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[IP] Re: Correcting for lows

Sue Ann Wrote:
Yes, but the correction in the Paradigm (and I think for the others 
also) does not take into account the amount of insulin on board when 
correcting for a low. Example from my own pump history:  BG 70 at
lunch.  Ate 60 carbs.  Pump calculated 3.7 bolus for food, - 1.0 
correction--fine.  But the 1.1 U IOB it calculated was totally ignored, 
as the recommended bolus was 2.7.  I took it, and was fighting lows by 
an hour after lunch.

Ricardo Responds:
Based on the current definition for IOB it should not be taken into 
account when we are below target.

In my opinion current pumping technology is an insulin delivery system 
with a built in calculator (for bolus recommendations) and some 
programability (for basal changes, reminders, etc.). I think the 
confusion with IOB comes about when we tend to project too much 
intelligence onto the pump.

Current pumps make bolus recommendations with assumptions of correctly 
set basals, insulin to carb ratios and insulin durations. When we are 
low too soon after a meal it is indicative of an incorrect basal or 
carb ratio or the effects of stress, hormones etc. The pump does not 
correct for any of these factors or even give you a warning. The only 
warning my Animas IR 1200 gives is for high or low BG. low cartridge, 
etc. Other than the effect of IOB on correction boluses it does not do 
any evaluations on the pump settings I entered. In order to take IOB 
into account when below target it would have to  do an evaluation 
outside of the current definition for IOB.

If I ate a meal , gave a bolus and was 70 a few hours later I would 
love for my pump to show a warning that says

"Your BG has been below target within 2 hours of your bolus for the 
last 5 days. Please check your basal rate or carb ratio."

Intelligent pumps would do some diagnostics on our data and make 
recommendations based on variables as well as the assumptions. Current 
technology does not offer this. I think future pumps are moving in this 
direction with web links but the logic would lie on the servers instead 
of the pump.

Dx'd 1967, Pumping since 1/14/2004 w/ Animas IR1000 and since 7/2/2004 
w/ the Animas IR1200
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