Can someone explain what happens if the sensor says your BG is high but it’s not? My CDE wants me to get the 5, but first off I’ve heard it’s expensive on Medicare and second I’ve heard of issues.
I am extremely insulin sensitive, getting up to 200 or more points out of a.5 units. I know you can set it for things like that, but I’m not sure about my confidence in it. And my husband has questions I can’t answer 
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Not to over-simplify the pump, but it will just do what the algorithm is programmed to do. If your BG goes above your target, it gives more insulin.
If your CGM says you are higher than you actually are, it will give you more insulin than you may need. And if your CGM says you are lower than you actually are, then it will give you less than you may need.
You can turn off the auto-mode and just use it as a manual pump. Or you can constantly check your BG and re-calibrate your CGM all the time.
But if you are going to do that, there may not really be an advantage to using the O5. It would just end up being more work for you.
So perhaps the more important question for you is how much trust you have in your CGM.
Here is a worthwhile question to consider.
Why do they want you to get it?
Do they use it themselves? Did they read good stuff about it? Do they think your BG goes low too often?
I don’t generally trust advice from endo’s or CDE’s unless they are themselves a diabetic. The non-diabetic medical people are always like - “Oh no! BG went below 70! The sky is falling!”
Yes, theyre diabetic. It’s not that I have too many lows, but that the plummet I get from a tiny bit of a dose is just pretty drastic. So I have a roller coaster going. I was looking at some simple decision making based on CGM trends, and think that might be easier and safer to try to use.
Might be worth trying. You aren’t locked in long-term like you would be with some of the other pumps.
I think with Tandem it’s generally like a 4 year thing, since the pump itself is so expensive. With the O5, you can just buy a PDM and a box of pods for a few hundred bucks and try it for a month or so.
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Do you calibrate the dexcom when you see it is off what you expect/bg check. Sometimes can re-enter same calibration if it was way off.
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I should do it more than I do!
I’ll probably use it just like previous models (in manual mode/open loop) when they force me to upgrade from the older model.
You can configure it to setup an increase in insulin delivery when your bg raises above a certain limit and run it in closed loop (like an artificial pancreas system, APS), but it’s not quite that simple - there’s a lot of functionality that will be enabled and you need to have all that stuff set just right in order to have any success.
There may be ‘tricks’ you used to use with your old equipment that you can’t pull off with the new one. Expect the new system to have more rules and less flexibility, more configuration effort, and more complexity when troubleshooting when you run closed loop/aps.
Don’t do the thing that everyone does upfront - don’t try to outsmart the system automation or ‘get around’ it doing things that it does. The automation either works or it doesn’t. If it’s not working, don’t be shy about simply turning off the automation. That’s OK. Deal with the automation when you have the time and flexibility and motivation to do it. Don’t assume that it works. Watch it closely. You’ll want to monitor sensor accuracy during that time. Put real effort into the settings configuration. Its possible that the auto works for a period of time after setting it up, but then your body changes a little (maybe you gain 5 lbs) and the system settings fall out of balance. You need to be able to recognize how that looks and figure out that you need to reconfigure your settings.
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Well I have a zillion pods from the old system, and one spare PDM. In October I move to Medicare and I understand right now the 5 coverage is rather poor. We’re on low income Medicare programs due to my husband having cancer. I don’t see any reason to hurry at all. He doesn’t think I will do well with the 5, because I have so many fluctuations including the insulin sensitivity that ever changes, and thyroid disease that also changes. Weight gain, weight loss etc.
If I could just tune up my current settings I think I would be just fine and can get the DASH later.
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We have about 6 months before they discontinue the old model.
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I have a stash because of the way my RX is written, and at one time a rep gave me two free PDMs. But I suppose I will have to get the DASH just to be sure my Medicare has it all covered. I guess.
I am in the same boat as you are, Laura_S. I am extremely sensitive to insulin, so small doses can make a BIG difference in my glucose levels. I also can ditch low if I get even a little too much exercise, due again, to my insulin sensitivity. For meals, I generally take .50 - 5 units of insulin depending on how many carbs I eat for a meal. On most days, my total insulin dosage is between 15 - 20 units. I also have a thyroid condition for which I take Synthroid. I also am on Medicare. The difference? I have used the OmniPod 5 for almost a year, and I LOVE it!
I don’t know what kind of coverage you have on your Medicare plan, but I have found that changing from the OmniPod DASH to the OmniPod 5 was within $5.00 of the same price. Virtually no financial impact.
As far as the control goes, I use the Auto Mode almost 100% of the time. Yes, you will need to work with a CDE or an Endo who understands the pump to get it set up to your needs, but once you get on the OmniPod 5, Insulet Corporation does offer training. I actually worked with a CDE, and I found the following:
The alarms for lows and highs during the night disappeared almost immediately. I can sleep through the night, and my glucose stays almost flatline within range. You can set up (within some limits) what you want for your TIR levels. But once you and your trainer get the pump set up, the pump takes good care of keeping the user within range throughout the night.
The pump can automatically give me 0.05 mini-boluses when the CGM tells it that my glucose is starting to creep up. That helps keep me in range.
You can use several adjustments on the pump to react to YOUR sensitivity. As with the older OmniPods, you can work with Maximum Basal Rates, Insulin to Carb Ratios, Duration of Insulin Action, and – an important and often overlooked setting – the Correction Factor. All of those settings are fed into the algorithm to help me stay in control without going too low or too high.
Under History, I can see on one screen a summary of my day. Currently, the time is 2:15 p.m. My TIR is 98%, with 2% above range – due to readings right after I ate and before the insulin kicked in – and I have used 8.25 total units of insulin. That usage is 55% basal and 45% bolus for a fairly balanced day. So you see that even though I am really sensitive to insulin, using the Auto Mode on OmniPod 5 can give people like you and me good results.
I like the Activity Mode for when I exercise. I take two walks daily and also do lots of yard work or other home maintenance projects. I will drop low if I do not use Activity Mode. (Sometimes I STILL drop low. When that happens, I tell my husband that he is working me too hard, and I quit to have a snack.) The Activity Mode, though, basically watches my glucose and shuts down the whole system for hours at a time if I don’t need any. With the first two types of OmniPod pumps, what you had programmed for the basal background is what you got, whether you needed insulin or not.
I can check History/ Auto Events at any time to see what the Auto Mode is giving me insulin-wise every five minutes. For example, I just looked and saw that for the last hour, I have not received ANY insulin because I did not need any. I love that about the Auto Mode on this pump. My doctor can download all of my readings and just how much insulin I get at any point. If no insulin is given, the chart shows a red line. I was shocked (but not surprised) at how often during the day that red line appeared.
Do not be afraid to change to the OmniPod 5 when your current supplies run low on the old system. Yes, I still have some highs and some lows. Yes, since the Dexcom G6 is the CGM that the OmniPod 5 uses, I still will have to go to Limited Mode (basically, the Manual Mode) until the 2-hour warm-up is done every 10 days. But even for insulin sensitive people like you and me, the OmniPod 5 in Auto Mode is a game changer. I can sleep through the night, my TIR is better, and my A1C is lower than it ever was before. The OmniPod 5 can be a new opportunity for you to get better control with less hassle. When the time comes, give it a try.
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Wow, thank you for the great detail! Very thorough! Right now I have a giant stash of Eros pods, and a spare PDM. I’m on Medicaid so everything is 100 percent paid and my CDE has me at two day changes just in case. My hubby is on Medicare and they left him on Medicaid for 2023 because our expenses are so high (his chemo pills are 10,000 per month.) but we don’t have an advantage plan. We’ve got A and B and low income D. I’m gonna call my Medicare rep and figure my coverage out in a few weeks for my 65th in October.
Right now I use about 17 total daily dose, and get often a 150 to 200 point drop from just one unit. I don’t eat much and if BG is up it doesn’t take much to drop it.I do use extended bolus and temporary basals quite often (and I guess those are just not in auto mode?). I don’t want to get stuck with a Medicare bill for the 5. I don’t know if they will leave me on Medicaid, then it wont matter. Right now tho, I just want to make sure I have not many expenses!
Laura_S, I agree with you that you should use up your supply of the Eros pods, perhaps keeping the last 10 in reserve as a back-up so that when you DO have to change to a new system, you have those to fall back on should the new system not work out for you and you want to order something different. That said, I think that you would have great success with the OmniPod 5.
I used to use the extended bolus and the temporary basal a lot when I was on the DASH, and those things ARE still available in the OM5 if you use the Manual Mode. They are not necessary in the Auto Mode, however, because the pod automatically adjusts your insulin to match your blood glucose every five minutes. Doing so gives you more control than using an extended bolus which will still program X units of insulin, but just at an extended period of time. In Auto Mode, the OM5 will give me the insulin that I need when I need it to keep me in range. I don’t have to think about it or worry about it. And if, for some reason, I start to go high, I al ways have the option of just giving myself an additional bolus. I let the Controller calculate what I need, and it generally works just fine.
I agree that the larger problem may be the accuracy of the CGM than with the OM5. The first day of a new transmitter, I generally take blood tests because for me the G6 is not terribly accurate. I always can recalibrate the G6 or just wait a day and let it settle down. Just because the OM5 is set on Auto Mode does not mean that I have no control. The opposite is true. I still can add or subtract the amount of a bolus, take an extra bolus, or turn on Activity to get less insulin during activities.
I wish you all the best, and I believe that you are on the right track to researching Medicare and the OM5. I am NOT on a Medicare Advantage plan at all, and Medicare still covers my Pods. I have a great supplementary insurance which, after three years of high deductibles, now picks up whatever Medicare will not pay, so I pay nothing out of pocket for my Pods.
Good luck and God’s blessings to you as you continue to research what will work the best for you in the future.
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Bless you too. The Medicare planning is sure to be fun…???..