Diabetesnet.com
12-14-2009, 07:15 PM
Visit our Ask John Q&A Blog (http://www.diabetesnet.com/ask_john/) for more entries and leave your comments (http://www.diabetesnet.com/ask_john/?p=72#respond).
My first pump was the Deltec 1800 (http://www.diabetesnet.com/diabetes_technology/insulinpumps_deltec.php) and all I’ve known is their HypoManager (http://www.smiths-medical.com/landing-pages/promotions/md/coz-features.html). In Feb I was informed that I need to select a new pump and chose the OmniPod. I really miss the HypoManager and am looking for a replacement tool. Do you know of any? Or where I can get the formula to figure out the needed carbs like the pump did? I’ve tried Google searches but nothing so far.
Thank you in advance for your suggestions.
M
——-
M,
The Cozmo pump was very special and offered more features and functionality than anything available today. Two of the Cozmo engineers, Rhall Pope who led their pump projects and was an exceptional person but who passed away in 2008, and Mike Blomquist who has diabetes and commonsense creativity, were instrumental in designing Cozmo’s software and in providing its many useful features.
Some background first. I ran into Rhall and Mike at a diabetes conference in about 2005 and gave them the idea for the HypoManager (not the name). I pointed out that pumps were giving only half the story. Whenever a glucose test is done, the glucose plus the bolus on board (http://www.diabetesnet.com/diabetes_control_tips/bolus_on_board.php) (BOB) at the time let the user know whether they have an insulin deficit or a carb deficit, and that a pump should tell the user the complete story. Any time that BOB is greater than the correction need or greater than the correction need plus the planned carb intake, a carb deficit exist.
In a later discussion, they said they thought they should warn of a carb deficit only when the glucose was below the glucose target in the pump. I pointed out that a relative carb deficit can be present even when the glucose is well above the target glucose. Even when the glucose is high, if the pumper knows they have a relative insulin excess (or carb deficit) a warning would warn them that they need to check their glucose later due to this excess bolus insulin. Sort of a poor man’s CGM. That is how the HypoManager ultimately got set up.
Since Cozmo’s demise, discussions have been conducted with other companies regarding the acquisition of Cozmo’s intellectual property, including the HypoManager, but I don’t know if another pump company has picked this up yet.
Though none of today’s pumps offers the convenience of the Cozmo HypoManager, you can calculate a carb deficit on any pump. Keep in mind that the Omnipod, with its default settings, cannot do this. Its default setting only counts correction boluses given in the past as “insulin on board”. Why they don’t count carb boluses for BOB is beyond my comprehension because most carbs (not all) are digested in a much shorter period of time (less than 2 hours) than its carb bolus will stop lowering the glucose (about 5 hours or more). So the bolus recommendations from the Omnipod pump can often be excessive if you use its default settings.
Fortunately, the Omnipod offers what they call a “reverse correction” that should always be turned on. When on, this oddly-named feature allows carb boluses to be included in BOB so you can see an accurate amount. BUT, when the current BOB is greater than your correction bolus need at the time, the Omnipod does not subtract the excess BOB from your carb coverage unless your glucose happens to be below your target glucose, similar to the current Ping pump. The Paradigm never subtracts BOB (active insulin) from a carb bolus, no matter how excessive it happens to be. Because the Omnipod calculates duration of insulin action in a linear fashion, be sure to set the Omnipod’s DIA time to 4.5 or 5 hours to get an accurate BOB calculation.
Once you have this set up, look to see whether your BOB is greater than your correction bolus need each time you check your glucose. If your BOB is greater, subtract your correction bolus need from it. Then multiply this excess in your BOB times your carb factor to find out how many grams of carb you may need to compensate for the excess insulin. That is:
If BOB > correction bolus need: (BOB – your correction bolus need) x your carb factor = grams of carb you need
For instance, if you use 1u/10 grams and your correction need happens to be 1.5u but your BOB is 4.0u:
4.0u – 1.5u = 2.5u x 10 grams/u = 25 grams of carb that you may need later.
Calculating your carb need when you are low is a tad more complicated. A quick way to do this is add 1 gram of carb for every 4 mg/dl you are below your target. So if your target is 100 and your glucose is 6:
100 – 60 = 40
40/4 = 10 grams of carb
If your BOB at the time happens to be 2.5u, then 25g for the BOB plus 10g for the low glucose = 35 g needed to correct the situation. Like the HypoManager, knowing this can help avoid emptying your refrigerator when you get low!
So now you know the rest of the story.
John
Visit our Ask John Q&A Blog (http://www.diabetesnet.com/ask_john/) for more entries and leave your comments (http://www.diabetesnet.com/ask_john/?p=72#respond).
My first pump was the Deltec 1800 (http://www.diabetesnet.com/diabetes_technology/insulinpumps_deltec.php) and all I’ve known is their HypoManager (http://www.smiths-medical.com/landing-pages/promotions/md/coz-features.html). In Feb I was informed that I need to select a new pump and chose the OmniPod. I really miss the HypoManager and am looking for a replacement tool. Do you know of any? Or where I can get the formula to figure out the needed carbs like the pump did? I’ve tried Google searches but nothing so far.
Thank you in advance for your suggestions.
M
——-
M,
The Cozmo pump was very special and offered more features and functionality than anything available today. Two of the Cozmo engineers, Rhall Pope who led their pump projects and was an exceptional person but who passed away in 2008, and Mike Blomquist who has diabetes and commonsense creativity, were instrumental in designing Cozmo’s software and in providing its many useful features.
Some background first. I ran into Rhall and Mike at a diabetes conference in about 2005 and gave them the idea for the HypoManager (not the name). I pointed out that pumps were giving only half the story. Whenever a glucose test is done, the glucose plus the bolus on board (http://www.diabetesnet.com/diabetes_control_tips/bolus_on_board.php) (BOB) at the time let the user know whether they have an insulin deficit or a carb deficit, and that a pump should tell the user the complete story. Any time that BOB is greater than the correction need or greater than the correction need plus the planned carb intake, a carb deficit exist.
In a later discussion, they said they thought they should warn of a carb deficit only when the glucose was below the glucose target in the pump. I pointed out that a relative carb deficit can be present even when the glucose is well above the target glucose. Even when the glucose is high, if the pumper knows they have a relative insulin excess (or carb deficit) a warning would warn them that they need to check their glucose later due to this excess bolus insulin. Sort of a poor man’s CGM. That is how the HypoManager ultimately got set up.
Since Cozmo’s demise, discussions have been conducted with other companies regarding the acquisition of Cozmo’s intellectual property, including the HypoManager, but I don’t know if another pump company has picked this up yet.
Though none of today’s pumps offers the convenience of the Cozmo HypoManager, you can calculate a carb deficit on any pump. Keep in mind that the Omnipod, with its default settings, cannot do this. Its default setting only counts correction boluses given in the past as “insulin on board”. Why they don’t count carb boluses for BOB is beyond my comprehension because most carbs (not all) are digested in a much shorter period of time (less than 2 hours) than its carb bolus will stop lowering the glucose (about 5 hours or more). So the bolus recommendations from the Omnipod pump can often be excessive if you use its default settings.
Fortunately, the Omnipod offers what they call a “reverse correction” that should always be turned on. When on, this oddly-named feature allows carb boluses to be included in BOB so you can see an accurate amount. BUT, when the current BOB is greater than your correction bolus need at the time, the Omnipod does not subtract the excess BOB from your carb coverage unless your glucose happens to be below your target glucose, similar to the current Ping pump. The Paradigm never subtracts BOB (active insulin) from a carb bolus, no matter how excessive it happens to be. Because the Omnipod calculates duration of insulin action in a linear fashion, be sure to set the Omnipod’s DIA time to 4.5 or 5 hours to get an accurate BOB calculation.
Once you have this set up, look to see whether your BOB is greater than your correction bolus need each time you check your glucose. If your BOB is greater, subtract your correction bolus need from it. Then multiply this excess in your BOB times your carb factor to find out how many grams of carb you may need to compensate for the excess insulin. That is:
If BOB > correction bolus need: (BOB – your correction bolus need) x your carb factor = grams of carb you need
For instance, if you use 1u/10 grams and your correction need happens to be 1.5u but your BOB is 4.0u:
4.0u – 1.5u = 2.5u x 10 grams/u = 25 grams of carb that you may need later.
Calculating your carb need when you are low is a tad more complicated. A quick way to do this is add 1 gram of carb for every 4 mg/dl you are below your target. So if your target is 100 and your glucose is 6:
100 – 60 = 40
40/4 = 10 grams of carb
If your BOB at the time happens to be 2.5u, then 25g for the BOB plus 10g for the low glucose = 35 g needed to correct the situation. Like the HypoManager, knowing this can help avoid emptying your refrigerator when you get low!
So now you know the rest of the story.
John
Visit our Ask John Q&A Blog (http://www.diabetesnet.com/ask_john/) for more entries and leave your comments (http://www.diabetesnet.com/ask_john/?p=72#respond).