Omnipod 5 SmartAdjust supplement

Hybrid Closed Loop (HCL) system

This page has been written to help you get the most from using your Omnipod 5 (OP5) insulin pump with continuous glucose monitoring (CGM) in hybrid closed loop mode (HCL): SmartAdjust.

Information is accurate as of July 2026.

Diabetes insulin pump team contact numbers

Please contact the team if you need advice regarding your diabetes. You can leave a voicemail on one of the numbers below (the answerphone is checked regularly Mon-Fri office hours)

• Diabetes specialist nurses: 01223 348790
• Diabetes specialist dietitians: 01223 348769

Urgent advice: In an emergency, please call the Type 1 emergency out of hours service. If you do not have this number, please ask your diabetes educator.

Alternatively, you can use the Diabetes eConsult service

To contact a diabetes educator, please use MyChart (preferred route of contact)

• Click on Messages

• Then click "ask a question"

• Then click "New question for your clinical team"

• Choose the appropriate option then choose Diabetes Educator

• Or use this email address: cuh.diabeteseducator@nhs.net

If using email, you must ensure the subject of the email includes full name, date of birth and hospital number.

All messages are checked: Mon/Wed/Fri. It is for non-urgent enquiries; allow up to 5 days for a reply if using the eConsult service. Please ensure you have uploaded your pump to Glooko (if applicable).

For any technical queries please contact Insulet directly on the number below:

0800 011 6132 or +44 20 3887 1709 if calling from abroad.

Please note that the pump company cannot give medical advice, they can only offer technical support.

How do these systems work?

A Hybrid Closed Loop (HCL) system is made up of 3 parts:

1. An insulin pod (pump): Omnipod 5.
2. A continuous glucose monitor (CGM) – Libre 2 Plus (1st line) and Dexcom G6/G7 / Libre 3+ (2nd line – additional approval is required).
3. An algorithm that automatically adjusts basal insulin every 5 minutes based on CGM readings, glucose trends and users personalised target glucose level. This mode is called the “SmartAdjust" feature.

Hybrid closed loop may also be called Automated Insulin Delivery (AID) systems.

Your insulin pod will deliver insulin in 3 ways:

1. As basal - an ever-changing amount of insulin (adjusted every 5 minutes) according to the glucose information received from the CGM. The Smart Adjust system predicts glucose 60 mins into the future. It may suspend (stop) basal delivery if the hybrid closed loop system predicts below target glucose level or conversely increase basal delivery for elevated glucose levels.
2. With carbohydrate - you will need to give a bolus of insulin for carbohydrate eaten using the SmartBolus calculator (with pre-programmed insulin to carbohydrate ratios).
3. As corrections – Correction boluses are initiated by the patient using the SmartBolus calculator.
4. The system can keep your glucose levels within target range when conditions are stable, but it is not as responsive to rapid changes to glucose levels with exercise or after carbohydrate intake. You will still need to give timely bolus insulin for carbohydrates, accurately count carbohydrates, adjust for exercise and be aware of active insulin on board when exercising or treating hypoglycaemia.

What settings can I adjust on the pump?

In the SmartAdjust feature, the following settings can be adjusted:

• Active insulin time – 3 hours is the recommended starting setting. This can gradually be adjusted with support from an educator.
• Carbohydrate ratios used for boluses for carbohydrate.
• Target glucose and correct above; either 6.1 mmol/L, 6.7mmol/L, 7.2mmol/L, 7.8mmol/L or 8.3mmol/L set by the user.
• Correction factor used for boluses, but not for algorithm.
• Reverse correction: recommended as set to off.
• Activity mode: this temporarily reduces the automated insulin delivery and will set a higher glucose target of 8.3mmol. This is useful during increased periods of physical activity, during menstruation and during times of persistent hypoglycaemia.

Getting started

Initially this technology may take more of your time and attention as you get used to using it and whilst you work on getting your settings correct. Some parts of using the system will be very familiar to you such as giving a bolus of insulin to cover carbohydrate intake, whereas other aspects might feel very different such as treating a hypo and giving corrections. Consider clearing your diary as much as you are able for the first week or so to give yourself time to adapt to the new approaches.

You may find that there are more alerts initially – these might be hypoglycaemia alerts, lost sensor alerts or the system requesting attention and further information. Be patient and keep in contact with your educator – it can take a few weeks to really understand how the system operates and to see if adjustments to your pump settings are needed.

If there is an interruption in the sensor data and/or the system is not happy with the glucose data, it is receiving then it may come out of HCL and run in Automated Limited. Please troubleshoot the issues surrounding the Automated Limited alert, so that the SmartAdjust algorithm can start again.

Top Tips for using the OP5 in SmartAdjust Feature

1. Get the basics right

• Carbohydrate counting – work to get this as accurate as possible. If you need further support, consider booking onto a carbohydrate counting workshops or completing the Dose Adjustment for Normal Eating (DAFNE) closed loop essentials course (see further resources section for details).
• Bolus for carbohydrates 10-15 minutes before carbohydrate food and drinks.
• Take corrections – for the first 3 pods it is suggested that you monitor your glucose levels more regularly (i.e. every 2-4 hours) and correct any high glucose levels by entering the glucose into the system and taking the suggested correction. The Smart Adjust system is working conservatively to deliver insulin with the first 3 pods. Giving regular corrections helps the system to know your true total daily dose and to effectively adjust basal insulin.
• Regular pod changes – every 2-3 days.
• Rotate insulin pod sites to avoid poor insulin absorption due to overused or lumpy sites.
• Make sure your insulin has not been out of the fridge for more than 28 days.
• Sensory accuracy:

- Dexcom G6: calibrate your sensor with a fingerpick glucose test if there is more than a 3mmol difference between your sensor and blood glucose value (calibration is done via the DEXCOM G6 app, not on the Omnipod handset).

- Libre 2+ / Libre 3 + / Dexcom G7 consider changing sensor if inaccuracy continues (if there is more than a 3mmol difference between your sensor and blood glucose value). If sensor reading inaccurately, switch back to manual mode until issue resolved.

2. Meal bolus timing

If you are using Novorapid, Trurapi or Humalog, give the bolus 10-15 minutes before eating/drinking carbohydrate so that the insulin and carbohydrate are absorbed at the same time and the bolus insulin will cover the carbohydrate most accurately. Mis-timed boluses can lead to high post meal/snack glucose levels followed by hypoglycaemia as the HCL may over-compensate if it detects a rapidly rising glucose.

2.1 Missed boluses:

• If less than 30 minutes have passed: bolus for all the missed carbohydrate.
• If 30-60 minutes have passed: bolus for half of the missed carbohydrate.
• If 60+ minutes have passed: give a correction for the current glucose only.

3. Treating hypoglycaemia

• Generally, less hypoglycaemia treatment is required with hybrid closed loop systems. This is due to the algorithm predicting that a low glucose will occur and therefore suspending insulin to prevent this and restarting insulin once glucose levels are predicted to rise above your target glucose levels within 60 minutes. It would be worth checking sensor arrows and insulin on board to guide the amount of hypoglycaemia treatment required, if any.
• Consider the cause of the hypoglycaemia: e.g. unplanned exercise; overestimation of the carbohydrate?
• It is also worth noting that these systems will alert you that you are heading towards hypoglycaemia; the system will have shut down insulin delivery to avoid this. You should try to resist acting too quickly with rapid acting carbohydrate top-ups which could result in overtreatment and rising above your glucose target. The low alert soon alarm (not hypoglycaemic) is a prompt to monitor your glucose more carefully and see if the system is levelling the glucose out or if you do need a small carbohydrate top up (3-7g) as well. If you are hypoglycaemic or glucose is falling rapidly, then please treat with 8-10g of rapid acting carbohydrate, for example 2 jelly babies.
• You no longer need to follow up a hypo treatment with 10g of slow released carbohydrate e.g. a biscuit unless you are planning to do physical activity.
• Consider using a blood glucose meter to check your levels to avoid over treating hypoglycaemia.

4. Managing hyperglycaemia

Remember your system is designed to keep your glucose in your target glucose range; if your glucose levels are running above this range for more than 2 hours and not coming down with corrections then it is likely your insulin pod has failed and should be changed. Ensure that you check your ketones if this does occur.

5. Managing illness and ketones

The SmartAdjust function does not manage well when ketone levels are raised (e.g. during illness, steroids). It cannot meet the need for increased insulin requirements fast enough. For periods of illness where ketones are present (greater than 1.5mmol/L) turn off automated mode on your handset and follow the sick day rules:

• Sick day rules (opens in a new tab)

For those that are pregnant, we would suggest turning off SmartAdjust at a ketone level of greater than 1.0mmol/L and following pregnancy specific sick day rules.

6. Plan for physical activity

Planned activity

• Turn on the exercise activity feature 60-120 minutes before planned exercise to reduce the insulin on board for starting exercise.
• You may still need to supplement with small amounts of carbohydrate every 10-30 minutes dependent on the intensity of the exercise.
• Avoid pre-loading with carbohydrate before exercise as this results in a rise in blood glucose that activates the automated basal to increase which could then lead to hypoglycaemia.
• If you are partaking in extended periods of physical activity and require larger amounts of carbohydrates before and during the activity to maintain glucose levels, you may need to consider turning off SmartAdjust (switching to manual mode). This will enable you have adequate carbohydrate intake and set reduced temporary basal rates. Please feel free to discuss this with an educator.
• Resistance exercises (for example weightlifting, strength training) will likely require no or fewer carbohydrate top-ups.

Unplanned activity

• Set exercise activity feature immediately.
• Consume 10-20g carbohydrate before physical activity if sensor glucose reading 7.0mmol and below.
• Check insulin on board for amount of carbohydrate needed.

Sensor use during activity/exercise

Sensors can be useful when exercising, however there are a few points to consider for your safety during these sessions.

• Use the trend arrows to help you decide how much extra carbohydrate to have before or during an activity.
• During exercise, consider setting your low glucose alert alarm to 5.5mmol. There can be a time delay between blood and sensor glucose levels due to the greater changes in glucose between the blood and tissues.

7. Managing alcohol

There is a higher risk of hypoglycaemia if alcohol has been consumed. The following advice does not have a formal research base. You should use your own experiences with how alcohol affects you when making decisions about glucose and alcohol.

• Consider turning on exercise activity feature 90-120 minutes before consuming alcohol to raise your glucose targets. Keep activity mode on for the whole duration of drinking alcohol; and all night (while asleep).
• Carbohydrate count your alcoholic drinks and enter half the amount of carbohydrates into your pump (so you get half the amount of insulin).
• Ensure your hypoglycaemia alarms are turned on; you may want to consider increasing the customizable low alert alarm to 5.0 mmol/L or more for overnight.
• Continue the activity feature the morning after alcohol if you have had a lot to drink the night before.
• If eating: consider a reduced carbohydrate bolus to prevent hypoglycaemia. E.g. start with a 20% reduction in the carbohydrates you enter the pump. If hypoglycaemia occurs despite this, consider a 30-50% reduction in the bolus.
  • A pasta meal of 60g carbohydrates while on a night out drinking alcohol; enter 48g into the pump (20% reduction).
• If planning to drink larger amounts, you can consider stopping automode and running in manual mode. You can use reduced temporary basal rates and/or eat additional carbohydrates. We would recommend a 20% reduction in temporary basal rates overnight and the morning after.

8. Avoid overriding the system

You may have been tempted in the past to add pretend carbohydrates to your pump to bring a high blood glucose down when corrections haven’t worked well enough. This approach does not work in HCL and will increase the risk of a hypo.

9. Review the data

You can get a lot of data when using HCL. Over time this will become more familiar and useful to you. Your educator can help you interpret what the reports mean and how to adjust settings. The reports also present your glucose data in a different way; in addition to predicted HbA1c (GMI) you will get time in range. You are aiming for at least 70% time in range (3.9-10 mmol/L) with less than 4% below 3.9mmol/L and less than 1% below 2.8mmol/L. Every 1% more time in range is the same as another 15 minutes with blood glucose in range, so even small changes make a difference to your health.

Additional resources

Website addresses only available in online version.

Omnipod 5 video tutorials:

• Omnipod® 5 Video Tutorials | Omnipod (opens in a new tab)

Pod site and preparation and placement

• Omnipod_Pod-Placement-Guide_English.pdf (opens in a new tab)
• Skin Care Tips for Diabetes Device Users | Omnipod UK (opens in a new tab)

Pod placement with sensor – Importance of Line of site.

• What is Line of Sight? | Omnipod (opens in a new tab)

Pump sick day rules:

• Sick Day Rules (opens in a new tab)

Uploading your pod/handset

The data from the Pod/handset should automatically upload to Glooko, if 1.) you have linked your Glooko account to the Addenbrookes diabetes clinic (code ukaddhos) and 2.) if you have linked your Glooko account during your Omnipod 5 onboarding. If you have not been able to link your Glooko account during the onboarding process, please contact Insulet customer service.

Carb Counting Workshops

The workshops are held face to face and virtually.

To book on please email:

• n.croxon@nhs.net

Or send a message to MyChart.

DAFNE closed loop essentials

• The focus of the course is keeping safe using closed loop, so people are aware of what closed loop can and can’t do, and the user input required to use closed loop effectively.
• 4-6 hours of self-directed online learning.
• The course content is not specific to a particular pump and is not designed to cover specific pump functions other than the basics.
• Participants will require access to a computer, laptop or tablet and a WIFI connection to complete the course.
• You will learn:
  • How HCL works
  • Carb counting
  • Checking your settings
  • Hypos and HCL
  • Sickness and ketone guidance for HCL
  • Going back to injections
• To access the course, please message the diabetes educator team using the eConsult service,

Email: cuh.diabeteseducator@nhs.net

Insulin pump looping groups

These are group education sessions that are tailored specifically to the insulin pump that you are using (Medtronic 780G Smartguard or Tandem Control IQ or Omnipod 5 SmartAdjust, or Ypsopump Mylife CamAPS FX). See below for content of these sessions:

• Learn more about the algorithm your pump uses – a representative from the company will be available for any queries.
• Learn how to review your pump download.
• Meet other people using the same technology.
• Hear about the ways other people have found helpful in managing tricky situations such as exercise/large meals/hypoglycaemia.
• Ask questions.

To access the course, please message the diabetes educator using the eConsult service,

• Email: n.croxon@nhs.net

Or message on MyChart.