I’m only three weeks into O5, and I know it can take a while for the algorithm to learn, but when it comes to diabetes, my middle name is Impatient. I find the algo far too aggressive – it keeps driving me down into the low alert zone. Every few days I raise my targets and I:C ratios to get it to ease off on the basal, but it’s just as aggressive.
For those with more experience with the 5, would it make sense to do a reset and start afresh with new settings? Or is it best to keep making incremental tweaks and wait it out?
From what I’ve come to understand the pod is taking info from at the most the last 3 or 4 pods so waiting a month for it to get better is pointless.
Ummm I would definitely reset with a lower total daily dose but that really only works for one pod in my experience. The next pod will have your actual higher TDD info from the first.
If I have a sudden increase in sensitivity I do not reset the controller. I put on activity mode for the entire day.
Have you tried changing the target BG?? Under bolus settings- target glucose and correct above. It can be as high as 150. That could be easier than constantly putting on Activity Mode.
You can reduce you IC ratio which you are already doing.
Are you pre bolusing far enough ahead to prevent a large spike??? If my pre bolus is late for a higher carb low fat meal and I notice it’s going above 200 quickly I will put on activity mode for a couple of hours to prevent a crash. Or plan on having like 10 carbs or so on the quick decline to make up for the extra basal.
Their algorithm is not too sophisticated. I think 50% of your TDD (Total Daily Dose) goes toward basal.
(I am not 100% sure of the exact percentage they use, but I think it is 50%. That is what I have heard from others.)
So is it basal that drives you down? Or is it the corrections they are giving? Sounds like from what you are saying, it is the basal causing you the problem.
So in your case, 50% of your TDD is too much basal. (Personally, I think it’s kind of dumb that across the board, they use the same percentage for every user. )
That means your TDD needs to be somewhat lower. A lower TDD means a lower basal.
If you take 1 of your meal boluses with injection, that would decrease your TDD and therefore decrease your basal. I know that’s not super convenient, but I think that would work. Probably would be easier to do it for a bolus when you are at home, so you don’t need to carry insulin around with you.
Here is a little example to illustrate it with numbers. (I will use easy numbers, because I am not too smart. )
Suppose a person takes 48 units per day. That means the O5 thinks they need 24 units per day of basal, or 1.0 units per hour. Easy, right?
Now suppose that same person starts taking 8 units of mealtime bolus with an injection. Now their TDD (as far as their O5 knows) is 40 units per day. The O5 does not know they took 8 units with injection.
So their basal would now be 50% of 40 units (instead of 48 units). That’s 20 units per day, or roughly 0.83 units per hour.
I’d read a lot of people saying that over on Reddit, and suggesting that being aggressive with corrections for the first few weeks would increase the TDI and result in higher basal adjustments. Which is what I did – I noticed the incremental adjustments increasing – but maybe I went too far.
Lower TDI (or TDD) is what I’m aiming for, by raising the target BGs and lowering the boluses via I:C ratio.
It’s primarily the basal that’s driving me down, though my boluses could be too much as well. (The corrections are the basal, since I’m almost always in Automated mode.) For example, I’ll go low several times each night, 8 to 10 hours and more after my last bolus. It’ll suspend basal/correction delivery, but not soon enough. I’ll go up from my treatment, but then instead of the algo levelling me off, it’ll drive me down again.
Yeah, the 50/50 goal strikes me as dumb too. And so far it hasn’t got close. The last few days it’s been around 40/60 basal/bolus, but before the most recent tweaks it was closer to 30/70 or even wider. But it hasn’t reduced the problem of going low.
It’s tempting to inject to fool it, but then I’d have to keep doing that, because as soon as all one day’s boluses are from the pod, the algo will readjust, won’t it? I’m happy that with a combo of U200, Tegaderm, and extending any bolus over 5 or 6U, I’ve avoided tunnelling, and therefore any need to inject, but it may be necessary if nothing else works.
Yes. For overnight, when the problem of the basal forcing me down is worse, I’ve gone from an initial 6.1 (110) to 6.7 to 7.2 and now 7.8 (140). Only one option left. I’ve also increased my daytime target to 6.7.
I prebolus at least 15 minutes, but any longer than that and I can crash quickly. Almost all my boluses are extended at least half an hour, so I need to be in Manual mode, which rules out Activity mode. But switching to Activity is a good tip for other times when I can see I’m heading down and I can see the algorithm isn’t doing its thing soon enough – thanks for that. (And here I thought I could be less “focused 24/7” with the O5 …)
The benefit of a hard reset would be to make the algorithm forget everything. I’d like to start from scratch with my current (adjusted) settings, rather than with anything remembered from the two weeks with the last 5 pods. Not sure that’s the best solution, though.
Sorry I I was unclear. I was talking about a hard reset and starting over.
The very first pod would give you less corrections because of the lower total daily dose that you would put it. - This is your initial basal program. To be easy let’s say your basal is 1 unit a hour normally. Instead you would say your basal is .50 or .70 a hour if the corrections were too much. That amoun Is what the algorithm is basing corrections on along with the blood sugar target.
But…. 80 hours later the second pod gets the true total daily dose amount from the first. Not the initial basal rate you set. Then it will ramp up the corrections over the next 2 pods to the same amount you are finding too much.
Unless for some reason you are just way more insulin sensitive than normal in which case it would be just fine.
Seems to make a pretty weak effort to make the basal/ bolus 50/50 because I’m taking generally 2x the bolus with it in auto mode and it still Won’t give me near enough basal
Sorry @Beacher but I have never heard of the Omnipod 5 driving peoples BG too low, it seems like the rest of us had the opposite problem. I gave up on Automode entirely and set up a basal program that I use 80% of the time in manual mode. However, I will still use Auto mode for a workout or bike ride, hike etc. because it will automatically pause insulin if I’m dripping towards BG 110, (which never catches it in time and I often will drop down to the BG 70 or below range). I also use Automode if I want to drop off to sleep with insulin on board and it does a decent job of preventing a low BG overnight.
One thing to look at in Auto mode…somehow the algorithm considers part of the insulin you used over the past few hours and might think of as basal, but it is counted as “IOB”. For example, waking up in the AM in Automode with a BG of 120 or 130 and Omnipod 5 says “IOB 2 units” or similar…even though I had not taken a bolus for 10 or more hours. That attribute causes me to ignore the bolus calculator, because it was including that phantom IOB which made no sense to me. However this unexplained IOB in the algorithm would tend to drive peoples BG high and not low.
My suggestion is reset and then run Omnipod 5 in manual mode for a few weeks to load it’s memory with a TDD that works OK keeping you in range and then try Auto mode again.
I haven’t really found anything that seems to help. I’ve tried running stronger basal profiles in manual for weeks at a time (except when sleeping) so that it sees a higher TDD, and that hasn’t seemed to made any difference for me
I believe the Omnipod 5 in auto-mode modulates the basal rate to keep the blood sugar in the target range. The IOB amount you see when you wake up may be the cumulative result of overnight basal rates (or cumulative micro-boluses) that exceed your normal basal profile.
I would definitely reset with a lower total daily dose but that really only works for one pod in my experience. The next pod will have your actual higher TDD info from the first.
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