The other day, my dad told me that he'd recently hired a woman at his company who has LADA (Latent Autoimmune Diabetes in Adults). She wears an insulin pump, and when he mentioned that I went off my pump this Spring and went back to taking multiple shots a day, the woman was apparently shocked and couldn't figure out why I would "go backwards."
It's true that switching from a pump to multiple daily injections (MDI) isn't nearly as common as people who switch from shots to a pump. But people do it. And I'm one of them. It's not that I don't like insulin pumps or that they don't work. It's just that when my pump happened to break back in March, I decided to take advantage of the opportunity to have a "pump vacation."
I've discovered that one of the most difficult parts of being off the pump is doing the D-math that my pump used to do for me.
When I first started my break, I used my iPhone's calculator to do all my calculations. First, I'd enter my blood sugar and figure the correction factor. Then, I would enter my carbs and use my I:C ratio to figure the bolus dose needed. I'd then add them together, do some rounding, and inject. It worked really well for several weeks.
And then I got lazy.
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Instead of taking out my calculator, I just started estimating how many units of insulin I needed, and let me tell you, my mental math skills have never been that good. I also could never accommodate for Insulin On Board (IOB) properly, which was frustrating.
Thanks to our columnist, Wil Dubois, another pump renegade, I discovered RapidCalc, a new mobile app designed to work like a Bolus Wizard calculator. A couple of weeks later, I found out about a similar tool, ManageBGL, when the company followed me on Twitter. Apps to replicate a Bolus Wizard? Genius!
These two apps have some similarities: they're both owned by Australia-based companies, were founded by type 1 PWDs, and the apps essentially calculate your insulin needs the same way a pump-based wizard does. They just have different bells and whistles.
Invented by Ian Gillespie, a PWD for 30 years, the RapidCalc app has a sleek and simple user interface made for a smartphone.
Meanwhile, the ManageBGL is a web-based program right now (but a phone app is being launched by year's end!) and it was created by Simon Carter, a PWD for 24 years who also has a daughter with diabetes.
Cost is a key for most people and each comes down differently on that aspect. RapidCalc comes in at $7.99, which I think is pretty pricey for an app. The ManageBGL website is free at the moment, but that's set to change. Starting in March 2013, it will cost $29.95 a year, with the phone app included in the subscription. Big price difference, huh? Well, a lot of that has to do with the different features, so let's continue...
Set-up and Interfaces
Set-up for both apps is a bit time-consuming. Each app allows customization for ratios, correction factors, and sensitivity to exercise. RapidCalc allows users to adjust for upcoming exercise (less insulin), or to indicate whether you've had alcohol or a recent low blood sugar (which eliminates any correction dose). ManageBGL also allows for customization of additional "life factors," such as menstruation, sick days and stress levels. ManageBGL can also take the glycemic index score of your food into account, and you can also keep track of food favorites in its food directory. That's certainly more than an insulin pump bolus wizard bothers to do! Once these factors are plugged in, both apps take them into consideration to adjust your recommended insulin dose.
Entering blood sugars into RapidCalc is a bit odd. Although the design is nice, it uses a "slide-and-tap" scrolling horizontal bar for blood sugar and carbs. This means you slide to approximately the right number of carbs, and then you tap the plus or minus sign to select the exact number. Although the company claims this is faster, I find it awkward and annoying. It wasn't until I looked up their extensive FAQ section that I figured out how it even works.
ManageBGL's website, on the other hand, is more straightforward. Just enter in the numbers using the keypad and you're done. The phone app will function the same way, they tell me. The website and app will also allow you to enter in carbs, blood sugars or insulin separately if you choose not to use the bolus wizard calculator.
Although I personally prefer the user interface of RapidCalc, the ManageBGL has an advantage when it comes to caregivers. Since it's web-based, it can be accessed from anywhere and by anyone who has permission. When I had some questions about using ManageBGL, founder Simon Carter was able to check in on my logs immediately... from almost 10,000 miles away!
A Virtual CGM
ManageBGL's real uniqueness is its "virtual continuous glucose monitor." Yes, seriously. Using your current blood sugar, carbohydrates and insulin intake, and any other factors you've entered, its algorithms project what your blood sugars might be over the next few hours.
Now, of course, the readings are definitely not meant to be used for any dosing, and Simon acknowledges at the virtual CGM is a bit of a "pipe dream," but he says it can have a real education benefit for patients.
"What we're really after is to identify trends, to educate people as to how their insulin is going to act (especially if stacked), to hopefully ward off a few hypos, and arm more people with ratios to give them flexible eating," he says.
I definitely found it interesting to see what the CGM predicted, but I don't think it's something I would pay attention to regularly.
In contrast, RapidCalc has fairly simple features. It sticks to basic insulin calculations, and only takes into consideration exercise, alcohol and previous low blood sugars. The only prediction it makes is A1C (and it was only off by .1% for my last A1C, so I think that's pretty reliable).
Active Insulin & Other Advantages
Another big difference was how the two apps apply Active Insulin. In RapidCalc, you can manually adjust the percentage of insulin considered to be "in use" for each hour. So for instance, knowing a little about how insulin hits my body, I might set my expected absorption to 15% being used in the first hour, then 35% in the second hour, for a total of 100% in 4 hours. In ManageBGL, Active Insulin is calculated automatically through their algorithms.
If you're wondering, my personal preference is RapidCalc. It's the first one I found, and while I really like the features of ManageBGL, right now I don't need to share my logs with anyone. Having multiple users via the website isn't as important as having an easy-to-use iPhone app that I can take anywhere, especially when comparing a one-time cost of $7.99 versus $29.95 a year. However, if I were a parent or caregiver, or if I didn't have a smartphone, I'd likely pick ManageBGL because the data sharing is so much more convenient. Simon, who has an elementary-aged daughter, says it's been much easier communicating with school staff during the day using the website.
While a bolus wizard app certainly won't replace an insulin pump, it's a relief to have some of the more complicated dosing math taken care of. In some instances, like exercise, even more math is done by the app than by the insulin pump! That's pretty cool!
So if you're thinking taking a pump vacation or are already on MDIs and frustrated with all the math, don't worry: there's an app for that!