I just figured out (when all else fails read the manual) that BOB is only calculated for correction boluses. I had been assuming that the pump was letting me know if ANY insulin was still working - oops. So my question is…when I bolus to eat and check 2 or 3 hours later and my sugar is still above range (say 180 after 3 hrs), what should I do? I know the insulin has longer to work, but the bolus wizard calculates a full correction bolus. What has happened to me in the past is that I would correct after 2 hrs, correct again after 3 hrs … or some variation of that … and end up low.
What is the rationale for not warning of BOB for meal boluses?
I am writing everything down in an attempt to spot a pattern or a need for a higher bolus in the mornings (usually when the problem is), but this is still a general question that I’ve never really found an answer to. Thoughts?
You should set up your PDM for the length of time you believe the insulin is active for you. In my son’s case, if he is not down by the 2 hour mark, he is not going to go down much further. So, we give the full correction.
My understanding of the IOB calculation is that you have not changed the amount of food you ate and bolused for, so that should not factor in when deciding if a correction is needed. There are opinions on whether this is right or wrong, but that is my understanding of how it is.
This has been a major complaint of mine to Omni from the very beginning.
By not calculating IOB or BOB for carbs that are entered, Omni is making the assumption that everytime you count your Carbs you are going to be 100% accurate which we all know is impossible.
You have a couple of ways to deal…Simply do not correct until 4 hours (or whatever time your IOB is set for) after you have eaten carbs. I also have figured out what my dose is going to be between my carbs and correction. I then tell the Omni I want to take a correction shot ONLY and then just type in what I had previously figured for carbs + correction. The only thing about this is that if you want to use an extended or combo bolus the PDM will not allow you to extend any insulin if you input your info this way (you told the PDM you need to correct- there is no reason to extend if all you are doing is correcting).
Let’s hope Omni will try to change this. If you have an Omni and this bothers you make sure to let Insulet know!!!
I think daneenm explained it pretty well. I, for one, am glad to have it this way; as long as the active time is set correctly and the carb counting is reasonably accurate, this works out best for me.
As for your problem with morning boluses, according to my endo, it’s pretty common for patients to need a higher IC ratio in the morning. He recently adjusted mine up because of trends we saw.
I wish they would include food bolus as well - I have a preschooler and it would be much easier if the school/babysitters were allowed to correct when they test her off schedule because they end up doing it by accident anyway.
For me, Apidra does not last 4.5 hours. Novalog maybe, but not Apidra. Mine is currently set at 2.5 hours, and based on my I:C ratios and corrections factors, this seems to work well for me. I’d talk to you doctor, but maybe bumping that back to at least 3.5 hours might be beneficial for corrections (so it would give you a higher suggested bolus b/c it would read less active insulin on board).
The other issue may be your I:C ratio is off for that particular meal (like Eric suggested), so that’s another option to investigate.
I was on the Medtronic minimed and when I switched to the Omnipod, the difference in the calculation of the IOB was the one complaint I’ve had about the Omnipod. I talked with my clinic and tried to get it straightened out so I would learn how I needed to handle things differently. I finally met with a nurse through Insulet, and we figured out a way to make it work. For me, if I check my BG within up to 2.5 hours after a meal and I’m high, I let the OP do the calculation for a correction and/or for additional carb intake and I subtract 2 units off of the calculation. Of course that has worked well for me, but you should probably work with your trainer and/or clinic to figure out a possible solution for you. When I met with the nurse/trainer from Insulet about this last summer, she did say that they had decided to change their IOB calculation to be much more in line with how some other pump technologies calculate it. Apparently they’ve had a lot of complaints. She was estimating that change to go in sometime around mid to end of 2011. Of course, since that time, I know that their plans (smaller pod, integrated CGM, IOB calculation) have been delayed, and I’m not sure the release order of the various initiatives or if they’re going to group them together, but I do believe this issue will be addressed/resolved, just a matter of time.
I have mine set at 3 or 3.5 hours for Apidra. It has a shorter tail than other fast acting insulins, so I’d recommend under 4 hours. Like Bradford, I had a longer duration set when I was on another insulin (Humalog).
