What is the initial setup for Omnipod 5 (automated insulin delivery system) with Humalog (insulin lispro) for a 66-year-old female patient with hyperglycemia (A1C of 10.8) and obesity (weight 182.6lb)?

Omnipod 5 with Humalog Prescription for Severely Uncontrolled Diabetes

For a 66-year-old female weighing 182.6lb (82.8kg) with an A1C of 10.8%, the recommended initial Omnipod 5 setup with Humalog should include a total daily insulin dose of 24.8-41.4 units, with approximately 50% as basal and 50% as bolus insulin.

Initial Insulin Calculation

• Calculate total daily dose (TDD) based on weight and degree of hyperglycemia:

  • For severely uncontrolled diabetes (A1C >10%), start with 0.3-0.5 units/kg/day 1
  • For this 82.8kg patient: 0.3 × 82.8 = 24.8 units (minimum) or 0.5 × 82.8 = 41.4 units (maximum) 1

• Distribute insulin in basal-bolus pattern:

  • 50% as basal insulin: 12.4-20.7 units/day 1
  • 50% as prandial insulin: 12.4-20.7 units/day, divided between meals 1

Omnipod 5 Initial Settings

• Basal Rate Programming:

  • Start with 50% of TDD as basal: 12.4-20.7 units/day 1
  • Program hourly basal rates (typically 0.5-0.9 units/hour) 1
  • Consider slightly higher basal rates overnight if dawn phenomenon is present 1

• Bolus (Mealtime) Settings:

  • Initial insulin-to-carbohydrate ratio: 1 unit per 10-15g carbohydrate 1
  • Correction factor (insulin sensitivity): 1 unit to lower blood glucose by 30-50 mg/dL 1
  • Target blood glucose range: 80-130 mg/dL (fasting) and <180 mg/dL (post-meal) 1

• Automated Mode Settings:

  • Enable automated insulin delivery mode after 24-48 hours of manual mode to establish baseline insulin needs 1
  • Set glucose target range: 110-130 mg/dL initially 1

Monitoring and Adjustment Protocol

• Initial Follow-up:

  • Review glucose data after 3 days to assess patterns 1
  • Adjust basal rates, insulin-to-carbohydrate ratios, and correction factors based on glucose patterns 1
  • Schedule follow-up within 1-2 weeks for dose adjustments 1

• Hypoglycemia Prevention:

  • Prescribe glucagon for emergency hypoglycemia 1
  • Set low glucose suspend threshold at 70 mg/dL 1
  • Consider reducing initial doses by 10-20% if patient has hypoglycemia unawareness or history of severe hypoglycemia 1

Special Considerations for Omnipod 5 with Humalog

• Insulin Properties:

  • Humalog (insulin lispro) is a rapid-acting insulin analog with onset in 15-30 minutes and peak action in 30-90 minutes 2, 3
  • Humalog should be administered immediately before meals when using Omnipod 5 4

• Pod Change Schedule:

  • Program pod changes every 72 hours 1
  • Include instructions for site rotation to prevent lipohypertrophy 1

• Patient Education Requirements:

  • Provide comprehensive diabetes self-management education 1
  • Ensure patient understands carbohydrate counting, correction doses, and system alerts 1
  • Train on hypoglycemia recognition and management 1

Common Pitfalls and Caveats

• Avoid Overbasalization:

  • Watch for clinical signals of excessive basal insulin: high bedtime-morning glucose differential, hypoglycemia, or high glucose variability 1
  • If basal dose exceeds 0.5 units/kg/day, reevaluate the regimen 1

• Insulin Resistance Considerations:

  • With A1C of 10.8%, patient may have significant insulin resistance requiring higher doses 1, 5
  • Consider adding metformin if not contraindicated to improve insulin sensitivity 1
  • Monitor for need to increase insulin doses over time 1

• Technology Adaptation:

  • Allow 2-4 weeks for algorithm adaptation and optimization 1
  • Ensure patient has backup insulin pens in case of pod failure 1