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Tandem

The Tandem t:slim X2

Tandem G6 2019

Pump Features 

  • Color touchscreen pump with rechargeable battery and tubed infusion sets
  • Control-IQ Features: Modulates basal insulin and provides auto-corrections
  • Changes to these settings impact automated insulin delivery:
    • Basal rates
    • Insulin Sensitivity Factor (impacts basal modulation aggressiveness)
    • Carb ratios
    • Target glucose & Sleep/Exercise modes
    • (Automated insulin delivery also impacted by IOB, current & 30-minute predicted glucose, time of last bolus)
  • More about the algorithm
    • Auto-corrections: Up to 60% of correction once an hour based on 30-minute predicted glucose if no bolus within the past hour.
    • IOB is dynamic. Can be 5 hours or reduce to less with rapid glucose changes
    • CGM Loss: Reverts to manual basal after 20min without data
    • Setup: Requires weight and TDD (update if significant changes)
    • Sleep Activity has more aggressive basal adjustments
    • Exercise Activity: auto-corrections continue; overrides Sleep Activity.

 

Tandem CIQ Adjustment Ranges Icons




 

Adjusting for Hypoglycemia

 Review: How to Make Control-IQ Technology Adjustments Using Tandem Source Review: How to Make Control-IQ Technology Adjustments Using Tandem Source

  • Address actual episodes of hypoglycemia. Frequent basal suspensions in the reports (red bars) do not necessarily indicate a need for a change.
  • Check for patient over-rides, e.g. when delivering more insulin than the system suggests.
  • If fasting/overnight lows: Consider reducing basal rates 1 - 2 hr before lows; advise to use Sleep Schedule.
  • If lows after highs or corrections: Weaken ISF (correction factor) by 10-20%.
  • If lows are 1-3 hr post meals: Consider making carb ratio less aggressive by 10-20%.
  • If meal bolus was forgotten (e.g. patient remembers 1 hr after eating), consider a 50% meal bolus reduction, give or take, depending on the IOB and the current glucose reading. (The “Quick Status” screen will show if an automatic correction bolus was delivered.)
  • If regularly boluses late, inputting the full carb and not able to change this habit, consider weakening the correction factor to prevent delayed hypoglycemia.
  • If using a "no bolus" profile with very aggressive ISF, advise caution with manual corrections.
  • Consider addressing hyperglycemia differently:  A more aggressive ISF usually results in less lows than does more aggressive basal rates and/or carb ratios. See "Hyperglycemia" below.
  • Consider exercise management. See heading below.
  • If patient is fearful of lows (and this is impacting care or usage of pump): Consider leaving Exercise Activity on. It shuts basal off sooner and is less aggressive when toggling basal. 

 

Adjusting for Hyperglycemia

 Review: How to Make Control-IQ Technology Adjustments Using Tandem Source Review: How to Make Control-IQ Technology Adjustments Using Tandem Source. Frequent auto basal increases or hourly auto corrections do not necessarily indicate a need for change in therapy. Remember that each option below must be assessed for safety within the individual patient context. 

  1. Strengthen ISF: 
    Rationale: Control IQ varies the automatic basal delivery from zero up to a maximum of about 4X the programmed basal rate. How much it toggles the basal is impacted by the ISF.  A more aggressive ISF (lower number) has the algorithm respond by:
    • giving more aggressive automatic basal delivery
    • giving more of an automatic or manual correction bolus, as expected
    • minimizing risk for lows (whereas increasing CR and/or basal rate alone may result in more lows) Note: extremely aggressive ISF(CF) changes could still potentially impact TBR.
    • Note: Work with the client to adjust ISF gradually and safely. This may include moving to 90/TDD first, then 85/TDD, then 80/TDD etc. Or it may be include a more aggressive adjustment of 10-20% change to ISF with each visit, depending on the patient.
    • Note: Patients using Control IQ are encouraged to wait for Autocorrections. Autocorrections are based on predicted glucose and can be larger than manual corrections. 
  2. Carb management, if highs 1-3 hr post meals
    • Consider pre-bolusing 10-20 minutes
    • Consider a stronger Carb Ratio  (strengthen by 10-20% or start at 450/TDD)
    • Consider if an extended bolus is required 
    • If patient boluses sporadically, consider less aggressive Carb Ratio, and more aggressive ISF
  3. Consider "No Bolus" Options for those who routinely miss boluses.
    • In each option below, provide extensive safety education for clients/caregivers, so they are aware of how and when to use each profile (no bolus days/bolus days) appropriately. Consider discussing with Tandem clinical support staff or educators who have used the option.
    • Consider a “no bolus” Personal Profile with a stronger ISF for those days of week where bolusing is forgotten. Consider the same basal rates and carb ratio but strengthen the ISF. e.g. 90/TDD first, then 85/TDD, then 80/TDD… The patient would switch back to the “usual” profile days they regularly bolus.
    • Consider a “no bolus” Personal Profile with a stronger ISF just for the meal times, vs the whole day. 
    • This option is least desirable as could have higher risk of low: Consider a “no bolus” Personal Profile with higher basal rates at certain times of day to better address the planned missed boluses. Remember, previous studies involving Tandem show that hypoglycemia is generally less if making the ISF more aggressive, versus the basal
  4. Assess or change the basal rate:
    • It is not unusual, especially in DIP, to have have a programmed basal rate that is up to 25% greater than the rate being delivered.  
    • If waking high, consider Sleep Schedule and increasing basal rates 10-20% for 1-2 hrs prior the hyperglycemia. 
  5. Consider 3 primary Personal Profiles for patients to toggle between as needed.
    This needs to be carefully considered for safety with each individual. This may include:
    • PLUS 10-30% of usual Personal Profile (or if preferred, just one of the profile elements e.g. basal, carb ratio, ISF)
    • Usual profile
    • MINUS 10-30% of usual Personal Profile 
      (or if preferred, just one of the profile elements e.g. basal, carb ratio, ISF)
    • Note: Up to 6 personal profiles can be set.
  6. Assess if overtreating lows: Per any AID pump, consider 5-10 g of rapid carbohydrate to treat lows and evaluate, since basal insulin delivery will also have been suspended. 
  7. Consider (carefully) resetting programming to
    • Basal: 50% current TDD / 24 
      (may also consider 40-60% of TDD / 24)
    • Carb Ratio: 450/current TDD
    • ISF (correction factor): 90/current TDD
  8. Assess other: 
    • Assess treatment of lows: Often, only 5-10 g is needed. Check glucose levels post lows. 
    • Check infusion set and site concerns (crimps, tunneling).
    • Ask if suspending pump when it is off (showers, intimacy, sports). This is important so the algorithm knows how much to replace when connected again. 


 

Exercise Options

  • Consider Exercise Activity (higher target) 90 minutes prior exercise or as individualized by patient. Note, the system will still give automatic corrections once hourly. 
  • Avoid starting exercise with a higher glucose reading. Control IQ will still modulate basal rates and give partial correction doses to address this. 
  • Prevent automatic correction bolus (for an hour) by giving a tiny bolus e.g. 0.05 unit prior exercise. This will prevent the system from giving an auto correction for an hour. 
  • Consider creating a new Personal Profile. This may also be needed for exercise that is longer in duration (e.g.10k run) or extreme or extreme.  As an example only, as this needs to be individualized:
    • half the basal rate e.g. 1.0 u/hr to 0.5 u/hr
    • double the carb in the ratio e.g. ICR of 10 to ICR of 20
    • double the sensitivity of ISF e.g. ISF of 2 to ISF of 4
  • Longer duration exercise of over an hour may be managed by eating a small amount of CHO every half hour without bolusing. Caution though, as higher glucose readings will still trigger partial corrections. This emphasizes the importance of setting safe alternate ISF, basal rates and glucose target for exercise.
  • If worried about delayed lows overnight, consider keeping Exercise Activity on overnight.It will override "Sleep Activity".
  • Consider this Tandem webinar - Control-IQ Technology in Clinical Practice: Optimizing Control-IQ Management and T1D Outcomes (tandemdiabetes.com)

 

 Use in Diabetes in Pregnancy 

 

 

Training & Reports

 

REPORTS

 

Infusion Sets

 

Company Contacts & "Office Hours" for HCP Questions

 

"Drop In Sessions" for Healthcare Professionals ONLY to connect with Tandem Trainers are below: 

 

Third Party Products Supporting Tandem Pumps