Tandem tslim vs Omnipod 5

I have been reading about people with the O5 and some of their issues so far.
I am confident that I can overcome almost everything that I have read so far.
My Tandem tslim is out of warranty, and my new insurance provider does NOT cover tandem pump supplies! My endo is suggesting I try the new Omnipod 5 (still waiting to see if my insurance covers THIS setup!) to tide me over until the newest Tandem itteration.
I honestly would like the option of having either pump, and if I can swing it, I would have supplies for both to use as I need.
With Tandem and their control-IQ, I have learned how to tweak it to do what I need. I run sleep mode 24/7, and have cranked up my ratios, bumped up my basals, etc. to make it run like I want it to (well, as good as your going to get for a commercial closed loop anyways.)
Has anyone really messed with the settings on the O5 to make it a lot more aggressive and stay in auto mode 24/7?
Control-IQ has been a game changer for my quality of life, in that I do not have to think about my D as much as I used to, and I can eat different foods more with less issues, etc.
If I can tweak the settings on the O5, then I know I can make it work for me.
But I see where it has a ‘learning curve’ where it adjusts to you. Does it lock you out of a lot of settings because of this?
If my insurance covers it, I will try the Omnipod 5 out to see how I like patch pumps, and the new Auto mode.
But thought I would ask first to see if someone has really tried to push the O5. Most posts I see are either newbies to the O5, or everyone talking about how they loop with the Dash

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Bumping - I’m in the same boat as you. My Tandem warranty expires this fall and I love it but am interested in trying Omnipod since they have changed so much since I tried it last, 4 years ago (and didn’t like it).

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The only settings that you can tweak to make a difference is target glucose then only bolusing things likev correction factor, carb ratios and reverse correction for bolusing. If you dont like the number you generally hang out at changing target glucose is your only option after increasing carb ratios and adding manual boluses. If that doesn’t work your out of luck. You can give correction boluses as needded too which could help add to your total daily dose.

You can change basal rates, duration of insulin and correction factor but it will only matter in manual mode. The system runs on total daily dose and after the first day ignores all your settings.

Im finding that the system does a great job for me during the day. If I spike it brings me down to around a hundred before my next meal without crashing. The only problem I’m having is on certain nights I need a lot more basal than my total daily dose would indicate. So Im sitting at 140 to 160 all night even though my target is 110. I’ve been using dash for a few years traditionally pumping so I just put it in manual mode for those nights but I think most would not be comfortable with that.

I would love to hear someone coming from tslims opinion on the algorithm as well!

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I messaged my CNP to see what her thoughts were and she said she has tried both - here is what she told me (hi KN if you’re out there reading this):

I have been using Omnipod 5 for about 3 months now. It has been interesting. I was under the impression that Omnipod 5 would deliver correctional insulin like the Tslim does, but it does not. It takes the reading from Dexcom and adjusts basal every 5 minutes, but never gives a significant correction bolus. There is no sleep mode, but there is activity mode. There is no way to set up different setting profiles. The tubelessness is a really nice feature! In order to stay connected, Dexcom and the pod have to be on the same side of the body, which has been an unexpected annoyance for me.
Overall, I am finding that I have to be more proactive with the Omnipod as far as manually correcting high blood sugars. I like the Tslim algorithm better and I will be switching back in the fall. I do really like the Omnipod for summer though! It’s nice to swim without disconnecting and going high. Both systems have their own frustrations.

She also recommended this FB page for people’s thoughts (Juicebox podcast): Bold With Insulin

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Hmm, not being able to set your basals seems a little concerning.
I know on the tslim control IQ I went very aggressive on the correction ratios and it adjusts in small increments nicely for me.
I actually DON’T like the pump to give me automatic boluses, so I like that part.
Can you set the BG target for exercise? Or is it hard set to something like 150?
Also, can you set your TDD? Or does it ignore it anyways after it learns?

Also, odd question. Can you force the O5 to relearn? Like starting over again?
I could potentially see the benefit of restarting the learning with completely different ratios, etc.

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I like keeping my Tandem pump in sleep mode 24/7 because it DOESN’T give automatic boluses that way - I tried it in regular mode for the first week I had it and about threw it out. The pump’s adjustments in sleep mode are much more gradual.

I can’t answer any of those questions since I haven’t used it myself BUT I don’t think pumps “learn” at this point. They just use the data they have at the time and don’t make changes to the underlying settings. (The Tandem pump doesn’t learn, so I’m thinking Omnipod doesn’t either.)

The correction bolus with Omnipod 5 Auto mode can be significant. Last night I fell off the wagon at a party and had pizza and cake. The BG spiking started pretty late. For various reasons I did manual corrections and went to sleep at BG 200 and falling, Auto mode. About an hour later my BG peaked at 250+ but overnight the Automode brought it down over about a 2-3 hour time frame. I looked at the history and noticed that Automode was correcting with 0.4 to 0.45 units every 5 minutes for about an hour to reverse this spike. Those are the largest correction bolus amounts I have seen yet in Automode. They are about 400% of my basal dosage.

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In sleep mode it does not give boluses - it just changes the basal rate. If you’re in regular Auto mode, it does give boluses.

I know it technically doesn’t give correction boluses but… just like John58 said when above target range it gives basal plus extra basal every five minutes. I would consider that a small correction every five minutes. The IOB will reflect that extra amount and if I were going to give a correction myself it would be considerably less than normal.

I have not had to do a mealtime correction so far on this system. The algorithm has always brought me back down on its own within 3 hours of the initial meal time dose. The only time it didn’t was because of a clogged canula. But I dont eat pizza or anything that causes a significant rise a couple hours after eating so this might only reflect my experience. I do eat at least 40-50 carbs per meal just not slow ones.

It does have a activity mode that will make your target 150. You can only set your daily dose on day 1 pod one. Its not actually a question it asks you its just asks for your basal rates. Which I believe are supposed to represent half of your TDD.

You can start over again but if your using the same amount of insulin I dont think it would do any better.

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Are you using Omnipod or Tandem?

That is awesome that you haven’t had to make any corrections! Thanks for sharing your experience. It is helpful to read.

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Well, looks like my insurance will cover the O5. So I need to have the Dr do a Prior Authorization to get it started.
Hopefully this process will get started soon and I can try out the newest Omni Pod. I didn’t want to loose the Control IQ portion of the tandem pump, so I haven’t tried the omni pod setups (didn’t feel like messing with the riley link, etc. for looping.)
And now that they have a commercially viable closed loop setup, I think it is time for me to try out Omni Pod!
I know my Endo is happy that I can try it out, as she knows that I will tweak it until it works for me. And I will be her first patient that she has that will tweak teh settings as needed, and definitely the only one with prior Tandem experience to give a good comparison to.
Little exited to try something new. Of course it means a learning curve to see how much I can MAKE the new system do what I want. And how much it will actually do on it’s own. And if it will be a good candidate for a pump for me.
Time will tell!

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I edited my earlier post to clarify: I am using Omnipod 5

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Check the owners manual about that starting over question…I think there is an option to do that with a pod change.

As far as tweaking the algorithm goes, I took my basal rates and added 20% which helps when I am in Manual mode. The algorithm uses the total daily basal from the user input so that 20% seems to help as an algorithm tweak.

I have tried and have found no way to tweak the “Smart bolus calculator” which is (IMO) the weak link of the system. In order to do a correction bolus or a meal bolus, I always (1) go to Manual mode to start my standard basal rate and (2) do a quick calc in my head and increase the bolus above the calculated amount. Does not always work out perfectly but seems to work much better than the bolus that Omnipod calculates.

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Can you adjust your carb and correction ratios to make up for the bolus calculator? That is what I did on the tandem setup. The correction factor really helps when control_IQ is changing the basals for higher BGs. I really cranked mine up and noticed a big difference fast. But I do have to watch when I let it calculate for a large meal bonus. That is the only real time I have to watch out for this issue.
Can I set some rediculously high TDD to start with? Tandem limited the amount, so I set it to max TDD and max body weight. Small things, but they help.

Is there an online owners manual I can read? Need to start my reading/researching now!

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I have not tried that. The problem with the bolus calcs is the way Om 5 does IOB. It takes some but not all of the every-5-minute-basal (or microbolus) and factors it in as IOB. It also will not allow a goal BG for a bolus calc to be lower than 110. I always add 1/2 unit instinctively to get past that but the IOB has caused some bizarrely low numbers to come out of the calculator.

Omnipod-5_User-guide.pdf

392 pages…be careful with all that new knowledge!

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Thank you!
And tandem is 112 with it’s target, so no big difference there.
I could easily get it to keep me in the 90 to 100 range if I wanted to. But I had to change that approach for a few reasons.
I imagine it only figures the basal for IOB that is above what your normal basal should be. If so, that would be similar to the Control_IQ approach.

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I guess you could set a crazy high TDD but it would only make a difference for the first 24 hours. From what Ive experienced there is no way to manipulate basals aside from manual boluses and carb ratios. Coming from a tslim you might not need to tweak carb ratios. I am more the norm and had to increase my carb ratios quite a bit in order for this system to work and definitely pre bolus. If you do not pre bolus adequately the basal corrections could cause a low later. As John58 said they can be significant at higher numbers(210+) in my month plus time on this.

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Good to know.
Basically I have carb and correction ratios to play with.
I don’t prebolus unless my BGs are higher than normal.
I use Lyumjev though, so it acts pretty fast (I use Fiasp as my backup. And am curious to see how it acts in the Omnipod vs in the Tandem cartridge.)

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I’ll be curious how Lyumjev works for you with the pods…I’ve always used Fiasp with pods but formulary reasons are causing me to switch over the Lyumjev.

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