Authors’ Note: this is not medical advice. This insight is based on experiences using DIY Loop, thoughts as a CDE and information from the Loop team. Please consult with your healthcare team before making any self-management decisions. DIY Omnipod Loop is STILL EXPERIMENTAL and is being used off-label.
Loop recently released a branch that adds support for Omnipod users, adding to the already existing support for certain models of older Medtronic pumps. Many people with T1D and their caregivers are excited to set it up and use it! But, before you start Loop, it is important to understand where Loop is different than typical pumping . Loop at the surface is much like traditional Omnipod use; you’ll enter basal rates, carb ratios, target blood glucose range, and insulin sensitivities into your Loop app. When you go to eat a meal, you’ll still be entering in a carb estimate and Loop will provide you with a bolus recommendation.
What happens after that though is where Loop takes a new path. Loop predicts your future blood glucose over the next six hours based on those settings, meals, and any insulin on board. Using the prediction, Loop automates insulin delivery using temporary basal rates to help reach your target blood glucose. If your predicted blood glucose drops below your suspend threshold, Loop will temporary suspend insulin to prevent a low. If you are predicted to go above your target blood glucose, Loop will set a higher temporary basal rate to help.
Just like with any new insulin pump or medication, it takes time to adapt to using Loop. In order for the system to do wonders to your blood sugars, you will likely have to make adjustments. It’s normal to have to make adjustments for the first couple weeks using Loop. However, if you don’t understand how Loop functions or how to use the system effectively, it may not help your blood sugars as much as it could. Here are a few suggestions before getting started with Loop!
1) Understand the Pump
It is critical to understand the Omnipod system before starting. If one is new to Omnipod, one must understand its essential functions, what typically can go wrong and how to problem solve. Understanding how and why pods may fail (assessing for leaky pods, site irritation, kinked cannula) is particularly important. When a site is bad, Loop may appear to be working ineffectively. One should be able to identify potential pod issues that cause hyperglycemia or increased insulin usage.
Regarding insulin usage in the Omnipod system, basal rate needs may differ if one changes from a different pump to pods. Each insulin pump has a different delivery mechanism, speed of and precision of insulin delivery. This may impact basal insulin needs. A personal example is that my basal insulin needs differ significantly when using the Animas vs. the Tandem vs. the Omnipod. It may help to wear Omnipod for a week or so first and do some basal testing. Regardless, basal testing should occur before starting Loop. In addition to basal testing, insulin sensitivities and carbohydrate ratios should be tested as well. When these settings are correct, the system will work the best for blood glucose management.
2) Let the PDM and extended boluses collect dust
Pods are very monogamous creatures and they bond with the device they initially pair with. In the switch to using Loop, you’ll now be pairing your pods to your Loop app on the iPhone. This means you will leave your bulky PDM to collect dust. Instead, you’ll carry a small device, about the size of a matchbox, called a RileyLink that will do the communicating between your phone and the pod. You will need to make sure you have your RileyLink and phone in order to control the pod now…those are replacing your PDM in terms of function. If you leave them behind, you’d have to wait to bolus or change insulin delivery just like you would if you’d left the PDM behind.
Extended boluses are also going to be handled by Loop for you now. If you had a meal that you normally would have done an extended bolus for because it was slow, long digestion (ahem…Chinese food, I’m looking at you!), you can tell Loop about that ahead of time using a handy pizza icon. When Loop sees that icon, it will automatically split up your bolus for you. You’ll get some of your bolus immediately and the remaining part later using high temp basals when the later blood glucose spike starts up. No more manual extending of boluses.
3) Use LoopDocs and LoopTips for Training
As Loop isn’t currently FDA approved, it doesn’t come with educators or pump trainers to help you navigate the system. So, the best way to educate yourself about how to set up the system and how it works is to read LoopDocs!
LoopDocs provide information on how the whole system functions- basically, it’s the Loop User Manual with extensive information from how to build the Loop to effective use the system. LoopTips provides information on the algorithm, blood glucose prediction, basal adjustments and bolus recommendations. LoopDocs also provides tips on analyzing patterns, workout tips (temp targets, loop considerations for exercise), troubleshooting lows, tips for disconnecting, extended bolusing, navigating site failures, troubleshooting highs and how to download your pump settings and reports. These tips are critical in using the system effectively.
Should you still read LoopDocs if you’ve used an automated insulin adjustment system (670g) before? Should you read LoopDocs if you’re an experienced pumper? Yes—DIY Loop is different than typical pumping and different than the 670g.
4) Understand Your Insulin Needs and Pattern Management
Loop is not “set it and forget it.” Even if one has basal rates, insulin sensitivity and carb ratios figured out before Loop, they may need to be adjusted when Looping. As the system bases insulin delivery off of the user-defined settings, it is critical to understand the amount of insulin that is safe for the individual before automating your Loop’s insulin delivery (called “closing the loop”).
One should also be able to download their pump and BGs and understand how to analyze patterns. For example, one should be able to identify when a carbohydrate ratio or basal rate needs to be adjusted. It is also important to keep in mind that pre-bolusing is still key as it is still the same insulin at the end of the day. Even though the system will increase basal after carbohydrate consumption, one will still have BG spikes if they do not give insulin a head-start with a pre-bolus. If one is not confident in pattern management, Loop may not be a great fit. Click here to learn more about fine-tuning settings!
Editor’s Note: On May 17, the FDA issued a warning against the use of “unauthorized devices for diabetes management”. Beyond Type 1 encourages people with diabetes to consult with their health care providers in regards to emerging technology, and before making any changes to their diabetes management.
To read Katie DiSimone’s thoughts on the recent FDA warning, click here.