Subscribe
eNewsletter
Ready to get certified?
Free CDCES Coach App
Download
Free Med Pocket Cards
eNewsletter
Free CDCES Coach App
Free Med Pocket Cards
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.
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.
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.
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.
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:
References:
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more!
If you’re preparing for the CDCES or BC-ADM exam, this conference, paired with a handful of free bonus courses, serves as the ideal study companion! Plus, this content counts toward the ADA Standards requirements for CDCES Renewal.
With interactive co-teaching, we keep sessions engaging, relevant, and fun.
Let’s learn and grow together!
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Program Objectives:
Upon completion of this activity, participants should be able to:
Grace is a 38-year-old female who has lived with type 1 diabetes for 20 years. She is a nurse and works variable shifts. She voices concern today about her hemoglobin A1c being elevated at 8.4% over the past 6 months. She is doing everything she can to manage her diet, daily exercise routine, and reports rarely missing insulin doses. She is currently using a Dexcom G7 CGM.
She has never pursued insulin pump therapy because she was fearful that she would no longer be in control of her diabetes if she used a pump. She is now interested in an automated insulin delivery system and asks you which pump is “best” for controlling blood sugar.
What is the best way to answer this question?
For last week’s practice question, we quizzed participants on RT forgetting their insulin, and what would be the best response. % of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Grace is a 38-year-old female who has lived with type 1 diabetes for 20 years. She is a nurse and works variable shifts. She voices concern today about her hemoglobin A1c being elevated at 8.4% over the past 6 months. She is doing everything she can to manage her diet, daily exercise routine, and reports rarely missing insulin doses. She is currently using a Dexcom G7 CGM.
She has never pursued insulin pump therapy because she was fearful that she would no longer be in control of her diabetes if she used a pump. She is now interested in an automated insulin delivery system and asks you which pump is “best” for controlling blood sugar.
What is the best way to answer this question?
Answer A is incorrect: % chose this answer, “Discuss the insulin pump options that connect with the Dexcom G7 CGM. This will help simplify her transition to pump therapy by minimizing the learning curve when starting an AID system.” Although some insulin pumps are compatible with the Dexcom CGM, switching to a different CGM supplier should not restrict clients from selecting the insulin pump that best suits their needs.
Answer B is incorrect: % chose this answer, “Acknowledge Grace’s interest in insulin pump technology and recommend that she wait until more advanced insulin pump algorithms are available that are easier to use.” Automated insulin delivery systems offer advanced automation. Waiting for future technology will not help Grace improve glycemic control now.
Answer C is incorrect: % chose this answer, “Recommend that Grace use a tubeless pump as it will suit her better due to her work as a nurse and active lifestyle. This will help to avoid tubing issues or the insertion site becoming dislodged.” The type of pump, with or without tubing, is a personal decision and is not based solely on occupation.
Answer D is correct: % chose this answer, “Review with Grace the details of all the available insulin pumps, algorithms, and compatible CGMs so she can make a personalized decision based on her preferences and lifestyle.” Choosing the right insulin pump is a highly personalized decision. Each insulin pump has different variables and CGM connectivity that must be considered. Grace will need to be educated on the available options so she can determine which insulin pump will work best for her.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!