Switching Patients from Multiple Daily Injections (MDI) to Omnipod® 5

Guest Blogger
Category: Tips & Guidelines
 

“Tubing is such a barrier for so many people. ….  tons of people that would just not even consider pumps, are now saying ‘ok, I’m ready, I’m willing to try this because it’s finally tubeless’. And just seeing how it’s simplified people’s lives and helped them to increase their time in range and improve their diabetes outcomes.” 

—Dr. Diana Isaacs about Omnipod 5

Diana Isaacs, PharmD is an Endocrine Clinical Pharmacist. She has an ongoing commercial relationship with Insulet Corporation.

Data from the Omnipod® 5 RADIANT Randomized Controlled Trial (RCT)2 shows that Omnipod 5 users spent an additional 5.4 hours per day in range (70-180mg/dL) compared with those using MDI with a CGM.

Key results from the RADIANT trial2:

Icon of a clock outlined in orange

Time in Range improved by 22% (over 5 hours per day), avg across all users

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No difference in time below range (<70mg/dL), avg across all users

Lower A1C with a downwards arrow and everything in orange

HbA1c reduced by -0.8%, avg across all users

Lower A1C with a downwards arrow and everything in orange

Those with an A1C ≥8% experienced a 1% HbA1c reduction

Setting up your patients for Success using Omnipod 5:

If you have patients making the move from MDI to Omnipod 5, below are some reminders to help them achieve the best results.

Importance of a Close to 50/50 Basal-Bolus Split 
 

One of the key features of the Omnipod 5 AID system is that it  adapts to the user’s insulin needs over time. To do this, it takes into account the patient’s total daily insulin (TDI). Upon initiation, Omnipod 5 uses the Basal Program to estimate TDI. It then calculates how much insulin it should deliver each hour. The algorithm assumes the entered Basal Program accounts for 40-50% of the TDI while bolusing accounts for 50-60%.3 

For a refresher on this concept, including initiation, everyday use, and expectation setting when starting patients on Omnipod 5, you can view this 4-minute video. 

 

Why does this matter? The key factor to success is TDI. If the starting settings are not based on the approximately 50/50 split, it may take longer for the system to adapt.3  

It's important to consider behaviors when assessing TDI. For example, if your patient chronically misses boluses, this will underestimate the user’s true TDI. It is recommended to reassess insulin needs and to input a basal program that is equal to about 50% of TDI, while still representing basal delivery that would be safe and effective in Manual Mode.

Strong Initial Settings for Strong Results 

Use fillable Initial Pump Therapy Order form to assist with the calculations.

  1. Determine TDI for pump calculations3
    Consider:
    A. Current TDI x 0.75
    B. Weight (kg) x 0.5
    or
    C. an average of the 2 methods
  2. Use that calculated TDI for Automated Insulin Delivery/initial basal rate. (TDI/48)
  3. Choose lowest appropriate target glucose and correct above for best time in range. (110-150 mg/dL)
  4. Calculate IC Ratio 400/TDI3,5-6
  5. Calculate Correction Factor (1700/TDI)3

 

Additional Suggestions for Success:

  • Ensure that the initial basal rate entered when activating the first Pod accounts for about 50% of the patient’s TDI3
  • Encourage the patient to pre-bolus for meals and to correct for hyperglycemia as needed to inform the system of their TDI needs.
  • “The dynamic nature of AID often results in less insulin on board (IOB) leading up to mealtimes than with nonautomated insulin delivery; therefore, a 10–25% increase in mealtime bolus insulin dose may help to optimize postprandial glucose control for some individuals.”3 This is why users may benefit from stronger insulin to carb ratios (ICR) compared to ICR used with MDI.  Use the fillable Pump Therapy Order form to calculate IC Ratio.
  • Review bolus settings to optimize glycemia around meals and correction boluses. These settings include ICR, correction factor, and duration of insulin action.

 

Considerations for Long-Acting Insulin Discontinuation 

Omnipod 5 exclusively uses rapid-acting insulin4. This means that your patients switching from MDI will need instructions on how to discontinue use of their long-acting insulin prior to starting Omnipod 5. You can provide those instructions to the patient and to the trainer on the Pump Therapy Order Form.  Depending on when training is scheduled and when your patient took their last dose, there may be some long-acting insulin still active in their body. If so there are features that can be used to temporarily lower insulin delivery during this time:
 

  • Activity Feature: If you are starting your patient in Automated Mode, consider using the Activity feature until the long-acting insulin is metabolized. When the Omnipod 5 Activity feature is activated, insulin delivery is reduced and the Target Glucose is set to 150 mg/dL for the amount of time you choose, up to 24 hours. This intentional decrease in insulin delivery could help your patient safely start Omnipod 5 until their last long-acting insulin injection has been metabolized. Once the designated duration of the Activity feature ends, the system automatically switches back to full Automated Mode. For a more in-depth reminder of this functionality, watch the brief Omnipod 5 System Activity feature video. 
 
  • Temp Basal: You can safely start your patient in Automated Mode right away, but if you choose to start in Manual Mode, one way you can reduce insulin delivery is by setting a Temp Basal. This Manual Mode feature will let you override the insulin delivered by the active Basal Program for a chosen duration of time, up to 12 hours. After the chosen duration has passed, the system switches back to the previously active Basal Program. The system remains in Manual Mode. Your patient will have to remember to switch their system into Automated Mode to receive the full benefits of automated insulin delivery. For a reminder of Temp Basal rates, you can watch the short Omnipod 5 System Temp Basal Setting video.
 

Helpful Resources

Omnipod 5 is indicated for people with type 1 diabetes, ages 2 years and older and type 2 diabetes in persons 18 years of age and older. Rx only. WARNING: Do not use SmartAdjust™ technology for people under the age of 2 or who require less than 5 U of insulin per day. Please see omnipod.com/safety for important safety information.

  1. The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Controller is not waterproof.
  2. Wilmot E, et al. Presented at: ADA; June 20-23; Chicago, Il. Data on file. 2025. A 13-week randomized, parallel-group clinical trial conducted among 188 participants (age 4-70) [51% HbA1c≥ 8%] with type 1 diabetes in France, Belgium, and the U.K., comparing the safety and effectiveness of the Omnipod 5 System versus multiple daily injections with CGM. Time in range (70-180 mg/dL) with OP5 improved by 22% (43% MDI vs. 65% OP5, p<0.001). Time below range (<70 mg/dL) with OP5 was non-inferior to MDI (2.27% MDI vs. 2.56%, p=0.2). HbA1c 13-weeks: control group 8% vs. Omnipod 5 group 7.2% (p<0.0001). RF-042025-00015.
  3. Berget C, Sherr JL, DeSalvo DJ, et al. Clinical Implementation of the Omnipod 5 Automated Insulin Delivery System: Key Considerations for Training and Onboarding People With Diabetes. Clin Diabetes. 2022;40(2):168-184. doi:10.2337/cd21-0083 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160549/
  4. The Omnipod 5 ACE Pump (Pod) is compatible with the following U-100 insulins: NovoLog®, Humalog®, Kirsty®, and Admelog®. SmartAdjust technology is compatible with the following U-100 insulins: NovoLog®, Humalog®, Kirsty®, and Admelog®.
  5. Griffin TP, Holloway M, Choudhary P, et al. UK’s Association of British Clinical Diabetologist’s Diabetes Technology Network (ABCD-DTN): best practice guide for hybrid closed-loop therapy. Diabet Med. 2023;40(7):e15078. doi:10.1111/dme.15078
  6. Phillip M, Nimri R, Bergenstal RM, et al. Consensus recommendations for the use of automated insulin delivery technologies in clinical practice. Endocr Rev. 2023;44(2):254–280. doi:10.1210/endrev/bnac022
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