Something needs to change - Omnipod vs TSlim question too

Hi all. Type 1 for 26 years (I am 43 now) and I could use some input.
My control for the past few years has not been great. I was at one time on the Medtronic pump, then went to the Omnipod about 5 years ago. I do love being tubeless but at the same time I feel like I have had a lot of problems with the omnipod. I never really know if my bolus’ are going to be enough or too much, even if I try to eat the same exact thing every day and play with the bolus. Sometimes I suspect I have a bad insertion and change the pod after a day, and then it is better. Other times it seems fine. I feel like I look at my Dexcom readings ALL DAY. Even though I have alarms set I had to expand them to a higher high because they were going off constantly. I am now giving myself injections for some bolus’.

I just got my AI1 down from an 8.2 to a 7.2 by trying to be more diligent (weighing my food, tracking everything in sugarmate, etc) but I feel like it needs to be much better - especially considering the amount of time I am dedicating.

Talking to my doctor he suggested I get the TSLIM system with control IQ. I think I am ok with the tubing. However, since I just got my Omnipod Dash it would cost $1,000 for me to upgrade out of pocket and probably higher cost of infusion sets. Do you think this would be helpful?

Things can change quite a bit over 5 years, but I’m curious how your control was when you were on Medtronic? I’ve never used Omnipod - I’ve been on TSLIM with Dexcom for several years, and am doing training to upgrade to Basal and Control IQ. I think I have seen discussions on the forum about pod issues (do a search for Pods in the search tab and you may get some helpful info. I know it’s tempting to respond especially when you see this CGM arrows rising or falling. I start to rise fast after eating, even when I’m positive I’ve bolused correctly - and I would take a little extra hoping to “head things off.” My doctor have me strict instructions but to give any any insulin for 2 hours (in my case) unless I ate more or realized I really had under-calculated, because I was not giving the insulin time to work. I fixed myself to just turn off the alert and just check how much time had elapsed. Sure enough after about 2 hours (in my case) I was leveling off.
My doctor recommended Control-IQ, and as I said before I will be starting with Basal IQ very soon, the stepping up to Control (her office wants me to do it that way). I’m looking forward to it as my A1Cs run in the mid 7s and I would like to tighten things up. However, given the investment you’ve already made in your Dash you might want to go through the process of elimination by checking out pod issues on the forum and what users did to resolve them. I see you’ve been on the pod for quite a while but I personal find I sometimes overlook things despite longevity.

From what I’ve read about Tslim and Control IQ, it seems to be a good option. The cost is another matter. As you consider the technology you want (and can afford), have you consulted with a diabetes educator? Early this year, I was going nuts with my Dexcom results as I tried to balance everything. The diabetes educator helped me understand the numbers better and gave me some valuable perspective so that I could work on tighter control and enjoy life a bit more. I wish you well as you wrestle with this decision.

Hi Jen @JenS, nice seeing you again, it has been a while.
Pumps are good, all of them to some degree, but all pumps are only as good as the basic information that we feed them. You’ve had diabetes for a long time, so I feel as if I can speak directly to you [I’m not a medical doctor, but I’ve “learned diabetes” from my several decades experience], and compare pump efficiency to accounting and apply the familiar “GIGO” - garbage in, garbage out.

If your pump personal information is not correct and applicable for your activity levels it just will not produce the outcome you want or need. Critical personal information the pump needs includes:

  • Insulin Sensitivity for various time periods;
  • Insulin to Carbohydrate ratios for all meal times;
  • Basal Rates for each hour of the day - or groupings of a few hours; basal rates are most important especially for "closed-loop management.

I will suggest that you first validate your basal rates by “fasting” - by this I mean, eat a normal supper and then do not eat again until about 1 PM the next day. Monitor your glucose levels closely and do not make corrections unless you go too “low” or too “high”; with your experience, you know what is too high or too low for YOU. If you see a pattern of being out of range, adjust your basal rates in “small” increments. If you are uncertain if your Pod is delivering bolus insulin, inject meal-time and correction insulin during the times you are validating basal rates.

Yes, this does take time, but in my opinion it is worth the effort. Do keep in mind, that your body needs change over time and you may need to do the validation again.

Now my thought on the t-Slim Control IQ - AWESOME!!! I’ve been using the CIQ since late January and my time in range [TIR] is well over 90% - which is a major thing for me. What CIQ has done for me, is smooth out my DexCom peaks and valleys - greatly reduce my standard-deviation over the course of the day. That said, I have heard from a few people that CIQ didn’t work well; in most of those cases, those people did not have reliable basal rates in their Personal Profile. IMHO, basal rates are the most important factor in effective diabetes management.

I went to t:Slim with CIQ when it came out in January. Since the my DexCom scores have been between 99 & 96 % between the lines. I see the CIQ up & lower my nasal insulin & even see it turn the pump off. My A1C three weeks ago was 6.2, down from 7.4 in September.

I whole heartedly recommend the CIQ with DexCom over any other combination on the USA market today!

I use Omnipod, DexcomG6 and Riley Link which is like artificial pancreas. Have not had issues with any other Than mistakenly a few times out pod into near muscle. If you put Omnipod in muscle it does t work - pinch out fat on your belly good place to insert or arm or thigh where there’s fat and no muscle.

Hi @JenS. I’ve also been diabetic for 26 years and I just started using the Omnipod in February. I’ve never used another pump before, so I don’t have much to compare it to, but I’ve experienced similar problems to the ones you described. Seems like when it works it works well but when it doesn’t work it really doesn’t work. I’ve been struggling to figure out appropriate basal rates, carb ratios, etc. because my schedule has been crazy since the pandemic hit. I just don’t have the consistency I need. I’m hoping that thing’s’ll get easier once my work schedule goes back to normal. But I’ve also heard that insulet is hoping to release closed-loop systems with both dexcom and freestyle sometime this summer, so I’m also kind of waiting for that to happen before I make any more big decisions. If the cost of switching to TSLIM is an issue, maybe you can hold on for a few more months? Personally, I’d be ok with 7.2 right now. I’ve never gotten below 6.5, myself, and my blood sugar was low all the time back then.

@bsteingard The Horizon hybrid closed loop system is not being released this summer. When they made the announcement 6 months ago that they hoped for a summer release, it was never going to happen. They had a major setback a few months ago, which they are still not being honest about and have delayed the launch to sometime in the first quarter of 2021, but in reality it will most likely be mid to late 2021.

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Well, that’s disappointing.

I had an omnipod for 4 years and it honestly was great in the beginning but at the end it would give me around half the insulin I needed and it turned out to only be 23% accurate at delivering insulin. I’m on the 670g and I love it I loved being tubeless but I’d rather not have a 10 a1c. The last time I wore my omnipod the cannula went in to far when I was laying on my site and it caused me to bleed so badly I passed out. Love the company but I can’t go back :grimacing:

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Hi Jen,

I have been using the omni pod for several years and it works great for me. However, when I started looping there was a dramatic improvement in my time in range. Most importantly, my number of lows at night when from multiple times per week to about one per month. My sleep was so much better and my quality of life was improved because of the Loop.

My research suggests that the Tslim is great but not a significant difference from looping. If you start looping there is no long term commitment with Omnipod so you could switch at any time in the future.

I like the “no tubing” part of the omnipod.

Jason

Thank you Dennis for this response. You are correct - I currently have no grasp on my ratios right now. They seem to have changed since I last did testing and my insulin sensitivity is way down. I also seem to go through periods of stress with work and at those points it is very difficult to figure out the patterns. Do you have any resources you recommend for figuring all of these out? Thank you as well for the good referral to the t-Slim. I am still waiting for a response from them on whether I have been approved or what my monthly cost will be vs the Omnipod.

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Thank you for your response! I am finding It is just not consistent as well.

Awesome thank you for your experience!

Jason, I feel really behind the times because I know nothing about looping. I will look into this thank you!

@JenS, This whole thing gets more and more Topsy Turvy as you get tighter control. My CDE said when I related having the same CHO intake (three of the same meals from a restaurant) three days in a row and ended up high, low, & perfect on each of the three days. The acronym she used was SWAG. Scientific Wise Assuming Guess. <<< GRIN >>>