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Updated Bolus Calculators for Diabetes Management

New updates to the automated bolus calculators (ABCs) for diabetes…. 

In the past, healthcare providers helped control glucose by using insulin dosing algorithms. Within the last decade, personal digital assistants (PDAs) have been used to help with postprandial glucose control in patients that have to calculate their meal insulin boluses. More recently, automated bolus calculators (ABCs) have been used to assist with pre-meal insulin dosing for patients using insulin without pumps. Examples of ABCs include: ACCU-CHEK®, Aviva Expert® and FreeStyle InsuLinx® blood glucose monitoring systems. With the advance in smart phone usage, even more innovating technology is being made to help patients manage diabetes through smart phone applications.

Previous studies have proven that the use of ABCs are effective and well accepted in diabetic patients. Most of the previous studies using ABCs were conducted in type 1 diabetic patients. ABCs have been proven to be effective in managing glucose levels and preventing hypoglycemia. Current ABCs help save time and money on numerous doctor visits while trying to adapt to new insulin regimens.

Barriers to effective glucose control include fear of hypoglycemia. Even though this is common, the reality is that only about 50% of patients with diabetes actually achieve the targeted glucose level. Of all of the patients taking medication for diabetes, only about 30% of this group achieves targeted glucose levels. Other barriers that concern diabetic patients are: cost of medications, durable medical products, time demands for appropriate glucose control and a few others. Barriers that concern physicians include: time requirements, lack or reimbursement and frequent insulin or medication adjustments during and between office visits.

Meal bolus insulin dose calculators are based on several factors. The calculators based calculations on the target blood glucose level, the current glucose level, the carbohydrate-to-insulin ratio, total carbohydrates for that one meal and the insulin sensitivity factor. Built into most ABCs is an insulin correction algorithm to adjust pre-meal glucose levels which are out of range; ABCs used by insulin pumps also factor in the active insulin on board (IOB). IOB algorithms help prevent "stacking" of multiple insulin boluses which can make patients severely hypoglycemia.

Smart phone ABCs can increase access to the automated dosing algorithms and should further help manage intensive glucose control. Having ABCs available on their phones will help patients who can’t appropriately calculate bolus insulin doses. It would also save time for patients concerned about the time that it takes to appropriately manage their glucose levels. ABCs on smart phones will also be beneficial for all insulin patients not just those who are on insulin pumps. Some limitations include: carbohydrate counting for each meal, requires calibration based on empirical observation of each patient, and the calculations are based on the carbohydrates in the meal and not the glycemic index of fats and proteins in that meal.

Practice Pearls:
  • There are about 84 different automatic insulin calculator apps on iTunes.
  • Many of the smart phone apps work along with diet and exercise apps so that patients can manage his or her diet and disease state(s).
  • There are approximately 40,000 health apps available for smart phones; from 2011 to 2012, the amount of health apps downloaded doubled [127 million to 247 million].

Schwartz F and Marling C. Use of Automated Bolus Calculators for Diabetes Management. US Endocrinology. 2013;124-127.