You asked so I answered! So many listeners wanted to know how our experience on Omnipod 5 has been going so I thought it would be nice to put it in one spot. I talk about why we made the switch, important things to keep in mind, dealing with insurance, what has worked for us in terms of settings, the pros and cons, and how I adjust settings when we are seeing highs or lows. I think it's a pretty thorough overview. Always keep in mind, I am not a doctor or a diabetes educator... just a mom with a daughter living with type 1 who hopes to help and empower other moms. Nothing you hear on this episode should be considered medical advice... I am just sharing our experience with you all. Enjoy and let me know what you think! What has your experience with the OP5 been so far?
MORE INFO AND RESOURCES FROM THE EPISODE
Juicebox Podcast 3 part series on Omnipod 5 click HERE
For Stacey Simms' (from Diabetes Connections) episode on the Omnipod 5 click HERE
ALL ABOUT DIY LOOP
Loop Docs Website
Looped Facebook Group
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All right. It is time. This is episode 86 of the sugar mama's podcast. And today it's just me. I don't have a guest. I just wanna talk to you guys about how our experience with the Omnipod five system has been going so far. In just a second, you will hear our intro that we do every single week that has our medical disclaimer in it. But I feel like I need an extra medical disclaimer for this one. I have had so many people ask me how it's going. How do I like it? Do you have any tips or tricks? So I thought, instead of trying to answer everybody's comments and questions, I would put it all together in one podcast episode for people to listen to. I just want to be clear. I am not a doctor. I am not a diabetes educator. I am a mom with a daughter who is living with type one diabetes. And we have been on the Omnipod five system for the past two months. So I am in no way giving you medical advice or telling you what to do. I am merely telling you what we have done and what we have seen work for us and what we have seen, not work for us. So again, not giving you medical advice, merely letting you know how our experience has been so far. Of course, something I say may resonate with you, and you can take that back to your medical provider and talk to them about. Maybe moving forward with the Omnipod five system or ways to change your settings, to enhance your diabetes management experience. Okay. With that said, let's get started. You're listening to the sugar mamas podcast, a show designed for moms and caregivers of type one diabetics here. You'll find a community of like-minded people who are striving daily to keep their kids safe, happy, and healthy in the ever-changing world of type one. I'm your host and fellow T one D mom, Katie Roseboro. Before we get started. I need you to know that nothing you hear on the sugar mamas podcast should be considered medical advice. Please be safe, be smart, and always consult your physician before making changes to the way you manage type one diabetes. Thanks. All right. Well, how should we start this episode about the Omnipod five? I guess I should start by saying that when Sarah was diagnosed on August 19th, 2020 we of course were started on MDI. So injections with our long acting insulin and then our pins with short acting insulin. And we were told about some of the different pump systems, not in great detail because with our insurance, we had to be diagnosed for at least six months before we could get approved for a pump system. But they just kind of briefly went over the different pumps that were out there. And when they started talking about Omnipod, they mentioned that coming soon, The Omnipod world was an automated insulin delivery system and all about how it would connect to the Dexcom and adjust insulin accordingly, depending on your needs. Then they told me that there was also a non FDA approved system called the DIY loop system and the Riley link. that was also an automated system. So both of those things kind of perked up my ears. I don't even think they mentioned the tandem pump at the time. They probably did. Who knows? I was so overwhelmed. I think I just really liked the idea of having a tubeless system, so that one really stuck out in my mind. No doubt. They sent me home with a brochure about all the pumps, but you know, it's a whirlwind when you're in the hospital at diagnosis, but hearing about the automated insulin delivery systems or AIGs for short, definitely peaked my interest. I could already tell a day or two into this diagnosis that this was gonna be life changing and challenging and anything that could be done to make our lives easier with this new diagnosis. I was all for it. So I was so excited to hear that that was coming up and was on the horizon. Well, six months later was March of 2021 and Sarah was ready to get on her first pump. We had tried and tried and tried to get her on the Omnipod dash system through prior authorization after prior authorization and just continued to get denied. I felt like I was getting the run around calling Omnipod and then calling our insurance, which is Aetna and then calling our doctor and so on and so forth and around and around we go that I finally just was like, okay, fine. We're not gonna get approved for the Omnipod dash. Let's go with the classic Omnipod system. And hopefully in the near future, our insurance will change and we'll get approval for the dash. So I hadn't completely given up hope, but I just wanted to get Sarah started on something. And it looked like it was gonna be quite a battle to. Continue to go for the Omnipod dash. I really wanted the dash because of the view app where you could see her management decisions throughout the day while she was at school. Especially since her school did not have a nurse. So I wanted to be able to see what she was doing with her insulin throughout the day. That didn't happen. So we kind of waved the white flag at that time and went ahead and got, got started on the Omnipod Aeros system that has the big old, clunky PDM, no Bluetooth technology, no view app, nothing like that. And honestly, it was fine. It worked great for us. We had a great experience on it. Definitely a learning curve as with all changes to the way you manage diabetes. But I would say after a few months, maybe three or four months, we felt pretty confident in using the pump and. Felt like we had really kind of settled in, So then another 9, 10, 11 months goes by, we're happy with the Omnipod we're on, but we also hear whisperings of the new Omnipod five that's currently under review for FDA approval. So I knew that was coming hopefully very, very soon. So that's when I really started to kind of dive in and be like, okay, getting a denial from our insurance company, just isn't acceptable at this point in time. So what do we need to do to get the omnipod five approved. So that's when I really started digging. Of course, I started calling again. I called Omnipod again. I called our insurance again. I called our doctor again. We tried to submit again for approval and got denied. So finally I went to my husband and I said, I feel like I have done all that I can do on my end, cuz we get our benefits through his work. I said, I feel like it's time for you now to go to somebody in the HR department who deals with employee benefits and insurance and talk to them about what do we need to do to get this device approved for our daughter the reason I wanted him to go to HR is because I kept being told by our insurance company that under our plan, it was an exclusion that system, both the dash and the upcoming Omnipod five would not be covered because it was a plan exclusion I don't know exactly what that means or why that was, but I basically said, what do we need to do to override that? And then everything that they suggested we do just wasn't working all the prior authorizations and letters from doctors and all of that. So that's again, when I went to my husband, I said, okay, tag, you're it, it's your turn. He started talking with HR long story short. They eventually did get approval for the Omnipod five. We got a letter in the mail and it said that we've been granted approval. It did say that it, the approval was for one year. So to be quite honest, I don't know what's gonna happen in like 10 months when that year is up. And I'm hoping that it just kinda rolls right into being forever approved, but we will have to wait and see, I'm just kind of choosing not to worry about that or stress out about that. Right. At this moment, I'll follow up with that, like next year in March or something like that. So all that to say. I'm not great with details. I, I know, I didn't tell you like every single detail about how that all happened with insurance. Because I don't exactly remember every single detail, but I can tell you this, if there is something that you want and you feel like your child needs, and would make your life with type one diabetes easier, do not give up, continue to call, continue to email, continue to ask questions, you know, just lay it out there for, 'em be like, look, this is what we want. I feel like this would be best for my child. So what do we need to do to make that happen? Okay, so backing up just a little bit. We got on the Omnipod five officially in July like the middle of July. And now it's about the middle of September. So it's been about two whole months that we've been on Omnipod five. For those of you that have been following me on social media, you probably know that we also did the DIY loop system and we switched from just the, the classic version to doing DIY loop with that classic Omnipod, that Aeros PODD, we switched to that back in. I wanna say late April. To be quite honest, we had a few very challenging diabetes weeks in a row where Sarah was just running high all the time. It seemed like, and I just got really, really fed up and it was like, that's it, I'm not waiting around anymore for these automated systems to be approved by the FDA or for our insurance to approve them. I am going to build this DIY loop thing myself and we are going to get on an automated system one way or the other. So that's what I did. I talked about our decision to switch to DIY loop and then our decision to switch from DIY loop to Omnipod five a few weeks ago in episode 84. So go back and take a listen to that. That was more towards the end of that episode that I was talking about that, But I'll kind of go over it briefly. Again, we get on the DIY loop system. And for those of you that don't know, you have to build this system on your computer and then transfer it to your phone, to be used as an app. You also have to purchase at the moment. This is about to change, but at the moment, you also have to have either a Riley link or an orange link. And that's just a small device, about half the size of a deck of cards that acts as the translator between. The Omnipod pump your Dexcom CGM and an app on your smartphone. So without that Riley link or orange link, your pod and the Dexcom cannot communicate with each other and adjust insulin. So I would not call myself a techy person. Sure. I figured out how to do a podcast, but that's about as far as it goes and I can say. First certain that building the DIY loop on a computer was maybe one of the most stressful things I've ever done in my life because my daughter's diabetes management depended on it. And I was like, I cannot screw this up. And I don't even know what I'm doing. Luckily, there's a website called loop docs. I'll leave a link in the show notes. It takes you step by step through the whole process of what you need to do to get set up and then the steps that you need to do to build it. It's confusing. I'm not gonna lie. It's kind of hard, but again, I'm not, I don't speak that tech lingo. So for somebody that's in the tech world on a regular basis, you know, it's probably just like reading a children's book to you. You would understand it all. But for me, it was like reading a complex legal document. It did not make a whole lot of sense. So it was stressful. DIY loop was created by some people who were just tired of waiting on. Companies to create and the FDA to approve automated insulin delivery systems. in other words, these people are geniuses. They also have a Facebook group on Facebook where it's basically tech support. So if you have a tech issue with your, with your loop system or something crashes, or you need help, you get on that Facebook group and you ask your questions and submit pictures to go along with it and they will try to help you troubleshoot and figure it out. I'll also leave a link to that in the show notes. Okay. So why did we decide to leave DIY loop and go to Omnipod five? Because a lot of people on DIY loop, even when Omnipod came out, they were like, no way, are we switching to Omnipod five? We're sticking with DIY loop because it's so much more customizable. You can set the target glucose range anywhere that you want it basically. Whereas you're kind of limited with Omnipod five because the lowest you can set the target glucose value is at 110 milligrams per deciliter. So I was kind of hesitant too. I was like, gosh, I just built this whole thing. Do I really wanna switch? Maybe we should stick it out a little bit longer. So what it finally came down to was I just really never had a piece about the whole technology side of DIY loop. My husband to be quite honest, w he was supportive, but he wasn't super on board. He didn't love the fact DIY loop was not an FDA approved product, which, you know, I get it. It's. it's our child. And we want what's best and safest for her, but I just never had a piece about it. I mean, you, you build this app on your computer and it could CRA there's the potential for it to crash at any point in time, which means you would have to scratch everything and start from scratch and rebuild it. And then even if that doesn't happen, you still have to rebuild it every single year, because with the apple developer license that you have to purchase, which is about a hundred dollars, that's required, you have to rebuild it every single year. So that just kind of stressed me out. The DIY loop system has a kind of a view like app it's called night scout. That is also something you have to build on your computer. That's not just something you can sign up for. That stressed me out that I would have to build yet. Another thing. I actually paid somebody to do that for me. There's a service called T one pal that will build night scout for you for about like 10 or $11 a month. And I signed up for that, cuz I just, I just couldn't take having to build one more thing on a computer. So that's really what it came down to was just kind of the stress level of me. Always having it in the back of my mind that I was gonna have to rebuild it could crash and I could rebuild. There's also like your loop. Can, we were getting a lot of red loops, which for those of you that have done DIY loop, you know what I'm talking about, but basically it's like communication is lost between the devices. So the loop system can't work. I felt like we were dealing with a lot of red loops and we couldn't figure out why. And it took a long time for the red loops to turn to green loops, which means that the system's working And we also just, I mean, we had decent results with DIY loop, but they really weren't really any better than what we were seeing before on the classic Aeros Omnipod system. In fact, they might have been a little bit worse. Just because I felt like it was such a touchy system. Like you had to have your settings perfectly 100% correct. In order to see good results insulin sensitivity factor or correction factor was a huge part of the DIY algorithm. I don't know. I just never felt like we could get it right with that system. So we decided to make the switch to Omnipod five and we officially did that in the middle of July. So before I made the decision to make the switch, cuz truly this was something that I really wrestled with as to whether or not to try it and get off the DIY loop. I read, I probably spent a good three weeks every night, just reading. Facebook posts some in the juice box podcast, Facebook group a lot of them in the Omnipod five Facebook group. There's a really great group out there for Omnipod five users. Again, I will put a link to that in the show notes. I just read thread after thread, after thread and comment after comment, after comment, to make sure I really understood from a user perspective how this system was operating. One of the smaller things that I really wrestled with about whether or not to switch to the Omnipod five was the information that I had been reading on line of sight and how the two devices, the Omnipod and the Dexcom had to be in the same line of sight on the person's body. And I was really worried that that was gonna be a problem for us because. At the time, Sarah was only willing to wear her pods on her thighs on the front of her thighs and her Dexcoms on the back of her arm. So that would not be in the same line of sight. Like an example of the same line of sight would be like Dexcom on one arm back of one arm. And then Omnipod on the back of the other arm, or maybe Dexcom on the back of one arm and Omnipod kind of on like the love handle or upper, but region on the same side. Another example would be like both devices on the abdomen. but with Sarah, I was worried because you know, front of the thigh and back of the arm. It's not in the same line of sight, but I read a lot and I saw several comments from families that were worried about the same thing, but they decided to try it anyway. And it turned out that they didn't have any issues. And it seemed like if the person wearing the devices was on the smaller side in leaner side, then they had little to no issues with the line of sight. It's when it was like an adult that was maybe a little bit heftier where. They started to see issues. So basically I just decided to risk it and give it a try. And it turns out we've had no issues with the devices, not communicating with each other and connecting. However, in other exciting news, Sarah, just last week decided she was gonna try her pod on a different spot. So she actually tried her pod on the back of her arms and she tried her Dexcom in a new spot too. She tried it on her muffin top area, which I know muffin top is like not the PC term for that, but, you know, that's the best way I know how to describe it. Sarah is super lean. So she does not even have muffin tops, but you know, the area that I'm talking about. And that has been going well, too. No issues with line of sight there. So again, something else to keep in mind. For the most part, a lot of the posts were very negative. Lots of people were unhappy with the system cuz it was super conservative. So they were seeing a lot of high blood sugars where as before they had great management. So I think that was frustrating for a lot of people, but I also read a lot of comments of people saying like, yes, we saw high blood sugars, but this is how we made adjustments. And now it's really working for us and we really like it. So based on everything that I read, I knew that for us, because I did not wanna have to wait out 3, 4, 5 weeks for this system to learn my daughter. I didn't wanna have to wait that long and suffer through a bunch of high blood sugars before we started seeing good results. So I decided that for us, I was gonna start off pretty aggressive with all of the settings that we programmed into the pump. So I kind of picked an arbitrary place to start for me. I didn't wanna go too crazy, like change everything by 50%. So I decided 20% was probably a good place to start. So we had our basal rates already from pumping before. So I decided I was gonna increase all of our basal rates across the board by 20%. I was going to strengthen our insulin to carb ratios by 20%, I was going to lower our insulin sensitivity factor, which is also called a correction factor by about 20% because a lower ISSF or a lower correction factor is a little bit more aggressive. So the system would be giving you more. So, for example, if your ISF is 100, that means that for every unit of insulin, it's going to bring your blood sugar down by a hundred points. If you have your ISF set to 50, that means for every one unit of insulin, the system is gonna bring your blood sugar down by 50 points. So if you are at 200, right, and you wanna get your number down to 100, if you have an ISF of 100, that means you're gonna need one unit of insulin to go from 200 to 100. you're 200 and you wanna get to 100 and your ISF is 50, that means you're gonna need two units of insulin to get you from that 200 down to 100. So a lower ISF or a lower correction factor is a more aggressive number. When we were on DIY loop, I had Sarah's set at one 10, so I lowered that number by 20%. I set our glucose target to one 10, which is the lowest. It can be set on the Omnipod five system. And I set the correct above number at one 20. So anything above one 20, the system would start correcting for that and take that into consideration. When doing BOS calculations, I had the two hour insulin action time or duration of insulin action is also called I think that's what it's called in the actual controller to set up the Omnipod five duration of insulin action. I had that set at two hours. That's the lowest you can set it. Again, based on everything I had read from all these social media post, that is what seemed to be working for most people. I'll come back to that in a little bit. Because I think it's important to remember a few things. When you have your insulin action time set at a low number like that, I did turn the reverse correction off. I also read that people were getting better results with that turned off. So basically what that does is, you know, if your target is at one 10, which again is the lowest, you can set it, but you're currently sitting at 80 and you go to Bo bolus for a meal. It's going to take into consideration that you're already 30 points under. Where your target is set. So it's gonna take away some of the insulin that you would normally give for the carbs in the meal that you're about to eat. So I didn't, I didn't want to do that. I, if we were gonna be eating carbs, I wanted to give enough insulin to cover all the carbs. So I turned the reverse correction off. So I went in real strong, right. Go big or go home. I was a little bit nervous about it, just because it was a lot more aggressive than what we had been doing previously. But again, I just had read so many things online how people were having to make all their settings more aggressive. I just decided I'm gonna go in from the beginning and make my settings more aggressive. We saw fantastic results. I mean, right from the get go, Sarah was anywhere between 70% and 95% in range. I don't think we've had a 100% in range day ever. Maybe, maybe we've had one, but anyway, not, not on the Omni FOD five system at least. And I'm fine with that. I don't care about that, her time in range, which to me is one of the most important things was already amazing from the get go. And I have her range set on her on her Omnipod five controller and on the Dexcom clarity app that we kind of like at all the CGM data and look at all the trends. I have her range set to 70 to one 50. So that's a little bit lower than what most endocrinologists offices will recommend, which is 70 to 180, I just really wanted to aim for being between 70 and one 50, 70% of the time or more. That was my goal that I had set for us. So even with the range being a little bit smaller, we were still seeing good results from the beginning. With those more aggressive settings, I think the reason why you have to go into this system in particular with your settings set slightly more aggressively. Or the way that I thought about it was that this system is super conservative and it's really designed first and foremost to prevent your child from having low blood sugars. So if it thinks there's a chance that they're going to have hypoglycemia or fall below their target, the system will turn off basal insulin. So if there's a system that's constantly turning off basal insulin, you're most likely going to need more Boless insulin to overcome that and prevent after meal spikes. And lingering high blood sugars, you know, before we were on any sort of automated insulin delivery system. And we were just using the Omnipod Aeros classic system. Sometimes we would do, what's called a super Bowlus and I haven't read the book sugar surfing yet, but I think that comes from. The guy who wrote sugar surfing, which is Dr. Ponder, but a super bolus is if you're gonna be eating a food, that's really high on the glycemic index. And my favorite example is breakfast cereal. Then kind of one of the ways he suggests to get ahead of that after meal spike is to give a pretty hefty pre bolus, right? Like give the insulin ahead of time, but also turn off. And I should probably mention before I go any further that this is something that only pump users can do. but he suggests turning off basal insulin for, I think it's two or three hours. So you completely turn that off for two or three hours, but rather than just not getting that insulin at all, you give it all up front with the bolus, for the cereal or whatever high GI food you're gonna be eating. So if your basal rate was one unit an hour and you were gonna try a super bolus for cereal and you were gonna turn your basal off for three hours, you would give those three units of basal insulin that you would be missing. You would give that upfront with the first bolus. So that's a, that kind of helps me to think about how to approach. the Omnipod five system, which is a little bit more on the conservative side. It's almost like I'm doing a super Bowlus because the system, a lot of the times turns basal off for a very long time to prevent low blood sugars. But I still want my daughter to stay in range. So I kind of have to give more insulin front to allow that to happen. You'll hear me talk a little bit more about this later in the episode, when I talk about pre bolusing with the Omnipod five system. Okay. I will say though, that over time, like starting, maybe. Three or four weeks ago. So maybe like a month in to using the system, we started having a lot of lows. And so I did have to back off a little bit on some of the settings, I had to take the insulin sensitivity factor back up a few points. I did not touch the duration of insulin action. I left that at two hours. I continued to leave off the reverse correction factor. But I actually, I even had to like set the target a little bit higher. I had to change insulin to carb ratios a little bit, so they weren't quite as aggressive. And then I didn't do anything to the basal rates because changing the basal rates in automated mode do nothing. They do not do anything. If you switch to manual mode, that's when your basal rates that you put in the system matter, but in automated mode, it will do absolutely nothing to change the basal rates. So again, I knew that going into it, and that is another reason why I chose to start off a little bit more aggressive with our basal rates from the get go. Cause I knew once I put 'em into the system, I could not go back and change them. It would've done. No good being in automated mode. So a lot of people have asked me if I still have to do a pre bolus with the Omnipod five. And just a reminder, a pre bolus is where you give the insulin a set amount of time before you actually eat. I think most endocrinologists recommend like 10 to 15 minutes for us. We have always had to do our longest pre bolus in the morning. Usually anything less than a 30 minute pre bolus. And we will see a huge spike. I mean, even if we wait like 26 minutes instead of 30 minutes, we will still see a huge spike. It, it does a little bit depend on what we eat though. I mean, if we're eating like a lower car breakfast or something with a lot of protein and fat, then we might not need as long of a pre bolus. Very rarely will I give the insulin like right before we eat, but that's kind of just, if Sarah's having like just bacon and eggs, you know, only protein, which doesn't happen very often in our house, but you know, something like breakfast, cereal, I mean, it has to be a 30 minute pre bolus, or we're gonna see a spike. Sometimes, I even have to give Sarah a few carbs while she's waiting that 30 minutes. So she doesn't crash before she actually eats the breakfast that she told me she wanted. I will say absolutely. Yes. We still have to pre bolus with the Omnipod five. In fact, I think it's even more important than it was before. Mostly because this system is so conservative. I think the main goal of the system from what I've read and listened to is to keep people from having hypoglycemia or low blood sugar. So it's ultra conservative and many times to keep you from going below your target. It will shut off basal insulin, you know, so overnight while you're sleeping. Your basal insulin could have been shut off for an entire hour or more before you eat breakfast. So keeping that in mind, you're really gonna need to give your insulin extra time to start working before you eat, to kind of offset the fact that you don't have a whole lot of insulin working in your system you wake up in the morning. So sometimes I'll take a look at the history in the Omnipod five controller. To kind of determine how long I'm gonna pre bolus, or if I need even need to give a correction, if my daughter's blood sugar is high, because the history will allow you to see if you go to auto events, it will allow you to see the micro bolus that the system has been giving her. So if I look and see like, oh, it's already been giving her quite a bit of insulin to bring this blood sugar down, then I will know, okay. Maybe I don't need to give a correction. Maybe I just need to wait it out a little bit longer see if it will bring her down on her own. So the short answer to that question is, yes, we still have to pre bolus. We still have to do about a 30 minute pre bolus in the morning. And for the rest of meals and snacks during the day, it's anywhere between like a 10 and 20 minute pre bolus. That kind of depends on the amount of activity she's been doing beforehand, what her blood sugar is when she's giving the bolus, all of those things. But yes, definitely a pre bolus is important again, unless it's just one of those super high fat meals where it's gonna slow down digestion and those carbs are gonna get later So here's another thing about pre bolus before we move on. My daughter bless her precious heart. I don't wanna throw her under the bus, but sometimes when she's not with me, like when she's at school, she's not great about doing a pre bolus for the amount of time that she really needs to do a pre bolus for. So I've really been trying to talk to her about how important the pre Boles is, because this is what happens if she doesn't pre Boles. Okay. Let's say it's snack time at school. And she waits until the last minute to give herself 30 carbs for that snack. So she gave herself the full amount of insulin that she would need for the carbs and that snack, but she just didn't wait or give the insulin enough time to start working before she ate. Right. So the carbs are gonna hit a lot quicker than the insulin has time to start working. So that's gonna cause a big spike, which. When she has a big spike that tells the automated system, the Omnipod five, that it needs to give her more insulin. So it starts correcting for that high blood sugar number. And now she has lots of insulin on board, cuz she has all the insulin for the carbs that were in the snack and all this extra insulin that the system has been giving her to try to bring that blood sugar down. So that usually leads to a big crash. So I've been trying to really stress to her like sweetheart, if you would just wait or give your insulin right. When I text you. Cause I, I do text her. I, I try to give her enough time to do a proper Prebus I'm like if you would just do it right then and there, you wouldn't have these big spikes. So the system wouldn't be dumping more insulin into you and then you wouldn't have these big crashes, you know, a couple hours later. because you have too much insulin on board. You know, if you, if you just would do that pre bolus, then you'd almost have like hardly a spike at all, or just a little bump up in your number. And then the system wouldn't be giving you extra insulin that you didn't need, and you would avoid this crash later on. And you know, of course she's like, oh, okay, mommy, I know, I'm sorry. And I don't, I mean, I really don't give her a hard time. I try not to NA her or get onto her much about diabetes. I try to calmly explain why it's so important in hopes that one day it will stick and she will realize, you know, all that stuff. My mom was telling me all those years ago, she was right. Maybe I should pre bolus. But also along that same vein, I have learned that, like, let's say we get into a situation where we can't pre bolus or we just flat out don't want to pre bolus, you know, maybe we're at a birthday party or cakes coming out right now. And like, I'm not gonna make Sarah wait around to eat this cake. I have learned that in those situations, when there's not enough time for a pre bolus to actually give her less insulin than what the bolus calculator is suggesting, because I know we're gonna have a spike anyway, regardless because we're not pre bolusing. And I know that because of that spike, the system's gonna dump more insulin into her. So I'm trying to like take into account. That knowing that she's gonna be getting more insulin with a spike and to prevent a crash later on. So that has been helpful to keep that in mind that if we just don't have time for a pre bolus or just don't want to, to actually give her a little bit less insulin to avoid that crash later on. So that was just a kind of a pattern I kept seeing. And I'm like, well, let's give this a try. And I mean, you're still are dealing with a spike, which is unfortunate, but you know, it happens something else that I think is important to keep in mind is the duration of insulin action. Now I have it set to two hours and I think a lot of people have it set to two hours on every other system I've been on. I've had it set, I believe with the classic Aeros Omnipod system, we had it set. We kind of played around with three hours. in four hours kind of switching back and forth between those two to see if it would make a difference with the loop system. You actually have to set insulin action time at, I wanna say six hours is what they recommend. In fact, they might even not let you set it any lower than that, but it was a lot longer than any, any other system I had seen before or read about before. Like they wanted it to be at six hours because of that tail. That even though there's not a ton of that, even though there's not much insulin at all, working at that five and six hour mark, there still is some. So they wanted to take that into consideration. Huh, but again, mama was not messing around when she got on this Omnipod five system. So I knew to be more aggressive, we would need to set that time lower. Now if you're on FIAs, which we've never used, I mean, that might be kind of truthful, right? Because I think FIAs works quicker than like Novalog and Humalog and it's out of the system a lot quicker. So that two, our time might be a little bit more accurate with FIAs P which FIAs is not approved for the Omnipod five system at this time. But I do know that people are using it in their pump and they're seeing good results, but we used Novalog and I knew that Novalog was not gonna be out of her system in two hours. I mean, it doesn't matter what I set it at. Like Novalog has I'm opening up think like a pancreas to remind myself of what Novologs insulin action profile is according to think like a pancreas Novalog will peak between 45 minutes and an hour and a half. And then it will last in the system for about three to four hours. So I would, I would kind of have to mentally keep track of, okay. I know after two hours, the Omnipod five is gonna tell me there's no insulin on board, but in my head, I really know there is still some insulin on board. So I would, you know, that would come into play. Like if Sarah was gonna go swimming or go on a bike ride, you know, I'd look at the insulin on board and it would say zero. And then I would look at the last bolus and it was given like two hours and 15 minutes ago. Well, according to our pump, our. Because of the settings that I entered, it thinks that all the insulin is out of her system. Cuz it thinks that after two hours it's gonna be out. But in my head I know that that's not true. Right. I know that it's still gonna be another hour and a half or two hours before all of that Boless insulin from the last meal or snack is out of her system. So, you know, in that case, maybe I'll say, Hey Sarah, I think you're gonna need a snack before you go on this bike ride or hop in the pool or like have a juice box. Let's put you into activity mode or set the target higher for a little bit longer to keep you from crashing. Cuz I know that you still have insulin board, even though it says zero on the screen. So keep that in mind. So real quick, I just wanna talk to you a little bit about how the Omnipod five system works. Listen again, not a doctor, not a diabetes educator, not an Omnipod rep, just a mom with a daughter living with type one diabetes who has read the Omnipod five manual, read a lot of stuff online, listen to some podcasts. So the way that it works is it goes off of total daily insulin. So it looks at all your basal insulin that was given all your Boles insulin that was given. It looks at the total amount and then creates kind of an adjusted, basal rate based on that total daily insulin. Every pod learns from the pod before it. So, if you had a weekend where you took your kid to two or three birthday parties, and they were eating cake and pizza, and you were boing lots and lots for all the carbs and maybe to correct for some high blood sugars, then once you changed that pod, the birthday party pod, you might notice for the next couple days or for the next three days with the new pod that you're having a lot of lows because that pod was learning from the birthday party pod and looking at the total daily insulin where you're giving like a ton of bolus for all these carbs that are being eaten. And it thinks like, oh little Susie needs more insulin. So I'm gonna set the adjusted basal rate higher. Which, you know, now little Susie is back in school and she's not going to birthday parties all day long. And so that higher adjusted, basal rate is causing her to have a lot of lows. So keep that in mind. I mean, it could go the opposite way too. Maybe you're an adult on the Omnipod five and you decide that you're gonna do a cleanse. And so all you eat is lettuce for three days. So the lettuce pod right. Is gonna learn and think like, oh, they don't need a whole lot of insulin. Look, they hardly gave themselves any Bo of insulin throughout the last three days. So the next pod that you put on is gonna learn from the lettuce pod that you don't need as much insulin cuz your total daily insulin was less. So it's gonna set the adjusted basal rate, lower, which then after your three day cleanse, if you decide you really missed pizza and ice cream and you start eating like you did before your basal rate is probably not gonna be enough because it was learning from the lettuce pod. And so now you're probably gonna see some higher blood sugars. So a friend of mine, we were recently talking about this and she was saying how, you know, they try to keep her daughter's carb intake to around the same amount, like on a daily average, just to kind of keep things consistent from pod to pod with like the learning of the algorithm. Which I just kind of let out a big sigh when we were talking about that, cuz it's like, oh one more thing to think about, but it makes sense. Right? You don't wanna have these giant swings and fluctuations in your insulin delivery because you're constantly changing what you're eating. So overall big picture, try to keep it consistent. If nothing else, it gives you a little insight into why you might be seeing a lot of lows or a lot of highs with a new pod that you put on. So things that I adjust when we see a lot of low blood sugars I recently, again, I do not adjust basal rates at this point. There has only been one time where I have switched. System back into manual mode. And that was when we were eating a big, heavy dinner. Honestly it didn't work great for us when we switched it back to manual mode and tried to do an extended bolus. So I decided, well, I'm just gonna leave it in automated mode then. And that way it can do all the learning and we can try to make the most out of this automated system. So being in automated mode for most of the time, I know that adjusting basal rates is gonna do no good. So when I start to see some low blood sugars, things that I adjust to prevent those lows are the target. So I have set the target a little higher. I had the target set at one 10 initially, and then the correct above I had at one 20. So with the lows that we are seeing, I decided to set the target. A little higher. I wanna, I think I actually set it up to one 30 while she was at school. And then the correct above number I put at one 40 and that helped a lot. We hardly dealt with any lows after that. I also did back off on my insulin decarb ratios a little bit, but not much. I wanna say Sarah's breakfast ratio was at like six one to six. And so I took it to one to 6.5 and then actually just this morning I took it to one to seven. But that is because Sarah just tried a new spot to put her pod. She put it on the back of her arm instead of on her thigh, which is a huge deal for us because in the two over a year and a half that she's been pumping. She has refused to wear it anywhere other than her thighs. So I was very excited that she was willing to put it in a different spot, but I will say that the arm has a much faster absorption rate than the thigh. And over the weekend, we were seeing a lot of lows. So I decided to, err on the side of safety for this first Monday back to school with the pod in a new spot. And I changed her insulin to carb ratio, just a tiny bit. I, for the breakfast one, at least I, I changed it to one point to one to seven. And so far we have not dealt with one low all day. So I'm super excited about that. You can also increase the insulin sensitivity factor or the correction factor. If you're seeing a lot of lows, I personally would not make a huge change in there, you know, start by bringing it up by like five or maybe 10 points and seeing if that makes a difference. But again, remember if you make that number higher, then it's gonna be less aggressive. So the system is going to. Give less insulin. So that would help to prevent some of those low blood sugars that you've been seeing. I already said it before, but I have not messed with changing the duration of insulin action. At this time to see if that might help to prevent low blood sugars, I've just left it at two hours. the opposite would be true things that I do when I see high blood sugars on the Omnipod five system, again, not adjusting basal rates, cuz that does no good, but I might set the target a little lower along with the correct above number might set that a little bit lower as well. I would make the insulin to carb ratios a little bit more aggressive. My rule of thumb and I think the advice that was given and think like a pancreas was to start by changing that about 10% and seeing. If that makes a difference and then you can decrease the insulin sensitivity factor or the correction factor. And that lower number will be a little bit more aggressive. So now that we've been on Omnipod five for two months, and the system has had lots of opportunities to kind of learn Sarah, like I said, I, it, it definitely has gotten more aggressive. It's been giving us higher values of correction, bolus. Or higher values of micro bolus when Sarah has like a spike in her blood sugar, or if she's running a little bit higher. I mean, we've even seen, I think the highest that I've seen in a micro bolus and micro bolus potentially could be given every five minutes is I think the highest I've seen is 0.35, which I think most people don't seem much above like two. So I think it's really doing a good job in learning Sarah so much so that now when she is running higher, I really have to make an effort and go and look at the history before I will give a correction, cuz I'll, I'll go to history and I'll look at auto events. And if I see that the system has been giving her a good amount of insulin, you know, if, if it's been giving her like 0.3 and then another 0.3 and then. Point three, five, and then 0.2, five, you know, back to back to back to back every five minutes, then I'll say, Ooh, it's, it's been giving her quite a bit of insulin. I probably just need to wait this out. Cuz if I give her a correction on top of that, then she's gonna have a crash. So that's good. I feel like it's taken some of the burden away from me and I, and I do feel like it does it pretty quickly. It can get her back down pretty quickly. Now, now in the beginning, not so much in the beginning, I had to give more manual corrections because I wanted the system to learn like, Hey, when she's up this high, I don't want her to be up this high. I want her to come down quickly, but also safely. But now that we're a few months in, I know that I need to be a little bit more patient and give it some time to do its thing and bring her back down on its own. And if I do that, typically she will come back down nice and safe and smooth and she'll land, you know, somewhere near her target. And if I don't and if I get inpatient and I rage bolus, then that's when we usually see the crashes. I actually think the Omnipod five gets Sarah's blood sugar under control when it's high, a lot faster than what we saw on DIY loop. I don't, I really don't know why that is. I mean, I could see what the DIY loop was doing in terms of how it was adjusting her basal. And it seemed like it was giving her a lot, but it just would not. Bring her down quickly when she was running high. So I've been very happy with the way in which Omnipod five has learned Sarah and can now get her number back down pretty safely. I think a lot of people were pretty upset to hear that the lowest target glucose value that you could set on the Omnipod five was 110, cuz I think a lot of people didn't want their kids sitting at 110 throughout the day. You know, they would've preferred 85 or 90 or whatever the case may be. Well, I'm here to tell you that Sarah spends plenty of time below her target value. I mean, just this morning she had yogurt and granola with berries on top, top like regular granola. Not like a low carb version or a low carb granola, like regular granola and regular yogurt, not a low carb keto version. Like it was the, the real deal with berries. We did a 30 minute pre bolus. She never got above. I think 1 25 was the highest. and then she came back down and she, I think the lowest she got was maybe 84, 85, and she kind of coasted around there for a solid hour or so. And then the system kind of slowly started bringing her back up. But by the time she went to bolus for her lunch today, she was sitting at I'm looking at the screen right now. She was sitting at 1 0 8 when she went to do her lunch bolus. And her target right now for school is set at one 30. So it's definitely possible to get your kid to kind of sit below their target value for a good chunk of time during the day. It might require some tweaking of settings on your part, but it is possible. Let me make a quick comment about activity mode. The Omnipod five does have a feature called activity mode. When you put the pump into activity mode, you can choose how long you want it to be in activity mode. I think the shortest amount of time is an hour, and then it goes up in hour increments after that we don't use it a ton every now and then if Sarah is like recovering from a low blood sugar, I will put it in activity mode for an hour, just because I don't want her to like. Drink a juice box and have a spike. And then the system see that and be like, oh, she needs more insulin. I don't wanna have to deal with another low right after the low we just fixed. So every now and then I'll put it in activity mode after we've treated a low, that has been helpful. What activity mode does is it automatically sets the target glucose at 150. So it te sets that target a little higher and it also gives less overall insulin. I forget what the percentage is of how much less that it's giving, but it is giving less insulin overall. So that's pretty conservative. So I have found for Sarah, like if we're using activity mode while she's swimming or actually being active sometimes. She starts to run high, even while she's doing those activities because of how conservative activity mode is. Or sometimes it works well for us, but then once she's done with the activity, because her insulin has been off for so long, then we'll see like a rebound high. So I'll still put it in act. I'll still put it into activity mode every now and then, but usually like if Sarah's gonna get in the pool and I know she still has insulin on board my, the alternative that I prefer for us is just to like, have her drink a juice box and maybe just temporarily set the target higher, like not set the target and overall insulin. Activity mode does two things, right? It sets the target higher and it gives less insulin overall. Whereas if I just went in and set the target higher, that would still be helpful in preventing low blood sugars, but not as conservative as activity mode would be. So that could keep her steady swimming, but also keep her from having like a rebound high later, if that makes sense. But a lot of times, for us, especially towards the end of the summer, when her body was so used to swimming all the time, I found that if she still had an insulin onboard from a previous bolus, if I just gave her a Popsicle or juice box, I mean, who doesn't want that in the summertime? That that did better for us to keep her from crashing during swimming than like putting her into activity mode. Again, I'm not telling y'all what to do. I'm just telling you what we did do. I think hearing other people's experiences is helpful. You know, it kind of like makes you perhaps think in a, allows you to think about things in a way that maybe you didn't before, and then you can take that back to your healthcare provider and kind of talk things through. All right. I wanna talk to you about some things that we're gonna talk about the pros and the cons. I'll start with the cons first, so we can end on a good note. But there are some things I do not love about the Omnipod five system. Personally, I am fine with Sarah has an iPhone and personally I am fine with the fact that. It is not compatible with the iPhone at the moment, because I kind of like having the separate devices. I think a con is for a lot of people that it's not compatible with iOS devices at the moment, but for me, I see it as a pro because I like Sarah's almost 11 years old. So she's on her phone during the day. She has little friends that she texts with. Some of them are diabetes. Some of them do not have diabetes. She plays games on her phone sometimes she'll watch a show on Disney plus on her phone sometimes. So I kind of like that I can hold her controller and manipulate the settings if I need to, or give her a bolus without having to get her phone from her, or, you know, say, Hey Sarah, you need to stop what you're doing and, and do this for your diabetes management. So personally I kind of like having the separate devices. Sure you have to keep up, keep track of another device, but that's kind of always been what we've had to do anyway. So it's nothing new for us I will say that the controller has been a little glitchy at times, so I don't love that there was one day when Sarah was at a volleyball camp over the summer and she was running it like, this is not even funny. I'm not sure why I'm laughing, but she was running at like 350 and I'm like what is going on? I'm texting her, I'm calling her. I even had to call the volleyball clinic to get in touch with her. And the lady on the phone was like, she says, she's giving herself insulin. I'm not sure what's happened. And at this point in time, it was like 30 minutes before I had to go pick her up anyway. So once I got her in the car, I looked at her PDM and I couldn't even. Swipe through on the screens. Like it wa the touch screen wasn't working, it was super glitchy, nothing was loading. And I'm like, Sarah, has it been like this all day? I'm she's like, yeah. And I'm like, sweetie, you didn't give yourself any insulin for lunch. Like you should have called me. And she's like, I thought it was giving me insulin. It was just so glitchy. So anyway, lesson learned, I told Sarah that if this ever happens again, you need to call me right away. But we also, I was really nervous cuz that was only like two weeks into the Omnipod five. And I was thinking, oh my gosh, I'm gonna have to call customer service and get a new controller cuz this one's broken. But before I did that, I just decided, okay, let's try to restart it. And see if that helps and just restarting the controller, fix the problem. I have had to do that one other time where it was starting to look a little glitchy and I was like, Ooh, I'm gonna restart it real quick. So I don't love that. I don't know why that happens. But it. It does. And for us so far just restarting, it has helped. Restarting does not mean resetting. There is the option to completely reset the controller, but that's like putting it back to like factory default settings where you have to start from square one. You lose all the learning that the system has done if you reset the controller. So I mean, I don't, I don't wanna do that. so but I did mention to a friend once that, cuz she was seeing lots and lots and lots of high blood sugars and I said, you know, you could reset it and enter more aggressive settings into the PDM to see if it could maybe learn your daughter a little quicker. So food for thought. That's another thing that I don't love about the Omnipod five system that eventually, if the system does become compatible with iOS devices and we decide to switch over to the phone app, we're gonna have to start over like the system does not. If you have to get set up on a different device, there's no way to like transfer your data over. You have to start from square one and you have to start all over with the automated system, learning your child. I definitely don't love that. I'm probably not gonna do that. Honestly. Like if it becomes compatible with iOS devices, I'm probably just gonna keep the controller that they gave us and just pray that it keeps working and doesn't get dropped in our pool because I don't wanna have to restart. But with that in mind every now and then go into the controller and take pictures of your settings. So you know what they are because in the event that you do have to get a new controller or restart the learning process, you will know what your settings are and you'll know what your settings were at, where you were seeing success with the system. I do that every now and then maybe like every three weeks, I'll just open it up and take pictures of the settings. So if something should happen, I'll know where we left off something else I don't love about the system is there is no view app for anybody that was on the Omnipod dash system. You will know what I'm talking about. The view app was an app for like a parent or a caregiver to be able to see the. Management decisions that their kid was making throughout the day. So like Sarah's at school right now. And if I had a view app for the Omnipod five, I'd be able to go in and see, okay, good. She did give herself insulin for her snack and she gave it about 15 minutes before she was going to eat. And I would just be able to go in and double check. And for me that would be so huge. Because again, there's no nurse at Sarah's school, so it's really just me kind of monitoring things throughout the day and texting with her about what she needs to do. And it would just be, cuz there have been some days where she has forgotten to bolus for lunch or a snack or she's running really high. And I would love to see like, okay, did she just forget to bolus? Or maybe did somebody bring in cupcakes for a birthday? And I didn't know about it. Like that would be super helpful. I would also love to be able to see what the system is doing in terms of the. Auto events with the micro bolusing, because if she is running high, you know, I could look in there and see like, okay, well she did give herself her lunch insulin. Maybe she didn't pre Boles well enough, but also the system has been working very hard to get her number back down, and it has been giving her pretty significant micro bolus. So maybe I just need to wait and not do a rage, bolus and overcorrect. Cuz then I don't want her to go out to recess in 30 minutes and have a crash. So anyway, again, Omnipod a view app would be incredibly helpful. I really, I just don't. I love y'all. I am loyal to your product. I don't think we will ever go to a non tubeless system. So you're stuck with us for better or worse, but I would really love a view app. So anybody that's out there listening. That works for Omnipod. Can you please put that on the top of your list of priorities of things to get done? I just come on y'all. If I can build the DIY loop system on my computer in one day, your employees can build a view app. It can happen, you know, it can what's the deal. Come on, Now I will say there ISCO. So you do have a way to see some of the management decisions that your kid has been making throughout the day, but glucose is slow. So you don't really get to see it until like an hour or two after your kid has given themselves insulin. And by that time, I mean, it's kind of too late. There's not a whole lot you can do with it, but if you are on O P five, definitely go to the Omnipod website and. Click on all the links to get yourself set up with glucose and sync your device with the glucose system. Because that way, when you go to the endocrinologist, all of your data is right there for them to see, and you don't have to upload anything. It automatically syncs when you're connected to wifi. SoCo is a handy feature, but it's definitely no view app cuz you don't get to see decisions in real time. There's like an hour or two lag. Okay. We are gonna end on a positive note and I wanna tell you what I absolutely love about the Omnipod five system. I love the range that the controller has. Again, if you guys follow me on Instagram, I recently posted a reel that tested out the range and I was sitting on the top step of some bleachers. And my daughter was probably, I don't even know, 80, 90, a hundred feet away from me, ice skating. And I was able to deliver a bolus from where I was sitting and it communicated with her pod and delivered insulin to her while she was ice skating. That is phenomenal. At night my bedroom is pretty close to Sarah's. And so at night I can, I charge her PDM on my bedside table. And at night, if she needs a correction or I need to do something with the controller, the range is amazing. I do not even have to get out of bed, whereas before I would have to get up, I'd have to walk into a room and try to tiptoe in and hold the controller, like right over the pod in order for it to Deliver insulin to her or suspend insulin or whatever it is we wanted to do. So the range is amazing. I absolutely love it might be one of my top three favorite features. I love how quickly the controller shows Sarah's blood sugar numbers. For those of you that don't know the controller, if you have the separate controller or if you have the app on an Android device it shows Sarah's Dexcom number with the trend arrow, and it comes up so much quicker than the actual number on like the Dexcom app on a smartphone. Like if there's a signal loss and you know, you have the little message that says like signal loss, please wait 30 minutes. Well, that might be up for another 15, 20, 30 minutes. But if you have the Omnipod five controller right next to Sarah, that number will come up almost immediately, which makes things like checking her number while she's swimming so much better. Because you know, there's always a signal loss when they're submerged in water and when I have her get outta the pool to check, we literally just stand there for. Almost no time at all, anywhere from like 20 seconds to two minutes and her number will pop right up, which is so much faster than the Dexcom app on her phone. I really just love that it's tubeless. I mean, it's always been tubeless, so that's nothing new that makes life just so much easier with the amount of swimming that we do. And Sarah's so active. You know, she doesn't have to disconnect from her pump when she's swimming or taking a shower or riding her bike. She doesn't have to worry about getting the tube caught on anything. So that's always been and continues to be an amazing feature. Oh, I really love how this is specific to Omnipod five, but I really love how the pod and the Dexcom communicate with each other. Even when the controller and the phone is nowhere near the person wearing the devices. So Sarah could be down the street playing with a friend and she could have left or forgotten her controller and her phone at home, which I wouldn't love because then I wouldn't be able to follow her. Cuz her phone wasn't near her, but still she could leave those devices at home, go down the street to play and the automated system would still be working it, they would still because the algorithm is built into each and every pod. It can communicate with the Dexcom and make insulin adjustments without that controller or phone being anywhere near her. I think that's phenomenal. The other day, where do we go? We went to church the other day. We went to church and Sarah had her phone. So I would still be able to see her Dexcom numbers on the follow app. You know, when we dropped her off and her, her little class at church but she forgot the controller. I told her, I said, Hey, sweetie, you know, you're just not gonna be able to give yourself, or you're just not gonna be able to have snack today at church. I'm sorry. Lesson learned. Hopefully we'll remember it next week, but you know, for today you don't, you're just gonna have to skip snack, however, Even though we didn't have the controller, the system was still adjusting. Like she had a little bit of a bump up because of breakfast. And so it did what it needed to do to bring her back down. And then it helped her to land safely at a good number that wasn't a hypoglycemic event. All with that controller being nowhere near her, obviously she would need the controller near her if she wanted to give herself a bolus for a snack or maybe lunch. And then, you know, her phone does still need to be near her for me to be able to see her numbers, right. Cuz if her phone's not near her, then the Dexcom app, isn't picking up the number and then it's not able to share that with me, so I wouldn't be able to follow it, but I just love that the algorithm still works. When those devices aren't close to her. Okay. I think that I covered everything that I wanted to say. There are some really fabulous podcast episodes that have been re recorded about the Omnipod five system. I'm gonna link to those in the show notes. Juice box did a three part series with a diabetes educator who helped people through like the clinical trial with the Omnipod five. So she was a wealth of information. I'm gonna link to that in the show notes because she kind of talks about specifics with settings and some other features. I think that would be worth a listen. Stacey Sims, the host of the diabetes connections podcast. She also had a really fabulous episode, all about the Omnipod five, where she interviewed it was one teenage girl, like older teenage girl that had been using Omnipod five and then two other moms of a type one diabetic they were using the Omnipod five for their kid. So she interviewed those three people and then she also interviewed An Omnipod five employee and not just an employee, I'm forgetting his exact title, but it was like definitely somebody, one of the higher ups in the Omnipod insulate world. So those interviews that she did are combined into one podcast episode, and I really love the way that she, she did that interview. So that's for sure, worth a listen. I got lots of good nuggets of information from that one. I'm gonna link to both of those in the show notes, because share the love. You know, I'm here to help parents and caregivers of type one diabetics, and you can listen to my podcast, but you can also listen to these other awesome podcasts there's room at the table for all of us. And really my main goal is to make sure that you are well informed and. Feel empowered so you can make good diabetes management decisions for yourself or for your kid. Whoever is the one living with type one. All right. You guys, that is all I have to say about Omnipod five. There's so much. I'm sure, as soon as I'm done recording, I'll think of 10 more things that I wanted to tell you that I didn't. But feel free to reach out to me with any of your questions, your comments. I'd love to know your thoughts on this episode. If you've kind of done some similar things or. I would just love to hear the results that you've had with the system and how you got there. Personally, we love it. We're sticking with it. Like if you wanna know what our clarity, our Dexcom clarity numbers show, I can tell you that everything is for time and range. Again, remember I have her range set at 70 to one 50. I'm hoping to actually bump that down to one 40 soon. But this is on like, you know, the Dexcom clarity app. So like for our 90 day range, which remember we've only been on the Omnipod five for two months, so there's a whole month in there. In this data that is not taking into account the Omnipod five that's when we were still doing the DIY loop. But like right now, 90 day average is 1 31 standard deviation is 52. I definitely think there's some room for improvement there. We saw lots of high blood sugars when she was on loop. Anyway her A1C is predicted to be at 6.4. I will say that every single time we've had the prediction in the clarity app, it's always about a half of a point lower than what it actually shows in DCOM clarity. So with the prediction being at 6.4, I'm kind of thinking she'll probably be at like six, right at six or maybe 5.9 when we go in for our appointment. But we'll see. And her 90 day time and range is 70%. So, but then if you go back earlier, like 30 days would be probably a little bit better reflection of what. The Omnipod five has been doing for her since, you know, we've only been on that for the past month. So her average glucose for 30 days has been 1 28 standard deviation is 45. So that's a little better. The predicted A1C is still at 6.4 and the time and range is a little bit better. It's at 73%. So just to give you a guys, oh, I really like the seven day average. The average glucose is 1 24 standard deviation is 41 and the time and range is 77%. I'm I'm gonna choose to look at that. I like that. That makes my heart happy. all right. You guys have a fabulous week. Thanks for listening to me, ramble on about the Omnipod five. I hope that I provided you with a good kind of overview and summary of how it's been going for us and what we've experienced. I will chat with you soon. But until then stay calm and Boless on. Bye.