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Varying ICR and pump settings

Discussion in 'Parents of Children with Type 1' started by Twinklet, May 14, 2008.

  1. Twinklet

    Twinklet Approved members

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    I see that many of you have varying ICR's, depending on amount of exercise your child gets. I'm thinking I need to have a differing ICR for dinner occasionally.

    For all the things I love about the Cozmore, I don't see where I can quickly change the ICR on the fly if I want to. :confused: I'd have to manually calculate it and subtract from the bolus screen or subtract off carbs at the start.

    Do the MM and Animas pumps allow for this? With Cozmore, I can change the ICR by time of day, but can't just decide to use say, 1:15 instead of 1:12 for a certain meal without going in and changing the ratio on the setup screen. Am I making sense?
     
  2. Heather(CA)

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    I understand what you saying, unfortunately I don't know much about pumps...What I can tell you is that going form 1:17 to 1:15 is lowering it by about 1/2 a unit. So if the opump was telling you 6 units, could you do 5 1/2 instead? I don't know if you can put that in manually or not?:confused::cwds:
     
  3. Mary Lou

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    We use the MM and you need to set carb ratios by time, too. It is not easy to change on the fly. If i know that the boys are heading out to exercise, and I feel that the temp basal alone won't keep them from going low, I will just deduct the insulin from the meal. At school, if Andrew is below a certain number for morning recess, the nurses subtract 10 carbs from his snack (in addition to the temp basal) and that is working great.
     
  4. twodoor2

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    We have the MM as well, and like Mary Lou indicated, you cannot change the ICR on the fly. However, I know (through lots of experimentation) that around .2 units is a magic number where it makes a signficant effect on her blood sugar. Her ISF is on average 170 throughout much of the day, so .2 units really makes a difference in how her BG changes. Therefore, if I think she needs a little less or more, I generally change the carb ratio so that she gets about a .2 units differential. However, I can do this on the fly as well since once I get the pump to calculate the bolus, I just add or subtract .2 units at that time. Then later on, if that works, I adjust the ICR to reflect that .2 unit change. Now if she needs a huge change, that's about .4 units, but those don't happen often (usually with growth spurts and sickness).

    Lately with the warm, cold, warm, cold, warm weather we've been having, I've had to make lots of small adjustments lately, so this .2 unit rule really helps.
     
  5. Jacob'sDad

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    I can do it on the fly with Animas.
     
  6. Twinklet

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    Thanks, everyone. I wish we could order insulin pumps like computers--with the features we want on them!

    I'd take the screen and ability to change ICR on the fly from Animas, the IOB calculation and correction bolus + meal bolus feature from Minimed (I *HATE* how Cozmore calculates this, so we do it in 2 steps rather than 1) and ability to do things remotely from a PDA, like the Omnipod.

    I can dream, can't I? ;)
     
  7. Nancy in VA

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    On the Animas, you can set I:C by times of day AND then on a single dose, you can change the ratio on the fly for that one instance.
     
  8. BrendaK

    BrendaK Neonatal Diabetes Registry

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    On the Cozmo software, you can set custom boluses that you can put on your main menu screen. We have one set up that says "Pizza Hut" under the Meal Bolus Screen. If you get on the Cozmanager and go to Custom Meal Boluses, you can program in the specific meal you want to program, give it your own name, and then where it says Carb Ratio Type, it defaults to "Schedule" which is your preprogrammed schedule. If you click down, you can say "Fixed" and then it will ask you to program in the specific insulin to carb ratio you want for THAT specific custom meal bolus.

    Does that make sense?

    So if you normally use 1 unit for 20 carbs at dinner, you can program in one that says "Alternate Dinner Ratio" (or whatever name you want) and make it 1 for 15 units, or a combo, or whatever...

    Oh -- and if you click on the "Use" box at Custom Meal Bolus, it will show up on the Meal Bolus Screen under "Standard"

    You can do a ton of custom meal on the cozmo, but I can't find how to change it on the fly...
     
  9. twodoor2

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    Andie,
    Just curious, what do you hate about the IOB calculation from the Cozmo
     
  10. Twinklet

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    Thanks, Brenda! We do have several custom meal boluses, but I never thought to change it up so that I can use different ICR's. I'll try that today!

    Marsha--Cozmore subtracts too much insulin when we use a combination meal and correction bolus. It always defaults to subtracting ALL the IOB, but sometimes she still has carbs on board, too! So we do it in two steps: Correct a high BG first, then bolus for food. Otherwise she'd be high all day long.

    And if she's lower than her target (say 85 instead of 100), it will subtract both carbs and insulin from her meal bolus.

    For these reasons, we have the "add correction bolus" feature turned off!

    I've spoken to Cozmore about this a number of times, written letters, downloaded the pump and E-Mailed them....but they claim it's a safety feature. It makes me crazy. It would theoretically work if they calculated IOB in a non-linear fashion, but even then it would give me pause.

    I had a Minimed Paradigm here for about a month and they calculate correction bolus + meal bolus with IOB exactly right. Or, I suppose I should say--exactly the way it works best for us!

    I have to run to a meeting, but later I'll find the thread where Mama Belle and BrendaK gave great examples of their issues with this.
     
  11. twodoor2

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    I had a feeling that was your problem, that's why I asked. You know I have the highest respect for you and I know you use the Cozmo, which is a wonderful pump. But I also know you and your husband have a very scientific minds, and I always wondered how you got that linear IOB to work for you.

    I guess it bugs you as well (some other parents complained about it too). Just so you know, the curvilinear IOB works wonderfully, we never worry about subtracting too much insulin because it gives incrediby good estimates due to the smaller time intervals and percentages it uses on the tail end of the DIA. The Cozmo is a great pump though and it has so many wonderful features that I wish the Medtronic had.

    I wish you could customize a pump with features, similar to how you purchase a computer. It would be nice to have all the best features of all the pumps in one!!
     
  12. hawkeyegirl

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    Wouldn't it, though? I am always amazed that the pumps don't snatch up the best features of the other pumps more quickly. Some of this stuff can't be that tough, can it? (I'm thinking specifically of the MM dropping the hundredth place when it calculates boluses, rather than rounding, or not displaying the IOB on the status screen.) I know it's all proprietary technology, but a lot of it is not rocket science!
     
  13. twodoor2

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    Unfortunately, many of these features are patented and proprietary technology, and the algorithms have tons of safety code worked into the logic as well. The patents are probably so specific as to how the bolus and basal algorithms work, that the pump companies probably need to substantially modify the algorithms as to not get sued.

    I wonder if the reason that Omnipod and Cozmo use the linear IOB has something to do with the fact that it's proprietary to use curvilinear IOB's in general. Perhaps Animas and Medtronic have some agreement going on with each other to use them, but to make the algorithms slightly different (Animas calculates boluses to the hundredths unit I believe and MM does not).

    I think Animas is supposed to help Medtronic with dosing up .025u/h feature.

    Well, don't want to hijack the thread. Just some thoughts I always wondered about. It is a competitve market and each pump has to have special features to sell. It's a pity they all can't work together for the sake of people suffering with Diabetes to make one awesome pump.
     
  14. Mom2rh

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    That sound like it would work though...put in the custom meal bolus and then choose it when it is needed. I think that would answer the OPs problem/question.
     
  15. Twinklet

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    Strangely enough, the linear IOB doesn't mess with our correction boluses, so long as we don't add a meal bolus to it.

    The thing is, I don't want ANY IOB subtracted when I do a meal bolus; most of the time, there are carbs on board still digesting. The IOB is there for a reason, IMO.

    I know that for some, this feature does work but for us it takes off too much.

    I looked in vain for that thread where Mama Belle and BrendaK discussed this with examples. It must be a REALLY old thread because I waded through threads up to 18 months old. If I find it, I'll post it because the examples they listed were great.
     
  16. twodoor2

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  17. BrendaK

    BrendaK Neonatal Diabetes Registry

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    Hi Andie,
    We've finally made peace with the IOB on the Cozmo. We do it exactly like you do. Turning it off on for the meal bolus and using it only for highs. Using the Cozmonitor really helps us with that because we don't have to manually enter the numbers in.

    We now have the IOB at 4 hours and it is working fairly well. But I don't hardly ever subtract IOB from any meal bolus. It's only taken into account when we need to correct another high.
     

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