Twiist Pump: A Provider's Take

I've lived with Type 1 diabetes since I was a child and have been on insulin pumps for over 20 years, so I've seen a lot of improvements and changes in pump technology along the way. I recently had the opportunity to try out the Twiist pump for a trial run, and here's my honest take on this newly released system.

CGM Integration: Libre 3 Plus — Core Limitations

Accuracy and Calibration

Libre 3 Plus is the only current CGM natively supported with Twiist in the U.S., and unlike Dexcom, I cannot calibrate it to my meter — which was a dealbreaker for me as an experienced pump user who relies on tight control and manual calibration.

I noticed significant discrepancies compared to my Dexcom G7 and fingersticks, often higher or lower by 20–30 mg/dL, and especially unpredictable in the first day or two of a sensor session. I've also seen many users on community forums report similar issues.

Nighttime Alarms & False Lows

During my trial, Libre 3 Plus generated frequent low alarms at night — especially from compression or placement issues — that woke me repeatedly. I experienced urgent low alarms even when my actual BG (checked via my Dexcom G7) is normal, with no ability to silence alarms temporarily.

This same issue alone has been cited as a reason people abandon the system — and I can see why, especially if you sleep on the sensor site or are a restless sleeper like I am.

Data Sharing & App Limitations

Libre 3 Plus via Twiist only reports to one device, and does not push CGM alerts to loved ones (e.g., spouse/caregiver) like Dexcom's Clarity can. It also doesn't allow me to track trends over time in real-time like my G7 does.

Bottom line: If you consider Dexcom G7 the baseline for accuracy and configurable alarms, Libre 3 Plus feels like a step backward for hybrid closed-loop. Especially at night, the noise from false alarms and inability to calibrate interrupted my sleep — a dealbreaker for me.

Pump Alarms & Occlusion Detection

Alarm Profile

The Twiist pump has loud alarms with no volume control or vibrate-only option — much like Mobi, but I found it arguably more abrupt because there's only one volume level.

I experienced occlusion alarms in the middle of the night without clear cause while sleeping, which caused sleep interruption for a small issue that did not truly cause a real occlusion. I've heard similar reports from other users.

Occlusion Detection Technology

Twiist's iiSure™ technology is marketed as faster occlusion detection (sound-wave-based) than other pumps.

But in my experience, the real-world feedback is mixed: while I did see some rapid alerts, I also experienced false occlusions or odd alert patterns, especially during the early learning phases of using the system.

Bottom line: The alarm system isn't quiet or discreet, and night interruptions were a real annoyance for me — on par with (or worse than) other pod/pump alarms I've used. If silent or customizable alarms are key for you, this system may fall short.

Form Factor vs. Tandem Mobi

I found Twiist to be slightly larger than the Tandem Mobi pump, though still compact enough for pocket wear or clipping to clothes.

It's a tubed pump — which inherently adds physical bulk compared to tubeless options like Omnipod that I've also used.

As someone who prioritizes minimal footprint and tubeless convenience, I tend to prefer systems like Mobi or Omnipod over Twiist.

Overall User Experience & Practical Considerations

Positive Points

• I found the algorithm and app interface to be generally well-designed for usability and predictive dosing and basal rate adjustments.
• The pump's manual bolus button and sizable reservoir (300 units) are solid design choices that I appreciated.

Cons That Matter for High-End Users

• Libre 3 Plus accuracy & calibration limitations — significant for me as someone used to Dexcom's performance.
• No alarm customization or vibrate-only mode, and frequent night noise that disrupted my sleep.
• App and data tools are less mature than established systems I'm used to (fewer analytics, less sharing flexibility).
• Learning curve & parts complexity (tubing, set changes) versus simpler pods. I found the Cleo insertion easy to mess up and rip off the skin.

Summary (For a High-End Experience)

What I Liked:

• Strong algorithm and dosing logic.
• Intelligent design features like manual bolus button and reservoir size.

Key Dealbreakers for Me:

• Libre 3 Plus accuracy limitations versus Dexcom G7, with no calibration — this can directly affect closed-loop performance, which is critical for me.
• Loud, non-adjustable alarms that woke me at night — especially problematic when combined with CGM false lows.
• Slightly larger footprint than Mobi and tubed design felt bulkier to me.