Review – Roche Accu-Chek Aviva Expert

By | 12 April, 2011
A picture of the Aviva Expert stolen from the Roche website. Sorry Roche.

A picture of the Aviva Expert stolen from the Roche website. Sorry Roche.

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?

Lo! and behold! Everyone’s second favourite diabetes peripheral manufacturer – Roche – has done just that, with the new and wonderful Accu-Chek Aviva Expert.

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.

More copyright infringement in action

More copyright infringement in action

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!

25 thoughts on “Review – Roche Accu-Chek Aviva Expert

  1. Tim Post author

    Oh yeah, it also does pretty graphs and things of your results – which look great on the colour screen. It also plugs into your PC to download data if you’re into that sort of thing.

    Reply
  2. jason

    Great review Tim. I use the Combo pump and this meter and I love it because it is very easy to use and I really like the remote bolusing feature.The Roche rep told me that they are also working on CGM capability although it will be “next year” before we get anything juicy to check out 🙂

    Reply
  3. Mike

    thank you @tim

    a pleasure and confirms that roche have indeed produced a meter that has the capacity to drown puppies..

    for sure my next stop if I can get hold of one. Mike over at every day ups n downs has been raving about the meter too..

    question? how does the wizard of bolusy place compare with the pump?

    Reply
  4. Tim Post author

    Thanks @Jason – I hate writing reviews, so I’ve been putting this one off for months 😉

    Reply
  5. Mike

    sorry mate, tragedy of having kids that watch the disney channel.. 🙁
    how does the bolus wizard on meter compare to pump bolus wizard?

    Reply
  6. Tim Post author

    @mikeinspain He he!

    There’s not much in it – but I think I actually prefer the interface on the Expert – it’s just a smidgen more intuitive than the wizard on the Veo. In terms of number of settings, etc., they’re much of a muchness.

    Reply
  7. Annette A

    For info, the wizard is (I think) exactly the same as the one on the Accuchek Spirit pump – the pump one came first, then they lifted it for the non pump people.
    Next job for @tim – comparing the wizards, please…

    Reply
  8. Annette A

    But I dont have the veo pump, so can only comment on the Accuchek Expert/Spirit wizard…Quite happy to do something on the Accuchek one, but it wouldnt really be a comparison…Me thinks its time perhaps for a joint effort here. @tim, I will be in touch…

    Reply
  9. Richard

    This is one of the meters i would most like to try out, as i really think it would help me getting the correct doses, – i currently always seem to drastically under estimate the amount of insulin i need

    I did contact Roche a few months back asking if i could buy one, they gave me a price of £110 but they wouldnt even sell me one without a referal from my DSN

    in previous communications with my DSN she seems to rate all things ‘bayer’ besides i wouldnt really feel like contacting her with just a request for a referal for a glucose meter,

    so i guess my prescription for test strips will continue to be ‘wavesense jazz’ 🙁

    Reply
  10. Mike

    @searley I would deffo get on to your Bayer-touting DSN and get her to get hold of an Expert for you. It took me a couple of months after the initial setup to get mine set up right (for reasons too dull to go into here it can help to set some of your ranges and levels to be not quite what they are, but what the expert needs them to be to give you effective advice).

    I have to completely agree with Tim. When it’s working well it is really VERY effective at steering a course towards the midpoint of your range. Best so far has been approx 10 days with very few hypos and 70% of readings between 4-8 (including post meal). It even makes a half-decent stab during illness and other tricky times.

    Reply
  11. Richard

    @mike

    i use 2 insulins, novorapid with meals, levemir before bed, i assume the expert is only really concerned with the novorapid injections? and if i need to adjust the levemir i would do that based on what my readings are pre-breakfast, currently if im too high for a few mornings in a row i increase 1 unit every three days until im at a level in the morning that i am happy with

    or is the expert aware of the levemir too?

    Reply
  12. Tim Post author

    Uhm, I don’t know – were you expecting a professional review? 😉 I think it can log your long acting insulin but whether it can give you advice on your basal levels I don’t know – I would suspect not. Do you know @Mike?

    Reply
  13. Clare

    I’ve had one for about 6 months now. You can log your long-acting, but it doesn’t do anything with it, which can be frustrating if you’ve had too much or too little basal that day. I think this meter is really good, but it doesn’t go far enough in a way. It would be nice to be able to set up profiles for an exercise day, for example, rather than just for each blood test. Maybe it’s because I’m a software developer that I’m thinking about all the useful things that could be done with all that data 🙂

    Being able to see the active insulin on board is really helpful though and has stopped me from having too much on more than one accasion.

    Reply
    1. Mike

      Sorry, late to reply… and yes, while you can log basal the Expert just assumes all is fine and dandy with it.

      The other thing to bear in mind with the ‘Active insulin’ setting is that it’s not *quite* what it says on the tin. It’s only counting down ‘active correction’ whatever is added (or you did yourself as an override) which was not understood to be dealing with the carbs logged for the meal. If you want to track full doses you need to back out of the ‘bolus advice’ screen then add the bolus manually.

      Reply
      1. Alison

        @mike I find that a strange way of logging active insulin, but something at the back of my mind seems to remember that’s how the Roche pumps do it too – have I made that up or is that true?

        Reply
        1. Annette A

          No, thats true – as the Expert was lifted directly from the Spirit Combo pumps. I dont know why, but it seems to make perfect sense to me…

          Reply
  14. Rohan

    Hmmm. Sounds like a useful bit of kit. Sadly I STILL haven’t got around to working out numbers to go with my (usually pretty accurate) guesstimates. One day, maybe by the time this is a CGMS with allowance for basal and bolus, eh? 😉

    Also, is it just me that keeps reading @mikeinspain as mikes in pain?!

    Reply
  15. Mike

    @neobrainless Rohan you would be correct that @mikeinspain is indeed in pain! 【ツ】

    Reply
  16. Richard

    well.. i emailed my DSN, and she has a couple of these to give away, she wont give me one without an appointment which is early may.. so i soon should be able to have a play with one of these 🙂

    Reply
  17. Peter Childs

    Got given one yesterday by Kings College Hospital where I’ve just been refereed with the idea that I might be better off on a pump, No progress on that once yet they want more tests and numbers, They plan to put me on a CGM for a week in a months time. Its a lets collect more data issue but at least that’s positive! They gave a few ideas to improve what I’m currently doing, but lets say I’m not sure they are going to work.

    I was using a Accu-chek Mobile before and had used the standard Accu-Chek before that, hence I know how Accu-check machines work….

    However having tried to use the Accu-Chek Expert for 24 hours, I now HATE it with a passion!!!!! I suspect this is all horses for courses but it usually takes a lot to make me hate something this badly!

    I’ll point out I’m a computer programmer and I’ve been thinking of writing a Mobile App to do this for a while but never quite got round to it…. So from an IT point of view I should know my stuff! I was also interested to see something I’d been thinking of creating…..

    anyway why do I hate it quite so much.

    1. Waste! It uses strips! which only get scattered and spread everywhere, the things in my book are worse than Fag ends or chewing gum (and I don’t smoke and never have and I don’t chew either but you know how you get annoyed by how they get everywhere down the streets and councils spend no end of time fining people £60 for dropping them, when in my book test strips are not much better…….) I love the Mobile due to the Cassettes hence no tine waste, yes you have a cassette once a fortnight, but that’s big enough to end up in the bin it does not go everywhere….

    2. Too Many buttons and they are a poke setting it up is a pain and it does not “learn” there is nothing there there I can’t do my self and its not flexible enough to log real things.

    3. Its not very “expert”….

    3a If you do a test go and do something else and come back it does not allow you to bolus advise on the last test…. If you do a test, go away eat you meal then bolus (once you know how much you’ve actually eaten). It will not do anything, fat lot of use that is back to the paper and pencil method! or you want to change your ratios before injecting it will not do your maths for you any-more.

    3b It will not learn from previous tests and make suggestions as to what do to make improvements not sure I would want it do that but……..

    3c As someone else says it does not tell you “Insulin Onboard” but more like “Insulin leftover” a point that needs making more clear in the manual! Also if you go an do the maths your self and add that later its going to come up with quite different numbers!

    4. On the good side nice “free book” Carbs & Cals came with it if its not a little patronizing.

    Reply
  18. Peter Childs

    Ok having used it for a bit longer it grows on me…. Its one of these gadgets that once you sit down and work out how it works its quite useful. However its UI (User Interface) could been improved greatly.

    The comment that it needs setting up with the help of your DSN I would agree with, I would actually go further you need help setting up with the help of a Computer Tech, A DSN or somone who has used it for a while…. is probably true down to a Tee.

    In short its a useful gadget but I’m not sure its worth the effort of learning……

    A better User Interface would go a long long way. But that would probably need a a larger display and a touch screen, also I’d drop the Infra-Red and replace it with either BlueTooth (Since it looks the same as the Metre on the Combo Pump and that communicates via BlueTooth) or a USB Cable, possibly USB charger like Mobile phone’s have…..

    Peter.

    Reply
    1. Paul

      @peterchilds glad its grown on you a bit, I’d made a note to comment as some parts of it seemed a little harsh.

      Its not a bad little system (i use it with the pump & it does what I need) but I’d say its the flaky, I’ve always used their meters & this is the worst I’ve seen them make. I wanted the remote pump control, if I was entering manually I’d fall back to the aviva nano which was quicker & more stable for me.

      I’d still pick it again but it really could’ve done with some rounding of the corners before being released.

      Reply

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