Not sold on twiist (3 weeks in)
Hi! I'm looking for some help deciding how long I should wait to ultimately decide whether or not to keep using twiist or just go back to MDI.
My insurance coverage is pretty solid and I use an eversense already, so I thought it would be useful to try out twiist to just have the real insight on how useful automated insulin delivery would be after 30 years of classic pumps and MDI.
The first week was full of spikes and lows - my twiist trainer was tweaking settings near daily until we found our feet. My Carb Ratios are way less aggressive that I thought I needed. My ISF is more than double what it was before. And my basal rates are now higher than I would have thought (because that's more normal for the Twiist algorithm, I guess).
Invaluable lesson so far: I have been using too much insulin. And that might help my TIR regardless of my insulin delivery method.
My TIR on MDI without a lot of effort looked like 70% in range, 11% low, 19% high (though not super high). Average bg 136.
My TIR on the last three weeks of Twiist have been 79% in range, 5% low, 16% high. Average bg 135.
While objectively the Twiist helping, I'm not sure I can get past the other quality of life things.
I think I lean towards MDI for the following reasons:
I feel freer on MDI.
Less gear.
Fewer variables.
No painful sites.
No site failures.
MDI means no relentless beeping when I'm out of range and trying to sleep (I have all but critical alerts turned off and still I feel like a loud annoyance for my partner during out of range nights with beeping going on for up to an hour while I'm waiting for the correction to kick in) - my on body vibrations from the eversense work so much better for me.
The pump algorithm is not particularly aggressive in correcting a user error high. Did I underestimate dinner carbs? Well now I'm 260 and going to come back in range over approximately 6 hours.
I feel more disabled with a pump on. And I don't feel super disabled in general. Maybe it's just managing tubing or having to ask for help disconnecting if I'm wearing a site on my arm. Or having to decide not to swim if I want to leave my pump on.
And not least, every single pump site *hurts* by day 2-3 and just leave a scar that's slow to heal. I'm using Flonase, skin prep, skin tac.. but it's the continuous infusion of insulin under the skin where the cannula is that is noticeably irritated every single time. It's pain. Arm sites seem better, but the scars there also remain visible over a week later. It just doesn't seem sustainable.
So twiist users, how long do you think I should ride it out to form a full fair opinion?
I also welcome any tips to combat the complaints I've levied above.