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.
At the end of this lesson you will know:
The Bolus Advice function of your diabetes manager calculates bolus recommendations based on the following:
You will learn about the Individual settings later in this lesson.
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:
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.
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.
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.
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!
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:
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.
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.
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
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:
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.
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:
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.
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.
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: Correction Bolus Meal Currently allowed BG value: Corrected BG BG Test Result
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.
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.
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.
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.
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.
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.
Meal Bolus Currently allowed BG value: Meal Rise
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.
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.
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.
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.
From the main menu press or to select Settings
The first time you enter the settings for Bolus Advice, you will be guided automatically.
Setting the lower target limit of the Target Range:
Save your changes between each Time Block so that you don't loose them!
To change the Meal Rise:
To change the Snack Size:
To change the Acting Time:
To change the Offset Time:
You now know how to program the Bolus Advice settings into your diabetes manager. Let's now look at how to use Bolus Advice.
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.
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:
Check expiry date of strips
Add information about the Meal Time, planned food intake or your state of health, as follows:
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.
In the Bolus Advice screen, first set the amount of Carbs you are planning to eat:
Now Let's take a look at how to get advice on the Bolus Amount and type.
Do not exit this function until the bolus delivery is completed. If you do, the bolus delivery will be cancelled.
You have completed the getting Bolus Advice from your diabetes manager section.
Lesson - 5