Posted by on Saturday, 7 May 2011

Learning to love my Aviva Accu-chek Expert

I was given an Aviva Accu-chek Expert handset and have been using it for a little over 4 months now. I wrote a review a month in to the experience with a few reservations, but as time has gone on and settings have been tweaked and refined I've come to love it. It doesn't work perfectly and the bolus advice it provides is not faultless, but when life is relatively steady (and my basal is behaving itself) it has given me whole weeks of astonishingly good BG levels.

Take yesterday as an example: I'd been a bit on the low side the night before, going to bed at 4.1mmol/L (74 for US readers), so I tested at 2.30am to see if my little carb top-up had worked and was pleasantly surprised to read 5.9 (106). I was even happier reading the same 5.9 at breakfast. Left my usual delay between bolus and eating, had some toast and went to the gym. The Expert allows me to adjust breakfast bolus on gym days with a 'health' option, a percentage reduction for 'exercise 1', I've set -25% for the gym and -10% for more general pottering as 'exercise 2'. By lunchtime I was 4.2 (75). Not bad. Now because that's a bit 'near the edge' the Expert automatically deducts a proportion of lunch bolus to attempt to get me to the mid-point of my desired range (4-8mmol/L or 72-144). My pre-dinner test was 6.5 (117). Result! I like to keep an eye on post-meal spikes most days, and tested an hour after eating in the evening to find 6.2 (112). The meal was pretty low GI so I figured it still had a fair amount of carbs to release. Additionally we were meeting some friends for a couple of pints while the kids were out at a club, any rise from the beer ought to be handled by the potential over-enthusiasm of my evening Humalog. My bedtime test was a smile-inducing 5.9 (106).

A whole day and I'd guess I didn't go much above 8 (144) (hard to be sure as I didn't test at the likely peak after lunch). Neither did I hypo, despite a session at the gym. What US CGM wearing pumpers would call 'bolusing a no hitter'.

Now anyone who has read my last post will know that this doesn't happen all the time. When life is a bit more chaotic, when basal-needs change, when overall levels of activity rise or fall those carefully tweaked settings are just a little off. Not much but enough to put you on the glycaemic rollercoaster of guessing, double guessing, highs, lows, chaos and confusion. What US blogger Scott so accurately described last week as low blood sugars, guilt and fear.

After 20 odd years of handling all the calculations and adjustments by myself I'd guess I'd got pretty good at knocking a unit off here, adding one on there to try to match the constant ebb and flow of life and BG levels. Every so often I'd get a day just as good yesterday. What I've noticed since using the Expert though is that these days are no longer a shock. They are not normal by any means, but having been as rare as hen's teeth, I can now find weeks where I get several on the trot.

I'm continuing to experiment with settings for illness, and I clearly need to do a lot more work to handle the wider-scope shifts in routine that caused me so much trouble during April.

There are still a few things I'd change about the Expert, but it's certainly won me round and I'd highly recommend it.

8 comments:

  1. As a very new user , ie 5 days, I found this blog really useful. I thought I was pretty thick at carbs counting and messing up the good work of my brilliant diabetic nurse. But no, I am just normal and dabbling bravely on, learning faster than before the days of Expert and yes having more right hits than wrong ones. I found some of the bolus advice truly "wrong" at first and decided to proove the machine wrong by following the advice! ouch, the machine was right.So thanks for taking the time to write all this.

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  2. Thanks! And glad to hear you have found the Expert useful. Pretty much all of the users of smart meters I have come across agree that it takes a good few weeks/months to get things set up properly. I had far more 'consistently good' weeks while I was using the Expert for dose advice. Since moving to a pump, as you might expect, things are better still.

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  3. I found your blog really helpful as I am relatively new to diabetes, (1yr 2m) and my DSN has just offered me the Expert, I haven't got it yet, but am waiting for a meeting with their rep and other potential users. I'm now looking forward to using it after reading your input. Cheers for all your info.

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  4. Thanks Sue! Hope you get on well with the Expert. It takes a lot of the mental acrobatics out of dose tweaking!

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  5. Hi there, really good post and this follow up. There's a lack of decent reviews of kit especially focused on the UK. I've been using the Expert for about 1 year and also really get on well with it. I'm about to start using a pump and I feel it has prepared me well for the more detailed approach to bolus and corrections than MDI.
    One thing I was going to mention, the 360 software (whilst not free) has really helped me keep everything in one place. I also use the Mobile meter when I'm out as I find it more convenient on the go, and I can download both to the same database, you made the point about not being able to make entries about foods or notes on the meter, but on the logbook in the software you can do this. So if you download quite regularly I find it easy enough to take a few scribbled notes from my day and enter them in so I can more easily print off something to review or take to the DSN.
    Crazily though Roche have now made the new Mobile meter to be downloaded by USB - so I'll now have both IR and USB on the desk!
    Cheers Matt

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  6. Mike had my expert for about a week. It was all set up by the DNS except the health events. Do you have any advice on setting it up, the DNS was a little vague about it. Yours Julian

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  7. Hi Julian,

    Impossible for me to offer anything specific unfortunately - Your Diabetes May Vary and all that! What I can say though, was that the initial settings in that first meeting with the DSN were just a starting point for me. I think the best approach with something like the Expert is to really 'own' it - to get stuck in and tweak things for yourself until you seem to be getting reasonably reliable advice (and then not to be afraid to adjust things again when diabetes moves the goalposts as will inevitably happen!). For me this involved keeping good notes of meals/doses/BGs in those first months so that I could see whether the advice I was getting was giving me the results I was looking for. It really helps to get your basal (background) dose adjusted correctly first (see 'links' in the sidebar). Have a good read of the handbooks too as they help get your head around how the bolus advice is calculated - especially when considering things like 'meal rise' etc which are supposed to help you prevent dose stacking. For the health events, I found it was very much a case of 'suck it and see'. Try one % increase (or decrease) for the same activity 2 or 3 times, then if it's not quite right adjust up or down and try again.

    Good luck with it!

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  8. Very useful reviews. Thank you.
    I've been using my Expert for about a month and so far so very good. You're right about the importance of getting the basal amount right . But I can't believe how good my BG results are. After 35 years of being T1 and guesstimating insulin doses it's absolutely wonderful to have all this done for me. I Use it in tandem with My Fitness Pal (excellent app) which tells me carb amounts. For the first time ever I'm looking forward to the next HbA1c. How weird us that?

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