Started on Omnipod 5 this week and have questions...

[Conks01]

Hi

I've been placed onto the Omnipod 5 pod system which connects to a Libre 2 Plus sensor.

The clinician's introduction and training was a complete car crash, rushed, kit didn't work fully and generally pretty poor. I and the other 2 Guinea Pigs were left frustrated and overwhelmed.

This was Monday and we're now at Thursday. I have bounced off the diabetic nurse at the hospital on email but again have had stark responses.

Basal is set at 0.9u/hr. Am I correct in assuming that this runs all day and night?

I'm crashing at dinner/evening time and first thing in the morning. I'm also finding myself not actually having to bolus-up for the main carby meal in the evening as I seem to fall off a cliff if I do?

I'm not doing a lot of bolus generally to be honest.

In my mind, when the readings drop below 3.9 I had thought that the pod would stop releasing but I'm not sure if I have this right?

I'm now 6.0 after a plate of pasta and bread, consumed well over 2 hours ago. I did not bolus for this meal either. I've now decided to put the pod into Activity mode until 7am, more as a test, as I'm very concerned I'll drop overnight.

I'm new to this and it all seems a tad strange. I've been a type 1 for 48 years so it's a little daunting.

Any guidance greatly appreciated. Thanks.

 

[nonethewiser]

Shame your training didn't go well & you have had little support since.

There's loads of useful training vids on Omnipod website, not forgetting YouTube.

By looks of things your basal rates need some serious adjusting if your eating carby meals without a bolus, basal needs can change from hour to hour & many of us pump users have multiple basal rates over a 24hr period, so recommend you do some basal testing to get this right, again there will be vids on Omnipod site on how to do this.

 

[Inka]

I don’t have the Omnipod but have used pumps for 20+ years @Conks01 It sounds like your basal rate is too high, certainly at some times of the day if not all the time. How much basal insulin did you take prior to pumping?

I turned down a loop so nothing about that, but can you lower your basal in the settings? Like @nonethewiser I’ve found YouTube a good source of official videos to do stuff like that, and, for my pump at least, there’s a manual that provides clear step by step instructions.

 

[Richard F]

If you're in automatic mode the basal rate is immaterial, the only setting is for max basal rate. Mine's set to 3.

 

[Ivostas66]

I have been in a similar situation to you @Conks01. Thankfully my DSN has been extremely helpful. I have had a fortnightly phone call to discuss levels and fine tuning, which has helped.

It sounds like your basal rates and bolus rates need adjusting. I have had to decrease my nightly basal as my body seems to sit around 6.1 and then begin to fall from 5am, resulting in hypo territory at 7 or 8am. It has been much more stable since the change. My target glucose on the PDM is 6.1 and it is set to correct above that number. We were all given our targets by the lead DSN at the 'induction' - some thought their target was too low (one woman wanted 10 as she feels hypo when lower than that) and others (like me) that it was too high. 6.1 was actually the lowest out of anyone there and they stated that based on all of my data it was perfect for me.

My basal rate varies throughout the day, as did the other 9 people on the induction I attended. For reference, mine is 0.8 throughout the night, 0.6 then 0.5 morning and afternoon and 0.85 in the evening. Once you have a week or two of data you and your DSN should be able to fine tune the amounts. The PDM bases all of the decisions that it makes on the history/ data that it has built up for you. We were warned that the first couple of weeks would be really up and down, with 'perfect' days and then unexpected rollercoaster days as the PDM had nothing to base its decisions on other than current level and carbs about to be consumed.

My insulin to carb rations vary through the day. For reference:

0:00 - 12:00 1 U to 8g
12:00-17:00 1U to 12g
17:00 - 0:00 1U to 11g

In the settings menu, double check your glucose goal range (mine is currently 10 to 3.9). Under Bolus, check your Target Glucose and Correct Above and also your Minimum Glucose for Calculations (I think the maximum is 3.9, but if you're crashing this may be incorrectly set at a lower number).

I also had a carby meal recently (homemade wholewheat pasta and meatballs) and the PDM said I was 5.4 and calculated the bolus based upon my carefully measured amount of carbs. Hypo around 30 minutes after eating. I had the same a few weeks ago with porridge. I have always had to bolus early for breakfast in order to avoid the dreaded post prandial spike. Hypo around 30 minutes afterwards.

I have had to occasionally do what they told us not to. An alarm during the night with levels in the teens. We were warned not to bolus for this, that the PDM will be able to sort things gradually and bolusing when not actually consuming will skew the data. After a couple of hours of loud glockenspiel alarms and no discernible change in levels means I have to do something.

The only big issues I have found are 'missing sensor' values (Insulet have told me to pop the pod as close to the sensor as possible as 'line of sight' does not always work) and alarms that shake the walls of the house at 3am (there is a fiddly way to reduce the volume rather than the standard buttons on the side).

I have found Insulet really helpful to deal with, especially with replacing Pods that were not communicating with my sensor when they were too far apart (although they officially say this should not matter!)

Keep in touch with your DSN - I think I am lucky that mine always respond to non emergency requests within 48 hours and are really helpful. Remember, they have a duty of care to you and if you are concerned, tell them.

 

[Conks01]

Thanks all for your advice.

A lot of what's been said is what I've been experiencing and I'm on a call with the diabetic nurse on tue 2nd Dec. It's only day 4 admittedly but again, I awoke to chimes at 18bg and managed to get it under control however, it's dropped again pre dinner to 2.9. Noodles had for said dinner and I'm not going to bolus so we'll see what it is in the morning, if I make it...

 

[Hexidecimal]

Hi
Our Daughter is T1 and we've been on OP5 for over 12 months. Here are some key points that might help:
1) Persevere. The first two months are very annoying.
2) Automated mode does not use any of the programmed settings like correction ratios etc. All it uses is Total Daily Insulin (TDI) and it constantly predicts your future BG to administer an amount of insulin or stop insulin. That's it.
3) It uses data from your last 3 pods to create your latest TDI.
4) It takes a few pods to get your TDI to the right level. You can accelerate this by doing correction bolus where you bolus zero carbs using the BG from the sensor. I would strongly recommend doing correction bolus when you are above 10 from our experience otherwise automated mode takes hours to bring you down and your TDI will increase slowly over multiple pods.
5) Juicebox podcast has some great OP5 episodes. One thing I remember is the Omnipod rep saying that OP5 is not designed to do all the heavy lifting on its own. If you go too high then it needs help to bring you down.

 

[Conks01]

Hi
Our Daughter is T1 and we've been on OP5 for over 12 months. Here are some key points that might help:
1) Persevere. The first two months are very annoying.
2) Automated mode does not use any of the programmed settings like correction ratios etc. All it uses is Total Daily Insulin (TDI) and it constantly predicts your future BG to administer an amount of insulin or stop insulin. That's it.
3) It uses data from your last 3 pods to create your latest TDI.
4) It takes a few pods to get your TDI to the right level. You can accelerate this by doing correction bolus where you bolus zero carbs using the BG from the sensor. I would strongly recommend doing correction bolus when you are above 10 from our experience otherwise automated mode takes hours to bring you down and your TDI will increase slowly over multiple pods.
5) Juicebox podcast has some great OP5 episodes. One thing I remember is the Omnipod rep saying that OP5 is not designed to do all the heavy lifting on its own. If you go too high then it needs help to bring you down.

Great advice and many thanks!