Welcome to FuD! Great people here, glad to see another.
The Om5 Auto mode just can’t do it all 24/7. If you used Dash before, the Om5 can be used in Manual mode just like a Dash. (But beware the bolus calculator is different and not so good). Personally I have no problem with switching back and forth from Auto to Manual several times a day. Insulet marketing says we can stay in Auto mode 24/7, but I get better control by switching modes when I need to. I usually run 70 to 80 percent of the time in Auto mode and the rest in Manual.
The menu is under Settings-Glucose Goal Range.
Sorry, I just reread your post and realized he is recently diagnosed and going straight from shots to Omnipod 5. I think he will be better off to start in Manual mode 24/7…there are some basics of pumping that need to be understood before diving all the way in to the closed loop Om5.
There is a good book “Pumping Insulin” that will be helpful for the basics. Things like varying your basal throughout the day, using temp basals, and using extended bolus will be helpful to have dialed in before switching to Auto mode. Then when BG is in control and trending in the right direction, start experimenting with Auto mode between meals, at night, etc to get a feel for it.
Thank you for the advice. I actually mentioned to the Omnipod specialist about going manual during the day and switching to auto mode for the overnights, and I was told that if I did that, the system would not “learn him” and then not work to its ability. They are definitely pushing the 24/7 auto. Problem is, prior to switching to a pump, we were in range 80-90 percent of the time…now we’re down to 60-70 and it’s quite frustrating. I’m trying to ride out the learning curve because my son definitely likes the benefit of not having to give himself injections 4-5 times a day. Hoping it doesn’t kill his A1C at his next visit. Regarding the range settings, thank you for the directions on where to change them. I actually found that as I read through more of the manual and searched through the settings, only to realize that changing that setting will only affect the reports and display - not help the system keep him at a lower range. It says the auto system works mainly by trying to keep someone at their target (my son’s is set at the lowest allowed 110), but I just don’t see it happening. We are hoping that as he gets back into a sports season at the end of August (we started the pod around the same time he came out of a spring season of baseball and soccer with 2 hours or more of practice or games pretty much 6 days a week), that his numbers will improve. He definitely has had better numbers with the pod on days where we’ve gone hiking, kayaking, etc.
I do appreciate your response and look forward to learning more on FUD.
Yes that is how Omnipod 5 is being marketed. I have the impression that it does not learn very much, at any rate it does not learn enough to correct a rise and bring my BG back into range. Once I manually get the BG trending lower and in range the Automode does fine.
It did not take me too many pods to realize that it was better (for me) to learn what/when the algorithm was not handling my BG the way I wanted to handle it and go manual during those times.
When it comes to sports, I think you can do much better working in manual mode and adjusting the basal amounts yourself.
Since he is newly diagnosed, it will take some time to learn how to do it. But if you work on it together, he can have really good BG during his sports activities.
The “exercise mode” that pumps have simply target a higher BG number. And that does not make for the best sports performance.
I’d be happy to help you with it.
Thank you so much. We did pretty well with injection therapy and juggling two sports this spring, so I am staying hopeful. My son tends to spike during high intensity games (I attribute much to adrenaline) but immediately would start to drop as soon as the game ended. Of course this was with his 24hr basal dose. The Omnipod trainer suggested switching to activity mode about halfway through a game to help prevent the lows afterward…not sure if this will be the trick or not. I know a lot will be trial and error. He did okay in auto mode on a recent 5+ mile hike as well as a 2 hour kayak trip…different from playing a soccer game, but we will see!
First time posting on FUD. My son just started the OM5. We are finishing the first pod today. We are coming from Loop which I understood well, but the OM5 is mostly a black box.
Let me ask a specific question about bolusing for meals with OM5 which I don’t think I fully understand.
Let us suppose his BG is holding steady at 110. He eats say 50g of carbs and his carb ratio is 10. (just using the simple numbers for now). Loop would bolus 5 U up to the max bolus limit. Let say that max bolus limit is 3 U.
After some time, Loop would gradually bolus the remaining 2U. It would bolus based on the forecast, but eventually he would get the remaining 2U. At times, it can bolus quite aggressively.
I cannot tell if O5 will bolus the rest of the 2U. In the history, I never see more than 0.05 U or 0.1 U microbolus. In the chart, I frequently see an orange bar which means “insulin max reached”
Will it get more aggressive on the 2nd pod? Or is there a lot of manual correcting? I am in automode.
Thanks in advance!
@naromero , Welcome to FuD! If I understand your question example correctly I will say the answer is No in Auto mode and Yes if manually using extended bolus in Manual mode.
Insulet says Om5 in Auto mode will learn your insulin needs but in my opinion it does not have the ability to learn post-meal insulin needs or corrections. In fact, the bolus calculator has some details that I don’t like so I usually change the calculated bolus amount. Many commenters find that to be a fatal flaw. However, I find it easy to switch modes from Auto to Manual when needed. So the trick is deciding when to go to manual mode and when to stay in Auto mode. Hopefully after the third pod the patterns will be discernible and you can compare Auto mode to Manual.
Thanks – this what I feared. It looks like OM5 has no concept of carbs-on-board (COB) like Loop or AAPS.
It’s possible that COB is baked into the black box algorithm but if it is…it’s not aggressive enough to do much BG lowering when needed. Anyway, like I said it’s a fatal flaw to some people so maybe Insulet will improve the algorithm down the road?
We can always hope for improvements.
But as another data point, the Tandem Control-IQ does not take into account COB. (So, I am told – not from personal first-hand experience/knowledge, since it too is a black-box).
Algorithmic advances in commercial space seem to be driven by market competition. If Tidepool Loop (FDA-approved version of Loop), ever makes it out of the gate, maybe they will improve the OF5 algorithm.
I guess I will try this out for a couple of more O5 pods and then just go back to Loop with DASH.
I am definitely not as experienced as some of these other guys, but I can speak to what I have found so far with my son (12yrs old) and the Omnipod5. He started with it on July 11, so we are now on his 8th pod. With each pod, it has definitely gotten better in pumping out the basal when he starts to run higher (but I have still only seen .05 and .1 in the auto history) and we have also increased his insulin:carb ratio for meal boluses to prevent him from having too many spikes hours after eating. The max bolus setting can be adjusted- we haven’t touched that yet as his is set at 5 and we haven’t run across an instance when we’ve needed more than that. There are also times when we bolus with 0carbs to just speed up a correction. We are currently playing around with his IC ratios at different times of day – he seems to need more per carb in the morning for breakfast and if eating later in the evening (after 7). At first I was hesitant to have his meal boluses increase so much, but the automated basal system has usually kept him from going low…even when he seems like he’s headed there, he steadies out. I have no other pump system to compare to as he came from injections to the pod, but as sceptical as I was at the beginning with the Omnipod 5, I am equally beginning to trust it and like it.
I don’t use it (I use AndroidAPS with the Dash pods) but so far as I can see from the documentation you are correct; the COB thing, which can be very, very mysterious, is not part of the Insulet algorithm.
That’s probably partly historical; Insulet have always assumed that boluses covered carbs, so if a max bolus prevents that this would cause a problem at least for the period of the carb adsorption time (which, of course, depends on the carbs).
I suggest dropping, or overriding, the max bolus for carbs. Unless you count the carb equivalent of fats and protein and eat a large meal with fat or protein the carbs will certainly go through before the insulin, (guess we could have a pizza-effect argument here) so limiting the insulin while doing the carbs doesn’t seem right to me.
AndroidAPS doesn’t handle underestimates of carbs and a bolus limit really is an underestimate. There is a spike which can take me over 180mg/dL when the rest of the time AndroidAPS keeps me in range.
The oref2 algorithm (which is what I am using) does seem to be informed by COB, but the spike is still there. oref2 seems robust to updates to carb intake; for example adding 5g during a meal because of taking extras even though the added 5g delivers no insulin because of the “missing” carbs from the start of the meal.
This is why I described it as weird; the Insulet Dash algorithm would just believe me and drop .5IU (my ratio is, indeed, 10). AndroidAPS says, “Let’s wait and see.” In it’s defense it does seem to work but I’m not sure it’s better than the Insulet, “Ok, I trust you.” algorithm in a closed loop system.
We definitely need more people like you who have used both and can comment on the relative merits of the algorithm
Hey @John58 , great information here. One of the originals at FUD, but has been some time since I’ve posted.
Just went from Tslim x2 with CIQ to the OP5 and I’m running into some similar issues as others trying to figure out how to more aggressively treat unexpected highs.
My target glucose is 110 mg/dl and Correct above is set to 120 mg/dl with DIA set at 2 hours. Glucose goal range is 150 upper and 70 lower (although I think these are for statistics only and not used in calculations).
I believe what you said about about I/C and Correction ratios is correct on the OP5. I think they really need to be dialed in and carb counting be accurate as the OP5 just does not do a great job as correcting large post-prandial spikes based on poor carb counting or non-accurate ratios. For example, if I didn’t bolus enough for a meal on the Tslim, there were numerous times I’d see a temp basal well over my normal basal. I just don’t see that happening on the OP5. I do find it interesting that the user entered basal rates are not used at all in Auto mode. I guess that is part of the “learning”.
When are you switching into Manual mode again and did you mention that sometimes you ignore the bolus calculator?
I do love my OP5, just need to tweak as with all new pumps/technology.
Hi @mikep , glad to see more early adopters for the Omnipod 5, hopefully by comparing notes we can dial the pods in. Your message caught me in another experiment…I decided to try a few pods at 100% Auto mode to give the algorithm a better shot at its learning tasks. I am on the second pod with that experiment and so far it’s been a post meal spikeathon.
I always ignore the bolus calculator, because it is calcing a bolus to a BG of 110 and I want to calc my bolus to 85. Lately I have been pre bolusing for 30+ minutes and increasing my meal bolus by a lot, seems to help. Will keep you posted!
Hey @John58 . . . Thanks so much for the further information. I actually listened to the Juicebox Podcast … what a treasure trove of information.
I’ve been running auto mode 100% of the time and my numbers have been excellent. I think patience is very very key with the OP5.
Hey @mikep, nice to see you! Hope you are doing well!
I second that. Great to see you @mikep!
Hey @Eric and @ClaudnDaye !!! Great to see you both as well. All is well on my end and hope all is well with you both!!!
From my experience with AndroidAPS that’s generally true of closed loop systems. The better the input information the better the results. It’s true of open loop systems, including the Dash pods, too; if I’d done what I did to get AndroidAPS working for me but with the Dash pods I could probably have got great results too, just not as great.
The big thing that might be missing from the O5 system is taking the information required to learn the basal and using it to learn the I/C and correction values too. People who use NightScout can already do that, at least via a manual step. Those numbers are very difficult to get right and the work required to calibrate our bodies manually involves at least a day of not eating then a day of eating very exact amounts of carbs. The algorithms that are available today to work out the same numbers without such extreme diet changes (which might, indeed, actually change the numbers) do need to be incorporated into commercial systems.