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RE: [IP] Cozmo Correction/Meal Bolus - Insulin on Board



 I did not realize that I-P would strip the attachment so here is the info. My
apologies to those on the digest - it is very long.
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 Greetings Shelly, I read your post on IP and I wanted to reply as quickly as
possible. The situation you encountered with your son's Cozmo pump is directly
related to the concept of insulin on board.
 
 The correction bolus feature found on the Deltec Cozmo(tm) insulin pump is
unique to the insulin pump market and it is a wonderful new concept in insulin
pumping. The major intent of the correction bolus feature is to safely lower
high blood glucose levels. The Deltec Cozmo allows you to do this in two ways 1)
Stand alone correction bolus and 2) Correction bolus appended to a meal bolus.
 
 In order to understand the correction bolus concept and how it works in the
Deltec Cozmo pump, the following three topics need to be clearly understood.
 
 1. Correction Bolus Factor: Is how much one unit of insulin will lower a
person's blood glucose. You may have heard this referred to as "insulin
sensitivity" or "high blood glucose factor". Calculating a person's correction
bolus factor can be done in a number of ways. Work with your clinicians to set
up correction factors.
 2. Duration of Insulin Action & Insulin - on - board: The majority of insulin
pump wearers use rapid acting insulin in their pumps. Every individual may have
a slightly different duration of insulin action or how long insulin is active in
their body. This is a very important topic to understand because it will have an
impact on when individuals should test their blood glucose and it will affect
subsequent boluses that are within their duration of insulin action time.
  The Deltec Cozmo(tm) insulin pump allows people to set their duration of
insulin action from 2 - 8 hours. People using rapid acting insulin will most
likely program their duration of insulin action between 3-5 hours. After an
individual programs their duration of insulin action into their pump, Cozmo will
then be able to calculate insulin - on - board. Insulin - on - board is the
amount of bolus insulin that is still active in a person body at anytime
throughout their duration of insulin action. For example: Let's assume your
duration of insulin action is 3 hours and you just took a 3 unit bolus at 8
a.m.. Cozmo will calculate that at 9 a.m. you still have 2 units remaining on
board, at 10 a.m. 1 unit remaining on board and at 11 a.m. Cozmo calculates that
you no longer have any active insulin on board from your 8 a.m. bolus.
     
  Testing blood glucose and taking another correction bolus during the duration
of insulin action time - Unless otherwise directed by a person's health care
professional it is not recommended that a person attempt to take another
correction bolus within their duration of insulin action time. This of course is
due to the potential for a hypoglycemic episode. The Deltec Cozmo(tm) insulin
pump does automatically safeguard against this by continuously calculating the
remaining insulin - on - board. If somebody attempts to deliver another
correction bolus within their duration of insulin action time, Deltec Cozmo(tm)
insulin pump will subtract the remaining insulin - on - board and will suggest
either a lower amount of insulin or recommend no further bolus. Deltec Cozmo(tm)
insulin pump calculates insulin - on - board for all bolus insulin, meal and
correction, and if another correction bolus is attempted Cozmo will subtract the
remaining insulin - on - board from the total amount programmed. Example: in
this example the duration of insulin action is 3 hours, the correction factor is
30 mg/dl, the blood glucose target is 100 mg/dl and the remaining insulin - on -
board is 2 units.
 7 At 11:00 a person takes a 3 unit bolus (meal bolus or correction bolus)
7        At 12:00 the person tests their blood glucose and it is 160 mg/dl
 7 They go to Correction Bolus on their pump and enter their current 160 mg/dl
blood glucose
 7 Cozmo calculates that in order to bring their 160 mg/dl blood glucose to
target (100 mg/dl) they need 2 units because their correction factor is 30 and
multiplied by 2 will give then the 60 mg/dl needed drop
 7 Cozmo then takes these 2.0 units and subtracts the 2 units of insulin - on -
board from the 11:00 bolus and comes up with a suggested 0.00 unit bolus.
  In the above example, the insulin - on - board calculation assisted the person
in not taking unnecessary insulin. This insulin - on - board calculation occurs
anytime a person attempts to take a correction bolus either stand alone or
appended to a meal bolus while they still have insulin - on - board from a
previous bolus. Note: a person always has the ability to not use the correction
bolus feature on Cozmo and they can always override the suggested amount of
insulin. If someone is "grazing" or eating sporadically over a period of time,
they can just say no to the correction bolus and take the necessary amount of
insulin to cover the various carbohydrate they are eating.
 3. Target Blood Glucose: is the glucose target that the Deltec Cozmo(tm)
insulin pump uses to calculate a correction bolus amount. Example: a person's
current blood glucose is 250 mg/dl and their target blood glucose is 100 mg/dl.
Cozmo subtracts 100 from 250 which equals 150 (250 - 100 = 150). In order to
correct the current 250 mg/dl blood glucose the person needs to drop 150 mg/dl.
Cozmo then divided the needed blood glucose drop, in this case 150 mg/dl by the
person's correction bolus factor. If the person's correction bolus factor is 1
unit will lower their blood glucose by 30 mg/dl then this person would need a 5
unit correction bolus (150 w 30 = 5 units). Cozmo calculates that the person
blood glucose will return to their target of 100 mg/dl by the end of their
duration of insulin action time.
Key Education Notes:
 7 The purpose for the correction bolus feature on the Deltec Cozmo(tm) insulin
pump is to safely and consistently lower high blood glucose levels and safeguard
against overbolusing.
 7 Users must clearly understand the key topics of correction bolus factor,
duration of insulin action, insulin - on - board and target blood glucose.
 7 The correction bolus feature is NOT designed to be a blood glucose storage
database. The blood glucoses entered are only used for calculating and
suggestion a correction bolus amounts.
 7 Users must be aware that if they attempt to take a correction bolus and they
still have insulin - on - board from any previous bolus the Deltec Cozmo(tm)
insulin pump will suggest either a reduced amount insulin or will suggest no
further bolus (a safeguard against over bolusing). If a user is "grazing" they
can simply say no to the correction bolus and take the necessary amount of
insulin to cover their food intake.
 7 When using the correction bolus feature a person must enter their current
blood glucose in order for Cozmo to calculate and suggest the proper amount of
insulin.
 7 The correction bolus feature is a simple, linear mathematical calculation
that only takes into account a persons current blood glucose, target blood
glucose, correction bolus factor and duration of insulin action.
 
 I believe your educator was exactly right in telling you to take the 14 gram
bolus without the correction. Your case is similar to the examples and text
above where you are attempting to take another correction bolus while you still
have insulin on board from the correction bolus. This is where you would simply
say no to the correction bolus and deliver the 14 gram bolus. Insulin - on -
board calculation in Cozmo is a wonderful safety tool that can be used to reduce
the chances of overbolusing. Remember, you can always say no to a correction
bolus or override the pumps calculation if you are not comfortable with what is
suggested.
 
Please contact me with any questions,
 
Take care and thanks for your input.
 
Sincerely,   
 
Stuart L. Sundem, MS
Deltec Inc.
Diabetes System Division
Toll Free: 800-544-4734  ext. 7253
Ph: 651-628-7253
Fax: 651-628-7405
email @ redacted
www.DeltecCozmo.com

*************************************************
Shelley

--
Mom to Joshua, 3, dx'd. @ 20 mos.-Pumping Cozmo 6/3/03 & Jessie 21
western Massachusetts
--




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