Hi, everyone. I have hit the three month mark of having the Omnipod and have made tons and tons of changes and kept records of all of them. My insulin to carb ratios are more than twice as aggressive as mdi, but they seem to be dialed in pretty well now. However, I cannot seem to ever get enough basal. I have sent my duration of insulin to two hours, knowing that on MDI it’s really about 2 1/2 to 3 hours. My correction factors are now between 35 and 40 whereas .5 units of insulin on MDI would lower me 50 points. My target incorrect above are both 110. I crunched the data yesterday and found MDI for the last 30 days before I started the pump and the last 30 days of the pump as of yesterday, which was its best month, I have the exact same average blood glucose. The pump wins by two points for standard deviation being two points on average lower. I was 93% time in range on the pump and 95% on MDI. And please note, I hesitate to give even my real numbers, but my life is the best situation possible since I worked very hard to literally eat just three meals of mostly the same stuff, exercise, at least an hour and 10 minutes at high heart rate every day, and work out for about an hour with free weights two days a week. I do not snack. I am 2 1/2 years into this diagnosis and my lifestyle was already set with exercise so I changed my diet. I between 20 and 45 carbs per meal. And hope to soon learn to eat pizza and start living. I just wanted to get this ironed out first. Also, the Omnipod people and from reading here, I have tunneling in a bad way even using pod pals and I tried skin tag but really hate that. I did get my Endo to give me a prescription for changing the pods every two days, but I’m a person that tries to make scar tissue fast I think, Hence the tunneling besides the fact that I’m active. So the issue here is, I am spending a heck of a lot of time, making corrections and trying to push to give me more basal. It says I’m using 23.8 units of insulin total per day. Basil makes up 8.15 or 34% of that and bolus 15.6 or 66% of that. And yesterday I ate a total of 117 g of carbs. I just changed my max basil to 1.5 units per hour, so obviously that’s a lot more than I need. And finally the last piece of data Is that I’m using on average 16% more total insulin on the pump. I was using an average of 19.4 the last 30 days on MDI. How can I get this thing to get me out of the 130s overnight? And how can I get it to be even just in the one teens during the day? I guess I’m getting a little frustrated because I really want to use it and trust it to do better and be easier. And I really want to eat real food and enjoy life and bolus easily through the pump. I’m still learning to tweak the exercise situation and that will help a little bit as I have a rise every day after exercise. And right this minute I’m 207 and heading north, because I had to do The pod change and I guess this side is not liking the spot and I’ve already exercised hard, so not really feeling like walking so I will go check and make sure the insulin eyeball list after changing and after eating breakfast is not swimming on the adhesive. Anyway, I love this site and I don’t mean to offend that I have high standards for my management and want to keep that and live and I don’t mind going. Very aggressive to have more control. Please help with any and all of this that you can. and without complaining, my biggest concern is that I can’t spontaneously take the dog for a walk or go play tennis without planning to eat glucose. I could be 7/10 of a mile away from home, walking the puppy and start dropping so there’s no use and eating anything at that point because I’d be home by then anyway. So if you have any suggestions about how to live spontaneously or just tell me if I have to always be planning to try to get zero on board before any sort of activity and Paul’s insulin, then I’m fine with that. Just trying to learn to live my best life and I am ready now to let go all the fear and do the best I can in the easiest manner. I guess it Could end up on better with shots, but I do know my blood sugars would rise higher, but they came down very fast on MDI. So just looking for the best way to live. I appreciate any and all help and all opinions even if you tell me, I’m doing things all wrong. Thank you in advance and let me go deal with this blood sugar. Have a great day.
Omnipod 5 - 3months in - how to get overnights closer to 110; days, too. What else can I change?
Sorry for typos above. I’m speaking this to my iPad. Paul’s is pause above. And of course, it won’t default to Basal as an insulin insulin versus Italian cooking basil. And I just did a very fast walk where it was 212 and rising when I left and now I’m getting alarms because I’m 136 and two double arrows straight down. Frustrating but I guess the insulin is working. Maybe I just need to go for a walk right after changing the site. Now gotta decide when and if to go ahead and eat a glucose tab. As you can tell, I had inside the house, shots worked, and that was very different than learning to think like this Pump. Thanks again!
I am not qualified to help with your problem but I wanted you to know what can be done. I am in my eighties and had used Medtronic pumps for decades. My A1C averaged around 6.6. I switched to Omnipod 5 last July. My first A1C after 2 months was 5.7. Three month later it was 5.4. I run the Omnipod on automatic and make adjustment to the setting as required.
Please keep trying.
Thanks Cattell! I appreciate the encouragement and I am going to get all I can from this. That information helps alot just to keep me motivated and to stop questioning whether to keep using it or not (wasting energy) and instead to experiment more and find my best settings. Thank-you!
I second the motion not to give up! I have been using the Omnipod 5 for about 8 months and am still learning/discovering how to best make use of its algorithm.
My bg numbers are about the same as I had the past few years with Omnipod original and then the Dash. A1c in the 6.1 to 6.3 range pretty consistently but with fewer lows especially at night.
I have formed the opinion that the cannula on the pods does not work well for me sometimes which throws a whole nother variable into the equation. When Tandem comes out with the patch pump I will probably switch to that. But until then I will keep plugging away with the Omnipod 5.
Thanks John58. I agree 100% on the cannula situation and didn’t know Tandem is working on a patch pump! Yay! I will keep plugging away remembering that the lows at night are pretty nonexistent. If/when I get exercise and pausing insulin or activity mode down to a place where they work with both weights and fast walking, I will also be happier. If only they had the iphone app!
Also, if anyone else is reading this, I heard a Juicebox podcast yesterday about a mom to a T1D child had her controller die and had to start fresh with new device. This time she set up more aggressive ratios, etc. at the getgo. When I have had disconnect issues, I have used “restart” to bring it back, but I am wondering if anyone knows how to completely start fresh with the controller. This mom said in 4 days they were right back where they’d left off, so I surmise the algorithm can give more basal if I were able to start again. I used to rear having to start over when ios app comes, but now I would love to try that. Please advise if anyone knows how. “Restart” does not wipe it clean to initial state and I can’t find another way to do this (yet). Thanks to all and to John58 for keeping my encouragement going.
After changing a pod if you want to wipe out everything and start again with a higher Total Daily Dose- go to settings, then General. The last item is reset clear all data. You would need to set up a higher total daily dose overall. This could help for the first couple of nights get you down to 110 but it will make your daytime lows worse.
The algorithm ignores duration of insulin, correction factors, and basal rates(except for 1st pod). So changing those does nothing except help you make decisions for manual boluses.
It also really only looks at the last 3 to 4 pods for info. So if you are waiting for a month for it to get any better that is not going to happen.
I would recommend that you listen to the three episodes that Juicebox did on Omnipod 5. It covers a lot. On you tube there are Loop and Learn discussions for OP5 that are great as well. I’ve found that even providers have some errors when talking about this algorithm. Like changing some settings will make a difference when it doesn’t or waiting it out for weeks until OP5 gets to know you.
In the end this algorithm might not work for you and that’s ok. It was made for the masses and isn’t changeable except for carb ratios.Your unique needs might not fit. You might have to look into the tslim or DIY looping. When it doesn’t work for me I switch to manual mode and use my own settings.
Thanks, Josie! All of that makes sense and I will check out those other Juicebox episodes. I am glad there are choices and want to give this the best try I can. Thanks for the Youtube stuff to look up as well. I am glad it is not just me - I was making changes and not seeing changes and then ran out of things to change. I will definitely keep exploring. Thanks so much!
I was actually going to try to reset my algorithm also as when I first starting using it it was great now it sucks. Always keeps me too high no matter how many tweaks.
I would definitely love some kind of option to change the algorithm in future updates. Something like activity mode but exact opposite for extra basal insulin. Probably wishful thinking?
I was thinking they have have two modes, one default appropriate for kids and an aggressive mode which allows a more aggressive algorithm and/or set points. They could require a training video and acknowledgement form if they are that worried about it.
I just reset all my data so curious how it’s going to do. If it works well maybe I’ll reset it every few weeks.
Here is what I’ve been doing…works for me as long as my bolus matches my meal. The main reason I’ve been doing this is to use extended bolus, but it seems to also boost up the auto mode basals after a few weeks.
1/2 hr before meal: switch to Manual mode. Start temp basal increase (amount of increase depends on meal, trend before meal, etc. Sometimes I max it out) and set it for 1 1/2 or 2 hrs.
1/2 hr before meal: Bolus and use extended bolus. Usually I will do 50% extended bolus for 1/2 hr.
After meal: watch BG. When it is in range and dropping, turn off temp basal and switch to Auto mode.
The affect of all that is you are increasing your basal for 4 to 6 hours a day, during and after meals. The algorithm seems to get a little more aggressive with its basal after sticking to this routine for a few weeks. My understanding is the algorithm is mainly looking at your TDD and this manual mode temp basal routine increases that TDD.
I’m using a variation on your technique, John. Before meals, I’ll switch to Manual Mode as I’ll extend any bolus that will be delivering more than 5 units. If it’s a fatty meal I’ll start that bolus with the meal. If it’s a carb-fest I’ll start it early - sometimes way early. By being in manual mode I can extend the bolus, the adaptive basal rate won’t ding my dose as it sees my CGM line dip (Sugar Surfing Fan that I am), and my insulin volume won’t overwhelm the site and result in leaking. Using Manual Mode is a great tool! Two hours PP, if all is well, I’ll switch to Auto Mode.
I really, really, really wish that the whole thing about being patient and not using Manual Mode would fade away. I’ll even go as far as to suggest that if you can’t successfully pump in manual mode your technique and settings are so off that Auto Mode will be a frustrating adventure and the fix will be elusive.
I’ve forgotten to make the switch back to Auto mode after many a lunch. On those afternoons I am invariably trending towards low BG about 4 hours after the meal. Those lows seem to confirm that my basal program is intentionally a little high, which is intended to help with the process of using manual mode selectively for meals and swapping back into Auto mode after manual mode has fulfilled its mission.
Twins! I have the same experience, exactly.
What you relate confirms the most important benefit of OP5 Auto Mode: it will taper and cease 5 minute basal mini boluses in response to falling glucose, resume & boost as it is projected to increase. I stay full auto. If one goes too high (various causes), it may take a LONG time for basal mini boluses to correct. I pull up the dosing calculator, which knows IOB (still pending) enter no additional carbs, but let it calculate a corrective dose, as I would have on MDI pens, but better informed. I can override the number if I judge it too aggressive or too weak based on my history, whether I intend physical activity, whether I’ve eaten fast or slow carbs, etc. As I understand, he additional dose adds to TDI for the day, so helps adjust the basal algorithm going forward.
Re pizza, I have found I can eat it with marginal impact to blood sugar as long as I don’t pig out. YMMV. I get a Thin Crust pizza from the grocery store, garnish with additional toppings & bake at home 10-12 minutes. A small portion feels like a good meal eaten with a salad. The leftover pieces are still tasty cold the next day or reheated in microwave.
Re living one’s best life: after I developed T1 at age 19, I decided to do the best I could without going crazy. It worked. I would have done better had tools like CGMs been available.
Put that leftover pizza in an air fryer. Better than Day One! Seriously, I love your “…do the best I could without going crazy.” That’s the best thing I’m going to read on the internet today.
That advice reminds me of some words of wisdom from my first diabetes class: “Moderation in all things…including moderation.”
Thanks. I am beginning to see that. Also I have continued to work with more aggressive I/C ratios and now have my correction factors from 30-40 depending on time of day. Scary, because in November, one-HALF unit correction would bring be down 50 or a bit less, so this 30 seems so very extreme, but I think it is chipping away at my overnights so down to 120s now and hoping soon to be near 110. I still think I have a looper lurking inside, but I am still learning the OP5. Exercise remains a challenge between activity mode and pausing insulin and such, I still often rebound high post-exercise moreso than on mdi. Still, I think the OP5 is now approaching my mdi bests for TIR and average glucose, and definitely SD, so progress is being made! Only concerns now, besides worry about such low numbers for correction factors, is that I absolutely have to change pods at 48 hour mark and find it challenging to keep finding places for 5 pods to one dexcom. Thanks for the help!