My 12 year old daughter went live today with the omnipod.
I dont quite understand the whole Insulin on Board thing.
It was explained to me by the CDE that the Omnipod only tracks IOB from the correction doses, not with food bolus’s but when we started today, it subtracted insulin from her lunch bolus because we had given a correction an hour and a half before (no food then) Our CDE said that wasnt supposed to happen. so like I am all confused now as I know the other pumps do it differently. Help, can someone explain all this to me. (like in the Cliff Notes version)
Well I had a mimimed pump before the omnipod, and it only tracked the IOB from corrections, but from what I understand, the Omnipod tracks ALL insulin… from food, correction, or manual boluses. I like that a lot better and find myself overcorrecting high blood sugars less. I think your CDE must have been confused with the other pumps? Because it sounds like they got it backwards! Maybe someone more experienced/knowledgeable can explain it better, but this has been my experience!
It doesn’t subtract it “from” the correction - it subtracts any correction dose from the next bolus no matter what kind it is. But it doesn’t subtract food insulin from boluses afterwards. Does that make sense? It’s perfectly clear in my head but I was having trouble figuring out how to say it.
When the OmniPod tells you how much insulin is on-board, it does not include any boluses you’ve done for food. The pump assumes that the bolus insulin is “covered” by the food. That said, I’m sure it must include this information in its calculations. I find if I wait at least two hours after the last time my daughter had insulin (whether bolus or correction) that the pump’s calculations are usually right on. BUT (and it’s a big one), since you’re just starting the OP, you may need to do tweaking to the basals and the ratios, etc.
The reason the pump subtracted part of the correction was that it knew that some of that insulin was still present, and was attempting to keep your daughter from going low. I think my daughter’s OP is set for a 3-hour insulin action time. That means the OP assumes that the insulin is active for that long, and it will subtract a percentage of any corrections if it thinks there’s still insulin around. It took us awhile to trust the pump, but like I said, for the most part, it does a pretty good job. It’s like everything else with diabetes, lots of trial and error.
Good luck!
thanks. I do trust the pump, but have a hard time for some reason"getting this"
ok, so let me get this straight.
if her BG is in target and she gets her food bolus with out any correction included then this isnt an issue
when she has a BG out of range before she eats and she has a correction included with the food bolus, then the next time she eats, if its before 3 hours, it will track the IOB from the correction part of the previous food bolus?
Geez, I hope I am not confusing everybody. ( Im like getting obessed with this now LOL)
Sounds like you’ve got it. =D
My daughter has run into trouble when she’s been at parties and is grazing on foods. For some reason, if she boluses a few carbs at a time, but does it say five or six times, she goes low a couple of hours later. Her doctor suggested doing a larger bolus at the start of the party and extending it an hour or two, which has worked out well. We also do that with movie theater popcorn (and I think we got that suggestion from someone on this list!) and it works very well.
Yes, Serena explained it well and you have understood it correctly. Kelsey has it backwards. Having used several pumps, I like the straightforward way that Omnipod does things. The remaining insulin from a food bolus should not be subtracted, because it is still doing it’s job with digesting food. When we had the Cozmo pump, I was always having to add insulin back into the dose, because it subtracted insulin when it shouldn’t have.
The next version of the Omnipod is going to track ALL insulin. Which I think will be great! It is not such a big deal for me, but for my five year old, it is a big deal that omnipod only tracks correction boluses. He has gone low several times from caregivers/teachers not understanding how it works. The big danger here is if he is 100 one hour post meal bolus, and then he eats a snack, he will get another insulin bolus, and then go low. The other pumps take this into consideration, and know he needs more food to cover the original meal bolus.
Kelsie - you have OP and Minimed mixed up.
Jojo - you have it figured out!
Great, thanks everybody for your help. Now I get it.
Its the start of our second day on the pump and we are doing well.
Got up last night every 3 hours and had good numbers , probably just need a litlle tweaking as I think she has Dawn phenomenon, but when on lantus couldnt do much about it, now we can.
Jen, that would be my concern also re: the eating every 1-2 hours apart when they are hungry. My daughter is going to go through puberty at any minute she is always hungry , so I get concerned about the whole insulin stacking thing. but my daughter is pretty good and understands all this probably better then me and if she were 100 probably would not give herself a lot of insulin or any depending on how many carbs she was going to eat. (we used to do this on MDI)
thanks for your insight.
JoJo, there is a way around it that some people use. You can enter all doses as corrections. There are a couple of ways to do it, but we have never done it and I don’t recall the steps. I read about it on CWD. Someone is the UK showed their pump screen and the Omnipod does consider the IOB over there now, so I am sure that we will see it eventually here too. Not sure why they would have different versions.
This is one of my favorite things about pumping. My son definitely has dawn phenomenon and at first I just thought I couldn’t get his breakfast bolus under control. But then in the summer when he was eating later, I found out that he was still going up without eating anything. So we adjusted it on the pump and now his bgs after breakfast are WAY better.
My son doesn’t “use” his number if it’s less than 2 hours since he ate. That way even if he’s high it doesn’t correct it. That usually works, although not always.