What is the twiist?
The twiist is a new insulin pump by Sequel Medtech that can run as a closed-loop system, also known as an automated insulin delivery system (AID). This means the pump can connect to a CGM and use those readings to automatically make subtle insulin adjustments based on the pump's predictive algorithm to keep you in range.
The twiist is controlled through a phone app, but also has optional manual bolus controls on the pump itself. The twiist is about the size of a hockey puck, with 2 feet of tubing in the standard set. However, it can use any Luer Lock-compatible insulin tubing, allowing you to use any tubing or infusion site with the same connector, like Tandem or Beta Bionics. It holds 300 units of insulin and uses rechargeable batteries that should be replaced every 3 days, but can last about 5 days.
My Experience
I have had an amazing time with the twiist! It has given me so much more control over my diabetes management and the most peace of mind I've had since my diagnosis 15 years ago. Until about 8 months ago, I had used MDI and Omnipod (without the CGM integration), where I was manually counting carbs, calculating corrections, and managing my diabetes manually took up a lot of headspace.
I was interested in getting on a hybrid closed-loop system, but had a hard time trusting my CGMs (read more about that experience here.) However, once I started using the Eversense CGM, I finally found a CGM I could trust. By the time I was comfortable with Eversense, it had become compatible with the twiist. Now that I'm on the twiist I can't see myself running anything else.
Wearing the twiist
The twist comes with a plastic belt clip, which is nice for clipping to a belt or bra strap, but it always left me puzzled when I tried to sit on the toilet or take a shower. However, I have found 2 game-changing solutions. The first is an adhesive kit that lets you wear the twiist on your body like the Mobi, or an elastic pump belt, both of which almost completely prevent tube snagging.
Strengths
twiist’s Algorithm: Tidepool
Tidepool is the algorithm Twiist uses to adjust basal insulin based on your predicted blood sugar. Uniquely, Tidepool is an FDA-approved, open-source algorithm built on a grassroots foundation created by the diabetes community.
Because of this, the twiist is full of incredibly useful features (keep reading to learn more!) and is the most user-customizable pump currently available. This freedom gives you and your care team the most variables to adjust to dial in your therapy, plus useful features like the modes.
Premeal Mode (AKA Feast Mode)
This mode lowers your targeted blood sugar to a lower preset range before a meal when activated. Instead of pre-bolusing 10-20 minutes before eating, you can turn on premeal mode.
This mode is a lifesaver when eating out and you don't know for sure when your food will be served. I might turn on premeal mode on my way to the restaurant, or when I get there. Then, I'll wait to bolus until the food has arrived.
Exercise Mode (Aka Beast Mode)
This raises your target blood sugar range and lowers your insulin delivery to prevent low blood sugars while exercising.
Exercise mode does an excellent job keeping me from going low during my 1-3 mile walks (plus or minus some running), or hours-long bike rides around town. I even used this mode for the 30 minute walk into the city to go to a bar with friends.A Tip for Modes: While the modes are extremely helpful, they aren't magic. Since injected insulin takes time to absorb, it is best to activate either mode at least 20-30 minutes before your meal or exercise.
Block Detection
The twiist can quickly detect and alert you to blockages in your insulin tubing or site. Apparently, it has the fastest detection time of any pump, and some pumps don't alert you at all.
It alerts you with a loud screech, and all you have to do is follow the steps it displays: disconnect, inspect, wait for a self-check, plug back into your site, and restart delivery.
This feature gives me a lot of peace of mind, knowing my pump will let me know something is wrong rather than only learning after a mysterious, massive blood sugar spike or the potential for DKA.
99% of my alerts have been from me laying on my tubing too much, and only once did I have some form of blockage that required me to change my tubing.
Heads-up: This feature only detects blockages; it will not detect leaks.
Apple Watch Compatibility
The Twiist app is easily the best diabetes management app I have seen on Apple Watch. It lets you see your blood sugars and trend arrow on your watch face. Tapping your blood sugar opens the app and lets you use any day-to-day controls on your pump. Bolus, modes, and all the information you can get from the phone app are right there.
Note: the watch connects to your phone, not directly to your pump, you still need your phone nearby.
Exceptional Customer Service
Sequel Medtech offers 24/7 free customer service, and my experience has been exceptional. Every time I've called, I've waited no more than 5 minutes and reached a real person who always seemed to know what they were talking about. No AI, no terrible phone menu. More importantly, they were always able to help.
The training and onboarding staff were also extremely helpful and always available. Whenever I had a question or needed information, they were always a call or text away.
Shortcomings
Infusion Site Applicator
The infusion site applicator can be tricky. The issue is that the site itself sometimes adheres to the applicator more than to my body, so the site can stick to the applicator and get ripped out when when you remove the applicator. There've been times when I had 3 consecutive failed site applications.
The trainers will teach you tips to prevent this, like letting the adhesive come to your body temperature or rolling the applicator off, which do help.
Only compatible with 2 CGMs (right now)
Right now, the twiist is only compatible with Eversense 365 and FreeStyle Libre 3+.
I currently use the Eversense, but previously had success with the Libre 3+ as well. The Eversense is especially nice to pair with a pump since it does not require site rotations, and the transmitter is powerful enough to connect to the twiist from the opposite side of your body.
Libre 3+ Tip: To connect a Libre 3+, you need to activate it in the twiist app. you cannot connect a Libre 3+ that is already in use.
But that's it.
Recent and Upcoming Developments
Pharmacy Availability
The twiist is now available through all major retail pharmacies in the US, greatly improving accessibility. This means there's no contract that locks you into using this one pump for years.
I feel this shows a great deal of good faith on Sequel's part. Rather than locking users into a contract to keep them, they decided to make an excellent product, and it will sell itself.
Android and Dexcom compatibility
My pump trainer shared that Android and Dexcom compatibility are in the works, and Android compatibility will be coming soon.
Closing Thoughts
Overall, I am beyond thankful for my decision to get on the twiist, I wish I could have gotten on it sooner, but I really could not have. After moving out to begin my grad program, my life was a day-in-day-out struggle managing my diabetes on my own for the first time, and I was even starting to question if I could live independently at all. During a period of significant diabetes distress, I researched endlessly until I decided on the Eversense and the twiist and it has been genuinely life-changing. Finally being able to take my mind off my diabetes, even just a little bit, has given me so much more opportunity to live my life.
If you’ve been struggling with your T1D, I cannot recommend a closed-loop system enough.
This article was written exclusively by humans.
