Hi, Allison.
There are lots of folks here who will help you work it all out. We all have our own mostly-strong opinions, and they won’t necessarily all point in the same direction. But if you can stick with us, you’ll get there.
So here’s what I think.
First, when it starts to get too confusing, I always go back to the touchstone I got from my CDE early on. She said this: “If your blood glucose is too high, you need more insulin.” The utter simplicity of that helps cut through all the confusion and complexity.
If you BG is too high when you wake in the morning, you need more basal during the night. Starting about 2 hours before the rising trend.
If your BG is too high after breakfast, you need more insulin (or less carb) for that meal. And pre-bolusing or super-bolusing can help.
If you tell the Omnipod to give you more insulin and it doesn’t seem to be working, maybe you are having absorption issues, so switching the pod might fix it, but you don’t have to switch the pod, you can always take out a syringe and vial (or pen) and just take an injection. Some people prefer that for a large meal bolus even if they are pumping, so they help protect the site from an early failure because of too much insulin in one place. An injection can even can be IM if you’re looking for a quicker response.
Now if you need inspiration that you can get this under control, you can look to DaisyMae’s swimming thread. She started out afraid and confused, and now she’s a fearless, independent expert at dosing insulin for her exercise. Daisy Mae’s swimming BG thread
Sam likes MDI, tresiba, and afrezza. He knows how to get great results.
Eric likely will be happy to guide you through the process of figuring out your dosing, step by step. He’s a pumper and an expert in many things, including dosing for distance running and the low-level biological processes underlying diabetes and treatments. I agree with Eric’s comment that “a strong and sufficient basal sets the stage for everything you do. If you have a sufficient basal, you won’t be chasing highs and won’t need to pre-bolus as long.” Figuring out your basals is an excellent starting point.
By the way, I agree with your thinking that if you get the shape of your basal profile right, mostly you can just use percentage temp basals to adjust it up or down for the day’s circumstances; hormones, site age, immune/allergic reactions, and dozens of other factors. You don’t have to figure out and understand all those causes to fix your BG. If your BG is too high, you need more insulin. So if you see a trend (I’m running high today) you can just increase your temp basal percent, and keep turning that knob until it works. Michel and his son do this all the time.
I’m a big fan of Dexcom CGM. You said that you used it in the past. If you can get one, it could protect you from lows so that you can dose enough insulin to solve your high BG without getting into trouble. But you don’t have to use the CGM: DaisyMae figured out her insulin dosing strictly with needlesticks — lots of them; sometimes a couple dozen per day.
You’ll get this figured out. We’ll all help.