The Twiist AID System by Sequel Med Tech is a next-generation automated insulin delivery pump that measures every micro-dose of insulin in real time, a first in the industry. Designed for people with type 1 diabetes aged six and older, Twiist pairs advanced pump hardware with the twiist Loop™ algorithm and integrates directly with your iPhone and Apple Watch, putting discreet control right on your wrist.
In this review, we’ll cover how Twiist works, what makes its technology different from other pumps, who it’s designed for, and what real users and clinicians should know before considering it.
Searching for a specific answer? Jump to our Frequently Asked Questions for quick answers about the Twiist AID System.
Twiist AID System: Quick-Reference Summary
| Feature | Details |
|---|---|
| FDA Clearance | March 2024 (Type 1, age 6+) |
| Algorithm | twiist Loop™ (based on Tidepool Loop) |
| Compatible CGMs | FreeStyle Libre 3 Plus and Eversense 365 |
| Mobile Control | iPhone & Apple Watch |
| Insulin Capacity | Up to 300 units |
| Weight | Under 2 oz (56.7 g) |
| Glucose Target Range | 87–180 mg/dL (4.8–10.0 mmol/L) |
| Key Innovation | iiSure™ real-time flow measurement |
What is the Twiist AID System?
The Twiist AID System is an automated insulin delivery (AID) pump built by Sequel Med Tech. AID systems, sometimes called closed-loop or hybrid closed-loop pumps, automatically adjust how much insulin your body receives throughout the day based on your real-time blood sugar readings from a continuous glucose monitor (CGM). You still deliver mealtime doses, but the pump handles the constant background adjustments for you.
What sets Twiist apart from other AID systems is its iiSure™ technology (explained below), which physically measures insulin flow rather than simply assuming the expected amount was delivered — an added layer of dosing verification not found in other currently available AID pumps.
Who is behind Sequel Med Tech?
Sequel Med Tech was founded in 2023 by Dean Kamen, Alan Lotvin, Pablo Legorreta, Bill Doyle, and Maureen Toohey. Kamen brings particular relevance to the mission: in the 1970s, he invented the AutoSyringe, widely recognized as the first portable insulin pump. Following years of research and recent advances in manufacturing technology, DEKA Research and Development, Kamen’s engineering firm, developed the Twiist hardware.
How does the Twiist AID System work?
The Twiist system has three main components working together: the unique pump hardware, the twiist Loop™ algorithm (based on the open-source Tidepool Loop), and your CGM.
Step 1 — Your CGM sends glucose readings to the pump
A compatible CGM, either the FreeStyle Libre 3 Plus (worn on your arm or abdomen) or the Eversense 365 (a sensor implanted just under the skin), reads your blood sugar continuously and wirelessly sends those readings to the Twiist app on your iPhone. You don’t need to scan or prick your finger for routine readings. Dexcom approval and Android compatibility are in development.
Step 2 — The twiist Loop™ algorithm calculates your needs
The twiist Loop™ algorithm, built on the open-source Tidepool Loop algorithm that is FDA-cleared for use in insulin pumps, takes your current blood sugar reading, for example, 145 mg/dL (8.1 mmol/L), combines it with your trend data and personal settings, and calculates how much insulin your body needs right now versus 30 minutes from now. It then tells the pump to automatically increase, decrease, or suspend your background (basal) insulin delivery to reach a target glucose level up to 6 hours later.
Step 3 — iiSure™ technology verifies every drop delivered
Here’s where Twiist does something no other pump currently does. The iiSure™ system uses advanced pressure sensors and microfluidic controls to physically measure the volume and flow of every micro-dose as it leaves the pump. Most pumps simply assume that if the motor moved, the insulin was delivered. Twiist confirms it.
This matters because tubing kinks, air bubbles, and cartridge issues can silently cause under-delivery, meaning you think you’re getting insulin when you’re not. iiSure™ detects blockages, leaks, and anomalies in real time and sends you an immediate alert, so you can act before your blood sugar climbs.
Step 4 — You control boluses from your wrist or pocket
When you eat a meal, you (or a caregiver) can deliver a mealtime (bolus) dose directly from the Twiist pump, the iPhone app, or the Apple Watch app. There’s no need to reach under clothing or fumble with a separate device. A discreet tap on your watch is all it takes.
Note: Bolusing before meals is a critical step to great glucose readings. For those who are unable or forgetful, the Loop algorithm has answers. Set the basal rate toward the maximum setting of 6.3 times the maximum rate. Also, gradually lower the CorrF (use the Pump Settings Tool to help determine your Correction Factor).
What are the key specifications of the Twiist pump?
| Specification | Twiist AID System |
|---|---|
| Weight | Under 2 oz (56.7 g) |
| Insulin Reservoir | Up to 300 units |
| Basal Rate | Fully customizable |
| Bolus Delivery | Via pump, iPhone, or Apple Watch |
| Glucose Target Range | 87–180 mg/dL (4.8–10.0 mmol/L) |
| FDA Clearance | March 2024 / Ages 6+ |
| Approved Condition | Type 1 diabetes |
Customizable glucose targets
One of the most flexible features in the Twiist system is the wide glucose target range, from 87 mg/dL to 180 mg/dL (4.8 to 10.0 mmol/L). That lower end of 87 mg/dL (4.8 mmol/L) is more aggressive than many AID systems allow, giving people working toward tighter control more room to personalize their settings under medical supervision. Lower targets are required during pregnancy. Always discuss your personal targets with your diabetes care team before making changes.
Which infusion sets and CGMs are compatible with Twiist?
Compatible infusion sets
The Twiist pump works with several widely-used infusion sets:
- Smiths Medical Cleo 90
- Unomedical Comfort
- Medtronic MiniMed Silhouette
- Medtronic MiniMed Quick-Set
If you’re switching from a Medtronic pump, the familiar Quick-Set or Silhouette sets mean one less adjustment to make. Twiist has a standard luer-lock connection
Compatible CGMs
Twiist currently supports two CGMs, giving you a choice based on your lifestyle and preferences.
FreeStyle Libre 3 Plus
The FreeStyle Libre 3 Plus is a 15-day wear sensor from Abbott that attaches to the back of your upper arm or abdomen. It sends glucose readings to your iPhone every minute and is widely available through pharmacies across the US. If you’re already familiar with the Libre family of sensors, transitioning to one with the Twiist pump is straightforward.
Eversense 365
Twiist is also the first AID system cleared to work with the Eversense 365, the only CGM that lasts a full year. Rather than wearing a sensor on the skin, the Eversense 365 uses a small sensor inserted just under the skin by a healthcare provider. A removable transmitter worn at the site sends glucose data to your smartphone every 5 minutes. The integration became broadly available across the US in early 2026.
For people who find frequent sensor changes inconvenient, or who have skin sensitivity from adhesives, the Eversense 365 option may be worth discussing with your care team. Note that the insertion procedure requires a clinician visit, which is a different process from applying a self-worn sensor.
Abbott’s future dual glucose-ketone sensor is also planned as a future compatibility option, though no clearance timeline has been confirmed.
How does Twiist integrate with iPhone and Apple Watch?
The Twiist app is a native iPhone application, not a retrofitted companion app, but a core part of how the system operates. Through the iPhone app and the Apple Watch, you can:
- Deliver bolus doses discreetly without touching the pump
- View your CGM data and blood sugar trends at a glance
- Adjust insulin settings on the go (within your programmed parameters)
- Share data remotely with caregivers or your healthcare provider for real-time support
For parents of children with type 1 diabetes, the remote monitoring feature is particularly valuable. A parent can keep an eye on their child’s blood sugar and recent insulin delivery from their own iPhone without interrupting the school day.
One important note: the Twiist system currently requires an iPhone. If your household uses Android, this system is not yet compatible, something worth factoring into your decision.
What are the pros and cons of the Twiist AID System?
| ✅ Pros | ⚠️ Cons |
|---|---|
| First pump to physically verify every insulin dose (iiSure™) | Requires iPhone — Android not currently supported |
| Choice of two CGMs: FreeStyle Libre 3 Plus or Eversense 365 | Eversense 365 insertion requires a clinician visit — not self-applied |
| Discreet bolus delivery via Apple Watch | Water resistance specs not fully published |
| Lightweight (<2 oz / 56.7 g) and compact design | Newer to market — long-term real-world data still accumulating |
| FDA-cleared for children as young as age 6 | Battery replacement details not yet fully documented |
| Wide glucose target range (87–180 mg/dL / 4.8–10.0 mmol/L) | Insurance coverage may vary; verify with your plan |
How does Twiist compare to other automated insulin delivery pumps?
The AID pump market is competitive, and each system has a different strength. Here’s how Twiist stacks up on the features that matter most to users.
Table A — Algorithm & Mobile Control
| System | Algorithm | Mobile Control |
|---|---|---|
| Twiist (Sequel Med Tech) | twiist Loop™ | iPhone & Apple Watch |
| Omnipod 5 | Horizon (Insulet) | Android & iPhone |
| Tandem t:slim X2 | Control-IQ | In-pump display |
| Medtronic 780G | SmartGuard | Dedicated iPhone or Android app |
Table B — CGM Compatibility & Approved Age
| System | Compatible CGM(s) | Approved Age |
|---|---|---|
| Twiist (Sequel Med Tech) | Libre 3 Plus or Eversense 365 | 6+ |
| Omnipod 5 | Dexcom G6/G7 | 2+ |
| Tandem t:slim X2 | Dexcom G6/G7 | 6+ |
| Medtronic 780G | Guardian 4 | 7+ |
According to Sequel Med Tech, no other commercially available AID pump currently uses a comparable direct flow-measurement approach. For users who have previously experienced undetected pump failures or occlusions, the real-time verification and faster blockage alerts are a practical distinction worth discussing with your care team.
If you use an Android phone or rely on a Dexcom CGM, Omnipod 5, or Tandem t:slim X2 may be a better fit right now. If you’re in the Apple ecosystem and want the option of either a 14-day wear sensor (Libre 3 Plus) or a one-year implantable CGM (Eversense 365), Twiist is currently the only AID pump that offers both. Talk with your diabetes care team to find the right fit for your lifestyle.
Is the Twiist AID System right for children?
Yes, the Twiist AID System is FDA-cleared for use in children with type 1 diabetes aged six and older. For families managing a child’s diabetes, several features stand out:
- Remote monitoring: Parents can view CGM data and recent insulin delivery on their own iPhone without needing to handle the child’s pump.
- Apple Watch control: Older children and teenagers can deliver boluses discreetly at school without drawing attention.
- iiSure™ alerts: Real-time notifications if insulin delivery is disrupted give parents faster peace of mind.
- Compact size: The lightweight design (under 2 oz / 56.7 g) is comfortable for smaller bodies.
As with any AID system for a child, thorough training and a clear communication plan with your child’s school nurse and diabetes team are essential steps before getting started. Accurate settings are essential for this AID system. Use the Pump/AID Settings Tool (PAST) and start with the recommended settings for an insulin pump, then, over time, try the stronger settings for an AID system. We recommend that you use the CarbF in the PAST, rather than one derived from the outdated 450 Rule. Bolusing before meals is always an excellent way to improve glucose levels. For those who forget or are unable to bolus before meals, Twiist has good options. Raising the maximum basal rate up to 6.3 times the programmed rate and lowering the CorrF allows the Twiist to rapidly respond to a missed bolus. Be careful: do not shorten the duration of insulin action. This algorithm relies on a DIA of 5 to 6 hours to precisely measure insulin action and prevent hypoglycemia.
What training and support does Twiist provide?
The Twiist system includes comprehensive training to help users get started confidently. This typically involves working with a certified diabetes care and education specialist (CDCES) or a Sequel Med Tech clinical trainer who walks you through pump setup, infusion set changes, adjusting settings, and responding to alerts.
If you’re new to insulin pump therapy, don’t underestimate this step. Even experienced pump users benefit from hands-on training when switching to a new system, especially one with new technology like iiSure™.
Helpful Resources & Research
- FDA: Twiist AID System Clearance (P230031)
- Tidepool Loop: Open-Source Automated Insulin Delivery Algorithm
- ADA Standards of Care 2026: Section 7 — Diabetes Technology
- Sequel Med Tech: Official Twiist AID System Information
- Eversense 365: CGM Integration with the Twiist AID System
Frequently Asked Questions
What is the Twiist AID System?
The Twiist AID System is an automated insulin delivery pump made by Sequel Med Tech for people with type 1 diabetes. It uses the twiist Loop™ algorithm (based on the open-source Tidepool Loop) to automatically adjust your background insulin based on real-time CGM readings, and it integrates with iPhone and Apple Watch so you can manage your doses discreetly throughout the day.
How is Twiist different from other insulin pumps?
Twiist is the first automated insulin pump to physically measure the volume and flow of every micro-dose of insulin as it’s delivered, using technology called iiSure™. Most pumps assume insulin was delivered if the motor moved — Twiist actually confirms it and alerts you immediately if something goes wrong, like a blockage or kink in the tubing.
Which CGMs work with the Twiist pump?
Twiist currently works with two CGMs: the FreeStyle Libre 3 Plus, a 14-day wear sensor from Abbott, and the Eversense 365, a one-year implantable CGM from Senseonics. The Eversense 365 integration became broadly available across the US in early 2026. Abbott’s future dual glucose-ketone sensor is also planned as a future option, though no clearance timeline has been confirmed.
Is the Twiist pump FDA-cleared for children?
Yes. The Twiist AID System received FDA clearance in March 2024 for people with type 1 diabetes aged six and older. Parents can monitor their child’s blood sugar and insulin delivery remotely through their own iPhone, which makes school-day management more manageable.
What blood sugar targets can I set with the Twiist system?
Twiist allows you to set a personal glucose target anywhere from 87 mg/dL (4.8 mmol/L) to 180 mg/dL (10.0 mmol/L). That’s a wider and more flexible range than many other AID systems offer. Always discuss your target with your diabetes care team before adjusting it.
Can I control the Twiist pump from my Apple Watch?
Yes — one of Twiist’s key features is the ability to deliver mealtime doses (boluses) directly from your Apple Watch or iPhone, without touching the pump itself. This makes dosing at meals, work, or school much more discreet.
Does the Twiist system work with Android phones?
Not currently. The Twiist system is designed for the Apple ecosystem and requires an iPhone to operate the app. Android compatibility has not been announced yet, so if you use an Android device, another AID system may be a better fit for now.
What infusion sets are compatible with Twiist?
Twiist works with several widely-used infusion sets: Smiths Medical Cleo 90, Unomedical Comfort, Medtronic MiniMed Silhouette, and Medtronic MiniMed Quick-Set. If you’re switching from a Medtronic pump, you may already be familiar with these options.
What happens if there’s a problem with insulin delivery?
The iiSure™ technology built into the Twiist pump continuously monitors insulin flow using pressure sensors. If it detects a blockage, leak, or any delivery issue, it sends you an immediate alert so you can act quickly — before your blood sugar is significantly affected.
How do I get started with the Twiist AID System?
Start by talking with your endocrinologist or diabetes care team to see if Twiist is a good fit for you. If you move forward, the system includes comprehensive training from Sequel Med Tech to help you set up the pump, change infusion sets, and use the iPhone and Apple Watch apps with confidence.
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Last Updated on March 19, 2026
