Encourage use of appropriately adjusted embedded bolus calculators
STEP 1 — Gather Information
Collect patient's current insulin-to-carbohydrate ratio, correction factor (insulin sensitivity), glucose target, active insulin time, carbohydrate counting proficiency, recent glucose logs, pump model and embedded calculator availability, and any history of hypoglycemia or hyperglycemia postprandial.
STEP 2 — Rule In / Rule Out
Determine if the patient is using CSII with rapid-acting analog insulin and has an embedded bolus calculator available; if yes, proceed to stratification, if no, consider alternative bolus calculation methods or defer calculator use.
STEP 3 — Classify or Stratify
Stratify by patient's experience with bolus calculators: novice (never used) vs experienced (previously used but may need adjustment) to tailor education approach.
STEP 4 — Decide
For novice patients, provide structured education on how to input carb ratios, correction factors, and active insulin time, and encourage use of the embedded calculator for all boluses; for experienced patients, review and adjust settings based on recent glucose trends and reinforce education on limitations.
Clinical Guardrails / Mimics / Pitfalls
Do not rely solely on the calculator for meals high in fat or protein without considering extended bolus features; avoid using outdated carb ratios; do not ignore active insulin time leading to insulin stacking; ensure patient understands that the calculator does not replace glucose monitoring.
Concrete Clinical Example
A 24-year-old with T1DM starting CSII with insulin aspart reports carbohydrate counting ability but uncertain about bolus amounts. Clinician gathers current ICR 1:10 g, correction factor 1:50 mg/dL, target 120 mg/dL, active insulin time 4 hours. Patient is novice with embedded calculator. Clinician provides education on entering these values into the pump's bolus wizard, demonstrates a test bolus for 30g carbs, and advises to use calculator for all meal and correction boluses while checking postprandial glucose.
Source: Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults, Endocrine Society, 2016, doi:10.1210/jc.2016-2534
TODO: consider adding scripts/calc.py for the endo-bolus-calculator-use-encourage calculator