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Meal iob work around?

Discussion in 'Parents of Children with Type 1' started by Traci, Jul 1, 2013.

  1. Traci

    Traci Approved members

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    Yes, another meal iob question for the new Omnipod. We need a "beating a dead horse" smilie. ;)

    Just started on the new omnipod after being on the old for four years. Had no issue with the way iob was calculated on the old, and even have come to appreciate the information aspect of the meal iob on the new. However, that's where the love ends.

    I am doing a side by side comparison with the old and new to check it out. I'm using an expired old pod filled with water sitting on the counter and a new insulin filled pod on ds. All settings are the same. Everything was fine and all bolus deliveries were the same until ds had a bg of 272 two hours post meal and I tried to correct. Our dia is currently set to 3hrs. Old pdm suggested a correction of 1.65 but new pdm suggested only .80 due to .85 meal iob. The high was caused because his pod was wrapped too tightly with vet wrap for swimming, not the meal (used a meal that I KNOW affects him a certain way), so I knew he needed the full 1.65 and we just increased the bolus using the "?" screen.

    So, my question is...is this the work around that others are using? Is there another way? I don't want to lessen dia because I don't want to double dip on true corrections, but I'd like that meal iob outta there! Is there some other setting I should adjust?
     
  2. hawkeyegirl

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    What did you do when you pumped with Cozmo? It subtracted meal IOB.
     
  3. Traci

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    Good question! Well, I remember we'd select yes then no to see which way the bolus was higher, but honestly, that only applied at meal/snack times. We'd always take the higher bolus then.

    When it was just a correction that was subtracting meal iob, I don't remember bypassing it (and i confess that I don't remember being so stymied by it) so I guess we just used the smaller correction amount. Hmmm...you've stumped me! Might have to see if I have any old records to figure it out!

    Thanks!
     
  4. denise3099

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    Basically, I like the meal iob b/c just b/c she's high right now doesn't mean that the 1.6 units or whatever from her meal aren't still working. But if I think she's high from somethng else, or I just don't think the iob is going to bring it down then I just use the up arrows to add more. So if the meal is still 1.6 left then I may add that much back. Or I may just estimate and give an extra unit or two. And the cgm helps here too. 200 with up arrows is not the same as 200 with 2 down arrows so no way would I treat that the same.

    I think this is why I couldn't get the hang of the pods last summer coming from MM.
     
  5. Traci

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    Just thinking out loud here, but what if I just increased his correction ratio? It's currently at 1 to 100...I could increase to 1 to 75 so he would get more correction.

    This was our second situation today:
    Bg was 216 and ds was eating 40 carbs two hrs past his last bolus. (He's hit a bottomless pit stage at 13 where he constantly is hungry. He's growing like a weed!). Old pdm suggested 4.0 units (1 to 14 ratio and correction of 1.15) and new pdm suggested 2.85 (same ratio and correction) with the reduction being meal iob of 1.15 (new pdm reduced correction by meal iob, which just happened to be the same amount).

    With a different correction ratio, he would have gotten an additional .75 correction in spite of the meal iob reduction. I guess I just need to see how his corrections have been coming down.

    And, Denise, I totally get what you are saying! Each situation can be different and while I'm fine adjusting up, he's going into middle school and will be flying solo for the most part next year. Trying to figure out the best settings so he's not having to add back a reduction in the middle of running around being a teen.
     
  6. StacyMM

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    This is my biggest complaint with OmniPod. I hate this. It just conveniently throws in a meal IOB that is almost always the exact same amount. It's crap. Which I tell OmniPod every time they give me a chance to do a customer satisfaction survey. ;)

    Our trainer suggested that we reduce the IB time to 3 hours, even though DS is 4 hours and DD is more like 4.5. It's a mess. What we typically do is manually override DD's bolus by a third or a half of the reduction, which is already affected by having a 3 hour IOB instead of 4.5. Works great when she is with us but completely useless for daycare and school. For DS, the 3 hour adjustment does the trick, usually. More issues at dinner than anything else, but he's honeymooning and is relatively low maintenance.

    My newest approach has been to adjust their IC numbers for a small window after breakfast and lunch. It calculates their meals at what I feel are the right amounts but applies a different number 1-3 hours post-meal. My hope is that it will push the correction higher, helping to offset the reduced bolus recommendation for the meal IOB. I don't know if I explained that right...but I hope it makes sense. It seems to be working in the mornings (my first test) for both and I'm just starting to tweak the afternoon numbers.

    I'm convinced that both of their a1cs would go up if I trusted the OmniPod. I have also considered going back to an app we had great success with and just use it for the math and enter the bolus amount manually. If they weren't CGM'ing, we would probably have done that...but carrying the PDM, the CGM and an iPod Touch is just too overwhelming, especially for my son who wants to fit everything into his SPIbelt.
     
  7. Traci

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    I like the higher IC ratio idea. I feel ds should be in range at two hrs post meal, so that would accomplish my goal.

    And I agree completely on the higher a1c. That's going to make me crazy.

    On my test situation above, 2 hrs and 45 min post bolus, he was 101. I did use the new pdm suggested bolus (reduced for prior meal). It certainly worked for that situation, but I wish he could have checked at exactly two hrs.
     

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