OmniPod 5 Questions/Best Practices

Good afternoon,

I have a few questions for people using the Omnipod 5. I have referred to the manual often and I can’t seem to find the answer or if the answer is there, I am not understanding it. I have a call into their Client Service but I thought I would check with people who are actually using the product and see what your best practices are.

  • Activity mode - I don’t understand why it still gives me micro shots if my BS is >150? I usually adjust my IC and carbs for when I work out so I go in on the high side knowing my BS will come down due to the exercise. Also, I usually exercise 3 hours into my last bolus so I don’t have a huge amount of IOB. I found out, the hard way, that it will still give micro shots even though I don’t want it to. What is the rationale for this (real question and not sarcasm!)? I now go into manual mode and pause insulin. I am not sure if this is the best course of action but I am constantly going low because of these micro shots. What do others do for exercise so they don’t go low (or get the dreaded down/double down arrow.)

  • Manual mode - I can’t figure out if it stops all insulin or just my temp basal. The history details just show it goes into manual mode and then nothing else is shown till I go back into automated mode.

  • IOB - It only shows boluses and not any of the micro basal shots (confirmed this with Insulet Client Service) How can I easily figure out how much insulin I truly have onboard? Currently, I go to History and just add up the auto events.

This is my first pump so I am learning a lot and had to change quite a few things from being on MDIs. Overall, I really like the POD but the micro shot (and why they are given) is really stumping me. Recently, I find myself using manual mode quite a bit and even pausing my insulin after my meals (again, because micro bursts are still being given even though I accounted for all of my carbs with my meals bolus and the insulin needs to work for the next 2ish hours.)

Any recommendations or best practices are appreciated. I know that no one here is a medical professional, I am just hoping for some real life suggestions on how you use your POD that the manual/basic training didn’t cover.

Thanks!

MF

Mary-Francis @MFBarry, I don’t use any OmniPod but I have glanced at sections of the user manual.

To begin with, I think that your decision to “pause insulin” is correct and fits YOUR body’s needs and is very wise. I recognize your caution to be wise.
I found this piece on page 302 of the manual -

  • "… While Activity is enabled, the Omnipod 5
  • System does the following:
  • • Reduces automated insulin delivery
  • • Sets your Target Glucose to 150 mg/dL,
  • regardless of your target settings
  • With Activity enabled, you can still deliver a
  • bolus as you normally would. ".

This is the explanation for the micro bolus trying to bring you down to 150 mg/dl while in activity; your experience says you don’t need this extra insulin.
I believe the “pause insulin” stops ALL insulin delivery - basal, bolus, correction.

The IOB in the Pod, t-Slim, and if I correctly remember the MiniMed ONLY refers to bolus, it ignores basal - I’ve suggested that this needs to be addressed. Humalog insulin, both basal and bolus has a lifespan of 4-5 hours and a portion of the should be addressed when calculating a meal bolus - especially by those guilty of constant “over basalization”.

I like the way you work to find your own “best practice” - awesome! For me with the t-Slim, I found the auto-correction bolus to severe especially in Exercise Mode where the attempt of the pump algorithm is to target 140 even though the historic formula for calculating a correction was used and the calculated bolus was reduced by 40%, I needed to adjust mt ISF to reduce the delivered bolus. That appeared to solve the issue I experienced; in my old-age, I’ve become very sensitive to insulin and find that even 0.05 units make a difference. My thoughts may not be applicable to OmniPod use, as the algorithms between Tandem and Insulet differ - the OmniPod was developed similar to the Medtronic theory.

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@MFBarry there is NO PUMP on the market that can address exercise mode. my sensitivity increases by 100% and I’ll immediately go low because of the intensity of my typical workout. The only predictive and adaptive pump controller that can do that is my brain. I know what I need to do if I am eating with IOB, or with preemptively reducing basal. CIQ/Automode and Omnipod 5 cannot do this. - You are doing the right thing, you are a better controller than the one in the pump for this!

yes I think all pumps ignore basal insulin as IOB which is a huge problem if you are sitting at your desk in the morning and then running/bicycle riding in the afternoon. if you do the same levels of activity then basal IOB matters a whole bunch less.

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I have been using Omnipod for about 6 months now but rather than tell you too much I suggest you go back to your trainer so they can give you additional one on one coaching and guidance.
That said, with regard to to goal of 150 in activity mode, it’s important to remember that 150 is the goal it’s aiming for but it won’t be exact. And now since you are going in on the high side I imagine it’s giving those micros to bring you down. The system learns your body’s responses, so in theory the more you use activity mode the less it will give those micro doses, but those adjustments might depend on how far in advance you start the mode, how active you are, and other factors.
Manual mode is not meant to stop insulin - for that you must go into manual mode and then select “pause insulin”: manual is for times you need to “override” the pod’s programming for some reason; if the system kicks you out of auto because you have exceeded the maximum amount of insulin allowed; or if you go off your Dexcom for instance. In my settings, manual mode delivers 0.7 units/hour part of the day, and 0.9 the rest, so if I turn off auto mode that’s what takes over. It’s very important to know what your rate/s should be, even if you plan to stay in auto mode most of the time.
I think you would find additional time with your trainer to be very helpful - I was frequently in touch with mine for few weeks after I started and she was very helpful.

@Dennis Thanks for this! I know that you are very active from your other posts. I wanted to make sure I wasn’t doing something VERY wrong. The mini boluses are wreaking havoc with me when I do other than sit.

@joe Totally agree! The amount of micro boluses given over the course of 4 hours really adds up - especially if I go high after a meal (waiting for my meal bolus to kick in.) Using the IOB just for meal boluses seems redundant - I know how much I gave myself and I can divide by 4 (the length of time I set my insulin duration for.) Thanks for the input!

@wadawabbit I am waiting for the Insulet Training Team to get back to me to answer these questions. My regular trainer told me that ‘pause insulin’ is very rarely used and mostly by extreme athletes. When I found that pause insulin worked best for me when I was getting ready to exercise because it shut off the micro boluses, I thought I was doing something wrong or misunderstanding the usage.

Part of the reason I noticed the micro boluses, is that I was coming off of a low and my actions worked perfectly (which I could never replicate!) - no up arrow and a slow steady rise to 132. When I looked at my history, I noticed I was once again getting micro boluses which was lower than my settings of 150. I needed to figure what was going on or I would constantly be in a cycle of recovering then go low again because of the micro boluses.

I really like the POD, just need to figure out activity and immediate highs after eating so I don’t go low later.

I appreciate your insight! You are part of the reason I decided to try the POD. :wink:

True - the algorithm is the Omnipod5 is such that we shouldn’t need to stop insulin except in extreme circumstances such as you mentioned. How long have you been on the pod?
I stopped going to the gym several days before starting on the pod: I had been going 4 or 5 days a week but wanted to minimize the variables that would affect the system’s learning. It took two or three pods for it to learn, then I returned to the gym. No one told me to do that but in the past when doctors wanted to help me tighten things up a bit they addressed one thing at a time - diet, exercise, weight - so I figured it would be better to take it out and add it back in later. It seemed to work for me. That said, ask my teachers and they will tell you I did not excel in science, and that’s putting it mildly - so my personal finding may have just been a happy accident, but if you’re just starting it might be worth asking about.

@wadawabbit Good morning! I have been on the Pod for about 3 months. The first problem was that I got sick with a cold that lingered for 3 weeks just after I started, so the Pod needed to ‘relearn’ me.

My biggest problem is that I am constantly going low with the Pod - most people are finding the exact opposite. I went low (in the red) twice yesterday - after a walk with the dog and during the night. I find that I am constantly managing the process more now than before.

I am curious if the Insulet trainers will have any recommendations for me. Maybe I am trying too many things and the Pod is confused? Maybe, as a new pump user, I need to adjust to certain things that I didn’t realize? But right now, I haven’t been to the gym in over a month because I am not only going low, I am going low with double down arrows for something as simple as walking the dog (not a fast pace) for 30 minutes or going grocery shopping. I have eaten more sugar tables/drank more apple juice in the past month than I have in the 1.5 years of being a T1D.

I am not ready to give up yet. I know I can get this to work - I just have to figure out what, potentially, I am doing wrong or how to get the Pod to adjust. Fingers crossed!

I used Tandem for several years before switching to Omnipod, so with my old pump I felt I could speak with some authority - although stopping short of crossing the line to giving medical advice.
But since Omnipod runs its own algorithm in auto mode there are only a few things you can change to help get your numbers lower or higher. My Omnipod trainer gave me some advice to use to help tighten up my numbers - since yours are going too low of course you would want to increase rather than decrease. Please discuss this with your own trainer and check with your endo on where to set your target if you’re not comfortable doing this on your own.
The Omnipod system adjusts insulin delivery every five minutes with the goal of getting your blood sugar to your selected target blood glucose. In the Omnipod if you go to menu, settings, bolus, target blood glucose you will see that your target is ###. If you want to tighten up your blood sugars then you would lower this target to (###-xx). In addition you would lower the correct above which is when the system starts giving insulin.

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