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Omnipod Insulin Management System

Omnipod 5 dexcom integration

Omnipod 5 Features

  • Automated Insulin Delivery (AID) pod pump uses Dexcom G6 and G7.
  • Tubeless, waterproof pods adhere to skin, contain the cannula, contain the algorithm, and communicate wirelessly to "Controller" that looks like an Android phone. The Omnipod 5 in Canada does not yet operate from a cell phone. 
  • The Controller contains an Insulet SIM card to automatically upload results to Glooko. (No cell phone plan is required for the Controller to function.)  All programming and pod changes are done via the "app" in the Controller.  
  • The user requires a separate phone to activate each Dexcom glucose sensor from a Dexcom app.  A phone is not needed again until the sensor is deactivated and a new one is inserted. After sensor set-up, the sensor communicates directly with the Pod. The pod communicates directly with the Controller.

SmartAdjust Algorithm

  • The following can be adjusted by the user:
    • Target glucose: 6.1, 6.7, 7.2, 7.8 and 8.3 mmol/L with up to 8 time segments per day. 
    • Carb Ratio: usually stronger is required at start; patients can store "custom foods" with CHO content
    • ISF (corrections) are manual via the SmartBolus Calculator
    • Correct Above
    • Duration of Insulin Action: often 3-4 hrs with initial starts
    • Reverse Correction: turn off for most as it withholds insulin; it is 'on' by default
    • Bolus calculator options at time of bolus: Sensor glucose value AND trend if selected* (recommended) OR manually entered blood glucose value. (* If sensor trending up, the suggested bolus is increased by up to 30%; if trending down the suggested bolus is decreased by up to 100%)
    • Patient bolusing & pre-boluses practices are important as per most AID pumps.
    • (No extended bolus and no temp basal are available in automated mode)
  • The following cannot be adjusting by the user:
    • Basal Rates (Adaptive Basal Rates)
  • Adaptive Basal Rate Notes:
    • The algorithm determines the Adaptive Basal Rate according to TDD from past pods. It can increase, decrease or pause basal every 5 minutes based on current glucose and a one-hour future glucose prediction (sensor trend, target, IOB).
    • The max basal increase is 4x current adaptive basal rate (e.g. if adaptive basal rate is 1 unit/hr it can increase to a max of 4 unit/hr). 
    • The algorithm is updated every 2-3 days with a pod change, considering TDD for the past 4-5 pods.  (Pods contain the algorithm.)
    • Optimization could take a few weeks, or less.
    • A pod will continue to modulate basal insulin even if separated from the controller. The pod communicates directly with the glucose sensor.
    • During the first 48 hours, the programmed basal rate and the TDD are referenced for basal delivery until an "adaptive" basal rate is calculated and used in the second pod.
    • Automated Mode Limited starts 20 minutes after loss of sensor reading. This mode uses the lower of either the programmed basal rates or the adaptive basal rate. An alarm will trigger after 60 minutes of no sensor data.
    • FYI: Insulin on Board (IOB) = active insulin on board from bolus and insulin ABOVE the adaptive basal rate.Duration of Insulin Action is only applied to bolus and correction insulin, not to basal modulation. 
  • Initial Setup 
    • Basal Manual Programming: Since POD#1 is conservative with basal, users new to pump therapy may wish to use 50% of their current MDI Total Daily Dose of insulin/24 as the manual basal rate - with no 25% reduction in TDD as routinely seen with other new to pump starts. Those moving from another pump to OP5 may also consider 50% of the older pump's TDD/24 rather than directly transferring their existing basal settings.
    • POD #1: For this limited time, the algorithm's adaptive basal rate references the active manual basal program and the parameter that 50% of TDD is basal. Expect the first 2-3 days' time in range to be lower than desired.  It will improve with each subsequent pod. It is important to bolus with all carb intake. Give realistic expectations. 
    • POD #2 (at least 48 hrs after pod 1): The algorithm adjusts using total daily insulin from first pod and can start modulating up to 4 X the adaptive basal rate. 
    • With each new pod: The algorithm adjusts according to total daily insulin, with the past 4-5 pods having the greatest impact.
  • Other
    • Automated Mode Limited occurs after 20 minutes of no sensor value. The pod will use the lesser of these: the programmed basal rate or the Adapted Basal Rated. At 60 min, the "Missing Sesnor Values" alarm occurs.
    • Automated Delivery Restriction: Insuiln has been paused or delivering the max amount for too long. Follow instructions on screen (do blood glucose, identify cause, must switch to Manual Mode for a minimum of 5 minutes. 
    • Tunneling: Remind patients to change the pod if the pod's material is wet (insulin travelled back up the cannula). It can occur with movement of the pod depending on site, laying on pod and after bigger boluses.It may only be visible on the back of the pod vs the side material, so advise to change pod with unexpected higher readings that won't come down. 
  • Key Reminders 
    • Pod and sensor need to be in direct line of sight. 
    • Controller volume should not be on low, off or silent

 

Adjusting for Hypoglycemia

Be aware that the only glucose alarm issued by the OP5 Controller is an urgent low of 3.1 mmol/L or less. All other sensor alerts or alarms occur only through the Dexcom app on the patient's phone. 

If recurrently hypoglycemia, assess the appropriateness of the following:

  • Increase the glucose target
  • Make Carb Ratio less aggressive
  • Make ISF less aggressive
  • If forget to bolus: 
    • > 30 min (<60 min) after eating, remind to only enter 50% of carbs; 
    •  > 60 min after a meal, advise not to enter carb. Just correct. 
  • Adjust the "Duration of Insulin Action". 
  • Adjust the "Correct Above" glucose level. 
  • Assess any bolus calcuator overrides
  • See "Exercise Options" (click here) for additional strategies

 

Adjusting for Hyperglycemia

Consider the following as appropriate for the patient:
  • Check that "Reverse Correction" is off.
  • Lower the glucose target 
  • Make Carb Ratio more aggressive by up to 20%-25%
  • Set "Correct above" to equal the target glucose e.g. 6.1 mmol/L
  • Remind to bolus and pre-bolus
  • Remind to touch  "Use Sensor" on the bolus calculator screen to transfer glucose reading and trend into the calculations.
  • Make ISF more aggressive
  • Verify that hypoglycemia is not over-treated with glucose
  • Assess, and if necessary, adjust the "Duration of Insulin Action".
  • Advise additional boluses for unexpected high readings not caused by infusion site issues or ketones.
  • If > 10% time in "Limited" mode, assess and troubleshoot sensor connections.
  • If highs secondary high fat and protein that don't respond to normal bolusing, consider a second bolus 90 minutes pc. 

 

Exercise Options

  • Advised to start the feature 60-120 min prior activity.
  • Use "Activity" feature before (1-2 hr), during and potentially after exercise. This setting further will do both of these: reduce automated insulin delivery by 50% and set target to 8.3 mmol/L. This is more conservative than just an 8.3 mmol/L target alone. It can be set from 1 hr to 24 hrs in 1 hr increments. 
  • Advise reduce meal bolus if exercising within 2 hr afterwards
  • Avoid large snacks or high glucose readings prior exercise as can result in increased insulin delivery.

 

Pregnancy

Omnipod 5 is not indicated for use in pregnancy. This article (click here) reviews two cases of OP5 used in pregnancy. 

 

Training

 

Reports - Glooko

 

Company Contacts