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Re: [IP] MiniMed not registering Active Insulin

When you press the B button on the 515 it will ask for your BG,  press ACT 
and it ask for the Carbs..... may have missed the carbs msg

----- Original Message ----- 
From: "Sarah Dowdell" <email @ redacted>
To: <email @ redacted>
Sent: Tuesday, June 06, 2006 8:58 AM
Subject: RE: [IP] MiniMed not registering Active Insulin

> <<<I bolus 8 units for a meal
> I then test BS, BS sent to pump
> I then tell pump using the Bolus Wizard what the carbs were
> With my ratios the answer was 7.6
> It suggests I take 7.6>>>
> It sounds like the wizard is working exactly as it is intended.  You're 
> supposed to program in the number of carbs before you give a bolus, not 
> program in the number of carbs after you give the bolus.  The wizard can't 
> know that the 8 units you just gave were for the carbs that you later 
> programmed in.  It thinks that the 8 units that were already programmed in 
> were for something else, even though you didn't tell it what it was for 
> (more carbs, a high BG, missing basal).  The wizard thinks that you are 
> consuming an additional amount of carbs equal to another 8ish units of 
> insulin.  The wizard does not subtract remaining insulin from a second 
> bolus for a new source of carbs, only for a high or low BG.  The wizard 
> thinks that any previous insulin is working on food that you already 
> consumed, and by entering more carbs, you are consuming more food.  It is 
> done this way so that you can bolus effectively when you are eating food 
> in more a grazing motion, kind of like when you eat out at restaurants or 
> at a party.
> For example, you have 20 g carbs in the appetizer and you bolus for 20 g 
> carbs.  20 minutes later your meal comes and you have 60 g carbs and you 
> give a second bolus for the 60 g carbs (which you would certainly want to 
> get the full amount for even though most of the previous bolus is still 
> active--if the wizard subtracted the IOB, then you would effectively only 
> bolus for 40 g of your meal and not 60 g).  30 minutes after that you 
> decide that want desert which is another 50 g carbs (at this point if the 
> wizard were to subtract the IOB, it would not suggest that you take any 
> insulin for the remaining 50 g carbs).  So instead of giving enough 
> insulin to cover 130 g (20g+60g+50g) of carbs, if the wizard subtracted 
> the IOB, then for the meal that you just ate, the wizard would have 
> suggested that you only bolus for 60g of that total!  I don't know about 
> you, but 70g of unbolused carbs would send me into the 400s or higher.
> You do need to be aware when using the bolus wizard on ANY pump and take 
> into consideration common sense.  It is possible to make a mistake 
> calculating the number of carbs that you ate, or your body may just decide 
> not digest the food that you just ate, or whatever.  The pump, as a 
> machine, has to go by what you tell it and take that as absolute fact.  It 
> can't think, "well I just delivered 8 units so the person programming into 
> me must have already taken the insulin to cover what they are telling me 
> that they are going to eat, so I won't suggest any insulin."  Instead, the 
> pump is programmed to calculate "I delivered 8 units a few minutes ago. 
> Now they are telling me they are eating more carbs.  I need to suggest 
> more insulin to cover those carbs."
> On a side note, since you mentioned that you are using the MM512, the 
> insulin on board calculations are not accurate anyway.  This pump assumes 
> that insulin remains active for 8 hours, which almost all people find is 
> way too long for fast acting insulin.  This problem was fixed in the MM515 
> pump (and the MM522 pump) so that you can put the active insulin time at 
> around 3-6 hours, which most people find much more accurate.  When I was 
> using the MM512, sometimes I would find that if I gave a correction bolus 
> before bed, the pump would think I still had active insulin in me when I 
> woke up the next morning!
> Hope this helps!
> Sarah, dx'92, pumping'00
> .
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