She was very excited about the imminent rollout of the new PDM. She seems to think it will be soon. I got the feeling they will roll out by midyear. She also seemed pretty confident that Medicare/Medicaid approval will be coming soon as well, particularly given the fact that Dexcom recently announced approval for the G-5 CGM. I was glad she was there because I had planned to discuss U-200 insulin with my endo. My insulin tolerance has increased so that now I only get about two days out of a pod. Although Insulet is soon to begin testing a pod designed specifically for U-200, apparently there are people already using it off label by simply adjusting their basal, bolus and sensitivity settings accordingly. My endo said she would speak with people who are already doing this. I’m hopeful that I can significantly decrease my pod consumption very soon.
Hi, Jim2. I heard the same during my very recent “what to buy?” pump research and want to share my tiny window of experience with a non-100u insulin in an Omnipod. I am so pleased with my results so far (knock on wood…).
I just started with a pump in mid-Jan (TD2 since 1998). Choose Omnipod and am already experiencing my best control ever! My 7 day ave is 101 (my target is set at 100) with a range of 55-165 (one outlayer at 234, see below), 80% in range, 11% below, 9% above (can I go to the “flatliner” forum now??). My morning BG is right on again at 80-100. I use Humulin RU500 insulin (5x as concentrated as u100). Officially this is not approved by either Lilly or Insulet but my Endo supported it. At the time I started U500 in 2005 it was blacklisted by the FDA since there were no syringes to match that concentration of insulin. I dose and still think in terms of “normal” insulin but am very aware that I am self dosing with powerful stuff (and luckily no one around me wants to do me in as in some murder mystery plots, I’d be so easy to bump off and get off scot free!).
My MDI regime… I’ve been using RU500 about 8 years. Before finding an endo who would prescribe it I was on 6 shots/day Lantus and Humalog taking 40-90u/shot (about 350u/day if other insulins) with an A1C never better than 11%. Got down to 8% with the U500 3 shots about 22u/shot. Then lost some weight and quit being quite as stupid about food choices and got to 2 shots/day 22-15u/dose average 30u of the U500/day w/A1Cs around 7%. Then about 18 months ago I started waking up w/BG always above 160 as high as 220. A1C went to 8.4% w/o changing much else so I talked to my GP about getting CGM since I was missing some big highs with my usual 2-3 times testing. Also talked to him about changing to one of the newer 200 or 300u insulins since my insulin usage was decreasing through the years and the U500 is expensive. He sent me to a new endo who recommended Omnipod. I researched and was throughly impressed by the pod design when a guy on youTube took one apart. Also wanted a waterproof pump and no tubing.
Things I fretted about before buying Omnipod… Once again my U500 use as listed as a “no no” so can the pump settings be done correctly? Yes, my Omnipod trainer had prior experience w/U500 clients. I googled it relentlessly and found enough detail to feel comfortable about even though nothing directly discussed it. There is one FDA trial underway for U500 in Ominpod, results due in April 2017… Do I really want to commit to PDQ carb counting with every bite? Yes, time to get serious about it and dial back the denial… Since I am not type 1, insurance said no to a CGM. Can I successfully use a pump w/o out it? This is where an Omnipod sales rep helped. CGM still requires manual finger sticks. I thought I was going to get out of that. 
Yes, you can manually test and manage a pump… I had poor records. Can the insulin:carb and insulin sensitivity factors be figured out? I’m a nerd and love data but knew I had zip other than how much insulin I took a day. My CDE had a form to plug my current insulin use in and based on the excellent results I’ve seen so far, pretty much nailed the factors.
Other things that have helped me get off to a great start…
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Omnipod trainer had solid experience with U500 in pods. The length of insulin action is set to to the longest possible, 6 hrs. U500 is a fast acting insulin but lasts much longer. I did have trouble the first two nights with going too low to 50-60. I simply stopped the pod for 2 hrs until I could reach my CDE (starting with a new device on Saturday wasn’t my brightest moment!). Then we added a 2nd basal rate .05 lower from 7pm-4am.
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Related to #1 above, I found a paper on pumps with key advice: Don’t chase your BG numbers. Resist the urge to tweak too much just because you can. If you are low at night, it started 6 hours earlier, adjust basal. If you are low during the day, adjust boluses.
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My GP recommended not changing from U500 insulin at this time since I already know how I feel on it. I do think I will be headed to U200 or 300 in the future. Particularly since with the Omnipod, my daily use is now down from 30u to around 22u/day.
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Thank you TuDiabetes community… While researching pumps, I found this site. Then found the forum on high BG readings right after a pod change. My first BG after my first pod was 234. So easy to compute a correction dose and it dropped easily to in range. For the second pod change, I adjusted my first bolus 10% higher and my next BG was as expected. Problem solved from other podders posting here!
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My rainbow glitter world would be a truly integrated CGM and pod. Surely it is possible to engineer a BG sensor in/with the delivery tube… Current “integration” as it’s being called now is the receivers being able to share data. Not good enough! Meanwhile I manually tested about 10/day 24/7 for the first week of pump use. Am feeling confident enough now to cut to 6/day. I look like I wrestle with porcupines. But looking forward to instead of dreading my next A1C.
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Without the “Lose It” app on my android phone I would not be able to get decent carb counts.
Keep calm and pump on… Cheers!
Thanks, OBX. The integrated pod/CGM is in the works, as I’m sure you already know. They’re looking at a 2019 rollout, give or take. Corporate appears quite pleased with the algorithm that will drive insulin delivery. Medtronic’s integrated system is coming out soon, so it will be interesting to see how well it works in the real world. I’m sure this will be an ongoing development process once these devices find widespread deployment. My A1C jumped from 6.1 (about where it has been for awhile) to 6.7 at my last visit. My CGM did not indicate much difference in my readings, so I’m hoping that was just an abberation. I did change my strip code from 16 to 17 to help push my numbers down a little bit, and I also bought an Apple Watch so I can see my Dexcom reading at a glance (it will actually show up right on the watch face, so it’s there every time I look). I need to get back with my endo to see if she has found out anything about U200. I noticed you said the higher concentrations have longer tails than U100. How is the onset of effectiveness – any faster or slower than U100? Faster sure would be nice.
Jim2, IDK how U200 compares to U500 on the length of insulin action. I took U100 so long ago and it worked so poorly that I have no frame of reference on how fast it was working. When I currently use the PDM calculations “as is” for the few correction boluses, I’ve needed I get what seems to me to be fast results over my former 2 shots/day where there was no correction capability. Now my BG will drop about 30 pts/hr until I get back to my target setting. That seems fast to me but IDK how that compares to what is “normal”. Last few weeks I have been sticking to 40-75 carbs/meal and have had only three post meal readings over 140.
Way cool on the Apple Watch! I want a CGM but not going to happen.
One more thing I did find on U500 that may interest you is that the spherical size of the bolus under your skin affects absorption rates. A higher concentration of insulin requires a smaller sphere, hence, has less surface area for absorption. Once you start using larger doses (I was up to shots with 80-90 units at a time on the U100), rates of absorption and therefore, net insulin effectiveness can get more erratic. So yet another variable in all this…
Keep calm and pump on. Cheers!
The bolus size issue you mention might be a good reason to go with U200 instead of U500.