Tandem tslim x2 Site Change Issues on 1st Day

Hi All. I’ve been reading the boards for a while. I have a question/issue that I hope you guys can shed some light on. I have been on the tslim/x2 for about 3 weeks and really like it but I am having issues with my infusion sets and my BS readings I get on the 1st day. I have figured out how to insert the infusion site and fill the cartridge pretty well but on the 1st day my body just doesn’t seem to respond well to the insulin. I’ll run consistently high until I give a manual injection. I’ve even changed the site, thinking maybe it’s a bent cannula only to find that’s not the case. Does this happen to anyone else? Any suggestions?

I haven’t experienced that but I will share something about the infusion sets: I used the Autosoft 90 for a long time - they were similar to ones I used when I had a Minimed pump years ago. However, the ones I used with Minimed were made so you could hold the tape in place as you were removing the inserter. With the Aurosoft 90 there’s nothing to hold, and I was never quite sure that the cannula had not shifted in the process. In point of fact, my numbers were fine after the site change so all was well - I was just not confident for a while.
Recently I switched to the Autosoft 30 which, as the name suggests, inserts at an angle. There is a tab to hold down the cannula as I remove the inserter and I’m much more assured that it is in place.
I’m not saying there’s anything wrong with the 90 - lots of people use it with no problem. But you might want to give the 30 a try and see if the insertion goes better for you. Also some people find switching the insertion angle helps from time to time. I’ve found I don’t need a new rX to change the style, so you might try a box next time you place an order.

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@VivWell hi Viv welcome to TypeOneNation. If it’s only a problem on day 1 and things work better on day 2, then you may just be sensitive to the new set. I am as well. When I put in a new set I need to give myself a lot of insulin typically for 4 hours and then things are fine. I don’t have tslim but I do have a moderate histamine reaction to the infusion set.

I change sets at breakfast, and usually bolus double for that meal. Do not do take more insulin unless you are completely comfortable and promise to test 1x per hour for 4 hours or follow your CGM.

The histamine reaction at the site is minimized by a shower as well. When my timing is right I can get wedge in a hot shower after a set change.

Another strategy is to reduce histamine by working out. A walk, run, or weights at the gym pretty much fixes everything. When I have the time to be active, right after a set change (rare) I do not use the extra insulin.

I also “fill cannula “ with 2 units when the manufacturer specifies 0.3 units. This may be a Medtronic thing.

Anyway, I fix mine with insulin and showers and it’s been ok for me.

If you find that it’s wonky on day 2 and + you may need to change the kind of set as above. Good luck.

Hi @VivWell, I don’t use Tandem, but it sounds like you might not be filling the cannula, per @joe comments. If Tandem allows it, I would try slightly increasing the cannula fill amount - perhaps in .5 unit increments - and see if that helps. There is a lTandem T%Slim X2 users” group on Facebook that might offer more specific help.

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I appreciate everyone’s response and feedback. You all have given me some things to consider and try. I will definitely look for the Facebook group.

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Hi Viv, I always have day1 infusion issues like you. I’ve used insulin pumps since 1982 and probably every kind of infusion set, even before there were “infusion sets”. We used standard IV needles and tubes inserted sub cue at an angle then taped in place. I’ve always noticed a delay in absorption for a few hours as the insulin spreads out in the new surrounding tissue. After a bit a kind of “pool” of insulin permeates the surrounding tissue from the constant basal and future boluses. So that very first bolus exposure takes longer to enter the bloodstream. I plan my new infusion sets in between meal boluses just knowing there will be a couple hours before the absorption rate smoothes out.

Additionally if I insert in a basal period I will compensate for a small dip in the basal absorption rate either with a tiny extended bolus or a small, short increase in basal rate. You will never get it exact because every new site might have better blood flow or even scar tissue. Be aware on day one the first few hours are different.

@VivWell Hi Viv and Welcome to the TypeOneNation Forum! I hope you have found here what you wanted and that we will see you continue posting.

When I read your post on the day it appeared I thought - coincidence. My BGL was running much higher than usual and it was my first day with a new t-Slim cartridge. Today I’m back to “my normal” after changing cartridge and infusion-set last evening. For me, the cartridge was tricky at first after having used MiniMed pumps and reservoirs for years - but now, into my 10th month with Tandem, it is much easier and goes well. Scar tissue and insulin absorption is another thing.

I’m in my seventh decade using insulin and there are countless of thousands of injections and infusion-sets “holes” in my abdomen and occasionally I hit a place that just makes insulin disappear. Don’t give up on all the hard work you put in to managing your diabetes and go with the “swing” of an occasional miss-hit with an infusion-set; maybe try a different type. I now use exclusively the Auto-Soft 30 and this week was the first that didn’t work for me; It is extremely easy to insert and is visible when pressing on the adhesive strip.

My doctor has told me that some people always run high right after changing infusion sets, and some run low. I run low. I am allergic to all but the steel cannulas, so I have used these with the three different brands of pump I have used. And I ran low for the first 24 hours after inserting a new set. To compensate, I reduce the basal rate for the first 24 hours. In addition, I usually have to have a snack an hour after insertion. For you, a temporary raised basal rate would be suitable. Instead of manually injecting, you could try an extra bolus using the pump. You could also try different sorts of infusion sets, as suggested by a previous answer.

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Thank you so much for your response. Everyone has been so helpful. I’m glad I took the plunge and joined.

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