Journey to Podlandia

Good luck with Auto mode! I had similar issues with meal bolus absorption in Auto mode and tried two methods of limiting meal bolus size:

  1. Limited pod bolus to 5 units, used syringe for the rest of my bolus. This did not noticeably improve things and might have made things a bit worse by hiding some of my TDD off the books and fooling the algorithm.
  2. (Sorry this is a bit convoluted but this seems to work for me): Prior to meal I switch to Manual mode. Usually will add a temp basal at about 1 unit per hour greater than normal basal, for duration of 1.5 to 2 hours. If necessary, take correction bolus and wait for BG to get in range. Meal bolus: About 4-5 units 10-20 minutes prior to meal and remaining bolus Extended for 1/2 or 1 hour depending on size of meal (longer for large meal). After meal: Watch BG, cancel temp basal and switch to auto mode as soon as BG is both in range and dropping. I use 70-150 as my range.

To make a long story short, after trying everything I could think of to improve Auto mode performance for meals I ended up with much better BG using manual mode for meals so I could use Extended bolus. The way things worked out I am probably in Manual mode about 4-5 hours per day.

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Thanks for that valuable advice, John. I suspect that I’ll eventually use auto mode only during fasting hours, which makes up about 12 hours of my day. But I want to give it a fair trial in auto because, well, you never know until you try it. I’m going to start out by simply splitting larger insulin doses. So, if I’m doing Chinese, and will need 8 units that I’d normally give over 90 minutes, I’ll instead plug in half the carbs and give half the bolus before the meal and the remaining carbs/insulin in 60 minutes, then I’ll cross my fingers. :wink:

I’d like to have a working plan in place before the 27th, when I leave for a modern-day Roman orgy known as a cruise. Oh, my.

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My 770G warranty ran out Jan 3 and I’m looking for a new pump. The problem I had with the Omnipod was it’s only available through a pharmacy Rx. My Medicare gap part D has it as a Tier 4. Tier 4 has a $500 deductible and 50% copay. This will end up costing me about $1,500 a year. I called Insuet and they told me that they only could list the Omnipod on Pharm or Medicare Part B Durable Medical Equipment . They would have a larger customer base with Type 2’s if it was on a Parm plan. If I was able to get it through DME it would cost me $0. So no trip to Podlandia for me.

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A few people have reported getting OmniPod 5 through Medicare Part B (durable medical). But folks don’t tend to differentiate between Traditional Medicare coverage and Medicare Advantage Plans, so it’s tricky making comparisons or blanket statements regarding coverage. OmniPod has up until recently only been available by prescription paid for under prescription coverage. Maybe that’s changing with some Advantage plans? Don’t know.

My insurance is somewhat unique. I am on Traditional Medicare with a supplemental BCBS policy that is quite generous. It is a retirement perk that the same coverage I had as an employee (RN - large teaching hospital) would remain in place as a Medicare supplement. In fact it even goes a bit further - whatever the current coverage is for working nurses, under the current nursing union contract, is what I get. This supplement includes prescription coverage. My cost for starting OmniPod was $90 for the starter pack (controller and 11 pods) and $90 for 30 pods. So, ongoing costs will be about $1 a day. My insulin is covered 100% under pharmacy benefits.

I’m a huge believer that there needs to be a fairer way for our healthcare expenses to be covered. I got lucky and getting needs met shouldn’t fall to luck.

As to pumps - if you could get coverage for the T-Slim X2, that’s a good way to go. It’s a great pump with lots to rave about. I was in the position of either needing to order a new Tandem pump or trying something different. Since there is no long-term commitment needed to try the OP5, I jumped in. But truth be told, as much as I’m liking the “no tubing” thing - I wouldn’t go broke trying to pay for it if my insurance was stingy.

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@TEH4PWR I see you are new here. Welcome aboard!

Glad to see someone else who likes to “experiment” with their toys. I’m currently looking for another pump that’s covered by my province (I live in Canada). My Animas Ping (yeah many of us still use Animas) needs to be retired - and I’m hopping on the band wagon of coverage for my next 5+ forever pump. I dabble too like you with MDI, tried out the Ypsomed - but it had problems - so was snatched away from me during the 2 week trial period (they refused to give me a pump to continue with trial and told me they didn’t feel this pump was a good fit for me - like … really … BITE ME). So hopped on the bandwagon of Medtronic and trialing that (you can see some of my posts in social media on the ups/downs with the 770G / Guardian 3 “closed loop”. Main thing, I’ll not fling any of my provinces money onto a new pump until I know it’s the right fit for me.

Hey there - and welcome to TuDiabetes ! There’s no way you can pay some of the costs out of pocket like I do here in Canada to be on part of the “Podlandia” journey? I only get $2,400 here in Canada for pump supplies - so Omnipod if I use it all the time is more costly than a tubed pumping - but it’s so nice I only treat myself to a box for holidays where I am going to be more active. I use the Eros - original one without smart phone because I’m an old far and hate technology … sort of :rofl: :kissing_heart: . In a purrfect world (pun intended) - if only a worldwide Pharmacare existed so we don’t have to go through all this shite to be able to afford technology.

Psst, I’m currently trialing the 770g - with hopes of seeing if 780g algorithm for folks like me who like tighter control - is my next pump (I use Animas Ping usually - but flit from various pumps to try out - and I guess I’m a bit of a pro with MDI and app that works like a pump calculator - so it’s what I call a ‘poor mans pump’ .

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Thanks. I have been active on T1Dexchange and on Ford Truck forums for years and realize there might be a forum for T1D. Glad I found y’all.

I have a gap plan because it allowed me to not change my Endo and GP. I live in central Virginia and the closest Endo is 34 miles away. Luckily my GP is in town 6 miles form home. I had been using CVS Caremark while employed and had good luck with them. My minimed pump and supplies were covered 100% after I met the medicare deductible. That usually happens by the end of January.

I have been T1d for 30 over years and a minimed user for 20 years. I’m frustrated with the algorithm and all calibrations and false alarms with the 770G. I cant get below 7.1 A1C, except for one 3 month stint. I have been waiting for the 780G upgrade for 3 years. Minimed will not tell us when the 780G will be available.

I am looking at the Tandem pump now. I have confirmed the T-Slim X2 and Dexcom 6G will be covered by Medicare. I will be talking to my PA and Endo on Friday and see how much they think of the T-Slim pump.

Thanks for your inputs.

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Well, today it’s my turn to have diabetic issues. Bet you didn’t know we are destined to take turns with issues, did you? :wink:

Yesterday, I started my second pod. I was in auto mode. The rest of the day was a dumpster fire. My food choices were reasonable with known carb counts and yet I couldn’t get a post-lunch high of 230 to break. I ended up giving a supplemental syringe coverage bolus, and that worked. Around dinnertime I exited auto mode and while in manual mode bolused then ate and I went back up to 220 and stayed there all evening. I finally gave another small syringe correction and called it a night. Dang it. There didn’t appear to be any pooling visible at the site. My feeling was this pump sucked and everyone who hated them was right.

I was quick to blame O5. That was rage problem solving. This morning I again calmly reconsidered those highs and remembered I’d opened a new vial (six months old/refrigerated) to fill the pod. The supplemental syringe bolus was from a disposable pen I’d had in use for a couple of weeks. So, bad insulin, maybe, despite it coming from a sealed vial?

I just got off the phone with Omnipod support and they are sending out a replacement pod. I’m discontinuing the one I’m wearing and filling the new one with fresh insulin. You’d think after all these years I would have suspected the insulin; I would have had I been on the T-Slim. Technology bias in play, maybe?

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I find it fascinating how Canada manages their healthcare coverage. We so often hear about service delays and treatment denials but I’ve never actually spoken to a Canadian who would rather go with a For-Profit Health Care System such as what we have in the USA. So, thanks for your comments here.

And I’m curious - what MDI bolus calculator app do you have available in Canada? We’re pretty limited here by developers willing to go through the FDA approval process. Diabetes:M has recently had to remove their calculator for USA users. I’m worried Jade might be next.

For a little perspective, many diabetics in the world would consider “only” $2400 government money for pump supplies to be a lifesaver. In Ontario (where I assume you are since that’s the Assistive Devices Program annual amount) that’s roughly 70% of the cost of supplies. Plus in Ontario you get your pump or PDM covered 100% with no outlay on your part, with none of the age limits that apply in most other provinces. Plus Libre is covered 100% or, if you qualify, Dexcom is covered 100%. And if you’re a senior in Ontario, diabetic or not, prescriptions for about 5000 drugs are covered. That’s a pretty darn generous “only.”

No argument. Full coverage would be nicer but happy to get the support I get (also in Ontario, also get $600 every 3 months as long as I get all the supporting documents done).
I am also lucky to have employer sponsored benefit plan that covers most of the $300 monthly Dexcom outlay. That is subject unfortunately to an annual maximum of $3,000.00 so I’m out $600.00. Part of which is not tax deductible.

Overall, I am responsible for about $1,200.00 per year of supply costs, after reimbursement. Plus the drug deductible of another few $100s.

Lucky to be in Ontario. Luckier yet would be not to have diabetes.

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Thanks for all the info on Canadian coverage. I’m a big fan of Ontario and (local to me) you are our neighbor to the south. :wink: I am curious if you have an equivalent of the FDA in Canada that essentially tells pump manufacturers how much control the end-user has over their pump settings? An example would be allowing a target blood glucose in automatic mode to be no lower than 110. Although this seems to be changing as the newly announced Tidepool Loop software (FDA approved) is allowing a lower target of 89 if I remember correctly.

Update on my Omnipod 5 experience - I’m using automatic mode except while delivering an extended meal bolus. I’m extending all boluses over 5 units with no leaking at the site and the adaptive basal delivery is allowing almost precisely what my manual basal doses would be. TDD is the same in auto as in manual mode.

Bottom line at this point - I think Insulet had to make a judgment call when they advised how to start using the O5 pump. They could have advised everyone to spend a month in manual mode dialing in their settings and usage before going auto but this would have drowned many users for whom this is simply beyond their skill set. Or they could have advised new users to slap that puppy on in automatic mode, fasten your seatbelt, be patient, and tolerate the chaos trusting that eventually the pump will know your TDD and all will be well. They went with the seatbelt on-boarding. My advice to anyone with any savvy as to diabetic management - get it working perfectly in manual mode then go auto. Less drama.

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I honestly don’t know. Health Canada reviews and approves medical equipment, but I don’t know how much direction they give to manufacturers. I used to read complaints about the US PDM bugging you to test after starting a new pod, but with the Canadian PDM that alert was optional. My PDM (not Omnipod 5 yet) has range targets of 3.9 (70) to 11.1 (200), but I don’t know if those are Insulet’s numbers or something the gubmint told them to set.

Health Canada’s website uses sort of waffly language:

Health Canada regulates the safety, effectiveness and quality of medical devices imported into and sold in Canada, including medical devices like insulin pumps. As part of this work, we:

  • review insulin pumps to make sure they meet our requirements for safety, quality and effectiveness before we grant a medical device licence to manufacturers