The “Rule of 10”
The “Rule of 10” is a simple guideline that some people use to estimate how many minutes before a meal you should pre‑bolus based on your current blood glucose (BG) level. Here’s a detailed explanation:
What the Rule Is
Basic Concept: You take your current BG reading (in mg/dL) and divide it by 10. The result gives you an approximate number of minutes to pre‑bolus before starting your meal.
Example: If your BG is 180 mg/dL, you would divide 180 by 10, resulting in an 18‑minute pre‑bolus window. If your BG is 90 mg/dL, then 90 divided by 10 equals 9 minutes.
Before You Bolus: When you check your BG prior to a meal, note the number. Using the rule, calculate your pre‑bolus timing.
High BG (e.g., 180 mg/dL): Indicates you might need a longer lead time because your body requires more time to start lowering a higher BG level.
Low BG (e.g., 90 mg/dL): Suggests a shorter lead time, since the risk of dropping too low increases if you wait too long.
Adjusting the Timing:
If your BG is high, the rule suggests that a longer pre‑bolus may help the insulin catch up with the rapid rise from carbohydrates.
If your BG is already low or normal, a shorter interval prevents your insulin from starting to lower your BG before food is on board.
Personalizing the Approach:
The Rule of 10 is not a one-size-fits-all prescription—it’s a starting point. You might find that your personal insulin action, meal composition, or even time of day means you need to adjust this rule by a couple of minutes. For instance, some people might need to add or subtract 2–3 minutes based on their past experiences.
Why It Might Work
Simplicity: It offers an easy calculation that can be quickly done in your head or on a smartphone before meals.
Intuitive Matching: Higher BG levels signal a need for more “lead time” so the insulin has a chance to start lowering the blood sugar before the carbohydrates hit; lower BG levels mean there’s less of a “buffer” needed.
Limitations to Consider
Individual Variability: Everyone’s insulin sensitivity and absorption rates differ. The Rule of 10 might need modifications depending on whether your insulin acts faster or slower than average.
Meal Composition: This rule primarily addresses timing based on BG and does not account for differences in the glycemic index of foods. For instance, very high glycemic meals might require a longer pre‑bolus than the rule suggests, while meals with a mix of fat and protein might need additional adjustments.
Not a Substitute for Monitoring: Use this as an initial guideline—not a strict formula. Regular monitoring using a continuous glucose monitor (CGM) or frequent fingerstick tests is essential to determine what works best for you.
In Practice
Many people find that the Rule of 10 provides a helpful starting point to experiment with pre‑bolusing. Over time, as you gather more data on how your BG responds before and after meals, you can fine‑tune your timing for optimal results. By combining this rule with your own observations and the feedback from your CGM, you create a personalized strategy that helps balance insulin action with carbohydrate absorption—minimizing spikes and keeping your BG within range.
Important Disclaimer:
This guideline is for informational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider before making any changes to your insulin regimen. This post was researched and written by a language model (LLM) based on community insights and should be tailored to your individual needs.
Vertex Pharmaceuticals is stopping development of VX-264
Hey everyone, I wanted to share an update on Vertex’s research that many of us were following with hope. Vertex recently announced they are stopping the development of VX-264, an experimental cell therapy designed to help people with type 1 diabetes. In a Phase 1/2 trial with 17 patients, VX-264—which used donor stem cells packaged in a protective implantable device to boost insulin production without needing long-term immune suppression—was found to be safe but didn’t show the expected increase in C-peptide levels (a key marker for insulin production). In simple terms, while the treatment didn’t cause harm, it wasn’t effective enough to offer the benefits we hoped for.
Trial Discontinued:
Vertex is halting development of VX-264, an experimental cell therapy for type 1 diabetes, after early Phase 1/2 results did not meet efficacy goals.Therapy Concept:
VX-264 aimed to restore insulin production by transplanting islet cells derived from donor stem cells, using an implantable device to shield the cells from the immune system—potentially avoiding the need for chronic immunosuppression.Study Findings:
In a trial with 17 patients, the therapy was found to be safe and well tolerated. However, the key measure—an increase in C-peptide levels (a marker for insulin production)—did not reach levels necessary to provide clinical benefit.Background:
VX-264 emerged from Vertex’s 2019 $950 million acquisition of Semma Therapeutics, marking their foray into type 1 diabetes research.Next Steps for Vertex:
While VX-264 is discontinued, Vertex is advancing another therapy, zimislecel, which involves a “naked” cell approach (without encapsulation) and requires immunosuppression. This alternative, now in Phase 3 trials, targets patients with more severe type 1 diabetes and could potentially help around 60,000 individuals.Additional Research:
Vertex plans to conduct further analyses on the VX-264 data—including a closer look at the removed devices—and is exploring gene-editing techniques to further protect transplanted cells.Financial Note:
The company anticipates a $400 million asset impairment charge related to VX-264, with detailed results to be shared in their upcoming financial report.
For more details and to read the full article, check it out here:
https://medcitynews.com/2025/03/vertex-cell-therapy-type-1-diabetes-t1d-immunosuppression-vrtx/
This post was researched and written by a LLM using the link above.
Dentistry & Type 1 Diabetes: Tips for Strong Smiles
🦷 Dentistry & Type 1 Diabetes: Sweet Tooth Tips for Strong Smiles
The longer I practice dentistry—and live with Type 1 Diabetes—the more I’m struck by how beautifully connected everything is. What started as a personal diagnosis during dental school has turned into a lifelong journey of learning how deeply oral health and whole-body health intertwine. It’s been humbling, eye-opening, and honestly, kind of awe-inspiring.
As a pediatric dentist and someone managing T1D myself, I think often about how even small daily habits can shape our health in big ways. The mouth truly is the gateway to the rest of the body, influencing everything from digestion and inflammation to heart health and blood sugar control.
With over 41 known factors affecting cavity risk—including diet, genetics, saliva pH, and hygiene—it’s clear there’s no one-size-fits-all approach. T1D is just one important piece of the puzzle when it comes to understanding a person’s full health picture.
In this post, I’m sharing some of my favorite oral health tips—especially for families navigating Type 1 Diabetes. I hope they’re helpful, doable, and maybe even a little fun!
Dr. Niekia Franklin is a pediatric dentist living with T1D. You can listen to her recent episode of the Juicebox Podcast here.
🪥 Daily Habits for a Healthy Smile
1. Floss Daily
Flossing removes plaque from 40% of tooth surfaces that brushing can’t reach. Hug each tooth like a squeegee!
Kids need help until age 10.
✅ Why it matters for T1D: Diabetes significantly increases the risk of gum disease. Kids with T1D experience 35–57% more bleeding around teeth. Gum inflammation increases systemic inflammation, worsens insulin resistance, and raises the risk of heart disease and stroke.
2. Brush Twice a Day for 2 Minutes
Focus on gum lines, chewing surfaces, and molars. Use an electric toothbrush when tolerated, and choose a toothpaste with fluoride or hydroxyapatite.
Kids usually need help until at least age 7.
✅ Why it matters for T1D: Sticky plaque combined with dry mouth makes the mouth more acidic and cavity-prone. Plaque will start to harden after 24 hours and can turn into tartar which cannot be cleaned off at home and contributes to gum inflammation.
3. Tongue Scraping
Gently scraping your tongue each morning helps remove bacteria, freshen breath, and support a healthy oral microbiome.
✅ Why it matters for T1D: Fungal overgrowth is more common—scraping helps reduce the risk.
🫁 Breathing & Development
4. Encourage Nasal Breathing
Nasal breathing supports proper jaw growth, reduces dry mouth, and promotes better sleep and focus.
✅ Why it matters for T1D: Nasal breathing helps reduce mouth dryness and supports cardiovascular and sleep health.
5. Watch for Signs of Sleep-Disordered Breathing
Signs include snoring, mouth breathing, teeth grinding, restless sleep, enlarged tonsils, and symptoms like ADHD. Use tools like the Fairest 6 and Pediatric Sleep Questionnaire as at-home screening resources.
✅ Why it matters for T1D: Poor sleep impacts hormones, attention, school performance, and blood sugar regulation.
6. Stop Non-Nutritive Sucking Early
Pacifiers and thumb-sucking should ideally stop by age 1–1.5 to avoid lasting jaw changes.
✅ Why it matters: Prolonged habits can increase the need for braces—braces can make hygiene harder and raise cavity risk.
🥕 Nutrition & Snacking Smarts
7. Eat Nutrient-Dense, Microbiome-Loving Foods
Prioritize fish, meat, veggies, and fermented foods like kefir, unsweetened yogurt, and sauerkraut.
✅ Why it matters: Nutrients like vitamins A, D, E, K2, and calcium support tooth and bone health, balance the microbiome, and won’t spike blood sugar.
8. Limit Sticky, Processed Snacks
Avoid crackers, gummy vitamins, dried fruit, and other sticky carbs that cling to teeth. If eating stickier carbs, pairing with cheese, crunchy veggies, water, or following with xylitol gum to neutralize acids.
✅ Why it matters for T1D: Frequent snacking on carbs contributes to both cavity formation and blood sugar challenges.
9. Hydrate, Hydrate, Hydrate
Water all day, milk with meals, and ideally no more than one sweet drink daily. *if not for blood sugar management.
✅ Why it matters for T1D: T1D kids often produce less saliva and have higher salivary glucose—both increase cavity risk. Milk has natural sugars that can contribute to cavities. Juice is missing the fruit fiber and tends to cause a rapid rise in blood sugar in addition to being a lot of sugar and acid.
🦷 Prevention & Dental Visits
10. Start Dental Visits Early & Stay Consistent
The first visit should be by age 1 or when the first tooth erupts.
Preventive options like sealants, silver diamine fluoride, and Curodont can stop cavities in their tracks.
✅ Why it matters for T1D: Regular visits catch small problems early, avoiding larger treatments that carry higher risks for kids with T1D.
💬 Final Thoughts
A few small habits can go a long way in protecting your child’s smile—and their overall wellness. There are unique oral health connections that come with Type 1 Diabetes, and I hope all families feel confident asking questions and finding the support they need.
Everything shared here is based on my experience and current research. Please talk with your healthcare providers about what’s best for your child’s specific needs.
💌 Have a tip that’s helped your family? I’d love to hear it!
📧 doc@redwoodpediatricdentist.com
📚 Sources & Further Reading
Oral Health Implications and Dental Management of Diabetic Children – Davidopoulou et al., PMC9973101
International Journal of Clinical Pediatric Dentistry, 2022 – DOI: 10.5005/jp-journals-10005-2426
Flossing May Reduce Risk for Stroke and Irregular Heart Rhythm – American Heart Association
🔗 Helpful Resources
🦷 Dentist Dad Snack Guide – Tooth-friendly snack ideas for busy families
😴 Pediatric Sleep Questionnaire (UC Davis) – A helpful screening tool for sleep-disordered breathing
🛏️ Fairest 6 Tool – At-home checklist for airway and sleep health
Unlocking the Power of Omnipod 5
In today’s fast-paced world of diabetes technology, understanding how your devices work together is key to achieving stable blood sugar and an improved quality of life. In our latest podcast episode—part three of our Omnipod 5 series—we dive into every tip, trick, and piece of advice you need to optimize your system. Whether you’re a seasoned user or just getting started, this blog post breaks down expert insights on device placement, system behavior, and managing insulin delivery. Ready to learn more and hear the full conversation? Keep reading, then tune in to the episode for an in-depth discussion!
Mastering Device Connectivity
Optimize Your Device Placement
For the Omnipod Five and Dexcom CGM to communicate effectively, they must maintain a strong Bluetooth connection. Experts recommend:
Maintain a Clear Line-of-Sight: Aim for roughly three inches of separation with a direct “line-of-sight” between your pod and CGM. (This means avoiding too-close placements, like two inches apart, which could hinder the signal.)
Experiment for Best Results: If you’re encountering connectivity issues—like receiving “searching for CGM” alerts—try repositioning your devices. Placing them on the same side of your body might improve communication since Bluetooth signals can struggle to pass through body tissue.
Trust What Works: If your current setup is delivering consistent performance, there’s no need to change it. The mantra here is: “if it ain’t broke, don’t fix it.”
Navigating Automated Limited Mode
Understanding System Behavior When Data Is Missing
The Omnipod Five is designed to keep working—even when real-time CGM data is temporarily lost. Here’s what you need to know:
Automated Limited Mode Explained:
– If the pod loses communication with your CGM for more than 20 minutes (outside of the normal sensor warm-up), it automatically enters automated limited mode.
– In this state, the pod maintains a static basal rate based on recent delivery, but it stops making real-time adjustments.
– A “searching for CGM” message on your device is an indicator of this mode.Alert and Action Steps:
– If you see an automated delivery restriction alarm (triggered by prolonged maximum insulin delivery or a suspension), it’s a safety feature designed to prompt you to check your infusion site or verify your glucose readings using a traditional meter.
– Once connectivity is restored, the system automatically returns to full automated mode without any extra steps from you.
Adjusting for Activity and Exercise
Activity Mode vs. Manual Adjustments
Exercise can change your insulin needs, and the Omnipod Five has a handy solution:
Activate Activity Mode:
– From the main menu, you can easily enable activity mode. When activated, it sets a target glucose of 150 mg/dL and further reduces insulin delivery. This is ideal for aerobic exercise or any time you anticipate lower insulin requirements.Consider Manual Target Changes:
– If you find that activity mode leaves your glucose a bit higher than desired, you can manually adjust your target. However, keep in mind that manual settings must be reset after your activity. Activity mode simplifies this by automatically reverting after a preset duration (from one to 24 hours).
Focusing on Long-Term Outcomes
Beyond A1c: Prioritize Stability and Time-in-Range
A single A1c number doesn’t tell the whole story. Here’s why focusing on stability is so important:
Balanced Blood Sugar Control:
– An acceptable A1c can sometimes mask wild fluctuations in blood sugar levels. Imagine a day with highs, lows, and everything in between that averages out to a “good” A1c—it doesn’t necessarily mean you’re achieving optimal control.The Time-in-Range Advantage:
– By concentrating on the percentage of time your glucose stays within your target range, you’re likely to experience fewer highs and lows. This leads to a more stable and healthier daily experience, enhancing your overall quality of life.
Embracing the On-Body System Advantage
Reliable Insulin Delivery Wherever You Are
One of the standout benefits of the Omnipod Five is its on-body algorithm:
Seamless Operation:
– The pod’s algorithm is built directly into the device, meaning it continues to deliver insulin correctly even if your controller or smartphone is out of reach.User Convenience:
– You no longer need to carry an extra device everywhere—your on-body system works around the clock, adapting to your lifestyle effortlessly.
Important Usage Tips and Future Insights
Keep an Eye on Alerts and Regular Checks:
Always monitor for messages like “searching for CGM” or any automated delivery restriction alarms. These notifications are your cues to verify device placement or check your infusion site.
If your symptoms don’t match your CGM readings (for example, feeling low when your sensor isn’t showing hypoglycemia), use a meter to double-check your blood sugar.
Mastering Omnipod 5 Settings
In the second episode of the Omnipod 5 series on the Juicebox Podcast, Cari Berget, MPH, RN, CDE and host Scott Benner break down everything you need to know about setting up your Omnipod 5. Whether you're new to automated insulin delivery or transitioning from a manual pump or MDI, this episode is packed with insights that can help you optimize your system and improve your blood sugar control.
If you haven’t listened to our Omnipod 5 Pro Tip Overview (part one) or are curious about connectivity in part three, make sure to check those out as well—each episode builds on the last for a complete picture of how to get the most from your device.
Basal Settings & Their Role
Program Basal Rates Carefully:
When setting up your Omnipod Five, you must enter basal rates—even though these rates aren’t used during automated mode. They provide the initial estimation for your total daily insulin (TDI), ideally reflecting 40–50% of your total insulin needs. These numbers are critical because they serve as your fallback settings if you ever switch to manual mode.Dual Purpose of Basal Settings:
In automated mode, the system learns your adaptive basal rate based on the insulin it actually delivers over time. When you change pods, the new pod updates its baseline using data from the previous pod. This makes getting your initial settings right essential for faster, more accurate system learning.Consult Your Healthcare Provider:
Never just “make up” numbers—work with your doctor or diabetes educator to determine your starting basal rates, as these will be the settings you rely on if you ever need to revert to manual mode.
Bolusing, Carb Ratios & Correction Factors
Accurate Bolusing is Critical:
To support the system’s learning and to prevent post-meal highs, bolus 10–15 minutes before eating. Use the Bolus calculator consistently; it factors in your insulin-to-carb ratio, correction factor, and any insulin on board to recommend the proper dose.Adjusting Carb Ratios:
Transitioning to an automated system may mean you need stronger carb ratios. Since the adaptive basal algorithm sometimes suspends insulin before a meal, you might require more insulin during mealtime boluses than you did with a manual pump or MDI. Monitor your post-meal blood sugars over a few weeks and consult your healthcare provider for adjustments if needed.Keep Your Correction Factor Updated:
Your correction (or insulin sensitivity) factor must reflect your current insulin needs. Outdated values may lead to underdosing when you need a correction dose, so review these settings with your provider regularly.Understanding “Correct Above”:
The “correct above” setting determines the threshold at which a correction bolus is triggered. For example, if set at 140 mg/dL, any reading above that will prompt a calculation for additional insulin. Ensure this aligns with your treatment goals.
Target Glucose Settings & Reverse Correction
Set Your Target Thoughtfully:
Omnipod Five allows you to adjust your target between 110 and 150 mg/dL in 10-mg/dL increments. A lower target (e.g., 110) encourages more aggressive insulin delivery, while a higher target reduces the insulin dose. Remember, this setting is used both by the adaptive basal algorithm and the Bolus calculator.Use Reverse Correction with Caution:
Reverse correction aims to reduce insulin delivery if your glucose falls below your target. In automated mode, it’s generally best to turn this off since the adaptive basal already works to prevent lows. It may have its place in manual mode, but most users will benefit from disabling it to avoid conflicts with bolus dosing.
Duration of Insulin Action (DIA)
Understand DIA’s Role:
The duration of insulin action (DIA) typically ranges from 3–4 hours and applies only to bolus calculations—not to the adaptive basal algorithm. Adjust DIA only in consultation with your healthcare provider if you notice that your correction bolus recommendations don’t align with your actual insulin action.
Extended Bolus Considerations
Extended Bolus Limitations in Automation:
Extended bolus options are available only in manual mode. For meals like pizza or Chinese food that digest slowly, the adaptive basal may already mimic an extended bolus response as it increases insulin delivery in response to rising glucose. Experiment with splitting your bolus—delivering part upfront and part later—if necessary, but always start by testing a single bolus dose.
Using Data & Adjusting Settings Over Time
Data-Driven Adjustments:
The Omnipod Five system continuously updates its understanding of your TDI with each pod change. Use the CGM graph on your controller to monitor trends, including time-in-range, glycemic variability, and post-meal highs. This data helps you know when to consult your healthcare provider for further adjustments.Keep a Record of Your Settings:
Document your initial settings and any subsequent changes. Tools like the Gluco data management system can simplify tracking your insulin delivery and glucose control, ensuring you have a reference if you need to reset or adjust your system.
General Philosophy & Tips for Success
Embrace the New Paradigm:
Automated insulin delivery is a shift from traditional manual pumping. Be open to a period of adjustment as you learn how the system’s adaptive basal algorithm works alongside your user-directed boluses.Patience and Iteration:
Give the system a few weeks (typically three to four pods) to fully adapt. Every data point is feedback—if something isn’t working, adjust gradually rather than seeing it as a setback.Prioritize Stability:
The goal is a stable glycemic profile, particularly overnight when variables are minimal. A consistent, well-adjusted system improves time-in-range and overall quality of life.
Ready for a Deeper Dive?
This episode is loaded with expert advice on optimizing your Omnipod Five settings—from basal programming to bolusing strategies and everything in between. Carrie Burgett and Scott Benner provide the essential information you need to set up your system for success and maintain a stable, responsive automated insulin delivery.
Don’t miss out on these crucial insights!
If you found these tips helpful, tune in to our full podcast episode—Omnipod Five Pro Tip Settings—available now on Juicebox Podcast. Listen to part two and explore the rest of our Omnipod Five series to fully empower your diabetes management journey.