Seeking Your Insights on Closed Loop Systems and CGMs

[Bluemarinejosephine]

Dear Everyone,

I hope this message finds you all well.

I’d love to ask for your thoughts and advice on a few matters.

I’m currently a pump user on the Omnipod Dash and use the Freestyle Libre 2 for glucose monitoring. Over the past 30 days, my time in range has been around 92%, though I’ve had about 6% mild hypoglycemia. Recently, I’ve been approved for a closed loop system with the Omnipod 5 and Dexcom G7.

For those of you who are using or have tried a closed loop system—are you happy with it? I confess I feel a bit hesitant to surrender complete control to the device, as I find reassurance in managing things myself. That said, I do recognise the freedom a closed loop could offer, especially since I still struggle with exercising without the looming risk of frightening hypoglycemic episodes. I dearly miss the active lifestyle I enjoyed when I was on multiple daily injections, where I felt freer to exercise without fear.

My second question is for those who’ve used both the Freestyle Libre and the Dexcom: do you find the Dexcom more accurate? Are there particular features you love? Would you recommend making the switch?

I’d be truly grateful for any insights you’re willing to share.

Warmest thanks and kind regards,
Josephine

 

[h884]

Dear Everyone,

I hope this message finds you all well.

I’d love to ask for your thoughts and advice on a few matters.

I’m currently a pump user on the Omnipod Dash and use the Freestyle Libre 2 for glucose monitoring. Over the past 30 days, my time in range has been around 92%, though I’ve had about 6% mild hypoglycemia. Recently, I’ve been approved for a closed loop system with the Omnipod 5 and Dexcom G7.

For those of you who are using or have tried a closed loop system—are you happy with it? I confess I feel a bit hesitant to surrender complete control to the device, as I find reassurance in managing things myself. That said, I do recognise the freedom a closed loop could offer, especially since I still struggle with exercising without the looming risk of frightening hypoglycemic episodes. I dearly miss the active lifestyle I enjoyed when I was on multiple daily injections, where I felt freer to exercise without fear.

My second question is for those who’ve used both the Freestyle Libre and the Dexcom: do you find the Dexcom more accurate? Are there particular features you love? Would you recommend making the switch?

I’d be truly grateful for any insights you’re willing to share.

Warmest thanks and kind regards,
Josephine

Dear Everyone,

I hope this message finds you all well.

I’d love to ask for your thoughts and advice on a few matters.

I’m currently a pump user on the Omnipod Dash and use the Freestyle Libre 2 for glucose monitoring. Over the past 30 days, my time in range has been around 92%, though I’ve had about 6% mild hypoglycemia. Recently, I’ve been approved for a closed loop system with the Omnipod 5 and Dexcom G7.

For those of you who are using or have tried a closed loop system—are you happy with it? I confess I feel a bit hesitant to surrender complete control to the device, as I find reassurance in managing things myself. That said, I do recognise the freedom a closed loop could offer, especially since I still struggle with exercising without the looming risk of frightening hypoglycemic episodes. I dearly miss the active lifestyle I enjoyed when I was on multiple daily injections, where I felt freer to exercise without fear.

My second question is for those who’ve used both the Freestyle Libre and the Dexcom: do you find the Dexcom more accurate? Are there particular features you love? Would you recommend making the switch?

I’d be truly grateful for any insights you’re willing to share.

Warmest thanks and kind regards,
Josephine

Hi Bluemarinejosephine

I am using Omnipod 5 and Libre2+ closed loop. I previously used Omnipod dash with dexcom 1. It has taken a while for the algorithm to learn me and my requirements. It did take me a while to get used to giving control over to the pump. There is an activity setting on Omnipod 5 which should help with exercise.

I have 2 main challenges with Omnipod 5. Firstly maintaining line of sight between the pod and sensor. The best way to maintain line of sight is to have the pod and sensor is to have both on your arm. The sensor lasts 15 days and the pod 3 days. The skin on my arms is suffering.

My other issue is that I do not hear the alarms on the pdm overnight. I wear hearings aids so during the day hearing the alarms is not an issue.

I have found Libre 2+ more accurate than Libre 1 or Libre 2. For me I have found dexcom more accurate. The other benefit with dexcom is that you can locate it on more sights. Libre 2+ is only licensed for use on the arm.

Hope this helps you a bit with your decision making

 

[Nicola M]

I can’t comment on your potential particular set up as I’m on Medtronic, however, being on closed loop has changed my life. I was a ‘bad’ diabetic (I hate saying that but I was) before going on closed loop, I mean we are talking highs of 20 every single day for hours. My HbA1c was 78 And I honestly felt unwell most of the time. Since being on closed loop my HbA1c floats around 48 and I’m in range around 70% of the time with lows of around 2% or less.

I think the things with closed loop is you have to remember to try not take over too much as it needs to learn from you itself without intervention, however, if you feel you need to intervene you absolutely can. There’s times when it’s said my blood sugar is low when it absolutely isn’t so I’ve intervened to say as such or I’ve felt higher than it’s predicting and I’ve intervened to ensure I get more insulin. It’s a scary thought initially thinking a machine is essentially doing everything for you (aside from carb entry) but it’s now such a normal part of my life I forget half the time it’s doing everything for me, I’ve been on closed loop for coming up to 4 years now and I’d never go back. There are so many settings that can help you day to day with closed loop (such as exercise settings).

I could not recommend closed loop enough in all honesty, like has been said previously though you do definitely have to make sure your pump and sensor are within range of each other at all times.

 

[Juicyj]

Hi @Bluemarinejosephine Without any hesitation yes go for it. It's the best treatment for type 1 out there currently, it's changed my life, my sleep quality is 95% better with HCL, doesn't take away the anxiety as that comes hand in hand with t1d as far as i'm concerned but it's made my life easier as less decisions, more time to live my life, anything that gives you back some quality of life from living with t1d is well worth it.

In regards to exercise anything is possible, you can use exercise mode or a temp basal pattern or just have more carbs and less insulin, don't fixate on what you perceive to be barriers, focus on the positives.

 

[himtoo]

I use Omnipod dash and Libre 2+ ..my 90 day time in range is 93% in range, high 3%, and low 4%. my estimated A1c is 5.6%
i am really fortunate that i am retired and can spend a lot of time managing the T1d ---- My endocrinologist admits i won't improve those number using HCL but it could mean less manual intervention on my part. i wish you well in your search for the right solution for you .

 

[Bluemarinejosephine]

Thank you all, so so very much!

 

[363weeks]

Hi, I tried the omnipod and dexcom closed loop system back in December 2024. It didn't work well with me, as the omnipod didn't stay attached. The dexcom was excellent. The actual system when the omnipod stayed attached, it was perfect.

April 2025 I was switched back to medrontic and I tried their closed loop system, using the sure T steel cannula.

The closed loop system is worth its weight in gold. I couldn't recommend it more.

 

[Jhon Doe]

Hi, I'm sorry, but I don't understand what a closed-loop system is.

I don't know if it's the same as a continuous glucose monitoring system.

If it's not, you'd better not read my answer, because it's not relevant to the question.

If it is, and you get used to each other, you can improve a lot. What I'm going to talk about refers to a continuous glucose monitoring system connected to the pump (MiniMed 780 G pump and Guardian 4, for now, because they want to switch us to the Simplera sensor when there is enough stock). The point is not that you will more time in the perfect range, the point is that you will not have hypoglycaemia, and I assure you that you can achieve this. You can also tell it to learn your habits, including when you do exercise, and in sport mode it will try to keep your glucose higher.
And you can always set alarms for the glucose levels you want it to warn you about.

At one point, I didn't even trust the decisions made by this automatic mode (called Guardian mode in Medtronic), and I was constantly monitoring and correcting it. To do that, it's better to leave the automatic mode off, because it's super stressful.

Best regards

 

[evilclive]

Yes, closed loop refers to combining a blood glucose sensor with a pump. The loop is read sugar level, dose appropriately, see which way blood sugar level is changing by reading, dose appropriately, repeat.

Closed-loop controller - Wikipedia

en.wikipedia.org

I will suggest that "You will not have hypoglycaemia with a closed loop pump" might not be entirely correct. I've got closed loop on my omnipod, and I definitely have hypoglycaemia. Exercise is the main thing which does this - running particularly so. "activity mode" is only really good for mild activity, it can't cope with anything strenuous in my experience. The trouble is it doesn't take very much insulin at all for my sugars to plummet while exercising, and the pump will give that insulin if you've eaten before setting off and your sugars start going up. I've started pausing insulin completely to cope with this, with varying degrees of success - but that varying is on the hyper rather than the hypo side, so better than running out mid way through 7 miles of running and having to eat and wait for that to take effect before being able to run again.

 

[Jhon Doe]

@evilclive, you're quite right. But I'm speaking from my own experience with the pump model I use.
Firstly, you need to prepare yourself (and the pump) for intense exercise (which may involve taking fast-acting carbohydrates, depending on whether you know you'll need them before you start; if possible, about 15 minutes before you start to feel hypoglycaemic). You should also indicate the carbohydrates you have consumed by setting the amount of insulin to inject to zero. All of this can be done in normal mode (Guardian mode) with the pump model.

With my pump model, you should stay like this for at least a week (in non-Guardian mode). And I would tell it that for x amount of time (x being the duration of your exercise), do not inject insulin: this can be done with my pump model. If you manage to make this a regular pattern, i.e. always at approximately the same time, on the same days (which do not have to be every day), my pump model ‘supposedly’ learns it.
And so, most importantly, you would be avoiding hypoglycaemia.

Best regards

P.S. All of this must be prescribed by a specialist. I am telling you this on a personal level from my own experience.

 

[evilclive]

"You should also indicate the carbohydrates you have consumed by setting the amount of insulin to inject to zero." - I'm struggling to make sense of that sentence. Do you tell it "I've eaten Xg but don't give me any insulin for that"?

Regarding time of day - nah, not helpful Closed loop should be able to cope with exercise at different times of day - I'm happy to tell it that I'm doing it, just as I tell it when I need to bolus, but this stuff is about freeing up from enforced routine.

 

[Jhon Doe]

"You should also indicate the carbohydrates you have consumed by setting the amount of insulin to inject to zero." - I'm struggling to make sense of that sentence. Do you tell it "I've eaten Xg but don't give me any insulin for that"?

Regarding time of day - nah, not helpful Closed loop should be able to cope with exercise at different times of day - I'm happy to tell it that I'm doing it, just as I tell it when I need to bolus, but this stuff is about freeing up from enforced routine.

Hi evilclive,
‘You must also indicate the carbohydrates you have consumed by setting the amount of insulin to be injected to zero.’

The previous sentence is trying to say the following:
We assume that the physical exercises you are doing cause hypoglycaemia. If this is the case, we must teach the pump the following (unless you are consistent with your exercise routine, it will be more complicated).

I have personally been able to fix this in several ways:
0- Raise the blood glucose level you want for that period. If you normally want 100, you should indicate that you want 150 (for example) at that time.

1- Eating additional carbohydrates without telling the pump. But this is a temporary fix for a given moment.

2- Do the exercise at specific times (we must tell it that at those times, carbohydrates require much less insulin) and thus, you can accustom the pump to the optimal levels for those times.
In addition, an adequate amount for those extra carbohydrates may be zero insulin.You can also lower the basal rate to zero.

3-And also tell it that the temporary basal rate for the time you define can be zero.

But with all of the above to do, I would do it very carefully and knowing how many carbohydrates you consume and how much extra insulin it is giving you.

I would never make all the changes at once and would be quite conservative, because just as we don't want hypoglycaemia, we also don't want hyperglycaemia every time we exercise.

f you try the above points one at a time and separately (NEVER ALL AT ONCE) and carry out each specific point for several days (not just once), and you still have low glucose, I would move on to the next point. And so on, until you reach a level where your glucose remains within the appropriate range.

That would be my recommendation, bearing in mind that it is based on personal experience, which may not apply to you, and that I am not a medical professional.

Regards