Have you heard about the twiist insulin pump? If not, don’t worry – we are here to keep you in the loop! The twiist is the latest automated insulin delivery (AID) system to join the diabetes treatment toolbox. This insulin pump features a unique algorithm powered by Tidepool Loop Technology, offering clients another option in insulin management.
Meet twiist
The twiist is an AID system that looks and acts a bit differently than current insulin pumps. FDA-approved for individuals 6 years old and older, it is a circular-shaped insulin pump. There is a bladder-type reservoir, called a cassette, that holds up to 300 units of insulin. The twiist AID system is currently compatible only with the Libre 3+ continuous glucose monitor (CGM) and iPhone. Meal and correction boluses are delivered via the phone app or Apple Watch for discreet diabetes management. Humalog (insulin lispro) U-100 and Novolog (insulin aspart) are the insulins approved for use with the twiist insulin pump.
iiSure Technology and Tidepool Loop
The twiist AID system uses iiSure technology within the pump and the cassette to dose insulin. Sound waves are used for direct volume measurement to ensure accurate insulin dosing. This feature also identifies occlusions faster than other currently available AID
systems.¹ Insulin moves through the pump chamber into the iiSure chamber, where sound waves use four checkpoints to verify insulin flow and correct dosing:
1. A baseline measurement is taken of the empty iiSure chamber before the insulin reaches this part of the cartridge.
2. The iiSure chamber fills with the determined dose of insulin and is measured for accuracy.
3. A second check of the iiSure chamber is verified for accuracy.
4. After insulin delivery, the pump measures the iiSure chamber to calculate the amount of insulin delivered. ¹ Tidepool Loop is the algorithm that powers the twiist AID system. Tidepool Loop creates a 6-hour glucose prediction forecast based on pump settings, insulin on board, recent carbohydrate entries, and CGM history. This information is collected every 5 minutes to create a 6-hour glucose forecast. Clients using twiist can view this glucose forecast to help make treatment decisions.
How Is twiist Different?
As we have discussed, twiist not only looks different but also functions slightly differently from other AID systems.
Here are a few more unique features:
Target Range: One of the most interesting twiist differences is that the lowest target range setting is 87 mg/dL, with the highest being 180 mg/dL for insulin delivery recommendations.
Retroactive Meal Adjustment: Users can adjust the CHO amount for a meal or snack bolus if they consume fewer carbs than planned.
Emojis: Using meal emojis helps the algorithm set a personalized prediction of food absorption based on carb, fiber, and fat content. If emojis aren’t used, the system defaults to a 3-hour food absorption.
No contracts: The twiist is a pharmacy benefit (rather than a Durable Medical Equipment benefit) and does not require a long-term contract commitment.
Premeal Preset: This option allows the user to temporarily lower the correction range before a meal to help prevent a post-meal glucose spike.
Workout Preset: This optional setting allows for glucose ranges from 87 mg/dL to 250 mg/dL to be set before, during, or after a workout.
Clinical Pearls — With a twiist
Diabetes healthcare professionals are considered experts in insulin pumps. Whether you are discussing insulin pump options, training, or troubleshooting the twiist insulin pump with clients, here are some helpful clinical pearls:
- Assess for physical and cognitive ability to use, manage, and troubleshoot the twiist insulin pump. Also, evaluate clients’ current cell phones or their willingness to change, as twiist can only be used with the iPhone at this time.
- If a user needs to be away from their iPhone, a small button on the pump itself can deliver an insulin bolus.
- The Libre 3+ CGM cannot connect to the Libre family of apps or the reader when using twiist. All CGM alerts will be through the twiist app.
- There are multiple alarms for various conditions. Education is vital to clients about these different alarms for identification and prompt intervention of potential issues.
- The twiist AID system is not safe for MRI, CT scans, x-ray, or any other procedures involving radiation and will need to be removed for these procedures.²
References:
- twiist. (n.d.). iiSure technology: Introducing the next generation of insulin delivery. https://www.twiist.com/iisure-technology#:~:text=Introducing%20iiSure%20Technology,Join%20the%20Insider%20Listhttps://doi.org/10.2337/dc25-S015
- twiist. (n.d.). Support & resources. https://www.twiist.com/twiist-on-supportCOUTCOMES.123.010157
