Avid readers of your soaraway Shoot Up will know that I’m a fan of my puntastically named pump Englebert Pumperdinck. This is for many reasons which I’ve covered off in previous articles so I won’t bore you with them again here.
However, one of the unexpectedly useful features of Englebert is the bolus wizard, which Alison has also raved about in an article last year which was peppered with confusing references to some apparently popular fictional child wizard.
In essence the bolus wizard is a calculator that you program with a variety of details pertaining to your diabetes (more about this later). Once programmed, you can then bung in the amount of carbs you’re going to eat, your current blood glucose reading and it flings out an educated guestimate of how many units of insulin you should inject.
So for example, I’ve just said to my pump that I’m going to have 280g of carbs (the sort of carbs associated with an over-indulgent bacchanalian 19-course medieval feast) and it’s told me to put in 36.8 units of insulin (which I declined to do, as I’m about to eat an apple, not gorge myself on 19 courses of sweet meats and mead). All this based on my current BG, my carb ratios for this time of day, the amount of insulin that’s currently swimming through my veins and so on.
Needless to say, once I got the bolus wizard set up I become incredibly reliant on it and rarely use anything else to work out my insulin needs. It’s made me very lazy – but that’s mainly because it works extremely well.
Wonderful though it is, the bolus wizard is actually pretty simple. It’s a basic formula on a basic calculator. So why, I wondered, had no-one made a version of just the bolus wizard calculator bit of the pump for people on injections?
The Aviva Expert is basically a blood glucose meter with a bolus wizard for MDI users built in and very, very good it is too!
As a meter the Expert is quite sexy; it’s pretty small, black, has a nice colour screen and logical and easy-to-use menus, buttons and backlights. But that’s not nearly the whole of it.
The first time you use the Expert you’ll need to run through the set up wizard. This is somewhat more complicated than a normal meter and I (and the Roche rep. I spoke to – hello Andrew!) would strongly recommend you go through it with your DSN or other usefully competent diabetes specialist the first time you use it.
First of all you set the units you measure carbs in – like most people I went for grams – but you can do exotic things like “Bread Equivalent” and “Carbohydrate Choice”, which I’ve never even heard of. You then set your upper and lower BG limits – say 12mmol/L for too high and 3.5 mmol/L for too low.
As well we all know, our insulin needs, insulin sensitivity, etc. change throughout the day and this is reflected in the next section of the set up process in which you define “time blocks”. So, for example, the Expert comes with time blocks of 00.00 to 05.30, 05.30 to 11.00 and 11.00 to 17.00 and so on. In each time block you can set different BG target ranges. So you might want to give yourself a lower target range to wake up with or a higher target range for after lunch.
You can further customise the time blocks by tweaking your carb ratios throughout the day. So, between 05.30 and 11.00 you might have a carb ratio of 1u of insulin to 10g of carbs, while in the evening between 17.00 and 23.00 you might go for 1u to 15g of carbs.
Similarly you can also adjust your insulin sensitivity throughout the day. So you might program it to remember that between 05.30 and 11.00 1u of insulin might reduce your BG by 3 mmol/L, while between 17.00 and 23.00 1u of insulin will reduce your BG by 2 mmol/L.
Moving on, you can also configure various “health events”. So if you’re doing “Exercise 1” it will know to calculate that you need, say, 10% less insulin than normal and if you’re indulging in “Exercise 2” then you need 15% less. If you note that you are suffering from “Stress” it will calculate that you will need, say, 20% more insulin than usual. Each event is individually programmable for your needs.
You can then adjust various settings including the typical size of “snacks” you consume and how long your insulin is active for – which is then used to calculate how much insulin you have “on board”.
As well as the bolus wizard there are a lot of other settings that could be useful. For example, the meter can be configured to remind you to test, say, two hours after a high blood glucose reading or 15 minutes after a low reading.
If all this sounds complicated, then – well – it is. There are a gazillion settings which all need to be set and tweaked as you work out what’s best for you. Hence Roche recommending you get your DSN to help you set it up. Something I would wholeheartedly endorse as I mentioned a minute ago.
So after investing all this time in setting it up, how does it work?
First of all you might do a blood test (the meter functions are pretty much like any other meter so I won’t bore you with them here) and it’ll spit out a reading. Leave it for a second and it’ll move onto the next menu, from which you can select “Carbs”. You then put in, say, 25g of carbs and hit “Bolus”.
So when I tested a moment ago, I had a reading of 5.8 and my target was 6.0 for this part of the day; so it subtracted 0.2 units to bring me back up to 6.0 and added 2.8 units for my 25g of carbs. Giving a total of 3.0 units to inject.
You can override the advice if you want to (perhaps you’ve been out a walk and so you might knock off a unit or two). Once satisfied you finally hit “Confirm” and the device records that you’ve stuck in 3 units and will then tick this amount down over the next few hours to allow you to calculate your insulin on board.
So, once it’s set up, you essentially have a meter with a built in bolus wizard for MDI users. Obviously the results it spits out are dependent on you programming and using it correctly (after all it can’t be expect to calculate your insulin on board if you don’t tell it when you inject) – so, as always, rubbish in rubbish out. But used properly, the Aviva Expert is undoubtedly a very, very good and useful bit of kit which I really do think could be a brilliant tool to help MDI users get better control more easily.
Unlike my other meter reviews, I’m not going to mark the Expert out of five in our usual categories. This is because comparing it with another meter is like comparing apples with cheese; much like that odd analogy, it just doesn’t work. However, if I was to mark it just as a meter it would actually score pretty highly; it’s small, sexy and has a lovely big colour screen.
But the Expert is far, far more than just a meter – it’s genuinely a brilliant bit of kit. If you’re on MDI and want to have a bit of help with deciding how much to inject then start badgering your DSN for a go on the Expert today. It really is worth it!