The first insulin pump to directly measure the volume and flow of every microdose — powered by the Loop algorithm, available at the pharmacy, with the widest glucose target range of any commercial AID system.
Device specifications change frequently — always verify current information directly with the manufacturer before making any decisions. Full disclaimer.
New to twiist? Start here.
twiist is a tubed automated insulin delivery (AID) system made by Sequel Med Tech — co-founded by Dean Kamen, the inventor of the first wearable insulin pump back in the 1970s. It launched commercially in the U.S. on July 7, 2025, and is built around three things no other AID system has combined before: acoustic microdose measurement, the Loop algorithm, and pharmacy-channel access with no long-term commitment.
First pump to directly measure the volume and flow of every microdose using sound waves. Detects blockages up to 9× faster than other AID systems. More about what you're actually getting matters here.
Powered by Tidepool Loop — the FDA-cleared version of the open-source Loop algorithm originally created by and for people with diabetes. Lowest glucose target of any commercial AID system: 87 mg/dL.
Available at the pharmacy like a CGM, not through a 4-year DME commitment. Starter kit $0 with commercial insurance. No more than $50/month for refills. Try it without locking in.
Dean Kamen commercialized the first wearable insulin pump in the 1970s. Decades later, he co-founded Sequel Med Tech — calling twiist his "sequel" to that original invention. The pump hardware was developed by DEKA Research, his firm.
— Sequel Med Tech · sequelmedtech.com · via DiaTribe and Drug Delivery Business NewsAbout the size of an Oreo cookie, weighing roughly 2 oz. One side is disposable (insulin cassette, 300-unit reservoir, replaced every 3 days). The other side is reusable and lasts up to 3 years. Comes with 4 batteries and 2 charging docks.
Based on the open-source Loop platform. Adjusts basal insulin every 5 minutes using a 6-hour glucose forecast. Can also recommend correction boluses (with user confirmation). Only uses Humalog or Novolog (U-100).
Works with Abbott's FreeStyle Libre 3 Plus. Eversense 365 added in 2026. Sequel's stated goal is compatibility with all commercial iCGMs over time.
Full pump control via the twiist iPhone app. Bolus delivery directly from Apple Watch. Data reports through Tidepool (tidepool.org).
Acoustic microdose measurement (first in class). Lowest glucose target of any commercial AID: 87 mg/dL. Pharmacy-channel access — no 4-year DME commitment. Tidepool Loop algorithm (open-source community heritage).
Standard pump settings required: basal rates, I:C ratio, ISF, target glucose. Max Basal Rate is critical — program at 4–6× the highest basal rate. This is the algorithm's ceiling and significantly impacts performance.
Currently requires FreeStyle Libre 3 Plus or Eversense 365. Keep pump and CGM on the same side of the body to maintain signal. Libre 3 Plus offers 15-day wear with no fingerstick calibration.
Pharmacy benefit — $0 starter kit with commercial insurance, ≤$50/month for refills. No multi-year commitment. Not available for Medicare/Medicaid at launch. Check twiist.com/savings for current program details.
twiist gives you more precision and more flexibility than most AID systems — but it also requires more from you in terms of setup and meal management. Here's what to focus on to get the best results.
Glucose Targettwiist allows you to set a glucose target as low as 87 mg/dL — the lowest of any commercially available AID system. The correction range spans 87–180 mg/dL, giving you significantly more room to dial in tight control than other systems. A lower target means more aggressive algorithm behavior, so setting is meaningful.
At 87 mg/dL, the algorithm works harder to keep you in a narrow range. Better for those who have dialed-in settings and want the tightest possible control. Start higher (100–110) when first learning the system.
The Max Basal Rate is the algorithm's ceiling — the highest it can go for automated delivery. PANTHER clinicians recommend programming it at 4–6× your highest basal rate. Too low and the algorithm can't respond adequately to highs.
twiist updates a rolling 6-hour glucose forecast every 5 minutes, using CGM readings, insulin history, and carb history. This forward-looking model helps the algorithm adjust before glucose changes, not just in response to them.
Unlike some AID systems that deliver automated corrections silently, twiist recommends correction boluses and asks for your confirmation before delivering. You can accept or skip.
twiist has three meal absorption profiles — represented by food emoji — that tell the algorithm how quickly your meal will affect glucose. This is one of its most practical features, especially for high-fat meals.
Rapid-acting carbs — juice, candy, white rice, fruit. Algorithm doses aggressively upfront expecting a quick rise.
Mixed meals with moderate carbs, fat, and protein. The default choice for most meals. Algorithm spreads insulin delivery more evenly.
High-fat, high-protein meals that digest slowly and cause delayed glucose rises. Algorithm extends insulin delivery over a longer window.
Review at every visit. Program at 4–6× the highest basal rate. This is the most impactful single setting. Too low = algorithm ceiling reached during highs = inadequate correction. Common reason for suboptimal TIR on twiist.
Pull 14-day Tidepool report (tidepool.org). Select: AGP (CGM), Basics Chart, Daily Charts, Device Settings. The PANTHER twiist clinical tool walks through big picture patterns → small picture reasons → plan step-by-step.
Reinforce pre-meal carb entry for every meal and snack. Encourage use of meal absorption presets (fast/standard/slow) — they meaningfully improve post-meal control. Retroactive entry is available but proactive is preferred.
Most patients benefit from starting at 100–110 mg/dL, then lowering to 87–100 as they gain confidence. Lower target requires well-calibrated I:C ratio and ISF to function safely — verify these before titrating down.
twiist combines three independently significant innovations into one system: a fundamentally new pump delivery mechanism, an algorithm with deep community roots and real-world evidence, and an access model designed to remove cost as a barrier. Here's how each piece works.
iiSure™ TechnologyThe twiist pump uses acoustic sensors to directly measure the volume and flow of each insulin microdose as it's delivered — in real time. No other commercially available AID system does this. Every other pump infers delivery indirectly from motor steps and back-pressure.
The iiSure system includes four validation checkpoints for every dose: confirming the commanded volume was actually delivered, checking flow rate, detecting air, and monitoring for blockages. All four happen with every microdose.
Traditional pumps detect blockages when back-pressure builds up enough to trigger an alarm — a process that takes time and allows glucose to rise significantly first. twiist detects the discrepancy between commanded and delivered volume immediately. Clinical studies show detection up to 9× faster at low basal rates, 5–30× across all rates.
"Silent insulin non-delivery" — where a pump appears to be running normally but isn't actually delivering insulin — is a known clinical risk with tubed pumps. iiSure's direct measurement catches this scenario before glucose starts rising, instead of after.
The Loop algorithm has one of the most unusual origins in medical device history — it was created by the diabetes community itself, for the diabetes community, before any company got involved. Understanding this history explains a lot about how twiist behaves.
It's important to emphasize that all AID systems are better than a pen. But that doesn't mean they can't be improved upon. We're still in a scenario where we have a lot of work to do.
— Alan Lotvin, MD, CEO & Co-Founder, Sequel Med Tech · Drug Delivery Business News · drugdeliverybusiness.comThe C|A|R|E|S Framework from the PANTHER Program at the Barbara Davis Center for Diabetes — applied to twiist.
twiist Loop algorithm (Tidepool-cleared open-source Loop). Updates 6-hour glucose forecast every 5 minutes. Adjusts basal automatically. Recommends correction boluses (user confirms). Max Basal Rate = ceiling — program at 4–6× highest basal rate. Meal presets: fast/standard/slow absorption.
Glucose target: 87–180 mg/dL (widest range of any commercial AID). Basal rates, I:C ratio, ISF, Active Insulin Time all programmed by user. Max Basal Rate (critical). Retroactive carb entry with time of eating. No dedicated activity mode — raise target manually for exercise.
Loop can be turned off — pump operates with a simple bolus calculator in manual mode. CGM signal loss pauses automated adjustments. Occlusion detection up to 9× faster than other systems via iiSure acoustic sensing — alerts trigger before significant glucose rise.
Pre-meal carb entry for all meals/snacks (fixed entry acceptable for simplicity). Use meal absorption presets. Retroactive entry available if meal bolus forgotten. Keep pump and CGM on same side of body. Max Basal Rate is the most impactful single setting — review at every visit.
CGMs: FreeStyle Libre 3 Plus (15 days), Eversense 365 (365 days, added 2026). Goal: all commercial iCGMs. Data: Tidepool reports (tidepool.org). iPhone app + Apple Watch. No stated remote caregiver follow app as of launch — verify current status at twiist.com.
Source: PANTHER Program / danatech twiist Clinical Tool · Barbara Davis Center for Diabetes · twiist.com User Guide · Sequel Med Tech product documentation