Recent Posts - DAFNE Online

Jun 25, 2012

Podarcis 14 posts

Topic: Site Development / Auto calculate QA from BG - let's get it right

Yes, it was me who asked, and this discontinuity issue is exactly what I was investigating when I asked. Let me explain. We will be using an equation to compute the QA correction we need for any given BG level. In mathematics, a discontinuity is when the result of applying an equation to values that are a small distance either side of some particular value results in a large jump in the result of the equation.

As I showed above, there is a discontinuity at BG 17 (also at 13 and 10). BG 16.9 gives +7.6 while BG 17.1 gives +11.6. So if you have a BG of close to 17 (say 17.5, or 16.5, perhaps), your QA correction will be either +7 or +11, approx. Now, clearly, both of these cannot be the right corrective dose to use. If +7 is right for a BG of 16.5, then +11 is clearly way too much for a BG of 17.5.

What my previous post says is that we can avoid this discontinuity problem by applying the corrective factors only within the bands they apply to. This will assist in obtaning good and consistent corrective adjustment values, and will help the app users to achieve better BG control.

No doubt some personal tuning by trial and error will be needed to arrive at the QA:BG ratios for each band. But I believe it will be a simpler task to arrive at these ratios if we use this banded application, in spite of the method being harder to understand. It will be safer, too: the discontinuity issue would have the potential to cause unexpected and unanticipated overcorrections.

Jun 25, 2012

RichFreed 51 posts

Topic: Site Development / Auto calculate QA from BG - let's get it right

I'm the same as Novorapidboi26. Since beginning DAFNE I've identified 2 bands so far, when I'm in the higher band my correction was being calculated at 1QA for each mmol so with a 15 reading I'd be taking 15QA. No consideration enters into it from the reduced correction of the lower band.

Jun 25, 2012

novorapidboi26 1,819 posts

Topic: Site Development / Auto calculate QA from BG - let's get it right

I think I remember you or someone else asking me if I used all the bands of blood sugars when correcting, as obviously, my blood sugars would be dropping and therefore would need less.......

But for me, the method I use, which is just to use one band, has worked perfectly, and its simple, however this could just be specific to me.........its all about insulin resistance, hence the varying effectiveness of 1 unit....

My theory is that if I am above 17mmol/l then the cells of my body have a higher resistance to insulin than I would at lower levels, but its likely my blood sugar levels would drop quicker than that of my resistance and therefore trying to calculate a correction by using all the bands wouldn't really apply.....

I conclude this from my own personal experience and blood sugar results, quite simply, I am on target by the next meal time......

Its interesting though and I would be interested to see someone testing this method...

What do you mean when you say discontinuity? If I was 16.9, I would treat that as if it was 17 or above, not an exact science by any means........... Smile

Jun 25, 2012

Alan 49 284 posts

Topic: General Discussion / Targets

Thanks very much JWo

Jun 24, 2012

JayBee 587 posts

Topic: General Discussion / Targets

You access it from the BG Diary page (it's near the bottom of the page). Here's the address to the page you're looking for:

http://www.dafneonline.co.uk/diary/settings

Jun 24, 2012

Alan 49 284 posts

Topic: General Discussion / Targets

Can someone please remind me how I can amend my BG Targets.

Jun 23, 2012

Podarcis 14 posts

Topic: Site Development / Auto calculate QA from BG - let's get it right

There is a danger of a discontinuity here...

BG is 16.9, corr is (16.9-5.5)/1.5 = +7.6
BG is 17.1, corr is (17.1-5.5)/1.0 = +11.6

Logically the different corrective ratios should be applied separately to each band and accumulated, but nobody will already be doing that in their head. A computer can do it, though. And that will avoid the discontinuity problem.

Eg:
BG is 17.1, need (17.1-17)/1.0 = 0.1 to get to 17,
plus (17-13)/1.5 = 2.7 to get to 13,
plus (13-10)/2.0 = 1.5 to get to 10,
plus (10-5.5)/2.5 = 1.8 to get to 5.5.
So corr = 0.1+2.7+1.5+1.8 = 6.1.

This is lower than novorapid would want, I suspect, but that's due to the corrective ratios being applied to each band. By using slightly different ratios the desired correction can be made in all cases without any discontinuity problem.

I recommend that we should use this calculation method, since it will give reliable results.

Jun 23, 2012

HelenP 218 posts

Topic: General Discussion / Pump life advice!

Ruth..being generous i have no idea what the Korean hostess told the passenger as I don't know Korean and I do not know whether the Korean hostess' English was good enough for "insulin pump!". Lost in translation!

Helen

Jun 22, 2012

novorapidboi26 1,819 posts

Topic: Site Development / Auto calculate QA from BG - let's get it right

I currently use:

below 10mmol/l = 1 unit drops 2.5
10-13mmol/l = 1 unit drops 2
13-17 = 1 unit drops 1.5
above 17 = 1 unit drops 1

you can see the pattern........this could probably be tweaked much more accurately, but I feel this would be going to far......... Wink

Jun 22, 2012

RuthW 5 posts

Topic: General Discussion / Pump life advice!

Thanks Helen, that was really useful! glad to know when they say that you can wear it where-ever you actually can! and also with the exercise, i think can get those band strap things here in the uk too have seen them online when looking at the pumps available. I cant imagine why on earth someone would fiddle with your tubing on the plane - i cant imagine playing around with anything of a fellow passanger let alone something so obviously medical related!!!!!!
and congratulations on the low hab1c thats really great!
Ruth

Jun 20, 2012

HelenP 218 posts

Topic: General Discussion / Pump life advice!

I have just come home from my regular endocrinology appointment. My HbA1c is the best it has ever been and whilst my BGs are not &quot;perfect they are very, very good&quot;.

I find it hard work but the rewards are there. I currently have my daughter, son-in-law and grandchildren here...and I now know why I found it so difficult to get good BGs when my kids were little. I find it easier to run the pump now that I am retired and I am more in control of my routine. I do water aerobics in summer (Sept-May) and it took a couple of weeks to get the basals to the point where I could get in on 6 and get out at 5 (able to drive home and call in and have a coffee and a chat on the way). My pump is an Animas 2020 and is able to go into water. Sleeping is fine...I wear it on my pjs just on the front towards the right or left side depending on where the infusion set is positioned. Occasionally I have to swing it around but I seem to do this almost subconsciously. In the summer when i tend to wear just a T shirt (no knickers!) I wear a band available here in Australia from Diabetezy (I think, I will check and post later). Wearing the pump while exercising is not a problem,,, when in the pool I wear it clipped to the top of togs or on my waist. While doing circuits, Qui Dong etc It is just clipped to the back of whatever pants I have on. I know some people wear their pumps on their calves and on their thighs... I think you work it out to suit yourself. Apparently there is a web site that has a list of 100 ways to &quot;wear&quot; your pump listing hairstyles that incorporate your pump and other somewhat creative positions for the pump. My friend wears hers in her bra but my boobs are to big and why would I want them to appear bigger! I also find it more accessible on my waist.

I have run into problems on an international plane trip(economy class). The non-English speaking person on my right where I had positioned my infusion set and pump kept interfering with the tubing (60cm long), tugging on it etc. I talked to the cabin staff and tried to have it explained but she could not leave it alone. I now ask for an aisle seat on the right of the middle row of seats and wear the infusion set (and pump) on that side so it is not between me and the adjacent passenger. I then make sure the pump is on that side when I board the flight. This has only happened once but it was very disconcerting.

My only advice re wearing the pump is that you will work out what is best for you. You are only limited by your imagination.

Good luck.
Helen

Jun 19, 2012

Simon 578 posts

Topic: Site Development / Auto calculate QA from BG - let's get it right

Hi Novorapid,

What are the 4 correction factors you use? Currently you specify a normal correction factor (QA:BG ratio) and then add overrides which specify a BG range or time range to use a different QA:CP ratio.

Cheers

Jun 19, 2012

novorapidboi26 1,819 posts

Topic: Site Development / Auto calculate QA from BG - let's get it right

The main thing for me is;

Will the app be able to consider my BG level and use one of 4 correction factors that I use...

Jun 19, 2012

Margaret 2 posts

Topic: General Discussion / Pump life advice!

I attended my DAFNE clinic today and was also asked to consider going on the pump. I am probably older them most of you, but very active and enjoy water sports, where I often end up in the water.

I would be very interested to hear any replies from Ruth's questions,

Many thanks, Margaret

Jun 19, 2012

Phil Maskell 194 posts

Topic: Site Development / Auto calculate QA from BG - let's get it right

novorapidboi26 said:
it would seem both, I would be aiming for 5.5 mmol/l, so that would be 33%?

1 unit drops me by 2mmol/l when between 10-13mmol/l.....

3 units * 2 = 6 I would expect you to be at 4.8 on 3 units.

You wouldn't be able to get exactly to 5.5 like I couldn't get to 6.0 in my example.

You would need a correction @ 1:2 of 2.7 to drop by 5.4, Simon always rounds down for safety, the app should suggest a correction of 2 units here.

Phil

Jun 19, 2012

novorapidboi26 1,819 posts

Topic: Site Development / Auto calculate QA from BG - let's get it right

it would seem both, I would be aiming for 5.5 mmol/l, so that would be 33%?

1 unit drops me by 2mmol/l when between 10-13mmol/l.....

Jun 25, 2012 Podarcis 14 posts	Topic: Site Development / Auto calculate QA from BG - let's get it right Yes, it was me who asked, and this discontinuity issue is exactly what I was investigating when I asked. Let me explain. We will be using an equation to compute the QA correction we need for any given BG level. In mathematics, a discontinuity is when the result of applying an equation to values that are a small distance either side of some particular value results in a large jump in the result of the equation. As I showed above, there is a discontinuity at BG 17 (also at 13 and 10). BG 16.9 gives +7.6 while BG 17.1 gives +11.6. So if you have a BG of close to 17 (say 17.5, or 16.5, perhaps), your QA correction will be either +7 or +11, approx. Now, clearly, both of these cannot be the right corrective dose to use. If +7 is right for a BG of 16.5, then +11 is clearly way too much for a BG of 17.5. What my previous post says is that we can avoid this discontinuity problem by applying the corrective factors only within the bands they apply to. This will assist in obtaning good and consistent corrective adjustment values, and will help the app users to achieve better BG control. No doubt some personal tuning by trial and error will be needed to arrive at the QA:BG ratios for each band. But I believe it will be a simpler task to arrive at these ratios if we use this banded application, in spite of the method being harder to understand. It will be safer, too: the discontinuity issue would have the potential to cause unexpected and unanticipated overcorrections.

Jun 25, 2012 RichFreed 51 posts	Topic: Site Development / Auto calculate QA from BG - let's get it right I'm the same as Novorapidboi26. Since beginning DAFNE I've identified 2 bands so far, when I'm in the higher band my correction was being calculated at 1QA for each mmol so with a 15 reading I'd be taking 15QA. No consideration enters into it from the reduced correction of the lower band.

Jun 25, 2012 novorapidboi26 1,819 posts	Topic: Site Development / Auto calculate QA from BG - let's get it right I think I remember you or someone else asking me if I used all the bands of blood sugars when correcting, as obviously, my blood sugars would be dropping and therefore would need less....... But for me, the method I use, which is just to use one band, has worked perfectly, and its simple, however this could just be specific to me.........its all about insulin resistance, hence the varying effectiveness of 1 unit.... My theory is that if I am above 17mmol/l then the cells of my body have a higher resistance to insulin than I would at lower levels, but its likely my blood sugar levels would drop quicker than that of my resistance and therefore trying to calculate a correction by using all the bands wouldn't really apply..... I conclude this from my own personal experience and blood sugar results, quite simply, I am on target by the next meal time...... Its interesting though and I would be interested to see someone testing this method... What do you mean when you say discontinuity? If I was 16.9, I would treat that as if it was 17 or above, not an exact science by any means...........

Jun 25, 2012 Alan 49 284 posts	Topic: General Discussion / Targets Thanks very much JWo

Jun 24, 2012 JayBee 587 posts	Topic: General Discussion / Targets You access it from the BG Diary page (it's near the bottom of the page). Here's the address to the page you're looking for: http://www.dafneonline.co.uk/diary/settings

Jun 24, 2012 Alan 49 284 posts	Topic: General Discussion / Targets Can someone please remind me how I can amend my BG Targets.

Jun 23, 2012 Podarcis 14 posts	Topic: Site Development / Auto calculate QA from BG - let's get it right There is a danger of a discontinuity here... BG is 16.9, corr is (16.9-5.5)/1.5 = +7.6 BG is 17.1, corr is (17.1-5.5)/1.0 = +11.6 Logically the different corrective ratios should be applied separately to each band and accumulated, but nobody will already be doing that in their head. A computer can do it, though. And that will avoid the discontinuity problem. Eg: BG is 17.1, need (17.1-17)/1.0 = 0.1 to get to 17, plus (17-13)/1.5 = 2.7 to get to 13, plus (13-10)/2.0 = 1.5 to get to 10, plus (10-5.5)/2.5 = 1.8 to get to 5.5. So corr = 0.1+2.7+1.5+1.8 = 6.1. This is lower than novorapid would want, I suspect, but that's due to the corrective ratios being applied to each band. By using slightly different ratios the desired correction can be made in all cases without any discontinuity problem. I recommend that we should use this calculation method, since it will give reliable results.

Jun 23, 2012 HelenP 218 posts	Topic: General Discussion / Pump life advice! Ruth..being generous i have no idea what the Korean hostess told the passenger as I don't know Korean and I do not know whether the Korean hostess' English was good enough for "insulin pump!". Lost in translation! Helen

Jun 22, 2012 novorapidboi26 1,819 posts	Topic: Site Development / Auto calculate QA from BG - let's get it right I currently use: below 10mmol/l = 1 unit drops 2.5 10-13mmol/l = 1 unit drops 2 13-17 = 1 unit drops 1.5 above 17 = 1 unit drops 1 you can see the pattern........this could probably be tweaked much more accurately, but I feel this would be going to far.........

Jun 22, 2012 RuthW 5 posts	Topic: General Discussion / Pump life advice! Thanks Helen, that was really useful! glad to know when they say that you can wear it where-ever you actually can! and also with the exercise, i think can get those band strap things here in the uk too have seen them online when looking at the pumps available. I cant imagine why on earth someone would fiddle with your tubing on the plane - i cant imagine playing around with anything of a fellow passanger let alone something so obviously medical related!!!!!! and congratulations on the low hab1c thats really great! Ruth

Jun 20, 2012 HelenP 218 posts	Topic: General Discussion / Pump life advice! I have just come home from my regular endocrinology appointment. My HbA1c is the best it has ever been and whilst my BGs are not &quot;perfect they are very, very good&quot;. I find it hard work but the rewards are there. I currently have my daughter, son-in-law and grandchildren here...and I now know why I found it so difficult to get good BGs when my kids were little. I find it easier to run the pump now that I am retired and I am more in control of my routine. I do water aerobics in summer (Sept-May) and it took a couple of weeks to get the basals to the point where I could get in on 6 and get out at 5 (able to drive home and call in and have a coffee and a chat on the way). My pump is an Animas 2020 and is able to go into water. Sleeping is fine...I wear it on my pjs just on the front towards the right or left side depending on where the infusion set is positioned. Occasionally I have to swing it around but I seem to do this almost subconsciously. In the summer when i tend to wear just a T shirt (no knickers!) I wear a band available here in Australia from Diabetezy (I think, I will check and post later). Wearing the pump while exercising is not a problem,,, when in the pool I wear it clipped to the top of togs or on my waist. While doing circuits, Qui Dong etc It is just clipped to the back of whatever pants I have on. I know some people wear their pumps on their calves and on their thighs... I think you work it out to suit yourself. Apparently there is a web site that has a list of 100 ways to &quot;wear&quot; your pump listing hairstyles that incorporate your pump and other somewhat creative positions for the pump. My friend wears hers in her bra but my boobs are to big and why would I want them to appear bigger! I also find it more accessible on my waist. I have run into problems on an international plane trip(economy class). The non-English speaking person on my right where I had positioned my infusion set and pump kept interfering with the tubing (60cm long), tugging on it etc. I talked to the cabin staff and tried to have it explained but she could not leave it alone. I now ask for an aisle seat on the right of the middle row of seats and wear the infusion set (and pump) on that side so it is not between me and the adjacent passenger. I then make sure the pump is on that side when I board the flight. This has only happened once but it was very disconcerting. My only advice re wearing the pump is that you will work out what is best for you. You are only limited by your imagination. Good luck. Helen

Jun 19, 2012 Simon 578 posts	Topic: Site Development / Auto calculate QA from BG - let's get it right Hi Novorapid, What are the 4 correction factors you use? Currently you specify a normal correction factor (QA:BG ratio) and then add overrides which specify a BG range or time range to use a different QA:CP ratio. Cheers

Jun 19, 2012 novorapidboi26 1,819 posts	Topic: Site Development / Auto calculate QA from BG - let's get it right The main thing for me is; Will the app be able to consider my BG level and use one of 4 correction factors that I use...

Jun 19, 2012 Margaret 2 posts	Topic: General Discussion / Pump life advice! I attended my DAFNE clinic today and was also asked to consider going on the pump. I am probably older them most of you, but very active and enjoy water sports, where I often end up in the water. I would be very interested to hear any replies from Ruth's questions, Many thanks, Margaret

Jun 19, 2012 Phil Maskell 194 posts	Topic: Site Development / Auto calculate QA from BG - let's get it right novorapidboi26 said: it would seem both, I would be aiming for 5.5 mmol/l, so that would be 33%? 1 unit drops me by 2mmol/l when between 10-13mmol/l..... 3 units * 2 = 6 I would expect you to be at 4.8 on 3 units. You wouldn't be able to get exactly to 5.5 like I couldn't get to 6.0 in my example. You would need a correction @ 1:2 of 2.7 to drop by 5.4, Simon always rounds down for safety, the app should suggest a correction of 2 units here. Phil

Jun 19, 2012 novorapidboi26 1,819 posts	Topic: Site Development / Auto calculate QA from BG - let's get it right it would seem both, I would be aiming for 5.5 mmol/l, so that would be 33%? 1 unit drops me by 2mmol/l when between 10-13mmol/l.....