Click here to the Aviva Combo meter Training Manual

Click here to the Aviva Combo meter Training Manual
Training Handbook mmol/L
Accu-Chek® Aviva Combo blood glucose monitoring system
Dear User,
Congratulations on choosing the Accu-Chek® Aviva Combo meter!
Your new meter will help you to manage your diabetes easily,
quickly and discreetly.
This Handbook is provided as part of your training on the new
Accu-Chek Aviva Combo meter.
It will help you to set up your meter, so that it quickly becomes
part of your daily life.
Roche Diabetes Care
!
This document is not intended to replace training by a qualified diabetes
instructor, or the Owner’s Booklets (Instructions for use) provided with your
new meter.
Before starting therapy with your Accu-Chek Aviva Combo meter, please consult your Accu-Chek Aviva Combo meter Owner’s booklets for detailed information regarding warnings and precautions related to their use.
In this Handbook the term “meter” always refers to the Accu-Chek
Aviva Combo meter.
Table of Contents
1 Your Accu-Chek Aviva Combo meter...................................................................... 5
1.1 Summary of functions and features................................................................. 5
1.2 Button functions...................................................................................................... 6
2 Getting Bolus Advice from your meter.................................................................... 9
2.1 About Bolus Advice................................................................................................ 9
2.2 Setting up Bolus Advice.....................................................................................10
3 Measuring your blood glucose (bG) level..........................................................26
3.1 Running a control test.........................................................................................26
3.2 Performing a blood glucose (bG) test...........................................................29
3.3 Using Bolus Advice..............................................................................................33
4 Managing your data.....................................................................................................39
4.1 Transferring data to a Computer ....................................................................56
5 Using Reminders...........................................................................................................59
6 Changing your meter Settings..................................................................................73
Appendix..............................................................................................................................77
Your Accu-Chek Aviva Combo meter
1 Your Accu-Chek Aviva Combo meter
1.1 Summary of functions and features
Features
j
Convenient blood glucose (bG) testing.
j
Test results in five seconds.
j
Provide Bolus Advice.
j
Small sample size that allows testing from the fingertip.
j
Unreliable test results are detected automatically.
j
Keep record of events related to your diabetes management, for
example bG test results, bolus and basal insulin delivery, carbohydrate
intake, health events.
j
A variety of Reminders that help to remember tasks of your diabetes selfmanagement.
5
1.2 Button functions
Infrared (IR) Window
, . Left / Right Soft Button
=Enter
xUp
zDown
>Right
<Left
* Backlight Button
Teststrip Slot
+ Power On / Off Button
6
Your Accu-Chek Aviva Combo meter
Key
Name
Function
+
Power
On / Off
·· turn the meter on and off
*
Backlight
·· adjust the backlight level (low, medium high)
<
Left arrow
>
Right
arrow
·· move through screens
·· scroll left in an information screen
·· move through screens
·· scroll right in an information screen
·· move through menus, functions and information screen
x
Up arrow
·· scroll up in an information screen
·· increase a value in a setting screen
z
Down
arrow
·· move through menus, functions and information screen
·· scroll down in an information screen
·· reduce a value in a setting screen
7
Key
Name
Function
·· select a menu or option
=
Enter
·· save changes
·· exit
,
Left soft
button
·· select a menu on the display above the button
.
Right soft
button
·· select a menu on the display above the button
Press and
hold
·· enables Keylock / disables Keylock
,.
simultaneously
8
Getting bolus advice from your meter
2 Getting Bolus Advice from your meter
The Bolus Advice function on your meter will provide you with recommendations
on the amount of insulin for food intake and for correcting bG levels that are
not within your Target Range. In the following chapter you will learn how to
program all your individual settings for the bolus advice calculation and how
to use Bolus Advice in your day-to-day life.
2.1 About Bolus Advice
The Bolus Advice function of your meter provides you with bolus recommendations based on your:
·· Current bG test result
·· Expected food intake
·· Current health or activity
·· Individual settings, such as Carb Ratio, Insulin Sensitivity, and other settings
that will be explained later in this chapter.
When you have programmed these settings, you will only need to:
·· Measure your bG level
·· Enter the amount of carbs you are currently planning to eat
·· Enter your current health or activity state
Your meter will then calculate the required amount of insulin based on your
personal settings. You can adjust the calculated dose as appropriate. After
confirmation, administer the insulin using your pen or syringe.
If you are interested in details of the calculation for the recommended bolus,
please refer to Appendix A, B, and C.
9
2.2 Setting up Bolus Advice
Before you can start setting up the Bolus Advice function, you need to discuss
the required setting parameters with your healthcare professional. The following
settings are necessary:
Time Block settings
j
Time Blocks …
split the day into periods, to facilitate the programming of those settings that change
throughout the day, such as Insulin Sensitivity
and Carb Ratio. You only need to set the endtime of a Time Block, as this is also the starting
time of the following Time Block. Five Time
Blocks are set up by default, but you can set up
up to eight if necessary. The following parameters can be set up separately for each Time
Block.
Target Range …
is the range of your blood glucose, consisting of
a lower and an upper bG value that is considered to be acceptable as long as you are fasting
(in the morning or before a meal). The target bG
will be calculated automatically as the average
between the upper and lower bG values.
j
10
Getting bolus advice from your meter
j
Carb Ratio …
is the amount of insulin you need for one unit of
carbohydrates. You must program the Carb
Ratio for each Time Block you wish to set up.
j
Insulin Sensitivity … is the amount of insulin you need to lower your
bG level by a given amount. You may know this
as the “correction factor”. You must program
this for each Time Block you wish to set up.
Health Event settings
j
Health Events …
are percentages that allow you to adjust the
calculated insulin amount to allow for individual
needs and health status; for example, when you
are planning physical activity (subtract percentages) or you are ill (add percentages). You can
set percentages for:
·· Exercise 1
·· Exercise 2
·· Stress
·· Illness
·· Premenstrual
You cannot adjust Fasting.
11
Advice Option settings
j
Meal Rise …
is an increase in your bG level that is acceptable
after a meal. After a meal, the Meal Rise is
added to your bG target. After a meal, the bG
target value plus the Meal rise value is accepted
without a correction bolus, as long as Acting
time and Offset time are effective (see the
explanations below).
Snack Size …
is the amount of carbohydrates that is not to
be counted as a regular meal. A bolus will be
recommended but no Meal Rise is triggered.
Acting Time …
is the time during which a bolus is effective.
The Acting Time starts afresh for each new
bolus.
Offset Time …
is the expected time taken for your bG level to
fall after you inject a bolus. The Offset Time starts
afresh for each new bolus.
j
j
j
12
Getting bolus advice from your meter
13
1
Press + until the meter powers up.
The Accu-Chek screen appears for a few
seconds.
2
The Language screen appears. If you wish to
keep the default language, press . to select
Next and continue with step 6.
3
Language
Language
English
Deutsch
English
Press enter to display
Españiol
available options
Français
Otherwise press = to display the language
options.
Cancel
4
Language
Language
English
Deutsch
English
Press enter to display
Españiol
available options
Français
Cancel
14
Press x or z to select the language.
Getting bolus advice from your meter
5
Press = to save the setting.
Press . to select Save.
6
Time/Date
Time Format
10
Time
Date
HH
00
MM
1 Jan
DD MMM
Back
24 hr
08
YY
The Time / Date screen appears. If you wish to
keep the default time, press . to select Next
and continue with step 12.
Next
7
Time/Date
2400hr12amhr
Time Format
10
Time
Date
HH
MM
1 Jan
DD MMM
08
YY
Otherwise press = to change Time Format.
Cancel
8
Time/Date
1200hr12amhr
Time Format
10
Time
Date
HH
MM
1 Jan
DD MMM
08
YY
Press x or z to select 12 hr or 24 hr Time Format.
Press = to save the changes.
Cancel
15
9
Time/Date
Time Format
Time
Date
8HH
12 hr
00
30 am
MM
1 Jan
DD MMM
A/P
08
YY
Press = to change the hour.
Cancel
10
Time/Date
Time Format
Time
Date
10HH
12 hr
00
30 am
MM
1 Jan
DD MMM
A/P
08
YY
Press x or z to select the hour and = to save.
Cancel
11
Time/Date
Time Format
Time
10
Date
Back
HH
12 hr
30 am
MM
2 Feb
DD MMM
A/P
08
YY
Next
Continue using =, x, z and = to set
·· Minutes
·· AM or PM if needed
·· Day
·· Month
·· Year
Press . to select Next.
16
Getting bolus advice from your meter
12
The Units screen appears.
Use =, x, z and = to set
·· the units for carbohydrates
·· the Insulin Increment
·· the Max Bolus
Press . to select Next
13
Warning Limits
Hyper
Hypo
16.5 mmol/L
4.0 mmol/L
Select the upper (Hyper)
and lower (Hypo)
limits of your bG
Back
The Warning Limits screen appears.
Next
14
Warning Limits
Hyper
Hypo
mg/dL
mmol/L
12.5 220
Select the upper (Hyper)
and lower (Hypo)
limits of your bG
Use =, x, z and = to set the Hyper- (High bG)
Warning Limit.
Cancel
17
16
Warning Limits
Hyper
Hypo
12.5 mmol/L
60 mg/dL
3.0 mmol/L
Select the upper (Hyper)
and lower (Hypo)
limits of your bG
Use =, x , z and = to set the Hypo- (Low bG)
Warning Limit.
Press . to select Next.
Cancel
17
Setup
The Setup screen “Would you like to receive
bolus advice from your meter?” appears.
Press . to select Yes.
Would you like to
receive bolus advice
from your Meter?
No
Yes
18
Setup
Edit at least one
time block by selecting
a time block
and pressing enter
Back
Next
The Setup screen “Edit at least one time block
by selecting a time block and pressing enter”
appears.
Press . to select Next.
19
Start
0:00
5:30
11:00
17:00
21:30
Back
18
Time Blocks
End
5:30
11:00
17:00
21:30
0:00
The Time Blocks screen appears.
Press = to enter the first Time Block.
Getting bolus advice from your meter
20
Time Blocks
5:30 am
6:00
Target Range
0:00 am
4.0 mmol/L 8.0 mmol/L
Carb Ratio
1 U for
--Insulin Sensitivity
Cancel
The first Time Blocks screen appears.
Press = to enter the end time box.
Press x or z to select the end time.
Press = to save the setting and move to the
lower target limit box.
21
Time Blocks
0:00
6:00
Target Range
4.5
mmol/L
140 mol/L
Carb Ratio
1 U for
--Insulin Sensitivity
Cancel
Press = to enter.
Press x or z to select your lower target limit.
Press = to save and move to the upper target
limit box.
22
Time Blocks
0:00
6:00
Target Range
mmol/L
4.5 mg/dL
Carb Ratio
1 U for
--Insulin Sensitivity
Cancel
6.5
Press = to enter.
Press x or z to select your upper target limit.
Press = to save and move to the insulin for carb
box.
23
Time Blocks
0:00
6:00
Target Range
4.5 mmol/L 6.5 mmol/L
Carb Ratio
1 U for
--Insulin Sensitivity
Cancel
Press = to enter.
Press x or z to enter the insulin amount.
Press = to save and move to the carb box.
19
24
Time Blocks
Target Range
4.5 mmol/L 6.5 mmol/L
Carb Ratio
g BE
1.2
1 U for
Insulin Sensitivity
1 U for
--Cancel
12
Press = to enter.
Press x or z to select the amount of carbs
covered by the amount of insulin.
Press = to save and move to the insulin for bG
box.
Press = to enter.
Press x or z to select the insulin amount.
Press = to save and move to the bG box.
25
Time Blocks
Target Range
4.5 mmol/L 6.5 mmol/L
Carb Ratio
12 g
1 U for
Insulin Sensitivity
1 U for 2.5 mmol/L
--Cancel
Save
Press = to enter.
Press x or z to select the decrease in bG
expected for the insulin amount.
Press = to enter.
Press . to save and exit to the Time Blocks
screen.
26
Start
0:00
6:00
5:30 am
11:00
17:00
21:30
Back
Time Blocks
End
6:00
11:00 am
17:00
21:30
0:00
Next
Press x or z to move to the next Time Block.
Press = to enter.
The settings from the first Time Block will be
copied to all other Time Blocks.
Press . to select Next.
27
Repeat steps 20 to 26 accordingly to setup all Time Blocks as necessary.
Press . to select Next.
20
Getting bolus advice from your meter
28
Health Events
Exercise 1
Exercise 2
Stress
Illness
Premenstrual
0%
0%
0%
0%
0%
The Health Events screen appears.
Press = to enter the Exercise 1 box.
Next
Back
29
Health Events
Exercise 1
Exercise 2
Stress
Illness
Premenstrual
-15 % 0%
0%
0%
0%
0%
Press x or z to select the percentage as needed.
Press = to save.
Cancel
30
Health Events
Exercise 1
Exercise 2
Stress
Illness
Premenstrual
Back
-15%
-20%
+10%
+50%
+10%
Press x or z to move to the next Health Event
you wish to setup.
Next
31
Use =, x, z and = to setup all Health Events as needed.
Press . to select next.
21
32
Advice Options
Meal Rise
Snack Size
Acting Time
Offset Time
5.5 mmol/L
--4:00
1:00
HH MM
The Advice Options screen appears.
Back
33
Advice Options
100 mg/dL
3.0 mmol/L
---
Meal Rise
Snack Size
Acting Time
Offset Time
4:00
1:00
HH MM
Cancel
Press = to enter the Meal Rise box.
Press x or z to select the meal rise level.
Press = to save and move to the Snack Size
box.
34
Advice Options
Meal Rise
Snack Size
Acting Time
Offset Time
Cancel
22
3.0 mmol/L
g --4:00
1:00
7
HH MM
Press = to enter.
Press x or z to select the Snack Size.
Press = to save and move to the Acting Time
box.
Getting bolus advice from your meter
35
Advice Options
Meal Rise
Snack Size
Acting Time
Offset Time
3.0 mmol/L
7g
4:00
1:00
4:30
HH MM
Cancel
Press = to enter.
Press x or z to select the Acting Time.
Press = to save and move to the Offset Time
box.
36
Advice Options
Meal Rise
Snack Size
Acting Time
Offset Time
3.0 mmol/L
7g
4:30
1:00
1:15
HH MM
Cancel
Press = to enter.
Press x or z to select the Offset Time.
Press = to save.
Press . to save all settings and select Next.
37
Advice Options
New Snack Size has
also been applied to
After Meal Reminder
OK
You receive the message that the new setting will
be applied to the After Meal Reminder Snack
Size.
Press . to select OK.
38
Setup
The screen “Would you like to set up bG
Test Reminders?” appears.
Press , to select No.
Would you like to
set up bG Test
Reminders?
!
No
Yes
23
39
Setup
The Setup Wizard is complete.
Press . to select Next and enter the main
menu.
Setup Completed
Successfully
Next
40
Switch of the meter.
Now you can continue with coding your meter.
Before you can test your bG level with your meter you must code it with the
code chip accompanying the test strip container. You should also perform a
control test.
24
Notes
25
3 Measuring your blood glucose (bG) level
3.1 Running a control test
You need:
·· a new test strip
·· a control solution level 1 or 2. The control level is printed on the bottle label.
1
Place your meter on a flat surface (for example,
a table) and insert the test strip into the Test
Strip Slot in the direction of the arrow. The
meter turns on.
2
bG Test
Match Code to Vial
Code
111
The “Match Code to Vial” screen appears. Make
sure the code number on the screen matches the
code number on the test strip container.
3
bG Test
Apply Sample
The “Apply Sample” screen appears and a beep
indicates that the strip is ready for testing.
26
Measuring
your blood glucose (bG) level
4.
Remove the cap from the control solution bottle
and wipe the tip with a tissue.
5
Squeeze the bottle until a tiny drop forms at the
tip. Apply the drop to the front edge of the yellow
window of the test strip.
6
bG Test
Analyzing
The “Analyzing” screen appears as soon as you
have applied enough solution. Wipe the tip of the
control solution bottle and then put the cap on
the bottle tightly.
7
10:02
Control Result
2 Feb 08
6.4
The “Control Result” screen appears.
mmol/L
Menu
Level
27
8
Compare the result to the acceptable range
shown on the label of the test strip container.
Press . to display the Control Level screen.
9
10:02
Control Result
2 Feb 08
No Entry
Level 1
Level 2
Press x or z to select the control solution level.
Press = to confirm.
Cancel
10
10:02
Control Result
6.4
mmol/L
Menu
28
2 Feb 08
Level 1
Within range
When the control test result is within range,
the test strips and meter are working properly.
Remove and dispose of the test strip.
Measuring
your blood glucose (bG) level
3.2 Performing a blood glucose (bG) test
You need:
·· your lancing device
·· a new test strip
1
Prepare the lancing device according to the
instructions provided. Wash and dry your hands.
2
Place your meter on a flat surface (for example,
a table) and insert the test strip into the Test
Strip Slot in the direction of the arrow. The
meter turns on.
3
bG Test
Match Code to Vial
Code
111
The “Match Code to Vial” screen appears. Make
sure that the code number on the screen matches
the code number on the test strip container.
29
4
bG Test
Apply Sample
The “Apply Sample” screen appears and a beep
indicates that the strip is ready for testing.
5
Prick your finger with your lancing device.
6
Gently squeeze your finger to get a blood drop.
Apply the blood drop to the front edge of the
yellow window of the test strip.
7
bG Test
Analyzing
The “Analyzing” screen appears as soon as you
have applied enough blood.
30
Measuring
your blood glucose (bG) level
8
Your bG Result appears on the display.
9
About three seconds later the detailed
“bG Result” screen appears.
Here you can enter information about meal time,
the carbs you are planning to eat and you
current health or activity state.
10
bG Result
10:02
5.9
Nomg/dL
Entry
Pre Meal
Meal
Post Time
Meal
Carbs
Bedtime
Health
Other
--- U
Active Insulin
Cancel
Press x or z to move to the Meal Time box
(or Carbs / Health accordingly), and press = to
enter.
Press x or z to select a value.
Press = to save the value. If you enter values for
carbs and health here, they are adopted to the
Bolus Advice screen.
Press . to select Bolus and move to the Bolus
Advice screen.
In the next section you will learn how to get Bolus Advice after a bG test.
31
Understanding your bG result
The coloured bar on the bG Result screen indicates the meaning of your bG
result:
If the bar is
Hyper
Hypo
Your bG level is
Blue
above Hyper Warning Limit. It is highly recommended that
you check for ketones and measure your bG level frequently.
Blue
above your Target Range but below Hyper Warning Limit.
Green
within your Target Range.
Yellow
below your Target Range but above your Hypo Warning Limit.
Red
below your Hypo Warning Limit. It is highly recommended
that you eat an appropriate amount of fast acting carbs
immediately.
Discuss appropriate action for each of the situations with your health care
professional.
32
Measuring
your blood glucose (bG) level
3.3 Using Bolus Advice
Bolus Advice can only provide a reliable bolus recommendation, when a current
bG test result is available. Therefore it is highly recommended that you always
use Bolus Advice by starting with a bG test. When you use Bolus Advice without a current bG test result, you will be prompted with a warning if the last bG
Test result dates back for more than five minutes.
Taking Bolus Advice from a bG Test
To take bolus advice from a bG test, you need:
·· your lancing device
·· a new test strip
33
1
Prepare the lancing device according to the
instructions provided. Wash and dry your hands.
2
Place your meter on a flat surface (for example, a
table) and insert the test strip into the Test Strip
slot in the direction of the arrow. The meter turns
on.
3
bG Test
Match Code to Vial
Code
111
The “Match Code to Vial” screen appears. Make
sure the code number on the screen matches the
code number on the test strip container.
4
bG Test
Apply Sample
The “Apply Sample” screen appears and a beep
indicates that the strip is ready for testing.
34
Measuring
your blood glucose (bG) level
5
Prick your finger with your lancing device. Gently
squeeze your finger to get a blood drop.
6
Touch the blood drop against the front edge of
the yellow window of the test strip.
7
bG Test
Analyzing
The “Analyzing” screen appears as soon as you
have applied enough blood.
8
Your result appears on the display.
35
9
About three seconds later, a detailed “bG Result”
screen appears. Here you can add information
about the Meal Time, planned food intake or your
state of health, for statistical reasons, where
appropriate.
If you use the bG result for Bolus Advice, you cannot change entries later
on. Therefore it is recommended that you add information about Meal Time
here.
10
bG Result
10:02
5.9
Nomg/dL
Entry
Pre Meal
Meal
Post Time
Meal
Carbs
Bedtime
Health
Other
--- U
Active Insulin
Cancel
36
Press x or z to move to the Meal box (or Carbs/
Health accordingly), and press = to enter.
Press x or z to select a value.
Press = to save the value. If you enter values for
carbs and health here, they are adopted to the
Bolus Advice screen.
Press . to select Bolus and move to the Bolus
Advice screen.
Measuring
your blood glucose (bG) level
11
➊ Press = to enter the carbs Box.
Press x or z to select the amount of carbohydrates you are planning to eat.
➋ Press = to save and move to the Health box,
and press = to enter.
➊
➋
➌
➍
Press x or z to select your current state of
health, as appropriate.
➌ Press = to save and move to the Bolus
Amount box.
If you need to change the recommended bolus
amount, use =, x, z and = to change the
bolus amount and move to the Basal box.
➍ Otherwise, press z to move to the Basal box
directly.
Press =.
Press x or z to set the basal insulin amount.
Press = to save.
12
Press . to confirm and move to the Confirm
Bolus screen. Press . to select OK.
Use your pen or syringe to administer the insulin
accordingly.
37
38
Managing your data
4 Managing your data
Careful analysis of your bG data is an effective way for you and your healthcare
professional to control and manage your diabetes.
Your meter automatically stores up to 1000 diary records with their time and
date. You can review up to 250 diary records on your meter, or up to 1000 diary records using compatible software. These records are stored from the
newest to the oldest. It is very important to set the correct time and date, to
ensure that you and your healthcare professional can accurately interpret your
blood glucose results and that the bolus advice uses the appropriate settings
of the current time block.
Each diary record can contain:
·· Date and time
·· bG test result
·· Meal time (events)
·· Carbs
·· Health Event
·· Bolus amount
You can display filtered or sorted diary data in graphical or table format.
Your meter generates reports, such as bG averages with standard deviations,
for the time period you choose (for example, the past 7 days or the past
30 days). Graphs can be a good way to view your bG results. Your meter can
display a line graph to depict bG record trends, a graph showing result ranges
for daily or weekly, and a pie chart with different colours to illustrate the
amount of test results within, above, or below your bG Target Range.
39
The following table depicts the icons used to display your data:
Date of Record(s)
Time of bG Test
bG Icon
View Data
20:06
17:33
16:06
13:52
10:02
Back
1 Feb 08
mmol
/L
3.8
7.0
8.6
3.3
5.9
Select View
bG Value
Bolus Icon
Health Event Icon
Meal Time Icon
Carbs Icon
Icon
40
Icon Name
Description
bG Test
·· Icon is displayed when information exists for
this diary record regarding a blood glucose test.
Meal Time
·· Icon is displayed when information exists for
this diary record regarding Meal Time.
Carbs
·· Icon is displayed when information exists for
this diary record regarding carbs.
Health Event
·· Icon is displayed when information exists for
this diary record regarding Health Events.
Bolus
·· A Bolus has been deliverd.
Managing your data
Viewing your data
1
From main menu press x or z to select My Data.
Press = to enter.
2
10:02
2 Feb 08
View Data
Add Data
Reports
Data Transfer
The Data screen is displayed and View Data is
highlighted.
Press = to enter.
Menu
3
View Data
20:06
17:33
16:06
13:52
10:02
Back
1 Feb 08
mmol
/L
3.8
7.0
8.6
3.3
5.9
Select View
The View Data screen appears.
Press x or z to view other records (the screen
scrolls if there are additional records).
41
4
View Data
20:06
17:33
16:06
13:52
10:02
Back
1 Feb 08
U
bG Value
2.4
Bolus
Carbs2.2
0.7
1.8
The screen shows the bG test results in the right
column by default, but you can also view bolus or
carb data.
Press . to select Select View.
Press x or z to select carbs or bolus.
Press = to enter.
5
View Data
20:06
17:33
16:06
13:52
10:02
Back
1 Feb 08
U
2.4
2.2
0.7
1.8
Select View
To view the details of a specific record press x or
z to move the record.
Press = to enter.
6
The View Detail screen is displayed.
Press < to view the previous or > to view next
(newer) record.
42
Managing your data
Editing your data
You can also use this function to add information on your Basal insulin.
You are in the View Detail screen in step 6 of the previous procedure.
1
View Detail
16:06
1 Feb 08
bG Value 8.6 mmol/L
Pre Meal
Meal Time
60 g
Carbs
Health
Stress
2.2 U
Bolus
Back
Modify
Press . to select Modify.
2
16:06
Cancel
Modify Data
2 Feb 08
8.6 mmol/L
Meal Time
60 g
Health
Bolus
Save
Press x or z to select the field you wish to edit,
and press = to enter.
3
16:06
Modify Data
1 Feb 08
154
No mg/dL
Entry
Meal
Time
Pre Meal
g
Post 60
Meal
Bedtime
Stress
Other 2.2
Press x or z to change the entry, and = to save
the change.
Cancel
4
Edit the other fields accordingly, as necessary.
Press . to save the changes and exit.
Warning
Diary Entry Used
For Advice
Diary entry used for
Advice, modifications not
allowed
You cannot go back and edit data that have been
used with Bolus Advice!
OK
43
Adding data
You can add data to a diary record for Carbs, Health, Basal, and Bolus, but not
for bG Test results.
1
From the main menu, press x or z to select My
Data.
Press = to enter.
2
10:00
2 Feb 08
View Data
Add Data
Reports
Data Transfer
Press z to move to Add Data.
Press = to enter.
Menu
3
Add Data
10
HH
00
MM
2 Feb
DD MMM
08
YY
Carbs
Health
Bolus
Press x or z to select a field.
Press = to enter.
Cancel
4
Add Data
10
9HH
00
MM
2 Feb
DD MMM
08
YY
Carbs
Health
Bolus
Cancel
44
Press x or z to edit the entry.
Press = to confirm.
Managing your data
5
Add Data
9
HH
20
MM
2 Feb
DD MMM
08
45Health
YY
g
Carbs
Use x, z and = to edit other entries accordingly.
Bolus
Cancel
6
Add Data
9
HH
20
MM
2 Feb
DD MMM
Cancel
08
YY
45 g
Health
Bolus
Save
Press . to save and return to the My Data
screen.
45
Reporting data
In this menu you can view many different statistics for your bG test results,
such as bG averages and standard deviations. Standard deviation is a statistical
expression that indicates how far the individual test results are scattered
around the average.
1
From main menu, press x or z to select My
Data.
Press = to enter.
2
10:02
2 Feb 08
View Data
Add Data
Reports
Data Transfer
The My Data screen appears.
Press z to select Reports.
Press = to enter.
Menu
3
Reports
bG Averages
Trend
Standard Day
Standard Week
Target
Back
46
The Reports screen appears.
Managing your data
j
bG Averages …
shows you averages and standard deviations for your bG test results for the categories Overall, Pre Meal, Post Meal, Bedtime
and Others. Test results without Meal time
entry only occur in the Overall category.
You can choose whether the averages and
standard deviations include the results of
the last 7, 14, 30, 60 or 90 days.
1
Reports
bG Averages
Trend
Standard Day
Standard Week
Target
From the Reports screen, press = to enter bG
Averages.
Back
2
Last 7 days
mmol
SD Tests
/L
Overall
Pre Meal
Post Meal
Bedtime
Other
Back
9.1
7.6
11.2
3.1
9.7
4.5
3.7
6.9
2.8
37
13
5
1
2
The bG Average screen appears.
Press < or > to select the period of time included
in the calculation.
3
Last 30 days
mmol
SD Tests
/L
Overall
Pre Meal
Post Meal
Bedtime
Other
Back
8.8
7.4
12.3
4.8
9.9
4.3 144
4.0 98
6.4 32
8
3.0
3.1
4
Press , to select Back and return to the
Reports screen.
47
j
Trend …
combines your bG test results for the categories
Overall, Pre Meal, Post Meal, Bedtime and Others with the entries for Carbs and insulin. You
can view them either as a table or as a graphic.
You can choose whether the results of the last
8, 24 or 48 hours or 7 days are included.
1
Reports
bG Averages
Trend
Standard Day
Standard Week
Target
From the Reports screen, press z to select Trend.
Press = to enter.
Back
2
25
20
Last 8 hours
Overall
U
15
mmol
/L
10
5
0
Back
48
120
g
14:00 16:00 18:00
Table
The Trend screen appears.
Press x or z to switch between the selection of
the included period of time and the Meal Time
field.
Managing your data
3
25
20
Last 48 hours
Overall
U
15
mmol
/L
10
5
0
Back
120
g
08:00 20:00 08:00
When the time field is highlighted (8, 24 or
48 hours or 7 days), press < or > to select the
included period of time.
Table
4
25
20
Last 8 hours
Pre Meal
U
15
mmol
/L
10
5
0
Back
120
g
14:00 16:00 18:00
When the Meal Time field is highlighted, press <
or > to select the Meal Time category you wish to
view.
Table
5
Last 8 hours
Overall
2 Feb 08
20:06
17:33
16:06
13:52
Back
mmol
/L
3.8
7.0
8.6
3.6
g
U
66
60 2.4
20 2.2
60 0.7
Graph
Press . to switch between Graph view and
Table view.
Press , to select Back and return to the
Reports screen.
49
j
Standard Day …
shows you averages and standard deviations for
your bG test results for the categories Overall,
Pre Meal, Post Meal, Bedtime and Other calculated for each Time Block of your Bolus Advice / Time Block setting. You can view them
either as table or as graphic. You can choose
whether the averages and standard deviations
include the results of the last 7, 14, 30, 60 or
90 days.
1
Reports
bG Averages
Trend
Standard Day
Standard Week
Target
From Reports screen press x or z to select
Standard Day.
Press = to enter.
Back
2
25
20
Last 7 days
Overall
mmol
/L
10
5
0
Back
50
6:00
12:00 18:00
Table
The Standard Day screen appears.
Press x or z to toggle between selection of
included period of time and Meal Time field.
Managing your data
3
25
20
Last 30 days
Overall
When the time field is highlighted (7, 14, 30, 60 or
90 days), press < or > to select the included
period of time.
mmol
/L
10
5
0
Back
6:00
12:00 18:00
Table
4
25
20
Last 30 days
Pre Meal
When the Meal Time field is highlighted, press <
or > to select the Meal Time category you wish to
view.
mmol
/L
10
5
0
Back
6:00
12:00 18:00
Table
5
Last 7 days
Overall
0:00 - 4:00
4:00 - 8:00
8:00 - 12:00
12:00 - 16:00
Back
mmol
/L
8.7
8.0
11.1
7.4
SD Tests
3.7
2.7
8.0
4.1
3
4
4
9
Graph
Press . to switch between Graph view and
Table view.
Press , to select Back and return to the
Reports screen.
51
j
Standard Week …
shows you averages and standard deviations for
your bG test results for the categories Overall,
Pre Meal, Post Meal, Bedtime and Other, calculated for each day of the week. You can view
them either as a table or as a graphic. You can
choose whether the averages and standard
deviations include the results of the last 7, 14,
30, 60 or 90 days.
1
Reports
bG Averages
Trend
Standard Day
Standard Week
Target
From the Reports screen, press x or z to select
Standard Week.
Press = to enter.
Back
2
Last 7 days
Overall
25
20
mmol
/L
10
5
0
M
Back
52
T
W
T
F
S
S
Table
The Standard Week screen appears.
Press x or z to toggle between the selection of
included period of time and Meal Time field.
Managing your data
3
Last 14 days
Overall
25
20
mmol
/L
10
5
0
M
Back
T
W
T
F
S
S
When the time field is highlighted (7, 14, 30, 60 or
90 days), press < or > to select the included
period of time.
Table
4
Last14
7 days
Last
days
Pre
Meal
Overall
25
20
mmol
/L
10
5
0
M
Back
T
W
T
F
S
S
When the Meal Time field is highlighted, press <
or > to select the Meal Time category you wish to
view.
Table
5
Last 7 days
Overall
mmol
/L
SD Tests
Monday
12.4 2.2
Tuesday
10.0 3.9
Wednesday 8.7 5.5
Thursday
8.8 4.1
Back
5
5
5
5
Graph
Press . to switch between Graph view and
Table view.
Press , to select Back and return to the
Reports screen.
53
j
Target …
shows you percentages for your bG test results
for the categories Overall, Pre Meal, Post Meal,
Bedtime and Other, that are
• a bove your Target Range
(between upper and lower bG target limit)
•w
ithin your Target Range
(between upper and lower bG target limit)
•b
elow your Target Range
(between upper and lower bG target limit)
•b
elow your Hypo Warning Limit.
You can view them either as a table or as a pie
chart. You can choose whether the percentages
include the results of the last 7, 14, 30, 60 or
90 days.
1
Reports
bG Averages
Trend
Standard Day
Standard Week
Target
From the Reports screen, press x or z to select
Target.
Press = to enter.
Back
2
Last 7 days
Overall
The Target screen appears.
Press x or z to switch between the selection of
included period of time and Meal Time field.
Above
Within
Below
Hypo
Back
54
Table
Managing your data
3
Last 14 days
Overall
When time field is highlighted (7, 14, 30, 60 or
90 days), press < or > to select the included
period of time.
Above
Within
Below
Hypo
Back
Table
4
Last14
7 days
Last
days
Pre
Meal
Overall
When the Meal Time field is highlighted, press <
or > to select the Meal Time category you wish to
view.
Above
Within
Below
Hypo
Back
Table
5
Last 7 days
Overall
Above
Within
Below
Hypo
Back
48%
32%
18%
2%
Graph
Press . to toggle between Graph view and
Table view.
Press , to select Back and return to the
Reports screen.
55
4.1 Transferring data to a Computer
1
Position the infra-red window of your meter
opposite the infra-red cable of the computer, and
prepare the computer for data transfer
(for detailed instructions, see the instructions
provided with the according software on your
computer.)
2
From main menu on the meter press x or z to
select My Data.
Press = to enter.
3
10:02
2 Feb 08
View Data
Add Data
Reports
Data Transfer
Press x or z to move to Data Transfer.
Press = to enter.
Menu
4
Data Transfer
Transferring Data
56
The data transfer begins.
When the data transfer is complete the Data
Transfer Complete screen appears for three
seconds and then the meter turns off.
Managing your data
57
Using Reminders
5 Using Reminders
Managing your job, managing your family or managing school often require
your full attention. The meter can assist you managing your diabetes. With
reminders it helps you remembering a variety of diabetes related tasks.
Three different types of reminders are available to accommodate for different
requirements:
j
bG Test Reminders … remind you to test your bG level in special
situations:
·· after a high bG test result (hyperglycaemia):
After High bG
·· after a low bG test result (hypoglycaemia):
After Low bG
·· after a meal: After Meal
j
Alarm Clock …
You can set up to eight different alarm clock
reminders per day.
You can set them to remind you of:
·· a bG Test
·· an injection
·· other events
j
Date Reminders …
remind you of events like:
·· Dr. Visit sounds at a special date
·· Lab Test sounds at a special date
59
To set Reminders
1
From main menu, press x or z to select
Settings.
Press = to enter.
2
2 Feb 08
10:02
Reminders
Bolus Advice
Meter
Sound/Vibrate
Time/Date
The Settings screen appears.
Press = to enter Reminders.
Menu
3
Reminders
bG Test Reminders
Alarm Clock
Date Reminders
Back
60
The Reminders screen appears.
Using Reminders
bG Test Reminders – After High bG
This reminder will turn on the meter. You can dismiss it by pressing ..
You can reschedule (snooze) it to occur in 15 minutes by pressing ,.
1
Reminders
bG Test Reminders
Alarm Clock
Date Reminders
From the Reminders screen press x or z to
select bG Test Reminders.
Press = to enter.
Back
2
bG Test Reminders
After High bG
After Low bG
After Meal
Off
Off
Off
The bG Test Reminders screen appears.
Press = to enter After High bG.
Back
3
After High bG
Reminder
Off
bG Threshold 16.5 mmol/L
Remind After
0:15
On
HH MM
Off
Cancel
The After High bG screen appears.
Press = to enter Reminder.
Press x or z to select On or Off as needed.
Press = to confirm and move to the bG Threshold box. The Hyper Warning Limit is set as bG
threshold for triggering the reminder by default.
61
4
After High bG
Reminder
On
300 mg/dL
bG Threshold mmol/L
Remind After
0:15
16.5
HH MM
Cancel
To change the bG threshold press =.
Press x or z to select the bG value as needed.
Press = to confirm and move to the Remind
After box.
5
After High bG
Reminder
On
bG Threshold 16.5 mmol/L
Remind After
0:15
1:30
HH MM
Cancel
62
Press = to enter.
Press x or z to change the period after which
the reminder sounds as needed.
Press = to confirm.
Press . to save and return to the bG Test
Reminders screen.
Using Reminders
bG Test Reminders – After Low bG
This reminder turns on the meter. You can dismiss it by pressing ..
You can re-schedule (snooze) it to occur in five minutes by pressing ,.
1
Reminders
bG Test Reminders
Alarm Clock
Date Reminders
From the Reminders screen press x or z to
select bG Test Reminders.
Press = to enter.
Back
2
bG Test Reminders
After High bG
After Low bG
After Meal
Off
Off
Off
The bG Test Reminders screen appears.
Press x or z to select After Low bG.
Press = to enter.
Back
3
After Low bG
Reminder
Off
bG Threshold 5.0 mmol/L
Remind After
0:15
On
HH MM
Off
Cancel
The After Low bG screen appears.
Press = to enter Reminder.
Press x or z to select On or Off as needed.
Press = to confirm and move to the bG Threshold box. The Hypo Warning Limit is set as bG
threshold for triggering the reminder by default.
63
4
After Low bG
Reminder
On
300 mg/dL
bG Threshold mmol/L
Remind After
0:15
3.5
HH MM
Cancel
To change the bG Threshold press =.
Press x or z to select the bG value as needed.
Press = to confirm and move to the Remind
After box.
5
After Low bG
Reminder
On
bG Threshold 3.5 mmol/L
Remind After
0:15
0:20
HH MM
Cancel
64
Press = to enter.
Press x or z to change the period after which
the reminder sounds as needed.
Press = to confirm.
Press . to save and return to the bG Test
Reminders screen.
Using Reminders
bG Test Reminders – After Meal
This reminder will turn on the meter. You can dismiss it by pressing ..
You can reschedule (snooze) it to occur in five minutes by pressing ,.
1
Reminders
bG Test Reminders
Alarm Clock
Date Reminders
From the Reminders screen press x or z to
select bG Test Reminders.
Press = to enter.
Back
2
bG Test Reminders
After High bG
After Low bG
After Meal
Off
Off
Off
The bG Test Reminders screen appears.
Press x or z to select After Meal.
Press = to enter.
Back
3
After Meal
Reminder
Snack Size
Remind After
Cancel
On
20 g
2:00
On
HH
MM
Off
The After Meal screen appears.
Press = to enter Reminder.
Press x or z to select On or Off as needed.
Press = to confirm and move to the Snack Size
box.
The Snack Size is the same as entered in the Bolus Advice Options.
If you change it here it will also be changed in the Bolus Advice settings.
65
4
After Meal
Reminder
Snack Size
Remind After
10
On
g20 g
2:00
HH MM
Cancel
Press = to enter.
Press x or z to select appropriate Snack Size as
needed.
Press = to confirm and move to the Remind
After box.
5
After Meal
Reminder
Snack Size
Remind After
Cancel
66
On
20 g
2:00
1:30
HH MM
Press = to enter.
Press x or z to select an appropriate period of
time as needed.
Press = to confirm.
Press . to save and return to the bG Test
Reminders screen.
Using Reminders
Alarm Clock
This reminder turns on the meter. You can dismiss it by pressing ..
You can re-schedule (snooze) it to occur in 15 minutes by pressing ,.
1
Reminders
bG Test Reminders
Alarm Clock
Date Reminders
From the Reminders screen, press x or z to
select Alarm Clock.
Press = to enter.
Back
2
Alarm Clock
HH MM
Off
Off
Off
Off
Off
Save
0:00
0:00
0:00
0:00
0:00
Cancel
The Alarm Clock screen appears.
Press x or z to move to the alarm clock you
wish to change.
Press = to enter the time box.
3
Alarm Clock
HH MM A/P
9:00
12:00 am
0:00
0:00
0:00
0:00
Cancel
Off
Off
Off
Off
Off
Press x or z to select the appropriate time for
the alarm.
Press = to confirm and move to the Off or
purpose box.
67
4
Alarm Clock
HH MM A/P
9:00
0:00
0:00
0:00
0:00
bG Test
Off
Off Off
bG Test
Off
Other
Off
Off
Cancel
Press = to enter.
Press x or z to select Off, bG Test, Injection or
Other as needed.
Press = to confirm.
5
Alarm Clock
HH MM
9:00
0:00
0:00
0:00
0:00
Cancel
68
bG Test
Off
Off
Off
Off
Save
Where appropriate, repeat steps 2 to 4 to set
more Alarm Clocks accordingly.
Press . to save and return to the Reminders
screen.
Using Reminders
Date Reminders – Dr. Visit
This reminder does not turn on the meter, but sounds as soon as you turn on
the meter on the selected day. You can dismiss it by pressing ..
1
Reminders
bG Test Reminders
Alarm Clock
Date Reminders
From the Reminders screen, press x or z to
select Date Reminders.
Press = to enter.
Back
2
The Date Reminder screen appears.
Press x or z to move to Dr. Visit.
Press = to enter.
3
Dr. Visit
Reminder
Off
Appointment Date/Time
Date
2 Feb On
08
DD MMM Off
YY
Time
--:-HH MM
(Optional)
Cancel
The Dr. Visit screen appears.
Press = to enter the Reminder box.
Press x or z to select On or Off.
Press = to confirm an move to the Date line.
69
4
Dr. Visit
Reminder
On
Appointment Date/Time
12
Date
2 Mar
08
Feb
Time
(Optional)
DD MMM
--:--
YY
HH MM
Cancel
Save
Press = to enter the day box.
Press x or z to select the day.
Press = to confirm and enter the month box.
Press x or z to select the month.
Press = to confirm and enter the year box.
Press x or z to select the year.
5
Press = to confirm and move to the Time box.
Press = to enter.
6
Dr. Visit
Reminder
On
Appointment Date/Time
Date
12 Mar
08
DD MMM
10:00 am
11:30
HH MM
Time
(Optional)
Cancel
70
YY
Press x or z to select the time.
Press = to confirm.
Press . to save and return to the Date
Reminders screen.
Using Reminders
Date Reminders – Lab Test
This reminder does not turn on the meter, but sounds as soon as you turn on
the meter on the selected day. You can dismiss it by pressing ..
1
Reminders
bG Test Reminders
Alarm Clock
Date Reminders
From the Reminders screen press x or z to
select Date Reminders.
Press = to enter.
Back
2
The Date Reminder screen appears.
Press x or z to move to Lab Test.
Press = to enter.
3
Lab Test
Reminder
Off
Appointment Date/Time
Date
2 Feb On
08
DD MMM Off
YY
Time
--:-HH MM
(Optional)
Cancel
The Lab Test screen appears.
Press = to enter the Reminder box.
Press x or z to select On or Off.
Press = to confirm and move to the Date line.
71
4
Lab Test
Reminder
On
Appointment Date/Time
12
Date
2 Mar
08
Feb
Time
(Optional)
DD MMM
--:--
YY
HH MM
Cancel
Save
Press = to enter the day box.
Press x or z to select the day.
Press = to confirm and enter the month box.
Press x or z to select the month.
Press = to confirm and enter the year box.
Press x or z to select the year.
5
Lab Test
Reminder
On
Appointment Date/Time
Date
12 Mar
08
Time
(Optional)
DD MMM
--:--
YY
HH MM
Press = to confirm and move to the Time box.
Press = to enter.
Save
Cancel
6
Lab Test
Reminder
On
Appointment Date/Time
Date
12 Mar
08
Time
(Optional)
Cancel
72
DD MMM
10:00 am
8:30
HH MM
YY
Press x or z to select the time.
Press = to confirm.
Press . to save and return to the Date
Reminders screen.
Changing your system Settings
6 Changing your meter Settings
As your life or health situation may change, you may need to change some of
the values in your meter settings. Discuss with your healthcare professional
before you change settings.
1
From main menu press x or z to move to
Settings.
2
10:02
Reminders
Bolus Advice
Meter
Sound/Vibrate
Time/Date
2 Feb 08
Press = to enter. The Settings screen appears.
Menu
3
Use x, z and = to edit the particular setting as needed.
4
Where appropriate, press . to save and exit.
73
You will find the particular settings as follows:
Reminders
Reminders
bG Test Reminders
Alarm Clock
Date Reminders
› bG Test Reminders › After High bG
› After Low bG
› After Meal
Back
› Alarm Clock
› Alarm Clock 1– 8
› Date Reminders
› Dr. Visit
› Lab Test
› Time Blocks › End
› Target Range
› Carb Ratio
› Insulin Sensitivity
› Health Events › Exercise 1
› Exercise 2
› Stress
› Illness
› Premenstrual
› Advice Options
› Meal Rise
› Snack Size
› Acting Time
› Offset Time
Bolus Advice
Bolus Advice
Time Blocks
Health Events
Advice Options
Back
74
Changing your system Settings
Meter
› Warning Limits › Hyper (high)
› Hypo (low)
› Key Lock › ON / OFF
› Language
› Units
› Grams, BE, KE, CC
› Insulin Increment
› Max Bolus
› Beeper › Off, low, medium, high
› Vibrate
› ON / OFF
Save
› Key Sound
› ON / OFF
24 hr
› Time Format
Sound / Vibrate
Sound/Vibrate
Beeper
Vibrate
Key Sound
Medium
Off
On
Cancel
Time / Date
Time/Date
Time Format
10
Time
Date
Cancel
HH
00
MM
2 Feb
DD MMM
YY
08
› Time
Save
› Date
75
Appendix
Appendix A
Calculating a correct bolus is a tricky business.
If you had to work it out yourself,
here’s what you would have to do.
Sweety’s
dy-
a Rea
r
o
f
e
ip
c
Re
olus
ulin B
s
n
I
e
s
U
to-
ts
drates
y
h
o
b
Ingredien
r
a
c
mount of
a
h
Ratio
s
e
b
r
r
f
a
C
··A
o
t
insulint
n
e
result
r
r
t
u
s
e
c
t
r
)
u
o
G
Y
··
cose (b
lu
g
d
o
lo
b
level
t
··A fresh
e
g
r
your
a
t
d
e
ll
G
a
b
c
t
o
n
e
r
ivity (als
it
s
n
··Your cur
e
s
n
li
ent insu
r
r
u
c
r
u
o
··Y
actor)
f
n
io
t
c
e
r
cor
ess,
r
t
s
e
,
e
im
t
is
c
t
c
r
re
for exe
t
n
e
··The cor
m
t
s
u
j
e ad
eded)
e
s
o
n
d
s
a
n
li
d
u
s
d
··An in
ation (a
u
r
t
s
n
e
m
e
pr
illness or
··Insulin
77
Tools
clock
r
o
h
c
t
a
··A w
··A meter
trip
··A test s
device
g
n
i
c
n
a
l
A
··
syringe
r
o
n
e
p
lin
··An insu
tes by
a
r
d
y
h
o
b
the car
tions
y
c
l
u
p
i
r
t
t
l
u
s
n
m
I
me and
i
t
atio.
e
R
h
t
b
r
k
a
c
C
e
h
ust not
-to
1. C
n
m
i
l
u
d
s
n
n
a
i
t
h
ren
be fres
t
s
u
your cur
m
s
e
lus.
hydrat
o
o
b
b
r
s
a
u
c
o
i
v
e
e
Th
r a pr
bolus.
o
l
f
a
e
d
m
e
s
r
u
u
is is yo
h
test
have been
T
.
G
e
b
d
)
i
s
w
e
a
n
t
(
l
e resu
a fresh
t
e
g
o
t
2. Put th
t
bG tes
a
m
r
o
f
utes old
n
3. Per
i
m
e
v
i
f
than
s
s
e
l
s
i
result.
t
l
olus.
esu
b
r
s
e
u
h
t
io
v
e
e
r
r
for a p
Make su
d
e
s
u
n
e
ot be
and has n
78
Appendix
4. Take
away you
r curren
your bG
t bG ta
t
e
s
rget leve
t
r
e
s
5. Multi
u
l
t
.
l from
ply the a
n
swer by
tivity lev
your cur
el (chec
rent ins
k the tim
correcti
ulin sens
e
). This g
on bolus
iives you
.
6. Add
the
the corr
e
c
t
i
o
n bolus
you prep
to the m
ared ear
eal bolus
l
i
e
r. (If t
0, you d
that
o not ne
he resul
e
t
7.Add
d to inje
is less t
or take
ct insulin
han
a
w
a
a
t
y
the mom
the heal
exercise
ent.)
th perce
, stress
n
,
t
i
a
l
l
ge for
ness or
required
premens
.
truation
8. Injec
as
t the re
s
u
l
t
i
ng amou
pen or s
nt of ins
yringe.
ulin usin
g your
Note: Do
not re-u
se the c
result fo
arb amo
r a seco
unt or b
nd bolus
dosage a
G test
a
s this co
nd hypo
uld lead
glycaemi
to doubl
a.
e
79
Thankfu
lly, calcul
ating a c
Accu-Ch
orrect bo
ek Aviva
lus with t
Combo me
he new
ter is so
m
uch easie
Ingredie
r.
nts
··A fresh
amount o
f carboh
··A fresh
ydrates
bG test
r
e
s
··A health
ult
percenta
ge for ex
premenst
ercise, st
ruation (
ress, illne
add as n
ss or
eeded)
Your Acc
u-Chek A
viva Comb
considers
o meter a
the curre
utomatica
nt time, y
Ratio for
lly
o
u
r insulinthe curre
to-Carb
nt time, y
Sensitivit
our curr
y (also c
ent Insu
alled the
the perce
lin
c
o
r
rection f
ntages fo
actor) an
r exercis
premenst
d
e, stress
ruation a
,
i
l
l
s
n
e
y
s
o
s
u entered
Wizard.
them in th or
e Set-up
80
Appendix
eter
m
o
b
m
o
iva C
Chek Av
Tools
cuc
A
r
u
o
Y
··
strip
··A test
g device
n
i
c
n
a
l
ringe
y
s
··A
r
o
n
ulin pe
s
n
i
r
u
o
Y
··
sult
bG Re
Chek
ccuA
w
e
n
r
you
10:02
5.9
mmol/L
ime
Meal T s
Carb
Health
--- U
n
Insuli
Bolus
Active
tions
Instruc a bG test using
Menu
t
m
l
u
r
o
s
e
f
r
R
1. Pe
Test
.
G
b
r
e
e
t
h
e
t
m
from
e
Combo
c
i
v
d
A
Bolus
s
s
e
bs you
c
r
c
a
A
c
f
2.
o
mount
a
e
.
h
n
e
t
e
r
r
e
sc
mation
ent
r
,
o
e
f
c
n
i
i
v
y
d
n
olus A
and a
e
m
u
s
n
o
3. In B
g to c
ed.
n
r
i
i
n
u
n
q
a
e
l
r
p
s
a
you.
are
s
r
t
o
n
f
e
v
n
E
o
i
t
alth
alcula
nge.
i
c
r
e
y
h
s
t
about He
r
o
o
r pen
e will d
u
c
i
o
v
y
d
g
A
n
i
s
s
Bolu
sulin u
n
i
e
h
t
r
niste
4. Admi
81
Your Ac
cu-Che
k Aviva
cally en
Co
sure th
at neith mbo meter will
test re
er a ca
sult is r
rb amou automatie-used
nt nor
for a s
a bG
e
cond bo
For fur
lus!
ther de
tai
Advice
Calculat ls see Appendi
x B and
ion.
C: Bolu
s
82
Appendix
Where to find the Bolus Advice settings on the meter
Manual calculation
Time dependence of
parameters
(circadian rhythm)
On your meter
Time Blocks:
In Settings › Bolus Advice › Time Blocks
Carb Ratio:
Insulin-to-carbohydrate ratio Within each Time Block (in Settings › Bolus
Advice › Time Blocks)
Insulin Sensitivity:
Insulin Sensitivity / correction
Within each Time Block
factor
(in Settings › Bolus Advice › Time Blocks)
Target Range:
bG target level
Insulin dose adjustment for
exercise, stress, illness or
premenstruation
Within each Time Block
(in Settings › Bolus Advice › Time Blocks)
The target value is calculated automatically as
midway between the upper and lower target
limits.
Health:
In the bG Test Result screen or in Bolus
Advice. Select the value in Settings › Bolus
Advice › Health Events.
83
Manual calculation
On your meter
Meal Rise:
Prevention of double dosage In connection with Acting Time
after meal
and Offset Time (in Settings › Bolus Advice
› Advice Options).
Offset Time
Prevention of double dosage
and
after a high bG test result
after a correction bolus.
84
Acting Time
Appendix
Appendix B: Bolus Advice Calculations
In this section you will learn how Bolus Advice recommendations are calculated.
To make sure that the recommendations meet your needs, you must give the
Bolus Advice feature on your meter some extra information, as well as the
basic blood glucose (bG) and carbohydrate values. As a safety measure, Bolus
Advice will not work without this information.
Your healthcare professional will give you the information that you need for the
Bolus Advice feature.
Carbohydrate Units
Choosing how your carbohydrates will be measured is important. In this way,
Bolus Advice can give you an accurate result. You just select what carbohydrate units Bolus Advice will use to make its calculations. You can choose
between:
·· Grams
·· BE (≈ 12 g)
·· KE (≈ 10 g)
·· CC (≈ 15 g)
85
Time Blocks
Your insulin needs may vary depending on the time of day,
so using the same values and factors throughout the
day would probably not suit your metabolism or lifestyle.
This could also lead to incorrect doses of insulin.
Start
0:00
5:30
11:00
17:00
21:30
Back
Time Blocks
End
5:30
11:00
17:00
21:30
0:00
The screen above shows the Time Blocks feature within Bolus Advice. Time
Blocks consider your time dependent requirements when calculating your insulin
dose at different times of the day. You can program up to eight Time Blocks,
depending on your lifestyle. For example, your insulin needs in the morning or
evening may not be the same as those in the afternoon or at night, so you can
program these different periods as Time Blocks. There are no pre-defined Time
Blocks that you should follow. You can choose when a Time Block ends to suit
your lifestyle.
86
Appendix
Within Time Blocks you will find the following settings:
Time Blocks
Target Range
4.0 mmol/L 8.0 mmol/L
Carb Ratio
10 g
1 U for
Insulin Sensitivity
1 U for 2.2 mmol/L
Save
Cancel
Target Range Your bG results should be between the lower and upper values of the Target
Range as long as you are fasting (in the morning or before a meal). The target
bG will be calculated automatically as the average between the upper and
lower bG values.
Carb Ratio
The Carb (carbohydrate) Ratio defines how much insulin is needed to compensate for a certain amount of carbohydrates.
Insulin Sensitivity
The Insulin Sensitivity (correction factor) shows how sensitive you are to a dose
of insulin. This is how much your bG drops in response to a certain amount of
insulin.
You can define all of these values separately for each Time Block. The Bolus
Advice calculation automatically takes these values into account for the time
of day.
87
If your bG level is …
… the Bolus calculation is
hyper
Without a meal – that means, when you do not enter Carbs – these
are the Calculations
(bG – Target bG) × Insulin Sensitivity
Additional recommendation to measure BG
more frequently and check for ketones.
above Hyper Warning
hypo
between Upper Target
(bG – Target bG) × Insulin Sensitivity.
Limit and Hyper Warning
between Upper and
Lower Target Limit
No correction bolus necessary.
between lower Target
Limit and Hypo Warning
No correction bolus recommended.
below Hypo Warning
Hypo Warning! Recommendation to eat fast
acting carbs.
Bolus Advice function not accessible!
Remember the colored bar in the bG test-result screen tells where your
current bG level is compared to your target bG.
bG Result
10:02
5.9
mmol/L
Meal Time
Carbs
Health
--- U
Active Insulin
Bolus
Menu
88
Appendix
Before a meal – that means, when you enter Carbs – these are the
Calculations
The Meal bolus will always be calculated as:
carbs × insulin-to-carb-ratio
hyper
If your bG level is …
above Hyper Warning
… the Bolus calculation is
(bG – Target bG) × Insulin Sensitivity +
Meal bolus. Additional recommendation to
measure bG more frequently and check for
ketones.
hypo
between Upper Target
(bG – Target bG) × Insulin Sensitivity +
Limit and Hyper Warning Meal bolus.
between Upper and
Lower Target Limit
(bG – Target bG) × Insulin Sensitivity +
Meal bolus. Note that correction bolus can
be negative.
between lower Target
Limit and Hypo Warning
(bG – Target bG) × Insulin Sensitivity +
Meal bolus. Note that correction bolus is
negative.
below Hypo Warning
Hypo Warning! Recommendation to eat
fast acting carbs.
Bolus Advice function not accessible!
89
Health Events
If your routine was always the same from one day to the
next, then Time Blocks would provide enough information
to calculate the correct boluses. However, sometimes your
daily routine may be different and your insulin needs will
then change.
Health Events
Exercise 1
Exercise 2
Stress
Illness
Premenstrual
Cancel
-10%
-20%
0%
+20%
0%
Save
You can use Health Events to take into account various activities or events that
increase or decrease your insulin needs. You can choose different Health
Events depending on how you are feeling or what you are doing. For example,
sport or physical activity could decrease your insulin needs, whereas illness or
the menstrual cycle could increase your insulin needs.
Many of these activities or events do not occur at regular intervals, and Time
Blocks cannot take them into account. With Health Events, you can program
how much extra insulin (as a percentage of your usual bolus) you may need.
For example, when exercising, your insulin requirement may be 25 % lower. You
and your healthcare professional should discuss what percentage to
program for each Health Event.
90
Appendix
When one of the programmed Health Events occurs in your daily life, you can
choose the Health Event on your meter so that Bolus Advice can calculate the
correct insulin dose. You can program five different Health Events:
·· Exercise 1
·· Exercise 2
·· Stress
·· Illness
·· Premenstrual
The Bolus Advice screen and the bG Result screen call these Health with the
-icon.
Within Health on the Bolus Advice and bG Result screen you can also select
Fasting. However, you cannot adjust Fasting by percentage and it does not
scale advice calculations.
Advice Options – Meal Rise, Snack Size, Acting Time,
and Offset Time
Advice Options help to make sure that Bolus Advice does
not recommend a second bolus for a blood sugar event,
such as a meal or a high bG level, that has already been
covered by a previous bolus.
Start
0:00
5:30
11:00
17:00
21:30
Back
Time Blocks
End
5:30
11:00
17:00
21:30
0:00
91
Meal Rise
After a meal, bG levels usually increase by a noticeable amount, even in people
without diabetes. Depending on the type of meal, your bG can reach a maximum
about an hour after your meal and return to its original level after another one
to two hours. This is a normal process, so Bolus Advice takes this into account
using Meal Rise.
bG level
Acting Time
hyper
Offset Time
Meal Rise
Target Value
Target Range
hypo
Current
bG values
Time
Meal
Bolus
Bolus
not required
Currently allowed
bG value: Meal Rise
Fig. 1: Meal Rise
The dotted line shows how your bG level typically changes after a meal bolus.
Bolus Advice tolerates an increased bG level within the Meal Rise range
(green) without calculating an extra correction bolus. Each time you tell Bolus
Advice that you have consumed more carbohydrates than the Snack Size, the
Meal Rise entry is added to the bG target value. How long the Meal Rise lasts
(the width of the green area) is determined by the Offset Time and the Acting
Time.
92
Appendix
Snack Size
The Snack Size defines a certain amount of carbohydrates for which a meal
bolus is calculated, but no Meal Rise is triggered. No bG level above the Target
Range or currently allowed bG is tolerated for this amount of carbohydrates, so
Bolus Advice will calculate a correction bolus for any increase in bG after a
snack.
Acting Time
The Acting Time is the time for which the insulin delivered as a bolus is still
effective. It is the whole time for which an increase in bG after a meal bolus or
a correction bolus is taken into account. Bolus Advice will not recommend a
correction bolus for this time if your current bG level is less than the bG level
covered by the previous bolus (Meal Rise or a corrected high bG).
To choose the correct value for the Acting Time, you and your healthcare
professional should think about the following:
·· Whether you use rapid-acting insulin analogue or fast-acting regular human
insulin (the Acting Time should be longer for regular insulin)
·· Your average bolus amount (the larger your average bolus amount, the longer
the Acting Time should be)
You can program the Acting Time from 1½ to 8 hours.
93
Offset Time
The Offset Time is the time taken for the bolus to take effect. After the Offset
Time, your bG level should decrease because of the insulin, and at the end of
the Acting Time it should return to the target level.
The Offset Time must be at least 45 minutes, and the maximum value will be
limited by the Acting Time that you choose.
94
Appendix
Example
The following example explains the effect of the Offset Time and Acting Time:
bG level
hyper
Target Value
Target Range
hypo
Current
bG values
Bolus
Fig. 2: Example blood-sugar curve (bG-level)
You calculate and administer a correction bolus at 12 o’clock. The insulin
needs time to become effective, so your bG value (dotted line) may not be
significantly reduced, even by 2 o’clock. (If you had not administered the
correction bolus, your bG might even have increased.) You measure your bG
at 2 o’clock and it is nearly the same as at 12 o’clock. Between 2 o’clock and
4 o’clock the effect of the correction bolus, which is still active, will decrease
your bG level to a value within the Target Range.
95
hyper
Target Value
Target Range
hypo
Current
bG values
Potential
bG level
Bolus
Fig. 3: Example blood-sugar curve – double dosage
However, at 2 o’clock, if Bolus Advice took only your current bG value into
consideration, it would ignore the ongoing effect of your correction bolus.
It would then recommend an additional bolus to compensate for the raised
bG value. Where the effect of the two boluses overlap it could lead to a hypoglycemia (red line), because you would have had two boluses for the same
blood-sugar excursion.
Therefore, Bolus Advice always compares your bG result with the currently
allowed bG value, and not just with the target value for the current Time Block.
96
Appendix
The currently allowed bG value considers the following factors:
·· The upper limit of the Target Range for your current Time Block
·· Excursions beyond the Target Value that have had a correction bolus that is
still active (Acting Time)
·· bG values that were tolerated as a Meal Rise and which have had a meal
bolus that is still active (Acting Time)
·· The expected reduction of your bG level due to the effect of insulin during the
Acting Time (the decrease between the end of Offset Time and end of Acting
Time)
97
Acting Time
bG level
hyper
Offset Time
Corrected bG
Target Value
Target Range
hypo
Current
bG values
Time
Bolus
Bolus
not required
Currently allowed
bG value: corrected bG
Fig. 4: Corrected high bG
The above diagram shows an example of the effect of this rule. The first correction bolus at 12 o’clock remains active during the Acting Time (the width
of the blue area). If a measured value at 2 o’clock falls within the currently
allowed bG value (height of the blue area), no new correction bolus is calculated.
98
Appendix
bG level
hyper
Target Value
Target Range
hypo
Current
bG values
Bolus
Fig. 5: Subsequent boluses
Where the measured value is greater than the currently allowed bG value, the
newly calculated bolus (light-blue) only considers the difference between the
current bG value (dotted line) and the currently allowed bG value (the height of
the blue area). During the Acting Time of the first correction bolus (the width
of the blue area), only the currently allowed bG value is used to calculate the
second bolus.
99
Acting Time
bG level
hyper
Offset Time
Meal Rise
Target Value
Target Range
hypo
Current
bG values
Time
Meal
Bolus
Bolus
not required
Currently allowed
bG value: Meal Rise
Fig. 6: Subsequent meal boluses
Subsequent meals
If you eat several meals in a row, the Meal Rise will not add up, but start afresh
for each new meal bolus.
100
Appendix
Appendix C
The Mathematical Basis for Bolus Calculations
Below is a list of the most important formulas and principles that Bolus Advice
uses to calculate your bolus. It is difficult to accurately calculate a bolus yourself using these formulas (remembering to include the Acting Time and Offset
Time of your most recent boluses). This is why Bolus Advice is so useful. It will
save you a lot of time and avoids the risk of mistakes in your calculations.
Carbohydrates
This calculation is required when the bG result falls below the Hypo Warning
Limit. It is based on the other values defined for the current Time Block, and
the result recommends how much carbohydrate you should consume.
The words written in orange in the formula refer to the setting that you find
on the meter screen.
Carbohydrates = ( Target Range mean value – Current bG) ×
according to block definition
Insulin
D bG
from Insulin Sensitivity
×
Carbohydrates
Insulin
from Carb Ratio
Meal bolus
Meal bolus = Carbohydrate intake ×
Insulin
Carbohydrates
from Carb Ratio
101
Currently Allowed bG Value
The currently allowed bG Value considers all blood sugar excursions, that
have already been treated by a meal- and/or correction- bolus. For all bG
test results below the currently allowed bG value no correction will be
recommended. The currently allowed bG value is calculated as follows:
Currently allowed = Target Range mean value + Meal rise +
according to block definition
∑
blood glucose range covered by
correction bolus
currently acting correction boluses
When no Meal Rise or correction bolus Acting Time is in effect, the value
for these in the formula is 0.
Correction Bolus
Generally, a correction bolus is only calculated if your current bG value is
above the hypo bG warning limit and outside of the Target Range. Additionally, it must be above the currently allowed bG value. Only correction
boluses greater than 0 will trigger an Acting Time.
Correction bolus = (current bG – currently allowed bG) ×
Insulin
D bG
from Insulin Sensitivity
The size of the correction bolus depends on the following:
·· If your bG is higher than the currently allowed bG, then:
Correction bolus = (current bG – currently allowed bG value) × Insulin
Sensitivity
·· If the current bG is higher than the Hypo Warning Limit, and the current
bG is lower than Target Range lower limit, then the correction bolus that
is subtracted from the meal bolus is:
Correction bolus = (current bG – Target Range average value) × Insulin
Sensitivity
102
Appendix
Correction Bolus with Carbohydrate Intake
Whenever you tell Bolus Advice that you have consumed carbohydrates, the
related meal bolus is always offset against any correction bolus (even negative).
When you eat a meal, Bolus Advice also calculates the correction bolus for bG
results that are within the Target Range; more specifically, if your current bG
result is below the Target Range average value, or if your current bG is above the
currently allowed bG value.
Boluses that are calculated to be less than 0 are just displayed as 0.
103
Changing your Meter Settings
1. From main menu press x or z to move to Settings.
2. Press = to enter. The Settings screen appears.
10:02
2 Feb 08
Reminders
Bolus Advice
Meter
Sound/Vibrate
Time/Date
Time Blocks
Menu
3. Use x, z and = to edit the particular setting as needed.
4. Where appropriate, press . to save and exit.
List of Meter Settings
Reminders
› bG Test Reminders
› After High bG
› After Low bG
› After Meal
› Alarm Clock
› hh:mm (×8)
› Date Reminders
› Dr. Visit
› Lab Test
Bolus Advice
› Time Blocks › End
› Target Range
› Carb Ratio
› Insulin Sensitivity
› Health Events › Exercise 1
› Exercise 2
› Stress
› Illness
› Premenstrual
› Advice Options
› Meal Rise
› Snack Size
› Acting Time
› Offset Time
Meter
› Warning Limits › Hyper (high)
› Hypo (low)
› Key Lock › ON / OFF
› Language
› Units
› Grams, BE, KE, CC
› Max Bolus
› Insulin increment
Sound/Vibrate
› Beeper
› Vibrate
› Key Sound
Time/Date
› Time Format
› Time
› Date
00048011192/C
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