I am currently looking at moving to a pump from MDI. I’ve been using MDI for 27 years, so it’ll probably be a bit of a change for me.
One of my main concern: and potential things stopping me making the change is I live at the coast and go swimming a lot, and go surfing a few times a month. I’m usually only in the water for 40-60 minutes. And understand with tubed pumps you can disconnect for up to an hour.
For those that pump, what type of effect does this have on your BGLs? Can you disconnect for 60 minutes and have minimal impact or do you always see a fairly large raise? Are there ways to prevent this happening?
I am currently tossing up between the Tslim
and the Omnipod. I know the omnipod won’t have this issue as I can wear it swimming and surfing, but from what I’ve seen it has less user control
over the settings so I’m leaning towards the Tslim for that reason.
I don’t do all those water sports that you do, but I do disconnect my Tandem x2 pump daily while I shower. I do see a rise in BG levels afterwards and correct accordingly. Sometimes I correct ahead of time. You should also take into consideration what exercise does. Some people see a rise while exercising; and some people go low. You should also be sure to insert the “shower cap” into your inset to avoid water going in. They give you two of those in every box of insets.
I am swimming 30 minutes every day, followed by a 10 minute shower. No issues. I use OmniPod DASH with DIY Loop. My understanding is that DIY Loop gives you even more control over settings than any FDA-approved pump.
I’m using the omnipod 5 and I can swim with it. I avoided swimming on the mobi, because the cannula would always come out. The tslim is not waterproof so it wasn’t even a possibility.
But when I did, I would inject 10 units of lantus an hour before disconnecting. Then I could be off for up to 2 hours.
I also was told that the algorithm was better on tslim and mobi.
And I noticed I ran higher on average on the pods. But I have fewer highs and lows.
I got my first a1c back since switching to pods this week and it was 5.3. And my average on tandem was 5.9.
So I’m not really sure if it was an anomaly .. I was averaging 90% in range on tandem and 96% on the pods.
I really don’t know why there is nothing really obvious.
Omnipods do not do auto bolus, so it was surprising to me.
I think individual experience will reall make the decision for you.
Whatever you choose, give it 2 months before giving up.
It always takes em that long to fine tune it.
I went from animas to Medtronic to tandem back to omnipod.
It always takes me time to adjust
I had thought about the potential of giving some Levine (my current basal) before I go surfing or swimming. Swimming in usually in for 30 minutes but surfing can be 60+.
On paper the omnipod 5 sounds great, one thing that appealed to me about the Tslim was the extended bolus. Particularly for fatty meals.
I do like the idea of the omnipod dash and the loop app. I need to do more research on it, and also understand how my insurance would cover it. I guess they just cover the dash and you go ahead and set up the loop part yourself.
That is correct about the dash.
I’m using the omnipod 5 and I’m happy with the loop it provides, but my insurance won’t cover the dash for whatever reason, otherwise I would be all over it.
I am enrolled in a study for the omnipod 5 with a new algorithm and a lower set point, it is supposed to include things like extended bolus as well. Going by the data,it will likely also include automatic bolus similar to the tslim because they ask you to refrain from bolusing more than 3 times a day. I do 6 or 7 currently because I constantly make adjustments.
Still I manage to be 95% time in range which is better than I was on tslim.
Maybe it will be better with the new algorithm, or maybe not since I need to refrain from corrections.
The omnipods are so very waterproof it’s insane. I had a few come off in the ocean but never fail. You can use waterproof tape for swimming in saltwater. I had one alarming after I removed it and I put it in a glass of water. Many hours later it was still working.
I’m actually shocked how much I like pods, and I resisted them for a long time thinking I would lose my ability to tweak the pump.
The pods cannula enters at an angle, which es perfect because that’s how I used to put in my sets on Tslim and Medtronic.
If you are lean it’s a definite need because straight sets would hit muscle and bend or kink, it was a big problem until I discovered the angled sets, all pumps have a version of that. Varisoft or silhouette
I don’t personally have much problem disconnecting while swimming. The exercise mostly balances out the lack of insulin. I do need to bolus (though not necessarily right away) once I reconnect to make up for the lost basal. It’s a trial and error sort of thing for me.
You can always jump out of the water for a minute if you’re running high and give yourself some insulin.
I’m glad you reminded me.
I have actually gone into DKA while exercising very hard kayaking.
My pump suspended because my glucose was in range, as it should.
At the end in my last mile, I felt awful, muscles were cramping and that awful awful feeling of DKA, that you can’t explain unless you have experiences it.
At that point I was at 150 but I gave myself 3 units. 10 min later I was at 200, all with no food. I made it on to shore but by then I was vomiting and at 280. So I took 10 units and laced down and I eventually recovered, but I was thinking I might need to go to the hospital, but didn’t.
It was a tough lesson when I work out hard and long where it seems like I don’t need insulin, but really I did. So now if I’m doing anything g above moderate I will take insulin and some food before I start. I keep my pump on if I can manage it.
Lantus onboard is also a great way to prevent DKA, but it takes a lot more planning
I’ve never noticed an issue with a 60 minute disconnect. From time to time I’ve thought about bolusing the missing 0.5IU of basal afterward but it doesn’t seem to make a difference whether or not I do. I do use an AID system; Omnipod Dash+G7 with xDrip+ and AndroidAPS and AndroidAPS knows that my basal is missing so automatically ends up filling it in. I haven’t observed hyperglycaemia regardless of exercise levels during the disconnect.
That’s tricky. You will lose 'pods because you surf. Surface swimming is fine; at this time of year I do that every day (in a pool). Anything that takes me significantly below the surface, just a few feet, however eventually kills the 'pod. This is because it is vented so immersion compresses the air space in the 'pod and water gets forced in. A 'pod at the end of its time fails more regularly; at the end of 3 days the 'pod has squeezed three days of insulin out of its reservoir and replaced that by the same quantity of air.
It should help turning off the basal while in the water but it doesn’t. I’ve tried that; I’ve had basal delivery at 100ft depth and the 'pod failed but I’ve also tried turning off and the 'pod failed. Admittedly 100ft is over four times the surface pressure so a lot of water gets forced into the vented 'pod
I guess it depends; how good are you at surfing!
I suggest talking to your endo about trying the Omnipod because the 'pod does not require a separate pump My understanding is that insurance companies will lock you in to a separate pump once you start to use it (although there are, apparently, rental arrangements). The Omnipod isn’t a lock in so it may be a better place to start particularly as it is the option which is most likely to fail; if it doesn’t and you really like it problem solved.
As for the settings it sounds like you are considering the O5, which is an integrated AID system with the Dexcom G6 and some control software which runs in the pump. It should work while surfing but water blocks the bluetooth between the pump and the G6 so that might mean spurious alerts.
An alternative is the Dash 'pod which does not require a CGM. I use Dash in the same way as the O5 (with a CGM) but the system I use is a hack; my endo is OK with it but many aren’t.
I don’t know how the O5 or the t.slim work with extended disconnects. That’s a whole new thing I haven’t seen discussed here, or, indeed, anywhere. The O5 will not disconnect because it goes with you into the water but it may lose the signal. The t.slim will have to be disconnected and it may get fruity about that.
AndroidAPS (i.e. my chosen hack) works fine; it gets a bit whiny but it’s easy to shut up, particularly as my 'phone isn’t waterproof so it stays in the car
Systems like the O5, indeed all AID systems, handle fat and protein automagically. Extended bolus simply isn’t possible with an AID because it immediately gets overridden by the AID algorithm. fat, protein, small carb snacks can, and mostly should, just be ignored with an AID. Accuracy in meal boluses is far less critical, indeed for me “big” and “little” are adequate for coming up with a meal bolus.
It’s just really helpful so you don’t burn thru equipment while on travel and run out. They do fall off.
You can increase/decrease temp basals and perform extended bolus on Omnipod. It will deliver insulin the whole time you are in the water…unless it falls off in the sea. Always have a backup on shore.
What happens to the pods once they expire after three days? Do they just get disposed of in clinical waste or is there
Some recycling system given they presumably have electronics and PCBs in them?
The T-slim supports a variety of infusion sets and angles, the Omnipod only one. There is more flexibility in where you infuse with a tubeless pump but much more flexibility in how you infuse with a tubed pump.
Insulet used to offer recycling in the US; they were sent back by mail and then most likely thrown into the trash. That did, however, avoid the need to consider local trash disposal laws which, in the US, are highly variable, frequently incomprehensible and invariably not usable by many non-rich Americans.
I just throw mine into a big bag and sometimes I get round to Dremeling a few of them open, removing the three standard cells (which can be reused for the most part) extracting the sharp (which is hidden inside the 'pod so don’t do what I am describing), putting it into my sharps disposal then throwing the rest, including the PCB, into the trash.
It, the rest, goes via a 50 mile route to White City and gets buried. 1 million years in the future when this planet is excavated by archeologists from Alpha Centuri what I have throw into the trash will be a completely mysterious, utterly inexplicable, thing that is never understood. Nevertheless.
Hi Timothy:
I would like to get in an Omnipod 5 study using a lower target. How can I do that? I have been using pods for several months, but in manual mode. However, since the new iPhone app came out for Omnipod with Dexcom G7, last week I switched to automatic mode. So for the last week, the algorithm has been decreasing my basal and my average glucose reading has gone up from about 108 to 117. The algorithm doesn’t want me to have glucose lower than 110. Using manual mode, I was able to maintain a range of 70 to 180 about 98% of the time. I am very fastidious about eating low carb and generally have an HbA1c of 5.6 to 5.9. For the last week as the algorithm lowered my basal, I have been increasing my boluses to try to adjust. My total basal amount yesterday was 3 u, but I did 8 boluses to try to compensate. I think I will need to go back to manual since the algorithm seems to be fighting against me. I can see that if I wanted to keep my glucose above 110, the algorithm would be good. Long story short, an Omnipod with a lower target would suit me very well.
