What To Expect From The twiist Pump

The twiist insulin pump, developed by Sequel Med Tech, is an FDA-cleared device expected to hit the market this year. What makes it truly unique? twiist is the first insulin pump to allow bolusing directly from a smartwatch, offers the lowest glucose target in the U.S. at 87 mg/dL, and introduces the unique ability to retroactively adjust logged carb inputs. Plus, it features advanced occlusion detection using sound waves—an entirely new approach to insulin delivery technology. Let’s break it all down.

The “sequel” to an industry legacy

Sequel Med Tech was founded by Dean Kamen, the inventor of the first wearable insulin pump, the AutoSyringe. Now, decades later, Kamen is back with his “sequel.” The twiist pump was originally designed for another medication—Remodulin, used for pulmonary arterial hypertension. Sequel adapted this technology for insulin delivery, creating a device that prioritizes precision, flexibility, and ease of use. I had the opportunity to speak with the co-founder and CEO of Sequel, Alan Lotvin, in a recent interview. Check it out below.

twiist offers unique design & wearability options

The twiist pump stands out with its compact, modular design. It features a reusable top housing the battery and internal electronics, while the bottom section—where insulin is stored—is disposable and replaced every three days. The pump holds 300 units of insulin and is water-resistant up to 12 feet for one hour, making it more durable for active users.

When it comes to wearability, twiist offers multiple options. Users can clip it to their clothing, tuck it into a pocket, or attach it to the body using adhesive. This flexibility means the pump can adapt to different outfits and lifestyles without sacrificing function or convenience. The pump also offers a bolus button directly on the device, similar to the Tandem Mobi, so users can take insulin without the use of their phone when needed.

Its algorithm is powered by Tidepool Loop

twiist is the first commercial insulin pump to integrate Tidepool Loop, a FDA cleared version of the DIY Loop algorithm. Originally developed by the diabetes community, this algorithm offers a high degree of personalization. Users can set glucose ranges with a base as low as 87 mg/dL, log carb entries with glycemic index indicators (including emoji-based food classification), and adjust pre-meal targets for better postprandial control.

The emoji-based food classification system allows users to quickly log the glycemic impact of their meals by selecting an emoji that represents the type of food they’re eating. For example, a lollipop emoji indicates a fast-acting carbohydrate, while a pizza slice represents a meal with a prolonged digestion curve. This feature helps the algorithm predict glucose responses more accurately and adjust insulin delivery accordingly.

Additionally, the pre-meal target function enables users to temporarily lower their glucose target before eating. This feature prompts the system to increase basal insulin in advance, helping to mitigate post-meal spikes. By proactively managing glucose levels, users can achieve smoother post-meal control without the need for aggressive correction doses later.

Another standout feature is the ability to make retroactive carb adjustments. If a user overestimates or underestimates their meal, they can modify the carb entry within one hour of logging it, and the system will recalculate insulin delivery accordingly. This is one of my favorite abilities I have with DIY Loop (which I’ve used for a few years now, learn more about my experience here).

My favorite feature: Apple Watch control

The twiist pump is controlled via an iPhone app that mirrors the twiist interface – effectively called twiist Loop – ensuring a familiar experience for Loop users. A unique innovation is its Apple Watch integration, allowing users to not only bolus discreetly without pulling out their phone, but to also enter into exercise mode, pre-meal targets, log carbs, and view the glucose level chart. While the watch still requires a connection to the phone, this feature provides more convenience and discretion than any other pump currently on the market.

Faster occlusion technology uses sound waves

The twiist AID System uses advanced sound wave technology for precise insulin delivery, known as iiSure Technology. Unlike traditional pumps that estimate delivery based on motor movement, iiSure leverages sound wave technology to measure insulin volume with extreme precision, setting a new standard in diabetes tech.

This technology can detect blockages (occlusions) up to nine times faster than other AID systems, helping reduce unexplained high glucose and potentially allowing users to take action before experiencing severe highs or diabetic ketoacidosis (DKA). By checking each insulin dose at four key points, iiSure ensures precise delivery and quickly identifies any issues.

When can we expect twiist?

Back in December, I received an email teasing the pumps release for 2025. Originally set for a limited release in late 2024, twiist is now expected to launch in the second half of this year for users in the U.S. aged six and older. The pump will be available through pharmacy channels, making it more accessible and potentially lowering out-of-pocket costs for users.

I’m excited for users to get their hands on twiist and for consumers to finally have the power of Apple Watch control for the first time! twiist will surely make waves in the diabetes tech world pushing other pump producers to innovate–my hopes, forcing them to bring features like smartwatch control and pre-meal targets.

The future of twiist & DIY technology

Sequel Med Tech has expressed openness to working with the DIY diabetes community to bring additional algorithm advancements—such as those seen in Trio—to an FDA-cleared platform. This signals a future where users could choose between multiple algorithm options, further personalizing their diabetes management.

Stay tuned for updates on the future of twiist and the latest in diabetes tech by following along on my TikTok, Instagram, Youtube and podcast.  

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