Tandem T.Slim X2 or Minimed 780G AID

T1D Tech & Daily Management Support
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Glad you are happy with TSlim/Dexcom/Control IQ. As I have had the 780g for over a year my experience refers to the 780g and not the 770g. The 780g works as I explained. The sleep and exercise targets weren’t mentioned because this is possible in both algorithms but C IQ has only one “normal target” and Smartguard with the 780g has three. Targets may be “customizable” on the TSlim but I would doubt that this is possible within C IQ and would have to be done as a manual setting (I may be wrong on this)

As you mentioned C IQ adjusts the basal rate (as with the 670g) and the 780g automatically calculates the basal rate as described in my post. In terms of the battery, I am free to use rechargeable batteries if I so wish so this point against Medtronic is irrelevant. For the sensor, I have had the Medtronic G4 since June of last year - zero calibrations, and I would put it up against the Dexcom any day - Dexcom does have 3 more days of sensor life. I think that Medtronic will likely stick with the 7-day sensor cycle (ST) to coincide with the 7-day extended wear infusion set.

Finally, I never said that the 780g is better but it is more flexible and the auto-bolus more assertive than Control IQ. We’ll see how Tandem responds in the next major release of Control IQ 2.0. Competition is a benefit to all T1s!

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@tellblom
Martin, as you are in Europe I am almost certain that Medtronic is shipping the 780G with the new G4 sensor. I can attest to the performance of both the 780g algorithm and the G4 sensor that requires zero calibrations. You may also be able to get the new 7-day Extended Wear infusion set. Those that have it are now changing the infusion set and sensor only one day/week.

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You are indeed mistaken.

And, in case it needs to be said for the benefit of anyone reading this thread: The point here is not to “win” for one company/pump or the other. It’s to share accurate information so everyone can make informed decisions for themselves.

I use the T:Slim X2 with Control IQ. Part of Control IQ is setting up one or more personal profiles. Profiles can be activated automatically or manually. So you can have a nighttime profile and a daytime one and the pump will automatically switch between them at the hours you designate. You can also manually activate a profile by pressing a couple of menu buttons. Profiles consist of baseline basal rate, correction factor (how many units to give for how many points above the SG target), carb ratio (how many units to give per amount of carbs consumed), SG target, and insulin duration (how long the pump should estimate insulin will remain in your system). You must have precisely one profile active at all times for Control IQ to work.

You can easily copy a profile. You’ll be prompted to give the copy a new name. You can then adjust the variables on the copy as needed. So if you just want to change the SG target, you could copy your main profile, leave the carb ratio, etc. as-is, and input the new SG target.

So, yes. You can set your own SG target and it will work to set the variables for Control IQ. You can set up multiple profiles, each with a different SG target, and switch between them as you see fit.

You complained that you didn’t like the Tandem battery. I explained the two systems.

Medtronic uses a AA battery. These are readily available, but it’s highly recommended that you use a longer-lasting lithium battery (not rechargeable) or a rechargeable NiMH battery. All of which need to be purchased separately at your own expense. Batteries usually last a week for rechargeables or two weeks for disposables. If the pump determines that the battery level is low, it will stop functioning. Replacing the battery means removing the battery cap. The battery cap is a small plastic disc with a strip of aluminum glued to it. It’s easily fumbled, dropped, and potentially lost. The pump will not function without it. If anything happens to the aluminum strip, the pump will not function. Your life depends on the pump functioning. When the aluminum strip became detached from my battery cap, I was lucky that I was able to find the strip and glue it back in place without impairing funciton. I had Medtronic mail me a replacement cap and made sure to always carry a spare with me. I had the battery fail unexpectedly while I was out at a meeting, and the pump rejected both battery caps and the spare batteries I had with me. It took quite a bit of panicked fiddling before I got it working again.

The Tandem pump has an internal battery. It does mean you have to stay close to an outlet to recharge it on a regular basis. But it doesn’t take too long to do so. There’s no battery cap. There’s no additional expense. There’s nothing else you need to carry with you. The charge lasts for about a week, but you can top it up any time you like. I usually do so at around 50%. Eventually, the battery will lose its ability to hold a charge. But it’s been entirely reliable so far, and such batteries usually last several years. So I should be fine until I’m due for a new pump. However, should the battery fail, I would be stuck without a functioning pump until Tandem mailed me a new one. That’s more of a problem than simply replacing a AA battery, but it’s also not particularly likely.

Indeed it is. I’m glad to see both companies improving and learning from each other.

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@WearsHats I will admit that the possibility to create numerous profiles is currently an advantage of Control IQ. However, I still doubt that Control IQ operates with these personal settings. As with the 780g Control IQ and SmartGuard can “adjust” the basal rate and stop prior to lows but in Control IQ the auto-bolus is “stopped” in sleep mode and I would think that most “custom” profiles would only apply “outside” of Control IQ. With the 780g you can schedule the basal rate, carb ratio, and ISF over a 24 hour period and the AIT can be set to as low as 2 hours but there is only one setting that applies to AM and MM. Unfortunately, with the 780g these settings have to be set individually in separate parts of the settings menu and cannot be grouped as a profile. One “new” aspect of Control IQ that I have learned is that auto-bolus is active during the temp auto used for exercise. With the 780g auto-bolus remains active in what you would call “sleep mode” and the auto-bolus can be left on or turned off. When put in “temp target” of 150 the 780g turns off the auto-bolus.

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I’m telling you: personal profiles are integral to Control IQ. It won’t work without one. And I worked with my endo to set up separate profiles for sleep and wake specifically to use with Control IQ. And they do make a difference with Control IQ on. Even in conjunction with sleep mode. I don’t know how to make it clearer. Your bold assumption is wrong.

As for sleep mode: It does indeed turn off auto bolus. The idea is that you’re not going to be taking in any more food for hours, and it’s not worth risking a low BG. That said, it will more aggressively adjust basal rates to keep you to a lower and tighter range. In fact, I’ve unofficially been informed by a Tandem trainer that some patients find they have better control using sleep mode 24/7. On the other hand, sometimes I deliberately don’t turn on sleep mode when I go to bed on a full stomach. So I have that option, as well.

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Thanks for providing your experiences here. As a 770 user in manual mode, I look forward to trying the 780 and newer sensor.

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@WearsHats I read the manual again and you are correct that Control IQ uses the “active” profile so you are able to adjust the basal rate, carb ratios and ISF. However, you are not able to change your target of 110 except with sleep mode (112.50-120) and exercise mode (140-160) and no matter what you change the AIT to it will always be 5 hours in Control IQ. You also have to exit Control IQ before setting a temporary percentage adjustment of the basal rate. With the 780g both the ISF and basal rate are automatically calculated by the algorithm every five minutes - the relevant ISF is used by the SmartGuard bolus and auto-bolus, therefor there is no option to set either outside of the algorithm. In certain situations this could be seen as a “weakness” of the 780g algorithm. For example, after a cortisone shot I have to increase basal insulin to 200% for a few days. I find that the auto-basal can adjust up to 150% but beyond that I have to exit AM until I’m back to 150%. I suppose that with Control IQ I could have a higher basal rate set in personal profiles for such an event.

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I switched from Medtronic 670 to Tandem t:slim X2 about April 2022. My experience with the two largely mirrors yours. So far, in over a year, I’ve found only 2 Dexcom G6 sensors to have problems, and only at the beginning of wear. Now, I only calibrate if I have a question about the reading, e.g., because it does not conform with my expectations, or because I’ve inserted a new sensor after a meal and do not have a good sense of what the glucose level is. In contrast, I had never-ending problems with the Medtronic Guardian sensors. I’d feel like ripping the pump off my chest when I was driving, it would start beeping incessantly, and there was nothing I could do without pulling off the road to deal with the stupid thing. What really drove me nuts was when the Medtronic sensor became “confused” and would give a message that it was trying to figure things out, that it could take up to 3 hours, and the damn thing would sound an alarm every 30 minutes to tell me to not do anything until the sensor awoke from its stupor.

I MIGHT switch back to Medtronic when my HMO will give me a new pump, but it would take a LOT to make me switch back. I’m looking forward to starting with the Dexcom G7 sensors, but the G6’s have worked so well for me that I doubt that the improvement will be very significant.

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@schnauzer1 , I used to suffer terribly with my MEDTRONIC 670 G too. For years it tortured me with Notifications, Sensor Updating—- Do Not Calibrate. It was always something. Usually, it would conk out when I had an important event like a concert or party. I counted the days to ditch it for a new system. THEN, suddenly it stopped all that nonsense. It started working great. No more of those notifications……Auto mode keeps me in good shape lately. I stay in straight line all night and I’m sleeping all night. My TIR has improved greatly. I just got to 75% TIR, which for me is a great improvement. I think I’m on track to do even better! I will admit that auto mode was running me low at night, but I resolved that by having a 15 carb snack in the evening.

Now, I feel compelled to stay with what I have or upgrade to 780G. I’m now having to convince myself that switching to another system is needed, especially if the Extended Infusion sets and Reservoirs lasts 7 days AND the new CGM requires Zero calibration. Oh, I forgot to add that my sensors always worked well and I’ve never had wildly different numbers from my fingerstick. I did go through periods where the pump would say the signal was lost and to place the transmitter closer to the the sensor, but that doesn’t happen anymore either! It’s crazy! Is it a fluke? Idk. I feel I should pinch myself.

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I actually preferred the Medtronic pump and infusion sets to my new Tandem pump and infusion sets, but the Medtronic sensors were driving me crazy. I would not have switched if mine had started to work great as yours did.

I have more trouble with the signal being lost on the Tandem, particularly at night, because the Tandem case is aluminum, which blocks the signal except through the front face. So, for example, you might lose signal if you put the pump in your pocket with the face to your body. HOWEVER, I have NEVER had a Sensor Updating message with Tandem/Dexcom and that, to me, is the main reason I prefer Tandem. But products change. By the time I am ready for a new pump, I may decide that Medtronic is the better choice, just as I did when I got the 670G.

The important thing is to use what works and what keeps us out of the hospital. I was admitted to the hospital 7 years ago with glucose over 1000 when I suddenly became diabetic at age 70. (I was in the normal range when I had blood work done a month earlier.) The doctors assumed I was Type 2. However after 6 months of not being able to consistently control my glucose levels, they tested me, determined I was Type 1, and offered me my choice of the 670G pump or whatever the Tandem offering was at the time.

I have not been back to the hospital for diabetes since I was discharged 7 years ago, so the pumps are helping me do my job of controlling the diabetes.

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It’s natural to want to place the face of the pump against the body for protection, but Tandem does say it should be worn facing out.

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John @schnauzer1 one good feature about when you update your t-Slim x2 to work with the new G7 is that Tandem is including a toggle switch that permits easy changing between G7 and G6. I figure that if/when I apply the update, that I would give the G7 a month trial and then go to G6 to use up backlog supplies and decide which I prefer.

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Ill tell you what I am really interested in @Dennis , the G6 had a really strong transmitter (I could pick it up on my phone from anywhere in my house) yet a lot of people complain that tandem loses contact with g6. I’ve been using G7 for 60 days and Im really happy with it, however the G7 transmitter is noticeably weaker then G6. Im wondering if Tandem with G7 will be a problem. Tslim is very likely my next pump. I’d really like to know about G7 reception. Other than that, G7 is as accurate as G6 and with no separate transmitter, smaller, and 25 minute warmup, it goes 10 days + 12 hours. so it has its advantages.

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There are some great things about each one……however, my Medtronic is working so well right now….I sure hope the cost for an upgrade is not prohibitive for me.

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I’m halfway through my fifth year with my t-Slim, most of that time with the G6 after a partial year with G5 and have very rarely had a pump loss-of-signal, not even during hot-tub 30 minute therapy when my pump was left on a table for BGL monitoring. I can probably count pump loss-of-signal errors on one hand even though much of my sleeping time I have the pump clipped on so the screen faces my skin; could be that may be because I take the time to wash the face of the pump.

I’m waiting for software upgrade for Tandem before odering the G7.

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good to know Dennis! thanks!

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I have been using various Medtronic models for years until landing on an older (670g) model with DIY looping and Dexcom G6 CGM. I had tried the Enlight and Guardian sensors and was not happy with their accuracy or functionality.

Dexcom is, in my opinion and experience, the best, most accurate, easiest to apply sensors and CGM system available in the U.S.
I decided to get a back-up system because if my 670g pump (for my nearly perfect DIY looping system) fails, I’ll probably be out of luck and without a pump.

I’m not happy with the t:slim cartridge loading system, the insertion sets or the fact that you have to go into “sleep mode” 24/7 to achieve a lower threshold and autocorrection boluses are disabled, unlike in the Medtronic 780. That seems ridiculous to me but must have to do with FDA approval.

Bottom line for me is that the best (maybe only) good thing about the t:slim is it works with the Dexcom G6.
The worst (possibly only) thing against the Medtronic 780 is the (Guardian) sensor.
If I could use the 780 pump with the Dexcom CGM, that would be my clear choice.
Absent that option, I’ll begrudgingly and reluctantly get the the t:slim (which I’ve been trying for 2 months) but keep it on the shelf and go back to my Medtronic 680 with Dexcom DIY looping until it fails. I’ll take my chances that I can still order Medtronic reservoirs / insertion sets even though Medicare is buying me a new t:slim.
Not sure how that’ll work. I feel handcuffed a bit.

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One thing I believe I’ve read that people have done (for various reasons) is to turn CIQ off overnight and back on on the morning.
Have you considered Omnipod? The Omnipod5 loops with Dexcom as well, and its programming might give you the flexibility you’re looking for. You can usually try it with no commitment.

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My husband agrees that his t:slim cartridge system is archaic, but the pluses outweigh the negatives. His A1c is far superior on this system, though the tighter control can be finicky. Plus, if we had a dollar for each Guardian 3 sensor that failed or bled on insertion, we could have retired two years earlier. They were such a headache!

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