Specifications of the Bolus Wizard

1. Option is “OFF” by default from the factory. All settings must be complete before the Bolus Wizard can be used.
2. The wizard’s calculator tool uses either manually entered BG values or BG values received from the Link Meter.
3. Calculator uses the following information to determine a BOLUS insulin dose:
a. BG (manually entered or beamed to pump from the BD Link meter)
b. Individual insulin to carbohydrate ratio.
c. Insulin Sensitivity Factor (ISF) also known as a “correction factor”
d. Your target pre-meal blood glucose range.
e. Active insulin (insulin from last correction BOLUS still exerting an effect on your blood sugar.
f. We refer to the individual factors as your “ratios”
4. An “estimate” is created for you to review prior to accepting and delivering the suggested amount of bolus

Bolus Wizard Calculator

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Key Benefits of the Bolus Wizard:

Bread & Bricks
If we were baking bread, and were missing one of the ingredients, the whole loaf may not turn out. Likewise, if we bake bread with the wrong ingredients, we are likely to end up with a brick instead of a soft loaf of homemade bread!

This concept is the same with the bolus wizard calculation tool. Without each “ingredient” – carbohydrate ratio, insulin sensitivity factor, and target blood sugar the Wizard will not operate. If your individual rates that are entered into the Wizard tool are incorrect, you will likely not see positive results.

-Though it is called a “Wizard” it cannot magically transform a lack of information or improper values into-positive results!

Procedure for Implementing Bolus Wizard

*Remember, we are aiming for success not perfection!

1. Talk to your health care provider. Have you determined your ratios? When were they changed last? Have they been verified by post-meal blood sugar checks?
2. If you are just beginning pump therapy, it is best to establish the basal rate(s) prior to setting up the bolus wizard.
   a. Your ratios will change when you start pump therapy as your total daily insulin dose changes. Therefore the ratios that worked for you when you were on injections may not work for you on a pump.
   b. Work with your Diabetes Care Team to help you establish and adjust your ratios.
3. If you are moving from one model of pump to another and have verified your ratios, you may set up the Wizard when you feel comfortable with the other programming changes.
4. If you have been using a pump for a while but not consistently using carbohydrate ratios or insulin sensitivity factors to bolus, you may need to “re-tool” to get the most out of your new Paradigm Pump. Speak with a Medtronic MiniMed Certified Insulin Pump Trainer or diabetes educator to help you with this.
5. If you are unsure of the Bolus Wizard functions, then DO NOT activate it!

Tools for setting up your Bolus Wizard:

• Pump User Guide
  
• Record of your individual ratios
  
• Your pump
  * Remember to write down all of your pump settings each time you make a change.

Making “Active Insulin” Work for You
“Active insulin” is the term for what is also known as the “un-used insulin” rule. The basis of the active insulin formula incorporated into the pump functioning is from clinical studies looking at the curve of glucose uptake vs time. Glucose uptake is how fast the body uses up the insulin. Active insulin only takes bolus insulin into account: not basal which should be considered “background” insulin.

The following are some Frequently Asked Questions (FAQ’s) and a Case Study relating to Active Insulin.

Q. When does the pump consider “Active” Insulin?

A. “Active insulin” is only taken into consideration by the Bolus Wizard if there has been a correction bolus within a certain time frame established by the formula in the pump. The pump determines how much of the previous correction bolus has exerted its’ effect on your blood sugar and how much of it is yet to be active. Active insulin does not consider either basal insulin or bolus insulin to cover carbohydrates.

Q. Will the Bolus Wizard consider my activities when it suggests a bolus? Does active insulin stand for activity?

A. No, the Wizard is not a replacement for your own good judgement. If you plan on being active after a bolus, it is up to you to decide how much if any, insulin you wish to reduce or you may prefer to use a temporary basal rate depending on the type and duration of exercise you are planning. You can still use the Bolus Wizard to help you calculate your meal, correction and Active insulin. Once the bolus estimate screen is shown and before you activate the bolus, it is up to you to make any changes. You can still change this amount by using the scrolling keys (arrows) before deciding on a bolus dose. The Bolus Details screen will store what you actually took.

Q. What if I only use the Bolus Wizard some of the time? Will it still know what I have taken?

A. Yes, though you may not have used the Bolus Wizard to program a dose and used the express bolus instead, the Wizard will still factor in the Active Insulin (if any is left) the next time you use it.

Q. I am nervous about using the Bolus Wizard feature of my pump. What can you tell me to reassure me that it is safe?

A. The Bolus Wizard is a tool. Think of it as a calculator that you carry along with your pump. Would you trust the information it displayed? Now consider that instead of carrying it with your pump, it is in your pump. If you answered “yes” to the first question but feel that you would not trust the suggested amount on the pump you may be concerned unduly. Start with writing out your own calculations. Review what the Wizard suggests, but use your own judgement before selecting a dose. You always have the choice of whether or not to “activate” on the Wizard’s estimation and deliver the dose. Remember, there is no substitute for the Bolus Wizard between our ears!

Your Bolus Wizard Checklist:

• I have met with a nurse or dietitian to determine my individual ratios.
  
• I have tested my basal rates and know they are current.
  
• I have read and understand the Paradigm pump user guide.
  
• I have recorded my pump settings.
  
• I understand how to read the “Bolus Wizard Estimation” screen on the pump.
  
• I understand the rationale for the Bolus Wizards’ calculation.

Success with the Bolus Wizard may take some practice to make it work for you. With time and effort, your skills working with the calculator and fine tuning your rates will improve. Even the most precise insulin delivery system cannot foresee changes which need to be made to your diabetes management. Be realistic about what the Bolus Wizard can do for you.