I’m about a week into my Omnipod 5, after having used the Eros system along with Dexcom G6 for about 4 years…and many years of pumping before that. I have mixed feelings about this system so far, and questions as well. For what it’s worth, I’m holding out for the iphone app, so am using the PDM that was included with the system.
As background, I only intended to use Automated Mode during the night. I used to be able to get good control anytime without extra assistance, but something about perimenopause has made my insulin needs increase massively during the 2nd half of my cycle (so ovulation through the first 3 or so days of my period). Sorry if that’s TMI for the guys, but holy cow it’s really making my life miserable for the last 2 years roughly. Anyhow, my way to deal with this has been temp basals, anywhere from +40% to +75%. The problem is, every day is different, and nights are a complete disaster during this time. One night, +40% works ok. The next night it ends in the kind of night time low where my G6 doesn’t even wake me up. The night after that, I don’t increase my insulin at all, and wake up nearly 400 in the night (and NOT after a low). Freaking hormones. Anyhow, so having automated mode at night seemed like a great idea.
In truth, I’m irritated that the lowest target blood sugar I could enter is 110. So I went with that, and told it to also correct over 110. That’s as aggressive as I can be. So far, this makes my blood sugars run about 150-160 at night. I’m not thrilled with that, but it is still most likely better than the huge unpredictable swings I’ve been dealing with. I guess we’ll call that the “Good”.
The “Bad” - it seems to include temp basals in Insulin-On-Board? Or maybe even the regular basals? There is ALWAYS insulin on board, even when I haven’t bolused since the day before. For example, at lunch today, I was 91 and told the pdm I was eating 20 grams of carbs, but because of the insulin on board, it recommended I take NO insulin. Can any of you eat 20 grams of carbs and not have to take anything, cause I sure the heck can’t. So I had to manually calculate how much to take, and punch that in. So far, all good. 50 minutes later, and my blood sugar is 85. Which means my napkin math was right, and the PDM is full of crap. That makes this unsustainable in my mind. I mean half the benefit of having a pump vs MDI, is NOT having to manually calculate how much insulin to take.
The other thing I’ve found annoying is the amount of bolus calculated in the first place. Since the PDM is only correcting down to 110, it is already decreasing my boluses compared to what I used to take. I am experimenting with changing my insulin to carb ratios to get around that, so I don’t have to keep manually adding additional insulin to every bolus to get around it. If I let it go with its own calculations, I get up to near 200 after a meal, which I never did on the previous system, and I’m sorry, but I don’t consider that acceptable.
So if there is a direct question here it would be this: Is anyone clear on how the Insulin-on-board is calculated? I have contacted the company directly and haven’t heard back yet. I suppose there is no way to change it but it would help me to know how it’s being calculated in case I need to change my approach to multiple basal programs for my weird cycles instead of temp basals.
Also, is there any hope that we might one day be able to select a lower target than 110? Wishful thinking I’m sure…