name when you buy me a coffee, I will personally thank you. If you'd rather be anonymous then that's totally cool. Thanks for the caffeine!

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Upgrade

I wrote a tweet, a few days ago, where I mentioned my new insulin pump set up appointment. It's been a long time in the coming. You may have read some of my Path to Pumping blog posts, which began in 2021 and ran into this year. I'm still on "The Path" but the finishing line is very much in sight. It's been a journey, only matched by reality TV contestants as they reach the final stages before returning to a life of obscurity, and I'm delighted to finally be moving on - on to a new NHS funded pump and consumables and a reassuring warranty. 

The tweet? Yes, I noted that the upgrading of Diabetes tech is a strange, almost emotional, affair. Not at all like upgrading a phone or a TV. I thought nothing more of it yet, the tweet got a surprising amount of Likes and some offered their thoughts which seemed to be in agreement. Fantastic, I do enjoy social media engagement. However, that particular tweet must've reached more eyeballs than I thought and, following a few messages and emails, I'll be talking to Diabetes UK's Balance magazine on Sunday to discuss the subject of T1D and tech & upgrades.

The subject has been bouncing around in my brain since agreeing to the interview. The words of others have found my "hard relate" button. I don't know of any other technology to have had such a profound affect on my life. A car certainly changes a person's life, affording us more freedom, and if you pass your driving test at 17 then freedom is a huge thing! But, if I didn't pass my test, didn't get a car, then I suspect my life would've gone in a similar direction - probably less nipping out for a takeaway! Indeed, I haven't driven for 12 years and I've got by thanks to various other drivers. Really, that's as close as other technology has got to matching diabetes tech for me and it's still a million miles away.

I think the subject underlines just how much I value my health, today compared to the the years gone by and also how incredibly important access to this technology is. I've seen the data for things such as HbA1c and Flash / CGM use, there are likely similar numbers kicking around for insulin pumps and, lately, looping. The cold, hard, numbers are important but they don't give the full picture. 

Technology has reduced my T1D burden beyond how I can express it in words. I feel that it's reduced it to such an extent that I don't have the T1D that I used to have. It does't feel like the full condition, now. Don't get me wrong, it's still absolutely crap on many occasions but not nearly as much work as when life was full of injections and finger pricks. I've noted many times; I'm blessed. My fund raising for Action 4 Diabetes and learning about their work in South East Asia has really underlined to me just how blessed I am.

The pump switch over is on Monday afternoon and I'm really going to miss this little black chunk of plastic and metal and battery. I've upgraded my CGMs, moved to different ones, taken CGM breaks, etc many times in the last 5 years but since starting on pump therapy I've remained on pump therapy. That'll be 15 months without an insulin injection. I've grown to love the pump. It's on my person all the time unless I'm taking a shower, we go on walks together, meals out, it's met my friends and I spoon it to sleep at night. Next week, it'll be safely back in its box with the battery removed. Another will take its place and do the same job in keeping me alive and well. Soon after, I'll say goodbye forever as the old pump is sent to another living with T1D. I promised to pay it forward and that's what will happen.

Not exactly a tear jerking moment, I know. It's a great moment for me and the next person to use the old pump. Paying it forward is a great thing, too. If you do find yourself in possession of spares then try to not let them waste away. There is nearly always somebody else who can use your old tech or consumables so pass them on... oh! and don't go profiting from it. I know some have sold pumps and fair enough if you bought it in the first instance but, if that tech came from the NHS then please give it back so they can use it to train staff members - assuming you know of nobody who you can pass it to for free. 

Upgrading diabetes tech is so different to upgrading our home technologies, our cars, the machines we use at work, etc. None of those will likely improve your health, I suspect very few of them wake up with you in the morning and it's unlikely that you'll get the opportunity or have the inclination to pay them forward.

 Thank you so much for reading this blog. I do appreciate your visit and your support. As you might know, I LOVE COFFEE! So I've teamed up with a thing called Buy Me A Coffee. If you enjoy my content and appreciate the time it takes to create such things then you can buy me a coffee! If you leave your Twitter @ name when you buy me a coffee, I will personally thank you. If you'd rather be anonymous then that's totally cool. Thanks for the caffeine!

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The Six Principles of Good Peer Support - My Thoughts

World Diabetes Day saw an eagerly awaited NHS document on peer support published. 'The Six Principles of Good Peer Support for People Living With Type 1 Diabetes' hit the NHS website and various socials. Many congratulatory responses were passed around, including my own.

I've written and spoken about peer support, both formally and informally, many times and I make no apologies for that. It might just be the key element in my own T1D care - the reasons for that? I've detailed so many times that I won't bother to do so again in this blog post, you likely already know them very well and I don't want to lose your attention in paragraph two. 

Let's take a quick look at the six principles which the NHS and helpers believe to be part of good peer support if you have T1D. I'll throw in my comments in Italics and bold. 

1. Driven by the shared experiences of people living with Type 1 Diabetes

Why is this important?

The value of good peer support comes from people sharing their experiences, frustrations and successes with others who have been through similar things themselves.

Straight in there with shared experiences. Great stuff. Many of us love to share but also to learn from the experiences of others. I think it's important to remember that, despite T1D, we are all very different in many ways. A review of a CGM or a pump can be completely different from person to person, a visit to a certain clinic, reactions to certain meds, diets, exercise. It's very obvious that there is little in the way of black and white when it comes to T1D. Taking on board the words of others and their experiences can absolutely prepare a person, give them a heads up, etc but don't always take a shared experience as gospel.

What does this mean for:

People with Type 1 diabetes accessing and giving group support as a group member?

People can share real-world examples of how living with Type 1 diabetes affects them. They can find reassurance and support from other people in the group who know what it’s like to live with the condition.

Absolutely. How often do you read "Hard relate" when somebody shares an experience? Very often, for me. 

People giving Type 1 diabetes peer support as a group leader/facilitator?

Facilitators being able to share their own experiences with confidence will help and encourage others to do the same, whilst being mindful that each person’s own experience is unique.

Mindful indeed. I'm pleased that this was added in Principle 1. Peer support cannot be "Do it this way because it works for me". Well done to whoever pushed that in.

Clinicians and service providers?

Referring people to a group of ‘experts by experience’ will provide a vital avenue for people to feel confident and supported in living with Type 1 diabetes.

I'm not comfortable with 'experts'. We might be! about our own T1D but about living with T1D in general? By all means, refer to yourself as an expert if you're happy with that. I think the word might also set high expectations from the newly diagnosed or those looking for a specific type of support. Peer support is largely voluntary and it might be very respectful to refer to us volunteers as experts but, I worry about expectations and disappointment. Clinicians could refer people to 'Experienced people living with T1D' and if specific support is needed? '...T1D and a related issue'. I run a T1D group for men, that might look like '...T1D and men's health'

2. Reciprocal, with opportunities for people to ‘give and get’, as well as to learn from one another

Why is this important?

Reciprocal support recognises the mutual benefit of giving and receiving support

What does this mean for:

People with Type 1 diabetes accessing and giving group support as a group member?

All experiences of living with Type 1 diabetes are valid and no one person is more ‘expert’ than another. It would be helpful for group members to understand the difference between information and advice.

Fabulous. Nobody is more important than another in peer support circles. Ugh "expert". No one person's experiences are more valid than another? Great, RE: info and advice. Do the signposting thing and the "My experience of that is..." thing. 

People giving Type 1 diabetes peer support as a group leader/facilitator?

The reciprocity of peer support emphasises the importance of creating a flexible space for people to share their experiences and from people to ‘give and get’ from one another. It is recommended that Facilitators have confidence in leading groups, including the ability to manage group dynamics and potentially difficult discussions.

Absolutely right. The GBDoc Twitter accounts often throw up issues and decision making which sometimes needs much discussion. To lead or facilitate requires a skill set that some don't possess. A track record is vital to good (and safe) peer support groups. 

Clinicians and service providers?

Confidence that people are being referred to an evidence-based, overarching experience that gives meaning and purpose.

A good track record? Cool. 

3. Safe and encouraging, enabling people to share their experiences free from any judgement

Why is this important?

Peer support should provide people with a safe, non-judgmental environment to be able to talk about their experiences of Type 1 diabetes.

What does this mean for:

People with Type 1 diabetes accessing and giving group support as a group member?

In listening to others’ experiences and building trust and confidence in the peer support group, people should feel safe to share their own experience of living with Type 1 diabetes. All group members may contribute to and agree common ground rules and boundaries (for example confidentiality) that will enable this trust to be built.

Essential and well done to whoever pushed this through. 

People giving Type 1 diabetes peer support as a group leader/facilitator?

Peer supporters should create the right conditions for a safe, nurturing, and welcoming environment, enabling and encouraging people living with Type 1 diabetes to share their own experiences and to learn from others. Group leaders might want to be aware of the benefit of establishing ground rules and/or a group agreement.

Absolutely right. In my own groups, we vet private group members before acceptance. In the open groups such as the GBDoc Twitter accounts, volunteers will discuss decisions to keep people safe and share information about anything which might put someone or a group of people at risk. 

Clinicians and service providers?

Confidence in referring people with Type 1 diabetes to a safe and supportive peer support group.

A good track record of protecting peers? Cool! 

4. Accessible and inclusive, available to everyone with Type 1 diabetes

Why is this important?

Everyone with Type 1 diabetes should have equal access to peer support.

What does this mean for:

People with Type 1 diabetes accessing and giving group support as a group member?

People can feel confident that they can access their choice of peer support group.

People giving Type 1 diabetes peer support as a group leader/facilitator?

Clear thought should be given to what would make groups accessible and inclusive e.g. the appropriate language for health literature, physical accessibility and/or cultural or religious considerations.

Barriers that might prevent people from accessing support should be mitigated wherever possible.

It is unlikely that any one group or avenue of support will be able to meet the needs of large groups of people, so knowing about and being able to signpost alternative avenues of support is useful.

I agree about unlikely but it is massively important to TRY. GBDoc has an Accessibility Pledge to cover very basic things in terms of accessibility such as ALT text (image descriptions) and disability friendly venues for get togethers. It is incredible to still see that many accounts of communities and their leaders/facilitators do not consider this. It has taken a lot of work from me to get the major diabetes charities on board with ALT text. I don't have high hopes for some volunteer led communities which offer peer support, sadly. That said, again, well done to whoever pushed through this very important aspect.

Clinicians and service providers?

Confidence in referring people to an accessible and inclusive peer support group.

Please check this before referring. Imagine referring somebody living with visual impairments to an account which does not ALT text their images? 

4. Person-centred, taking account of each person’s own strengths, values, needs and feelings

Why is this important?

Peer support should be focused on each person, their own unique characteristics, and what matters to them.

What does this mean for:

People with Type 1 diabetes accessing and giving group support as a group member?

People with Type 1 diabetes are seen as a whole person in the context of their own lives and experiences. Good peer support can help people to understand where their existing strengths and assets lie and how they can draw on these to help them manage their day to day lives.

People giving Type 1 diabetes peer support as a group leader/facilitator?

Good listening skills are implicit in supporting someone to identify their own skills and resources, as well as what is available to them in the community. Good peer support looks outside the peer support group itself to signpost effectively to other services, which meet the needs of each person in the group.

Perfect. Listen to your peers and the language they use, I guess? Send them to the right resources or another group if need be.

Clinicians and service providers?

Confidence that people are being supported to develop their knowledge, skills and confidence to support their Type 1 Diabetes.

5. Complementary, working hand in hand with health and social care providers

Why is this important?

Good peer support should run alongside existing health and social care provision, enabling holistic provision of services to suit each individual person’s needs.

What does this mean for:

People with Type 1 diabetes accessing and giving group support as a group member?

Good peer support is one component in a complete toolkit of care. It provides options, opportunities, and choice for people to live well with Type 1 diabetes.

People giving Type 1 diabetes peer support as a group leader/facilitator?

Working in a complementary way means that people will be encouraged to access a range of services that best meet their needs. It recognises that peer support is only one aspect of Type 1 diabetes management.

Absolutely perfect.

Clinicians and service providers?

Confidence in referring to a peer support group to complement the service that they are providing.

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To read the full document then tap/click here

I'm very happy with this document, despite there being two point 4s and zero point 6 (eck!). I think it covers all the good basics and my concerns are few and very minor. I write that as a Type 1 Diabetic and as a facilitator of many peer support groups. The task now? I think to put together a well vetted database of groups and individuals which NHSE can call upon or offer to people when needed. How to vet? The usual record checks but consult those who have been neck-deep in peer support for years (good track record) within the United Kingdom. There is a safety disclaimer on the document and I think that's very wise Without any vetting of referred groups and individuals there needs to be a "you do this at your own risk" agreement in place.

 

Thank you so much for reading this blog. I do appreciate your visit and your support. As you might know, I LOVE COFFEE! So I've teamed up with a thing called Buy Me A Coffee. If you enjoy my content and appreciate the time it takes to create such things then you can buy me a coffee! If you leave your Twitter @ name when you buy me a coffee, I will personally thank you. If you'd rather be anonymous then that's totally cool. Thanks for the caffeine!

BUY DIABETIC DAD A COFFEE HERE

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Peers

I have many photos of my peers and those guys are a very photogenic bunch! and I consider them to be my friends, too. To use one of those photos might mean neglecting friends from other photos. Anyway! That's the long explanation of why I've chosen a photo from FRIENDS the TV show rather than one of my own. My diabetes friends are my peers, there is a very strong bond between many of us. I'll be there for yoooouuuu!

I took part in the Diabetes Chat 24hr chat bonanza! yesterday. I had an hour to talk to Jules from Enough Now DOC and GBDoc to talk about safety within the diabetes community, peer support and a little about mental health. I think the conversation flowed well, from hearing about unsavoury incidents and characters to how to stay safe online and in the general community, then how peer support has impacted and benefited many across the GBDoc community. Meeting and communicating with members of the community has certainly lifted my mental health when it comes to living with T1D and I think I'm right in saying that others have had a similar experience.

I have lost count of the number of people who I've met at the events & get togethers which I've attended. I mentioned in the Diabetes Chat; I've yet to have a poor experience from meeting my peers. Each time, there has been a new story, new information or a new face to meet. Sometimes, I've been able to directly help somebody. From the accessing of the tech that they need to some gentle words of encouragement and everything in between. I've been on the opposite side of that coin, too! Several diabetes tech gadgets have found their way into my lap, a direct result of meeting my peers. Those gadgets have undoubtedly helped me to maintain or improve aspects of my T1D management. 

Without peers, where would my T1D be? I suspect that I'd be using a Libre but, likely still injecting 8 to 10 times per day instead of using a pump (soon to be replaced with a brand new NHS funded one) and instead of using a CGM - a direct result of me tweeting about T1D and being recognised as somebody worthy of being gifted a device. Without peers, my burden would be much more than it is today. Diabetes aside, my private life would be far less rich as well. I have a WhatsApp which is heaving with messages and group messages from friends. No longer are they simply "peers" and no longer is the conversation driven by our lack of beta cells.

The Diabetes Chat event was littered with my friends and peers. After I'd had my hour with Jules, I just listened when time allowed. It was brilliant to see the names of online friends, joining in and telling their stories and offering their opinions. I was very pleased to see Alex take the hot seat to present the GBDoc Quiz and equally pleased that Mo agreed to lead the Tweetchat segment to assist Jules. Alex and Mo are frequent names in the Twitter GBDoc community but I don't remember hearing them speak very often, aside from the Zoom quizzes and when I interviewed Alex for a Dad Chats to... They're lovely people and, if they read this, I'd like to encourage both to push for more opportunities. The same goes for others within the diabetes community - You're just as important as the frequently heard voices, the voices with a social media presence and the voices who work within diabetes. Personally, I enjoy listening to the infrequently heard voice rather than a repeated narrative. 

Monday (tomorrow, after this blog is published) sees the publication of a new NHS document. "The Six Principles of Peer Support" appears to have been a long time in the 

coming. There is much chatter in my circles about what to expect. I'm certainly very interested in what the NHS will come up with following private discussions with a few who live with T1D. There is absolutely many positives to peer support and my hopes are high that the NHS will only enhance what is already there. 

Monday is also World Diabetes Day. Perhaps you'll mark the day, perhaps you won't. Your diabetes, your rules. Personally, I'm going to the pub for an afternoon with my friends. It just so happens they have diabetes, too!

Thank you so much for reading this blog. I do appreciate your visit and your support. As you might know, I LOVE COFFEE! So I've teamed up with a thing called Buy Me A Coffee. If you enjoy my content and appreciate the time it takes to create such things then you can buy me a coffee! If you leave your Twitter @ name when you buy me a coffee, I will personally thank you. If you'd rather be anonymous then that's totally cool. Thanks for the caffeine!

BUY DIABETIC DAD A COFFEE HERE

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