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MYSUGR BOLUS CALCULATOR UPDATE

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
mum2westiesGill

mum2westiesGill

Well-Known Member
Relationship to Diabetes
Type 1
This morning I got the MySugr bolus calculator update with the 2 new settings on it which are
- offset time
- meal rise

I spoken to my DSN on the phone about these 2 new updates - but she said "she's very busy at the moment but will have a look at some point later today and work out some maths but for now she said just to use the default settings on the meal rise and the offset time.
 
My reply email from my DSN

Hi Gill , all I can suggest is that you contact the App directly to qualify the terms as I can't actually find any definition for the terms in relation to monitoring . so, feel unable to advise . You may need to look it up online .... Sorry
 
Those were on my daughter’s old pump and nobody would ever explain them properly so they always just got left on the default. Which i think was 1 hour for offset time (something to do with when the insulin is at its most active) and something like 2.8 for meal rise (the amount your blood sugars can go up after food before you start worrying about needing corrections). Don’t worry about it Gill, sometimes trying to understand all the details just makes the whole thing too complicated and you’ll just worry!
 
Sally71 said:
Those were on my daughter’s old pump and nobody would ever explain them properly so they always just got left on the default. Which i think was 1 hour for offset time (something to do with when the insulin is at its most active) and something like 2.8 for meal rise (the amount your blood sugars can go up after food before you start worrying about needing corrections). Don’t worry about it Gill, sometimes trying to understand all the details just makes the whole thing too complicated and you’ll just worry!
Click to expand...

Thanks @Sally71 re saying not to worry about - I've just checked and offset time is 1 hour but the meal rise is 4.2 which does have me worrying a bit
 
I wouldn’t reduce it though, you are injecting aren’t you, which means you can only do whole units or maybe half units? Pumps can do doses to the nearest 0.1 of a unit so can deal with smaller variances without you risking a hypo. The chances are your DSN might not be able to help you much either, Roche seem to be fairly tight-lipped about exactly how it all works. Just leave it on the default unless your DSN/app person tells you otherwise.
 
Sally71 said:
I wouldn’t reduce it though, you are injecting aren’t you, which means you can only do whole units or maybe half units? Pumps can do doses to the nearest 0.1 of a unit so can deal with smaller variances without you risking a hypo. The chances are your DSN might not be able to help you much either, Roche seem to be fairly tight-lipped about exactly how it all works. Just leave it on the default unless your DSN/app person tells you otherwise.
Click to expand...

Yes that's right I'm injecting and I do mainly whole units. I will leave it ie the 4.2 for the meal rise on the default.
 
Those sound very familiar. I am sure they were settings on the Expert meter. i’ll have a look and see if i can remind myself what they do!
 
everydayupsanddowns said:
Those sound very familiar. I am sure they were settings on the Expert meter. i’ll have a look and see if i can remind myself what they do!
Click to expand...

@everydayupsanddowns that would be great if you could do that and get back to me.
What do you think about the default settings for the offset and the meal rise?
 
mum2westiesGill said:
@everydayupsanddowns that would be great if you could do that and get back to me.
What do you think about the default settings for the offset and the meal rise?
Click to expand...

OK here’s what I found in the Expert handbook ( https://www.accu-chek.co.uk/download/file/fid/28256 )

Bolus Advice Options
Meal rise, snack size, acting time, and offset time are bolus advice options. Below are detailed descriptions of each of these settings.

Meal Rise
• During or after meals, an increase in blood glucose levels is considered normal, or “allowed,” within a certain range, even though a meal bolus has been delivered. A meal rise is in effect for a specified time period.
• Enter the maximum increase in your blood glucose test result that is to be tolerated without an additional correction bolus.

Snack Size
• The snack size is the amount of carbohydrates that is not to be counted as a regular meal with the expected meal rise.

Acting Time
• The period of time from the start of the meal rise or the delivery of a correction bolus until your blood glucose level is expected to return to the target level.
• You can adjust the length of the acting time to fit your individual needs, within a specified time interval
(11⁄2 hours to 8 hours).

Offset Time
• Offset time takes into account the expected delay for the blood glucose level to actually fall during the acting time of insulin in the body. It describes the first time period within the acting time.

Active Insulin
• Bolus insulin that has been given to lower your blood glucose, but has not yet been fully used.
• The meter automatically calculates the active insulin amount and it is displayed on the bolus advice screen.

And then also...

Other Boluses

Subsequent Meal Boluses
If you are planning to eat several meals or snacks in a short period of time, you should administer a meal bolus for each meal. The calculation is always the same as a meal bolus.

Correction Bolus After a Meal
After a meal, it is normal to allow for a rise of your blood glucose level even if you administered the correct meal bolus. The allowed blood glucose level rise is called meal rise. After a certain period of time (offset time) the meal rise decreases from its maximum until your blood glucose level has returned to the target level. The period of time from the start of the meal rise until your blood glucose level returns to the target level is defined as acting time. During this time, a correction bolus is only recommended if your blood glucose level exceeds the current meal rise level.

1622747326482.jpeg

The dotted line shows how your blood glucose level might change after a meal bolus. Bolus advice tolerates an increase in your blood glucose level within the meal rise range (green) without calculating an extra correction bolus. When you enter a carbohydrate amount that is greater than the snack size, the meal rise setting is added to the blood glucose target value. The shape of the meal rise (the width of the green area) is determined by the offset time and the acting time.
 
everydayupsanddowns said:
OK here’s what I found in the Expert handbook ( https://www.accu-chek.co.uk/download/file/fid/28256 )

Bolus Advice Options
Meal rise, snack size, acting time, and offset time are bolus advice options. Below are detailed descriptions of each of these settings.

Meal Rise
• During or after meals, an increase in blood glucose levels is considered normal, or “allowed,” within a certain range, even though a meal bolus has been delivered. A meal rise is in effect for a specified time period.
• Enter the maximum increase in your blood glucose test result that is to be tolerated without an additional correction bolus.

Snack Size
• The snack size is the amount of carbohydrates that is not to be counted as a regular meal with the expected meal rise.

Acting Time
• The period of time from the start of the meal rise or the delivery of a correction bolus until your blood glucose level is expected to return to the target level.
• You can adjust the length of the acting time to fit your individual needs, within a specified time interval
(11⁄2 hours to 8 hours).

Offset Time
• Offset time takes into account the expected delay for the blood glucose level to actually fall during the acting time of insulin in the body. It describes the first time period within the acting time.

Active Insulin
• Bolus insulin that has been given to lower your blood glucose, but has not yet been fully used.
• The meter automatically calculates the active insulin amount and it is displayed on the bolus advice screen.

And then also...

Other Boluses

Subsequent Meal Boluses
If you are planning to eat several meals or snacks in a short period of time, you should administer a meal bolus for each meal. The calculation is always the same as a meal bolus.

Correction Bolus After a Meal
After a meal, it is normal to allow for a rise of your blood glucose level even if you administered the correct meal bolus. The allowed blood glucose level rise is called meal rise. After a certain period of time (offset time) the meal rise decreases from its maximum until your blood glucose level has returned to the target level. The period of time from the start of the meal rise until your blood glucose level returns to the target level is defined as acting time. During this time, a correction bolus is only recommended if your blood glucose level exceeds the current meal rise level.

View attachment 17246

The dotted line shows how your blood glucose level might change after a meal bolus. Bolus advice tolerates an increase in your blood glucose level within the meal rise range (green) without calculating an extra correction bolus. When you enter a carbohydrate amount that is greater than the snack size, the meal rise setting is added to the blood glucose target value. The shape of the meal rise (the width of the green area) is determined by the offset time and the acting time.
Click to expand...

Thanks for this and do you think they are best leaving on the default?
 
So essentially the meal rise is the level of ‘spike’ that you are happy with after a meal (and the no correction will be triggered up to your target BG plus meal rise).

Offset time is another anti-overcorrecting measure, where you don’t expect a bolus to start reducing BG immediately.

I would say follow the advice of your nurse, and keep them at the defaults. But keep an eye on how the corrections are working, and consider tweaking if the suggested corrections seem to be reducing you below the middle of your target range?
 
Have to say my offset time has always been set to default since 2011 - and nobody has ever tried to explain it to me and anyways unless I'd been in the habit of test test testing after lots of meals to see how long it is before the meal rise starts to disappear, it would have been no advantage to know what it meant. With the Libre graph though - I can see how long it takes.

That graph in EDUAD's post above seems to indicate 'Default' is 2 hours.

My lunch today took 3 hours to move from the peak which had a flattish summit and after that started to descend agai.. Will start keeping an eye on this and have a think if I need to change the default.

Can anyone comment please - since I don't have any idea - what difference it would make if I do change it ? What change would I expect to see ?
 
trophywench said:
Have to say my offset time has always been set to default since 2011 - and nobody has ever tried to explain it to me and anyways unless I'd been in the habit of test test testing after lots of meals to see how long it is before the meal rise starts to disappear, it would have been no advantage to know what it meant. With the Libre graph though - I can see how long it takes.

That graph in EDUAD's post above seems to indicate 'Default' is 2 hours.

My lunch today took 3 hours to move from the peak which had a flattish summit and after that started to descend agai.. Will start keeping an eye on this and have a think if I need to change the default.

Can anyone comment please - since I don't have any idea - what difference it would make if I do change it ? What change would I expect to see ?
Click to expand...
The offset time is the delay between taking insulin and expecting your bg to start dropping. I think if you made it say 1 hour then it would recommend a correction after 1hour if your bg was above the meal rise allowance, which might then make you hypo later on, unless your bg has genuinely finished rising by then. If you made it longer say 3hours, then it wouldn’t recommend a correction between 2 and 3 hours if your bg was above the meal rise, as you’ve told it not to expect your bg to start coming down until 3 hrs.. hopefully I’ve interpreted that correctly!
 
My offset is on the default setting of 1 hour am I best to alter it or just leave it?
 
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