Omnipod thoughts

[frahm61]

I have been on the Omnipod5 for 6 months, and before that the Omnipod horizon for around 5 years and before that Medtronic 530g for around 4 years and MDI before that. My original PCP and Endo both said I was type 1 because of my high insulin needs. My current Endo actually checked and found I was type 2 though it made no difference to my treatment. anyway here is my post. 
                OMNIPOD POST
Good day to all, wish the best to all. I have been reading every thing on the O5 that I can find and tweaking my pump. I am going to try and be as concise as I can, and maybe stay on track.
*  First and probable most important thing I have learned is the biggest flaw in the O5 is the user, yes the user. If we eat properly and count cards, all carbs correctly and have our I/C ratio and correction ratio perfect. Exercise, limit stress, depression it makes it simpler. But who can do that. so...
* The O5 uses TDI to determine your basal's, adding the #s from your last pod to the prior determination of basal requirements, period.
  But in the way that it uses the #'s is where I found some interesting findings.
   first off it divides said #'s in half, because it wants a basal/bolus ratio of 50/50.
    ( I am sure we all do that, right?) and uses that 50% to base it's basal needs       
   estaminet on, but it is not limited to that #, and that's about it, but with that in
    mind, Here is a few points/thoughts/findings.
*  Most Doctors want a target range of 70-180.
   Now if you use such range and look at your history you will notice as your BG approaches the upper limit it will start reducing your basal, and below will almost stop, being perfectly happen letting you hang in the 150's. the target BG (say 110) is in my option useless. I "guess" if you didn't eat for a day or so it might get close. But for me, at least, it will only get down to like 120ish and that's when I get up if I go to bed early and sleep in.
*  now I have come to learn that TIR is considered as, if not more important as the A1C metric, there is a Tight range used for a TTIR (tight time in range) of 80-140. It was discussed in a panel devoted to it at the Advanced Technologies and Treatment (ATTD) last year in Germany.
   Now I set my target range to 80-140 the week before (I guess) and noticed that the basal would stay strong down towards 140 verses 180 and I would wind up, more than not, around 110ish. with the addition of bolus down into the 90's.
  And really surprising to me, at least, it would basal to keep me there in the range of 90 even 80, as a guess, because I was still in my target range. I have been able to get it to keep me in the 80's and still deliver basal to keep me there.
* Now I want to discuss "Stacking" as it pertains to the O5.
 Firstly the O5 in auto mode doesn't "per say" stack insulin, It takes IOB into account and will make recommendation for bolus as long as you are,
    1) your BG is climbing and,
    2) you are above your correct above setting.
    ( I believe I have noticed that it will recommend a bolus if you are high and     
        stable or even dropping.
      I also try to give bolus around 130ish if there is not a lot on board or if it has
        been an hour or so since my last bolus.
     I brought up "stacking" because when I eat and when my BG starts to climb
       I start bolusing and will bolus every 45 minutes until it starts to drop, I am
        on Humalog and it's peak action time is 30-45 minutes.
   I have also set my I/C ratio a bit lower than maybe I need to help get a little more insulin for carbs. I mean why not, the O5 will cut back on basal or stop altogether if going low, but I am shooting for the 80 range to land.
  To finish I want to say that this is my experience using information gathered by me, and interpreted by me. There is more but I believe I put out what I wanted to. and to say if I could take myself out of the equation I believe it would work great for me. My daily averages and TIR have for the most part been a lot better, I have days where my average BG was 112 with 95% in range with only 5% above and 0% and only one where my average was 137 with like 30% high. but I believe I only had one "low" and my target range is 80-140 so it was not really low. and have had a couple of dinners where I have had to go into manual and boost my basal to like 350units per hour for 2 hours with a temp basal.
  Anyway of course I am up to any critique and fully expect to get bashed by this, but, hay tomorrow is a new day, right? And hopefully we will all be here to do again, hopefully a little better.