Loop: Questions

Tips, Tech & Gear
1

Can anybody compare the overall BG management experience using Loop/Dash pods vs. standard Omnipod 5? The reason I ask is I’ve been using Omnipod 5 since it came out and overall have been happy with it or when necessary have used work arounds (such as recently started with Affrezza for correction bolus as needed). I’ve read so many positive comments about Loop and how great Loop is…but I have not convinced myself that the benefits of Loop are much different/better than I am already getting from Omnipod 5.

The majority of BG trouble I’ve had when using Omnipod 5 seems to be infusion related from the pods. Usually limiting meal bolus to about 5U (and extending the rest) seems to take care of that issue. “When in doubt change it out” seems to work on more obvious bad site occasions. And there are some sites that will not work for me no matter how many times I try them (thighs for example).
Question: Would Loop be different in any way when the pod cannula is not at 100% ability to infuse the insulin?

Another example that might illustrate my main question is: Many people comment that Omnipod 5 “goal BG” setting of 110 is too high, and they go to Loop which allows lower “Goal BG” settings. How does that work out in the long run with Loop? My own experience with Omnipod 5 has been I can average 100-110 on a day to day basis for short 2-3 day bursts when things are running optimally. (Maybe Loop would make things easier/better on those good days?). When the wheels fall off with a bad pod site or a questionable bolus, etc. the BG roller coaster will shoot me high/low regardless of what the Omnipod 5 algorithm is attempting to do…so it does not matter what the “BG Goal” setting is on the Om5 on those days, I am doing manual correction bolus anyway and daily BG averaging much higher than I would like.
The main question is: Is Loop any different/better on those type of roller coaster days? If a person screws up a bolus, for example under-bolusses for a meal, does Loop make it easier to fix the BG roller coaster that occurs for the next 3+ hours?

Anyway, thanks for any insights/answers on these (or other) questions related to comparing actual day to day experiences using Loop vs. Omnipod 5.

3 Likes
2

@John58 I haven’t used Omnipod 5, so I can’t compare the experience between it and Dash pods. I know Omnipod 5 has worked great and met some people’s needs; likewise it hasn’t worked so great for others. I don’t have statistics and doubt Insulet will publish them (probably wouldn’t trust them unless it was a double-blind by a known entity). What counts is Omni 5 seems to work for you and I’m glad it has.

I haven’t tried Omni 5 because I’m biased against “black box” solutions without extensive positive result/experience. Example: I worked in a war zone with Patriot anti-missile units in support; post-war analysis said they didn’t work, I was there, I saw them work, I trusted my life to them…I KNOW they worked…better than anything else available! I knew and understood how they worked. Omni 5 was/is a black box; I know what it takes in, I’m not allowed to know what it does with it, and very little of what it spits out and why. That said, we’re almost at a point of user observational data that I might give Omni 5 a re-look.

Ref your question on cannula: I don’t think the Omni 5 and Dash cannula’s are significantly different. I suspect the cannula components and operations are virtually identical. That leaves a difference in the firm/software used to control insulin delivery. I don’t know if Omni 5 limits the dosing pattern or structure. I know that Looping (Loop, Trio, or iAPS) with Dash can limit the dosing pattern/structure. One settable limit controls how much insulin can be delivered, another controls over what period of time; therefore, the delivery of the insulin can be modified if the cannula is functional, leaving the question if the body is capable of absorbing it. If the section of the body attached to won’t absorb the insulin, then it doesn’t matter which pump or firm/software is used.

Ref your question regarding roller coaster days: I don’t know how the Omni 5 software works on such events, but I understand the user has little, if any, control over it. I do know with Loop, Trio, or iAPS (others?), the user can set different profiles to address different needs such as roller-coaster days/meals and host of other situations. Just yesterday I participated in a Loop-and-Learn Open Mic session in which Marion Barker (she’s contributed extensively to Loop programming discussion, Loop docs, Trio and iAPS developments) advised how she adjusts for traditional rollercoaster meals (stated the infamous “Pizza” but referenced others) that often result in roller-coasters (high fat/protein meals are notorious for delayed action), she also commented how she addresses low treatments (whether she “informs” the software) regarding adding carbs (she normally doesn’t by the way, but has a couple of other methods of dealing with lows).

So the answer is a qualified “Yes,” DIY Looping (Loop, Trio, iAPS, others?) may offer you methods to better influence the off days or meals. However, I submit the more important aspect is which better serves you over the long haul, ala diabetes is a marathon, not a sprint. If you’re staying in target (100-110 day to day?..congrats if you do that consistently) 80%+ of the time with Omni 5, is it worth changing to Loop/Dash to get another 5-10%? What % would be worth it? And understand that 1) YDMV (sometimes this seems a copout, but also seems true), 2) where are you in your diabetes journey (25 yrs old? 50? 80? health status?), and the real “gorillas” in the room 3) how long until Dash is no longer made or Loop developers stop development or even when a caged transplant islet cell treatment will get approved?

Looping systems/Dash are not the Holy Grail, they are not “THE” way everyone should treat the dragon. They are only considerations. I like what Loop, Trio, iAPS, and others offer; I can understand them even if I don’t code; I think I use them to my advantage. That said, if Omni 5 or TSlim or Twist or G6 or G7 works for you (or I find they might work for me), then lets use them to the best our ability, but change only if we want to and they offer a substantial reason or capability we need or want.

4 Likes
3

This is a very good quick explanation of the different types of algorithms. Loop follows the same type of algorithm as the Tandem - it makes adjustments to the pre-programmed basal rate you have set. Omnipod 5 and Medtronic set their own rate, based on your daily dose.

The Omnipod 5 algorithm uses total daily insulin (TDI) delivery as the basis for insulin automation, similar to the MiniMed systems, which also use a TDI-based strategy to determine microbolus insulin delivery every 5 minutes. In contrast, the Control-IQ system automatically increases or decreases pre-programmed basal rates in response to CGM data, although it does use TDI to scale these adjustments.

(Posting the link because I quoted it above. But you already know everything about the O5.)

The big advantage of the Loop type of algorithm is that you can set your basal rates (like the Tandem system). If you know you will need more insulin at 4am, you already have that set. And it adjusts rates that are closer to what you need, rather than a rate it has created based on your daily dose (O5 and Medtronic).

I think the O5 and Medtronic systems are a little more reactionary. Read the number and react to it. Whereas the Loop and Tandem systems are more proactive, because you have set the rates ahead of time.

On the other hand, the big advantage O5 has, is that you don’t need your phone or controller with you for the adjustments to be made. With Loop, it only makes adjustments if your phone is with you.

3 Likes
4

@John58

I have use The Omnipod 5 & one reason I left it was because I was experiencing huge roller coaster rides & having to suspend insulin delivery all the time. After talking with Omnipod reps time after time being told just let it do it’s thing & it will learn. I was final told it was hard coded to give insulin down to 60 BG. Loop I believe is 70 BG. Last used Loop 3.4.1. I was seeking a system that I could tell it don’t give me any insuin below XX BG. I thought I found that in Trio 0.2.0 as you can set Minimum Safety Threshold to any number you want. That does stop insulin delivery from basal etc. But will still deliver SMB, Super Micro Bolus, below my set number of 85 BG. There probably is a setting that would stop that but I have not found it yet. Trio is very complex with a long learning curse. Next I have been on iAPS 5.0.3 for a few days, second pod just changed. it is a little less complicated then Trio but still have a long learning curve. I thought I had found the system for me day one 97% TIR came day two & had large meal red beans, rice & garlic knot, 100g carbs… I was over 300 that night until iAPS brought me down into range by the am. Still doing an eval so hoping to go though it’s curve & get back to being 90% TIR. I would be very happy with that. All in all it’s really about learning very well the system you are choosing to use. For simplicity I actually thought about going back to the Omni 5, swagging numbers for fat & protein then using the extended bolus. I think that system my be a whole less stress.

Both Trio & iAPS have what is called “Rewind Resets Autosens” This can take up to 6 hours after a site change. It re-learns your sensitivity which in theory should take care of the infusion of insulin.

I hope this post is understandable I am still battling Vertigo & reading & writing is making me dizzy. Time to go back to lurking. Maybe after I am a better I can write a review for comparing Omnipod 5, Loop, Trio & iAPS.

Cheer :smiley:

3 Likes
5

My Loop version stops all delivery when I am below whatever number I set. I would hope Trio and iAPS do something like that too!

I like to keep it simple!

1 Like
6

A slip of the tongue? Tongue in cheek? A foible? I like it no matter the cause… :wink:

@SobeiT I know the settings can be chosen in Trio and iAPS that will stop all insulin delivery below a set level, I just can’t describe which they are. I recommend posting on the Trio Discord channel, I’m sure Theresa Hasting or other will be glad to point out how to do it. I believe if you have the “profile” add in for Loop 3.4.1 you can do it as well. I’m not sure why the profile add in wasn’t made part of the last Loop update; however, you can add this code via a LoopandLearn browser build script.

1 Like
7

I don’t know why the developers have over-complicated everything. The new versions drove me nuts with all the different settings they have!

In mine it’s 2 clicks to get to it. Go to Settings, and then select your Suspend Threshold and put in whatever you want.

image

.

.

image

No, diabetes isn’t easy. But it does not need to be complicated!

4 Likes
8

Or it could be just poor spelling & typing skills :joy:

@TomH Thanks for the other information.

If the new Loop seemed complicated you may want to stay clear of Trio & iAPS both are pretty deep waters with some redundancies.

Amen Brother, Amen! :grin:

Your suspend setting is slick. I like it :clap:

2 Likes
9

Thanks!

You can run this if you want. All it takes is me sending the code to you on a flash drive.
(No, it isn’t in GitHub. Like I said - simple!)

10

@Eric It does seem the apps are becoming more complicated, though usually due to user requested functions. Some seem worthwhile, some not. I’ve pretty much given up on trying to understand iAPS, seems the developer just goes off Willy-nilly doing what he thinks and some contributors want with no controls and the worst part is it doesn’t seem anyone is focusing on the documentation. If you don’t keep up with the iAPS Discord channel discussions, you’re left with searching posts to figure out how to do what and many references to the Loop, AAPS, and other websites that may or may not describe a UI that actually applies. It seems if you’re not part of the “in” crowd, your left to flounder around. It seems a decent product, but as the adage goes, “Don’t let technicians and engineers write (or not in this case) your documentation!”

1 Like
11

@John58 I should have include in my above reply that “Omni 5 might work great for me”, then gone into the rest of it. The question is how much time do I want to spend “trying” different physical products. Example: I haven’t tried any tubed pumps, because I’m biased against getting a tube caught on a door handle, drawer pull, etc. And before anyone says “it’s not that bad”, I acknowledge I must be challenged as I already get belts, belt loops, the fly of my pants (don’t ask, I haven’t figured it out either), and other clothing inadvertently “stuck” on things! That said, I don’t get pumps or CGM knocked off on door jambs and the like, go figure… I’m sure someone will point out that I sure seem eager to try software (ala Loop, Trio, iAPS, Loop Follow, NightScout, etc.); in defense I can only offer they are very similar products, all work on my iPhone so no change of hardware there, and all are open-source where I can review other’s usage/results easily. That, and I’m a nerd about software/firmware :stuck_out_tongue_winking_eye:!

1 Like
12

After I am done evaluating the other programs I may Loop back <---- pun intended :grin: If I do I will certainly want to see if we can hook that up. Maybe even I can swap some supplies for it. I will PM you if it heads that way. Very generous, thank you! :smiley:

I am with you on this one. I think iAPS is the old man out once my current pod is finished. Too bad too because it does have some nice features. Heck all of them have some good & some not so good. :man_shrugging:

1 Like