5 Thoughts About the Omnipod 5 After 5 Days
Because clearly I'm an expert now ;)
In quasi-chronological order…
Whaaa?! This is amazing!
Truly, my first full day on the Omnipod 5 was the best day of my diabetic life. Stable, in-range BGs 99% of the day. My coefficient of variation was a whopping 15.2% (30% or under is the goal). Granted I was so utterly transfixed by everything going on that you wouldn’t have thought it was the easiest day ever by the number of times I looked at my CGM, but it was!
The next day was a tiny bit less stellar, but still great. Average 143mg/dl (first day was 141), 93.5% TIR (70-180), and a CV of 15.5%. Objectively great numbers, albeit a little bit higher of an average than the advertised 110mg/dl target.
This is definitely not perfect.
The third was… not great. Not even objectively. I decided to play around a bit and see what the autocorrection can do and it… doesn’t do much. So that experiment was an failure. I ended the day with an average of 180mg/dl, a time in range of 61.1% and a CV of 38.6%. Womp womp.
That night was my first pod change, which is when the pod stopped using my own preset basal rate patterns and began to interpret and present its own adaptive basal rate pattern based on a complex, proprietary algorithm that people spend hours on Facebook trying to deduce how it works.
I think the Omnipod 5 has a fear of hypoglycemia.
I know I’m not the only one who thinks this, because one of the most common complaints I’ve seen in the Facebook groups (which, again, use cautiously) is that the algorithm tends to send people a bit high at the start. I have noticed cuts in basal earlier than I would have expected and for what seems like a long time, and it almost always has the result of sending me high.
It appears too aggressive with preventing lows and not aggressive enough with treating highs.
Many people report having to adjust their insulin-to-carb ratio, correction factors or duration of insulin action (which is used to calculate your IOB trajectory) to compensate for what appears to be a consistently too low basal rate.
My fourth day was a bit better (mostly because I wasn’t doing any funny business), but the day’s average was now 152mg/dl, time-in-range was only 75.7% and CV was 23.6%. So stable… but higher than the expected target. And now it felt like I wasn’t just constantly checking the system because I was fascinated by it, but because I felt like I needed to babysit it to make sure it was doing its job.
I sure hope this algorithm gets with the program soon.
My fifth day once again had super stable blood sugars. CV of 19.5% but overnight my blood sugars didn’t go below 150 mg/dl. I wish the algorithm and I could just sit down and have a heart-to-heart. My blood sugars were better during the day, but all those hours overnight really spiked my average.
I have spoken to several friends and colleagues who are Insulet trainers and experts in this, and they tell me to be patient as the system gathers more data and to be more aggressive in my own boluses. The algorithm utilizes past CGM and insulin use to calculate new doses, which is fine, but I think for people who are already doing well, it may feel like starting from scratch because settings will need to be redone to match how the algorithm works. Also I’m wondering if the algorithm reacts poorly to “too aggressive.” It seems to cut basal if I’m dropping very fast, versus a nice gentle float back into range seems to keep everything copacetic.
It’s worth sticking with it.
The overall functionality of the system, though, is pretty impressive. The idea that something can shift basal to compensate for changing needs is so much more akin to what our own pancreas would be doing. If I can get the system to work somewhat near to what that very first day was like, it will definitely be worth it.
Overall, my first 5 days on the OP5 look like:
I don’t really have anything in the ways of tips or tricks at this point, other than to repeat what other people have told me to do. Right now I’m experimenting with a couple of things around insulin dosing and hope to have more to share in a few weeks.
There are a few things, though, that I think have helped so far that have been supported by what my colleagues in the field have told me:
Starting with accurate manual mode settings. Even though the system will eventually use its own adaptive basal pattern, and even though the ICR may change to compensate for how the algorithm prioritizes things, starting off with a solid foundation is only going to be a benefit to the system and hopefully shorten this onboarding time.
Because basal might be cut around the time of a meal, prebolusing sufficiently is really important. So far, OP5 does not appear very adept at “picking up the pieces” of a poorly counted meal, because the corrections it gives are small and spread out in 5 min increments.
I’m really glad that I have personally been coached in these areas, and I am really glad that I can support clients in identifying gaps in their insulin needs by studying patterns as well as supporting behavioral habits like prebolusing and carb counting. Personally, as a mom of 2, prebolusing is one of my weaker skills. Carb counting and incorporating macronutrients into my dosing strategies are two of my strongest skills, however, so I know it won’t be long before I will see my average go down.
If you are planning on going on any closed-loop system (Tandem, Omnipod or Medtronic), having a strong foundation of manual settings is really important as the systems do use these initially (and for Tandem, it continues to use them). Plus, any time you go out of automate, you want to make sure you won’t have any major issues. And having strong active management (decision-making strategies, habits, and choices) is even more important, because the system relies on those things to be happening in order to be successful.
If you need support in pattern analysis or behavior change/habit formation, I am currently booking for coaching spots to begin starting July 11. I have 3 different options, at various price points. Fill out an application or send me an email to learn more.