Slim and Dexi hookup with my iPhone

Living with Type 1 diabetes and my Dexcom G6 and t:slim X2 is like having a tiny, bossy robot that's constantly whispering secrets in my ear and occasionally saving me from eating that extra slice of cake.

It's an uncommon occurrence to receive a Type 1 diabetes diagnosis in one's early 40s, but such is life's capricious nature. My journey with Type 1 diabetes started in June 2001.

Imagine Type 1 diabetes as an unwelcome lodger that refuses to leave. I often liken my body to a bustling metropolis, where insulin serves as the gatekeeper, ushering glucose into cells for sustenance. However, in Type 1 diabetes, the body's immune system, typically vigilant against harmful invaders, goes on a drunken rampage and targets the insulin-producing cells in my pancreas. Consequently, insulin production halts, leading to glucose accumulation in the bloodstream. Mishandled, this scenario can pave the way for severe health complications1 like neuropathy or vision impairment.

In contrast, Type 2 diabetes is like a city where cell doors have rusty locks. Despite insulin's persistent attempts to unlock them, these locks (cells) resist, causing glucose to accumulate in the bloodstream. While Type 2 diabetes primarily affects adults over 40, it's increasingly prevalent in younger demographics. Factors like obesity, familial diabetes history, or a sedentary lifestyle often play roles in its development.

Type 1, an autoimmune puzzle with no known preventative measures, usually manifests in childhood or young adulthood, necessitating lifelong insulin therapy. Conversely, Type 2 diabetes can often be mitigated or managed through lifestyle adjustments and medication. Despite their disparities, both types demand meticulous oversight to maintain healthy blood sugar levels and ward off complications.

Once dubbed juvenile diabetes, Type 1 diabetes seemed an improbable diagnosis for adults back in 2001. It took the medical community decades to shed the juvenile label, recognizing that Type 1 diabetes didn't care if patient was too old for high school. My online web searches introduced me to fellow adults, recently christened with the diagnosis, who referred to it as Type 1.5 diabetes. These unfortunate souls had been misdiagnosed with Type 2 diabetes, underscoring the entrenched misconceptions surrounding Type 1 diabetes.

A Continuous Glucose Monitoring System (CGMS), my digital guardian angel, meticulously monitors my glucose levels round the clock, dispatching updates to my phone or insulin pump. Farewell, incessant finger pricks; hello, streamlined diabetes management. While my trysts with CGM systems date back to 2010, the Dexcom brand, particularly the Dexcom G6 Continuous Glucose Monitoring System (CGM), is my favourite. Designed to render glucose monitoring less intrusive and more continuous, it affords me a clearer snapshot of my glucose levels sans the incessant finger pricks.

The Dexcom G6 comprises a petite sensor snug against my skin, measuring glucose levels in the interstitial fluid (the fluid between my cells). This sensor, tethered to a transmitter, dispatches real-time glucose readings to my iPhone and insulin pump. Sleek and discreet, resembling a quarter in size, it requires replacement only every ten days, a welcome respite from the daily rigmarole of traditional blood glucose testing.

The Dexcom G6 is a quantum leap in the quality of life for people with Type 1 diabetes, offering more autonomy, less guesswork, and a deeper comprehension of how various factors sway glucose levels. In short, it gives me enhanced control and confidence in navigating the diabetes labyrinth.

The Tandem t:slim X2 insulin pump, sleek and user-friendly, streamlines diabetes management. Among its attributes, its integration with my Dexcom G6 continuous glucose monitoring (CGM) system stands out. This symbiotic relationship enables real-time glucose data transmission, laying the groundwork for features like Basal-IQ and Control-IQ technology, elevating insulin delivery to new heights of sophistication.

My tech squad, Dexi2 and Slim2, comprising the Dexcom G6 and Tandem t:slim X2, join forces to keep my diabetes demons at bay. Picture a personal assistant, perpetually on call, scrutinizing my blood sugar levels and relaying updates to my insulin pump. That's Dexi, keeping tabs on my glucose levels 247, nudging my pump with the latest updates every few minutes.

As for Slim, it's no slacker either. Endowed with the brainy Control-IQ technology, it processes intel from Dexi, analyzing glucose trends to forecast future trajectories. Much like a weather forecaster gauges atmospheric shifts before deciding on carrying an umbrella, Slim preemptively adjusts insulin delivery, forestalling glucose spikes or dips. This collaborative effort translates to fewer frets about glucose levels and more focus on living life to the fullest.

The peace of mind and adaptability afforded by this dynamic duo are beyond measure. The realization that my pump and CGM maintain an incessant dialogue emboldens me to embrace spontaneity. Whether hitting the hiking trail or enjoying meals, I can go about my daily activities without diabetes constantly intruding. My diabetes management is on autopilot, allowing me to live my life more freely.

The insights I glean from this system are invaluable, facilitating informed decisions and keeping me on track and in control.

A closed-loop system like the Dexcom G6 and Tandem t:slim X2 partnership makes diabetes management more seamless, efficient, and less intrusive to my daily life.

  1. Nerve damage and loss of sight are among the complications. 
  2. Dexi and Slim are common nicknames for these devices. 

Excited about the Omnipod 5 and Dexcom G6 Closed Loop System

I was diagnosed with Type 1 diabetes over 15 years ago. During that time, I have had to learn a lot. A lot. Before eating any meal, I had to read food labels, calculate the total carbohydrates, and calculate the insulin dosing based on a personalised formula before injecting insulin. Sometimes I got it right. Sometimes I got it wrong. Eventually, I switched to an insulin pump which helped with more accurate dosing, but I still had to do a lot of math. A few years ago, manufacturers started combing insulin pumps with continuous glucose monitoring systems, something the press hyped as an artificial pancreas. They are NOT!

What they are is a closed-loop Automated Insulin Delivery System. AIDS automates blood glucose (BG) control as much as possible. The patient performs less frequent fingerstick blood glucose readings and is alleviated from calculating how much insulin to dose or reduce based on those readings. I have one of the first devices to be approved by the FDA. For many reasons, I think it’s a POS.

Fortunately, the warranty is ending on the device. I will be able to get a new device. Fortunately, more recent and more capable AIDS were approved in 2020. I took a look at a few of them and got excited about the Omnipod 5 Tubeless Automated Insulin Delivery System with Smartphone Control 5.

Our Diabetes Community now has the first-ever closed loop system that automates insulin delivery with no need for plastic tubing attached to your body. And this new system will be the first that is Food and Drug Administration (FDA)-cleared to be controlled by your smartphone.
The new system combines the little white Omnipod patch pump with the Dexcom G6 continuous glucose monitor (CGM) and a controller algorithm to automate insulin delivery. Notably, Omnipod 5 makes history as the first such system to get FDA clearance for mobile app control and insulin dosing directly from your smartphone, eliminating the need to always carry a separate controller unit.

I sent a link to the Omnipod 5 "Patch" article to some friends. One of them responded with a few questions. In the process of answering his questions, I wrote this long-winded blog post.

Khurt, this sounds like great news, but how does the patch deliver insulin to you? Does it work on the same principle as the nicotine patch, which just gets absorbed into the skin?

Nature has had 500 million years to perfect homeostasis via the endocrine system. This is accomplished by a highly sophisticated network of hormones and neuropeptides released mainly from the brain, pancreas, liver, intestine, adipose and muscle tissue. Insulin, produced by a healthy pancreas, is just one of those factors. While these devices are welcome advances, they are crude stone-age tools compared to the human endocrine system. They can not control what happens once the insulin is injected into the body.

Banting discovered insulin nearly 100 years ago, but very little has changed human physiology. It is necessary to inject it directly into the body. Variability in insulin needs (every person has insulin needs specific to their body) and variability in skin absorption rates would produce too much unpredictability in insulin delivery if delivered via the skin. Absorption through the skin would make blood glucose control incredibly unreliable and extremely dangerous.

What's Inside an Omnipod? | Image © user DIS Boards user Gdad

The Ominpod 5 Patch is not a patch like a nicotine patch. Insulin is a hormone, not a drug. Insulin is regulated on-demand in a person with a healthy pancreas and liver. In a person with T1D, the pancreas no longer produces insulin.

“Patch” is just Insulet Inc.'s branding for their product. The “Patch” is an insulin delivery device attached with adhesive to the body. The “Patch” contains a vial of insulin with a ¼ inch cannula (skinny needle) that gets inserted into the body. The device injects insulin into the body. The insertion site must be changed every three days to prevent infections and buildup of fat deposits.

My current pump system and infusion set look like those in the photo below. Do you notice the tubing running from the insulin pump to a port on the body? I usually tuck the tubing into my pants with the pump on a clip to access the controls. But Dealing with all that tubing is a PITA. Sometimes it comes out, and I have had it snags on turnstiles and kitchen drawers. Sometimes it gets painfully yanked out. What Insulet Inc. have done is make an insulin pump that is attached directly to the body.

Insulin pump infusion set
Insulin pump infusion set
Woman wearing insulin pump to help control her diabetes
Diabetic woman wearing insulin pump to help control her diabetes | Image © Sus on

Can it deliver enough quickly in order to adjust to any spikes you may encounter, or is this something where you still may need needles to supplement in those cases, or would it require an even further adjustment to diet and avoid pizza and beer nights?

A spike in T1D means a rapid increase in blood glucose level over a 15-30 minute period. Despite what they portray in movies and TV shows, they don't happen in seconds. Since the Dexcom CGMS (Continuous Glucose Monitor System, a device separate from the insulin pump) sends blood glucose updates to the insulin pump every 5 minutes, the insulin pump algorithm can detect which direction blood glucose is trending and make adjustments to avoid spikes (or drops). Blood glucose spikes don’t pose any immediate health threat. Rapid declines in blood glucose may cause a person to blackout and go into a coma.

Dexcom G6
Dexcom G6 | Image © Tandem

The CGMS has a ½ inch to 1-inch wire sensor inserted into the body. The insertion site must be changed every 5-7 days to prevent infections. Repeated studies have shown that accurate blood glucose levels are impossible without a blood sample. This is why I downplay hyped-up headlines about blood glucose testing via contact lenses (tears), smartwatches (looking through the skin) or other stupid ideas. They all proved too inaccurate for making a medical decision (i.e. how much insulin to inject).

Dexcom G6 sensor and insertion device | Image © JDRF Forum user Mandy

Links for further reading:

As I mentioned earlier this month I have been using the web site to track my blood glucose and insulin dosages. Along with the Calorie King Exercise and Nutrition Manager the web site has helped me in controlling my BG. It's the modern day equivalent of a log book. I can see how my BG changes over time and how insulin and diet affect my BG. It's like a feedback loop. I log my current BG, record my meal carbohydrates and decide on how much insulin to take. Later when I test my BG again I can look back to how the insulin and food affected BG. I eat the same breakfast each morning which gives me a baseline for comparison. My one big feature request is for the folks at to work with the folks at so that I can enter my BG, insulin, and food intake all in one place.

Using is easy. After you sign up for a free account there is some initial setup to configure your account profile (insulin, measurement units, foods, etc). - Simple Online Blood Sugar and Diabetes Management

Navigation is quite easy with the menu bar always near the top of the site. - Index - Simple Online Blood Sugar and Diabetes Management

The Messages area allow you to send a small note with your BG and insulin readings to your anyone. This would be great for sharing my progress with my endocrinologist; if only he had an email account. The Logs section is I put information about my last doctors visit such as HbA1C and any changes recommended by my doctor. The medication section is where I enter information about the type of insulin I take and the units.
As you can see it's fairly straight forward.

One interesting feature of is the TrustedVue Login.

TrustedVue is a SugarStats feature that lets you easily share your statistics with your friends, family or health care professional.

I put my wife on this list. At anytime she can login with a username/password and see how I am doing. Again, if only my endo would use this.....

Of course all this is nice but what about entering and viewing data. Across the right hand side of the SugarStats page is a set of links for Views and Graphs and Trends. There are views for Today, Yesterday, Last 7 days, Last 14 days, and Last 30 days. There is even a link to upload data from your glucometer. Although only one meter brand is supported at this time I expect that to change as more people use the site and demand support for other meters.

The view section is where the user enters information about insulin dosage and BG readings. Data entry is fairly simple. - Day - Simple Online Blood Sugar and Diabetes Management
Enter your BG (or medication) value, pick a time and event and click "Save Entries". You can enter information throughout the day or all at once ("Add Another"). Your entries show up as a list below the input area. Once you have enough entries added SugarStats will start to compile - Day - Simple Online Blood Sugar and Diabetes Management
While knowing your average blood glucose, high and lows are interesting, for me the most exciting feature are the graphs. You can get to these by clicking on one of the "Graphs and Trends" links on the right side of the site. There are links for 7 day, 14 day and 30 day, one month, 3 months, etc. graphing. - Last 30 days - Simple Online Blood Sugar and Diabetes Management
The 30 day graph is my favourite. I love seeing how my BG trends over time and comparing that to my food log for the same period to see how different food affect my BG. One feature I would like to see added is the ability to click on any of the points on the graph and be taken directly to the entries for that day.

The other graph shows how your insulin dosage has trended over a similar time period to your BG. - Last 30 days - Simple Online Blood Sugar and Diabetes Management
I can see that over the last 30 days I have increased my Levemir dosage while my Novolog dosage has remained within a narrow range. Looking back at the BG graph I can see that during that same time period my daily BG average has decreased. It's a feedback loop. I know my dosing regimen is working because I can see the effect on my BG over time.

In summary, is a welcome addition to my overall diabetes management strategy. I can only imagine the wonderfully useful things that Marston and his team are working on.