Good day to all, wish the best to all. I have been reading every thing on the O5 that I can find and tweaking my pump. I am going to try and be as concise as I can, and maybe stay on track.
First and probable most important thing I have learned is the biggest flaw in the O5 is the user, yes the user. If we eat properly and count cards, all carbs correctly and have our I/C ratio and correction ratio perfect. Exercise, limit stress, depression it makes it simpler. But who can do that. so…
The O5 uses TDI to determine your basal’s, adding the #s from your last pod to the prior determination of basal requirements, period.
But in the way that it uses the #'s is where I found some interesting findings.
first off it divides said #'s in half, because it wants a basal/bolus ratio of 50/50.
( I am sure we all do that, right?) and uses that 50% to base it’s basal needs
estamate on, but it is not limited to that #, and that’s about it, but with that in
mind, Here is a few points/thoughts/findings.
Most Doctors want a target range of 70-180.
Now if you use such range and look at your history you will notice as your BG approaches the upper limit it will start reducing your basal, and below will almost stop, being perfectly happen letting you hang in the 150’s. the target BG (say 110) is in my option useless. I “guess” if you didn’t eat for a day or so it might get close. But for me, at least, it will only get down to like 120ish and that’s when I get up if I go to bed early and sleep in.
now I have come to learn that TIR is considered as, if not more important as the A1C metric, there is a Tight range used for a TTIR (tight time in range) of 80-140. It was discussed in a panel devoted to it at the Advanced Technologies and Treatment (ATTD) last year in Germany.
Now I set my target range to 80-140 the week before (I guess) and noticed that the basal would stay strong down towards 140 verses 180 and I would wind up, more than not, around 110ish. with the addition of bolus down into the 90’s.
And really surprising to me, at least, it would basal to keep me there in the range of 90 even 80, as a guess, because I was still in my target range. I have been able to get it to keep me in the 80’s and still deliver basal to keep me there.
Now I want to discuss “Stacking” as it pertains to the O5.
Firstly the O5 in auto mode doesn’t “per say” stack insulin, It takes IOB into account and will make recommendation for bolus as long as you are,
your BG is climbing and,
you are above your correct above setting.
( I believe I have noticed that it will recommend a bolus if you are high and
stable or even dropping.
I also try to give bolus around 130ish if there is not a lot on board or if it has
been an hour or so since my last bolus.
I brought up “stacking” because when I eat and when my BG starts to climb
I start bolusing and will bolus every 45 minutes until it starts to drop, I am
on Humalog and it’s peak action time is 30-45 minutes.
I have also set my I/C ratio a bit lower than maybe I need to help get a little more insulin for carbs. I mean why not, the O5 will cut back on basal or stop altogether if going low, but I am shooting for the 80 range to land.
To finish I want to say that this is my experience using information gathered by me, and interpreted by me. There is more but I believe I put out what I wanted to. and to say if I could take myself out of the equation I believe it would work great for me. My daily averages and TIR have for the most part been a lot better, I have days where my average BG was 112 with 95% in range with only 5% above and 0% and only one where my average was 137 with like 30% high. but I believe I only had one “low” and my target range is 80-140 so it was not really low. and have had a couple of dinners where I have had to go into manual and boost my basal to like 350units per hour for 2 hours with a temp basal.
Anyway of course I am up to any critique and fully expect to get bashed by this, but, hay tomorrow is a new day, right? And hopefully we will all be here to do again, hopefully a little better.
Where did you set that target range? The OP5 in automatic mode doesn’t consider any range. Target blood glucose (a single number) yes, but not a range. I suspect what you are referring to here is the range that is set regarding Dexcom readings for reporting purposes and that has nothing to do with how much or little insulin OP5 will give to keep you to keep you in that range. It’s all about TDI.
Good Morning, First off let me say no one knows exactly how the algorithm in the O5 works.
Next if the O5 only works off of TDI and the target BG (110 for me), then how does it know when the BG is high or low? Or for that matter at the target BG we set, does it not use the readings from the Dexcom, and does it not respond to those readings by increasing or decreasing your basal as required? albeit in the case of high BG rather poorly. (and yes the TDI will have an effect on how strongly the system will deliver a basal) They are an interconnected closed loop system, to what extent they are interconnected is beyond me (I of course did not write the code)
Okay, in the settings of the O5 there is a range setting where you can set a high and low Glucose Goal Value. Sure it says “these limits are used in Glucose history displays and in Glucose reading statistics” and of course we are able to set a high and low range in Dexcom. So which, or both, or any does the algorithm in O5 use to adjust your basal according to your BG?. furthermore we know it does adjust it or else it would give a flat basal as in manual mode not a basal that goes up and down depending on your BG. And from my experience the target BG value is a fantom number. and as I stated in original post I can get my BG down in the 80’s and as long as I am stable, with no food or exercise, it will basal to keep me there.
I realize there is some conjecture in this, but am I far off in that?
I would like to add that the “it’s all about TDI” fact everyone uses, even me, as I said “The O5 uses TDI to determine your basal’s, adding the #s from your last pod to the prior determination of basal requirements, period”. Drives me crazy because there are actions to how it uses the TDI that are known or reconized, “first off it divides said #'s in half, because it wants a basal/bolus ratio of 50/50.
( I am sure we all do that, right?) and uses that 50% to base it’s basal needs
estimate on, but it is not limited to that #, and that’s about it”.
Now the “but it is not limited to that #” statement I used is based on the idea that if we look at our history, do we get the same amount of insulin or even basal from day to day. Do we get many, if any, days with the same amount of insulin or basal. So I think it is a safe hypothesis that something or somethings are going on behind the curtain of TDI as used in the O5.
As always I look forward to any and all prospectives on any of this, it is of couarse a journey of discovery and I buy no means consider myself an expert on the Omnipod 5 only a person trying to make it work as best as possible for me. and just as important as finding things that work (for me) is finding where I am wrong in my assumptions.
The OP5 algorithm is proprietary and we don’t know how it works. But Insulet has been very clear in that the only factors we can control which influence the Adaptive Basal Rate (automatic mode) are the Total Daily Insulin Dose and Target Blood Sugar. The rest is only known to the man standing behind the curtain. I do agree with you that diet and exercise are very influential but that’s not under any pump’s control.
To answer a couple of specific questions - OP5 knows the blood sugar is high because Dexcom is reporting a high number. Nothing magic there. Insulet has also talked about that 50/50 basal/bolus ratio. It’s used by the Adaptive Basal Rate to smooth dose calculations but again, that isn’t something you can set or change. It is what it is when in automatic mode. I can’t make it be 50/50 if the Adaptive Basal Rate is giving me 25/75.
The essence of TDI importance is for those folks who are flailing in automatic mode and desperately making all kinds of changes to their basal rate, I:C, correction, and even duration of insulin action. None of that matters at all when considering basal doses in automatic mode. That’s a thing in manual mode only.
Agreed, but how can I explain the difference in the action and outcomes on the O5 since I changed the ranges. My time in range has actually gone up, and my daily average BG’s have gone down, and my daily insulin usage has gone up.
I truly am not being argumentative, I just feel there is more in the using TDI to “influence the Adaptive Basal Rate”. like if it is only using those factors how does it know how to adjust the basal rate, I know that sounds simplistic but the basal goes up and down to control the rate our BG’s fall, and I have been on the O5 I guess over 6 months now and have not ever had the O5 get me to my Target Blood Sugar.
The reason changes to your reporting range might result in better control could be it’s a different pod as the pods are dynamic, learning from the previous three. Or it could just be diabetes being diabetes. But correlation does not mean causation to use a trite phrase.
Have you listened to the Juicebox Podcasts? The expert giving insights has actually been involved from the very first trials. She knows OmniPod5 and presents great information in an easily understood style.
You’ve had 6 months on OP5 you have never had the O5 get you to your target blood glucose number? Whoa. Have you only been in automatic mode? How do you do in manual mode?
Okay this will be sort of happen stance.
Basal Rate adjustments will have an affect on automatic mode in so much as they affect your TDI, I use manual Temp. basalt increases when going really high, to me above 200 which affects my TDI. Now granted it has no immediate impact on automode but does affect my TDI.
In respect to my ideas on the 50-50 goal of the O5. I use in respect to the amount of TDI it uses to base you basal needs for the day. and sure it can go up or down as required.
of course the I:C and correction rates have an immediate and important impact in auto mode unless you only basal and never do carb, or correction boluses. Or for that matter boluses at all.
The duration of insulin action affects the IOB calculations. Almost exclusively.
Yea I stayed in automatic mode hopping for the magical moment that the O5 would learn me. To be honest I guess that was a false statement in that I have when I get up been in the 110-120 range. but never when up. and before changing my goal range it would be fine with me being around 150 giving 0.05 microdosces. I got fed up and started making changes reading everything I could find.
I also started using manual mode, but only for certain circumstances, example; before dinner if readings before were problematic, and if I go above 200 then I use Temp’s.
I was on the Omnipod Horizon for about 5 years and hade it dialed in except in the areas of overnight lows. I have gastroproises and tended to eat later in the day, around 7-9ish. but I Fixed that eating part, and through proper use of my meds I can get my stomach to digest close to properly (most of the time)
Okay thinks for the reply, have listened to all the podcasts many times, jukebox, insulate to name a couple. I am retired and spend a good portion of my time researching; diabetics, computers (I rebuild MacBooks on the side), and cooding. But that means I am by no means an expert on any of them just a old ass student I will say.