Calculating Insulin Settings
No two individuals are the same. As educators we know that this especially applies to selecting a mode of insulin delivery. It’s important to meet the patient where they are in their diabetes self-management journey and help guide them on their next steps.
We’ve all seen this patient: someone who is not ready or interested in beginning pump therapy but is motivated to manage their diabetes. A patient that wants more out of their current multiple daily injection therapy than arbitrarily delivering insulin before meals. A patient that often feels the fear and frustration that comes with experiencing hypoglycemia due to insulin stacking. In this case, the InPen™ Smart Insulin Pen might be able to help since it’s dose calculator, available in the app, can track active insulin. Whether the patient uses pre-set fixed meal doses, meal estimate sizes (for example: low, medium or high carb), or programming a carb ratio, the InPen™ Smart Insulin Pen can help simplify mealtime insulin dosing. Additionally, the InPen™ Insights report can help you assess how much the patient is dosing and gain full visibility into their meal intake and glucose values. This data also allows you to see whether a meal dose was forgotten or overridden and more importantly, whether the patient’s settings need to be adjusted. Overall, this can make it easier for you and the patient to collaborate and identify new ways to help them achieve their goals.
What about the patient that is beginning pump therapy but is not yet ready to use the Bolus Wizard™ feature? Not a problem! For this patient, there is a pre-set bolus option. This option allows for programming of fixed doses for breakfast, lunch, dinner and snacks. This enables quick and easy bolusing at the appropriate times without the need to count carbohydrates. In fact, the OpT2mise study showed that patients in this group can improve their glycemic control despite not counting carbs1. Specifically, 58% of type 2 participants in this study used fixed meal boluses and saw an average reduction in A1C of 1.2%.
And then there’s the patient who is ready to move to the next step, they’re ready to count carbs and want more precision when bolusing through their pump. Hello, Bolus Wizard™ feature! This feature uses the carb ratio, insulin sensitivity factor, blood glucose target and active insulin time recommended by you to calculate the patient’s mealtime doses. All they need to do is simply check their blood glucose and enter their carbs, leaving the math to the pump. And don’t forget, CareLink™ reports are available for you to assess the appropriateness of these settings.
Let’s take it one step further and consider the patient that is using SmartGuard™ Auto Mode as well. In SmartGuard™ Auto Mode, the hybrid closed loop algorithm determines the insulin sensitivity factor every 24 hours based on multiple factors including a glucose target of 120mg/dL. This leaves just two settings for you to adjust as needed: the carb ratio (most common) and active insulin time. For this patient, the Auto basal adjustment may help further reduce glycemic variability and increase their overall time spent in range*1-4!
Are you looking to learn more about how to complete initiation settings for patients starting pump therapy, continuous glucose monitoring (CGM) and/or SmartGuard™ Auto Mode? If so, you can learn more here. And as always, feel free to reach out to your Medtronic Clinical Territory Manager for support.
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Refers to SmartGuard™ Auto Mode. Some user interaction required. Individual results may vary.
1
Aronson R, Reznik Y, Conget I, Castañeda JA, Runzis S, Lee SW, Cohen O; OpT2mise Study Group. Sustained efficacy of insulin pump therapy compared with multiple daily injections in type 2 diabetes: 12-month data from the OpT2mise randomized trial. Diabetes Obes Metab. 2016 May;18(5):500-7. doi: 10.1111/dom.12642.
2
Bergenstal RM, Garg S, Weinzimer SA, Buckingham BA, Bode BW, Tamborlane WV, Kaufman FR. Safety of a Hybrid Closed-Loop Insulin Delivery System in Patients With Type 1 Diabetes. JAMA. 2016 Oct 4;316(13):1407-1408. doi: 10.1001/jama.2016.11708.
3
Garg SK, Weinzimer SA, Tamborlane WV, Buckingham BA, Bode BW, Bailey TS, Brazg RL, Ilany J, Slover RH, Anderson SM, Bergenstal RM, Grosman B, Roy A, Cordero TL, Shin J, Lee SW, Kaufman FR. Glucose Outcomes with the In-Home Use of a Hybrid Closed-Loop Insulin Delivery System in Adolescents and Adults with Type 1 Diabetes. Diabetes Technol Ther. 2017 Mar;19(3):155-163. doi: 10.1089/dia.2016.0421.
4
Forlenza GP, Pinhas-Hamiel O, Liljenquist DR, Shulman DI, Bailey TS, Bode BW, Wood MA, Buckingham BA, Kaiserman KB, Shin J, Huang S, Lee SW, Kaufman FR. Safety Evaluation of the MiniMed 670G System in Children 7-13 Years of Age with Type 1 Diabetes. Diabetes Technol Ther. 2019 Jan;21(1):11-19. doi: 10.1089/dia.2018.0264.