First let me preface this by saying that I’ve only used one pump, the OmniPod and prior to that, I was MDI. I’m having such a difficult time with corrections and can’t help but think that it’s due to the fact that the pod doesn’t recognize any left over meal bolus, when it suggests a bolus due to elevated BG’s. I could be wrong and am wondering if most pumps work this way? I feel like I’ve heard that some don’t…? How do you all handle this? I mean, I’d love to find out that this is why when I’m high I can’t seem to successfully get my sugars down b/c I know this and underestimate the correct dosage, or I over do it and crash. What formula do you all use to figure this math out? Thanks for any advice!
As long as you know what your correction factor is then the PDM will figure out the correct dose for you. It does calculate IOB for any correction bolus you have taken, but not for a food bolus. It’s thinking that all of the insulin you take for a meal will be consumed by those carbs and therefore is not used to caluclate a correction bolus. If you are still high 2 or more hours after you eat then your i:c ratio needs to be corrected. If you are high after a correction bolus, then your correction factor needs to be corrected. Have you tried testing your basal rates? These also may need to be changed, by my IDE had me change i:c and correction ratios first. Hope this helps.
This is the primary reason we decided the pod wouldn’t work for our family. Before the pod was on the market, our daughter began pumping with Cozmo. When it was time for a new pump, we just couldn’t fathom the idea of pumping without the IOB feature that we had become so accustomed to using.
At any rate, when the pod rep was trying to persuade us, he told us that we could enter all boluses as a correction dose and then it would, in fact, keep track of the active IOB.
I don’t really know if this helps, but thought I’d throw it out there anyway.
It was a little tricky for us, because we used Minimed for 3 years, and it calculates it differently. We use Apidra, and it lasts about 2.5 hours, so if she checks at 2 hours after a meal there’s still a bit left on board that the pod doesn’t show, like you said. She just reduces the correction dose a bit to compensate for it. If it’s been 2.5 hours since she ate last, we do a full correction because the food insulin is done working. If you are using Humalog or Novalog your insulin duration will prob be longer than 2.5 hours.
I’ve heard some people enter all food as a correction bolus instead — I can see why but It wouldn’t work well for us. I have a teen and we have to be able to see the carbs since it seems like they are always snacking, ha ha. Too many keystrokes for my dd to enter that way too.
My 4 yr old is on the omnipod - so we do have times when we check her before her insulin is used up - I try to take her blood reading at least 1.5 hours after a meal bolus ( I find that there is not too much insulin action in that first hour) and if I want to correct her then - I minus 1/2 of the meal bolus from the correction (at 2 hours I minus 1/3 at 2.5 hours I minus 1/6) - we have her set that the novolog takes 3 hours to work. I do hope they change the IOB calculation - it would make my life easier when she is being cared for by someone else.
Love the pod, but I’d like to see them change the IOB calc too. I’m not sure they will though. The old Cozmo pump had a bolus wizard almost identical to MM and MM sued them for trademark infringement. Sounds crazy but MM won the lawsuit and Cozmo went out of business. Animas and Omnipod both have slight differences to their bolus wizard and rumor has it this is why (avoiding MM lawsuit).
This is my one major beef with Insulet. In what crazy world do you report the “insulin on board” or “active insulin” as a number other than what it is? I love that they think we all know exactly how many carbs are in everything we eat and that those carbs all release glucose at the same rate.
At any rate, I just wait until after the 3.5 hour mark to make any correction adjustments.
Interesting post by MidwestMommy, though. I can see how the bolus wizard might be some sort of copyright issue, but the formula for calcuating IOB isn’t - unless every book it’s published in is paying Minimed to use that formula, which I highly doubt.
The infringement was actually on what they call a pre-populated field. When you get done putting your blood glucose and carb amounts in the pump and it comes back with a suggested dose this dose is actually already in “the field” (e.g. you do not have to type it in). Cozmo did not pay MM to have this feature thus the lawsuit. Omni actually did pay MM to use this pre populated field as a feature (thus after putting in your info the dose is already there- you do not have to “dial in” the dose). Animas will not pay MM so you actually have to “dial in” the dose when using the Animas pump. If you look at MM patient packets (the ones given to sell their product) this is actually one of their supposed “features” that they show Omni as being up to par with them on and Animas as having to have too many button pushes. I suspect that the next PDM Omni comes out with WILL have the IOB fixed but who knows with the FDA being how it is recently.
Agree 100%. Omni made a mistake on the IOB. Their rep was trying and trying to say the way they track IOB was a good thing but was unable to convince me.
It seems that the UK and US pods are different! My PDM uses all IOB when correcting, even if its a meal bolus! If it thinks I have IOB still no matter what type was given it will wont allow me to give a bolus, all I do in this case is when it shows the screen with the calculation I will press the ? button where it will then show me what it would have given me as a correction and I will then manually bolus instead of using the wizard.
Our CDE had also cautioned us not to correct in under 3 hours because the IOB is not what you might expect (she was careful not to say “not correct” but it seemed to be a struggle).
I think Insulet has decided to change it but will have to go through a Clinical Trial and submit it to FDA approval. The change will probably be included in one of the future upgrades. Our diabetes research center where my son is in the Protege Clinical Trail has posters up asking for study participants for various studies. You can sort of tell from the requirements what they are testing. They also ask my son sometimes. The last Omnipod one, he barely missed because he was only 17 and a half. The study was enrolling only 18 and up.
They must be different. The ? button gives useless info on the US version. I recall a conversation with Gil whats-his-name a while back and he kept telling those of us fighting the pod IOB calculation to just press the ? button to find out bolus amounts for corrections and meals. I was so confused b/c all I get is version numbers and the www.myinsulet.com website. Insulaet must have gotten their latest PDA through the UK clinical trials process rather than using the one we have in the US. I guess that means they are going to re-submit the PDA (or already have?) with the new IOB caculation here in the states.
I have just tried it to make sure I was correct, and have taken pictures of my screen, so I took my BG and it was 9.9mmol/l then pressed Enter and it asked if I was going to eat, I said NO so it then said no insulin required, I then pressed the ? button and got the detailed info, have attached 2 pictures, I hope? lol
I didn’t believe it originally (thought it was just a miscommunication . But there it is, the elusive " Meal IOB". lol.
American version looks roughly like this:
Meal: (shows I:C ratio in ( )
Correction: (shows correction factor division and total needed, if any)
Insulin on Board: (from prior correction boluses…but does not count any meal insulin)
Total: (gives the total based on the addition/subtraction from above).
Man. I want one!
lol, thats why I had to post the pictures, to make sure I was going on about the correct thing as I was getting a little confused!
So we in the UK have something you guys want, and you have something we want! the function to download your data to the computer!
Maybe we should get Insulin/Ypsomed to listen and take the best out of both PDMs and make one superior one
Yup yup. Totally different from what we in the US have. I love that ? screen.