The Twiist insulin pump is a next-generation automated insulin delivery system from Sequel Med Tech that received FDA clearance in 2024. It combines the Tidepool Loop algorithm with ultra-precise insulin dosing in 0.05-unit increments, offering people with type 1 diabetes a new option for closed-loop insulin therapy.
What the Twiist Pump Is
The Twiist is a durable insulin pump that uses a short tubing set to deliver rapid-acting insulin from a refillable cartridge. It pairs wirelessly with a smartphone app and with the Abbott FreeStyle Libre 3 Plus continuous glucose monitor to enable automated insulin delivery through the Tidepool Loop algorithm.
Unlike the older generation of insulin pumps built around proprietary algorithms, the Twiist is designed for interoperability. Sequel Med Tech built it around open standards that allow it to work with multiple CGMs and algorithms over time as additional FDA clearances are granted.
How Twiist Delivers Insulin
The Twiist pump delivers insulin in micro-boluses as small as 0.05 units, which is one of the most precise resolutions available in any insulin pump. For comparison, many older pumps deliver in 0.1-unit increments. This precision may matter most for children, people with low insulin requirements, and those who are very sensitive to small dose changes.
The pump supports both basal (continuous background) insulin delivery and bolus (meal or correction) doses. In automated mode, Tidepool Loop uses CGM data to predict glucose levels and adjust basal delivery every few minutes, with automatic correction boluses when needed.
The Tidepool Loop Algorithm
Tidepool Loop has a unique history. It began as a community-driven open-source algorithm (initially called Loop) used by people with diabetes who wanted automated insulin delivery before commercial systems existed. Tidepool, a nonprofit diabetes technology organization, developed and submitted the algorithm for FDA clearance, and it became the first FDA-cleared interoperable automated insulin delivery algorithm.
Loop uses forecasting math to predict glucose changes based on current readings, insulin on board, carbohydrates on board, and user-configured settings. It adjusts delivery to keep glucose within a user-defined correction range, typically 95 to 115 mg/dL for the target. Users can customize settings more extensively than with most commercial closed-loop systems.
Who Twiist Is For
The Twiist insulin pump is FDA-cleared for people 6 years and older with type 1 diabetes who use rapid-acting insulin. It is not approved for type 2 diabetes or prediabetes management. According to the American Diabetes Association, automated insulin delivery systems are a preferred option for people with type 1 diabetes when they can use the technology safely.
People exploring treatment options for elevated blood sugar in the prediabetes range will not find pump therapy in their plan. If your A1C is in the prediabetes range, lifestyle changes and sometimes metformin are the usual first approaches.
Key Features of the Twiist Pump
- Ultra-precise dosing — 0.05-unit micro-boluses for tight control.
- Tidepool Loop automation — FDA-cleared interoperable algorithm with customizable settings.
- FreeStyle Libre 3 Plus integration — Closed-loop operation with Abbott’s current CGM platform.
- Smartphone control — App-based interface for programming, bolusing, and reviewing data.
- Short-tubing design — Balances pump size with infusion site flexibility.
- Rechargeable battery — Typically lasts several days between charges.
| Specification | Details |
|---|---|
| Minimum bolus | 0.05 units |
| Reservoir capacity | Up to 300 units (varies by cartridge) |
| CGM integration | Abbott FreeStyle Libre 3 Plus |
| Algorithm | Tidepool Loop |
| FDA clearance | 2024 |
| Age indication | 6 years and older |
| Control method | Smartphone app |
Setting Up and Using Twiist
Getting started with the Twiist involves filling the cartridge with rapid-acting insulin, priming the tubing, placing an infusion site, and pairing the pump with the smartphone app. Users also pair the FreeStyle Libre 3 Plus sensor, which communicates directly with the pump to enable automated delivery.
Tidepool Loop settings include basal rates, insulin-to-carb ratios, correction factors, insulin sensitivity, and target glucose range. These settings are usually configured with help from a diabetes care team, especially for users new to pump therapy or automated insulin delivery.
Benefits Compared With Other Pumps
The Twiist offers some distinctive benefits compared with other automated insulin delivery systems on the market:
- More precise dosing resolution than most pumps.
- An FDA-cleared algorithm with roots in the diabetes community.
- Interoperable design that may support more CGMs and algorithms over time.
- Modern smartphone-first control interface.
Trade-offs include its newness (limited long-term user experience), initial supply constraints, and evolving insurance coverage. It also currently integrates with only one CGM brand (Abbott FreeStyle Libre 3 Plus), though this may expand.
Common Challenges
Users of any new pump can expect a learning curve. Common issues for Twiist users include:
- Settings optimization — Tidepool Loop has many customizable parameters that take time to tune.
- Smartphone reliance — The pump depends on smartphone control for most functions.
- Site adhesion and infusion problems — Common to any tubed pump.
- Learning CGM integration — Switching from another CGM requires adaptation.
- Supply chain variability — As a new product, supplies and shipping may vary during rollout.
Insurance, Cost, and Availability
As a newer product, Twiist insurance coverage is expanding. Sequel Med Tech works with commercial payers, Medicare, and Medicaid to establish coverage. Out-of-pocket costs depend on deductible, durable medical equipment coverage, and any financial assistance programs the manufacturer offers.
People interested in Twiist should check with their healthcare provider, Sequel Med Tech customer support, and their insurance plan to understand eligibility, timelines, and costs before committing.
The Bottom Line
The Twiist insulin pump brings together ultra-precise dosing, the community-born Tidepool Loop algorithm, and FreeStyle Libre 3 Plus integration into a modern smartphone-controlled insulin delivery system. It may help people with type 1 diabetes who want fine-grained control and interoperable design. As with any new technology, long-term experience, supply availability, and insurance coverage will continue to evolve. If you are considering Twiist, talk with your diabetes care team about whether its features align with your goals and lifestyle.
