Insulin Pumps Give Different Bolus Recommendations When BOB Is Large

[John Walsh, PA, CDE]

Bolus on Board (BOB) shows how much glucose-lowering activity remains from recent boluses so you can avoid insulin stacking, improve bolus accuracy, and know your current carb deficit or insulin deficit. BOB does not measure any basal insulin activity, only the amount of insulin that is still active from recent boluses. A pump requires an accurate DIA to accurately calculate the BOB.

Different insulin pumps will recommend very different bolus amounts when:

• BOB is present and the glucose is below target</li>
• or BOB is larger than the correction bolus need and additional carbs will be eaten
• or the BOB calculation is inaccurate due to an inaccurate duration of insulin action (DIA)

Find out why these differences are important and when they will occur by viewing the BOB slideshow. You can also download it as a Powerpoint presentation.

[Coravh]

What I liked about the Minimed 515 was that you could adjust the active insulin time. In the older pumps I never used the wizard because it had set the time for 6 hours. I only get three out of my humalog - so being able to adjust that time made a big difference in the bolus on board calculation.

Cora

[2098R]

Well after going throught that I bumped my DIA up 15 minutes to 4 hours. I want the new Deltec since it tell how many carbs are needed.
Cool!
Whit

[Orffyreus]

On sick days, I run increased basal + decreased sensitivity + decreased carb ratios on my 522, but the sick day settings don't really come together until I also drop my insulin duration down from 4hrs to 3hrs, and that seems to be the finishing touch.

I'm a stickler for counting carb grams accurately, which seems to be key to being able to trust the bolus wizard's decisions. Sure it's conservative, but it usually lands me close to my target if I'm patient and don't try to second guess it.

[Hand-Some]

I think the biggest difference going from MDI to the pump is that I feel like I've finally found the “knob” that turns my blood sugar up and down. I'm in control and it makes sense. I don't have the wild swings that I had before. It is quite an emotional high to feel so in control and so stable. And I feel like I finally have a blood sugar meter like the ones shown in television commercials ... you know, the ones that always read 103! Well okay, even now my blood sugar meter doesn't always read 103, but you get the idea.