I’ve been sharing my DIY Omnipod Loop experience on social media and I’ve been getting a lot of questions! Why did I decide to try DIY Omnipod Loop? I’ve been intrigued by Looping for a couple years now but I haven’t had the courage to purchase and use an older Medtronic pump. I was waiting for the Omnipod code to be cracked and as soon as it was available, I felt curious and comfortable about it. As a CDE, I want to better understand how this tool for self-management works… and what better way than trying it for myself? So, I’ve only been Looping for 72 hours but here is the full scoop and my initial thoughts.
DISCLAIMER- This is not medical advice. This is my experience as a PWD and thoughts as a CDE. Do not use my thoughts as suggestions for self-management without speaking with your healthcare provider first. Also, DIY Omnipod Loop is STILL EXPERIMENTAL (in Beta testing mode). It is not FDA approved and I am using this off-label.
What is DIY omnipod loop?
Loop is an app template you can use to build your own (DIY) automated insulin delivery system (automatic basal insulin adjustment insulin pump system).
The system requires a compatible insulin pump (Omnipod pods- Eros pods, not the new DASH pods in this case), a compatible CGM (Dexcom G6 in this case), Omnipod Riley Link (hardware device that communicates between the pod and iPhone), newer mac computer with Xcode to program the software, an iPhone and an Apple Developer account. I also use an apple watch as part of the system but it is not an essential piece.
Basically, after setting up the DIY Omnipod Loop system, I can use my phone as the PDM but need to keep the Riley Link, phone and my pod all nearby each other. The loop phone app is where you program your unique insulin settings. The system uses the settings you program in as baseline and then adjusts insulin up and down based on those settings and recent insulin activity. You use the app on your phone to enter carbohydrates and give insulin doses and change temp BG ranges.
Once everything was set up, it was easy to get going! One of my friends who is a software engineer helped me set it up so quickly. Otherwise, it may have been a lot more difficult for me as I only have a basic coding background. Working with someone knowledgeable but learning about and understanding the process is key.
Thoughts as a certified diabetes educator
Just like any new type of medication or diabetes technology- this isn’t immediately magical. As with anything else new for self-management, it takes time to adjust to the new system and insulin adjustments have to be made.
Similar to a typical insulin pump, if you don’t understand the device functions or how to use it appropriately, it won’t optimize your self-management. If you don’t understand how the insulin adjustments are calculated and delivered, it can be dangerous and ineffective. Make sure you fully understand target BGs range, basal rates, carb ratios, ISF, impact of exercise, impact of different types of nutrition (protein, fats, carbs, fiber) and how insulin works in the body before starting. Read information about the algorithm, BG prediction, basal and bolus before starting.
It is also important to understand the Omnipod. If you are new to Omnipod, you may want to use Omnipod first before jumping into loop. Understanding how and why pods may fail is important. Example: my first pod had a leaky site. This was common for me when I previously used the Omnipod system. This isn’t an issue specific to loop. You should be able to identify potential pod issues that cause hyperglycemia or increased insulin usage. Also having back-up plan in case of loop or Omnipod failure is key.
Basal rates needs may differ if you are changing from a different insulin pump to DIY Omnipod Loop. Each insulin pump has a different mechanism, speed of and precision of insulin delivery. This may impact your basal insulin needs. Personal example: my insulin needs significantly differ when using Animas vs Tandem vs Omnipod. It may help to wear Omnipod for a week or so first and do some basal testing. You should do basal testing before Looping regardless of being new to Omnipod or not. In addition to basal testing, make sure to test your ISF and ICR before starting.
This system will only work if you are confident and effective in pattern management. If you do not understand how to analyze your CGM patterns in comparison to your basal insulin (and basal adjustments), ICR, ISF and insulin action time, this system will be hard to adjust to use for optimal BG management. Click here to learn more about fine tuning settings!
Additionally, it is important to understand your CGM. If you use Dexcom G6, for example, it is approved to dose insulin off of. That doesn’t mean it is always 100% accurate. If your symptoms don’t match your readings, be sure to always double check with a finger stick. It is even more important to make sure your CGM readings are accurate when Looping as the algorithm is dosing insulin based off of them.
I have also seen discussion regarding how to upload DIY Omnipod Loop for healthcare providers. Many have reported just giving the CGM report. I disagree with this. Just providing a CGM report, especially if your BGs are super stable using Loop, doesn’t help providers understand how to help you optimize the insulin delivery system.
For example, maybe loop is ramping up your basal rates every day after breakfast. Although Loop “fixes” this problem itself, you can still make insulin adjustments! It would be best to change the carb ratio or to pre-bolus if not doing so in this situation instead of continuing to let loop do its thing.
What if Loop fails? Then what would you do? Doing pattern management even when looping will ensure your backup settings are accurate.
The only way (that I am aware of) right now to upload Loop for your healthcare provider is Tidepool. Make sure that your provider uses Tidepool. If they do not, you can have the provider set up a free account if they are willing, or upload to your personal account for your appointment.
Things not to do
Do not start with aggressive settings. Anytime you are new to an insulin delivery system or type of insulin, aggressive settings can be dangerous. Keep your eye on your BGs and slowly make adjustments. Make sure your max basal rate and target BGs aren’t too aggressive at first. Pick a safe suspension threshold that is higher than when you would treat a low.
Fake Carbs. Don’t fake carbs. Just don’t do it. If BGs are running high, the algorithm will increase basal insulin to adjust for this. If you enter in fake carbs, the system will give insulin for those fake carbs but it will then begin decreasing basal to prevent a low from happening as it doesn’t realize you didn’t actually eat the carbs. Do don’t do it.
Do not forget to pre-bolus. Pre-bolusing is STILL key. Although the algorithm will increase basal if you under bolus for carbohydrates, you will still have less of a post-meal spike if you pre-bolus.
Do not hide loop from your healthcare provider. I have seen many posts lately asking, “should I tell my diabetes provider I’m looping?” PLEASE don’t hide that you are looping. If we don’t know you are looping, the basal settings and insulin settings you provide are inaccurate. It is important to provide your current average insulin usage and method of insulin delivery in case anything happens so your provider can best support you. Everyone fears that their provider will not agree. Your provider may not agree as this is experimental and not FDA approved. However, some providers will support you in this.
Plus, the more providers that have patients who successfully use Loop, the more likely providers are to support the DIY Loop movement!
Tips and tricks
Stubborn highs! Make sure the pod isn’t leaking and that your site isn’t bad before assuming something is wrong with loop.
Take it slow! Make adjustments slowly. Do not start overly aggressive as you are just learning how loop and your body work together. Jumping to large adjustments may result in extreme insulin adjustments that your body doesn’t need.
Trial and error. As there are so many factors that impact BG management, sometimes the only way to figure out the best changes is by trial and error.
Safety. Make sure others understand Loop and know you are Looping. General safety for diabetes is to make sure your family members, friends, coworkers, etc, understand that you use injections or an insulin pump and what to do in an emergency. Follow the same for Looping.
How loop has helped me so far
That’s all for now! Look out for another post on my personal review of DIY Omnipod Loop and advanced tips and tricks!