Omnipod 5

How the algorithm works

Omnipod 5 has four components:

• The Omnipod 5 controller
• A Dexcom G6 or G7 compatible phone if using a Dexcom sensor
• If using FreeStyle Libre 2 Plus, no phone is needed for operation (though there are no followers with this configuration)
• The Omnipod Pod — the algorithm lives inside the Pod itself, with no tubing

Key principles of how the algorithm tends to behave:

• The algorithm works from an automatically calculated basal rate called the Adaptive Basal Rate
• Basal insulin increases when glucose is rising and is reduced or stopped when glucose is dropping, with updates every five minutes

Starting settings

SmartAdjust needs one basal rate and a 24-hour total basal amount to start. The first Pod runs at roughly half capacity; from the second Pod onwards, the algorithm runs at full strength.

Starting an AID system can be broken down into two phases:

Download the How to Survive and Thrive Guide — Omnipod 5 summary. A more comprehensive onboarding workbook is also available: Omnipod 5 Workbook.

Tips and practical approaches

Strong time in range on Omnipod 5 tends to combine the algorithm with good underlying habits:

• Three balanced meals
• Accurate carbohydrate counting
• Bolus insulin 10–20 minutes before eating
• Being active for 10–15 minutes after eating
• Rotating Pod sites

Follow these and you may find: 99 Problems But Highs Ain’t One (download/share)

Other practical points to be aware of:

• A compatible phone is needed to operate Dexcom G6 or G7 with Omnipod 5 — without the phone, there is no data and no operation
• The Pod holds up to 200 units of insulin, so it may not last the full three days if you use more than around 65 units per day

Preventing and managing hypos

The algorithm tends to prevent many overnight hypos, but hypos will still occur — particularly if bolus insulin is too high for a given situation or exercise is unplanned.

Hypo treatment amounts often need to be smaller than before AID, because the algorithm tends to have reduced or stopped insulin at least 30 minutes earlier.

It is also worth considering a pre-emptive response if glucose is 4.0–6.0 mmol/L (70–110 mg/dL) and trending down.

The hypo guide below is based on weight — example shown is for a 30 kg person, but weight can be adjusted. The Survive and Thrive Guide — Omnipod 5 generates a personalised chart once you enter your weight.

Download the Omnipod 5 hypo chart to use directly.

High-fat meals

From the Mealtime Insulin Guide, we know that high-fat meals with carbohydrates (pizza, takeaways) tend to need additional insulin due to delayed gastric emptying and insulin resistance.

In theory, entering 100% of the carbohydrates eaten allows SmartAdjust to respond to the delayed rise. In practice, a degree of individual trial and exploration is often needed.

Exercise

There is a quick method and a more comprehensive planned method.

The quick method

Turn on Activity mode before starting exercise — ideally 90 minutes beforehand. Then take small carbohydrate top-ups every 20 minutes as needed.

Avoid large carbohydrate loads all at once — glucose may spike and the algorithm may increase insulin, raising hypo risk.

How many grams every 20 minutes? It depends on body weight. The example below is for a 50 kg person. The Survive and Thrive Guide — Omnipod 5 generates a personalised chart once you enter your weight.

Download the generic exercise carbohydrate charts: mmol/L version and mg/dL version.

The comprehensive planned method

To use this approach, work through the Exercise Guide to understand exercise types, bolus reductions, and how to adapt plans after trials.

The T25/T25 table below tends to make more sense once you have read the exercise guide. The AID and Exercise Consensus Guideline is also worth reading — the infographic under the T25/T25 grid is particularly useful.

This downloadable exercise planning tool for Omnipod 5 makes creating and adapting exercise plans easier.

Explore the algorithm

The AID System Explorer generates exploratory output ranges for Omnipod 5 based on your TDD, weight, and responsiveness level. The detailed explainer explains how Omnipod 5 uses shorter AIT and lower targets to lower IOB visibility — the same optimisation strategy as the 780G — and the trade-offs this creates during exercise.