twiist is the newest insulin pump to enter the U.S. market, and after wearing it for just over two months, I feel like I really got to know this system—both its strengths and its growing pains. twiist is a tubed pump from Sequel Med Tech, available in the U.S. for people six years and up. It runs the Tidepool Loop algorithm, works with the Libre 3 Plus CGM, and is controlled entirely through an iPhone, with deep Apple Watch integration that honestly changes how you interact with a pump day to day.

Starting this experience, I was coming from DIY Loop, so I already had a strong understanding of how Loop-based systems behave, how the iPhone interface works, and what it feels like to manage insulin primarily through software rather than hardware buttons. That context matters, because twiist will probably feel more intuitive to someone with Loop experience — but even without that background, the learning curve isn’t steep.

One of the biggest differentiators with twiist has nothing to do with the algorithm or the app. It’s how you get it. Similar to Omnipod, twiist is available through pharmacy benefits with a prescription, not DME. That means no four-year lock-in, no massive upfront commitment, and the freedom to try it for a short period of time. You can use it for a month, see how it fits into your life, and decide from there. That flexibility is becoming more popular in pump land, and it’s exactly why I felt comfortable giving it a real-world test.