Artoo and I have been pottering along for almost two months now, and what with the New Year and everything it feels like about time for a bit of a catch-up.
Anyone reading who has watched my transition from pump-averse to pumper might be interested in how I have found it in practice. If you have wondered whether pumping might be right for you, but don't really like the idea, I suspect this might be doubly so.
Before Artoo and I hooked up I had read a lot of accounts of people who almost immediately felt 'at one' with their new robot pancreas. People who almost forgot it was there pretty much from day one and while most report that it takes a bit of work to get a pump set up and working well the physical 'attachedness' side of things seems to evaporate. I wish I could say that I felt just this way, but I don't. Not quite anyway. *Almost* all the time attachedness is of little or no importance. I've had nights of uninterrupted sleep. No-one around me has batted an eyelid whenever I've disconnected or reconnected in public (at the gym for example). Now that I've worked a way of hanging Artoo horizontally on my belt I no longer get dug/pinched in the side every so often. But in spite of all that there are still a few times every day when being attached by a short string to a lump of plastic is a tiny bit annoying. Most regularly i feel this while getting changed, but also occasionally just getting tubing caught on things. I even managed to pull a set out while hoiking up my trousers one day. Almost nothing, but I certainly couldn't say that I 'completely forgot it was there after a week'.
On the other hand, of course, I have already realised that the 24-hour attachment also offers distinct advantages. I arrived at a meeting not long after a meal only to find that some tasty nibbles had been provided. On MDI I would have had to politely decline, but because Artoo goes everywhere with me I was able to guess the carbs, bolus, and get stuck in! And lie-ins... Aaaaaah! Lie-ins. Since moving my basal injection to the mornings I had needed to keep regular morning hours whether work day or weekend, within an hour or so. But now that my basal is automatically following a predetermined pattern I can sleep in as long as I fancy.
One thing I hadn't quite expected was how quickly the set-changes would come around. Every two to three days sounded like almost never compared to 4-5 times every single day. In reality though they are quite a bit more of a faff than a single pen-injection. The sets hurt a bit more going in. You have to be quite careful and methodical to make sure you avoid bubbles and so on when setting up the reservoir. Added to that every single set change carries with it a 2-hour period of uncertainty, anxiety almost. Has it worked OK? Is the insulin being delivered? As advised, I make the changes before meals to ensure a proper 'test' but this also means that any slight miscalculation in the meal bolus can look like a potential dodgy insertion. I'm getting better at sensing whether sets 'feel' right in the first few minutes and I've only had one or two that I've replaced within the first hour or two, but it's not something that applies on MDI.
One peculiar observation from the first few weeks. I know two others who started pumping at almost exactly the same time as me and all of us had the same, rather odd phenomenon in the first few weeks. People often need quite a lot less insulin when pumping, so it's usual for your team to suggest a new total daily dose, basal and bolus ratios. In the first week these new levels behaved pretty well for each of us, but then, quite suddenly at around 7-10 days we found our BG results creeping upward and each of us had to significantly change what had worked fine the week before to establish a new 'normal'. Not sure of it's just coincidence, but if you are about to start pumping it might be one to watch out for.
And what about levels? After all that's the whole point of the exercise... During these two months I've had a bit of everything. Normality, illness, gym, no gym and of course, every diabetic's favourite mental obstacle-course... Christmas. Even in these early weeks I can see improvements. Fewer hypos and fewer and lower highs. And I have to remind myself that I am comparing with MDI results gained while using the Accu-Chek Expert, which (once I had it set up right) provided a general 'smoothing out' from the levels I achieved before that.
I've had some spectacular successes, and a few (largely self-inflicted) disasters too. The subtlety of delivery options is a fantastic addition to the arsenal. I still need to do a little more experimentation, but already the potential is plain to see. Most obviously, almost none of the doses I give these days are in whole units. It's always a decimal point here or there, and while my carb guestimates may be no more accurate, at least the doses are more precise so it's one error rather than two.
I had expected dual and square waves to be useful for 'tricky' meals, but I hadn't realised how handy they would be at other times. If I'm at the lower end of my range before eating I can just ease the dose in (or just a part of it) over 30 minutes to take the edge off. I'm getting better at remembering TBRs (temporary basal rates) too. I always knew these would be brilliant, but as my experience grows I've seen afternoons playing in the band (with a heady mix of physical effort followed a while later by bursts of stress and adrenaline) that I know from experience would have meant a hypo/high shuffle on MDI pass with bewilderingly serene BGs. Only a couple of days ago we ventured to Bristol's new 'all you can eat' world food market for a leisurely, and not insubstantial, slap-up food fest. Duals and squares (and a few good guesses) left me scratching my head when the awaited BG carnage failed to arrive.
I've had disasters along the way. For every success there have been wrong guesses and hasty corrections needed. I think it's quite funny, given that it looks like Artoo may well give me my best year of control for a very long time in 2012 that my very first test of the year (at 0.58 this morning) was 17.8 (320).
Ah well... What's life without a few ups and downs.
Showing posts with label accu-chek aviva expert. Show all posts
Showing posts with label accu-chek aviva expert. Show all posts
Posted by Mike on Sunday, 1 January 2012
Posted by Mike on Monday, 25 July 2011
Waiting for the storm
But last Friday was the end of term.
I'd been watching its approach like a ink-black cloud on a summer's day horizon. Hoping that it would not mean what I feared it might. Regular readers will know quite how well I've done with holiday periods recently. In short, not very.
So I'm steeling myself for a slightly wobblier period over the next few weeks. Last summer I seemed to manage pretty well, though I think my control has improved since then. At least when the kids are off school over the summer I have a few more weeks to try to find the new rhythm. I'm hoping it will just be a matter of getting some sort of holiday basal working to account for lack of gym visits, and that the new big meal strategy will continue to work its magic. Maybe.
I'll let you know how I get on.
Posted by Mike 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.
Posted by Mike on Friday, 1 April 2011
Not cool - insulin storage problem
I'm still waiting to write that post extolling the virtues of Colin, my Accu-Chek Expert, but even his shrewd bolus-calculating savvy was not up to coping with the BG craziness of the last seven days.
Things just went bonkers.
And it made me realise that this is not unusual. Since I started putting a lot more effort into my diabetes a year and a bit ago I've noticed a definite repeating pattern in what I previously thought was just diabetes randomness:
1. Finally work out the rules
2. Good numbers for a few days. Yay!
3. Wow that was an AMAZING day. Woo hoo!
4. Errrrr hang on where did that come from
5. Right something's definitely not right here...
6. So the rules have changed again then. Great, thanks for that.
7. Erm... try this?
8. Nope. That was annoying.
9. What about this?
10. Right OK not that either...
11. OK that's looking a bit better
12. Definitely on to something here...
....aaaaand repeat. Given enough trips around the cycle the doses/ratios/splits/timings begin to repeat themselves and off we go again.
But this one wasn't like that. This one was off the scale.
Looking back over recent records I'd had a spectaculatly good patch. Over a fortnight with 75% of readings between 4 and 8 (including several 1hr/2hr post meals). Anything over 10 was a bit of a surprise. I was also having almost no hypos during this period. In short it felt like I was winning. It felt amazing.
I started having a few hypos to tentatively dropped my Lantus by 1u to see if I'd settle just a notch higher up. I only lasted 2 days first with a prefectly acceptable 6.9 average, the second constantly fighting highs and averaging at 10.8.
The next two days, Lantus back up by 1u were not too bad, but the following few days were a complete disaster. Countless corrections were having little or no apparent effect. One morning despite a 2u correction the previous night (at 14.x) I woke to 16.6. I went for broke decided on double my usual breakfast insulin:carb ratio +20% for 'stress', injected 8u and waited for it to come down. 5 hours passed and I still hadn't eaten anything other than a lump of cheese (hoping to trick my liver into cancelling any DP action). BG stayed above 9.0 right up until lunch. The following day saw me needing 10u for a single slice of breakfast toast (that's 5x my usual amount)!
While waiting for our new fridge to be delivered, I posted a moan on a forum describing recent events, and suggesting that the Diabetes Gremlins had perhaps snuck in at night and replaced the Lantus in my cartridge with water. Someone happened to ask if there might be any problem with the way the insulin had been stored. Hang on a minute... "While waiting for our new fridge to be delivered...".
And then it all fell into place. Our fridge has been a bit flaky for some time, maybe even a year. Mostly keeping things cool, sometimes getting a little enthusiastic and getting really cold, other times appearing to warm things up, but never actually completely broken. The light had stopped coming on a week or so ago and we'd decided that enough was enough and ordered a new one. I was down to the last cartridges in the box of both Lantus and Humalog and it seems that the fridge's repeated misbehaviour had substantially affected the insulin's potency. The box of Lantus was the older of the two, so my guess it that it was pretty much shot. The newer Humalog left to fight the BG battle on its own at half-strength. Another one to add to the 'watch list': Count carbs, consider food absorption properties, check basal level, consider level of activity, rotate sites, make sure fridge is working.
I've ditched the suspect cartridges and with nice new fresh ones things have quickly returned to normal. Well today at least.
Things just went bonkers.
And it made me realise that this is not unusual. Since I started putting a lot more effort into my diabetes a year and a bit ago I've noticed a definite repeating pattern in what I previously thought was just diabetes randomness:
1. Finally work out the rules
2. Good numbers for a few days. Yay!
3. Wow that was an AMAZING day. Woo hoo!
4. Errrrr hang on where did that come from
5. Right something's definitely not right here...
6. So the rules have changed again then. Great, thanks for that.
7. Erm... try this?
8. Nope. That was annoying.
9. What about this?
10. Right OK not that either...
11. OK that's looking a bit better
12. Definitely on to something here...
....aaaaand repeat. Given enough trips around the cycle the doses/ratios/splits/timings begin to repeat themselves and off we go again.
But this one wasn't like that. This one was off the scale.
Looking back over recent records I'd had a spectaculatly good patch. Over a fortnight with 75% of readings between 4 and 8 (including several 1hr/2hr post meals). Anything over 10 was a bit of a surprise. I was also having almost no hypos during this period. In short it felt like I was winning. It felt amazing.
I started having a few hypos to tentatively dropped my Lantus by 1u to see if I'd settle just a notch higher up. I only lasted 2 days first with a prefectly acceptable 6.9 average, the second constantly fighting highs and averaging at 10.8.
The next two days, Lantus back up by 1u were not too bad, but the following few days were a complete disaster. Countless corrections were having little or no apparent effect. One morning despite a 2u correction the previous night (at 14.x) I woke to 16.6. I went for broke decided on double my usual breakfast insulin:carb ratio +20% for 'stress', injected 8u and waited for it to come down. 5 hours passed and I still hadn't eaten anything other than a lump of cheese (hoping to trick my liver into cancelling any DP action). BG stayed above 9.0 right up until lunch. The following day saw me needing 10u for a single slice of breakfast toast (that's 5x my usual amount)!
While waiting for our new fridge to be delivered, I posted a moan on a forum describing recent events, and suggesting that the Diabetes Gremlins had perhaps snuck in at night and replaced the Lantus in my cartridge with water. Someone happened to ask if there might be any problem with the way the insulin had been stored. Hang on a minute... "While waiting for our new fridge to be delivered...".
And then it all fell into place. Our fridge has been a bit flaky for some time, maybe even a year. Mostly keeping things cool, sometimes getting a little enthusiastic and getting really cold, other times appearing to warm things up, but never actually completely broken. The light had stopped coming on a week or so ago and we'd decided that enough was enough and ordered a new one. I was down to the last cartridges in the box of both Lantus and Humalog and it seems that the fridge's repeated misbehaviour had substantially affected the insulin's potency. The box of Lantus was the older of the two, so my guess it that it was pretty much shot. The newer Humalog left to fight the BG battle on its own at half-strength. Another one to add to the 'watch list': Count carbs, consider food absorption properties, check basal level, consider level of activity, rotate sites, make sure fridge is working.
I've ditched the suspect cartridges and with nice new fresh ones things have quickly returned to normal. Well today at least.
Posted by Mike on Sunday, 16 January 2011
Accu-Chek Aviva Expert Review - One month in
Well here goes. This could be a long one...
I was offered a 'trial' of the Accu-Chek Aviva Expert blood glucose monitor early last year, but for one reason and another it never happened. The idea, I think, was for Roche to get some feedback from real hands-on users as to how it worked. As I sit typing this I really wish I had had a chance to stick my oar in, though to be honest, by the time the trial was being offered I suspect the production unit was not going to change much, if at all.
Then a few months ago the DSN who had asked me about the trial asked if I was still interested as she had a few handsets that she was able to give away. Another thing to mention at the start of the review is that I don't really have a very wide range of experience of using different monitors day to day. I've always used Roche units and always been happy enough with them. If you have always loved another brand and/or hated Roche units you will have to bear that in mind as you read my opinions. Before being offered the Expert I was tempted by the sleek tininess of the Contour USB, but was intrigued by the offer of bolus advice and eagerly took up the offer of the Expert.
In a nutshell
The Expert handset is apparently based on the system which offers bolus calculations for their pumps, though it seems to have been simplified somewhat, it lacks Bluetooth connectivity and those exotic pumpy bolus delivery patterns. The basic idea is that you can test your BG, input the amount of carbs you are about to eat and the meter will then suggest a bolus based on the parameters you have set for the time of day (target range, insulin sensitivity, insulin:carbohydrate ratio, duration, level of activity and so on). These are careful calculations (read wild guesses) that insulin-using diabetics have to make several times each day. Often it feels more 'art' than 'science' and I know for my own part that there is often a fair amount of gut instinct that goes into a bolus calculation. I was less than sure that a bit of software would be able to read the ebb and flow of my days in the same way. Quite frankly it didn't seem likely.
But as walked to the appointment to be shown how to set up and use the meter, it became clear to me how much I was beginning to want it to work. To be able to hand over the hassle of all those little bits of information, ratios, correction factors to a little gizmo that would do it all for me.
The meter itself
The Expert is not dissimilar in size to my old Accu-Chek Aviva. A little wider, a little squarer, a little chunkier, a little thicker. Something like 55mm x 94mm x 25mm. For those who have had Roche meters before it will fit (along with a tub of strips and the excellent Multi-clix finger-stabber) in the familiar sized zip-up black pouch. It's a smart black and has rather more in the way of buttons on the front than other meters I've owned. The buttons themselves are those little rubbery affairs with a pleasing 'clu-dunk' action. One early annoyance was the location of the on/off button. Since this has been placed on the front of the meter it is all too easy to turn the unit on when just grabbing the zipped pouch.
This is the first meter I've owned with a colour screen. Ooooh! Don't get your hopes up though, the screen is smallish at around 34mm x 28mm and only has the resolution of mobile screens from 5-10 years ago. While in the most part this is perfectly adequate it does make some of the graphs the handset can offer rather less than clear. I'd heard murmerings about battery life before I got my hands on the Expert, and I haven't had it long enough to comment, but I would say that the box of goodies supplied with the meter came with two spare sets of batteries (3x AAA) and once you register with Roche they will send you replacement batteries on request.
When you first turn the unit on you are walked through a fairly lengthy but admirably simple set-up procedure where you define everything from time and date, high/hypo levels and expected rapid-acting insulin duration to target BGs, insulin sensitivity and carb ratios across a number of editable 'time blocks' through the day.
Testing itself makes use of the familiar Aviva test strips which require a code-chip every time you start a new box. Some might find this an annoyance, but I don't find it slows me down at all. Insert the strip (which turns the meter on even if you've 'locked' the buttons) and the brief pause while it prompts you to check the number on the pot of strips is just long enough to get a drop of blood going from your calloused fingers. The strips only need a relatively small drop of blood (0.6 microlitre) and handily if your first attempt is a little on the small side, you get the chance to squeeze out a little more blood and reapply before the meter throws an error message. Results are delivered in around 5 seconds.
Reports and data
Over the previous 5 months I had been carefully logging insulin, carbs, exercise and all manner of other details using the brilliant DiabetesDiary for iPhone/iPod Touch. All the averages, stats and pretty graphs a diabetic could wish for. I suppose this meant I was used to inputting data at every meal and I was pleasantly surprised at the ease of entry of details into the Expert. Unfortunately, although the Expert will record all the facts, there is no method by which you can add any notes or comments to records. Even a system whereby you could predefine your own 'comment list' by some lengthy letter-by-letter process and then attach notes to entries such as 'Gym day', 'Underestimated meal carbs', 'Fake hypo' or whatever via the Expert's click-and-choose menu system would make the results stored on the meter much easier to analyse at a later date. Which brings me to another gripe... I have no idea why meter manufacturers (and Roche in particular) are so obsessed with Infrared as a means of data-export. The Expert is compatible with the 360° software package, but I don't really want to buy-in to a whole expensive suite of data-management tools and infrared gizmo. I just want to be able to export and print a month or two's results and take them to my appointments. A simple USB port/cable and CSV file export would be fine thanks. And even if I did fancy the 360° system, I've just upgraded my PC and it won't currently run on Windows 7 so that's a non-starter. Unfortunately what this means is that the data logged in the Expert is trapped there and the screen is really just not up to the job of reviewing the information in anything more than a general overview way. The graphs and reports are just too tiny to be read with much clarity, and table views which offer just 5 lines of data mean much scrolling is required to look back over recent results. The graphs are particularly frustrating - there's a dotted horizontal line to show 'hypo' but no other lateral reference points. A line for 'hyper' and some shading to show the desired BG range(s) over the time period would have made them much more worthwhile, even at small sizes.
There are a bunch of charts, graphs and tables available which do give you a good overview of your recent control. My particular favourite is the 'Target' pie chart which instantly shows you the proportion of results high, in-range, below-range and hypo. Even this though could do with a tweak. The Expert allows you to set a range and a hyper and hypo warning level. This means that you can grade your results to identify low level ups and downs as different from more serious hypers/hypos. Inexplicably though the 'Target' charts do not differentiate between high and hyper.
Reminders
One area that I've not really explored is the comprehensive set of reminders and alerts which can be set to beep or vibrate at you. Reminders to test, prompts to retest after a high or low reading, waking you up for overnight testing, even just to use the expert as your alarm clock!
When it works well
The fact that I picked up my Expert a few days before Christmas might be seen as unfortunate timing. It's not the easiest time of year to get your carbs and doses right, and the first week or two were decidedly difficult, not least because my first attempt at setting up appropriate targets, sensitivities and ratios proved a little off, and I was a little too ready to take the Expert's advice even when I suspected it wasn't quite right. For seven days over the festive break though, when work seemed a million miles away, meals could be taken at leisure with careful bolus-eating delays and one day was much like another the expert performed spectacularly well. I had almost no hypos and something like 75-80% of readings were in the 4-9mmol/L range. I began to believe this could be the start of something really good.
Bolus advice
I won't go into all the complexities of the calculation system here (lest you lose the will to live) but essentially the Expert takes the mid-point of your target range and will always seek to pull or push your BGs toward that. If you come into a meal on the low side it will knock-off an amount of insulin, based on the figure you have given for BG change per unit, along with any plus or minus fractions allowed for exercise, stress, illness etc. Conversely, if you get a meal hopelessly wrong it will suggest a correction dose to bring you back in-range. There are safeguards in place that keep track of insulin duration and the timelag between correction doses and their effect being evident to help prevent over-correction. And of course the Expert is only making suggestions. You can easily override at every stage. One nice feature is the way it displays any plus or minus correction-factors involved in the advice, along with any rounding up or down of the final dose (to the whole or fractional units you have defined). This means that you can see whether the 6u bolus suggestion was based on 5.5u or 5.9u and also how much was down to the Expert wanting to get you from say, 4.5mmol/L to the midpoint of your target range.
A few set-up oddities
Once you have the thing basically set-up and are looking to fine tune it, a few issues begin to emerge. Insulin ratio is only available in whole units. While this is largely satisfactory, for higher carb meals being able to specify to a decimal place would be an advantage. The 'offset time' setting (the expected delay following an injection for BG levels to begin to fall) can be set as no less than 45 minutes. There seems to be no reason for this, and with the profile of some analogue insulins this seems less than ideal. Additionally only one 'offset time' can be defined, while my own experience suggests that I would expect a different delay at different times of the day. 'Active insulin' is another anomaly... the handbook suggests this shows 'bolus insulin that has been given to lower your blood glucose, but has not yet been fully used'. You might expect this to be tracking your whole meal bolus, plus any additional correction factor, but in fact it ignores any part of your dose which is supposed to be dealing with carbs and only reports on correction doses. If you want the Expert to keep tabs on your total insulin-on-board you need to back out of the bolus advice screen and then add the bolus in manually. A simple 'include meal bolus in Active Insulin figure' checkbox would have helped.
Final thoughts
Overall I think I'd have to say I think the Expert is pretty good. Strangely that is a real shame, because it could have been brilliant. There is nothing like it on the market for us folks on MDI and a little more polish could have made it something really special. In a week where one day was very much like the next it gave me excellent results. But in a working week where every day is different it is still struggling. It feels like there are just one too many niggles and concerns. The only reason you would want this meter is if you wanted something to give you more than just a simple record of BGs. I like being able to add data, but I'm not a machine, sometimes I make a mistake. I'd like to be able to delete entries which are wrong, or change times and dates where I make mistakes. To forbid me from doing so because you think I'll just lie to my healthcare team is ridiculous - if I want to deceive them I just won't show them actual results. Sometimes I'll click OK then change my mind about the amount of carbs, or dose I'll take. I'd like my meter to give me enough respect to allow me to log what actually happened. You can modify some records, but not enough and not completely enough. The bolus advice is often pretty good, but it falls down if I make an error in carb counting, and makes no attempt to track the absorption of any carbs, trusting the insulin to deal with them.
Having said all of that I'm glad I have one and will be persevering for the next few months up to my annual review to see if I can tweak the settings still further and repeat that 'perfect' week.
Final score: 4 out of 5.
UPDATE: Having re-read through this a day after posting I realise how nit-picky and negative it sounds. The truth is I really like the Expert, and careful tweaking of its parameters is getting it to provide more consistently effective bolus advice. I think the gloomy cloud over the review is down to the frustration I feel that the unit is only 'Good' when really without very much alteration it could be 'Great'.
Oh one other thing... I linked to this post on a forum and Rob, another Expert user pointed out a way to set fractional insulin ratios. It's not really a problem which affects my ratios, but if your ratio is, say, 1u:7.5g carbs and you have a larger meal containing perhaps 120g of CHO, settings in whole units would only permit a bolus suggestion of 17u (1:7) or 15u (1:8). Rob's clever suggestion is to set the ratio using a higher carb value, so 1:7.5 becomes 10u:75g CHO on the Expert. Ingenious!
On reflection I've pushed the final review score up to '4' from '3.5'. It's still early days. I may well post another update in a month or two after a little more experimentation.
FOLLOW UP: Learning to love my Accu-Chek Expert
Then a few months ago the DSN who had asked me about the trial asked if I was still interested as she had a few handsets that she was able to give away. Another thing to mention at the start of the review is that I don't really have a very wide range of experience of using different monitors day to day. I've always used Roche units and always been happy enough with them. If you have always loved another brand and/or hated Roche units you will have to bear that in mind as you read my opinions. Before being offered the Expert I was tempted by the sleek tininess of the Contour USB, but was intrigued by the offer of bolus advice and eagerly took up the offer of the Expert.
In a nutshell
The Expert handset is apparently based on the system which offers bolus calculations for their pumps, though it seems to have been simplified somewhat, it lacks Bluetooth connectivity and those exotic pumpy bolus delivery patterns. The basic idea is that you can test your BG, input the amount of carbs you are about to eat and the meter will then suggest a bolus based on the parameters you have set for the time of day (target range, insulin sensitivity, insulin:carbohydrate ratio, duration, level of activity and so on). These are careful calculations (read wild guesses) that insulin-using diabetics have to make several times each day. Often it feels more 'art' than 'science' and I know for my own part that there is often a fair amount of gut instinct that goes into a bolus calculation. I was less than sure that a bit of software would be able to read the ebb and flow of my days in the same way. Quite frankly it didn't seem likely.
But as walked to the appointment to be shown how to set up and use the meter, it became clear to me how much I was beginning to want it to work. To be able to hand over the hassle of all those little bits of information, ratios, correction factors to a little gizmo that would do it all for me.
The meter itself
The Expert is not dissimilar in size to my old Accu-Chek Aviva. A little wider, a little squarer, a little chunkier, a little thicker. Something like 55mm x 94mm x 25mm. For those who have had Roche meters before it will fit (along with a tub of strips and the excellent Multi-clix finger-stabber) in the familiar sized zip-up black pouch. It's a smart black and has rather more in the way of buttons on the front than other meters I've owned. The buttons themselves are those little rubbery affairs with a pleasing 'clu-dunk' action. One early annoyance was the location of the on/off button. Since this has been placed on the front of the meter it is all too easy to turn the unit on when just grabbing the zipped pouch.
When you first turn the unit on you are walked through a fairly lengthy but admirably simple set-up procedure where you define everything from time and date, high/hypo levels and expected rapid-acting insulin duration to target BGs, insulin sensitivity and carb ratios across a number of editable 'time blocks' through the day.
Testing itself makes use of the familiar Aviva test strips which require a code-chip every time you start a new box. Some might find this an annoyance, but I don't find it slows me down at all. Insert the strip (which turns the meter on even if you've 'locked' the buttons) and the brief pause while it prompts you to check the number on the pot of strips is just long enough to get a drop of blood going from your calloused fingers. The strips only need a relatively small drop of blood (0.6 microlitre) and handily if your first attempt is a little on the small side, you get the chance to squeeze out a little more blood and reapply before the meter throws an error message. Results are delivered in around 5 seconds.
Reports and data
Over the previous 5 months I had been carefully logging insulin, carbs, exercise and all manner of other details using the brilliant DiabetesDiary for iPhone/iPod Touch. All the averages, stats and pretty graphs a diabetic could wish for. I suppose this meant I was used to inputting data at every meal and I was pleasantly surprised at the ease of entry of details into the Expert. Unfortunately, although the Expert will record all the facts, there is no method by which you can add any notes or comments to records. Even a system whereby you could predefine your own 'comment list' by some lengthy letter-by-letter process and then attach notes to entries such as 'Gym day', 'Underestimated meal carbs', 'Fake hypo' or whatever via the Expert's click-and-choose menu system would make the results stored on the meter much easier to analyse at a later date. Which brings me to another gripe... I have no idea why meter manufacturers (and Roche in particular) are so obsessed with Infrared as a means of data-export. The Expert is compatible with the 360° software package, but I don't really want to buy-in to a whole expensive suite of data-management tools and infrared gizmo. I just want to be able to export and print a month or two's results and take them to my appointments. A simple USB port/cable and CSV file export would be fine thanks. And even if I did fancy the 360° system, I've just upgraded my PC and it won't currently run on Windows 7 so that's a non-starter. Unfortunately what this means is that the data logged in the Expert is trapped there and the screen is really just not up to the job of reviewing the information in anything more than a general overview way. The graphs and reports are just too tiny to be read with much clarity, and table views which offer just 5 lines of data mean much scrolling is required to look back over recent results. The graphs are particularly frustrating - there's a dotted horizontal line to show 'hypo' but no other lateral reference points. A line for 'hyper' and some shading to show the desired BG range(s) over the time period would have made them much more worthwhile, even at small sizes.
There are a bunch of charts, graphs and tables available which do give you a good overview of your recent control. My particular favourite is the 'Target' pie chart which instantly shows you the proportion of results high, in-range, below-range and hypo. Even this though could do with a tweak. The Expert allows you to set a range and a hyper and hypo warning level. This means that you can grade your results to identify low level ups and downs as different from more serious hypers/hypos. Inexplicably though the 'Target' charts do not differentiate between high and hyper.
Reminders
One area that I've not really explored is the comprehensive set of reminders and alerts which can be set to beep or vibrate at you. Reminders to test, prompts to retest after a high or low reading, waking you up for overnight testing, even just to use the expert as your alarm clock!
When it works well
The fact that I picked up my Expert a few days before Christmas might be seen as unfortunate timing. It's not the easiest time of year to get your carbs and doses right, and the first week or two were decidedly difficult, not least because my first attempt at setting up appropriate targets, sensitivities and ratios proved a little off, and I was a little too ready to take the Expert's advice even when I suspected it wasn't quite right. For seven days over the festive break though, when work seemed a million miles away, meals could be taken at leisure with careful bolus-eating delays and one day was much like another the expert performed spectacularly well. I had almost no hypos and something like 75-80% of readings were in the 4-9mmol/L range. I began to believe this could be the start of something really good.
Bolus advice
I won't go into all the complexities of the calculation system here (lest you lose the will to live) but essentially the Expert takes the mid-point of your target range and will always seek to pull or push your BGs toward that. If you come into a meal on the low side it will knock-off an amount of insulin, based on the figure you have given for BG change per unit, along with any plus or minus fractions allowed for exercise, stress, illness etc. Conversely, if you get a meal hopelessly wrong it will suggest a correction dose to bring you back in-range. There are safeguards in place that keep track of insulin duration and the timelag between correction doses and their effect being evident to help prevent over-correction. And of course the Expert is only making suggestions. You can easily override at every stage. One nice feature is the way it displays any plus or minus correction-factors involved in the advice, along with any rounding up or down of the final dose (to the whole or fractional units you have defined). This means that you can see whether the 6u bolus suggestion was based on 5.5u or 5.9u and also how much was down to the Expert wanting to get you from say, 4.5mmol/L to the midpoint of your target range.
A few set-up oddities
Once you have the thing basically set-up and are looking to fine tune it, a few issues begin to emerge. Insulin ratio is only available in whole units. While this is largely satisfactory, for higher carb meals being able to specify to a decimal place would be an advantage. The 'offset time' setting (the expected delay following an injection for BG levels to begin to fall) can be set as no less than 45 minutes. There seems to be no reason for this, and with the profile of some analogue insulins this seems less than ideal. Additionally only one 'offset time' can be defined, while my own experience suggests that I would expect a different delay at different times of the day. 'Active insulin' is another anomaly... the handbook suggests this shows 'bolus insulin that has been given to lower your blood glucose, but has not yet been fully used'. You might expect this to be tracking your whole meal bolus, plus any additional correction factor, but in fact it ignores any part of your dose which is supposed to be dealing with carbs and only reports on correction doses. If you want the Expert to keep tabs on your total insulin-on-board you need to back out of the bolus advice screen and then add the bolus in manually. A simple 'include meal bolus in Active Insulin figure' checkbox would have helped.
Final thoughts
Overall I think I'd have to say I think the Expert is pretty good. Strangely that is a real shame, because it could have been brilliant. There is nothing like it on the market for us folks on MDI and a little more polish could have made it something really special. In a week where one day was very much like the next it gave me excellent results. But in a working week where every day is different it is still struggling. It feels like there are just one too many niggles and concerns. The only reason you would want this meter is if you wanted something to give you more than just a simple record of BGs. I like being able to add data, but I'm not a machine, sometimes I make a mistake. I'd like to be able to delete entries which are wrong, or change times and dates where I make mistakes. To forbid me from doing so because you think I'll just lie to my healthcare team is ridiculous - if I want to deceive them I just won't show them actual results. Sometimes I'll click OK then change my mind about the amount of carbs, or dose I'll take. I'd like my meter to give me enough respect to allow me to log what actually happened. You can modify some records, but not enough and not completely enough. The bolus advice is often pretty good, but it falls down if I make an error in carb counting, and makes no attempt to track the absorption of any carbs, trusting the insulin to deal with them.
Having said all of that I'm glad I have one and will be persevering for the next few months up to my annual review to see if I can tweak the settings still further and repeat that 'perfect' week.
Final score: 4 out of 5.
UPDATE: Having re-read through this a day after posting I realise how nit-picky and negative it sounds. The truth is I really like the Expert, and careful tweaking of its parameters is getting it to provide more consistently effective bolus advice. I think the gloomy cloud over the review is down to the frustration I feel that the unit is only 'Good' when really without very much alteration it could be 'Great'.
Oh one other thing... I linked to this post on a forum and Rob, another Expert user pointed out a way to set fractional insulin ratios. It's not really a problem which affects my ratios, but if your ratio is, say, 1u:7.5g carbs and you have a larger meal containing perhaps 120g of CHO, settings in whole units would only permit a bolus suggestion of 17u (1:7) or 15u (1:8). Rob's clever suggestion is to set the ratio using a higher carb value, so 1:7.5 becomes 10u:75g CHO on the Expert. Ingenious!
On reflection I've pushed the final review score up to '4' from '3.5'. It's still early days. I may well post another update in a month or two after a little more experimentation.
FOLLOW UP: Learning to love my Accu-Chek Expert
Posted by Mike on Thursday, 6 January 2011
Diabetes is enough to drive you nuts
I came across this description from DiabetesDaily (a largely US-based diabetes community/forum/collection of blogs) today:
Diabetes hasn't made me smile in a long time, but some results yesterday were so crazy, so illogical, so utterly ridiculous that I found myself grinning all over my face this morning.
I've been having a pretty good run of results in the last few days - now that the craziness and unpredictability of Christmas eating has passed. I began yesterday morning with a bg of 8.0mmol/l (144 for US readers). A bit on the high side, but not too bad. I had a pretty standard low GI breakfast (two slices of Burgen toast) one that I know usually behaves itself and left my usual 45 minutes between bolus and eating. By mid-morning I had spiked way up to 14mmol/l (252). Took a correction and was nicely back in range with a 7.2 (130) before lunch. I put the spike down to a little liver-dump tomfoolery and left it at that.
For lunch I had two slices of Burgen again, low fat mayo and some leftover chicken. Plus a smallish Clementine to finish. Left 15 minutes between bolus and eating (which is usually enough at lunchtime for the Humalog to get going). Carbs-wise that makes around 35g so I bolused at my usual ratio (4u). 30 minutes later I'd only risen by a tiny 0.2mmol/L (meter inaccuracy notwithstanding). BUT two hours after lunch I checked again and had shot up to 15 (270).
So let's get this straight... I ate completely familiar foods, counted the carbs, took usual doses and in both cases ended up spiking to the sort of level I'd usually like to avoid.
At this point, our evening meal looked like a scary prospect. The girls were given horse-riding lessons from grandparents at Christmas so they were going to be back late and hungry. We'd decided to pick up food from the chip shop to make things easy. So this meal is massively high in carbs AND high in fat AND on a day when the usual rules seem not to apply. Hmmmm tricky! But what could I do except use my usual (and often fairly successful) approach of a stab-in-the-dark at the carbs and a 60:40 split dose 60% before eating and the rest an hour or so later.
Pie and chips. Carbs were estimated at 140g (I know... I know...). 10u up front with a pre-meal reading of 4.3 (78). An hour later I was up to 7.5 (135) and took the second half of the split - 3u to allow for being slightly close to the edge before the meal. At three hours after eating I had dropped back to 5.2 (94) still had a fair amount of insulin on board so had a couple of leftover Christmas chocolates to play safe. Went to bed at 11pm at 5.9 (106) with a reported 1.5u of active insulin according to Colin (my Accu-Chek Expert). I figured that at least some of the evening meal was still chugging through my system, delayed by the amount of fat involved so left it at that, trusting the chips to see me through the night.
I woke at 5am. This is very unusual for me, and I immediately assumed that my BG must have dipped into hypo during the night. A blood test revealed 5.7 (103) so I just went back to sleep.
Woke this morning to a reading before breakfast of 5.5mmol/L (99) and it was then I started grinning. Both my low fat, lowish carb, low GI meals in the day had ended badly, but a pie & chips blowout followed by chocolate and a glass or two of wine had resulted in spectacularly good levels. This is the mystery of diabetes. This is why it drives us crazy.
Now I'm not suggesting we all eat pie & chips constantly from now on, but after yesterday it is quite tempting :)
Diabetes is a complicated and unforgiving disease. To manage successfully, it requires knowledge, problem-solving skills, and a reservoir of patience. Even then, life happens and throws everything into chaos.It pretty much sums up my day yesterday.
Diabetes hasn't made me smile in a long time, but some results yesterday were so crazy, so illogical, so utterly ridiculous that I found myself grinning all over my face this morning.
I've been having a pretty good run of results in the last few days - now that the craziness and unpredictability of Christmas eating has passed. I began yesterday morning with a bg of 8.0mmol/l (144 for US readers). A bit on the high side, but not too bad. I had a pretty standard low GI breakfast (two slices of Burgen toast) one that I know usually behaves itself and left my usual 45 minutes between bolus and eating. By mid-morning I had spiked way up to 14mmol/l (252). Took a correction and was nicely back in range with a 7.2 (130) before lunch. I put the spike down to a little liver-dump tomfoolery and left it at that.
For lunch I had two slices of Burgen again, low fat mayo and some leftover chicken. Plus a smallish Clementine to finish. Left 15 minutes between bolus and eating (which is usually enough at lunchtime for the Humalog to get going). Carbs-wise that makes around 35g so I bolused at my usual ratio (4u). 30 minutes later I'd only risen by a tiny 0.2mmol/L (meter inaccuracy notwithstanding). BUT two hours after lunch I checked again and had shot up to 15 (270).
So let's get this straight... I ate completely familiar foods, counted the carbs, took usual doses and in both cases ended up spiking to the sort of level I'd usually like to avoid.
At this point, our evening meal looked like a scary prospect. The girls were given horse-riding lessons from grandparents at Christmas so they were going to be back late and hungry. We'd decided to pick up food from the chip shop to make things easy. So this meal is massively high in carbs AND high in fat AND on a day when the usual rules seem not to apply. Hmmmm tricky! But what could I do except use my usual (and often fairly successful) approach of a stab-in-the-dark at the carbs and a 60:40 split dose 60% before eating and the rest an hour or so later.
Pie and chips. Carbs were estimated at 140g (I know... I know...). 10u up front with a pre-meal reading of 4.3 (78). An hour later I was up to 7.5 (135) and took the second half of the split - 3u to allow for being slightly close to the edge before the meal. At three hours after eating I had dropped back to 5.2 (94) still had a fair amount of insulin on board so had a couple of leftover Christmas chocolates to play safe. Went to bed at 11pm at 5.9 (106) with a reported 1.5u of active insulin according to Colin (my Accu-Chek Expert). I figured that at least some of the evening meal was still chugging through my system, delayed by the amount of fat involved so left it at that, trusting the chips to see me through the night.
I woke at 5am. This is very unusual for me, and I immediately assumed that my BG must have dipped into hypo during the night. A blood test revealed 5.7 (103) so I just went back to sleep.
Woke this morning to a reading before breakfast of 5.5mmol/L (99) and it was then I started grinning. Both my low fat, lowish carb, low GI meals in the day had ended badly, but a pie & chips blowout followed by chocolate and a glass or two of wine had resulted in spectacularly good levels. This is the mystery of diabetes. This is why it drives us crazy.
Now I'm not suggesting we all eat pie & chips constantly from now on, but after yesterday it is quite tempting :)
Posted by Mike on Tuesday, 4 January 2011
Active Insulin - Continuing adventures with the Accu-Chek Expert
Well I've been using the 'Expert' for a few weeks now and I'm pretty pleased with it. It took a while to get the levels set up right and to understand how it was making its calculations but as of now it's making some pretty good bolus recommendations for meals and more often than not I'm just confirming them.
In a little while I'll do more of a full review with a slightly more considered account of my experience, but I'm investigating a slight oddity at the moment and want to get my head around it before I write that.
There is a line on the Expert's display which reads 'Active Insulin'. According to the blurb this gives you an estimate of the amount of working insulin you still have on board based on the timing of your injection and the figure you provide for insulin duration (in my case 4 hours). Except that it isn't doing that. Well not for me anyway. In the first week I can dimly remember seeing Active Insulin numbers which matched quite closely to what I would expect. At least once I tested after a meal and thought, "Well it's a bit high but I've still got a unit on board so it will come down into range soon enough."
Later I began to notice some very low 'Active Insulin' readings around 2 hours after a meal which did not seem to correspond with the amount of insulin that really was active at that point based on what my BGs did subsequently. Over the weekend I ran some tests to try to work out what sort of curve the device was using to plot the fall-off in insulin activity. I wondered if it was weighted to having a higher proportion of the dose being used up in the first few hours. This does not seem to be the case either... In three separate tests the Active Insulin was displayed consistently as either 0u or 0.1u at 30 minutes, 1 hour, 2 hours and 3 hours after a confirmed bolus of 4 or 6 units.
I've emailed my DSN to see if anyone else has had this problem. I may also drop Roche a line to see if they can shed any light on it.
I'll let you know if I hear anything.
Update: Active insulin explained - read the 'comments' below
Update: Accu-chek Aviva Expert Review - One month in
In a little while I'll do more of a full review with a slightly more considered account of my experience, but I'm investigating a slight oddity at the moment and want to get my head around it before I write that.
There is a line on the Expert's display which reads 'Active Insulin'. According to the blurb this gives you an estimate of the amount of working insulin you still have on board based on the timing of your injection and the figure you provide for insulin duration (in my case 4 hours). Except that it isn't doing that. Well not for me anyway. In the first week I can dimly remember seeing Active Insulin numbers which matched quite closely to what I would expect. At least once I tested after a meal and thought, "Well it's a bit high but I've still got a unit on board so it will come down into range soon enough."
Later I began to notice some very low 'Active Insulin' readings around 2 hours after a meal which did not seem to correspond with the amount of insulin that really was active at that point based on what my BGs did subsequently. Over the weekend I ran some tests to try to work out what sort of curve the device was using to plot the fall-off in insulin activity. I wondered if it was weighted to having a higher proportion of the dose being used up in the first few hours. This does not seem to be the case either... In three separate tests the Active Insulin was displayed consistently as either 0u or 0.1u at 30 minutes, 1 hour, 2 hours and 3 hours after a confirmed bolus of 4 or 6 units.
I've emailed my DSN to see if anyone else has had this problem. I may also drop Roche a line to see if they can shed any light on it.
I'll let you know if I hear anything.
Update: Active insulin explained - read the 'comments' below
Update: Accu-chek Aviva Expert Review - One month in
Posted by Mike on Friday, 24 December 2010
A rough start with the Accu-Chek Expert
When I look back in a few months time I suspect I will think to myself that this was just a bit of bad timing. That of course this was going to be a struggle at this time of year with the variety of 'unusual' seasonal meals adding a lot of confusion to the early days.
My first few days with the Accu-Chek Expert have not been easy. So much so that I was tempted to give the whole thing up on day 3. But the funny thing is I can feel myself wanting it to work so much. To be able to abdicate this responsibility of constantly holding all those threads in my mind. What has been injected, how long ago, what has been eaten, likely absorption curve. Level of activity, current BG level, factors which pull this way and that when trying to calculate the correct insulin dose for a meal. Wanting just enough insulin to pull sugars back from being a little high, without going too far and ending up dipping into a hypo. The relentless daily balancing act.
And this is just what the Expert promises to help with. But of course it's only as good as the information it has got to go on, and at the start, unsurprisingly, this has not been quite right. To begin with, perhaps to err on the side of caution, it was suggested by the DSN to try a ratio of 1u:15g (one unit of insulin to 15g of carbs). This was based on a quick '500 rule' calculation based on my total daily dose. I suppose I wasn't expecting it to work, having worked hard for a year to tighten things up if I'd been out by 50% I suppose I would have noticed. Nevertheless I gave it a go. The following day I dropped it back a little during most of the Expert's time blocks (you can set different ratios at different times of the day). But it was still disastrous, perhaps due in part to inaccuracies in some of the other settings (expected insulin duration, expected amount of BG change per unit etc).
One of the things which surprised me is how vulnerable I was to doubting my own experience. Seeing a bolus dose suggested and thinking, "That doesn't sound right...", but then worrying that the figure I had in mind might not have been right either. Kicking myself when I soared high or crashed low thinking, "Bah! I knew that was going to happen." when in fact I could have stuck to my guns and overridden the suggestion each time.
So from a daily BG average of 5.4 (97) and 5.9 (106) which are arguably slightly on the low side in the 2 days before the Expert, I had an average of 10 (180) ouch! Then 8.2 (148), 8.7 (156), 7.2 (130) and 7.1 (128). To make sense of those numbers... if I stayed completely in the recommended range and tested before and after each meal I would get an average of 6.5 (117).
Like many diabetes things, this will take care, attention and more than a little experimentation to get right. My hope though is that I might have Colin (E decided he needed a name) as a little digital assistant every time I eat, to offer a half-decent suggestion of a bolus for whatever carbs are on my plate.
Here's hoping anyway.
Merry Christmas everyone!
Update: Accu-Chek Expert Review - one month in
My first few days with the Accu-Chek Expert have not been easy. So much so that I was tempted to give the whole thing up on day 3. But the funny thing is I can feel myself wanting it to work so much. To be able to abdicate this responsibility of constantly holding all those threads in my mind. What has been injected, how long ago, what has been eaten, likely absorption curve. Level of activity, current BG level, factors which pull this way and that when trying to calculate the correct insulin dose for a meal. Wanting just enough insulin to pull sugars back from being a little high, without going too far and ending up dipping into a hypo. The relentless daily balancing act.
And this is just what the Expert promises to help with. But of course it's only as good as the information it has got to go on, and at the start, unsurprisingly, this has not been quite right. To begin with, perhaps to err on the side of caution, it was suggested by the DSN to try a ratio of 1u:15g (one unit of insulin to 15g of carbs). This was based on a quick '500 rule' calculation based on my total daily dose. I suppose I wasn't expecting it to work, having worked hard for a year to tighten things up if I'd been out by 50% I suppose I would have noticed. Nevertheless I gave it a go. The following day I dropped it back a little during most of the Expert's time blocks (you can set different ratios at different times of the day). But it was still disastrous, perhaps due in part to inaccuracies in some of the other settings (expected insulin duration, expected amount of BG change per unit etc).
One of the things which surprised me is how vulnerable I was to doubting my own experience. Seeing a bolus dose suggested and thinking, "That doesn't sound right...", but then worrying that the figure I had in mind might not have been right either. Kicking myself when I soared high or crashed low thinking, "Bah! I knew that was going to happen." when in fact I could have stuck to my guns and overridden the suggestion each time.
So from a daily BG average of 5.4 (97) and 5.9 (106) which are arguably slightly on the low side in the 2 days before the Expert, I had an average of 10 (180) ouch! Then 8.2 (148), 8.7 (156), 7.2 (130) and 7.1 (128). To make sense of those numbers... if I stayed completely in the recommended range and tested before and after each meal I would get an average of 6.5 (117).
Like many diabetes things, this will take care, attention and more than a little experimentation to get right. My hope though is that I might have Colin (E decided he needed a name) as a little digital assistant every time I eat, to offer a half-decent suggestion of a bolus for whatever carbs are on my plate.
Here's hoping anyway.
Merry Christmas everyone!
Update: Accu-Chek Expert Review - one month in
Posted by Mike on Sunday, 19 December 2010
New gadget - the Accu-Chek Aviva Expert
I have a meeting with a DSN tomorrow (Diabetes Specialist Nurse). A few months back they offered me a trial of the Accu-Chek Expert handset, and while that didn't quite work out, they do now have a few from the manufacturer that they are able to let people have.
From what I've been told the Expert is essentially the same as the 'brain' of the Roche insulin pumps. More than just a BG meter it allows you to input your carbs, level of activity and insulin ratios and will offer a suggested insulin dose based on the information you provide, plus an allowance for level of activity, stress etc.
It all sounds very promising and I'll be interested to see how fiddly it is to use in practice.
For the last 5 months or so I've been logging all of this information in the excellent DiabetesDiary for iPod/iPhone. It has really helped me spot patterns and thanks to its incredibly easy data entry and some nifty data views (monthly and 7 day graphs, monthly average and 7 day average graphs, min max and mean for any time of day flag etc) the Expert handset now has quite a lot to live up to in terms of usabillity and ease of use.
I'll let you know how I'm getting on when I've had a few days to play with it.
Update: Accu-Chek Expert Review - one month in
From what I've been told the Expert is essentially the same as the 'brain' of the Roche insulin pumps. More than just a BG meter it allows you to input your carbs, level of activity and insulin ratios and will offer a suggested insulin dose based on the information you provide, plus an allowance for level of activity, stress etc.
It all sounds very promising and I'll be interested to see how fiddly it is to use in practice.
For the last 5 months or so I've been logging all of this information in the excellent DiabetesDiary for iPod/iPhone. It has really helped me spot patterns and thanks to its incredibly easy data entry and some nifty data views (monthly and 7 day graphs, monthly average and 7 day average graphs, min max and mean for any time of day flag etc) the Expert handset now has quite a lot to live up to in terms of usabillity and ease of use.
I'll let you know how I'm getting on when I've had a few days to play with it.
Update: Accu-Chek Expert Review - one month in
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