Omnipod 5 - 3 months in and.....

[Conks01]

.... very hit and miss!

It's like Marmite. I seem to have a run of good days, then a run of not so good days.

My TIR sits between 50% - 70% on average I'd suggest but I have had a few 100% days here and there.

The spikes are terrible however and despite best intentions and following the rules, no matter what I do there are still spikes which is frustrating to say the least.

I'm due back to see the DGN in a month so will review then. I'm thinking that I may need a faster acting insulin.

I was wondering what anyone else feels about the O5. I'm sitting on the fence at the moment.

 

[Tdm]

The spikes would be down to you to deal with by carb counting, pre-bolusing etc...you are in charge of the bolus insulin whether the injection method is pump or pen,
What sort of spikes are you seeing?
I find a walk after eating really helps keeps the spike down

 

[helli]

Sorry your OmniPod is not giving you the TIR you hoped.
If you are using it in in a HCL mode, I have heard from multiple sources that the OmniPod is very gentle in terms of corrections compared with HCL on other pumps which may be contributing to your spikes regardless of your carb counting.
If you are not using it in HCL mode, it could be a need to tweak the basal profile or I:C ratio which your DSN can help with if you are not confident to do so yourself.
However, just like MDI, if your BG returns to your required level after 4 hours, your basal and bolus are likely to be about right and you need to pre-bolus earlier.
Unfortunately, high BG does tend to make us insulin resistant so we need more bolus and basal (which the basal profiles do not factor in) and they take longer to start working.
Faster acting insulins like Fiasp tend to be more sensitive to high BG. I take Fiasp in a pump without HCL and find the speed at which it works and, hence, my pre-bolus times, are dependent upon my pre-prandial BG. If I am in the 4s, the Fiasp will start acting immediately whereas, if I am over 10, my Fiasp can take an hour to appear to do anything.
So, if you have a tendency to higher BG, the "faster insulins" may not be as fast.
For me (without HCL), it encourages me to keep a closer eye on my BG and make more corrections if I see my BG is tending towards double figures. This is not an approach to take with HCL.

I apologise to those who walk after eating. I know it can help but I have a tendency to roll my eyes when I read it as a suggestion. I wish I had time to go for a walk after eating but I work full time and take a short lunch break. In the evening, it is too dark (and, this time of year cold) to go for a walk by the time I have eaten.
And I am not letting diabetes dictate what I should do when (apart from taking insulin).

 

[Conks01]

The spikes would be down to you to deal with by carb counting, pre-bolusing etc...you are in charge of the bolus insulin whether the injection method is pump or pen,
What sort of spikes are you seeing?
I find a walk after eating really helps keeps the spike down

They are quite steep and can take hours to come down. Noted re the post meal walk. Thanks

 

[Conks01]

Sorry your OmniPod is not giving you the TIR you hoped.
If you are using it in in a HCL mode, I have heard from multiple sources that the OmniPod is very gentle in terms of corrections compared with HCL on other pumps which may be contributing to your spikes regardless of your carb counting.
If you are not using it in HCL mode, it could be a need to tweak the basal profile or I:C ratio which your DSN can help with if you are not confident to do so yourself.
However, just like MDI, if your BG returns to your required level after 4 hours, your basal and bolus are likely to be about right and you need to pre-bolus earlier.
Unfortunately, high BG does tend to make us insulin resistant so we need more bolus and basal (which the basal profiles do not factor in) and they take longer to start working.
Faster acting insulins like Fiasp tend to be more sensitive to high BG. I take Fiasp in a pump without HCL and find the speed at which it works and, hence, my pre-bolus times, are dependent upon my pre-prandial BG. If I am in the 4s, the Fiasp will start acting immediately whereas, if I am over 10, my Fiasp can take an hour to appear to do anything.
So, if you have a tendency to higher BG, the "faster insulins" may not be as fast.
For me (without HCL), it encourages me to keep a closer eye on my BG and make more corrections if I see my BG is tending towards double figures. This is not an approach to take with HCL.

I apologise to those who walk after eating. I know it can help but I have a tendency to roll my eyes when I read it as a suggestion. I wish I had time to go for a walk after eating but I work full time and take a short lunch break. In the evening, it is too dark (and, this time of year cold) to go for a walk by the time I have eaten.
And I am not letting diabetes dictate what I should do when (apart from taking insulin).

Thanks for this, all useful so appreciate it.

Your comments re walking post meal I tend to agree with. It's near impossible what with the work and family routine each night

 

[rebrascora]

The thing that struck me about your initial post was the phrase "following the rules". I think this is one of my pet peeves with diabetes management which sometimes stops people from managing their diabetes better, in my opinion. People need to be encouraged to carefully experiment to see how their body responds rather than follow rules.
I think one of the key things as @helli has mentioned is prebolus timing and often people are told to inject 10 or 15 or 20 mins before eating or even just before eating with some of the faster insulins like Fiasp. In reality, that advice is not conducive to good diabetes management. I needed to prebolus 75 mins in advance of breakfast most of the time with NovoRapid or I would spike up to 15 every morning and then come crashing back down. When I moved to Fiasp it was a little quicker but I still needed 45 mins prebolus time most mornings unless my levels were in the 4s and then I only needed about 25-30 mins. If I woke in double figures I would be waiting well over an hour and sometimes two before eating breakfast to prevent a big spike. Other times of the day I need much less prebolus time usually 10-15 mins with Fiasp 20-30 mins with NR.
As @helli says, if premeal levels are low I need less prebolus time and if they are high I need longer. Generally these days, I just watch my Libre and start eating when I see my levels get down to mid 5s and the insulin is clearly active. I worked out these timings by ignoring the "rules" and slowly and carefully extending the prebolus timing by 5 mins every day or two until I found the timing that worked for me with the insulin I was using at the time. My consultant was absolutely horrified that I was prebolusing 75 mins before breakfast each morning with NR and still 45 mins with FIasp but he couldn't argue with my Libre results. I average 90% TIR.

You have to find what works for you. Try doing some experimenting on a non work day when you perhaps have a little more time or less pressure. Start where you are now and work on just one meal at a time, maybe breakfast to start and increase the prebolus timing by 5 mins and then maybe another 5 mins the next day until the spike starts to come down to an acceptable level.

I did it before I had Libre and I was finger pricking up to 16x a day to find the optimum timing. It is so much easier with Libre or other CGM!

 

[helli]

The other thing I would emphasise is Balance.
You need to find the right balance of managing your diabetes and living your life. And this depends upon your personality and your lifestyle.
My personality is stubbornly making sure I am in charge of my life and not diabetes. I will accept the risk of a few highs in order to spend time away from staring at my Libre.
We are all different. Pre-bolusing 75 minutes (or even 45 minutes) before breakfast like @rebrascora would not work for me as it is too restrictive. Diabetes is not going to make me get up early and restructure my morning so I can eat breakfast as my BG starts heading down. I may need to be out the door or may have meetings or I may just want I lie in. And I easily get distracted if I bolus too early - I cannot be staring at my Libre graph waiting for it to head downhill so I can eat. I can do this and have time to do this as much as I have time to go for a walk after every meal as it could help my diabetes. It does not suit my personality and lifestyle.

But it is perfect for others. So you need to find the balance that suits you.

 

[nonethewiser]

Spikes, if regular could indicate your not getting right balance between food insulin & bolus timing, although obviously there's others factors like stress illness even time of month for ladies can be to blame.

50-70% in range does seem low for O5, don't know if your know but even in automated mode you can still give a correction bolus even if pump says otherwise, system will take into consideration bolus you've given & will be visible as IOB, so it won't overcorrect that high bg reading.

Only ever used fiasp since starting on O5, find it works really well in pump & get incredible reliability using DexG6, system isn't perfect by any means so occasional highs are inevitable.

 

[Conks01]

Sorry your OmniPod is not giving you the TIR you hoped.
If you are using it in in a HCL mode, I have heard from multiple sources that the OmniPod is very gentle in terms of corrections compared with HCL on other pumps which may be contributing to your spikes regardless of your carb counting.
If you are not using it in HCL mode, it could be a need to tweak the basal profile or I:C ratio which your DSN can help with if you are not confident to do so yourself.
However, just like MDI, if your BG returns to your required level after 4 hours, your basal and bolus are likely to be about right and you need to pre-bolus earlier.
Unfortunately, high BG does tend to make us insulin resistant so we need more bolus and basal (which the basal profiles do not factor in) and they take longer to start working.
Faster acting insulins like Fiasp tend to be more sensitive to high BG. I take Fiasp in a pump without HCL and find the speed at which it works and, hence, my pre-bolus times, are dependent upon my pre-prandial BG. If I am in the 4s, the Fiasp will start acting immediately whereas, if I am over 10, my Fiasp can take an hour to appear to do anything.
So, if you have a tendency to higher BG, the "faster insulins" may not be as fast.
For me (without HCL), it encourages me to keep a closer eye on my BG and make more corrections if I see my BG is tending towards double figures. This is not an approach to take with HCL.

I apologise to those who walk after eating. I know it can help but I have a tendency to roll my eyes when I read it as a suggestion. I wish I had time to go for a walk after eating but I work full time and take a short lunch break. In the evening, it is too dark (and, this time of year cold) to go for a walk by the time I have eaten.
And I am not letting diabetes dictate what I should do when (apart from taking insulin).

Barbara - Thanks.

I would agree. I was formerly on Novorapid but now on Trurapi which, whilst working quicker, still really doesn't take effect until an 30 mins to an hour.

I'm also struggling with nighttime wherein, I have a tendency to go high between 2am -5am, especially when I've eaten a little later. On the Omnipod it's difficult as I'm on automated so have no idea how to combat this without waking up and firing in a bolus. Let's face it. Nobody wants to do that at 2am!

Ibe been a type1 now for 49 years and I'm still trying to perfect it! It feels like I'm starting all over again!

 

[Conks01]

The other thing I would emphasise is Balance.
You need to find the right balance of managing your diabetes and living your life. And this depends upon your personality and your lifestyle.
My personality is stubbornly making sure I am in charge of my life and not diabetes. I will accept the risk of a few highs in order to spend time away from staring at my Libre.
We are all different. Pre-bolusing 75 minutes (or even 45 minutes) before breakfast like @rebrascora would not work for me as it is too restrictive. Diabetes is not going to make me get up early and restructure my morning so I can eat breakfast as my BG starts heading down. I may need to be out the door or may have meetings or I may just want I lie in. And I easily get distracted if I bolus too early - I cannot be staring at my Libre graph waiting for it to head downhill so I can eat. I can do this and have time to do this as much as I have time to go for a walk after every meal as it could help my diabetes. It does not suit my personality and lifestyle.

But it is perfect for others. So you need to find the balance that suits you.

Yes, absolutely and it feels like we have the same lifecycle. It's a difficult balance to get right I guess. The joys of diabetes.

 

[Conks01]

Spikes, if regular could indicate your not getting right balance between food insulin & bolus timing, although obviously there's others factors like stress illness even time of month for ladies can be to blame.

50-70% in range does seem low for O5, don't know if your know but even in automated mode you can still give a correction bolus even if pump says otherwise, system will take into consideration bolus you've given & will be visible as IOB, so it won't overcorrect that high bg reading.

Only ever used fiasp since starting on O5, find it works really well in pump & get incredible reliability using DexG6, system isn't perfect by any means so occasional highs are inevitable.

Thanks. Yes, I've been giving correction boluses since starting on O5 as and when I need to.

To be truthful, the PDM mostly suggests I don't need to but of course you have to override this as it's not the case and i stay high for long periods of time without this.

On a separate note, has anyone experienced highs in the middle of the night? Another more recent frustration, especially if I eat a little later. BG ends to start rising from 2am - 5am. I could go to bed with BG at 6, around say 10pm, but there's now more of a common theme wherein the BG rises at said times. As I'm on automated, I have no control over this unless I wake up to bolus which I do not want to be doing at 2am!

 

[nonethewiser]

On a separate note, has anyone experienced highs in the middle of the night? Another more recent frustration, especially if I eat a little later. BG ends to start rising from 2am - 5am. I could go to bed with BG at 6, around say 10pm, but there's now more of a common theme wherein the BG rises at said times. As I'm on automated, I have no control over this unless I wake up to bolus which I do not want to be doing at 2am!

Tbh my nighttime bg levels have never been better since moving to O5.

Think you already know that it's your late evening meal that causing your delayed bg rise in early hours, more so if meal is heavier in protein fat. Apart from switching to manual mode then putting a TBR on for few hours not sure what to suggest, obviously eating earlier in evening would be ideal but this may not always suit your circumstances.