Insulin pump and continuous glucose monitoring system

Chapter 3

The basics
38

Basic programming
Setting the time and date
Setting the correct time and date in your pump is necessary for accurate basal insulin delivery and allows
you to keep an accurate record of your insulin delivery and other pump functions. You can select a 12-hour
or 24-hour clock. You must reset the time and date if you receive a CHECK SETTINGS alarm or you clear
your settings (Clear Settings function).
1
Go to the TIME/DATE
SETUP screen.
Main > Utilities >
Time/Date
ACT
2
Select 12-Hour Setup or 24-Hour Setup and press ACT.
3
Press ACT again to change the settings.
4
Change each of the settings as follows:
a. Hour
Change the hour. Press ACT.
For 12-hour setups, press 
 or 
 until the correct A (am)
or P (pm) appears.
b. Minutes
Change the minutes. Press ACT.
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Chapter 4

c. Year
Change the year. Press ACT.
d. Month
Change the month. Press ACT.
e. Day
Change the day. Press ACT.
5
The TIME SET AT screen will show the settings that you
programmed. Press ACT and exit the menus.
Your time/date settings are complete.
Selecting the language
The language shown on the pump screens can be changed. Some languages may not be available on all
pumps. Before you can select another language, you need to set the time using the English screens. Refer
to the previous section.
 
To change the language for your pump:
1
Go to the LANGUAGE
MENU screen.
Main > Utilities >
Language
ACT
2
Select your language, then press ACT.
3
The language setting is now changed. Exit the menus.
Basic programming
40

Bolus
There are three bolus types: Normal, Square Wave
®
, and Dual Wave
®
. This section gives instructions for a
Normal bolus using the express bolus button and navigating through the menus. (For information about
Square Wave and Dual Wave boluses, refer to the Optimizing pump therapy chapter.) 
The Normal bolus delivers an immediate food or correction bolus. It can be delivered at any time except
during another Normal bolus. During a Normal bolus, most pump features are disabled until after all the
bolus has been delivered. The suspend function and the STATUS screen, however, are always available. 
Setting the Normal bolus
Normal bolus can be used to cover the carbohydrate in a meal or snack and/or to correct a blood glucose
that is higher than your blood glucose target.
 
The following instructions are for a Normal bolus when the Bolus Wizard feature is turned off.
1
Go to the BOLUS MENU.
Main > Bolus
Select Set Bolus and press ACT. Go to step 2.
You can also use the 
 EXPRESS BOLUS button to get to step 2. Press 
 from your HOME screen.
2
a. If the SET BOLUS screen appears: (Dual/Square option is off) Go to step 3.
b. If the BOLUS TYPE screen appears: (Dual/Square Wave is on) Select Normal Bolus and press ACT.
Go to step 3.
3
The SET BOLUS screen (or SET NORMAL BOLUS screen if the Dual/Square option is on) appears with 0.0
unit bolus amount flashing.
Enter your bolus amount and press ACT.
NOTE: 
If you have BG Reminder turned On, a BG REMINDER DURATION screen displays. It allows you
to set the length of time after this bolus before you are reminded to check your blood glucose. See
the BG Reminder section in this chapter for information about this feature.
 
4
The BOLUS DELIVERY screen appears and the Normal bolus starts. The pump will beep/vibrate at the
start of the bolus. As the bolus delivers, the amount shown on the screen will increase until the entire
bolus has been delivered. When the bolus is finished, the pump will beep/vibrate again and the HOME
screen will appear.
The following practice lessons will help you understand this pump feature.
Basic programming
41
Chapter 4

Normal meal bolus using the exchange system
Normal bolus can be used to cover the carbohydrate in a meal or snack and to correct a blood glucose
that is higher than the target that was chosen for you.
Fred has been taught that he needs to take 1 unit of insulin for every carbohydrate exchange that he
eats (every milk, every starch or every fruit). For lunch today he will eat:
Turkey sandwich with two slices of bread 2 starches
1 small apple 1 fruit
1 cup of non-fat milk 1 milk
__________________
Total carbohydrate exchanges = 4
Fred's lunch has a total of 4 carbohydrate exchanges so he will take a meal bolus of 4 units for his lunch.
Bolus practice:
NOTE: 
Make sure that you are not connected to your pump while
practicing.
 
Going through the menus, program a 2.0 unit Normal bolus now.
Check here if you were able to program it. 
Using the express bolus button 
, program a 2.0 unit Normal bolus now.
Check here if you were able to program it. 
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42

Normal meal bolus practice using exchanges: 
Choose a meal you might eat and fill in the blanks.
Food:__________
exchange:____________
__________
exchange:____________
__________
exchange:____________
total exchanges:____________
You will take _______ units of insulin for each exchange. Your total bolus is _______ for this meal.
Normal meal bolus using carbohydrate counting
Lydia has been taught that she needs to take 1 unit of insulin for every 10 grams of carbohydrate. This is
her insulin to carbohydrate ratio. For dinner she will have:
4 ounces broiled chicken   0 grams
2/3 cup of rice 30 grams
1/2 cooked broccoli   5 grams
1 ounce dinner roll 15 grams
1 tsp margarine   0 grams
__________________
total grams of carbohydrates = 50 grams
Lydia's dinner totals 50 grams of carbohydrate. Her insulin to carbohydrate ratio is 1 unit: 10 grams. She
will take a meal bolus of 5 units for her dinner. She determined this by dividing 50 (total grams of
carbohydrate) by 10 (insulin to carbohydrate ratio).
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Chapter 4

Choose a meal you might eat and fill in the blanks.
Food:__________
grams of carbohydrate:____________
__________
grams of carbohydrate:____________
__________
grams of carbohydrate:____________
total grams of carbohydrate:____________
Your insulin to carbohydrate ratio: 1 unit of insulin for _______ grams carbohydrate.
Divide your total carbohydrates by your insulin to carbohydrate ratio and take _____ units of insulin for
your meal.
Meal bolus, correction bolus and insulin sensitivity
Jason is ready to eat his breakfast. He has calculated that he will need 4.0 units for his food.
He tests his blood glucose and finds that it is 200 mg/dL (11.1 mmol/L). Jason knows that his blood
glucose level is above his blood glucose target and will need additional insulin before he eats.
Jason's healthcare professional has determined the following for him:
Target BG:  110 mg/dL (6.1 mmol/L)
Insulin sensitivity
1
:  36 mg/dL (2.0 mmol/L)
Jason determines that he will need a correction bolus of 2.5 units insulin to lower his elevated blood
glucose. The 2.5 correction bolus will lower his current blood glucose of 200 mg/dL (11.1 mmol/L) to his
target of 110 mg/dL (6.1 mmol/L).
•
elevated blood glucose: 200 − 110 = 90 mg/dL (11.1 − 6.1 = 5 mmol/L)
•
correction bolus: 90 / 36 mg/dL (insulin sensitivity) (5.0 / 2.0 mmol/L) = 2.5 units
(He will add this 2.5 correction bolus to the 4.0 units of insulin that he will need for his meal bolus.
Jason will take a total bolus of 6.5 units.)
1. Insulin sensitivity is the amount (in mmol/L or mg/dL) by which blood glucose will be lowered after taking 1 unit of
insulin. Consult with your healthcare professional to determine your insulin sensitivity.
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Practice: Meal bolus
You have determined your meal bolus as: _______ units.
Your target blood glucose range is: _______ to _______ (average is _______).
Your current blood glucose level is: _________.
Your correction factor is: 1 unit of insulin will drop your blood glucose _________.
You will take ________ unit(s) of insulin to correct your high blood glucose level.
Your total bolus (meal bolus plus correction bolus) is _________.
Review your bolus deliveries
You can view a list of your bolus deliveries in the BOLUS HISTORY screen. This screen shows a list of the
dates, times, units, and types for your last 24 boluses. This feature is helpful for record keeping or to
check if you bolused for your last meal.
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Chapter 4

If a bolus was stopped before delivery was complete, the BOLUS HISTORY screen will show only the amount
actually delivered. Refer to the Bolus details section for instructions about viewing bolus details. 
 
Do the following steps to view the BOLUS HISTORY screen:
1
Go to the BOLUS
HISTORY screen and
scroll through the bolus
deliveries.
Main > Bolus > Bolus
History
If you used the Bolus
Wizard feature to
deliver any of these
boluses, the BOLUS
HISTORY screen shows
the carbohydrate/
food (CH) and blood
glucose values that the
Bolus Wizard feature
used to calculate the
boluses.
(with the Bolus Wizard feature)
date
time
amount/type
carb value
BG value
N = Normal
S = Square Wave
DN = Normal part of dual wave bolus 
DS = Square part of dual wave bolus 
2
Refer to the instructions in the Bolus details section, to see the details for any of these boluses.
Basic programming
46

Bolus details
You can view the details of any of the deliveries in the BOLUS HISTORY screen. The details include: 
•
bolus types: normal, square, and dual
•
programmed bolus amount
•
delivered bolus amount
•
Bolus Wizard feature information (if used)
 
To see the details of any bolus, do these steps:
1
In the BOLUS HISTORY
screen, select the bolus
that you want to review
and press ACT.
Press the down key to see the 
details
If the Bolus Wizard feature 
calculated your bolus, more 
information will appear in the 
BOLUS DETAIL screen.
delivery is active
delivery stopped
delivery completed
Without the Bolus Wizard feature
With the Bolus Wizard feature
2
The details for that bolus will appear on the screen. Scroll through the details.
3
Exit when you are done.
Basic programming
47
Chapter 4

Maximum bolus limit
The Maximum bolus (Max bolus) is a safety feature that limits the amount of insulin that can be delivered
in a single bolus. The factory setting is 10.0 units. You can specify the limit from 0.0 to 25.0 units. It is
important to discuss this feature with your healthcare professional to determine your Max bolus amount. 
 
To set the Maximum bolus limit, do these steps:
1
Go to the MAX BOLUS SETUP screen.
Main > Bolus > Max Bolus
2
Set your maximum bolus limit and press ACT.
3
Your Max bolus is set. Exit the menus.
Example 1: Max bolus
Shelby takes very small doses of insulin for her meal boluses. As a safety limit, she and her healthcare
professional reset her pump with a Maximum bolus of 5.0 units.
Example 2: Max bolus
David is a growing teenager. He loves to eat big meals and requires very large doses of insulin for his
food. He reset his pump with a maximum bolus of 20.0 units so he can take more insulin when he needs
to.
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BG Reminder
After you deliver a bolus you may want to check your blood glucose. The BG Reminder is an optional
feature that makes the pump beep or vibrate to remind you to check your blood glucose after a bolus.
However, this reminder is not available after an Easy Bolus. Your pump is set at the factory with the BG
Reminder feature turned off. 
When setting a bolus, if the BG Reminder is on, your pump will ask you to set up the BG Reminder
Duration. This sets how long after bolus delivery you will be reminded to check your BG. This time can be
from 30 minutes to 5 hours, or NONE. The BG Reminder is not available after an Easy Bolus. 
1
Go to the BG REMINDER SETUP screen.
Main > Bolus > BG Reminder
2
Select On and press ACT. The BG Reminder is now enabled. Exit the menus.
Now, the next time you program a bolus, your pump will ask you for the amount of time after your
bolus before you want to be reminded to check your blood glucose.
When the BG Reminder goes off, your pump will beep or vibrate and CHECK BG will appear on the
screen. Your pump will beep or vibrate periodically until it is cleared (ESC, ACT).
When you set a BG Reminder after a bolus, the STATUS screen will show the amount of time remaining,
in minutes and hours, before the reminder goes off.
Basal
Basal insulin is required to maintain your target glucose values when you are not eating. Your healthcare
professional will calculate this rate for you. Your basal insulin accounts for approximately one half of the
body's total daily insulin requirements. Your pump mimics your pancreas by delivering insulin continuously
over 24 hours.
You can set your insulin pump to change rates during the day to match your needs. Your needs depend on
your lifestyle and insulin requirements. Some people only use one rate throughout the day, while others
find they need more. Your basal rates are made up of insulin deliveries that have start and stop times.
Once set, these rates make up your 24-hour basal pattern and are repeated daily.
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Chapter 4

Start and stop times
When you set your basal rate(s) in the BASAL MENU, your pump prompts you to set the start time for each
basal delivery. The start time of one basal rate is the stop time of the previous rate. This gives you
continuous basal insulin through a 24-hour period. For basal rate 1, the start time is midnight and cannot
be changed. See the following sample graph of basal rates.
12:00 AM
Basal Rate 1
start time
3:00 AM
Basal Rate 2
start time
7:00 AM
Basal Rate 3
start time
9:00 PM
Basal Rate 4
start time
24 hours
rate 3
rate 4
rate 1
rate 2
The start and stop times of basal rates for this example are:
•
12:00 a.m. (00:00) to 3:00 a.m. (3:00) for basal rate 1
•
3:00 a.m. (3:00) to 7:00 a.m. (7:00) for basal rate 2
•
7:00 a.m. (7:00) to 9:00 p.m. (21:00 ) for basal rate 3
•
9:00 p.m. (21:00 ) to 12:00 a.m (00:00) for basal rate 4
If you need one basal insulin that starts before midnight and stops after midnight, you need to set up two
basal rates. These basal rates have the same rate but different start and stop times. For example, in this
graph a basal rate is needed from 9:00 p.m to 3:00 a.m (21:00 to 3:00) at one rate. Basal rate 1 always
starts at midnight and should be set to end at 3:00 a.m. (3:00 ). After setting basal rates 2 and 3, rate 4 is
set from 9:00 p.m. (21:00) to midnight at the same rate as basal rate 1. This gives continuous basal insulin
from 9:00 p.m to 3:00 a.m. (21:00 to 3:00) at one rate.
You cannot set a start time for one basal rate to overlap the next basal rate. The addition of a new basal
rate will erase any basal rates that follow.
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For best results, setting or changing your basal rate(s) should be discussed with your healthcare
professional.
Your basal settings
You must program your basal settings before you can deliver basal insulin. Keep a written record of your
basal settings.
It is recommended that you set your basal rates with the assistance of your healthcare professional.
If you plan to take off your pump for an extended period of time, i.e. more than a day, set the basal rate
to 0.00 U/H. This will ensure that the insulin delivery records in your pump are accurate. Refer to the If
you remove your pump section in the The basics chapter for more information.
Basal programming and delivery
NOTE: 
You cannot make changes to your basal rate settings while a percent temp basal is active.
 
 
To set your basal rates: 
1
Go to the SET BASAL RATE 1 screen.
Main > Basal > Set/Edit Basal
2
The SET BASAL RATE 1 screen flashes the basal rate in U/H.
3
Enter your first basal rate amount and press ACT.
The start time for your first basal rate is midnight and cannot be changed.
4
The SET START TIME 2 screen appears. The dashes under the screen name flash. The first basal rate is
now set.
If you do not need a second basal rate for the day, press ESC. If you need to set up a second basal rate
for the day, follow steps 5 and 6.
5
In the SET START TIME 2 screen, enter the start time for the next rate.
6
Press ACT. The SET BASAL RATE 2 screen appears. Enter the rate.
7
Press ACT. The SET START TIME 3 screen appears. The second basal rate is now set. If you do not need
to set up any more basal rates for the day, press ESC and skip to step 9. If you need to set up more
basal rates, follow steps 5 and 6 for each basal rate.
8
After you program your last basal rate, press ESC.
9
The BASAL RATE screen appears. Your basal rate(s) will now deliver as programmed. Exit the menus.
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Chapter 4

10 When you have finished programming your pump, you can save your settings. Refer to the User
settings section in the Utilities chapter for instructions.
Current basal delivery
current basal
The STATUS screen shows your current basal information.
Daily basal rate(s)
The BASAL REVIEW screen shows your daily basal rates programmed for delivery from midnight to
midnight. Compare your daily insulin deliveries to your blood glucose records to help you and your
healthcare professional identify your optimal daily basal insulin rate(s). 
 
To review your basal rates, do these steps:
1
Go to the BASAL MENU screen.
Main > Basal
2
Select Basal Review and press ACT.
3
If you do not use patterns, the
STANDARD screen appears.
The delivery details for your standard
basal will appear.
basal rate 
start times
basal 
delivery rates
(24-hour total)
basal insulin
Basic programming
52

basal rate 
start times
basal 
delivery rates
(24-hour total)
basal insulin
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Chapter 4

If you use patterns, the BASAL REVIEW screen appears.
The current basal pattern will be highlighted. Select the pattern you want to view. Press ACT.
The delivery details for that pattern will appear.
4
Exit the menus when you are done.
Setting the Max basal rate
Maximum basal (Max basal) rate is a safety limit for the amount of basal insulin that is able to be delivered
per hour. Your pump is sent from the factory with the Max basal set to 2.0 units per hour. It is important to
determine your Max basal rates with your healthcare professional. This safety feature will not allow you to
program any basal rates, including patterns and temporary basal rates, that are greater than the Max basal
rate.
If you are setting your Max basal rate after your basal rates have been set, you cannot set a Max basal that
is less than any of the programmed basal rates.
 
To set your Max basal rate, do these steps:
1
Go to the MAX BASAL RATE screen. The Max basal rate will be flashing.
Main > Basal > Max Basal Rate
2
Change the rate and press ACT.
3
Your Max basal rate is now set. Exit the menus.
Example 1: Max basal
Helen has a very low insulin requirement. Her highest basal rate is only 0.4 units per hour. As a safety
measure, Helen's healthcare professional set her pump with a Maximum basal rate of 1.0 units per hour.
Example 2: Max basal
Rusty needs large amounts of insulin to control his blood glucose levels. His new pump was delivered
from the factory with a Maximum basal rate of 2.0 units per hour, but he needs 2.8 units per hour in the
early morning. Rusty will reprogram his Maximum basal to 3.0 units per hour to accommodate his needs.
Basic programming
54

Stopping your pump
Suspend stops all insulin delivery including the current basal and any bolus or prime deliveries that are in
progress. While suspended, your pump will not deliver insulin until you resume your pump. When you
resume your pump, the basal delivery will continue. 
The pump will beep or vibrate about every 15 minutes on the hour to remind you that it is not delivering
insulin. Example: You suspend your pump at 11:20 a.m. The pump will beep or vibrate at 11:30 a.m.,
11:45 a.m., 12:00 noon, and so on until you resume your pump (basal resumes).
When suspended, your pump is in Attention mode with a solid circle showing on the pump. When in