Puppies, Rainbows, and Black Swans

I’m not quite ready to share the day to day graphs and learnings until we have a little more time on Omnipod 5. But I imagine you mostly want to know if it’s all puppies and rainbows?

TLDR: rainbows come after rain, sometimes the puppies growl at us.

Ancient wisdom for modern times

There is an ancient proverb that says “Sometimes the questions are complicated and the answers are simple.” Ok that was actually Dr. Suess, but the wisdom is still relevant and this describes how the transition to Omnipod 5 has felt. T1D management is incredibly complicated but Insulet has seemingly tried to solve it in what feels like the simplest possible manner. Has the switch been perfect? No. A failed pod during a 103 degree fever thwarted those lofty ambitions. But has the switch been simple? Absolutely.

Since we’re doing quotes...

“Things always become obvious after the fact.” This seemingly obvious quote comes from Nassim Nicholas Taleb: mathematical statistician, risk analyst, and author of The Black Swan which focused on randomness, probability, and uncertainty…or what we like to call “dosing for carbs".

An excerpt from The Black Swan:

“Before the discovery of Australia, people in the old world were convinced that all swans were white, an unassailable belief as it seemed completely confirmed by empirical evidence. The sighting of the first black swan might have been an interesting surprise for a few ornithologists (and others extremely concerned with the coloring of birds), but that is not where the significance of the story lies. It illustrates a severe limitation to our learning from observations or experience and the fragility of our knowledge. One single observation can invalidate a general statement derived from millennia of confirmatory sightings of millions of white swans. All you need is one single (and, I am told, quite ugly) black bird.”

“Black Swan logic makes what you don’t know far more relevant than what you do know”

#WeAreNotWaiting pioneer, former Medtronic engineer, resident T1D math genius, and all around great guy Lane Desborough says “Even assuming carb gram estimates are correct, I can think of half a dozen other factors which affect meal bg: size of bites,speed of eating, temperature of food, order of eating on the plate (carbs, protein / protein, carbs), prior meals / gastric emptying.”

My own paraphrase: There is more that we don’t know about carb absorption and its impact on blood glucose than that which we do know.

Unlike other AID (Automated Insulin Delivery) systems, Loop has a steamy love affair with carb math. I appreciate that this can work fabulously for some as the best solution, especially low-carb Loopers, but it can be the biggest obstacle for others. This is an opinion that has changed drastically from our first experience with Loop until today. It took a lot of research into the algorithm along with a few aha moments to realize why. There are simply too many Black Swans that cause the prediction to be completely wrong. One of ours was when we renamed a pack of Trader Joe’s muffins to the “magic disappearing carb muffins”. Others are times when you dose for the exact same meal with the exact same bolus and are perfectly in range everytime…until the time you are stuck on HIGH for hours. The bottom line is that we live in highly variable and imperfect bodies that don’t always follow perfect math equations.

Last quote, I promise

“Simplicity is ultimately a matter of focus.” - Ann Voscamp

This eloquently boils down my thoughts into seven words. If Omnipod 5 could talk, I imagine it would say “carbs? what are carbs? How about we just focus on BG and call it a day." If you are coming from Loop, this next sentence may be the hardest to wrap your head around because of Loop’s complex relationship with carbs.

Carbs are entirely irrelevant in Omnipod 5 immediately after the bolus.

This means:

• You don't need to “remove” carbs by editing past entries.
• Omnipod 5 won't predict BG to hit one million mg/dl from carbs that aren’t dosed for.
• Did you stay higher than expected? Just do a simple dose.

Omnipod 5 has allowed us to not worry about carbs, not worry about predictions, not worry about every 5 minute Bg reading. Each of our brains has processed a near infinite amount of data more than Loop ever can. And O5 has allowed us to focus on the 2 critical items of BG and IOB to take the correction that those 86 billion neurons tell us is needed.