Twiist Insulin Pump Review: A Diabetes Educator with T1D Weighs In

As a person with type 1 diabetes and a diabetes educator, I’m always on the lookout for new technology that can make our lives easier. So when I got my hands on the new Twiist insulin pump, I was excited to see how it measured up. I’ve been using it for a couple of weeks now, and I’ve got some initial thoughts to share.

Keep reading to see what I love about Twiist, what is not working so well for me, and a day-by-day replay of my experience so far.

This review is not sponsored, and all thoughts and opinions are my own.

First Impressions of the Twiist Insulin Pump

Getting started with Twiist was a bit of a process. The communication between my doctor’s office, insurance, Byram, and the Twiist team was honestly all over the place. I was on a list of 5 people in my area to get started on Twiist back in July 2025 when it was first released, and at that time, Byram was the only supplier that could be used.

At first, my insurance denied coverage. Several phone calls, a prior authorization, and an appeal later, we eventually got it sorted out (and I even had a $0 copay to my surprise!) Once it was approved, it was another few weeks before Byram saw that I was on “the list” and shipped the starter kit to me. I’m sure these growing pains will be worked out quickly as the Twiist becomes more mainstream.

Shortly after I got the pump, I met with the local trainer for training.  The training was very relaxed and easy. My trainer, Michelle, was so helpful and fun. We spent about two hours going over everything, and it was a great, laid-back experience. She even bought my iced tea for me at Panera, where we met for training (Thanks, Michelle!)!

The pump itself is incredibly sleek. After years of using the bulky Omnipod and Dexcom G6, the small size of the Twiist and the Freestyle Libre is a welcome change that feels very freeing. This whole setup feels like a pump in 2025 should – super high-tech. I love the lower targets I can set and how the algorithm adjusts my insulin every minute based on my blood sugar, carb intake, and exercise. The support from both the Twiist trainer and the rep has been outstanding, too.

The Pros: What I’m Loving

The Twiist has some features that really set it apart from other pumps I’ve used. Some of my favorites include:

• Pre-Meal Preset: This is a game-changer. I’ve gotten into the habit of using it before I eat, which is a lot easier than traditional pre-bolusing, especially when I’m at a restaurant and don’t know when my food will arrive. I’ve also found it’s a great tool for a stubborn high that just won’t budge.
• Customizable Food Types: I appreciate that you can select the food type – fast, medium, or slow-absorbing – so the algorithm can deliver the insulin in a way that matches your meal.
• Ability to Adjust Carbs: I really like that you can adjust how many carbs you’ve eaten after a meal. There have been a few times when I ate more or less than planned, and being able to adjust after the fact is a great feature.
• The Looping Algorithm: The way the Twiist adjusts my insulin every minute based on real-time blood glucose is incredible and so intuitive.
• Clear Picture of Insulin Delivery: I can see exactly how much insulin I’m getting at a glance, along with active insulin and active carbs. It gives me a much clearer picture of what’s happening.
• Tighter Control: You can set lower targets, as low as 87, which allows for tighter blood sugar control compared to the Omnipod, which doesn’t let you set a target below 110.
• Advanced Occlusion Detection: While I haven’t had any occlusions yet, I’ve heard from others that the Twiist is excellent at detecting them quickly. This is a huge safety feature.
• Apple Watch App: As someone who likes convenience, not having to pull out my phone to deliver insulin, start the pre-meal preset, or switch to exercise mode is a huge win.
• Size of the Pump: I love how small the pump itself is. It is a lot less bulky than the previous tubed pumps I have used, and it’s easy to store away on my waistband or my bra.
• Changing Settings is a Breeze: No more digging around in menus to find what you are looking for. I love how easy it is to find and adjust therapy settings as needed.
• The Sequel Team: The Sequel trainer and Territory Business Leader have been incredibly helpful throughout this process. The Territory Business Leader dealt with my doctor’s office, helped with the appeal, and ensured I was ultimately able to obtain the Twiist after it was initially denied. He even stopped by my house with Libre samples when I wasn’t eligible to get them through my insurance yet. The trainer has been checking in on me regularly and answering all of my questions. When I called the Twiist support line, they answered right away and helped resolve my issue. The support has been top-notch!

The Cons: Unexpected Challenges

There have definitely been a few challenges, and honestly, many of them are related to the Libre, not the Twiist. If I could wave a magic wand, here’s what I would change:

• Connectivity Limits: Your phone has to be very close to the pump to stay connected. If I even walk to the other side of my kitchen, the connection can drop, which means I can’t see my blood sugar on my Apple Watch or use my Apple Watch to take insulin.
• Tubes Again: After years with the tubeless Omnipod 5, getting used to tubes again has been an adjustment. It’s not a huge deal, and it’s nice to have a smaller infusion set on my body. I also like that I can disconnect the pump when I’m in the heat, which helps prevent my insulin from getting fried.
• Lack of Infusion Set Options: At first, I wasn’t a huge fan of the Cleo infusion set, but I’m getting used to it. I do wish there were more options to choose from, though. Other compatible infusion sets are available, such as the Inset and the Contact Detach; however, I have heard that some suppliers are cracking down and only offering this to patients using Beta Bionics pumps. 
• No Alerts for Loved Ones: The Libre 3+ can only connect to one device, and it connects to the Twiist. While family members can download a Twiist follow app to see your data, it doesn’t send alerts. I’m used to my husband getting alerts from my Dexcom if I go low overnight (especially if one of us is traveling), since I sometimes sleep through alarms.
• Data Reporting: I wish Tidepool had a better app. The website is excellent and has beautiful graphs, but the mobile app is a little lacking. The Twiist app itself doesn’t show much data either. I miss the detailed history section on the Omnipod 5 app that showed time in range, daily insulin use, and more, as well as the Dexcom Clarity app.
• Uncertain Insulin Levels in Cassette: It’s hard to determine exactly how much insulin is left in the cassette. One time it shut off when it said I had five units left, while another time it said I had zero units for about 8 hours. It would have kept going even longer, but I changed it before bed so it didn’t run out and wake me overnight. This may be related to how accurately you fill the cassette, but it makes planning difficult.
• So Many Pieces: I’m used to just carrying a few extra Omnipods and alcohol swabs, but with the Twiist, I need to carry the Cleos (several extras in case one doesn’t stick), the tubing, two syringe parts for filling the cassette, an extra battery and charger, skin tac, and the cassette itself in addition to my insulin. It would be great if some of these items came in a single, pre-packaged unit.
• Increased Insulin Waste: I’ve been filling the pump with about 30 more units than I did with my Omnipod to fill the tubing. This might not be an issue if you’re used to a tubed pump, but I had forgotten how much insulin is wasted in the tubing.

My First Two Weeks using Twiist, Day-by-Day 

Like with any new diabetes tech, my first two weeks have definitely been a learning curve and a bit of a rollercoaster. I think the next two weeks will go much more smoothly now that I have a few things figured out.

Week 1

Day 1: Training went well, and I was excited to get started. My first night was a bit rocky, though. My Libre was way off, telling me I was low when I wasn’t. I woke up with a reading of 96, but my finger stick said 206, and my Dexcom said 170. This was a definite issue with the Libre, not the Twiist, but I wasn’t expecting such a huge variance. Due to the Twiist thinking I was a lot lower than I really was, I was getting less insulin than I needed, thus messing up the algorithm and causing higher blood sugars. Despite this, I had fun nerding out on the new features and trying out the pre-meal preset.

Day 2: I was hoping for better luck with my Libre today. My numbers were a bit of a rollercoaster, with a high after lunch and a low after dinner. The Libre was still reading low when I wasn’t, but it seemed to be sorting itself out.

Day 3: The Libre thought I was about 30 points lower than I actually was all night, so I spent the night slightly elevated in the 140s-150s. It evened out by mid-morning. I went to a workout class and used exercise mode, which worked perfectly and kept my blood sugar steady without dropping.

Day 4: I woke up and changed my cassette and pump site. The Cleo was quite painful to insert on my stomach; I had previously used my mid-back area. About two hours later, I was at a park with my kids, and the cassette failed. I was out for the day and only had an Omnipod on me, so I put the pod on and wore that for the next three days. Twiist support was very helpful in getting replacements sent out to me.

Days 5-7: I restarted the Twiist on Monday night when my pod expired. I kept the Libre on the whole time I was using the pod, and it was still reading slightly low; however, everything else was stable.

Week 2

Day 8: I had a pretty scary experience this day. Around dinner time my Libre said I was 206, so I took the recommended amount of insulin for my meal, which was about five units. About twenty minutes later, I felt off, so I decided to check my blood sugar with a fingerstick. It was 50, and I had six units of insulin still on board and a full belly from having just eaten. I was home alone with my kids, so after having a mini freak-out, I ate and drank everything in sight quickly to get my blood sugar up to a safe range. After that experience, I put on a Dexcom for added peace of mind.

Days 9-11: Things were starting to even out, and I was feeling more confident using the Twiist and trusting the Libre. I even had a great day where I was over 90% in range!

Day 12: My Dexcom showed I was elevated overnight in the 140s-180s, likely because the Libre was reading 30-40 points lower and giving me less insulin.

Day 13: The Libre was still reading about 30 points low and starting to fall off. I had decided to pre-soak a new one for 24 hours to see if it would help with accuracy. The readings were super accurate most of the day, until bedtime, when it started reading low again, so I decided to run in manual mode. I was still elevated most of the night which could have been from poor absorption (I was supposed to change my infusion set but forgot) or the flu shot I got earlier that day. 

Final Thoughts on the Twiist Insulin Pump

Long story short, I am growing to really like the Twiist. It’s a robust pump with some fantastic features that feel truly next-gen. However, I realize that no CGM is perfect, but the Freestyle Libre 3+ has not been as accurate for me as the Dexcom G6, especially during the first few days of a new sensor and overnight. This makes me very excited for the planned Eversense 365 integration, and I hope to switch as soon as possible.

The Twiist algorithm is fantastic, but I do think you need to be a decent carb counter and diligent about entering your carbs as accurately as possible to have the best results. I had become a bit lazy with my Omnipod and would often give myself manual boluses when I was eating, so this has been a good reminder for me and should help improve my time in range.

I am planning for the Twiist to be part of my routine moving forward; however, I may need to use it in manual mode occasionally, especially during the first few days of a new Libre sensor, so the algorithm doesn’t get thrown off by inaccurate readings. I really do wish there were a way to calibrate the Libre to help with this. 

Have you had a chance to try the Twiist insulin pump yet? Let me know your thoughts below! 

Before you go, make sure to follow along on Instagram (@mamabetesblog) for more real-life tips, recipe ideas, and exclusive content, and don’t forget to sign up for the free Mama-Betes newsletter!