New Tandem user…a few questions!

Hi everyone. My hubby finally got his t-slim pump and Dexcom CGM setup. Very exciting, and so far things are going well. Learning the insulin filling process is a bit cumbersome but he is getting there. First question we have is when I went to reorder his 3-month supplies. I had to call the vendor and she told me to order 12 IPkit weekly supply kits. I have no idea what this is! Per vendor instructions, I ordered 12 IPKits, 3 boxes of 10 infusion sets, 3 boxes of 10 cartridges and 3 boxes of 3 Dexcom CGMs, plus 1 transmitter. Our original order to start hubby using the pump was only a one-month supply, so this was our first full order. Can anyone tell me what the IPKit actually is? Second question was regarding the current transmitter which the hubby is wearing and has only 10 days of use. Vendor told me to have him remove that transmitter when he gets the one just ordered and put that one on so his three-month supply order is all at the same usage rate. Is the original transmitter still reusable since it technically has 2.5 months remaining? Can it be restarted if he has an early transmitter failure down the line? I just hate waste and it seems silly to toss something that’s working fine! Hubby is on Medicare (Advantage plan).

Stephanie @Stephanie_Y , my first few times I did find the cartridge fill process a bit awkward but now it is almost routine and rather easy and do that task when not under pressure. For instance, while eating lunch today, I received an alert that my cartridge went below 20 units so I’ll prepare a new cartridge after I write this; I only use 20 units per day so I have plenty of time before I need to switch out the old. As an aside, I do NOT change my cartridge every three days when I change the infusion set; Tandem t-Slim requires a minimum 100 units to begin a new cartridge and the 100 units will last me 5 days meaning I’d throw out two days worth of insulin.

The “12 IPKits” is strictly used to properly bill Medicare Advantage for 12 weeks of supplies; no additional “goodies” have ever come with my order. My supplier, Byram, just asks me to click the “12 week supply” icon.

As far as the transmitter: continue using the transmitter he began with until it expires and keep the next one to use beginning with the new sensor he starts after getting the alert “Replace Transmitter soon” on his t-Slim and/or Dexcom Clarity. The transmitter is under warranty to last at least 90 days, and usually lasts about 112 days. Occasionally a transmitter will fail before it should, so by ordering and keeping on hand a replacement is a really good safety. Over the years, I’ve had transmitters fail.

I hope that this new system works well for your husband; it has worked well for me.

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You are a wealth of information! Thank you so much! The extra “goodies” not really being tangible seems strange, but I’m glad you gave me clarification. We also order from Byram, so the process is identical. One more question… are you saying it’s entirely permissible to load a cartridge and tuck it in the fridge until ready to use at a later time in the day? That certainly would take the pressure off him, since he has returned to working for a few months while helping his former employer. He was concerned about the whole process having to take place at his workplace. If the cartridge was prefilled earlier, that would be so much easier just to do the infusion set. Is there a specific timeframe that it needs to take place within? He uses about 50 units per day plus the additional wasted 45 for the fill process. One more question… are you on an Advantage plan? Are the supplies considered DME or are they zero copay for you? I’ve looked at the claims coming through our BCBS insurance (top tier) plan and it appears there is a DME copay for the initial items ($90 total). Just curious, because if we switch Advantage plans it would be beneficial to know which plans cover at 100%. All in all, the cost is still worth it, but hey, if we can save a few $, why not look around? Thanks again!

@Dennis covered pretty much everything. I just wanted to add that the transmitter cannot be re-start ed so always make sure you have the new one before the one he using runs out. You do get a couple of alerts counting down the days remaining.

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Again, Dorie, all of you regulars are so helpful! That’s good to know about the transmitter not allowing a restart. We will jot that bit of info down also!

Stephanie @Stephanie_Y , certainly fill a new cartridge at a comfortable time, but DO NOT put it in the refrigerator. Never, ever use cold insulin in a pump, or inject cold insulin. The only insulin that should be refrigerated [unless using animal extract, is unopened vials in storage; when I’ll be opening a new vial, I remove it from the refrigerator a day before putting it in a cartridge.

A word about “stockpiling” filled cartridges, if you have read the information packaged with each vial of analog insulin, you will see a statement that insulin in a cartridge should be discarded after seven days. I have found that a filled cartridge fits nicely in the box with a vial of insulin alongside the flyer and pump key. Whenever I’ll be away from home for more than a couple of hours, I have a ready cartridge [and emergency infusion set] in my “grab-bag” on my bike or car, even in Florida heat, just in case. Never know when tubing might get caught during work in the field.

For the 11.5 years since I retired at age 70, I’ve had a couple of United Health Medicare “Choice” Advantage plans. My over all cost, even seeing six doctors, is considerably less than it would be with other plans. For comparison purposes every year I use the tool at medicare.gov, entering all medications, doctors, devices I expect to use and let the program; tell me final yearly out-of-pocket cost; savings over some of my other choices of Advantage Plans reaches into the thousands.

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@Stephanie_Y , I have been on 3 different pump with several different suppliers and have never hear of such a thing. Every supplier I have used including Tandem, Edwards, Solara, & Byram have had the items ordered a la cart, cartridges [with syringe & needle], site sets [AutoSoft XC 9mm 43" for me], alcohol preps, skin prep, dressing [IV3000 for me], Dexcom sensors, Dexcom transmitter. I use Medicare and secondary (not supplimental) insurance.

Now your questions specifically,
[1] who is your vendor? reason a Google search did not return anything.

[2] Second question was regarding the current transmitter which the hubby is wearing and has only 10 days of use. ANSWER: Hubby would be well served to have both the Tandem t:Connect and Dexcom G6 apps on his phone and if the endo uses it, the Dexcom Clarity app. Specifically, the Dexcom G6 app in the settings will give the sensor life as well as the activation date of the current Dexcom transmitter. As far as doing the transmitter thing - HOG WASH. This is one time to stay on the rotation initiated at training, get ahead on transmitters so if one fails mid cycle, you have one and will not need to wait for Dexcom to replace a failed transmitter. That said, if a transmitter fails, call, report it, request replacement, hang up, open your on-hand transmitter and put it in play.

[3] Is the original transmitter still reusable since it technically has 2.5 months remaining? ANSWER: Yes, the original transmitter is usable for the 90 days following the activation date. The activation date is the key to how long it will last. Some users get 110 days, or 12 times of 10 days each.

[4] Can it be restarted if he has an early transmitter failure down the line? ANSWER: No, because you cannot turn it off. You are a wise wife. See discussion under #2 above.

[5] Hubby is on Medicare Advantage plan. ANSWER: you may want to consider traditional Medicare next open enrollment and get a secondary insurance to pick up copays and deductibles. Of note:
[a] Be careful about insulin for hubby’s pump. Insulin for a pump under Medicare is an expendable for a Durable Medical Equipment (DME) covered under Part B Medicare at 80% and may be significantly less expensive than the pharmacy benefit.

[6] are you saying it’s entirely permissible to load a cartridge and tuck it in the fridge until ready to use at a later time in the day? ANSWER: with what @Dennis has shared there are some issues with opening the sterile package adding insulin to the cartridge and then leaving it. [a] the sterility is gone. There is no way to prevent contamination of the pigtail connector easily. [b] the additional time ahead of use opens the discussion about insulin and the plastic. I am like Dennis, I load and run dry, usually more than 72 hours - more like 96+ hours.

[7] About insurance, I will send a private message. There may be something there.

[8] when you get to looking at the CGM graphs, there is a place I learned mountains about the CGM graphs and the way CIQ performs. It is a Facebook group “Tandem Diabetes Control-IQ Users’ Group”

Hope you and hubby the best.

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Hi @Stephanie_Y ! Bless you for looking into this for your hubby.
I’ve used both Minimed and (now) Tandem pumps, and a Dexcom CGM. When I started each one I was assigned to a company rep who helped find a supplier and got me set up with my supplies, and of course did training and helped when I had questions as a new user. It sounds like you got started on your own but you might ask your doctor to connect you with reps from each company: since your husband is new he might find it more helpful to work with them for his initial questions - they can work with him in person, and they might even know what those items are .
Tech support is helpful, and of course that’s who you call if you need replacements; but a rep might be more helpful for a new user. Just a suggestion.

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Hi Dorie–Yes, my hubby got an extensive training session with his diabetes educator. She even gave him her personal cell in case he had questions after hours! He had his first sensor replacement today, and it went as planned and so easy. I think he was sweating it out after dealing with the Guardian 3’s over the last four years. Whew! Online videos were also helpful. So, yes, it’s a learning experience, but so glad there is a forum like this one plus others who can also help! So far, it’s all been very positive.

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Thanks for reading my questions and adding some of your own suggestions! We got him through his first sensor replacement this morning. Easy peasy!

  1. Our vendor is Byram Healthcare. We have to order from them due to being in-network on his BlueCross Advantage Plan. We have our own alcohol preps, SkinTac, patches, etc. So it was just the IPKits thing that confused me. Dennis explained it well since he orders from the same supplier.
  2. Yes, hubby has all the apps on his iPhone and it’s been great. He loves it. His diabetes educator and endo have the ability to log on anytime to see his data. His DE has sent him several MyChart messages already to have him make a few tweaks in basal rates and carb ratios. She is great and knows him very well, plus she gave him her personal cell if he needs it after-hours.
  3. Yup, we are going to keep using that first transmitter until it runs out. WHY would we toss a perfectly good transmitter away?? I’m glad everyone on this forum thinks that same way! LOL
  4. Bummer. But my hunch was correct.
  5. We actually love his Advantage Plan (I also carry the same plan, and it has been fantastic). MN has extraordinarily high Medigap rates, which are not affordable and have worse coverage IMO. He likely could not switch now anyway, having passed that one-year date for re-entry into original Medicare. If anyone here knew what he went through last year on his Advantage Plan, and what it covered in the end, they would know we made the right decision to stay on it! (Two major incidents requiring surgery, not diabetes related–just stupidity.) I joke that the hubby “tested” the plan and came out a winner. It was incredible coverage. We do not have a copay for insulin. I think the supplies through Byram may not have a copay, according to a conversation I had with my BCBS rep. The pump DME may be a $90 one-time charge. The jury is out right now. Regardless, it appears that this all will be less $ than the Medtronic system.
  6. We thought the same thing about the pigtail and sterility. Honestly, after a couple more times doing this, it’s probably not going to be an issue. Thanks to all who mentioned keeping the opened insulin vial at room temp. The hubby usually runs his insulin cartridge down to a mere unit or two. He has been playing with the amounts to try to get an even 3 days, just to simplify the time of day he expects to have to change it. Come boating season, he may have to increase it so it ends up later in the day! :slight_smile:
  7. I got your PM…thanks.
  8. I’ll have him check out the Control-IQ Users’ Group about the CGM graphs. Sounds interesting!
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Congratulations - it’s always a relief when things start smoothly. Is your husband going to share his numbers with you? Some people find that helpful and reassuring.

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You will soon find out that all the requests to order things is really just a grab for more money from you and your insurance. You may notice the same with insulin and any prescription pills you take. If you are on automatic shipment for anything, it always comes weeks early so they can get another shipment in each year.

Yes, I get his numbers shared. I initially thought I also wasn’t receiving alerts, but got my first one today. I guess he hadn’t gone low enough.

Medicare doesn’t permit any auto shipments (at least not on my Advantage plan). Even though BCBS allows 3-months at a time, Byram Healthcare only shipped one month’s worth on my last order (I called for direction and ordered 3 months). :frowning: So annoying for me because I’m the ordering person! I would prefer my hubby have at least 2 weeks overstock in case of an issue.

I didnt do Advantage because of all the restrictions. I am on a Supplement and Medicare allows 3 months supplies and auto shipments of everything for me. I get everything directly from Medtronic. I think I can even do 6 months supply. I also pay zero for it all after my $233 deductible.

Sadly, MN Traditional Medigap supplement rates are very unaffordable. Then adding all the a la carte stuff for Part D, dental, vision, etc, it’s way less expensive to stay on the Advantage Plan and pay a small copay for supplies. We’ve been extremely happy with the coverage. The hubby never ordered supplies from Medtronic while on Medicare, so no comparison there. Their CGMs just became approved by CMS in 2022 for coverage. We were tired of beating that dead horse until the warranty ran out.

I agree with you there and I launched an age discrimination lawsuit against them and shortly after that, they got their act together. I went as far as calling their corporate office in Ireland. I caused a huge stink. Contacted my US Senator also and he told me the only thing holding it up for over a year was the label on the CGMs needed to be changed. That’s all it was. Medicare agreed to cover every sensor starting October of 2020.

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Glad you got on their case! Thank you! And Medtonic is a MN company too! But I will say that something is messed up on their end because the sensors we purchased on Medicare were listed under “hardship” coverage, meaning insurance would not cover them. I probably made no fewer than 25 calls to CMS, Medtronic and BCBS each, to no avail. We ended up paying 10% of actual cost during that time ($60 for three months). So now I’m curious why the disparity? Inane! Doesn’t matter now…the hubby is thrilled with his Tandem/Dexcom combo after just a few weeks. It was a worthwhile switch for sure. Thanks for your diligence!

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Oh it isnt Medicare at all that is causing the issue. They have helped me more than anyone. They even did a 3 way call with the supply part of Medtronic asking them why an order I asked them to submit to Medicare was rejected because they knew it was nothing on CMS or Medicare’s part. Medtronic refused to give Medicare the rejection code and after going back and forth eventually hung up. The Medicare agent said the reason why they would not provide the code is because they lied to you. No order was ever submitted for coverage to Medicare.

They have all kinds of offices here but they are based in Ireland. They sold their US Headquarters and became an Ireland based company to avoid paying US Income taxes.

You are correct they are very messed up but I still think they have the best product since it is all in one. I think eventually the 780G or 870G, whatever they decide to call it, will really improve our management tremendously. The folks in Europe who have used it for over a year now love it.

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I load my cartridge a bit differently. When I get the low volume remaining alert I pull the insulin vial out of the fridge butter keeper, load the syringe, then put the sterile cap back on the needle until the pump runs dry. In the meantime, I stand the capped syringe needle down in a small glass or other items that will hold it near vertical.
THEN when the pump runs dry or close enough I push the needle into the cartridge and pull the plunger almost all the way up. Larger bubbles pop immediately but I hold it there while watching other miniature bubbles come up from the cartridge as well as all over the cartridge. This makes sure all air has been evacuated and collected at the plunger tip, where they will stay after filling the cartridge.
The reason I leave the loaded syringe at room temperature is to make sure the insulin will release bubbles more easily, since cold insulin holds on to them harder.

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