Omnipod Settings: Different bolus settings for each meal

Diabetes Technology Insulin Pumps
#1

My doctor suggested me different bolus settings for each meal.

For instance he suggested for breakfast I should use 1 unit for every 6 grams of carbs.

For lunch, 1 unit for every 12 grams of carbs and 1 unit for every 8 grams of carbs in dinner.

Just wondering how to do it as Im new to omnipod.

Thanks in advance.

#2

Your doctor is giving you very bad direction on this. Honestly, if he doesn't know about setting up the pump for insulin:carb ratios etc., you need to find another doctor.

There are four critically important settings on any pump, including the Omnipod, that need to be determined and set properly to handle boluses as safely as possible. These are found by going to Settings->System Setup->Bolus/basal/calcs->Ratios/factors/targets. These settings are:

  • Target BG
    Start with this between 100-110 to be safer while working out the correct values for all these parameters. Later, as you decide what your own treatment goals and plan are, you can dial this down a bit if you want. I target 85 now that I'm totally dialed in.
  • IC ratio
    This is the number of carbs that will be covered by 1 unit of insulin. For example, if you eat a meal with 40 carbs, and your body needs 1U per 10g carb to fully metabolize it, then your IC ratio is 1:10. However, the actual ratio is store inverted -- C:I, so you would enter "10" for this parameter if your IC is 1:10. Mine's 1:4.
  • Correction Factor
    This is how much, in mg/dl, a unit of insulin will lower your fasting BG. "Fasting" is important here, because while you're digesting, BG values will increase but no correction is necessary because you already took insulin when you ate based on the amount of carbs in the meal. The neat thing about this, though, is the pump does all the book-keeping and accounting for you, so once these numbers are all set right for your individual body, you can simply do a BG test before eating, enter the carbs in the meal, and based on any insulin still active in your system from a previous bolus, the current BG level, and the carb load in the meal, the pump will calculate the precise bolus dose to get you back to your programmed target within the timeframe of the next parameter...
  • Insulin Action
    This is how long exogenous insulin stays active in your system. With fast-acting insulins (humalog, novolog, apidra) this is generally set to 3-6 hours, depending again on your own individual reaction.

Figuring out what the right values are for all of these is an involved, trial-and-error process that a CDE familiar with the Omnipod system should guide you through over the course of a week or two.

Best of luck, and keep the question coming. There's no better place for solid, informed advice than TuD.

#3

On the Omnipod site there is an online User Guide to walk you through the steps for setting up bolus calculation. Or you could look in your own manual. I think your pump uses a menu option called Bolus Preset to set them up as your doc advised. I have several bolus and basal calculations through the day on my pump. And every now and then, they need adjustment. We need to know how to set up the pump and make necessary adjustments when needed. My own doc does not do that.

#4

In the pdm: Settings > System Setup > bolus/basal/calcs > ratios/factors/targets > IC ratio. Here you can set the ic ratio for various times of day, down to half hour increments.

Here is the manual for further reading. Page 67 for setting IC ratio.
https://www.myomnipod.com/pdf/14421-AW%20UST400%20User%20Guide%20Rev%20C.pdf

#5

I really appreciate your help Dave! :)

God bless you.

#6

It sounds like the Doctor just wants you to have a different Insulin to Carb ratio for each meal, doesn't sound stupid to me, I think a lot of people do this, that's what I have. The suggestions to find the help information is good or, and this is what I do, just call them and they can walk you through setting up the pump to fit the Docs suggestions. They can't make the choices but if you have all the information from the Doctor they can tell you what steps to take to get it set up.

#7

I don't know anything about the Omnipod, so I'll leave that to others. But your I:C ratios are not something the doctor can "instruct you" on. You need to find out what they are for yourself, based on trial and error. You can start anywhere, though I would start more conservative than the 1:6 so you don't go low. 1:10 or 1:15 are common starting places. Then you take the correct amount of insulin for that I:C and test your results two hours after eating. If you are consistently high on 1:10 for example, you would then go down to 1:9 or 1:7 and see how you do for a few days at that, etc. Many of us do have different I:C ratios for different meals. (Mine are 1:6, 1:10 and 1:16. But the only way to figure out what yours are is trial and error.

Dumb question. You may be new to pumping (or the Omnipod) but I see you have had Type 1 since 2009. What I:C ratios were you using on shots? Many of us find that our I:C doesn't change all that much when we switch to a pump and at any rate that is a better place to start as you have been using it successfully already on shots.

#8

Yes, what Dave said.

Except people often have varying IC ratios throughout the day. Mine are 1:20, 1:26, and 1:29. In addition to the programming Dave covered, I would start with the doctor recommended IC ratios and adjust them as necessary with the assistance of your healthcare team.

#9

Maybe I'm different but I trust my Doctor. We discuss my readings and then he "advises" me on how to adjust my ratios, boluses and basal rates. I guess I can always just do what I want. Creating different ratios for every meal is a big change and his recommendation of ratios are just that, recommendations for a starting point based on this patients history. Of course you must test, test, test and watch closely, especially any time you make changes. Maybe I'm the only one here who trusts that my Endocrinologist knows what he's talking about. And he also trusts that I will watch and test closely and make informed decisions as far as any further changes. It's a team effort. No offense everyone, there's a ton of good information here but I always run it by my Doctor before going ahead with any advice from this site!

#10

Nothing wrong with that!