foreign is a closed loop system meaning that it talks to your Dexcom G6 and adjusts the amount of insulin that it gives you automatically sometimes they think that it's a completely hands-off system and that it's going to fix highs for you automatically and there's not going to be that much thought that has to go into it I just wanted to make a quick video that talks about that fact and really the three main ways that that I go about actually fixing highs and how some of that stuff is different and and what you can kind of look out for on your graphs to decide on which method to use so I'm going to uh share a couple of my Dexcom Clarity reports uh just for a couple of different days that show some examples of these things and I want to try to help out everybody that maybe is looking at this with a little bit of concern and not being sure what to do uh so again so I think when I first started on the the Dexcom is the the Omni Pi five I assume that when my blood sugar went High that the omnipod would give me the appropriate dose to bring it back to normal relatively quickly what I've seen in practice um is that if I do go high let's say I miss a mealtime bonus and I I just end up staying high after a meal uh the system will use those micro adjustments to try to give me additional insulin but it's go it's coming in such small doses that I'm actually just gonna kind of stay high for a long time so what I've noticed is that the omnipod really seems to like stability so let's say that I come up to a certain range let's say it's 180 and I'm kind of going along like this I'm too high but the system is is kind of happy that I'm stable so it's going to keep giving me um insulin doses I'm like the 0.5 or 0.1 or whatever it is that it'll give me in the background but it's really not going to bring the blood sugar down quickly it'll come down after many hours but if you're looking at a daily report and you're worried about your average blood glucose which when you kind of expand that out it turns into your A1C you're going to end up with a lot of time on a given day spent higher than you would like uh so if you're kind of waiting on those automatic adjustments you might be disappointed in the results and so I just wanted to kind of talk about that and how the system seems to to work best for me so let me find a couple of uh examples of this so I'm going to share my screen real quick okay so the first uh graph that I want to show is an extended high so I just took screenshots of these so hopefully this is big enough but I'll make it a little bigger okay so this area where I have my cursor you can hopefully see the little plus sign on the left uh this is an ex what I would call an extended high so you can see it's 12 am right here I'm at about like the 160 range and I come up to 170 or so I hit 180 and then I kind of just stay at 180 for a long period of time now eventually I have a nice smooth descent and I come down and then I go about my day but this was an example where I actually didn't wake up and give myself a manual correction so I tried to rely on the omnipod 5 doing the automated adjustments in the background and you can see that 12 a.m to really 6 a.m it's quite a lot higher than I wanted so that's six hours of being out of the range that I would like because I was relying on that sort of extended or the uh the background basil adjustments to bring my blood sugar down so helpful but not ideal and it's not the quickest fix so that's really the extended high and that's kind of what I see a lot if I do miss Ebola and I rely on the automated adjustments to to fix it it's gonna it's gonna fix but it's just gonna take a while so that's something to look out for if you see that on a graph foreign alternative which was uh I guess it was a couple weeks ago so here you can see 12 a.m same thing is happening I'm going up higher than I would like to I'm actually in the I think it's the 200s here which is why you see this little alert now in this case you see a much faster descent you see it come down much quicker than it did in the last in the last screenshot and that is because at this time I remember this one I woke up at about I think it was like right when it got to the very highest and I gave myself a manual correction so I used the smart balls calculator um to actually give me a correction which again to take a step back the system will will know based on your insulin to carb ratios and your correction factors how much insulin you would need to correct a high blood sugar more quickly but it's not going to do that automatically so you have to actually go on to the PDM put in or press the actual bolus calculator uh have it read your CGM and then it's going to give you an estimated correction dose and if you want to take that you can but that's not going to happen automatically so this is an example of I opened up the PDM I looked at the the correction that was needed I took it and you can see I came down much quicker now the cool thing about the omnipot 5 is that the fact that it adjusts the amount of of uh basal insulin that you get uh it you know this might have been actually a crash downward if I was on MDI because a lot of times if I take a relatively large dose especially at night once it starts moving the momentum is just going to keep pulling it and pulling it pulling it down so this is a great example of it was high I did a manual correction it came down but then you can see that it's moved out because again the omnipod likes these sort of straight lines the algorithm does and so it knew once coming down at a certain rate to stop giving me those background adjustments that it had been over here and now I'm nice and smooth so an example of in this case I really wanted to give myself a correction and then I ended up in a nice good range another one I wanted to show was exercise so exercise is another way to correct the high blood sugar as most people are aware but I wanted to show what that sometimes looks like on a graph so in this example this is 6 PM this is normally when I go to the gym and I purposely make my blood sugar a little bit higher so that I'm in a nice good range and I'm taking glucose tablets as I as I need to when I work out I believe that like I got up to the 180 Mark here this was when I started my cardio so I had a quick drop off that I took a quick break and you can see how I rebounded back up and then I did more cardio and then I really started the crash I came down until like I think it was like the 90s which for me is I don't necessarily feel comfortable in that range so I came down very very quickly from that hard exercise and then you can see it rebounded quite a bit so it came way back up and it kind of screwed up my night a little bit because then I was up higher than I wanted to be and I wasn't sure what to do with dinner um the reason that it came up is that when it was coming down so fast the omnipod saw that the blood sugar was dropping so quickly and it totally got rid of those background basal doses that I would normally have to keep me stable So Not only was I depleting the sugar from the exercise but then I was also not getting insulin from the system and so when I actually came to rest I jumped way back up and so you can kind of ping pong here if you're not managing that correctly so this is an example of very intense exercise and then rest and then the blood sugar kind of spiking back up so this is not ideal either but it does demonstrate how blood should have come down from exercise now the last one that I wanted to show was kind of a combination of the automated adjustments and lighter exercise so here in this example here you can see I'm a little bit over 180 almost at like 200 but not quite I believe in this case the way that I remedied this was with lower intensity exercise for not as much of a period of time so you can see that the descent is a little bit slower and then the rebound was not quite as extreme so instead of me coming straight down and then coming straight back up when I stopped with the exercise it kind of came straight it came down like more of a 45 degree angle and then it was pretty smooth after that so those are just a few examples um so what am I trying to say here so I do uh the fixing of a high blood sugar when you miss a dose in kind of three ways I can manage it in one of three ways one would be the first thing that we talked about which is just allowing the automated adjustments in the omnipot 5 to correct it so it will correct it but it's going to take a long time so you're going to end up with a higher average blood glucose for that day and you're going to maybe not feel so great when the blood sugar is pretty high but it will do a nice job of bringing it down at a slow smooth rate without the risk of crashing so there's some pros and cons to that option um the second option is to actually give yourself a manual correction using the smart bonus calculator so that would be the second example which I showed when I woke up in the middle of night at 200 and I gave myself a manual correction it came down much faster and then it smoothed out um I will say that when you first start on the onion pod five until the algorithm really gets to know you this might not work as well for you but once it starts to really get a feel for what you need in terms of the amount of insulin then you've got your correction factors dialed in that does work very well so it's a much quicker descent using the second option of giving yourself a manual correction you do have to be careful of what else you're doing though because if you're giving yourself a manual correction and then you go and take a walk or you do something active you're gonna you know exacerbate the effects of that correction so you have more of a risk of going low in that case usually the system is excellent at cutting it off and making it a smooth descent but it's just another consider so pros and cons there as well and then the third one is the exercise so as I kind of showed in that one graph intense exercise or particularly intense cardio is going to drop your blood sugar very fast but then there is a result of once it comes down spiking back up because sometimes the drop is really caused by the activity itself and the system is seeing this in the background and it's making adjustments meaning it's giving you less insulin so then when you actually rest it's going to come right back up and you're going to be stuck high for a little while potentially the other way to manage exercise that I sort of prefer especially when I want to actually be able to relax afterwards and have a nice day of blood sugar is to do not as quite of intense exercise so that's right where a walk might come in as opposed to going all out at the gym and you know really like busting it and trying to go crazy to get that blood sugar down or just being engaged in intense exercise because you like it um so the intense exercise is oftentimes going to lead to a rebounds whereas the the lighter exercise or the walk after a meal or something like that is gonna in many cases bring the blood sugar down a little bit more slowly and then you can allow you can kind of work together with the album Rhythm to make it a smoother transition into the rest of your your day so those are just some some things that that I've been kind of identifying in my own head that have been helping me and hopefully that sort of uh conceptualizes a few of the different ways to manage your blood sugar with on the cloud five