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  • Introduction

    The Bolus Advice function on your diabetes manager provides you with recommendations on the amount of insulin needed to cover food intake and for correcting high blood glucose levels. If you were to do these calculations yourself, you would need to consider many complex elements. Bolus Advice with the Accu-Chek Combo insulin delivery system is quick and easy.

    Let's see how!

    If you would like to review how the Bolus Advice function meets your changing insulin needs, click here.

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  • Goals

    At the end of this lesson you will know:

    • How the diabetes manager calculates Bolus Advice
    • The required settings and values you need to set up the Bolus Advice function
    • How to program the settings and values for Bolus Advice into the diabetes manager
    • How to get advice on bolus amount
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  • About Bolus Advice

    The Bolus Advice function of your diabetes manager calculates bolus recommendations based on the following:

    • Current BG test result
    • Expected food intake
    • Current health status or physical activity
    • Individual settings (such as carb ratio, insulin sensitivity and others)

    You will learn about the Individual settings later in this lesson.

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  • About Bolus Advice

    The Bolus Advice function takes into account the information that you have seen in the previous screen.

    After that, all you need to do is:

    • Measure your blood glucose level
    • Enter the amount of carbs you are planning to eat, and
    • Enter your current health or activity status.

    The diabetes manager will then calculate the required amount of insulin based on your personal needs. After you confirm the dose of insulin you wish to receive on the diabetes manager and confirm delivery, the pump will deliver the bolus. If needed, you can adjust the calculated bolus dose and choose the bolus type you prefer. You will learn how to do this later in this module.

    In order for the diabetes manager to perform these calculations, you need to set up the Bolus Advice function. Here's how.

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  • Setting up Bolus Advice

    A bolus calculation depends on the factors valid at the time the diabetes manager performs the calculation. Your lower and upper target BG targets, insulin sensitivity and carb ratios may change throughout the day. This in turn will affect your insulin requirements. To match your insulin needs to these changes, you can set different values in the Bolus Advice function of the diabetes manager for different periods of time.

    • Keep this information in a safe place for future reference.
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  • Setting up Bolus Advice

    Before you can start setting up the Bolus Advice function, you need to obtain the required values, or setting parameters, from your doctor or healthcare team. Once you have obtained these values, you will need to program them into the diabetes manager. The Bolus Advice function will be based on the values which are specific to you. Once this information has been entered into the diabetes manager, it will provide you with Bolus Advice based on your needs.

    Let's see how this is done.

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  • Setting parameters for Bolus Advice

    The parameters, or values, you need to have and record to set up the Bolus Advice function are:

    You need to pre-set all this information. The Bolus Advice function won't work without it!

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  • Setting parameters for Bolus Advice

    Health Event settings

    Let's first discuss Time Block settings.

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  • Time Blocks

    Time Blocks split the day into time periods, to help better manage the programming of settings that change throughout the day. Examples include the insulin sensitivity factor and the carb ratio. You only need to set the End Time of each Time Block, as this is also the starting time of the following Time Block. You and your doctor can determine the length of these periods. You will see how to do that later in this module. Five Time Blocks are set up by default, but you can set up to 8 if needed.

    The following parameters can be set up separately within each Time Block:

    • Target Range
    • Carb Ratio
    • Insulin Sensitivity Factor
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  • Time Block settings: Target Range

    The Target Range is the range that your BG levels should stay within. It has an upper and lower limit thought to be acceptable while you are fasting (for example in the morning or before a meal). The Target Range is used to create a target BG for each Time Block. The target BG is calculated automatically as the average between the lower and upper BG values you program for each Time Block.

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  • Time Block settings: Carb Ratio

    The Carb Ratio is the amount of insulin you need for a certain amount of carbohydrates. You must program the Carb Ratio for each Time Block you wish to set up. The Carb Ratio is used to calculate a meal bolus.

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  • Time Block settings: insulin sensitivity

    The insulin sensitivity factor is the amount of insulin you need to lower your BG level by a given amount. It is also called the "correction factor". You must program this factor for each Time Block you wish to set up since your insulin requirements may change over the course of the day. Now, let's move on to discuss Health Events settings

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  • Health Events settings

    Health Events allow you to adjust bolus doses using percentage increases or decreases. For example, when you are planning to exercise, you would decrease the bolus amount. If you are ill, you would increase the bolus amount. The Health Events values allow you to change bolus doses based on your needs and potential changes in health status.

    You can pre-set percentages for the following health events:

    • Exercise 1
    • Exercise 2
    • Stress
    • Illness
    • Premenstrual

    There are two exercise health event options to allow you to adjust boluses based on, for example, mild and strenuous exercise periods.

    Let's now discuss Advice Option settings.

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  • Objective of Bolus Advice

    One of the main objectives of the Bolus Advice function is to balance insulin with blood glucose.
    As you have seen, Bolus Advice takes the following Advice Options settings into consideration to achieve this:

    • Time Block (Target Range, Insulin Sensitivity Factor and Carb Ratio)
    • Health Events (Exercise, Stress, Illness, Premenstrual)
    • Advice Options (Meal Rise, Snack Size, Acting Time, Offset Time)

    Legend:

    1. insulin
    2. glucose
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  • Advice Options settings

    The Advice Options settings help to make sure that the Bolus Advice function does not recommend a second bolus if there is remaining glucose-lowering action from a previous bolus delivered to cover a meal or to correct an elevated glucose level.

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  • Objective of Bolus Advice

    Now, let's look at how the Bolus Advice function uses the Advice Option settings to make these types of calculations. Let's first look at how this applies to correction boluses.

    Legend:

    1. double dose
    2. high BG
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  • Bolus Advice in action

    In the next few screens, you will see this graph. It will help you to understand how Bolus Advice works. To understand this graph, it is important to know that the y axis (the coloured vertical bar on the left-hand side) refers to BG level. The x axis on the graph (the horizontal bar on the bottom with the clocks) refers to time. You will also see the following icons used in the graphs: Icon Correction Bolus Icon Meal Icon Currently allowed BG value: Corrected BG Icon BG Test Result

    Legend:

    1. Hyper
    2. Target value
    3. Hypo
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  • Bolus Advice in action

    Now, suppose you do a BG test and the result is higher than the Target value as shown here. Using the Advice Options settings pre-set in the Accu-Chek Combo insulin delivery system, a bolus dose will be calculated by the Bolus Advice function. The impact of this first bolus on blood glucose is shown in the graph by "Corrected BG". In the next few screens when you see "Corrected BG", it shows you the difference from the originally administered bolus.

    Legend:

    1. Corrected BG
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  • Bolus Advice in action

    The Offset Time is the time taken for this first bolus to start taking effect. After the Offset Time, your BG level should begin to decrease because of the glucose-lowering effect of the insulin. The Acting Time is the duration of insulin action, i.e. time for which the insulin delivered as a standard bolus is still effective.

    Legend:

    1. Corrected BG
    2. Offset Time
    3. Acting Time
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  • Bolus Advice in action

    Now, suppose you do a second BG test an hour after the first one. The Bolus Advice function will not recommend another correction bolus if your BG level is less than the BG covered by the first bolus. In other words, if your BG test result falls within the area shown by the blue box, the Bolus Advice function will not recommend a second correction bolus.

    Legend:

    1. Currently allowed BG value: Corrected BG
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  • Bolus Advice in action

    Now, suppose you do a third BG test some time later. If this third BG test result falls out of the range shown by the blue box, the Bolus Advice function will recommend a second correction bolus. In other words, the Bolus Advice function will recommend a second correction bolus if your BG level is more than the allowed glucose value after the first bolus. When calculating this second bolus, Bolus Advice will take into account insulin with remaining glucose-lowering activity from the first bolus, if this applies.

    Now, let's see how the Bolus Advice function calculates meal boluses.

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  • Bolus Advice in action

    After a meal, BG levels usually increase. Depending on the type of meal, the BG may reach a maximum about an hour after the meal, and may return to its original level after an additional two to three hours. This is the typical process and Bolus Advice takes this into account using the meal rise.

    Legend:

    1. Hyper
    2. Target value
    3. Hypo
    4. Normal BG increase in a non-diabetic after a meal
    5. Meal Rise
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  • Bolus Advice in action

    Once the carb content of a meal is entered into the Accu-Chek Combo insulin delivery system and a fresh BG test is performed, the Bolus Advice function will calculate a meal bolus. The offset time is the time taken for the bolus to start taking effect. After the offset time, your BG level should decrease because of the effect of the insulin. The Acting Time is the time for which the insulin delivered as a meal bolus is effective. It includes all of the time for which an increase in BG after a meal bolus is taken into account.

    Legend:

    1. Offset Time
    2. Acting Time
    3. Normal BG increase in a non-diabetic after a meal
    4. Meal Rise

    Icon Meal Bolus Icon Currently allowed BG value: Meal Rise

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  • Bolus Advice in action

    Now, suppose you do a second BG test one hour after the first one. The Bolus Advice function will not recommend another bolus if your BG level is less than the allowed gluocse level after the previous bolus. In other words, if your BG test result falls within the area shown by the green box, the Bolus Advice function will not recommend a second bolus.

    Legend:

    1. Currently allowed BG value: Corrected BG
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  • Bolus Advice in action

    Now, suppose you do a third BG test some time later. If this third BG test result falls out of the range shown by the green box, the Bolus Advice function will recommend a second bolus. In other words, the Bolus Advice function will recommend a second bolus if your BG level is more than the allowed glucose level after the first bolus. When calculating this second bolus, Bolus Advice will take into account the remaining meal rise from the first bolus, if this applies.

    Now, let's see how the Bolus Advice function works with snacks.

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  • Bolus Advice in action

    After a small meal, BG levels may not increase significantly. As shown by the dotted line in the graph, no BG level above the Target Range is therefore accepted by Bolus Advice after having a small amount of carbohydrates. The snack size defines the maximum amount of carbohydrates for which a meal bolus is calculated by the Bolus Advice function, but no Meal Rise is triggered.

    Legend:

    1. Snack / small meal
    2. No BG rise expected in people without diabetes after a snack / small meal
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  • Bolus Advice in action

    Now, suppose you do a BG test a short time after eating a snack and the result is above the Target BG value. The Bolus Advice function will recommend a bolus to correct the BG to the target value.

    Legend:

    1. Snack!
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  • Setting up Bolus Advice: step 1

    From the main menu press Icon or Icon to select Settings

    • Once Settings is selected press Icon
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  • Setting up Bolus Advice: step 2

    • Press Icon or Icon to select Bolus Advice
    • Press Icon

    The first time you enter the settings for Bolus Advice, you will be guided automatically.

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  • Setting up Bolus Advice: step 3

    • The Setup screen Would you like to receive Bolus Advice from your diabetes manager? appears
    • Press Icon, if you do not want to set up Bolus Advice - You will go back to the Settings screen
    • Press Icon if you do want to set up Bolus Advice and continue to the next step
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  • Setting up Bolus Advice: step 4

    • If you pressed Yes, you will see this screen
    • To continue, press Icon to select Next
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  • Setting up Bolus Advice: step 5

    • The Time Blocks screen will appear
    • Press Icon or Icon to select a Time Block to edit
    • Press Icon to choose the Time Block you want to set
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  • Setting up Bolus Advice: step 6

    • The selected Time Blocks screen appears:
    • Press Icon to activate the end time box
    • Press Icon or Icon to set the end time of the first Time Block
    • Press Icon to confirm and move to the lower Target Range settings
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  • Setting up Bolus Advice: step 7

    Setting the lower target limit of the Target Range:

    • Press Icon to activate the lower target limit box
    • Press Icon or Icon to select the lower target limit
    • Press Icon to confirm and move to the upper target limit box
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  • Setting up Bolus Advice: step 8

    • Setting the upper limit of the Target Range:
    • Press Icon to activate the upper target limit box
    • Press Icon or Icon to select the upper target limit
    • Press Icon to confirm and go to the Carb Ratio settings
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  • Setting up Bolus Advice: step 9

    • Setting the insulin amount for the Carb Ratio:
    • Press Icon to activate the insulin unit box
    • Press Icon or Icon to set the insulin amount
    • Press Icon to confirm and move to the carbs box
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  • Setting up Bolus Advice: step 10

    • Setting the carbs amount for the Carb Ratio
    • Press Icon to activate the carbs box
    • Press Icon or Icon to set the carbs
    • Press Icon to confirm and move to the Insulin Sensitivity settings
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  • Setting up Bolus Advice: step 11

    • Setting Insulin Sensitivity:
    • Press Icon to activate the insulin unit box
    • Press Icon or Icon to set the insulin unit
    • Press Icon to confirm and move to the BG box
    • Press Icon to activate the BG box
    • Press Icon or Icon to set the BG amount
    • Press Icon to confirm
    • Press Icon to save the changes

    Save your changes between each Time Block so that you don't loose them!

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  • Setting up Bolus Advice: step 12

    • When you save the changes you will return to the Time Blocks screen
    • Repeat Steps 5 to 11 for each of the Time Blocks, saving your changes each time
    • When you have done this, press Icon to select Next and go to the Health Events screen
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  • Setting up Bolus Advice: step 13

    • Change the Health Events as follows:
    • Press Icon to enter the Exercise 1 box
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  • Setting up Bolus Advice: step 14

    • Press Icon or Icon to select the percentage
    • Press Icon to confirm
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  • Setting up Bolus Advice: step 15

    • Repeat these steps to change the Exercise 2, Stress, Illness, and Premenstrual percentages
    • To continue, press Icon to select Next and go to the Advice Options screen
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  • Setting up Bolus Advice: step 16

    To change the Meal Rise:

    • Press Icon to activate the Meal Rise box in the Advice Options screen
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  • Setting up Bolus Advice: step 17

    • Press Icon or Icon to select the meal rise limit
    • Press Icon to confirm and move to Snack Size
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  • Setting up Bolus Advice: step 18

    To change the Snack Size:

    • Press Icon to activate the Snack Size box
    • Press Icon or Icon to select the Snack Size
    • Press Icon to confirm and move to Acting Time
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  • Setting up Bolus Advice: step 19

    To change the Acting Time:

    • Press Icon to activate the Acting Time box
    • Press Icon or Icon to select Acting Time
    • Press Icon to confirm and move to Offset Time
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  • Setting up Bolus Advice: step 20

    To change the Offset Time:

    • Press Icon to activate the Offset Time box
    • Press Icon or Icon to select the Offset Time
    • Press Icon to confirm
    • Press Icon to save the changes
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  • Setting up Bolus Advice: step 21

    • If you changed the Snack Size, you will receive the message that the new setting will be applied to the After Meal Reminder
    • Press Icon to select OK and go to the Bolus Advice screen
    • Press Icon to go to Settings Screen
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  • Setting up Bolus Advice: step 22

    • Press Icon to select Menu and return to the Main Menu

    You now know how to program the Bolus Advice settings into your diabetes manager. Let's now look at how to use Bolus Advice.

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  • Using Bolus Advice: before you start!

    It is important that you understand how bolus calculation works in order to use the Bolus Advice function correctly. The diabetes manager cannot tell if the data you enter are right or wrong. Always compare the Bolus Advice provided by the diabetes manager with the bolus amount you expected and adjust the bolus amount if needed.

    Always carry out the actions you enter into Bolus Advice without delay. For example, if you accept a bolus delivery for a certain amount of carbs you plan to eat, you should eat the amount of carbs you entered and not delay eating your food. Also, since the Bolus Advice will vary with the time of day, make sure that the time on the diabetes manager and insulin pump are correct.

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  • Using Bolus Advice: what you need

    Once you have programmed the Bolus Advice settings into your diabetes manager, getting Bolus Advice is quick and easy. You don't need to remember the settings you entered or do any calculations yourself. Bolus Advice can only provide a reliable bolus recommendation when a current BG test is available. If you try to use the Bolus Advice function without a current BG result, you will be prompted by a warning if the last BG test is older than 5 minutes.

    Let's now take a look how to take Bolus Advice from a BG test. You will need:

    • Your lancing device
    • A new test strip
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  • Getting Bolus Advice: testing BG: step 1

    • Prepare the lancing device according to the instructions provided
    • Wash and dry your hands
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  • Getting Bolus Advice: testing BG: step 2

    • Place your diabetes manager on a flat surface (for example, a table)
    • Insert the test strip into the test strip slot in the direction of the arrow
    • The diabetes manager turns on automatically
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  • Getting Bolus Advice: testing BG: step 3

    • The "Match Code to Vial" screen appears
    • Make sure the code number on the screen matches the code number on the test strip container

    Check expiry date of strips

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  • Getting Bolus Advice: testing BG: step 4

    • The "Apply Sample" screen appears
    • A sound indicates that the strip is ready for testing
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  • Getting Bolus Advice: testing BG: step 5

    • Prick your finger with your lancing device
    • Gently squeeze your finger to get a blood drop
    • Touch the blood drop against the front edge of the yellow window of the test strip
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  • Getting Bolus Advice: testing BG: step 6

    • The "Analyzing" screen appears as soon as you have applied enough blood
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  • Getting Bolus Advice: testing BG: step 7

    • Your result appears on the display. If you would like to see what the colours mean, click here.

    Now let's take a look at how to add information about a meal.

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  • Getting Bolus Advice: adding meal information: step 1

    • About three seconds after your glucose result appears on the display, a detailed "BG Result" screen appears
    • This is where you can add information about the Meal Time, planned food intake or your state of health
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  • Getting Bolus Advice: adding meal information: step 2

    Add information about the Meal Time, planned food intake or your state of health, as follows:

    • Press Icon or Icon to move to the Meal box
    • Press Icon to enter
    • Press Icon or Icon to select a value
    • Press Icon to save the value
    • Press Icon to select Bolus and move to the Bolus Advice screen

    If you use a BG result for Bolus Advice, you can't change entries later on. Therefore it is recommended that you add information about Meal Time here.

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  • Getting Bolus Advice: adding meal information: step 3

    In the Bolus Advice screen, first set the amount of Carbs you are planning to eat:

    • Press Icon to enter the Carbs box
    • Press or Icon or Icon to select the amount of carbohydrates you are planning to eat
    • Press Icon to save and move to the Health Event box
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  • Getting Bolus Advice: adding meal information: step 4

    • Press Icon to open the pop-up window
    • Press or Icon or Icon to select your current state of health
    • Press Icon to save and move to the Bolus Amount box
    • Repeat these steps to enter information about Health Events

    Now Let's take a look at how to get advice on the Bolus Amount and type.

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  • Getting Bolus Advice: bolus amount and type: step 1

    • Based on the BG result, the Carb and Health Event data the diabetes manager will automatically show the recommended bolus dose on this screen
    • If you feel the need to change the recommended bolus amount for any reason, use the Icon and Icon or Icon to select the bolus box and change it to the desired dose
    • Press Icon to save the change
    • Otherwise, press Icon to move to the Type box directly
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  • Getting Bolus Advice: bolus amount and type: step 2

    • If you wish to select a bolus type other than Standard:
    • press Icon to activate Type box
    • Press Icon or Icon select the bolus type
    • Press Icon to save
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  • Getting Bolus Advice: bolus amount and type: step 3

    • Press Icon to confirm and move to the Confirm Bolus screen
    • Press Icon again, to select Deliver

    The insulin pump starts delivering the bolus accordingly. To review the different bolus types, click here.

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  • Getting Bolus Advice: bolus amount and type: step 4

    • If you need to stop the bolus delivery for any reason press Icon
    • You can also stop the bolus by pressing and holding Icon or Icon on the insulin pump
    • Otherwise press Icon to select OK and return to the main menu screen

    Do not exit this function until the bolus delivery is completed. If you do, the bolus delivery will be cancelled.

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  • Quiz

    When getting Bolus Advice, which data do you NOT enter into the diabetes manager?

  • Quiz

    If you use a BG test result to calculate a bolus, you cannot add Meal Time details later.

  • Quiz

    Once the diabetes manager has calculated your bolus, you cannot change it and must use it as calculated.

  • Congratulations!

    You have completed the getting Bolus Advice from your diabetes manager section.

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