Excited about the Omnipod 5 and Dexcom G6 Closed Loop System

I was diagnosed with Type 1 diabetes over 15 years ago. During that time, I have had to learn a lot. A lot. Before eating any meal, I had to read food labels, calculate the total carbohydrates, and calculate the insulin dosing based on a personalised formula before injecting insulin. Sometimes I got it right. Sometimes I got it wrong. Eventually, I switched to an insulin pump which helped with more accurate dosing, but I still had to do a lot of math. A few years ago, manufacturers started combing insulin pumps with continuous glucose monitoring systems, something the press hyped as an artificial pancreas. They are NOT!

What they are is a closed-loop Automated Insulin Delivery System. AIDS automates blood glucose (BG) control as much as possible. The patient performs less frequent fingerstick blood glucose readings and is alleviated from calculating how much insulin to dose or reduce based on those readings. I have one of the first devices to be approved by the FDA. For many reasons, I think it’s a POS.

Fortunately, the warranty is ending on the device. I will be able to get a new device. Fortunately, more recent and more capable AIDS were approved in 2020. I took a look at a few of them and got excited about the Omnipod 5 Tubeless Automated Insulin Delivery System with Smartphone Control 5.

Our Diabetes Community now has the first-ever closed loop system that automates insulin delivery with no need for plastic tubing attached to your body. And this new system will be the first that is Food and Drug Administration (FDA)-cleared to be controlled by your smartphone.
The new system combines the little white Omnipod patch pump with the Dexcom G6 continuous glucose monitor (CGM) and a controller algorithm to automate insulin delivery. Notably, Omnipod 5 makes history as the first such system to get FDA clearance for mobile app control and insulin dosing directly from your smartphone, eliminating the need to always carry a separate controller unit.

I sent a link to the Omnipod 5 "Patch" article to some friends. One of them responded with a few questions. In the process of answering his questions, I wrote this long-winded blog post.

Khurt, this sounds like great news, but how does the patch deliver insulin to you? Does it work on the same principle as the nicotine patch, which just gets absorbed into the skin?

Nature has had 500 million years to perfect homeostasis via the endocrine system. This is accomplished by a highly sophisticated network of hormones and neuropeptides released mainly from the brain, pancreas, liver, intestine, adipose and muscle tissue. Insulin, produced by a healthy pancreas, is just one of those factors. While these devices are welcome advances, they are crude stone-age tools compared to the human endocrine system. They can not control what happens once the insulin is injected into the body.

Banting discovered insulin nearly 100 years ago, but very little has changed human physiology. It is necessary to inject it directly into the body. Variability in insulin needs (every person has insulin needs specific to their body) and variability in skin absorption rates would produce too much unpredictability in insulin delivery if delivered via the skin. Absorption through the skin would make blood glucose control incredibly unreliable and extremely dangerous.

What's Inside an Omnipod? | Image © user DIS Boards user Gdad

The Ominpod 5 Patch is not a patch like a nicotine patch. Insulin is a hormone, not a drug. Insulin is regulated on-demand in a person with a healthy pancreas and liver. In a person with T1D, the pancreas no longer produces insulin.

“Patch” is just Insulet Inc.'s branding for their product. The “Patch” is an insulin delivery device attached with adhesive to the body. The “Patch” contains a vial of insulin with a ¼ inch cannula (skinny needle) that gets inserted into the body. The device injects insulin into the body. The insertion site must be changed every three days to prevent infections and buildup of fat deposits.

My current pump system and infusion set look like those in the photo below. Do you notice the tubing running from the insulin pump to a port on the body? I usually tuck the tubing into my pants with the pump on a clip to access the controls. But Dealing with all that tubing is a PITA. Sometimes it comes out, and I have had it snags on turnstiles and kitchen drawers. Sometimes it gets painfully yanked out. What Insulet Inc. have done is make an insulin pump that is attached directly to the body.

Insulin pump infusion set
Insulin pump infusion set
Woman wearing insulin pump to help control her diabetes
Diabetic woman wearing insulin pump to help control her diabetes | Image © Sus on stock.adobe.com

Can it deliver enough quickly in order to adjust to any spikes you may encounter, or is this something where you still may need needles to supplement in those cases, or would it require an even further adjustment to diet and avoid pizza and beer nights?

A spike in T1D means a rapid increase in blood glucose level over a 15-30 minute period. Despite what they portray in movies and TV shows, they don't happen in seconds. Since the Dexcom CGMS (Continuous Glucose Monitor System, a device separate from the insulin pump) sends blood glucose updates to the insulin pump every 5 minutes, the insulin pump algorithm can detect which direction blood glucose is trending and make adjustments to avoid spikes (or drops). Blood glucose spikes don’t pose any immediate health threat. Rapid declines in blood glucose may cause a person to blackout and go into a coma.

Dexcom G6
Dexcom G6 | Image © Tandem

The CGMS has a ½ inch to 1-inch wire sensor inserted into the body. The insertion site must be changed every 5-7 days to prevent infections. Repeated studies have shown that accurate blood glucose levels are impossible without a blood sample. This is why I downplay hyped-up headlines about blood glucose testing via contact lenses (tears), smartwatches (looking through the skin) or other stupid ideas. They all proved too inaccurate for making a medical decision (i.e. how much insulin to inject).

Dexcom G6 sensor and insertion device | Image © JDRF Forum user Mandy

Links for further reading:

Disabling Auto-Mode on my Medtronic 670G

The @Medtronic 670G auto-mode is completely useless to me. My endo and the diabetes educator recommended turning it off. That's what I'm doing. I have to live 3 more years with this POS.

I currently use the 670G with the Guardian 3 CGM. Last year my endocrinologist recommended I try the 670G and I had no issues getting approval, and I started using the system in March of 2018. My A1C is worse than it has ever been. The 670G target BG is programmed to for 120mg/dL and unchangeable. My target BG has always been 90mg/dL.

But I've had too many issues with failed sensors over the last year. I have called into the support line over two dozen times since getting the 607G. I was losing my patience, and each call into the support center ended with a " ... we will send you a replacement sensor". The support reps responses made it seem that the problem was me, not the product.

No matter how carefully I insert and tape down a sensor, The sensor reading becomes unstable when I exercise. Medtronic reps told me directly, “The sensor can become unstable during vigorous exercise.” It was recommended that when this happens, I should replace the sensor. I exercise every day. What am I supposed to do?

Eventually, after numerous calls over two months last fall, I was given a link to request a new transmitter with updated firmware. That was several weeks ago, and I have not heard anything from Medtronic.

I don’t care anymore. The system is unusable to me. If I can’t exercise safely or go hiking with a CGMS, then it serves no purpose.

This week I had a long chat with my endocrinologist. She stated her other patients were doing well on the 67G and G3. They had improved outcomes, but these are patients who were never as tightly controlled as I was. She called Medtronic on my behalf. A Medtronic diabetes educator called me, and we spoke. She admitted that my A1C would be higher with the 670G system in auto-mode and recommended disabling auto-mode. So that is what I will do.

I may talk to my endo about going back to Dexcom. The G6 seems like a fantastic bit of kit.

Photography, Graves Disease, Insulin pumps and a lot of other things

Writing about a number of things that have been on my mind.

This post concerns several things that have been on my mind for a while.


During the 2017 end-of-year holidays, I dropped and damaged the mirror box of my Nikon D5100 baby DSLR. It was not a new camera when I bought it on eBay (circa 2012), but it has worked flawlessly for the years I have owned it. Indeed had I not dropped it, it would have yielded at least another five years of service. I was pretty upset when I discovered it was damaged but excited that the attached lens was in good shape. I was also excited at the prospect of buying a new camera. The D5100 was released in April 2011, and in the intervening years, more recent and more capable cameras were introduced by Nikon, Sony, Fuji, Olympus and Canon. Buying a new camera, however, presented a new challenge. Which camera to choose?

There are many buzzes around mirrorless interchangeable lens cameras (MILC). A new term is needed to describe these types of cameras. The term mirrorless camera is as silly as the term horseless carriage. I suggest the time digital viewfinder camera(DVC) or digital interchangeable lens viewfinder(DILV), or electronic viewfinder(EV). Whatever you call it, though, the new style of interchangeable lens camera seems to be popular with many photographers.

Kingston Mill, Red, Water,
Kingston Mill

Canon EOS 5D Mark III + Canon EF 70-200mm f/2.8L IS II USM @ 70mm ISO 100 1/320s ƒ/4

At one time or another over the last two to three years, I have rented Olympus, Sony, Fuji and Panasonic interchangeable lens cameras. They all have pros and cons, with the newer iterations of each camera improving and reducing the problem areas.

I must look like a wet mangy dog without my camera because my wife's best friend offered to let me use her father's 1 camera and lens, a Canon EOS 5D Mk II with Canon EF 70-200 USM IL f/2.8. The 5D Mk II is a full-frame DSLR with "pro" level features. The EF 70-200 mm lens is worth more than all my existing lenses combined. I've never used Canon cameras and lenses and was trying to figure out what to do with this kit. Last week, after learning from a work colleague that any EF lens will work with the EOS 5D MK II, I started looking for used 35mm and 50mm EF lenses on eBay. Getting a used lens for less than $100 was worth it. I was tired of shooting photos of the birds in the backyard. However, I didn't need to.


I remembered that my Dad had given me his Canon Rebel film camera a few years ago. I knew it was somewhere in the basement. It took a few weeks, but I finally found it. It has a Canon EF 28-80mm f/3.5-5.6 lens. It's compatible with the 5D Mk III. I took the camera and lens on a recent road trip to Michigan and Ohio. I downloaded a few photos and noticed the quality could have been better. The images all seem "hazy". I assumed it was due to poor skill on my part -- shooting images with the light in the background. But I noticed photos taken indoors with front lightning had the same issue. I examined the lens and discovered some semi-transparent "goo" on the inside of the lens.

If I continue to use this lens, I must use the Adobe Lightroom "dehaze" tool for every captured image.

I found some inexpensive Nikon to Canon lens adapters on Amazon. I could use my existing Nikon lenses. The caveat is that the adapters do not allow auto-focus and TTL metering. I promise not to replace my Nikon until after my 2017 taxes are filed. I can't wait. I'll get a deal on a Nikon D500.

I've also struggled with impostor syndrome. I look at the excellent work by an artist like Olaf and. I compare my work to theirs, which is a mistake. Olaf has talent and years of experience. I'm just an amateur who photographs mainly on the weekend. The comparison leaves me feeling inadequate. I put the camera down, and my skills atrophy. Why am I doing this?

Old Route 27

Graves Disease

Over 12 years ago, I was diagnosed with Type 1 diabetes. After diagnosis, I started seeing a specialist, an endocrinologist, about every three months. On these regular visits, we discuss my insulin regimen, diet, exercise and the results of my lab tests. The lab results have lots of exciting and helpful information for an endocrinologist, but I only paid attention to the cholesterol and A1C values. But my endo looks at all of it.

One of the things she was testing was my thyroid function, which until recently was normal. And then it wasn't. She tested my thyroid function because people with other immune system diseases, such as type 1 diabetes, have an increased risk of hyperthyroidism. And the onset happened just as rapidly as it did for my Type 1 diabetes. After a battery of tests over a few weeks, my endocrinologist confirmed a diagnosis of Grave's Disease, which the American Thyroid Association describes this way:

Graves' disease, named after Irish physician Robert Graves, is a common cause of hyperthyroidism in the United States. This autoimmune condition leads to the overactivity of the thyroid gland, primarily affecting women (7-8 times more than men).

The disease is triggered by the body's immune system, typically responsible for defending against foreign invaders like bacteria and viruses. However, in Graves' disease, the immune system can produce antibodies that mistakenly target proteins within our own cells. Instead of destroying these cells, these antibodies, known as thyrotropin receptor antibodies (TRAb) or thyroid-stimulating immunoglobulins (TSI), stimulate thyroid cells excessively.

These antibodies bind to receptors on the surface of thyroid cells, prompting them to overproduce and release thyroid hormones. Consequently, this leads to hyperthyroidism, where the thyroid becomes overactive, producing excessive thyroid hormone.

Kingston Mill

Looking back over the last few months, I know I felt the symptoms of the disease, even though I did know how to interpret them.

I was anxious, irritable, and quite emotional. Anger. And sadness. My hands are shaking slightly, and using a computer -- either a keyboard or touchscreen is more complicated. I am sensitive to heat, and I feel like sweating into my socks. I feel tired while simultaneously feeling energetic (heart palpitations), and falling asleep was challenging. I lost seven pounds.

So now you know. I now have two autoimmune diseases. My endo gave me options for treatment -- pills, surgery, radiation therapy. I opted for the drugs. I am hoping the pills work.

I'll also find out from her what the other results of my lab test mean. Am I at risk for another autoimmune disease?


Work has been stressful since a management change last year. As a consultant, I had worked harmoniously with the previous two managers, but over the last year, I had felt the relationship with the new manager was straining. It was also causing me considerable stress. On Monday, I had a panic attack while at the office. I came home early.

My wife reassured me that she was on board with me leaving. The toxic environment created by this person affected my mental and physical health.

Lake Carnegie
Lake Carnegie

I had started looking for new opportunities elsewhere, but my work for the client ended abruptly this week. I was told that my services were no longer needed. I didn't say a word. I didn't ask why. I said, "OK", packed my day bag, handed in my laptop and pass, and left.

Now, I have time to find my next gig or job. I've spoken to a few recruiters and contacted a few colleagues and friends. Next week, I plan to be busy with interviews and have a few offers by the end of April.



As a blogger, it's easy to fall into the trap of thinking everything I write about is already known by everyone or that my audience on Island on the Net has seen everything I've ever published. It's good to remember that every day, someone might be part of the few to learn something new to them, even if I've written about it previously.

I have a backlog of about 116 articles in draft mode. Most of these are technical articles about photography, web development, and the IndieWeb. I want to set aside time to work on these. Perhaps some will be long-form, but I suspect most will be short.


My diabetes management is reasonably good. I usually keep my A1C within the recommended range. However, managing diabetes is not without challenges. Because I often get hypoglycemic when hiking, I don't exercise as much as I may need for optimal health. The fear of hypoglycemia keeps me sitting at the computer. But that may soon change. A new type of insulin pump is on the market, and I have one of the first models, the Medtronic 670G. It's a closed-loop system. Readings from a CGMS are relayed back to the insulin pump, which can adjust insulin delivery to suit the need. On Tuesday, I was trained to set up and use the CGMS and 670G. There is a learning curve. I had my ACCU-Chek insulin pump and Dexcom CGMS for over four years. I had mastered the technology. I'll have to learn anew.