If you're on a closed-loop system, Control-IQ, Omnipod 5, or Loop, you've probably wondered whether the algorithm means you're off the hook for pre-bolusing. Neil has to be the one to tell you: you still do it. These systems are an incredible co-pilot, but they're not a self-driving car you can nap in.

Here's the reason, with a real number. In Omnipod 5 data, when people skipped the meal bolus, the algorithm poured in about 16% of their total daily insulin over the four hours after the meal trying to catch up, and it still couldn't stop the spike. These hybrid closed-loop, or automated insulin delivery (AID), systems are reactive, they respond after glucose rises. The guidance to bolus 10 to 15 minutes early is published, not opinion.

In this episode:

• Why closed-loop pumps still need you to pre-bolus your meals
• The Omnipod data: the algorithm used ~16% of daily insulin and still spiked
• Why AID systems are reactive, not predictive
• Why bolusing TOO early can backfire on a closed loop

This Week's Challenge: If you're on a closed-loop system, give your meal dose about 10 to 15 minutes before dinner and watch how your system rides along. Compare it to dosing at your first bite.

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Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1