Frequently Asked Questions

Yes, you can use the Bolus button to bolus directly from the pump itself, even when you are not close to your smartphone.

For more info, download the twiist™ Pump Button handout.

Download

Yes, you can use the twiist Automated Insulin Delivery (AID) System with Loop off whenever you choose.

The twiist AID System uses your preferences for whether Loop is on or off. When Loop is on, the system keeps "looping" when your continuous glucose monitor (CGM) is active and values are available.

If your CGM sensor expires, Loop is disabled and the system uses your pre-programmed basal settings. During this time, the Loop icon is displayed as an open Loop. When a new sensor is started and warmed up, Loop will resume.

No, the twiist Loop algorithm does not learn with time. The twiist Loop algorithm uses a 6-hour prediction based on your personal settings, your current glucose value, how much insulin you have on board, the past 30 minutes of glucose changes, and your carbohydrate information to adjust every 5 minutes to help keep you in your Target Range. 

The twiist™ Automated Insulin Delivery (AID) System is designed to work with compatible iPhones and Androids. View our Resources page for more information on Android phones that are currently compatible.

The twiist App works on compatible iPhones and Androids. Check out our Resources page to learn more about the compatible smartphones and smartwatches!

The twiist App is compatible with all released versions of the Apple and Android watch models when in communication with the twiist App on your smartphone. This optional component provides a discreet way to view your sensor glucose and insulin information. When you choose to have Loop on, you can also enter carbs, deliver a bolus, and more from your watch. For a list of compatible watches, please visit our Resources page.

Switching from MDI to the twiist™ Automated Insulin Delivery (AID) System could be a game-changer! With MDI, you're used to giving yourself insulin injections multiple times a day. The twiist AID System, powered by Tidepool, means no more injections! It automates insulin delivery for you, adjusting your basal insulin based on your real-time sensor data to help keep your glucose levels within your correction range.

If you have any more questions or need support with the transition, feel free to ask!

Call Customer Care at 1-877-4TWIIST (1-877-489-4478).

The twiist AID System is approved for people ages 6 and up with type 1 diabetes with a prescription. 

When the twiist™ Pump and app are not in communication or your smartphone is powered off, the following functionality is still available:

• When Loop is on, the twiist Automated Insulin Delivery (AID) System will continue to adjust basal delivery based on information from your continuous glucose monitor (CGM)
• When Loop is off, the twiist AID System will continue to deliver the programmed basal insulin
• One-button boluses can still be delivered (when enabled in Settings)
• Alarm, urgent alert, CGM alert, CGM urgent alert, and alert settings are saved in a manner that is unaffected by power loss

Yes, you can use the twiist AID System without a cellular data plan. The twiist Pump, twiist App, continuous glucose monitor (CGM), and optional smartwatch communicate using Bluetooth. An internet connection (WiFi or cellular) is required to share data with the twiist insiight™ App and Tidepool reporting, and to receive updates for the twiist AID System.

The twiist™ Automated Insulin Delivery (AID) System uses smartphone sounds, vibrations, and notifications to keep you informed. These will appear on the phone and sound on the twiist Pump (sound only). The settings that control notifications are your smartphone settings and the twiist App notification settings.

For more info, download

For iPhone: twiist AID System: iPhone and Pump Alert Settings

Download

For Android: twiist AID System: Android and Pump Notification Settings

Download

You can add the twiist™ App and twiist insiight™ App widgets to your iPhone Home Screen by following the steps on this Apple resource: https://support.apple.com/en-us/118610.

Yes, you need an iPhone to use Apple iPhone widgets with the twiist App and twiist insiight™ App. Widgets display information from the twiist App or twiist insiight App on your Home Screen, and the apps are only available on iPhones.

The twiist System is available on compatible Android smart devices. Visit our Resources page to see if your device is compatible.

Yes, the twiist insiight™ App provides the ability to remotely see key diabetes management data updates, including glucose levels, active insulin, and carbohydrate entries from the twiist AID System. The insiight App is not intended to be a replacement for the information displayed by the twiist System App and should not inform dosing decisions. The twiist insiight App is currently available on iPhone only.

To allow a follower to see notifications in the twiist insiight App, notifications must be turned on in the My twiist Portal.

In the My twiist™ Portal:

• Log in at www.mytwiistportal.com
• Select Manage followers
• Find the follower
• Look at the Allow notifications column
  • If it says Yes, notifications are already on
  • If it says No, select No, choose Allow, and select Save

For the follower:

• Open the twiist insiight App
• Go to Settings
• Turn on the notification options as needed

Followers can also turn on notifications by signing in to the My twiist Portal from their own insiight account.

The twiist insiight App is currently available for iPhones through the App Store. Our team is working on Android compatibility.

If enabled by the twiist user, you can receive notifications for Urgent Low Glucose Alerts, Low Glucose Alerts, High Glucose Alerts, Pump Alarms, and No Data Connection notices. View our twiist insiight™ App resource to learn more.

Note: twiist insiight App notifications have set values, which cannot be configured. Notifications may differ from the ones received by the twiist user on the twiist App.

The twiist insiight App can send alerts to invited followers. These alerts help followers know when attention may be needed.

Important to know:

• Notification Settings in the twiist™ App may not match settings in the twiist insiight App

Because of this:

• A follower may get an alert that the pump user does not receive
• The pump user may get an alert that the follower does not receive

The twiist™ Automated Insulin Delivery (AID) System uses an internet connection to send system data to Tidepool. If your smartphone is in connection with the twiist Pump, it can store approximately 2 weeks of twiist System data, which will be sent to the data management platform once an internet connection is available. If you will be disconnected from a cellular plan or WiFi for greater than 2 weeks, only the most recent 2 weeks of data will be transmitted.

Your HCP uses a data management platform to review your twiist™ Automated Insulin Delivery (AID) System data. The twiist System sends the data using an internet (cellular data or WiFi) connection.

Your smartphone can store approximately 2 weeks of twiist System data, which will be sent to the data management platform once an internet connection is available. To ensure that your HCP is able to view all of your twiist System data, it is recommended that you connect to WiFi or a cellular plan at least every 2 weeks.

You can share your twiist™ Automated Insulin Delivery (AID) System data with your HCP using the Tidepool Data Platform linked through your My twiist Portal account.

We are pleased to share that we have partnered with Tidepool. twiist™ users and their healthcare providers (HCPs) have access to their reports in the Tidepool Data Management System.

Your twiist™ Automated Insulin Delivery (AID) System data are viewable through Tidepool Web. View your bolus and bolus delivery details, site change information, carb entries, and more. View the Tidepool Web resource, "Viewing data from your twiist Automated Insulin Delivery (AID) System powered by Tidepool" here to learn more!

On your iPhone, you can view your Total Daily Dose with Apple Health, if sharing is enabled.

To turn on data sharing with Apple Health:

• Open the Settings app on your iPhone
• Tap Apps
• Tap Health
• Tap Data Access & Devices
• Tap twiist
• Choose your settings: Select Turn on All to enable sharing or tap Blood Glucose, Carbohydrates, or Insulin Delivery to individually enable

If you're using a compatible Android, or you have an iPhone but prefer an alternate method, you can find this information in your Tidepool web account here.

The twiist™ Starter Kit comes with 4 rechargeable batteries and 2 chargers, this helps ensure you always have a battery charged and ready to go.

A fully charged pump battery will power the pump for 3 days (72 hours) and should be swapped each time a cassette change is completed.

Using an iPhone for the twiist™ System? For more information about adjusting your Pump Volume Level with the twiist Automated Insulin Delivery (AID) System:

For iPhone: twiist AID System: iPhone and Pump Alert Settings

Download

For Android: twiist AID System: Android and Pump Notification Settings

Download

The twiist Pump offers a variety of flexible wear options. It can be secured to a belt or clothing using the provided pump clip or it can also be discreetly placed in a clothing pocket like a traditional tubed insulin pump.

Sequel is working on adhesive options for on-body wear. Alternative adhesive options are available through third-party providers.

The twiist Pump can hold up to 300 units of insulin.

twiist features iiSure™ Technology, which provides the fastest blockage detection - up to 9x faster than other automated insulin delivery (AID) systems.* This gives you more time to make necessary adjustments to potentially prevent high glucose levels related to infusion set failure.¹

1. Klonoff DC, et al. Time to Moderate and Severe Hyperglycemia and Ketonemia Following an Insulin Pump Occlusion. J Diabetes Sci Technol. 2024;18(6):1472-1479.

Enjoy your summer with the twiist Automated Insulin Delivery (AID) System at your side by following these few tips:

• The twiist Pump can handle small splashes, such as from rain or a water balloon fight
• The twiist Pump should not be put under water. Remove the pump prior to swimming
• The twiist Pump and twiist cassette should not be exposed to sunscreen. Sunscreen can cause damage, which may cause leaks or stop insulin delivery

We've all been there, but there are actions you can take to get your supplies and try to avoid insulin delivery disruptions.

First, see if someone at home can mail you your batteries and charger overnight. The batteries are lithium and require an approved hazardous materials shipper, such as FedEx or UPS, to expedite the delivery.

If your spare twiist batteries or the supplied charger are unable to be shipped to you, call Sequel Customer Care for help. We are available 24/7. Call toll-free: 1-877-489-4478

Remember to always be prepared with emergency supplies to keep your insulin delivery on track. Learn more about Emergency Supplies with the Emergency Guidelines resource.

The twiist Pump is small but mighty! It weighs less than 2 oz, and holds 300 units of insulin, making it the smallest available insulin pump with such a large capacity.* It can detect blockages up to 9x faster than other automated insulin delivery (AID) systems.^†

The patented iiSure Technology is an innovative technology that directly measures the volume of insulin delivered and includes 4 checkpoints along the way to help ensure that users get the insulin they expect. This technology also notifies users to blockages (occlusions) up to 9x faster than other insulin pump systems.*

• twiist has the widest Correction Range of any commercially available system (as low as 87 mg/dL and as high as 180 mg/dL)
• The Correction Range settings can be programmed with up to 48 different segments
• No other system has a Premeal Preset that can be used to target a lower glucose as a person is preparing to eat, which allows for some additional insulin to work prior to eating
• Workout Preset range (as low as 87 mg/dL and as high as 250 mg/dL)
• Emojis to represent carb absorption time (user can see "carbs on board")
• Users may go back and add or edit the carbohydrate amount entered
• Shows the user the glucose prediction graph that updates every 5 minutes as the algorithm makes basal insulin adjustments

Tidepool is a non-profit organization focused on diabetes. This technology is community-driven, designed by and for people living with diabetes, and offers extensive customizable options to truly personalize diabetes management. Sequel partnered with Tidepool because of their commitment to empowering the diabetes community. For further details about Tidepool, please visit: www.tidepool.org.

twiist Automated Insulin Delivery (AID) System powered by Tidepool is designed to help manage your diabetes by adjusting your basal insulin based on a 6-hour prediction of your continuous glucose monitor (CGM) glucose levels. You can set your correction range between 87–180 mg/dL, and the system will work to keep you in that range. For meals, simply enter the total grams of carbs into the bolus calculator, and it will help you calculate the right insulin dose. You can also give correction doses whenever needed. Plus, you can bolus right from your connected, compatible Apple or Android watch, your compatible smartphone, or from the pump itself.

For more info, check out ”The Loop Algorithm" section of the twiist User Guide.

Download

No, Open Source Loop has later releases that are not used by twiist. If you're an open source loop user, there may be features that are not included in the twiist Automated Insulin Delivery (AID) System. The twiist AID System is running a modified version of the Tidepool Loop algorithm based on the Open Source/DIY version of Loop. twiist Loop has been cleared by the Food and Drug Administration (FDA).

The Correction Range can be set as low as 87 mg/dL (4.8 mmol/L) and as high as 180 mg/dL (10 mmol/L). It can be set to different values at different times of the day to meet your unique needs. Your Correction Range should be set with the direction of your healthcare provider (HCP).

No, Correction Range and Target Range are different. Target Range is often used for reporting your Time in Range (TIR), between 70–180 mg/dL. Correction Range is the glucose value that the twiist™ Automated Insulin Delivery (AID) System is aiming for.

The twiist™ Automated Insulin Delivery (AID) System uses carb amount and absorption time to help calculate insulin. Absorption shows how fast and how long carbs affect glucose. This helps the system know when insulin is needed.

Watch video

For more info, download Carb Amount and Absorption Time.

Download

There may be times the twiist AID System does not recommend a bolus after carb entry. This can happen when you have enough active insulin to cover the carbs you entered, your glucose is currently below the Glucose Safety Limit, or your glucose is predicted to be below your Glucose Safety Limit. The system will show No Bolus Recommended. Tap Save without Bolusing to continue.

Check later to see if you need a correction bolus to ensure your carbs are accounted for.

The Glucose Chart on the Home Screen and the Meal Bolus screen may look similar, but they show different information.

The Glucose Chart on the Home Screen shows your current glucose, your recent glucose history, and where your glucose is predicted to be based on continuous glucose monitor (CGM) values and rate of change, active insulin, and carbs you have already entered.

The Meal Bolus Glucose Chart shows how the carbs you're entering into the twiist™ Automated Insulin Delivery (AID) System may change predicted glucose and the impact of the full correction dose being delivered by basal. Once you tap Deliver Bolus, the Glucose Chart on the Home Screen will reflect this carb entry as well.

twiist is compatible with both the FreeStyle Libre 3 Plus sensor and the Eversense^® 365 Continuous Glucose Monitoring (CGM) System!

Yes, we will be looking to add additional CGM partners in the future in order to make advanced diabetes management more accessible and flexible for people living with diabetes. We are on a mission to improve the lives of people with diabetes and give them choice in how they manage their diabetes. Having multiple CGM options, so people can select the one that is best for them, is one of the ways we will bring this to life.

twiist is now available nationwide! Learn more about twiist and get connected with us.

We're currently focused on the United States. Our ultimate goal is to make this innovative technology available to people worldwide. We're already taking steps to expand twiist™ availability beyond the United States. Regulatory approval and reimbursement vary by region; therefore, we don't have a timeline for international availability yet. Stay tuned and come back for updates!

Learn more about twiist, what to expect while getting started, and how to connect with a twiist representative by signing up below!

To make the twiist Automated Insulin Delivery (AID) System the best access experience for providers and people with diabetes, we are focusing on making it available exclusively through the pharmacy channel. We are not currently planning to make the twiist AID System available through the DME channel.

Most people pay $0 the first month for the twiist Automated Insulin Delivery (AID) System and no more than $50 each month thereafter.*

We continue to work to gain access across all types of insurance including different Medicare and Medicaid plans. Please reach out to your specific plan for coverage.

There is no contract obligation. People living with type 1 diabetes can try twiist without the 4-year commitment required by many traditional automated insulin delivery (AID) systems, but with the flexibility to manage their diabetes on their terms. Additionally, if you are using an AID system that is in existing warranty, you do not need to wait until your current warranty is up to try twiist.

People with type 1 diabetes with an automated insulin delivery (AID) system in existing warranty can still
try twiist through the pharmacy channel. They do not need to wait until their current warranty is up to try twiist.

Sequel offers training by Certified twiist™ Trainers, ensuring you get the support you need to use the twiist Automated Insulin Delivery (AID) System confidently and effectively.

We have 24/7 live product support with representatives fluent in both English and Spanish. In addition, you’ll have access to Diabetes Educators and a dedicated Customer Care Team to support you throughout your journey using the twiist™ Automated Insulin Delivery (AID) System.

Pre-training support:

Our team will connect with you to determine eligibility, ensure you have everything you need, and schedule your new start training.

Post-training support:

Our Customer Care team is available for whatever you need following your training. We will reach out to you directly to provide follow-up support on safe and effective use of the device post new start training and will provide additional refill support as well.

Ongoing support:

Our Product Support team is available 24/7 to help with any troubleshooting related to your twiist™ Pump, twiist App, or other system components.

The setup is similar to traditional insulin pumps. Healthcare providers (HCPs) assist people with diabetes with determining their Correction Range and other insulin pump settings.

Unlike traditional Open Source or Do-It-Yourself (DIY) Loop, you cannot build the twiist™ App yourself. twiist Loop is provided as part of the twiist Automated Insulin Delivery (AID) System.

View the twiist Automated Insulin Delivery (AID) System User Guide for full system instructions.

Download it here:

Download

Looking to learn more? We can help with that! The twiist™ Resources page has many guides for the use of the twiist Automated Insulin Delivery (AID) System.

We are here to help you 24 hours per day, 7 days per week. For support with your twiist™ Automated Insulin Delivery (AID) System, contact Sequel Customer Support, toll-free 1-877-489-4478.

Sequel is a company based in Manchester, New Hampshire, maker of the twiist™ Automated Insulin Delivery (AID) System powered by Tidepool. The twiist AID System is designed for people aged 6 and up with type 1 diabetes. To learn more, visit sequelmedtech.com and twiist.com.

Yes! We are looking to fill many roles as we continue to expand our US launch. Please visit sequelmedtech.com/careers/ to see if a position is right for you!

The twiist AID System is a user-friendly automated insulin delivery system designed to provide personalized type 1 diabetes management. At its core is the twiist Loop algorithm, which is based on Loop, an algorithm developed by people with diabetes for people with diabetes. The twiist System offers customizable target glucose ranges from 87–180 mg/dL, advanced occlusion detection, and control from your iPhone and connected Apple Watch. With flexible wear options, 300-unit capacity and a small, discreet form factor, twiist is built for people with diabetes who want to customize their diabetes management to meet their unique needs.

It is called twiist because you twist it to open the device (kind of like an Oreo cookie).

The ii in twiist stands for intelligent insulin.

We tried capitalizing the ‘T’ in twiist, but it just didn’t feel right—like wearing socks with sandals. Plus, lowercase ‘t’ keeps things small, sleek, and stylish…just like our pump!

The twiist Pump is proudly manufactured in the United States.

twiist offers unmatched personalization, allowing individuals to set their personal glucose target within the widest Correction Range of any available automated insulin delivery (AID) system (87 mg/dL to 180 mg/dL).* It also features next-level delivery technology, 24/7 world-class product support, and unique features like food emoji libraries and Pre-Meal Preset.

1. Try reinserting the pump battery in the battery charger.
2. If the status light continues to blink red, try inserting the pump battery into the other charging bay.
3. If the status light is still blinking red, one or more of the following components may be defective:
   • Pump Battery Charger
   • Pump Battery

Contact Sequel Customer Care for support at 1-877-489-4478.

1. Verify the connections between the battery charger, USB cable, and wall power adapter are secure.
2. Verify the wall power adapter is plugged into a power source.
3. If the status lights are still not turning on, one or more of the following components may be defective: 
   • USB Cable
   • Wall Power Adapter
   • Pump Battery Charger
   • Pump Battery

Contact Sequel Customer Care for support at 1-877-489-4478.

When the twiist Pump and App are not in communication or your smartphone is powered off, the following functionality is still available:

• When Loop is on, the twiist AID System will continue to adjust basal delivery based on information from your continuous glucose monitor (CGM)
• When Loop is off, the twiist AID System will continue to deliver the scheduled basal insulin
• One-button boluses can be delivered (when enabled in Settings)
• Fault detection and alarm generation is still intact

If an alarm is occurring, disconnect the infusion set tubing from your infusion site. If you cannot continue to use the pump to effectively treat your diabetes without your smartphone, switch to your backup therapy plan.

1. Make sure the twiist™ Pump and App are in communication with each other.
2. You may have Quiet Mode turned on in Therapy Settings. Confirm bolus is in progress by looking at your twiist App Home Screen.

If your bolus did not deliver, review the twiist App Home Screen to check your active insulin, active carbohydrates, event history, and your current continuous glucose monitor (CGM) glucose value to make appropriate bolus decisions.

Contact Sequel Customer Care for support at 1-877-489-4478.

If you need to suspend insulin delivery and the twiist App is not in communication with the pump:

1. Disconnect your infusion set tubing from your infusion site.
2. Remove the cassette from the pump. A Cassette Not Attached alarm is displayed and the pump plays the Alarm sounds.
3. Remove the battery from the pump to silence the alarm.

Rest assured, a simple press of the bolus button does not mean you gave yourself a bolus! Delivery of a One-Button Bolus requires you to press the pump button multiple times in order to initiate a bolus and also requires a playback before the bolus is delivered.

You can also check the Home Screen on your twiist™ App to see whether a bolus is delivering.

For more info, check out the "One-Button Bolus" section of the twiist User Guide.

Download

Make sure your smartphone has an internet connection.

• Make sure a fully charged battery is installed. Do not attach a cassette to the pump
• Put the pump in Bluetooth pairing mode by pressing and holding the pump button for 5 seconds, until the pump plays a Ready Beep
• Select the pump serial number that matches the one located on the pump label
• Make sure you entered the correct PIN number for pairing your pump
• If you are using an iPhone, and the pump was previously paired, you will need to forget the pump in your Bluetooth Settings

There is always a chance that you have information that the twiist AID System does not. Perhaps you know that you are getting sick or that your activity was more strenuous than usual. In those instances, take the action you feel is necessary to keep yourself safe from the effects of low and high glucose.

When the twiist™ Status icon is displayed as a closed circle, Loop is on and insulin delivery is automated.

When the twiist Status icon is displayed as an open circle, Loop is off and insulin delivery is not automated.

If Loop is on, the twiist Automated Insulin Delivery (AID) System will continue making adjustments in an effort to bring your glucose into your Correction Range. If Loop is off, or continuous glucose monitor (CGM) readings are inconsistent, you will need to respond to high and low glucose according to your healthcare provider (HCP)
instructions. You may need to eat additional carbs to prevent or treat a low or take additional insulin to prevent or treat a high.

For more info, check out the "twiist Status" section of the twiist User Guide.

Download

You can tap Settings on the Toolbar or the Pump Status icon to check the status of your pump, or to suspend or resume insulin delivery.

It is always a good idea to check that your devices are working as intended.

If your CGM readings do not match your symptoms or a fingerstick reading from a blood glucose meter, or if you are not getting updated readings from your CGM, your CGM may be having a problem. Tap the CGM Status icon to monitor your CGM.

If you need to replace your CGM, check out the "Start a New Sensor” (FreeStyle Libre 3 Plus Only) section of the twiist User Guide.

For additional support with your FreeStyle Libre 3 Plus, contact Abbott Diabetes Care at 855-632-8658.

Download

When attaching the twiist Cassette to the pump, align the alignment ridge on the top of the pump bump with the alignment ridge on the cassette. Lightly press together and turn the pump clockwise toward the infusion set tubing. You will hear a click when fully closed.

From the twiist™ Home Screen:

• Tap the Pump Status icon to be taken to the twiist Pump Menu
• Tap Check for Pump Update
• If an update is available, you can select to install it Now or set a reminder for Later

Before selecting to install the Pump Software update, be sure that both your twiist Pump and compatible smartphone have charged batteries. The update is sent from the twiist App to the pump using Bluetooth. It can take up to 10 minutes to install.

Note: You must disconnect your cassette tubing to install the pump update. The twiist App will prompt you when to disconnect.

There are 2 ways that the twiist App can update: Automatically or Manually. If you allowed for automatic updates of the twiist App, you will receive a notification from the twiist App to complete the update. If you did not allow for automatic updates, access the App or Google Play store to check if an update is available and start from there, if one is.