BWP (Bolus Wizard Preview)

10 Sep
fc-bwp1

BWP (Bolus Wizard Preview) is a plugin feature of the Funnel Cake (0.8.x) release. The purpose is to automatically snooze high blood sugar alarms when there is active IOB. A secondary goal is to alert the user that it may be time to test (and correct) as bg is moving out of ideal range. All information provided by BWP is purely suggestion. Always follow the advice and care plans out lined by medical professionals before BWP suggestions. All BWP suggestions rely on accurate and timely information being entered into care portal and configured in the profile. If this information is inaccurate it will adversely effect BWP suggestions.

BWP can (when appropriately configured and with current data):

  • Calculate bolus correction amount when above target
  • Suggest temporary basal rates to correct bg
  • Suggest carb corrections
  • Snooze high alarms when there is enough IOB present
  • Generate alarms when you should consider testing and correcting

BWP depends on:

  • Accurate care portal entries
  • Treatment profile accurately completed
  • IOB plugin

BWP does not consider:

  • COB (carbs on board)
  • CGM trend arrow

To enable BWP:

You will need to add BWP to your ENABLE variable in your site’s app settings. In Azure they can be found on the Configure tab. In Heroku they can be found on the Settings tab under Config Vars. If you have already enabled features or plugins you already have an ENABLE variable. Do not add another ENABLE but modify the one you have. For BWP to work you should have care portal, IOB and COB enabled. Your ENABLE variable should include “careportal iob cob bwp” (without the quotes). You may have more things enabled, just make sure they are separated by a single space.

You can modify some of BWP’s standard behavior with extended settings by configuring the following variables in your site’s app settings (in Azure/Heroku):

  • BWP_WARN — if BWP > BWP_WARN a warning alarm will be triggered. The default value is 0.50
  • BWP_URGENT — if BWP > BWP_URGENT a warning alarm will be triggered. The default value is 1.00
  • BWP_SNOOZE — If bg is higher than target_high specified in your profile (not BG_TARGET_TOP or BG_HIGH) and BWP < BWP_SNOOZE, high alarms will not sound for BWP_SNOOZE_MINS.
  • BWP_SNOOZE_MINS — Number of minutes to snooze a high bg alarm if there is enough IOB to cover the high. The default value is 10 minutes.
fc-bwp2

When BWP is enabled, you will see a pill labeled BWP with a number displayed below the current bg number. The number is the basal change in units necessary to correct bg (bring it into your target range). When the current bg is below target, BWP will be <0. At this time you may need to correct bg with carbs, or a low temp may be enough to prevent a low. Always use your discretion before following these predictions. When in range and predicted to stay there, you will see a BWP of 0. Congratulations you (probably) don’t need to do anything (for now)! Enjoy it while it lasts. When the current bg is above the target range, you will see a positive BWP number. If you hover over the pill you will see more detailed information and suggestions for how to bring the bg back into target range.

When below target, you will see:

fc-bwp3
-BWP: this is the amount of “extra” insulin that needs to be covered. It could be covered by carbs still working. [Note: Carbs-on-Board (COB) are not taken into account by the BWP’s calculations.]
Carb ratio: from your profile settings
Carb equivalent: based off of your profile settings and insulin amount calculated by BWP
IOB: calculated from care portal entries and your profile settings
Sensitivity: from your profile settings
Expected effect: the predicted change in bg based off info available
Expected outcome: what bg is expected to be after the expected effect
Projection below target: with expected target shown (This can be set in the profile settings. If a specific target is not named, the center of the target range will be used.)
Current basal: as set in your profile
Basal change to account for: estimated extra insulin on board (a negative value)

If the value is small enough, it can be compensated for via temporary basal rates. When possible, suggested temporary basal rates for 30 min and 1 hr durations will be shown. If bg is low enough or dropping rapidly, temporary basal rates might not be enough. A carb correction instead of or in addition to a temporary basal reduction might be needed. Remember these values are just suggestions. Always trust advice from a medical professional or written care plan when different. [Note: In the example above, the BWP suggestion was made shortly after a meal. The “extra” insulin was covered by the carbs-on-board (COB) and no further action was needed.

When in range, you will see:

fc-bwp4
Insulin on Board: calculated from care portal entries and your profile settings
Sensitivity: from your profile settings
Expected effect: the predicted change in bg based off info available
Expected outcome: what bg is expected to be after the expected effect

Because you are expected to be in range, no adjustments are suggested.

When above target, you will see:

fc-bwp5
Insulin on Board: calculated from care portal entries and your profile settings
Sensitivity: from your profile settings
Expected effect: the predicted change in bg based off info available
Expected outcome: what bg is expected to be after the expected effect
Projection above high target: with expected target shown (This can be set in the profile settings. If a specific target is not named, the center of the target range will be used.)
Current basal: as set in your profile
Basal change to account for: estimated extra insulin needed

If the value is small enough, it can be added via temporary basal rates. When possible, suggested temporary basal rates for 30 min and 1 hr durations will be listed. If bg is high enough or rising rapidly a temporary basal increase might not be enough. A correction bolus via pump or injection might be required instead of or in addition to a temporary basal rate. Current IOB may also be sufficient. Remember these values are just suggestions. Always trust advice from a medical professional or written care plan when different from BWP suggestions.