Still Using the Rule of 500? How Optimized Omnipod 5 Settings Can Push TIR to 80% or Higher
A Practical Guide for Healthcare Providers: Successfully Adjusting the Target Glucose, Insulin-to-Carb Ratio, Correction Factor, and Duration of Insulin Action
In this video:
- Why the 500 rule and 1800 rule may be holding your patients back — and what to use instead
- The Target Glucose setting change that can add up to 2.5 hours of TIR per day with no meaningful increase in hypoglycemia
- How more aggressive bolus settings can improve postprandial blood sugar and strengthen the algorithm itself
- Upcoming Omnipod 5 updates, including a new 100 mg/dL target option and FreeStyle Libre 3 Plus integration
Despite advances in diabetes devices and therapies, many patients are still not meeting their glycemic goals. While patient behavior and lifestyle modifications matter, the insulin pump settings themselves play a major role. Real-world evidence shows that when Omnipod 5 settings are optimized appropriately, TIR can reach 80% or higher. In this video, Dr. Steve Edelman and Dr. Jeremy Pettus — both endocrinologists and people living with type 1 diabetes — share the specific adjustments they recommend in their own practice. Simple, evidence-based changes you can make at your next visit to help close the gap between where your patients are and where they could be.
See an official clinical guide on Omnipod 5 optimization.
Would you recommend to make all the changes at once or one at a time? Also once making changes and your TDI rate changes say in 3 months, would you need to re-evaluate and make adjustments again?
No, do not make all the changes at once. It really depends on if you’re getting high before meals, after meals, or in-between meals. That will dictate which settings change.
If you’re getting high after eating, that would be insulin-to-carb ratio, if the system isn’t correcting fast enough for a high, that would be correction factor, and if you’re getting high or low in between widely spaced meals, that would be basal rate.
If your time in range is good at 3 months, you don’t really have to worry about making adjustments again. But if it’s not where you want it to be, then yes, you’d look again at the settings.
Is there a video like this for tandem tslim ?
We don’t have one yet on our website, but you can find videos from Tandem about the t:slim pump here:
https://www.youtube.com/watch?v=OpsxpDXGmPo
Hello,
For various midlife factors of insulin resistance or non optimization of many too many hormones I’m having a beast of a time with TIR and post meal chaos!
I followed this tutorial closely with great interest but what I do not understand (maybe I am getting old at 57) is when I need to review my history and TIR, am I switching back to 180 mgdl upper limit glucose goal? What am I missing? Did I not understand the information around resetting or coaching our algorithms for tighter glucose ranges?
Do I just switch the settings back to 70-180 to see how I’m doing?
I think my endocrinologist is going to think I’m crazy with my upper range set at 110… beep beep… thank you! I’ve tried for 4 days, and I am having more hypos.
Thank you!
EM
Your 180 mg/dL should be the highest level where you get an alert. The number we talked about is the time in range on your CGM download, which should be the percentage of time between 70-180 mg/dL, which should be 70% or greater. The lower the target that you set your algorithm for, the better off you’ll be. With the Omnipod, you can go down to 110 mg/dL. In the future, the lowest target will be 100 mg/dL.
If you’re getting low after eating, your insulin-to-carb ratio might be too aggressive. If you’re getting low in between widely spaced meals, your correction factor might be too aggressive.
Once you make your settings more aggressive, look at your postmeal blood sugars and if they’re still not good, you might have to make your insulin to carb ratio a little more aggressive, and/or if you’re elevated (like above 200 mg/dL), and it takes you a long time to get back down to your target, you might need to make your insulin sensitivity factor more aggressive. These calculations are fairly artificial, but they’re a good place to start, and then you’d go from there. Temporarily you could always just raise your target to be on the safe side. If I didn’t understand your question, feel free to email Lynne at lynne@tcoyd.org and she can get a better understanding from you of what you are trying to figure out and let me know. But please check with your own endo regarding changes to your settings as well.
The OmniPod-Dexcom “Aha!” Moment
Blame it on the brain fog that comes for women in menopause, but I’m having a total “boom” moment. I was so hyper-focused on your OmniPod tutorial and your words and video that I mentally cordoned it off from my Dexcom. Despite pumping since 1995, I’ve always viewed them as two distinct islands rather than a unified algorithm. Of course I know they are a “system” but holy mole I was so focused I missed the end goal! THANK YOU! It’s a major shift in perspective, but I’m all set with your suggestions. Let’s see what happens!
The “Endo Gap” on the Central Coast
Regarding my care, I won’t be telling my current ENDO… I’m transitioning to a UCLA affiliate next month. Living on the Central Coast, I’ve found the local healthcare landscape surprisingly subpar for endocrinology.
My previous endocrinologist in Santa Barbara recently stunned me by suggesting that, at 47 years into this disease, I likely understand the interplay of insulin, GLP-1 and estrogen receptors, SHBG, and the liver better than he does not to mention bone health. Ummm… I was floored. My husband was mortified.
He quoted a mentor at Cedars-Sinai, saying that by age 50, most T1Ds can “out-logic and out-maneuver” their doctors instructions and knowledge. While intended as a compliment to my 80%+ time-in-range, it left me flummoxed. This life stage has been the most difficult for my well-being, and I refuse to accept a 6.5%+ A1C as my “peak” just because I’m “working too hard” for it. On my way out, a PA whispered a single word of advice: Midi. It’s great to balance other hormones but while endocrinologists don’t deal with other declining women hormones, Hormone Replacement Specialists don’t really understand Type1. It’s an incredible journey, and it’s pretty much on my own.
Future Forward
I’ll be at your next San Diego event, but I have a proposition for you and Jeremy. You should consider a session on the “experiential difference” in care provided by MDs and NPs who are actually T1Ds themselves. In my four decades of experience, the care from providers who live with this “diabeast” is phenomenally, fundamentally different. It’s a perspective that goes beyond science—it’s about heart. You just left me in tears that you took the time to respond to me compassionately and with details!!
Thank you for the empathy and the clarity, Dr. Edelman. I’m on my way and I’m tinkering my settings! Phew!
EM
Thank you for that kind message, and really hope to see you at ONE!
Hi there,
We wanted to let you know that we’re going to do a podcast soon on women’s health and diabetes (likely May or June), so keep an eye out for it! You may also want to check out the website and Facebook group called T1D to 100 – they have a lot of helpful into too!
https://t1dto100.com/
https://www.facebook.com/groups/t1dto100/
Checking it out! Thank You!
😊