I was shocked that it only took 5 days from requesting Omnipod 5 at the endo appointment until it arrived in the mail. It was only 3 days if you don't count the weekend.
We were planning to start at pod change on Tuesday evening, but technology had other plans. Her Dexcom sensor had been throwing a temper tantrum for an entire day (day 6) but finally seemed to settle down. Unfortunately she was out to eat at the scourge of t1d management, also known as a hibachi restaurant, when Dexcom failed (day 7) followed by a pod failure 10 minutes later! I was looking forward to seeing how Omnipod 5 would handle this crazy meal but I wasn't about to start a new system in the middle 170 carbs and 13 units on board!
In the mean time, I decided to take a closer look at settings. I've been discussing settings with other people and reviewing our own settings to figure out the best place to start. I have heard from others that you should start with basal around 40-50% of TDD (Total Daily Dose) aka TDI (Total Daily Insulin). The Nightscout day to day report is very useful for this. Enable the Insulin Distribution option and then scroll to the bottom of the report. This is her last 30 days in the report. Keep in mind that this isn't completely accurate if you are using automatic bolus or super micro boluses with a loop system. Depending on how you bolus for carbs, some of those doses should be considered bolus and some should be considered basal.
These are her current settings for Loop that we are working from.
Her scheduled basal works out to about 60% TDD even though the report is 40%. We intentionally have it set slightly higher to more automatically handle overnight fat and protein. But this also skews the report a little more since there may be more times when basal gets shifted over to bolus in the report. Since I don't yet know how Omnipod 5 will handle these rises with the correction factor (ISF) alone, I think I'll back it off about 10% for the starting point for safety to start Omnipod 5. We can always do a reset of the learning to start it higher or lower if it doesn't seem to be learning how we'd like.
I will probably simplify her ratio and ISF to a single number 24x7 to start also. I am a big fan of simplifying settings as much as possible when you aren't exactly sure what those settings should be. It makes the task of reviewing data much simpler and the results much clearer. This is especially true if you have a large amount of basal changes in your scheduled basal. The Insulin on Board for basal is 2.1x the static basal rate. So a 1u/hour basal means 2.1 IOB from basal. Keep in mind this isn't reported as IOB on a pump, but it is still active insulin in the body. I will frequently adjust basal based on this number. For instance if we find that she always has 0.25 IOB to keep her nudged into range, then you can use the 0.25 / 2.1 to determine that basal might need increased by 0.1u/hr. If you have numerous basal rates, this math quickly becomes too complicated because you have to determine each change based on the decay curve from that hour.
The next pod change is Friday night which seems like a perfect time to start. Stay tuned!