Omnipod 5 - Mixed Feelings

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…

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It took me over a month and ten plus hours to finally get Omnipod 5 set up so i could use it. I had to talk to 9 customer service reps and spend over 6 hours on phone help to get it done. I finally got in contact with some one who knew how and and had the authority to fix my account by deleting the second one I had to create to to try access Podder Central which you had to do to use it on your phone. I had asked several reps to delete my account so i could crate one that worked but no one had the authority to do so till number 9. No one knew why or how my account got screwed up so I could not log into Podder Central or create a new account that might have worked.

Unfortunately they do not yet have an IPhone app. I can use their PDM or carry around another phone. I currently use my IPhone to run my Dexcom 6 and DIY looping program with Eros pods plus the usual phone stuff like regular text messages and phone calls.

So far Omnipod 5 looks to me like a slimmed down version of my DIY looping program which has more options and flexibility. Plus it would cost me an extra $500 a year to use Omnipod 5 so I doubt i will be switching to it. Right now i use Eros pods which insurance covers completely but Dash and Omnipod5 require me to use a pharmacy drug plan with a co-pay. I figure some time soon Insulet will stop selling the Eros Pods in order to make more money by increasing my costs. i know for some people with other insurance plans the pharmacy option could be cheaper but not for me. Then i will have to rebuild my looping app to use the Dash Pods.

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I have been using omnipod 5 for about a month. I really am beginning to enjoy it but the main task seems to be getting the settings correct. The one that comes to mind with your problem with insulin on board is, do you have the “Duration of insulin action” set correctly? I use a setting of 4 hours.

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I’ve got my duration set to 2.5 hours, the same duration I used with Dash and whatever pod system was before that. I do not believe that basal is included with the IOB calculation, but I guess I could be wrong about that. If it were, how could IOB ever be zero? Some people have tried “fooling” their G6 by calibrating insulin levels at 10 or so higher than they really are so that the pod is more aggressive, but I haven’t tried that. There’s definitely a learning curve, and it’s not “set and forget” for me, but it could be for others who are more consistent in their BG levels. I have a feeling that the 110 minimum setting was required by the FDA as a starting point to avoid people going low too often and that after some time out in the real world they may be allowed to lower that somewhat. Good luck in your journey. I am not 100% pleased with OM5 yet (still waiting for iPhone compatibility for one), but I will say that my A1C on my first doctor’s visit after being on the system was 6.2 compared with a prior 6.7, so it must be doing something right.

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I’m using dev version of loop with dash pods and love it. Works on my iPhone, so no more PDM to carry around. Setting flexibility is awesome. My A1C dropped a full point from 7.3 to 6.3 with very minimal behavior change. So nice to start every day with normal BG. Graph on app show basal reductions and micro bonuses so I can see if my basal settings are reasonable.

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Ok so, from the manual in regards to IOB:

"The SmartBolus Calculator considers the current IOB when calculating a suggested bolus. Insulin on board may come from:

  • Meal IOB - from previous meal boluses

  • Correction IOB - can be from previous correction boluses or from automated insulin deliveries."

If that’s the case, why when I woke up this morning, after being on manual mode all night (the first night in days that I didn’t have a 160 fasting bloodsugar when I got up, by the way) and not having taken any kind of bolus since 6 pm yesterday, did my IOB say it was .4 units? Something is not right, and so they are either outright lying, or my device is working incorrectly…I guess?

For what it’s worth though, after that quote, there is a section saying you can bolus WITHOUT factoring in the blood sugar. So you only enter the carbs, and not the blood sugar value. I experimented with this this morning and it does make quite a difference in the suggested amount, though I haven’t actually put it in practice with a meal yet.

I have been on the OmniPod 5 since August 31, and overall I am pleased with the results. (I am not at all happy with Dexcom right now, but that is another story…) I am not sure that you are really giving the system a fair try if you are switching back and forth all of the time between the Manual and the Automatic modes. As the manual says, the system needs to “learn” your needs, and switching from one mode to the other may mean that the system will never be able to work well with what you want from it.

That said, know that OmniPod 5 does seem to buy in to the FDA’s paranoia about lows. It would rather see you run at 160 than at 60, so the FDA has made sure that the built-in “safety” limits are all in place. You seem to be a person who wants everything to be at 110, and that may not happen easily with this system. I doubt that the 110 target will change any time soon, but I am happy with that target. That is “normal,” so I can accept that. You also mention “perimenopause,” so know that as we age, keeping at your chosen target goal also may become a bit more difficult.

I went from the DASH to the OmniPod 5, setting it up (as you probably did) with your previous settings. That part was easy. I did have some questions, though, so I went to a Diabetic Educator for some training. She was excellent in answering my questions and in helping me “tweak” some settings. You may find that you need to adjust your insulin/carb ratio, your duration of insulin, and your correction factor. Again, if you are not trying to use the system in Auto mode most of the time, though, I am not sure that will help. If you have access to a well-trained, certified diabetic educator, it may be worth your time to talk to someone who can look at what YOU want and need and help you adjust the OmniPod 5 to get there.

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