#900 Best of Juicebox: Omnipod 5 Pro Tip: Overview
Omnipod 5 Pro Tips: Overview was first published on Aug 15 2022
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Scott Benner 0:00
Hello friends, and welcome to episode 895 of the Juicebox Podcast
welcome back to another episode of the Best, the Juicebox Podcast. Today we're revisiting Episode 431, which originally aired on January 22 2001. This episode includes community feedback on the topic of switching from MDI to pumping. It's very informative. So if you're thinking of switching, check it out. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Are you a US resident who has type one are the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juice box join the registry complete the Scott Benner 0:00
Hello friends, welcome to episode 900 of the Juicebox Podcast
Welcome back to the best of the Juicebox Podcast. Today's episode was originally today's episode originally aired on August 15 2022. It's episode 736. It's called Omni pod five pro tip overview. It is the first of my three part series about how to begin on the Omni pod five. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. As I said, this is the first part of a three part series. They're available to you at juicebox podcast.com forward slash Omni pod five or, of course, right in your podcast player. If you're a US citizen who has type one or is the caregiver of someone with type one, please take the time to complete the survey AT T one D exchange.org. Forward slash juicebox you really will be helping type one research when you complete that survey T one D exchange.org forward slash juicebox.
This episode of The Juicebox Podcast is sponsored by ag one from athletic greens. I start every day with ag one and you can as well athletic greens.com forward slash juice box if you head over there now and get started. You get five free travel packs plus a year supply of vitamin D along with your first order athletic greens.com forward slash juice box best green drink I've ever had. The podcast is also sponsored today. By the contour next gen blood glucose meter. You can learn more or grab one at contour next one.com forward slash juice box you owe it to yourself to get an accurate meter and the contour next gen is just what you're looking for. Hello friends and welcome to part one of my Omni pod five series with Carrie Birgit.
Before we get started today with part one of this three part series, I'd like to tell you that insolate has paid the host of this podcast that's me Scott Benner and my guest Carrie Bergerac a fee to create this content. Kerry is an omni pod ambassador with an ongoing commercial relationship with insolate. This podcast provides general information discussions about health and related subjects. This information the other content provided in this podcast or in any length materials are not intended and should not be construed as medical advice. Nor is the information a substitute for professional medical expertise or treatment. Never disregard professional medical advice or delay seeking it because of something that you've heard in this podcast or read in any length materials. The opinions and views expressed on this podcast and website have no relation to those of any academic hospital, health practice or other institution. Please speak with your health care team if you or any person has a medical concern. And before making any changes to your diabetes management, you can always consult the Omni pod five automated insulin delivery system User Guide for more information. In short, nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan. You are about to listen to on the pod five pro tip overview. The second episode is on the pod five pro tip settings. And the third episode is on the pod five pro tip connectivity. Please listen to them in order as I think that is how they'll best serve you. If you're listening in an audio app, these three episodes went up at the same time so there'll be right next to each other or you can find them at juicebox podcast.com forward slash Omni pod five.
Cari Berget, MPH, RN, CDE 4:22
My name is Carrie forget I am a nurse and specialty nurse and diabetes care. I work at the Barbara Davis Center which is in a diabetes Center in Aurora, Colorado. It's part of the University of Colorado Anschutz Medical Campus. And I love my job I love working with families who have kids with type one diabetes, because I get to help them figure out how to make the most of their lives and still have a great life even though they're having to deal with type one diabetes, which can be really challenging.
Scott Benner 4:54
Don't have type one, is that correct? That is true. I do not have type one. How did you make it to this kind? of work.
Cari Berget, MPH, RN, CDE 5:00
My background as a nurse actually did not bring, like prepare me at all for type one diabetes care. But when I first I've been a nurse for 17 years, and when I first started nursing, I worked in the hospital and I didn't love it because it was, I didn't get to know people enough I was it was too much just put a bandaid on things and not really get to know or help or be a part of anybody's life. And so then I started working as a public health nurse where it would do the home visiting program for young mothers. And so I would go into their homes and support them throughout their pregnancy with health education, and I got to work with them until their child was two years old. So I did that for about seven years. And while I really loved that, too, I was kind of like, well, I think I want something that's a little bit more clinical, but not back in the hospital. And I had a friend from nursing school who had type one diabetes. And I learned a lot about it from her and was just amazed at how, how smart she was and how hard she had to work to manage her diabetes, but also how much self care and commitment it took. And so then when I was looking for another career, the Barbara Davis Center came up and, and I was like, you know, I think I think this is, this is the place for me because, you know, I don't want a job where I'm the, quote, nurse who's, you know, in charge, and I just tell people what to do know, like, I want I want, I wanted a place where I could connect with people and come alongside them and support them and be a team to help
Scott Benner 6:39
him because he you get to make a real tangible difference in someone's life, right? It's not, it's not like emergent care where you just kind of run in and do what you got to do with leave. But you get to know people and see where their struggles and their strengths are. And then and then and lift them up a little bit, which I think is what we're going to be able to do here with these episodes. So I appreciate you very much taking the time to let us know about yourself. We basically have our topics broken down into a couple of headlines. Right. So the first one we have here is what do we need to know before we get started with the Omnipod? Five? And I want to ask you first, how many families have you been involved with so far with Omnipod? Five?
Cari Berget, MPH, RN, CDE 7:19
Well, I've been working with Omnipod, five for over two years now, because I got to work on the clinical trial, which was the study that you do before the device is commercially approved. So I had about 30 families that were in the child from our center, and I was the primary nurse for that study. So I got to train them on the device and teach them how to use it. And then we got to work together to figure out how to use it best. So that's been for the last two years. And then now that the device is commercially available, we're rolling it out in our clinical practice as well. And we've had over 250 new prescriptions for it. And just these last couple months, and then over 80 have started the system. So there's been a lot of a lot of kids and families that I've worked with on the system. That's perfect.
Scott Benner 8:07
So you've got to we've got a couple of years worth of knowledge that we can pull from here, it's going to be terrific. We're going to start simply getting things laid out right. And person wants to start with Omni pod five. What do they need? They need on the pod five? That's pretty obvious. But they're also going to need a Dexcom G six CGM. Is that correct?
Cari Berget, MPH, RN, CDE 8:27
That is true. Yep, the Omni pod five works with the Dexcom G six, and you do need that Dexcom G six in order to use the system. In the automated mode.
Scott Benner 8:37
It's important to remember that these are separate items. You don't get a Omni pod five prescription that ends up bringing you a Dexcom. So if you have the G six, all you need is the Omni pod five. If you have neither, then you're going to need to talk to your healthcare provider about getting a prescription for each.
Cari Berget, MPH, RN, CDE 8:54
Yes, very important point. Okay. The other important point about that is that the Dexcom G six is it really is a separate device in the fact that you need to use it on your own cell phone with the G six mobile app, there is no way to download the G six mobile app on the Omnipod five controller. So that's also an important piece to to understand and that you can't use the Dexcom receiver either if you're using Omnipod five,
Scott Benner 9:22
right. So if you're already a Dexcom G six user, and you're using Dex comms receiver, you're going to need to move your Dexcom on to an app on your phone before you can use on the pod five with it.
Cari Berget, MPH, RN, CDE 9:34
Yes, that's correct. The G six mobile app to be specific. Yeah,
Scott Benner 9:37
thank you. Now you could use on the pod five, right without the G six but you would just be using it as a just a regular insulin pump. It wouldn't be an automated system. That is correct. Yes. Having said that, Carrie. I think if you're gonna do this, like get all the stuff because, you know, right?
Cari Berget, MPH, RN, CDE 9:58
Yes, absolutely not. If you're going to get Omnipod, five, use it in automated mode, that will definitely be the best way to go.
Scott Benner 10:05
Yeah. Okay. So does that mean that you can't use Omnipod? Five if you don't have a smartphone? Well?
Cari Berget, MPH, RN, CDE 10:12
Well, the short answer is yes. But let me give you the more complicated trail have that. So you do need to have the Dexcom G six mobile app in order to operate the Dexcom G SIX sensor. And as I mentioned before, you cannot use automated mode without the sensor. But if you had the G six mobile app on one smartphone, and the sensor was all up and running, and you had already connected it to your controller, the active sensor session, if you already have the Dexcom transmitter in the Omnipod, five, app, either on the controller or your own phone, then once that's up and going, you don't need the G six mobile app within range in order for the pod five to operate in automated mode,
Scott Benner 11:01
right? Well, yeah, we're gonna go over that probably a number of times. So one of the one of the great things about the system is that it's it's self contained within the things that are on your body. So the GS six will talk to the Omni pod five, without the controller for the, for the, for the on the pod five there or without your cell phone, those things could be nowhere near you. And the algorithm can run because the algorithm actually lives, like right on the circuit board inside of the on the pod five.
Cari Berget, MPH, RN, CDE 11:29
Right, the algorithm is directly inside the pod. So the pod itself that is on your body, each one of those pods has the automated insulin delivery algorithm on it. So the Dexcom actually sends the glucose data directly to the pod. And then that pod uses that CGM information from the Dexcom directly to calculate how much insulin to give. So yes, you do not have to have the controller, the Omnipod five controller nearby, in order for the automated insulin delivery to occur,
Scott Benner 12:02
okay, so we have our stuff we got, we got our gadgets and gizmos on our websites, and we know what we're doing. And we got to get started, right. So some people are going to train in person with a CDE or a nurse practitioner, whatever they have available to them. Even I guess, I'm guessing through people that on the pod provides. Is that true?
Cari Berget, MPH, RN, CDE 12:21
Yeah, there. I mean, it depends on your clinic, there's a variety of ways that clinics might go about training their patients on insulin pumps in general, a lot of clinics do use the industry trainers, so they'll have a trainer from Omni pod that covers their clinic, and that would be the trainer that they would Gotcha. They would work with Yeah.
Scott Benner 12:40
Now there's also like an elearning situation, right? Where you can go online and take no walkthrough. Isn't that great, I don't have a job, carry, I don't have a job. So I don't get to do things the way other people do. But I hear a lot of people train online and stuff. But that, but I did take the online training from the pod five, and I'm assuming that's available to other people as well.
Cari Berget, MPH, RN, CDE 13:01
Yeah, it's available to everyone who's a current Omni Potter. The way it's designed actually, is that if you are current on new Potter, and your specific healthcare provider has like, given the stamp of approval that they're good with their patients self starting, then when you get your intro kit from the pharmacy, inside that kit includes a QR code. And it's just not very complicated, just Omni pod.com backslash setup, you go there, and it'll walk you through the steps of setting up the controller. And then from there, you can access the elearning modules, which will walk you through how the system works, how to program it. And, you know, walk you through the steps of starting it up. Right.
Scott Benner 13:43
So let's talk about that a little bit. The, I think, a couple of the key words, you and I are going to hit over and over again. One of them's going to be settings, whether this means your Basal profile, your insulin to carb ratio for your meals, your correction ratio, insulin sensitivity, all these things that I mean, if we're being honest, I guess a number of people don't even understand they go with whatever set up for them. And then whatever happens happens. But on this automated system, I think the easiest way to consider this is that if your settings aren't good, it's going to be like sending, I don't know, five basketball players out to play a baseball game, right? Like, you know, you've kind of got the tools there. You got some athletic people, but they've never held a bat before. They don't know how to throw a ball overhand. And and she you've got these things, it's close to what you need. It's not exactly what you need. So having your settings correct, is I think, in my opinion, by far the most important step of getting going. Now, how does how do you do that? When you might be in a situation? I guess what I'm what I'm thinking about is what happens if someone sees automated system while an automated insulin delivery system? I'm out of this, but it's not just going to magically work. You're gonna have to give it a good starting point.
Cari Berget, MPH, RN, CDE 15:02
Yeah, that's all true. So programming the settings, the initial settings that you have, it's, I wouldn't recommend just just blindly programming whatever you have in your current insulin pump, when you go to start on the pod five, it's important that, you know, to get off to the best start, you really should have your Basal program representing about 40 to 50% of your total daily insulin needs. And the reason for this is because the algorithm is it's using this assumption that that's typically what people require. And so you'll, it'll estimate your total daily insulin best, when you first start the system. If you have about 40 to 50% of your total daily insulin coming from that Basal program, or at least that's what you have programmed in the system. So that's what it what it assumes. And that's, that's pretty physiologically accurate. I mean, that is what you would expect, you know, we have these two types of insulin delivery, when you think about it, for intensive therapy, you've got Basal insulin, you know, which is like your background, it's what's supposed to help stabilize your glucose levels and manage, you know, the livers role and storing and dumping glucose into the bloodstream. And then you've got the Bolus insulin, which is larger doses all at once that, you know, are For if the blood sugar gets high, or if you're eating. And this is basically how the, the body works with insulin delivery. So this is trying to simulate those same type of, of structure, right, so look at what your current settings are, and then see how close or far that is. So you can always start from, what is the total amount of insulin that I receive in a day. And then how much of that is coming from Basal quote from the pump, and how much of that is coming from boluses. And you know, people with diabetes, they're really smart, and they figure out how to make things work best for them. And on a manual pump, you might be getting some of what might be considered Basal through giving extra boluses and things. So that's where if if those splits are way off of that, I think that's a time to go to your health care provider, and try and reevaluate what they really should be to get off to the best start and then start from there.
Scott Benner 17:20
Yeah, Carrie, and I've kind of put that into layman's terms for people. And this is something I've learned baking the podcast over the years, there are times that people using insulin arrive at the right destination, but they don't quite get there the correct way. And just a general understanding of what that might mean is, let's say you should be using, I don't know, 24 units of basil a day, I'm obviously doing that. So it's easy for us to remember one unit an hour. But for some reason, your Basal program is set at point five, and you end up making up that other insulin through manual corrections. Or maybe you've figured out a way where your your meal ratio is really heavy, but it works because the basil is light, or vice versa. Maybe your basil is too heavy and you are eating on a schedule and feeding the the insulin like there are a lot of different ways that unbalanced settings can still look okay at the end. But this system is going to learn more quickly. If those settings are as close to write as possible, it can still learn if you if you begin with bad settings, but it will add to the amount of time is that right?
Cari Berget, MPH, RN, CDE 18:25
Yes, I'm sitting here like nodding my head, but you can't see that. So yes, that's absolutely right. And it's going back to your analogy of the, you know, baseball players trying to play basketball, or maybe it was vice versa. If you, if you teach those baseball players how to play basketball, they'll probably learn it eventually. So it's a similar concept that if it's not perfect at the beginning, or at least not optimal, it will eventually get there, it just is going to take a little bit longer to figure that out. And I think the other point I would make is that this system really operates off of total daily insulin, that is what it uses to base a lot of its automation decisions on not all of them because it's also taking your current glucose level. It's making these you know, decisions about how much to give every five minutes, but kind of the big picture factor that plays a huge role in that is your total daily insulin.
Scott Benner 19:21
Okay, and would that be the same for somebody coming from MDI?
Cari Berget, MPH, RN, CDE 19:27
Yeah, I mean, it would be the same as somebody coming from MDI, generally with MDI, you would look at, you know, what's your, what's your total long acting insulin dose, and that would typically, you know, be what you would use to figure out Basal settings and a pump. So you just would take that total Basal dose if it represents about 50% of your total daily insulin, and then you would divide that by 24 to get a starting rate. Okay, so Carrie, I'm
Scott Benner 19:57
gonna give you a little more anecdotal from my end, which is I see people frequently going from MDI, to any kind of pumping. And having a similar issue, where settings don't look the same, you know, and they, they'll, they run into it in all kinds of different ways. But, but kind of think of it like that. So you know, sometimes people from MDI go to pumping, and it takes them a while to get their setting straight, and find your you're on your way to doing that. But that pumps not trying to learn anything from what the settings are that you've told them. So have your settings really, really close before you start. And in the next part, we're going to talk about that a little bit more, but I just wanted to, to make sure to be clear about that. So So let's, let's imagine, here we are, we've done our learning, we've talked to our doctor, we have our settings straight, and we're sitting together, it's our on the pod five, we have our on the pod five controller, our Dexcom or Dexcom is on our phone, we're ready to go. Now you need to have the controller with you right to start up, you have to get it going. And earlier we talked about that the system works without being near anything. But there are of course, some things you need the controller for, for instance, you need it to give yourself a tell it how many carbs you're going to eat, right? You need it to hear alarms and alerts. There are things that if you walk completely away from it, you won't get alarms and alerts are a big part of it. The ability to control the, the system, as far as entering carbs is another one. If you happen to be in manual mode, you know, you have access to a few more settings, then you do an automated. So those things need to be nearby when you're making changes, or when you need to hear alarms and alerts. And the truth is right, you need to hear your alarms and work.
Cari Berget, MPH, RN, CDE 21:41
Yeah, the other thing is, if you want to see anything, you need to have the controller nearby. So you know, if you're gonna go swimming, just leave it on the on the chair. And you don't need to worry that it's not going to be able to deliver insulin. But generally speaking, you're going to want the controller nearby the unless you just want to be completely blind and not know what's happening. But a couple other just clarifying things there. They're calling it a controller now. So very fancy, no more PDM. But controller, that might be the lingo you hear when you like get your intro kit box and stuff. And then also, as far as alarms and alerts, I did want to clarify. Another reason for having the Dexcom G six app near you is that you cannot program any of the Dexcom CGM alerts on the Omnipod five controller. So that's another thing to keep in mind. If you want to be getting those Dexcom alerts, you have to have the G six app within range and get it through that app. There's a couple exceptions. There's a one LOW Alert on the Omnipod five, four if it predicts your glucose dropping below 55. And then there's some like pump related alarms and alerts. But I did want to make sure it was clear because this is a common question that I get that there are no CGM related alerts other than that 55 In the Omnipod five app,
Scott Benner 23:00
right so there so you have two devices that are speaking to each other but they're giving you their information on their their own separate platforms.
Cari Berget, MPH, RN, CDE 23:08
Exactly.
Scott Benner 23:15
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So let's I guess dig in a little bit into this algorithm and what we can expect it to do and what it's going to do. I feel like I want to ask you, and because I can, we've used the Omnipod five and I know a great deal about it. But I think you have a lot more than me, as far as knowledge goes. So there's a predictive control algorithm, right. And it's called Smart adjust technology. And we know how it's going to communicate back and forth with the G six that happens every five minutes to predict where your glucose is going to go. 60 minutes from now, it increases or decreases or pauses insulin, trying to get you to that level that you actually get the program right. So unlike other automated insulin delivery systems, I guess on the pod five has a 110 target, but it also has other targets.
Cari Berget, MPH, RN, CDE 27:05
Yeah, you can program the target anywhere from 110 to 150. In 10, and 10 milligram per deciliter increments. So 110 121 3141 50. And yeah, that is the only automated insulin delivery system where you can customize the target to what you want it to be. And then additionally, you can also set that target, you can have a different target for different times of day. So if you wanted to run 110 of the rent 110 target, you know, all day, but you wanted the 130 target overnight, you
Scott Benner 27:40
can do that as well. It does not go lower than 110. No, it does
Cari Berget, MPH, RN, CDE 27:45
not you cannot program a target lower than 110. Okay, that doesn't mean your blood sugar will never go lower than 110. But the the target that you program can't be lower than 110. Yeah. So
Scott Benner 27:56
that's as good a place as I need to talk about that. So your blood sugar could get lower, and then it's going to take away insulin trying to get back to the one time.
Cari Berget, MPH, RN, CDE 28:06
Yeah, that is correct. But I think
Scott Benner 28:09
that's important for people to hear that it doesn't happen instantaneously. If you were to, I guess there's a lot of different things right, you could you could make a Bolus for a meal that's too large for what you ate. And then you might get lower than that. And then this, the algorithm is going to just try as hard as they can to take away insulin, take insulin to create a new balance, but you could be lower while it's doing that. So there are times where you might have to step in and fix a lower blood sugar. There's it that seems accurate to you.
Cari Berget, MPH, RN, CDE 28:37
Oh, yeah, absolutely. I mean, you know, what we see with these systems is they, they do a really good job at helping prevent hypoglycemia, but they don't eliminate it altogether, usually. So you may still have a few, you know, situations that the example you gave is, is a really good one. Because if you do over Bolus for a meal, for example, once that Bolus insulin goes in the body, you can't take it out, you know it's there. So if you can't remove it, all the algorithm can do is just stop the automated delivery in the background. Yeah, so it should help. It should help kind of like cushion the fall if it's too much Bolus, but it may not always be able to 100% prevent the the low blood sugar entirely. Yeah,
Scott Benner 29:23
it comes from a personal experience I had with it because when we first got it, I was like, I bet you I could get this to keep a lower number. And I did it. And Arden's blood sugar was like 85 for like two and a half hours. I was like see, I trick the outcome. And then it didn't it tricked me because because it took away so much of her basil that her you know, once that act of insulin I used in the meal was gone. Then she just started going up and up because I had basically, you know, I had I had put the algorithm in a situation where it took away the basil for so long that the only thing that was going to happen later was arised. Like that's the only thing that could happen eventually I basically trade Did my meal insulin for basil? And it said, Well, we're going to, we're going to get you back up to 110. And then that rise happened. So I just, you know, I, it's not this stuff's all really very new to people, you know, and everybody's kind of had a way they've done things and there's going to be a different, you know, a slightly different way to do things. And these are the things that are gonna get you there. So, alright, so Carrie, we thrown on this, we got our first pot on, right? What happened? Yes, five minutes. 10 minutes later, my blood sugar's perfect.
Cari Berget, MPH, RN, CDE 30:30
So I wish Sunday. But so you put your first pot on, right, what'll happen is the with your very first pod, the system, you can go right into automated mode. So that's another cool thing about this is, even though the system operates off of total daily insulin, you can still go in automated mode with the very first pod, even though there is no insulin history. If you think about it, you might be wondering, wait, you just told me this algorithm operates off total daily insulin. But this is my very first pod. So how would the system even know you don't program your total daily insulin anywhere in the pot, it's based on the insulin you actually receive. So that goes back to what I was saying before that it estimates your total daily insulin. And it uses that to determine what they call an adaptive Basal rate. And so I would think of that as like a baseline, it's your baseline Basal rate that this system thinks you have. And then in then it adjusts up and down from that rate, based on the current glucose trend, recent insulin history, delivery history, all with the goal of trying to reach that 110 target. So the 110 is the brain's that's the number it's using when it's making these calculations every five minutes. And then, so you go along, and you give your meal boluses. Because that's really important. On a system like this. For one, if you want the best blood sugar control around meals, you should Bolus, you know 10 To 15 minutes before you eat, to get the best control around meals, but also to make sure that the total daily insulin that you need is actually accurate. Because if you miss the boluses, two things will happen. Your your meal control won't be as good, you're gonna go high, the system will increase to try and help you so still be better than missing a Bolus if you are on a standard pump. But the total daily insulin will start to be underestimated, then because you're not giving the Bolus and the automation can only do so much for you.
Scott Benner 32:26
So so if I, if and again, this is a great example of it's not, you know, it's not just like set it and forget it and walk away, you do still have to do the things you need to do Pre-Bolus In a meal is have you know, I think it's a basic concept. And and so what you just said makes sure I understand if I don't Pre-Bolus a meal, then we're going to see a big shoot up 2030 minutes after I've eaten my blood sugar is gone from wherever it was, you know, 100 and now it's it's 180 and on my CGM is telling me I got two hours up. And then all of a sudden, I remember to tell the, the Omnipod five, hey, by the way, I ate 45 carbs. So you're by doing that by not letting it know that food is happening when it's happening. It just thought you shot up out of nowhere, and it tries to stop it. And now you're putting the food in and telling it Oh, no, there was food here. But you're telling it that there's food at seven o'clock at night when really the food existed at 630. And then that kind of throws things off is that I understand that correctly?
Cari Berget, MPH, RN, CDE 33:24
Yeah, yeah. Yeah, the only thing I would add to that is, it's just that the time it's the time doesn't really matter. So like the algorithm doesn't really care when you like to eat breakfast, lunch or dinner, like it's not going to learn that it's not going to learn, oh, Scott always eats lunch it at seven, or dinner at seven, you know, yeah. But if you, like you said though, if you don't eat him, if you don't Bolus for a meal, your blood sugar will rise. And the algorithm will respond, you know, it will respond and try and increase the insulin delivery, the automated delivery, right? But the other but what happens if you put the 45 grams in an hour later, you've got a bunch of insulin on board now from this automated delivery, then you put in the 45 grams, it's just going to calculate, you know, based on your carb ratio, which is going to be too much because now you already had this other insulin in there. So it does create this yo yo effect because if you come in with the meal Bolus after, it's going to likely be too much. And then you're going to you're going to crash down and then you're going to treat that low and then you're going to rise up. So that's where it goes back again to the pre meal Bolus is is really important. Yeah, because but what I what I was saying before, it was actually more than if you just miss the Bolus altogether, the total daily insulin calculation will start to be be off to okay, it doesn't you don't give those boluses it's not going to know that you require the amount of insulin that you require.
Scott Benner 34:55
See, that's a bigger picture idea that's important. It needs to understand like I guess in this same breath. If you were a really high carb person for three days, and then decided to eat very low carb for three days, the system isn't going to magically know that you stopped eating 150 carbs a day versus now you're having 50 or something like that. Right?
Cari Berget, MPH, RN, CDE 35:15
Right? No, it won't. But it will update your total daily insulin every time you change your pod. So this is a very important point, because, you know, especially with kids, which is what you know, I work in pediatrics. And so kids grow and their insulin needs change all the time, constantly. And that's expected. And so a lot of people will ask, well, how, if it's based on total daily insulin, like how does it adjust as my kid grows, or, you know, needs more insulin, and it does that by updating the total daily insulin with each and every pot. So every pod, it's going to change the adaptive Basal rate based on the more recent total daily insulin, so it will adapt over time to changing insulin needs.
Scott Benner 35:59
Okay, so this first pod is on and it's collecting data, it doesn't know anything except the settings that we've given it. And it's just living with you. And it's seeing what you're doing. And it's seeing what's happening. After that first pod is done, you move to the next one. And that's where you really start seeing the system working a little more, right, that very, very first pod is a is a collection day, or days Excuse me.
Cari Berget, MPH, RN, CDE 36:24
Yeah, and it's, it's operating more conservatively, conservatively with the first pod, because it's only estimating your tea, it's guessing your total daily insulin. And then in so because of that, it's just more conservative, it's a little more constrained on how, how high the adaptive Basal can go how much it can increase the insulin. But then when you change, and you go to the second pod, it starts using your actual total daily insulin, and then those constraints aren't, aren't there anymore. So I see.
Scott Benner 36:55
Carry, I've been told something by my my little birds. And I want to know, if you see any value to it at all, they say, that first pod instead of going the full 72 hours, they say change it after 48, because it's learned everything it's going to learn and you want the next pot to get moving to have you heard that at all?
Cari Berget, MPH, RN, CDE 37:14
I haven't directly heard that. But my guess is that comes from the fact that you know, what's required for the system to start using your actual TDI instead of the estimated TDI after the first pod is at least 48 hours of insulin delivery and A pod change. Okay, so that might be where that comes from. But in my opinion, I don't, I don't know that I would worry too much about that. You certainly could change it after 48 hours and like, make it start using your actual TDI. But there's also concerns of like, do you, you know, do you really want to change your pod earlier than you need to you only get a certain amount of supplies. So I don't think it's essential, or will make a huge difference. But certainly could.
Scott Benner 37:55
I just wanted to get that in there because the internet always thinks it knows. And so I wanted to see what you thought. Thank you very much. All right, I have some questions here. Actually, I want to thank existing podcast listeners, they sent out a ton of questions for this. This person says, I've read that the first pot operates at a reduced Basal rate. Is that that true?
Cari Berget, MPH, RN, CDE 38:17
I mean, reduce from what I don't, and I'm not sure that that's actually true. I mean, what I would say is the first pod operates off of more conservatively than it will in subsequent pods. And I would say that the maximum delivery is more constrained. But I wouldn't say that it is operating off of a reduced Basal rate, because the adaptive Basal rate it determines is based on the total daily insulin it estimates. So a lot of that is based on what you have initially programmed for your Basal program,
Scott Benner 38:50
in a perfect situation, you're gonna put this first pot on, and you're gonna let it do its thing, you're gonna live your life and let it learn. Is that correct? Yes, yeah. What if you get into a situation where your settings were way off when you got started? So you're seeing a high blood sugar that you're just not okay with? Do you come in and correct it?
Cari Berget, MPH, RN, CDE 39:08
Yes. And I would encourage, especially in the first couple of weeks, as it's getting, you know, adapting and adjusting to your total insulin needs. If your glucose is high, give, give a correction Bolus, it all it can do is help because it does two things, one should help bring your blood sugar down. But then too, it's it's adding more insulin in to the total daily insulin. And so you know, that's going to increase the total daily insulin and then with the next pod, you're going to have a higher baseline adaptive rate, and it's all just going to balance out from there. So the principle of giving correction boluses really, really helps. But can I add one more thing about correction bonuses at this point? You're
Scott Benner 39:50
the only one here really, I'm just okay, if you don't, we're pretty dumb. You know what I mean? Yeah.
Cari Berget, MPH, RN, CDE 39:56
So, okay. And this gets to what you were saying before, a little bit. In that, you know, people who live with diabetes really figured out how to make their insulin delivery work for them. And there's a lot of different ways to get there. As you mentioned, when you're using a manual pump therapy, and the difference with an automated system is that you now have insulin delivery going on that you aren't in charge of anymore. And so my best advice for giving correction boluses is to follow the Bolus calculator recommendation. And I know that's really hard for for many people, because you know how much you need. But with an automated system, you can have a lot of insulin on board from the adaptive Basal increasing that you just may not be acutely aware of. Yeah, so what what's great about the system is if you're using the Bolus calculator, any insulin delivery that is above the baseline, so this baseline I told you, the system calculates for you, it will factor that into the insulin onboard. Point being you can see how much insulin onboard is active. And that includes the automated Basal, which is also different from standard pumps where typically Basal insulin is not incorporated into the insulin onboard calculation. And it is now if it's, you know, being given to deal with hyperglycemia. So, you can follow the recommendation and just be advised that the the correction dose may seem smaller, you know, a lot of people will say to me, oh, my gosh, this thing thought said, I needed point five and I, on my other pump, I would have given two units for this. And I have to tell them well, on your other pump, your basil was stupid, it wasn't helping you like it was stupidly delivering point five units an hour, no matter what your CGM was doing. So just keep that in mind and try to work with with the system and not against it. And that will really help with frustration, but also with getting better outcomes to
Scott Benner 42:00
carry Listen, may I make a mean, let me just be honest here for a second, I fought it. In the beginning, I was like, that's not what I would do. Or that's not what I need to have happen. Or and it really did just eventually occurred to me, I was like, this thing is gonna do stuff. I'm not going to understand it all. And if it works great, why do I even you know, you know, why am I fighting. And I was just applying what I knew prior to what was happening now. And it really did take me longer than it should have to say to myself, This is not an apples to apples situation here. I am not doing manual pumping the way I used to. That's not what this is. This isn't even another automated insulin delivery system, right? Think because they all work differently. I mean, there's a number of them that are available, and not one of them is accomplishing what they're accomplishing in the same way. And so I did find myself having to put away some of my old tools that I thought worked really well. And and look at on the pod five more and try to find the tools that I thought worked better with it. Yeah, you
Cari Berget, MPH, RN, CDE 43:03
may need to find some new tools, you know, and you will, but I think that that's, that's really, that's really the key, I think. And in admit it, I mean, that's hard to do. I mean, you know, when you've been spending years and years and years, taking care of diabetes, and then sometimes you'll you'll have to let those things go. But that can be in that can be hard to let those things go. So I usually tell people, you know, the system needs time to adapt to total daily insulin as far as thinking about expectations of like, you know, how long is this going to take to get used to this? Most people are asking, like, how long is it gonna take for the algorithm to figure out how much insulin I need? And while that's true, there's another piece, it's how long do I give myself to get used to a new type of insulin delivery. So that's another piece of it is it's you know, you as the user, you have to figure out where you need to let go and let the system do its thing. And then where you need to give insulin and do your part in how to find this, like, beautiful harmony, where the two of you work together the system and you you know, to get the best out of it. Yeah,
Scott Benner 44:11
I think we'll jump into that. We'll do a settings episode where we'll talk more about how to make those adjustments and even how to talk to your healthcare provider about making those adjustments. I'm just, I'm glad you brought it up. Because I feel like what I need to know like if I'm going to recap here is that I'm going to come in with as good a settings as possible. And could that even mean that I start on the pod five in manual mode for a couple of days, say I'm not coming from on the pod dash, maybe I'm coming from MDI or something else, right. If I start in manual mode for a little bit, I'm looking for that stability, right? It's my basil at a good place where I'm held. I mean, the way I talked about on the podcast is Bezos job is to hold you at a number, right and that number is, you know, it can be whatever you you think it is, but if your basil is set correctly, it will hold you away from food and active insulin. Add a number at 90 at 100, you could use a little more basil and have it lower, you could use less basil and have it higher. But stability is the important part. If you don't have stability, then your basil is not close to being correct away from food and away from an act of Bolus, you know, your blood sugar shouldn't be dropping very harshly, you're jumping up and down your basil. I mean, Basil is everything. I think it's the it's the bedrock of diabetes. And it's the way to, it's the way to have success is no matter what you're using. So maybe I even start on the pod five, in in manual mode for a little bit, it's still seeing if my basil is working, it's still seeing my bonuses and my corrections. And it seemed my total daily insulin, that would work as well. Right?
Cari Berget, MPH, RN, CDE 45:42
Yeah, I mean, you could do absolutely necessary, right, right, it's not necessary. And the only other caution I would give you is that, you know, the system isn't using the Basal rates themselves. So testing it, that'll give you a really great Bayes Basal profile for if you're using it in manual mode, right. But what's more important for getting the best start in automated mode is really just the total insulin. And so, you know, if your settings are just have gotten off over the years, like, let's say, you know, per your programmed settings, you only get 25% of your insulin from the Basal rate, I wouldn't recommend starting Omnipod five, with it like that, you could go into manual mode, tweak it all up, you know, test it out, if you want it to, but you could also just talk, look at what your actual total insulin is. Because if you have, you know, relatively, you know, good control that you're happy with overall, you have a total amount of insulin that you're receiving. And that seems to be working as far as the amount. So you could just re estimate what that basil really should be based on the total insulin, can I
Scott Benner 46:56
pick your brain a little more here on that? Yeah, so if my total daily insulin is whatever it is, but my average blood sugar is 180, then my total daily insulin might not be enough.
Cari Berget, MPH, RN, CDE 47:10
Right? Right. And that is a excellent point. Because, and especially I mean, I see this all the time, it's, I think this is very, very common in youth, even, especially, most kids are not getting enough overall insulin. And so I will sometimes when, because what I do at my clinic right now in prep for everybody starting up the system is I review, I try anyway, to review everybody's current pump settings, and suggest different settings for them, and work with them to you know, what they should programming Omnipod five, and if I see that somebody's, you know, got an average blood sugar of 200. And their last time in range was, you know, 45%, then I'll look at what their their Basal is. And if it's, if they're over Bayes alized on paper, as in like, Oh, they're getting 60 70%. But really, that represents more of an expected TDI, total daily insulin, then I probably just keep it. So that is an excellent point that just because on paper, the split might look off, it's all relative to whether the total daily insulin that you're getting is actually the amount that you need. Yeah, it
Scott Benner 48:25
just occurred to me that you might be, you know, doing great, you know, and thinking I'm doing fantastic. You know, my blood, my a one sees a seven and a half, and this is my average, you know, insulin intake, and then all of a sudden you put on this, you know, the Omnipod, five, and you put on target of 110. But you give it settings that led to a 170 or 180, those two things are in Congress at best. So, yeah, so that makes, there's going to be an adjustment period is what I keep thinking to say.
Cari Berget, MPH, RN, CDE 48:55
Right? Yeah. And it all starts with, I think, if you just remember that it really all starts with what's your total daily insulin? either? What is it that you're getting? Or? Or how much is it? Would you really expect that you would need? Because, yes, it is different for everybody. But it's not a complete mystery. Like there are ways to estimate how much you really should be expected to be getting based on just simply based on weight. So like, if you're really not sure that the amount you get, whether it's really close to optimal or not, you know, talk with your with your doctor. And it'd be like, what, how much should I probably actually begin, you know, and go from there.
Scott Benner 49:36
So, a minute ago, I talked about being in manual mode. And I just wanted to point out that even if you're in manual mode, the algorithm is paying attention to your total daily insulin there. But in manual mode, there's no algorithm to stop you from getting low. It's just you're using an insulin pump just like a regular old insulin pump then, and I didn't I didn't I didn't say that clearly enough. So I wanted to we ever A couple of things here, a person who started on the pod five, and they had, you know, they were like, well, I wanted to be more aggressive. And so they get to their fourth pod, and they start making all these changes to their settings, thinking, this is going to make it more aggressive, I'm going to increase my Basal the carb ratio, the insulin sensitivity factor, etc, on and on, right. Except that's not how this works. Like after that first pod, you put that first pod on the algorithm is learning. And it's adjusting those things. So if you made a change to one of those settings, that change would only be concrete if you were in manual. That's correct, right?
Cari Berget, MPH, RN, CDE 50:41
Partially, I mean, if so when you're in automated mode, I cannot stress enough that it does not care what Basal rates you have programmed. Even if it's the first pot, it doesn't care about the actual Basal rates, the profile itself, it's concerned about the total only to help it estimate your total daily insulin. So I just want to make sure that's really clear that even with the first pod, the actual rates themselves and the different ones you put at different times of day, it does not use those in any way. So no changing, no changing Basal rates at all, when you're using automated mode. Those would only be used if you were in manual mode. Okay. But for boluses, if you change your insulin to carb ratio, if you change your correction factor, that will change the amount of insulin that's recommended for your Bolus doses. And that can actually make a really big difference in your overall glycemic control. Really fine tuning those Bolus doses, because that's what you have the control over, it's your job to give those boluses for meals. And so focusing on those actually, I would highly recommend because it can make a huge difference in your overall blood sugar control.
Scott Benner 52:02
Okay. All right, thank you. I just, I'm trying to put myself in the position of somebody who just comes at it new and doesn't, doesn't quite understand what's going on. You want to do one more question? Or do you want to move on? Let's see.
Cari Berget, MPH, RN, CDE 52:17
Do you have questions? It's good for ya. It's like sending a man you know, then they want them answered. I think it's, that's good.
Scott Benner 52:23
I love you. You're very nice. I'm having a good time. It's our first time recording together. And I feel like we're doing well. What do you think give some credit for Yeah,
Cari Berget, MPH, RN, CDE 52:32
we're feeling great. I'm feeling more and more normal. And the more we go,
Scott Benner 52:36
you're not as nervous any longer. Cool.
Cari Berget, MPH, RN, CDE 52:39
Okay. Settling in.
Scott Benner 52:42
I'm oddly calm, just so you know,
Cari Berget, MPH, RN, CDE 52:46
you do seem very calm. I'm like waiting for the I don't know, waiting for you to yell at me about something.
Scott Benner 52:55
Okay, so carry, like, let's just kind of dig in. Before we move forward, let's add a little more clarity to total daily insulin in manual mode. So, okay, do you? Do you feel like we've covered it all? Or do you think there's more there? Like, I don't know, what to add to what you've said. So maybe you did.
Cari Berget, MPH, RN, CDE 53:16
I mean, I think the point you made of just making it clear that Omni pod five, it the pod tracks total daily insulin, whether you're using manual mode or automated mode, it's always tracking that. So if you went out of automated mode into manual mode, for whatever reason, for you know, a week, two weeks, a month, a year, it's still tracking it. So then if you switch back to automated mode, it's it's just going to pick up with that total daily insulin, maybe is the point there.
Scott Benner 53:49
Carrie, I believe that was a perfect explanation. Thank you very much. All right. So let's roll through a couple of questions that I have pretty simple answers. person asked, Will it be possible to decrease to decrease the target blood glucose level from the current built in minimum values? Now I know the answer to this one. So no,
Cari Berget, MPH, RN, CDE 54:07
no. No, the target is 110.
Scott Benner 54:13
Yes, yeah. And you can go higher if you so desire, up to 150. I think we've said already, all the way up to 150. If you want to target a 90 it, it's not going to do that.
Cari Berget, MPH, RN, CDE 54:25
It will not okay. All right. But can I just have one thing about that, please? Because I have stuff to say to go. Yeah, the target thing is fascinating. For me, because I work with a lot of automated systems, not just Omnipod five, and this is something that comes up with every single one. I would just realize that this target is the brains, it's the brains of the algorithm. It is not i It's not saying that your blood sugar is going to be at 110 all the time, and that it's never going to be under 110 or that you couldn't possibly ever be under 110 it's just every time The algorithm makes a dosing decision, it's doing it trying to reach 110. That doesn't mean you're always reach 110 Or never go below it. Does that make sense? So I would focus, when I think about adjusting the target, since this is the first system where you can do that, look at it more from the bigger picture. Like, if you're running high overnight, and your target set at 130, drop it, because then the insulin is gonna give more in the algorithms gonna give more insulin. So think of it more as like, if you want to try and make the algorithm more aggressive, because you're running high, overnight, drop the target, if you're running lower than you want to be, I don't even wherever that might be, like, I just worked with someone the other day who was running at five overnight, which some people would love, he, they did not love that. And so we bumped up the target, you know, so in it, it helped bring them up a little higher. So, think of it more pragmatically like that, like, it's a way for you to influence what it does and less focus on what the actual specific number, it's
Scott Benner 56:07
sorry, listen, I think if people listen to this podcast, they'll understand this. And if they're new to it, and they're finding it because of the only pod five episodes, and this might be a little lost on them for a moment. But there are so many variables that go into how insulin works for you. So if you're a person who does a set amount of exercise every day, your insulin will probably be more effective. If you're hydrated, well, it will probably be more effective than if you're not hydrated. Well, if you're experiencing a fluctuation of hormones, say, at one point, but you aren't at another point, the insulin is going to have different impacts. And so it's a lot about your behavior, as far as what you know about that, and what you and what you ask of the system. My point being, if you go along, eating, you know, a house salad for three days, and then on the fourth day, decide, I'm going to have a half a pizza, well go for it, except, just understand that if you are a person who has been eating how salads for a year, your your insulin to carb ratio, for example, is probably more tied into that style of eating. So if you're gonna slide into a completely different style of eating, all of a sudden, that insulin to carb ratio might not be the same for pizza, as it is for something else. And I'm getting a little outside of you know, I'm not a health care provider and etc. But you do need to understand how insulin works, I guess, is what I'm saying. And if you don't, you're gonna run into problems. And you could turn to, you know, and think it's, you know, you could, I don't know, you could chase ghosts around, you could think you see what's happening, but you might not be.
Cari Berget, MPH, RN, CDE 57:46
Yeah, and then I would just end that statement with I mean, I think that people give more concern to the target than I think is necessary. That it's not as big of a deal that sometimes it can be beat out to be. And so I try to encourage people not to worry too much about that back to what you were saying, just focus on doing what you can to get get the best control that you can, and the target is not really the most important factor here.
Scott Benner 58:16
Well, yeah, my only point was, is that if you're if you're targeting 110, and you know, your blood sugar's rising, and the system says, Oh, it's coming, you know, that's happening, I'll do what I did yesterday. And that'll work except that you've made some, yeah, here's, here's a better way to think of it maybe, if you are getting low overnight, for example, and the algorithm is stopping that low by taking away basil, you may have had less basil than your body really needs, you know, four or five o'clock, six o'clock in the morning, because of, I don't know, a bed Bolus, she made it about three o'clock, who knows. But when you wake up in the morning, the algorithm doesn't know to you know, that your toast is going to hit you extra hard now, because you really haven't had your full Basal for the last three hours. Like you kind of have to know that. And yeah, you know what I mean?
Cari Berget, MPH, RN, CDE 59:08
Right? That's a really good example, because it does show the interaction between, you know, things that the algorithm doesn't, and that's a perfect example of, of that kind of perspective. And that, oh, what's the word like, kind of the vision the that you see that that insight of, oh, look, I'm about to eat breakfast, I see that the system has suspended my basil for the last hour. And if I when I eat this toast, it's going to have a huge impact because I've got very little if any insulin currently working in the system. So in those cases, you know, Pre-Bolus saying as far ahead as possible, makes a really big difference because, you know, you get you make sure you have some insulin starting to work before you, you know, eat get those carbs in the system
Scott Benner 59:59
x One. I feel like care. Tell me something. I feel like we've done a good job here. Do you not agree?
Cari Berget, MPH, RN, CDE 1:00:07
I do.
Scott Benner 1:00:10
You're looking at the same notes I'm looking at. And I feel like we covered so much of it. Without getting to it in the notes, does that makes sense to you? Sure.
Cari Berget, MPH, RN, CDE 1:00:18
I, I haven't even looked at the notes. So I mean, I'm glad that you think we're covering it
Scott Benner 1:00:23
carry on me.
Cari Berget, MPH, RN, CDE 1:00:27
I mean, I've looked at the notes, but I didn't want to make a bunch of noise there right here. But I, yeah, I've seen them before. Yes, we're doing we're we're doing great.
Scott Benner 1:00:35
Okay. So I just wanted to sit down for a second and go through a couple of ideas about just making sure people understand what the adaptive Basal rate is. But I feel like we've done that. No, I'm just gonna run through them. And you tell me if you think we've done it, adaptive Basal rate is a baseline for automated insulin delivery. It is the insulin delivery calculated in units per hour than the smart adjust technology continues to change over time as only part five is used. And this is all of course, based on your total daily insulin. Yes, okay. Adaptive Basal rate is based on the total amount of Basal and Bolus insulin delivered in a 24 hour day or the total daily insulin again, updates with each pod change based on the previous insulin history to best match the user's needs.
Cari Berget, MPH, RN, CDE 1:01:21
That is true. I'd like to add one thing, this is a very common question. Can you what how do you know what your adaptive Basal rate is? The short answer is you don't? And there's no way to know you can't find it out. So we should probably get that out of the way.
Scott Benner 1:01:37
Yeah. Okay. And if for some reason, and I know, it's not a not fun to think of, but if for some reason your controller explodes, like you drop it in the pool, or you throw it across the street for some, I don't know what you might do to make it break apart. But if that happens, you are starting over again, when that next pod goes on. Yes, yes. Yeah. So I want to point out, always know, what you're like, know, your settings as best you can, right? Right. Like whatever you put to that thing, the first time write them down somewhere, don't just, you know, don't just go I don't know, know what your total daily insulin is like that, I think is incredibly important, right? Because then at the very least, even if you're just like, I don't know, any of these settings anymore, you can at least look at the total daily insulin, you could say to yourself, Okay, let me just take 50% of this and make it or break it up over 24 hours and make that the Basal. And I'll take the rest of this, and I'll look at some of my carbs, and I'll figure out my insulin to carb ratio. And these would be good restarting settings. That's a very basic way to think about it. But but at least you'd be getting that total daily insulin set in there. Does that make sense to you?
Cari Berget, MPH, RN, CDE 1:02:43
Yeah, no, it does end. But the only thing I would add to that is, you know, your insulin needs can change over time. So depending on how long it's been, since you started, before you broke your controller, I mean, if it's been a year, and your manual mode, Basal rates haven't been changed at all, they might be slightly off, if your total daily insulin has actually gone up any
Scott Benner 1:03:08
number of 1000s, changed your activity, a few pounds, lost a few pounds, etc, etc.
Cari Berget, MPH, RN, CDE 1:03:13
So the best way to really keep track of that information is to have your Omnipod five linked to gluco. Because this is one of my favorite things as a healthcare professional, because if you link your Omnipod, five to gluco, which is a data management system that you can summarize, you can get reports that summarize your insulin delivery and glucose control, then you can just log if you break your controller, you can log into gluco. And you can see what the settings were, and how much and you can see how much what your average total daily insulin has been okay, and so, and that it'll walk you through doing that when you go to the setup screens. So I highly recommend doing that and not skipping that part. Because it's, it's really cool. And then once you're set up, it will automatically upload the pump to gluco via the cloud without you having to do anything, you don't have to manually upload it. And then when you show up to see your your doctor, the data is already there, and everyone is so happy.
Scott Benner 1:04:15
I like not having to do anything that makes sense. So so keep track on your own use paper. If you still have a pencil on your house or use your computer or your phone. Most people just use their phones, right Carrie I sound very old now when I send someone to use their phones. Yeah. So keep track of all your settings and and utilize glucose. Glucose is free, right?
Cari Berget, MPH, RN, CDE 1:04:36
Yeah. And when you go through the setup, it will it'll walk you through pairing it and if you don't have a Google account, it will walk you through like creating one and everything.
Scott Benner 1:04:44
Okay. What can I see? So you've had a lot of experience with with the system and with the controller. So what can I see as a user day to day like what do I have access to?
Cari Berget, MPH, RN, CDE 1:04:57
On the controller? Yeah, like Can the app itself?
Scott Benner 1:05:01
Yeah, like, like, do I just see oh, it made a Bolus or do I see, you know how much it used?
Cari Berget, MPH, RN, CDE 1:05:07
Yeah, so what you can see on the main screen is you can see this current CGM glucose value and trend arrow. Because you've, you've paired the transmitter into your Omni pod five, so it can, the pod will send that duck that information to the PDM. So you can see the CGM data on the Omni pod five app. So you can see the CGM value and current trend arrow, you can see how much insulin on board you have. And you can see your last Bolus, it's very similar appearance to the dash interface very, very similar. So you can see the last bullet you gave and how much that was. And then there is a way that you can expand the CGM graph, you can, you can see the last three hours of the CGM values and on that graph, you can also see the insulin on board and the current CGM value as well. And then you can get a visual representation of the automated delivery. So at the bottom of the CGM graph, you can see if you're in automated delivery, or manual delivery, and then you can also see visually if the algorithm is at maximum delivery, or suspension. So you can see things categorically, but it won't show you the exact amounts. Okay. However, you could go to the history, if you want to see each five minute, you know, micro delivery that, you know, or adaptive Basal delivery, if you are so inclined. I mean,
Scott Benner 1:06:41
I think it's, it's pretty obvious, right, that the system is set up to try to take away your burden, and so that you're not constantly worried and looking and, you know, overwhelmed. I mean, I think, you know, I'm going to put my, my personal opinion in here, I think Omnipod five, for most people is going to be an incredible improvement for them. You know, like just an incredible improvement and, and getting it set up and getting it rolling is the crux of the whole thing, right? It's just why we're talking about it, because what's beyond this should very well be some fairly smooth sailing, where the algorithms learning and keeping up with you and making adjustments where it's necessary. And even you're learning as you go along. How to how to Bolus for your meals better, or how to think about things as far as the way the system works. And, and hopefully you're, you know, you're you're, you're feeling a weight lifted at some point.
Cari Berget, MPH, RN, CDE 1:07:31
Yeah, I think so. I mean, I think there's a lot of potential here for a lot of people to get much better blood sugar control than what they've been able to, you know, to get on a manual pump, as well as more stability. Because the other thing I think we often don't talk about is glycemic variability, just the ups and the downs. So sometimes the average looks fine. But when you really go and look at it, you know, yeah, you're spending 50% of your time high and 50% your time low. So this helps you kind of find the balance and be more stable with less big fluctuations. Yeah. And sleep. That's the thing,
Scott Benner 1:08:08
you still might think, oh, go ahead. Go ahead.
Cari Berget, MPH, RN, CDE 1:08:11
I was gonna say that's, that's the thing, especially for for parents. And you know, I worked in pediatrics, I always want to give that disclaimer, I don't really know much about adults. But for parents getting to sleep at night is the constant theme that that I hear, because not only is the blood sugar improved overnight, it's the stability that you just get to sleep the whole night. And that's just not something many parents and kids really experience so
Scott Benner 1:08:40
I have never slept so well, as I have, since some automated insulin delivery has become a reality. So and it sounds
Cari Berget, MPH, RN, CDE 1:08:49
overnight, it's really very exciting. If you think about it, it's half of your day. So I mean, it's, it's also super encouraging that, you know, the nighttime tends to be relatively, like, really reliable, like you can really rely that for almost everybody, like it's just it is gonna help overnight
Scott Benner 1:09:07
for sure. I think also, he had kids that go on sleepovers, or, you know, adult who's got a real heavy sleeper or no, you know, next to them or nobody next to them, they're on the road. I always think that being an adult with type one and living by yourself has got to add an extra amount of anxiety to your life. You got kids going away to college, all these things. It's just, it's, listen, I'm a huge fan of the stuff I have been saying on this podcast for years, that you do not want to get stuck in how it's done. Because, you know, people are gonna make advancements and you don't want to be back with like, Oh, I'm still peeing on this test strip. Is that not the way we're doing it anymore? You know? And so this is, it's a big deal. It really is. I can't I don't think I can quite say enough. What a big deal. Yeah,
Cari Berget, MPH, RN, CDE 1:09:53
it's a really exciting time, you know, and it's only gonna get more and more exciting as we go. I think I think we're just at the beginning. Okay,
Scott Benner 1:09:59
we're gonna hammer through couple of questions here. And then we're gonna we're gonna button this up, try to keep it around an hour, right? Okay. Realistically, how long should I expect it to take for the system to adapt, optimize the insulin delivery, do its thing, what did you see during the, during your time with it,
Cari Berget, MPH, RN, CDE 1:10:17
I think a couple of weeks is a is a good expectation to set for yourself that you've got to give it a couple of weeks, you know, three or four pods for it to really get some time to adapt. And then the other thing is that it's not even just the adaptive basil and figuring out the total, you know, giving the algorithm time to figure out the total daily insulin. That's obviously a huge part of it. But it is very, very common. And this has been true with every automated insulin delivery system I've worked with, you almost always need stronger carb ratios on an automated system compared to a manual system. And again, like, work with your doctor and look at this stuff, and talk about what your carb ratio should be. But if you're running high after meals, don't hesitate to reach out because there is something that can be done. Oftentimes, you just need to strengthen the carb ratios. And it's not a bad thing, it doesn't mean the system's not working. It's expected it's it's a dynamic Basal delivery, that's totally different than a manual pump, where it's just statically delivering. So because it's dynamic, you're going to have periods where it's turning off and then turning back on. And oftentimes leading up to a meal, you have less insulin on board, because there's been suspensions, because you're getting back to that target. And so, because of that, naturally, you're going to need a stronger carb ratio than maybe you used before. So keep that in the back of your mind. Because after those couple of weeks, if you're still running high, or higher than you'd like or high after meals, specifically, reach out to your doctor and in fine tune those carb ratios because it can make a huge difference.
Scott Benner 1:11:58
Well, it really does depend, I guess, on the person or its individual, how long it's going to take days, weeks, plus all the other stuff that we just spoke about.
Cari Berget, MPH, RN, CDE 1:12:06
Yeah, I would agree with that. I mean, everything's individualized. But I would say, you know, give it a couple of weeks. And if you're not where you want to be, you know, reach out to your health care provider to help you because there's probably, you know, some Bolus settings that can be adjusted to really help you get where you want to go.
Scott Benner 1:12:23
Let me ask you a question. Because you've seen so many people on it attached to this idea. Is there something I can be looking for that shows that we're moving in the right direction? Like, when's the when's the part where I go? Ooh, maybe I will call my doctor here. I think we're, we're at a point where maybe we've plateaued?
Cari Berget, MPH, RN, CDE 1:12:41
Yeah, that's a great question. Ooh, that's a hard question. Um, I mean, I'm a big, big picture person. I think time and range is the most important thing. And so if your timing range is not getting to where, you know, you want it to be, and you should be able to get it, you know, above 70%, and meet those targets. You know, reach out and, and help have your doctor help you get there.
Scott Benner 1:13:07
Okay, I guess in in the end, you can paint that picture to your doctor as well. And let them help you make the decision. If you can't decide if you're seeing Yeah, man or not. Carrie, I find that thinking about insulin is like a time travel movie, right? Like insulin I use now is for later. But really insulin that's happening now was from before, and it always helps to have another person to talk about that with. So you don't get a little lost. You know what I mean? Like, it's great to talk to your healthcare provider, your nurse practitioner, whoever it is that you're making those decisions with, because it's nice to just have another person to bounce it off of sometimes because, you know, like, at some point, you're sitting in the theater, and you're like, I don't understand how to slow those down. Like, you know, like, you need somebody else to chat with about it and, and make good sense of it. You sound like you would be a good person to do it. With.
Cari Berget, MPH, RN, CDE 1:13:56
Oh, well, thank you. I really enjoy it. And I do it a lot. So love working with people to get those carb ratios. Right,
Scott Benner 1:14:03
right. So if I even if I start the pod, and I'm like, Oh, God, I used all the wrong settings. I just might have to wait a little longer for it to figure it out.
Cari Berget, MPH, RN, CDE 1:14:11
Yeah, exactly. Yeah, you might just have to wait a little longer, but it will get there. It will all be okay.
Scott Benner 1:14:17
Okay, so time settings. bolusing. You know, the way you need to Bolus whether that means amount or timing, timing and amount, such a big deal. And then just let Omnipod five do its thing.
Cari Berget, MPH, RN, CDE 1:14:32
Yeah. And can I make one more comment about that? So the other thing is, like I already told you like, I highly recommend following the Bolus calculator for correction doses so that you can work with the system and not against it. But if you find that it's always recommending zero, and you're still running high, again, you don't have to just sit there it could be that your correction factor is two Hi, it needs to be stronger. I find that correction factor is like the forgotten about setting often. In pump therapy, you know, we're all in manual therapy, we're always tweaking the basals. And we often change the carb ratios, and we hardly ever do anything with the correction factor. And so I see this, you know, 15 year old and they have the same correction factor from when they were six
Scott Benner 1:15:22
was 350 points. Yeah, it's like, I don't think
Cari Berget, MPH, RN, CDE 1:15:25
that one unit is going to drop the 300 points anymore, you know, so the correction factor, yeah, it needs some attention to sometimes, you know, yeah.
Scott Benner 1:15:34
And I know it's, you know, it's, it sounds super simple. But the idea of, you know, if your correction factor is one unit moves you 50 points, but you haven't looked at it since you were five years old back when it was one unit moved to 350. Now you're trying to adjust the high blood sugar, and you have no hope of that working. And on top of that, you've told the algorithm this should work. And you've given a bad information.
Cari Berget, MPH, RN, CDE 1:15:59
Yeah, isn't the Bolus calculator is just going to use whatever is programmed in there to as part of his calculation, so Right, yeah, it makes a big difference.
Scott Benner 1:16:06
Okay. Well, I think this is a great time to break and say that we hope we see you in part two, where we're going to do a deeper dive on settings.
I'd like to thank Carrie Birgit for being on the show today and sharing her knowledge about the Omni pod five with us. And a huge thanks to the listeners of the podcasts who shared questions and comments that led to the building of these three episodes. If you're interested in getting started with the Omni pod five, we're learning more about it, go to Omni pod.com forward slash juicebox. And don't forget that these episodes will be available in your audio app forever. But you can also find them at juicebox podcast.com forward slash Omni pod five. This episode was just part one of a three part series, you still have Omni pod five pro tip settings and Omni pod five pro tip connectivity to listen to. If you found this episode helpful, and you're new to the podcast, be sure to subscribe or follow in your audio app for more diabetes and on the pod five content. Thanks so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. A huge thanks to athletic greens and contour for sponsoring this episode of the Best of the Juicebox Podcast. Get started today with that green drink ag one from athletic greens, athletic greens.com forward slash juice box you and I could be doing the same thing every morning together except not really together. But I mean, we you know what I mean? And of course, you want you need you deserve an accurate blood glucose meter contour, next gen at contour next.com forward slash juicebox. When you click on the links, you're supporting the podcast and I appreciate it very much. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
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