Omnipod 5 Settings

I’ve been using the O5 for over a month. With my endo and nurse trainer, in my opinion, we can’t get the settings right. I’m getting alot of highs and lows. From what Insulet says, the pump is supposed to see “into the future” an hour to adjust to help revent those swings. My numbers are off from when I was using the Tslim X2.
I’ve met with my doc and nurse five times so far. He’s one of CT Magazine’s Top 100 docs, and the practice is known for daibetes care. BUT, I’m wondering if maybe they’re not the right match for me setting up the O5?
Can anyone in the Hartford area recommend an endo you’re happy with with O5 knowledge?
Thanks, Mike

If you post your settings and general day-to-day examples of what you are seeing, with specifics of your activity, what you ate, and your BG numbers, you will probably get better real-world advice from the people here than the advice from someone who does not actually use it.

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Have you tried using the Glooko app that Omnipod syncs with? I’ve never tried it myself, but my understanding is that it offers settings suggestions.

Unfortunately, one of the weaknesses/strengths (depending on your experiences beforehand, where you’re coming from, and how well the algorithm fits your needs) with O5 is that your settings matter very little. It does it’s own thing based on the algorithm and presumes your basal rate based on half the insulin your previous pod delivered.

I didn’t have much luck going from T:slim to Omnipod Dash (DIY Looping) because I just can’t get along with the pods. I seemed to have really bad absorption, leaking, and constant failed sites. I used to be able to bolus as much as needed with the T:slim without a second thought, but couldn’t do more than 5 units at a time with the Omnipod. If I needed more than that, I would have to give it via an extended bolus. If you’re having a problem with after meal highs, you might be having a similar problem.

I keep reading people say “give the system time to learn you…” Except there really is no “learning”. The system learns exactly one thing: how much insulin the previous pod delivered. If it gave more, it will be inclined to give more on the next pod, and vice versa. I think the real learning that’s going on is that people learn to adjust their own behavior to better match how the O5 works.

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I think that’s generally been my experience but only because the Om5 is too slow/cautious in my view when correcting a high and rising BG trend. Whenever I have any concerns at all about making sure I get a proper bolus I use a syringe to supplement what the Om5 is trying to do. That’s partly to avoid absorption troubles with a bolus over 5 units and partly to speed things up. The other thing I’ve done when the algorithm can’t keep up is switch to manual mode and run a temp basal at +95% for 30 to 60 minutes. I probably would be doing the same things with Dash or Ero pods though.

For some people (Insulets target market perhaps?) they are probably content to just let it do it’s thing and eventually after a few hours BG comes back into target range. The algorithm gives little corrections every 5 minutes that eventually will work as long as the pod is not having absorption problems.

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Hi Robyn,
I checked out my Glooko app and don’t see that it offers suggestions. Glooko pruchased xbird back in January. From what I read, if and when it’s integrated with Glloko, it’ll offer lifestyle suggestions, whatever that means?
I agree that Omnipod doesn’t learn; no AI brain there.
Luckily I have’nt had problems with leaking, absorbtion or failed sites that we’ve been able to ascertain.
I’ve been considering going back to the T:slim and started the paperwork. But, being near the end of the year, Tandem, my insurance carrier and supplier don’t know if the order can be processed before 12.31. That will mean I’d lose the benefit of having met my deductible for the year.
I’m going to contact the local Omnipod rep, who uses the O5, to see what he can offer to help.

Hi John,
Yeah, I’ve been using temp basals to help out.

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My expectation is that you are going to need to do a lot of work to hit the mark, under normal circumstances, but also because we don’t have much experience with this device, as a community. I would write off any expectation that a Doc will be able to set this up for you.

I assume you started by setting the basal rates? How many do you use and how well are they working when you test them? I assume your testing them when you have no meal bolus on board.

Lets get our baseline correct and then work our way up.

The traditional advice doesn’t apply here. O5 does not use your programmed basal rates in auto mode. They are only applicable when you switch it to manual and forego any automation. Most of the settings only apply to the bolus calculator. ISF/CF is about the only sway you have on the system, besides how much and how often you bolus.

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He’s gotta be able to bump outta auto mode, don’t you think? Like, especially now when the thing isn’t setup right? How would you recommend starting? Maybe test the bolus calc in manual? How can we eliminate/isolate variables? I’m not someone who has ever used the bolus calculator (because the algo just doesn’t work for me). For some reason, its always been easier for me to do in my head. This is good information for me to have. Thank you, Robyn.

In Loop, if you didn’t have the basals set approximately correct, then you would go into a death spiral that was about impossible to recover from.

Maybe, is the first question this: “If @Mike1 eats nothing for a few hours, is the data flatline?” (absent any strange events, like a bunch of exercise.) Problems are 2-4 hours after eating? Are problems showing up 2 hours after eating or 4 hours after eating?

We might need detailed data about what the pump is administering.

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I’m a spanking brand new OmniPod user so what follows is based on observation not experience. But those who have succeeded with auto mode tend to have given the pump time to get how much insulin is both needed and safe to deliver before turning it over to the algorithm. Without enough data, the OmniPod5 is way conservative assuming the user is a lightweight. I get why that is but it makes the on-ramp frustrating. Tandem’s algorithm is math-based and pretty transparent with a couple of set parameters - you can manipulate the settings for a predictable result. The O5 knows where you’d like to be and with experience how much insulin you can safely have on board to get you there, but all that happens behind the curtain.

So here is my advice from a newbie - start fresh, reset the controller with the settings that have given you success, and run it in manual mode for seven or eight pods. Don’t give the pump autonomy until it knows your insulin needs. Don’t even think about going auto until you are golden in manual mode. People starting this way report good results but it requires patience. Best of luck!

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You might want to listen to the 3 episodes on the Juicebox Podcast about Omnipod 5. You can find it in your podcast app or here is an online link.

Good luck. I tried out pods a few years ago with DIY Looping. I absolutely hated the pods and never could get good settings because my absorption was so erratic. Some days things worked fine. Other days I had insulin leakage, bruising, and pain. Was very happy to return to my tubed pump. But lots of people love Omnipod and for sure I liked being tubeless.

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Those are excellent. The CDE Scott is interviewing was involved with the early trials through release. She knows the O5.

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I went back and re-listened to those podcasts.  In my opinion they're more adverstising for Omnipod seeing as how Insulit paid the two presenters and produced the 'casts. 
 What bothers me is the two people on the 'casts, and a lot of other people, kept saying the pods "learn".  They do not.   Delivery of insulin is based on insulin delivered by the last pod or pods. 
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I’ve been on the OP5 for three months and it is only just starting to feel a little bit better. 2 months in and I was ready to throw in the towel. For me, there are workarounds. For me, personally, I can’t use the Activity setting. I am still playing with ratios. I don’t blindly accept the suggested bolus. And its pretty stupid sometimes. But that is just me. The point really for me was giving it a chance, letting it learn, being SUPER frustrated, and finally feeling like it isn’t going to be perfect, but it is worth sticking out. Not sure if this helps, but just know you are not alone in that frustrated 1-month mark.

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I have been on the omnipod 5 for about 2 months. The first month was pretty erratic. I didn’t think I was getting enough insulin most of the time and my blood sugars ran in the low 200’s most of the time. I was less than happy with this. Then I listened to the suggested podcasts and learned that I needed to adjust to the way this pump works. When you are using the automated mode, there is no steady basal delivery. Instead there are micro-boluses that are given every 5 minutes based on the Dexcom readings and trends. This was completely different from what I was used to. I started to pre-bolus for meals since most of the time I had no IOB (insulin on board). Then I made some slight changes to my carb ratios and correction factors. I tried to stay on automatic mode most of the time and I bolused anytime my blood sugars went above 180. I sometimes switched back to manual mode if it seemed like my numbers weren’t coming down until they got back in range and then I would return to the automated mode. I am now happy to report that I have leveled off and am having more good days in range than ever. I am not experiencing low blood sugars as often and I almost always sleep through the night with no interruption. I almost forget to look at my blood sugar readings.

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Thanks Paula and Donna. Patience is not my strong suit :wink: I’m trying to put in use some of the suggestions you and others have suggested. I have another tele-med conference tomorrow to see if we can better dial this thing in.
One particular thing that is concerning the 5 minute micro-boluses; they don’t help. So I’m researching how to increase those and increasing my total daily dose. They both seem too low.

I have been on OM5 for about 4 months now, and things are leveling out well. If you think that your micro-boluses are too low, look at your Correction Factor. My trainer told me that the Correction Factor will influence how much is given in the micro-bolus because that number is factoring in how much insulin you need. Check out the manual that came with the system to understand how the Correction Factor works. Also, pay attention to the Insulin-Carb ratio. That number also will help you regulate how much insulin you are getting at your meal bolus, and that can make a great difference.

I agree with others that looking for a new Endocrinologist is NOT going to give you the answers you seek. Every Endocrinologist I have dealt with for the past 56 years is way too conservative for most of us – they are so paranoid about lows that they would prefer us all to stay at about 250, it seems. So, since no one knows our bodies better than we do, we must educate ourselves (through forums like this and reading the manual so that you really understand how the system works) so that we can take safe, appropriate actions to get the control we want and need.

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Mike1. In the first month or so, I felt like I wasn’t getting enough insulin. I was told by omnipod support that I should use a correction bolus to help keep my levels more even and that this would help the omnipod algorithm learn my insulin needs. I also think that because I often have little or no insulin on board, that my carb ratio and correction factor needed to be adjusted so that I actually got more insulin to make up for the lost basal. I had trouble thinking about going from no basal to a micro-bolus. In time, my numbers have improved dramatically. I check my stats on Dexcom clarity and also Glooko. Hang in there. It should get better!

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Hi SherryAnn and Donna,
I/we’ve been tweaking my insulin to carb ratio and correction factor numbers so hopefully the changes will pay off.
Thanks,
Mike

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