Omnipod 5 Review: Tubeless Automated Insulin Delivery

When I was diagnosed with type 1 diabetes 22 years ago, I never thought that a tubeless, automated insulin delivery (AID) system would ever be possible. 

At 12 years old, I was handed a syringe, a few vials of NPH and R insulin (pork insulin), and was told to test my blood sugar 10 or more times per day and hope for the best. It was brutal. 

Decades later, technology has come a long way, to say the least. 

I can now bolus insulin remotely, check my blood sugar seamlessly by glancing down at my smartphone, and with the newest Omnipod 5 system, not worry so much about high and low blood sugar levels. 

The system is automatically adjusting my basal insulin rates for me, according to what my blood sugar is, all in real-time. 

This article will discuss the new Omnipod 5 system, my first impressions, and what you can expect if you choose this system for yourself.

A short history of automated insulin delivery (AID)

Automated insulin delivery, or AID for short, has been the holy grail in the diabetes community for a long time. 

Even with traditional insulin pump therapy, people with insulin-dependent diabetes are often walking a tightrope of managing stubborn highs and scary lows, often feeling imprisoned by their blood sugar levels. 

AID offers hope to minimize not only the highs and lows, but to lighten the mental burden of a life lived with diabetes. 

People with diabetes in the #WeAreNotWaiting movement have been hacking their old insulin pumps for years to achieve hybrid-closed loop systems, but these were never approved by the Food and Drug Administration (FDA), and were not recommended by physicians, nor had any safety guarantees. 

The first system to receive approval from the FDA, Medtronic’s 670g, became available in the United States in late 2016. This system made automatic adjustments to basal delivery based on Medtronic’s own continuous glucose monitoring (CGM) system, The Guardian, and was extremely popular. 

That was quickly followed by the Tslim Control IQ system from Tandem that became available in the United States in early 2020, which was the first AID system to work with the Dexcom CGM system, and did not require fingerstick calibrations (unlike the Medtronic system, which requires calibrations every 12 hours). 

The Guardian CGM needed to be changed every 7 days, whereas the Tslim system, using the Dexcom CGM, only needed changes every 10 days. 

While people were very excited about these systems, millions were holding out hope for the (then-called) Omnipod Horizon system by Insulet. 

This system would be unique in the fact that it would be the first ever tubeless AID system, all run by Bluetooth.

Many people prefer the Omnipod system as it gives more freedom to exercise and feel more free, due to the lack of tubing. One also does not need to suspend insulin when doing things like showering or swimming. 

The Horizon system, now called Omnipod 5, was slated to be approved by the FDA in 2020, but the COVID-19 pandemic soon caused a major bottleneck in the approval process and it was repeatedly delayed, to much dismay.

Finally, on January 28th, 2022, the FDA announced its approval of the Omnipod 5 system: the first ever tubeless AID system (hybrid-closed loop). The approval is for people with type 1 diabetes aged 6 years and older, and is compatible with Android smartphones and the Dexcom G6 CGM system. 

Insulet conducted a limited release in February, with an expected market release in March 2022. 

How the Omnipod 5 works

It’s important to note that this is a hybrid-closed loop system, and users still need to count carbohydrates and bolus insulin for all meals and snacks. 

You also need to let the system know when you plan on exercising, and there’s an activity feature where you can reduce your insulin needs while you’re physically active. 

The AID system will, however, automatically adjust basal insulin rates according to blood sugar readings twenty four hours a day. 

The system is similar to their earlier versions, where a pod needs to be replaced and filled with insulin every 72 hours, and functions with the Dexcom G6 CGM, which needs to be replaced every 10 days. 

My first impressions 

I was lucky to be part of the limited release group and received the Omnipod 5 system on February 11th, 2022. 

My first impressions were that the personal diabetes manager (PDM) looks like a smartphone (probably because it is one), and the pods (self-contained insulin reservoirs) look remarkably similar to earlier versions of the Omnipod (both the Erros and the DASH use pods). 

The pod now “talks” to the Dexcom CGM sensor, so your basal rates will adjust automatically even if your PDM isn’t nearby (you only need it near you to bolus). Alternatively, if you use an Android phone, there is a compatible app that you can use for your PDM instead, and bolus straight from your smartphone (how cool is that?!). Since I use an iPhone, I opted for the traditional PDM. 

There is word that an iPhone-compatible app is forthcoming. 

I had a two-hour training session and quickly jumped into auto mode (why wait?). It’s been fantastic. 

I’ve only been on the system for two weeks, but I’ve already noticed a few significant improvements to my health. 

Improved sleep quality 

After switching into auto mode, I bolused for a normal dinner, ate, and got ready for bed. 

Like many people with diabetes, I’m used to not always getting much sleep at night. Between low and high blood sugars and their accompanying alerts and alarms, I often wake up between 1-4 times at night. 

If I’m not woken up by any alarms, I usually am thirsty or need to pee at least once, so when I awoke the next morning, after a solid 8 hours of sleep UNINTERRUPTED, I was ecstatic. 

I took a quick look at my Dexcom graph and saw that my blood sugar stayed between 110-130 all night long, and I had no highs and no lows. 

Most of my nights look like this now, and the feeling of being fully rested is incredible. It is a complete joy to feel like diabetes isn’t stealing my sleep as much as it used to, and sleeping through the night is definitely something that I’m looking forward to getting used to! 

Fewer exercise disruptions 

I am an avid athlete who exercises between 6-7 times per week. I love running, hiking, swimming, cycling, and weightlifting, and one of the most frustrating aspects about diabetes is how often low blood sugars seem to get in my way. 

I also dislike having to eat before exercise, because if I’m trying to lose weight, it can sometimes feel as though I’m defeating the purpose. 

I used to go low while exercising nearly daily. Well, since being on the Omnipod 5, I have had one low blood sugar in the two weeks that I’ve been wearing the device. One! 

The system lets you set a target blood sugar (in my case, I set it to 150 mg/dL), and it decreases your basal rate (or pauses insulin delivery) until it can predict you will reach that higher number. 

You can set the amount of time you’d like to be in the “activity feature”, anywhere from 1-24 hours, and it will automatically expire, so if you forget to turn it off after you’re done, you don’t have to worry about higher blood sugars later on. 

Each day, I set my activity feature to “on” about 45 minutes before I begin my exercise routine, and it smoothly will elevate my blood sugar just enough so I don’t crash, and then after I’m done, will bring it back down to a normal range. That has been amazing. 

Less mental burden 

Overall, being on the Omnipod 5 has lessened my mental burden of living with type 1 diabetes. 

One study has shown that people with diabetes make an extra 180 decisions nearly every single day just to take proper care of themselves, and having an AID system feels like those decisions have been cut in half. 

I don’t need to micromanage my basal rates during the day, and I’m not waking up to low alarms at midnight in order to pause insulin and have some juice anymore. I’m sleeping better than ever before. 

Exercise is a breeze (and I can finally exercise without such a fear of going low!). 

And while dosing insulin for meals feels just about the same as it always had (you still have to count carbohydrates and bolus for meals and snacks), I know the system will supplement with extra basal insulin if I’ve undercounted my carbohydrates to prevent a high, or will decrease insulin if I’ve taken too much by accident, to prevent a low. 

While diabetes will always be a mental burden on those who live with it (and their families!), having an AID system significantly decreases that burden. 

Conclusions

While automated insulin delivery (AID) systems are still not a cure for diabetes, I have found that the Omnipod 5 system has significantly improved my sleep quality, my ability to exercise, and has decreased the mental burden I experience as a woman living with type 1 diabetes. 

It is, however, still an external medical device: you can experience bad pump sites, occlusions, injecting into scar tissue, and failed adhesives. 

You will still experience both high and low blood sugar levels, and while sleep quality may be significantly improved, you will still probably have to pee in the middle of the night from time to time. CGMs will error out and give false readings. 

You need to literally plug your “pancreas” in nightly (the battery can last an average of 48 hours), and may run out of battery if you’re without power for extended periods of time. 

Nothing is perfect. But while we wait for the ever-evasive cure, this is one step closer to it.