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

Guest Blogger
Category: Tips & Guidelines
 
Diana Isaacs, PharmD is an Endocrine Clinical Pharmacist. She has an ongoing commercial relationship with Insulet Corporation.

“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

Omnipod 5 is the first and only tubeless automated insulin delivery (AID) system available in the US. It is discreet, waterproof1 and eliminates daily injections, helping your patients potentially alleviate the burden of diabetes management.

If you have patients making the move from MDI to Omnipod 5, below are some reminders to help set them up for success.

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

One of the key features of the Omnipod 5 AID system is that its algorithm—SmartAdjust™ technology—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, SmartAdjust technology uses the Basal Program to estimate TDI. It then calculates how much insulin it should deliver each hour, known as the Adaptive Basal Rate. The algorithm assumes the entered Basal Program accounts for 40-50% of the TDI while bolusing accounts for 50-60%.2

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 the success of SmartAdjust technology is TDI. If the starting settings are not based on the approximately 50/50 split, it may take longer for the system to adapt.2

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 and may affect the Adaptive Basal Rate. 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.

Suggestions for Improving Success:

  • Consider using the patient's current TDI on MDI or patient weight calculations to estimate the starting basal rate. “Commonly, 75–80% of the TDI a patient receives with MDI is used to estimate the starting basal rate.”2
  • Ensure that the initial basal rate entered when activating the first Pod accounts for 40-50% of the patient’s TDI2
  • 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.”2 This is why users may benefit from stronger insulin to carb ratios (ICR) compared to ICR used with MDI.
  • 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 insulin3 to function. This means that your patients switching from MDI will have to discontinue use of their long-acting insulin. If you feel your patient would benefit from additional steps to accommodate the discontinuation of long-acting insulin, the following features can be used to temporarily lower insulin delivery:

  • 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, SmartAdjust technology reduces insulin delivery and sets the Target Glucose 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 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. This will still keep the system in Manual Mode. Your patient will have to remember to switch their system into Automated Mode to receive the full benefits of the AID system. For a reminder of Temp Basal rates, you can watch the short Omnipod 5 System Temp Basal Setting video.
 

Helpful Resources

1. The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Controller is not waterproof.

2. 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/

3. The Omnipod 5 ACE Pump (Pod) is compatible with the following U-100 insulins: NovoLog®, Humalog®, and Admelog®.

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