Hi, all! Newbie here. Getting right to it, I’ve been on the Omnipod five part for over two months now and still cannot get the basil to be correct. I need anywhere from 100 to 120 g of carbs in a day and exercise six of seven days a week. The percentages continue to be about 65% bolus and 35%basal. And I am still giving multiple corrections after meals. Even after making more aggressive, much, I/C ratios. So it requires more work than I hoped to continue to have to do to use the Omni pod five. Also, I get up at 4:30 in the morning and I’m out the door exercising on one cup of coffee and some sugar-free delight by 530 and exercise for about an hour and 10 to 15 minutes. I have tried setting activity two hours prior to the fast walk, but I still go very low very fast before the 1st mile. I’ve tried not using it, and of course drop fast. But I don’t think I can make activity work. I am finding that adding a glucose tab or 220 or 30 minutes before going out. Helps me make it to at least a halfway point. Only problem with all this is that I seem to rebound higher after the exercises over. And the final complication, and I welcome comments on any and all of this, after talking to a rep on the phone yesterday, I may have what is called tunneling and of which I have read about here. I will be trying skin tac and such, but don’t quite get how the outside being more secure keeps the cannula under my skin steady. I do believe I make scar tissue fast and will also pursue 2 day rx. After 2 days, I can correct 10 times upon going to bed and wake at 143! First 2 days are better, but I have yet to wake more near 110-120. Also, lately dexcoms have needed multiple calibrations (hate a finger stick - often have to do 3 to get enough blood - grossed out squeezing my finger). And, I have red bumps at previous sites and some bruising and have sometimes changed the pod twice in one day - pooling of insulin and/or blood into the surrounding adhesive. But on the other hand, I was able to hike for hours on Saturday and eat just Nugo and Kind bars and was level and so much easier than shots and needles and paraphanalia on a hike. Yay pump! But by and large, I still want this to work without so many corrections. I keep it on automated, but it does not seem to be getting my basal right. I was on 11 to 14 Tresiba prior to pump, depending on stress, allergies etc and this is giving me only 7.45 units of basal a day! So, long introductory story, short (that ship sailed, I think!), I still wonder if mdi would be better. I use good protocol on pump sites, etc, but always stress as to where the next pump will go. Had a belly fiasco of pain and blood last week, but have overused, to me, lower back. I appreciate you for persisting through this long post and welcome any and all experiences and ideas and suggestions, inside or outside of the box! Thanks to all and I am happy to have found this site!
Hi @Quadgirl! Welcome to FUD!
For exercise, there are a few things you can do. It also depends on what type of exercise you are doing.
For a fast walk, I think the best thing would be to turn that pump and it’s auto-corrections off, and manually do it.
I’d suggest a starting point - depending on your BG before you start - would be a zero basal, maybe 30-60 minutes before you start, and keeping it off as you go, and taking carbs as you go.
Check your BG and adjust as you go, and also adjust the timing of the zero basal after you have tried it a few times and learn how it works for you.
There are a bunch of exercise posts on FUD!
Thanks so much for that quick idea! I appreciate it and am so glad to have foundFUDiabetes!
Kudos for your exercise routine. What are you doing. Aerobic exercise at moderate to tempo heart rate tends to a slow drop in blood glucose. HIIT, sprints and resistance workouts can cause BG to rise. That doesn’t mean those types of workouts are bad for us, just something to be aware of.
I use aTandem pump with C-IQ. For me the exercise mode doesn’t work. I stay in regular mode regardless whether doing aerobic or resistance. That usually works well fore.
Sounds to me that you are exercising while fasting. When I do a morning bicycle ride of 1 hour. It’s a couple of hours after my usual breakfast of 24g carbs. Longer rides, I have a Kind bar just prior. This causes a slow rise and slow drop.
We’re all different, but I would go hypo exercising for 1+ hour without food.
Sometimes what works today may not tomorrow. Saturday I did a 32 mile bike ride. At the turn around point I had 8 g of glucose because Dexcom had slowly dropped to 90 mg/dl.
On the return my BG rose to 144 and then slowly dropped. So far so good, but at 28 mile took a rapid descent to 88. I still had legs, but when I got to a good stopping point where I could sit, Dexcom was 61. Finger stick confirmed.
I was definitely feeling hypo and low energy. I sat on that wall eating a pack of peanut butter crackers (21g). After 15 minutes BG rose to 78. I finished the ride at 100.
This was an unusual thing for me. Fortunately I’m hypo aware.
As to the Omni 5 and C-IQ- well, I am more than a little skeptical about semi-automatic algorithms. If we were all cookie cutter people, well maybe, but we are all unique electo-biochemical beings.
Thanks for your example. I totally agree with you about these algorithms. And yeah my blood sugar will rise upon coffee and the sugar-free delight that I drink to about 165 and begin dropping so I do think eating a kind mini (8 carbs)before starting and then I usually need one or two glucose tabs about the 2 mile mark and that should help. I think I just expected the activity mode to work well. And when I was on MDI, I knew exactly what number to go ahead and eat at on the walk and could wait till bg was 115 or so, but on the pump I have to eat when it hits 140 because it drops so fast. And my heart rate is well up there because I’m doing a very fast walk, about 14 minute miles. I used to be a runner but picked up some virus when I walked the Camino a few years ago and pulmonologists tried to diagnose me as being an asthmatic and luckily I got to go to the mayo clinic and confirm that I was not asthmatic but I did need to stop running because I kept triggering all my lung issues. And sometimes I will run a mile of the 4 to 6 mile walks. Just trying to find balance. And so I do believe that I’m just going to learn to manage this with the pump and just note what works. One thing I really feel though, is that my sugars rise later and need to be dealt with, versus no issue on mdi. And that is irritating. I eat breakfast about 40 minutes after I finish exercise. And on weight training days, there’s a whole other learning curve. Anyway, thanks for the explicit example because it sure does help me.
The activity mode’s that all pumps use is simply targeting a higher BG. That’s not the best way to do it, because higher BG means your body is not using the glucose in your blood for fuel. And any fuel you take while exercising is also not being used.
The best way is to reduce your insulin and to take carbs for fuel. It takes practice to get it dialed in correctly.
I experience this regularly. I do a lot of stationary riding with a smart trainer controlled by an app. This is a whole different thing than riding on the road.
I’ll get a sudden drop per Dexcom around 20 30 minutes. If I stop BG will start rising without treatment. The virtual ride can be easy, medium or hard like a real ride. That’s the beauty of a smart trainer, but the effect on BG is rather odd.
This happened on MDI as well. It’s a mystery.
I’m a little jealous you got to do the Camino. A lady I ride with is doing it In portions. I asked her when they would get to Santiago. "Maybe 10 years. Laughing 
Thanks Eric. That makes sense and I sure hope to get this dialed in. Do you think a pump can do this as well as mdi? Thanks!
One more question, Eric. Do you think if I do my coffee, get up to 160s and pause insulin and exercise that may work? I see that from manual I can hit a pause insulin button. I wonder if I paused it upon waking, did my coffee routine and recording stats from previous day on both dexcom and omnipod, and then maybe ate 8 carbs, or not, and exercised, I might manage this more like when I was on shots? I know everyone is different and I will have to work to find my best way, but is that a sort of protocol for how to stop getting insulin before and while exercising? By the way, I did not get any guidance on setting up the manual mode stuff and later called endo people to be sure if I went on manual I wasn’t going to get too much insulin and they pretty much just asked about my basal rate settings making sure it was not totaling more than the 11 Tresiba I was on, so I have not done anything but go into manual for 10 minutes every so often hoping automated would somehow see those basal rates and give me more during the day. But I know I need less in the morning due to exercise and the omnipod aiming for 150 and unable to do that is messing up my start to the day, I think. If I can get exercise right, I think things will be better. This am it went from 140 (ate 8 carbs right then and was 130 by finishing chewing up tabs and felt low and dropped to 106 in minutes - hate having to stop and wait for the drop to stop before resuming exercise). I think I may have clouded things with too much detail of today’s frustration, so I guess if you just have any thoughts on the question in second sentence, that would be great😁. But maybe the rest can help - just don’t want to be a pain. Thanks!
We feel your pain. Joking and serious at the same time. Let’s see what Eric comes up with.
Thanks!
Thanks! I got lucky in my Camino timing, in retrospect, because it was 2014 and before my diagnosis. I am not sure I could handle all the extra Blood sugar stress at this point. It is quite a thing to do though!
A general thing about Omnipod5, Dash, and Tandem pump algorithms (not 100% sure about Tandem because I have never used that one myself)…
Suppose the normal BG target is 120. If you go over 120, they increase your insulin to bring you down. Not getting into the weeds about all the different algorithms that different pumps use, or if they do it by basal, micro-boluses, corrections, etc, etc. The very simple and general idea is that they give you more insulin if you go over your target.
Let’s suppose you set it to “exercise mode”. They all have a higher BG target for that. But I think that’s it. If you go over the higher target, the pump gives you more insulin to bring you down.
But I don’t think that a pump realizes that when you are exercising, your insulin sensitivity changes drastically depending on the type of exercise you are doing, and the duration, and at what point you are in the exercise.
Not 100% sure, but I don’t think exercise mode’s make changes to insulin sensitivity. Someone correct me if I am wrong on this!
If you are in the pump’s “exercise mode” and you go up to 160, guess what the pump is gonna do?!? It’s give you more insulin! And if you are exercising, that “more insulin” is gonna cause you to crash.
A manual basal adjustment keeps the basal rate at an exact number that you can designate. I use a zero basal. You may need zero, or 20%, or 50%, or something. But at least a manual basal setting will let you set the exact number that you find works for you.
Tell me what your body is going to use for fuel with this scenario?!?
Your body’s blood glucose! That’s all it has to fuel the startup of your walk. You are not giving it any fuel, so of course you crash.
Do you know how many total grams of glucose your blood has? Suppose your BG is at 80. Your blood only has about 4 grams of glucose in it total! That is nothing!
And if your body uses only 2 of the grams you have in your blood, you will drop to 50. 
You gotta give it some fuel!
Once you have walked for a little while, your body can start to metabolize fat as a fuel source. But initially, it is going to grab the easiest thing it can use. And that’s going to be the glucose in your blood.
These things take practice and testing and adjustment. You will have to do this many times and adjust it. But my initial recommendations are:
- Turn off exercise mode.
- Set a zero basal.
- Eat something before you start. Give your body some fuel.
A pump can do it much better than MDI, if you set it correctly. (And as long as the pump’s infusion works well for your body’s tissue type, etc. But that’s a different topic.)
The huge advantage of a pump is that you can turn OFF your basal! 
As far as spiking after you finish, that’s not too hard to fix. You can turn your basal back on about 15 minutes or so before your walk ends. And you can also take a small bolus a little bit before you finish. You have to practice the amounts to see what works. But it is easy to fix.
Not at all. That’s why we have FUD. 
BTW, lot’s of topics and quoting and things covered in this post. Not spending too much time proof-reading it, sorry for any typo’s or grammatical mistakes. I know @CatLady will have my back on that. 
Thank-you, thank-you thank-you! Every single bit of that makes perfect sense, and I will start experimenting with the basal rates for exercise tomorrow. I am ever so psyched that I may be able to get this tweaked just right for both fast walks and weight training and even dog walking and hopefully tennis and biking soon and get to live and do things I want to do and feel more powerfully in control. Side note: Yesterday, my Endo approved and sent in a prescription to change my pods every two days and that will help me mentally not worry that I’m gonna run out, but I’m hoping to get the things more stable on my body so I don’t have tunneling and can wear them three days.
But geez! I think this will be sort of fun trying to work within the manual mode. I had previously set six different basal rates segments when I first started Omnipod 5 because I thought it might influence the automated mode. And I wrote down my little notes about why I was adjusting it just by a little for each of the segments based on the behavior of my blood sugar at different times of day. And I just didn’t think about BG dropping fast out the door because it’s not yet burning fat- funny and dumb oversight! I’m just trying to consume the least amount of calories, but I do think I’m gonna choose to eat a kind bar, the 16 or 17 g size before heading out, maybe 30 minutes prior, and see if that will take care of things and of course carry glucose tabs. And maybe I will try very low basal rate, but I’m tempted to do zero. I don’t guess there would be any harm, jumping right into that and just keeping an eye on what happens. I know it cannot be any worse than using the activity mode. And I have places along my route where I can stop if I need to. This is very very much what I needed to know. And by the way, I turned on manual mode to see how it would handle my blood sugars out of curiosity earlier today and accidentally left it on for about an hour and a half. It brought BG down from 170s and kept it level at about 114 for the next 40 minutes until I realized I had forgotten to put it back on automated. I wonder if I should use manual mode for a day and just see what happens with the settings I had made back in October and then just have faith that I have a sense of what’s going on? Plus, I can easily adjust basal for exercise time segment since I had that in mind when I initially played with the settings. I wonder if anyone ever uses manual mode? Besides during exercise. They encourage you so much just to put it on automated and I guess that’s the point. But I never did think about controlling exercise using manual. My eyes have been opened! Thank you so much for taking time to address the bits and parts of my questions! And my pod change has made a big difference in my attitude. I wonder if anybody else feels like crap when you hit the 160s in 180s? I just call it grungy feeling. But it could be psychological because I’m disappointed. Anyway, I’m already learning so much here it’s unbelievable! I am so hopeful this pump may change my quality of life and that is a good feeling! Thanks!
In my non expert opinion I think it’s helped me to successfully run manual mode before OP5. Especially for times that Dexcom is not behaving, a bad pod site or when a algorithm is just not working for the moment.
When I first signed up for Dash the 5 was supposedly going to be approved around the corner. Well it turned out that it would be over a year before I could get it. The first month was hell but I finally figured out my body’s unique basal needs. I don’t think that would have happened if I just jumped into OP5. Now when Dex is off or Im more insulin resistant I’m just fine going into manual mode. I bought a old book on Amazon called Pumping Insulin by John Walsh. It helped a lot!
Sounds like you’re working it out. Stay with it and Good Luck!
I’ve been playing ice hockey with the Omnipod 5 and have settled in on something that works for me: I actually only tried Activity mode a few times and eventually decided it was not worthwhile. I am always in regular Auto mode for hockey and for at least 1-2 hours before and I spend my diabetes thoughts moving my BG up when needed to stay in decent range. The hockey games can last anywhere from 1 hour to 1 hr 45 minutes and I use the CGM to check glucose level and trend before and during the hockey games. When I start to see a drop below about 100 I start ingesting glucose to keep things in a range of (hopefully) about 80 to 110. Sometimes over those 2+ hours it might take 45+ grams of fast carbs to keep me in range, sometimes only about 15-30 grams. It all usually depends on what level I was at when I started and what that trend was.
With the Om 5 you can check the history tab and see how much insulin the pump algorithm was giving you during exercise. As long as I am in range when I start this pregame and during game BG routine, the pump usually gives me zero insulin over that 2 + hours. So basically it is a zero basal chosen by the algorithm. If something goes haywire and my BG is rising above 110 it nudges me back down with its Auto mode micro bolusses, very effectively during exercise.
Thanks, Josie. That is what I am sensing is helping me learn now. I appreciate that!
Thanks for those experiences. This is all making sense!
Hey, Eric! That has begun to work for me - I tried it this morning! I made a new post to share my experience with this and a couple of other things. Thanks so much for opening my eyes to what really works and what is possible. You are so right - the activity algorithms do not work in the best way, physiologically. I am so excited to be on the verge of getting my exercise right and without fear! What a great day! Thank-you so very much!
Congrats @Quadgirl!
I saw your other post. Awesome stuff you figured out with the duration and IOB too.