Me & my speech.

Posts tagged ‘tests’

1). Pump Diabetics- Ischemia Treatment Options & Painkiller Works with PUMP & CGM

Sorry everyone

Plans are to divide this info into multiple posts that are linked to the diabetic info posts and the Whoops disease posts in some areas. This lack of division means this incomplete paper of info is also still HUUUUUUGE, so that means it’s more difficult at present to locate the insulin & sugar variation issues and actions planned with insulin pumps and sugar processes to allow treatments of Ischemia as well as acetaminophen AND other drugs to be better with the care of diabetics on insulin systems like Rhapsodie is.

This also means at the present time if you’re reading this info you may find copying it and pasting it to a document allows you to copy and utilize Rhapsodie’s info, but please also know I have no medical education that’s not self learned and self taught. In addition I have not tried these actions, other than living with insulin pumps for over 25 years. So please operate with caution when considering using these action ideas and when communicating with patients about the actions and options.

Updates and fixes may take some time for this information and these posts to be better for you. I’m sorry…BUT here it is more of Rhapsodie’s Words-

Lower & Higher sugar levels for medical uses

This document section was originally part of the Ischemia or ischaemia Treatment options document, but since there are so many additional options and actions utilizing sugar level variations we’re adding this information here. For example one of the sets of info below is about diabetics suffering low sugar comas, and how ischemia damages and sugar treatment variations can improve their health with reduced risk for the patients. Parts of this information are from the discussed common treatments which can be varied with actions that impact blood coagulation including low sugar actions AND therapeutic hypothermia which is a part of the treatment info included within the Natural Infection & Pain & Inflammation Fighting document. Plus there are additional details about ischemia and treatments for reperfusion injuries with sugar treatments in the Ischemia or ischaemia Treatment options document.

The reason for this document is because insulin dependent diabetics with good basal patterns for their body uses, can generally keep their sugar levels consistent. This means if they have insulin levels below the normal and keep these maintained over a period of time by ‘changing’ the goal target ranges with their insulin levels, they can keep their sugars at the reduced ranges for fighting coagulations because of the blood thinning like are needed for recovery from ischemia injuries that include strokes and comas. The levels for each diabetic with the low sugar ‘changes’ impacting the body vary as do the higher sugar levels and how those impact the body as found from Rhapsodie’s experiences.

General Reduced sugar levels

The value of sugar levels at a slightly reduced rate still has thinner blood, because the red blood cells aren’t as full of sugar or other nutrients, thus they have a more difficult time at transporting white blood cells and other normal blood flow things. These blood flows are still fluid, and often more watery which means with some cases of Ischemia there could still be some blood flowing, but it’s not as heavy nutritionally. The value for reducing ischemia is that the blood flows are wimpier, which means that if a patient is treated for an injury with normal or higher sugars during surgery, but blood sugar levels are reduced for post-surgery recovery, there can be a reduced hit on the cells with the nutrition, white blood cells, and other cell foods.

For Rhapsodie if her sugar gets below 60 she gets slightly drunken,
- if her sugar goes below 50 she may get somewhat sweaty and jitter a bit,
- if her sugar gets down to around 40 or less there are more dramatic episodic problems, like epileptic attacks, and
- like others if her sugar reduces to below 05 she can go into a coma.

Common Higher sugar Levels

Red blood cells are released by the liver for sugar assistance and body uses. While an individual with sugar levels at normal stages are getting normal releases, there are thicker and fatter blood cells which actually have reduced blood flow. When low sugars are being fought more red blood cells are released to assist in keeping the body fed by the liver, feeding the body more. When high sugars are existing less red blood cells and care elements are released, so there is less nutrition for the body through the liver, but the cells are getting hit with a lot more at one time.

For Rhapsodie if her sugar goes up to 140 she feels slightly heavy,
- if her sugar goes between 140 and 180 the heaviness body feeling increase, plus she gets grumpier because of slight physical discomfort that grows.
- AND if her sugar goes up to numbers between 180 and 240 she gets hot and uncomfortable as well as feeling heavy.
- Plus if Rhapsodie’s sugar goes over 240 her hot feet, super heavy body, needing to pee a lot and more are just additional indications of higher sugar.

The blood restriction in the body can become more normal to people that live with it constantly, but with normal sugars around 100 these higher levels feel wrong. In addition with sugar testing there are thicker blood flows, which means the higher sugar levels are the harder it is to get blood from the body for the sugar checking. This is the exact opposite with lower sugar levels, this is part of the reason Rhapsodie believes this will be a value with reperfusion injury treatments for preventing ischemia.

Treating Ischemia & Reperfusion Injuries with Sugar Variations, Rhapsodie’s Ideas

For surgical treatments if Rhapsodie has prepped these sugar levels to rates which doctors can find useful with the surgical actions there can be assistance in reducing thrombosis and ischemia. This means having knowledge and preparations done with tests as well as time allowances for sugar changes for the resulting body value needs. Without OR even with the drugging influences that change her sugars, she could have thinner blood without the anticoagulation drugs that cause other issues on top of drug uses that could be avoided. Plus with the treatments corresponding to blood sugar levels and uses of the insulin pump there can be variations impacting results from these treatment actions and how those result for the patient.

How to utilize insulin and goal targets with sugar treatments are below, but first because of low sugar coma’s discussing how to avoid brain issues, stroke problems, with treatments is being discussed because it’s an area of treatment that can really impact many diabetics.

LOW BLOOD SUGAR COMA’S, BETTER TREATMENTS

When Rhapsodie suffers low sugars she fights to get treatment, the results of the low sugar make her movements more and more spaghetti flingish, epileptic. The reasons are that the blood feeding bones, brain, blood vessels, joints, and tissues are all reduced, so that muscle coordination and action controls are hindered. With the information about ischemia which is caused because ‘of blood starved body zones’ it can be that with low blood sugar levels that cause comas that dramatic sugar changes will actually increase brain injury to those patients. While an incremental shift could allow healthier reactions with slower sugar rising.

For example doing things over an 1 to 6 hour period to raise sugar levels, which should allow the starving brain zones to regain activity with less chances for ischemia, especially if they were done incrementally gradually.]

Reperfusion injury plays a major part in the biochemistry of hypoxic brain injury in stroke.
- Similar failure processes are involved in brain failure following reversal of cardiac arrest;^[3] control of these processes is the subject of ongoing research.

[It can be that sugar level changes can be a reason that diabetics in comas, from low sugar who are treated immediately to raise their sugars can suffer brain injury.

Instead of a slow and steady rise of sugars their bodies are hit with sugar all at once, and the enhanced blood changes could be causing ischemic injury to the brain. More in the Natural Infection & Pain & Inflammation Fighting document under the B3- Reperfusion Injury in Other Health Issues
For example if a person goes into a coma and they have sugar levels of 3, then their sugar levels are 300% lower than 90. This means that the blood flow is 300% thinner and less nutritious than normal. Now with these actions we’re thinking that there are extra insulin & activity aspects also influencing sugar levels, so sugar checking is a part of this recovery process as well as treatment against the ‘insulin activities and activities’ that are continuing.
- So if raising sugar is done with an instant glucose shot, the person may get hit with a lot of ‘blood fluids and food’ which can cause ischemia in the brain.
- If the treatment begins with some glucose, taking care of the activity issues and other insulin use issues this will not change the coma treatment processes other than keeping the patient from having sugars go lower.
BUT if the individual is given a sleep drug, to induce slower blood processing as well as reducing possible ‘epileptic style’ movements. Then with treatments that are given over hours of time glucose in a higher protein content it could be that recovery is much better as well as much healthier.

This would mean that the percentage of change would also gradually increase over time.

If the treatment begins with some glucose given for taking care of the adrenalin running activity issues and other active insulin issues this will not change the coma treatment processes other than keeping the patient from having sugars go lower. This is easier to know about with the insulin pump, more is mentioned above under the Sugar Value Adjustments heading, but activities are not always determinable without others OR even ‘video’ action evidence, so this is likely to be guessed on without that info being able to be available. These amounts for correction should be added before the raising work is started, this is done to reduce sugar dropping from happening any more.

If a diabetic comatic’s sugar is at 3 doubling that would mean it would be shifted to 6, this amount would be a glucose of a proportional level based on the individuals carb ratios if those are accurate. [More above.]
Doubling 6 would shift sugars to 12,
Doubling 12 would shift sugars to 24,
Doubling 24 would shift sugars to 48,
Doubling 48 would shift sugars to 96.
With the sleep drug, the patient wouldn’t awaken while that drug was working, but the sugar tests can still be done. With the slower body processes the sugar impacts are likely to be noted as being slower than normal. The impact would be what it should be, but if we give this process time I’d make sure that the process was slower at the beginning, speeding up towards the end to reduce injury to the brain and other body zones. Just like weight changing, it’s much healthier to have gradual processes that extend over time, graduate into normalities.

How to use sugar changes against coma more slowly?

The slower return of the brain to normal blood flows with normal sugar levels slowly being gotten should reduce ischemia damages for diabetics that suffer low blood sugar comas. If the treatment begins with some glucose given for taking care of the adrenalin running activity issues and other active insulin issues this will not change the coma treatment processes other than keeping the patient from having sugars go lower. This is easier to know about with the insulin pump, more is mentioned above under the Sugar Value Adjustments heading, but activities are not always determinable without others OR even ‘video’ action evidence, so this is likely to be guessed on without that info being able to be available. These amounts for correction should be added before the raising work is started, this is done to reduce sugar dropping from happening any more.

Since there are 5 levels of change here, with process times of changes varied by body uses and sizes it means that a change will still take time, depending on how much change is being worked on. This means that with the lower levels of change, smaller numbers, things will shift faster, but it’s better for the health of the body that body portions and areas are given time to get used to the adjustments to assist in keeping ischemia injuries and brain stroke issues minimized. So if we add 20 minutes to 30 minutes for each level for this whole process after the ‘active insulin & adrenalin’ care is done, it will mean between 1 to 1.5 hours for recovery to normal.

For uses of the generic levels, mentioned above, with 10 carbohydrates= 1 unit of insulin= 40 change in sugar levels math can assist in determining how to vary the sugar levels. Please remember these insulin evaluations above are only samples each individual has different numbers in use, so different calculations are needed with the same patterns of uses.

If a diabetic comatic’s sugar is at 3 doubling that would mean it would be shifted to 6, since in this generic level example 10 carbohydrates= 40 change, this means 1 carbohydrate= a sugar change of 4 we could just determine to add 1 carbohydrate because 4 is so close to 3… this would mean the proportional shifts would also vary for the amount of carbs.
- If we were set on doing just 3 because of doubling, then we would use ¾ of 1 carb in this generic level example.
  - The impact would be what it should be, but if we give this process time I’d make sure that the process was slower at the beginning, speeding up towards the end to reduce injury to the brain.
  - So I would make sure that 10 to 20 minutes were a normal time taken before a sugar check in the right hand is done, then after the ‘goal target’ is either reached OR surpassed I would start the next glucose treatment.
- Doubling a sugar of 6 would shift sugars to 12, the carbohydrate amount is 2 times more than from 3 to 6.
  - With that change of 3 being ¾ of 1 gram of carbohydrate.
  - So ¾ + ¾ = 6/4 or 1 2/4 or 5 carbohydrates.
    - And like the sugar rates, the carb rates would continue to double for raising sugars.
  - Doubling 12 would shift sugars to 24,
    - So 1.5 + 1.5 carbohydrates= 3
      - And like the sugar rates, the carb rates would continue to double for raising sugars.
    - Doubling 24 would shift sugars to 48,
      - So 3 + 3 = 6
        
        And like the sugar rates, the carb rates would continue to double for raising sugars.
      - Doubling 48 would shift sugars to 96.
        
        10 carbohydrates= 40 change, this means 1 carbohydrate= a sugar change of 4.
        
        Thus 48 divided by 4 equals 12 carbs.
        
        Again, done differently mathematically, 6 +6 carbohydrates= 12.
        
        And like the sugar rates, the carb rates would continue to double for raising sugars.

Over this whole generic levels process, the individual receiving carbs gets a total of the correction rates needed against previous activities and insulin in use, plus 22.25 carbs which have a value of 89. The value of these limited raises is that the brain isn’t hit with lots of sugar with no food value, that brain damage is reduced because the blood getting to the brain with more and more ‘value’ is gradual, and the results at the end are at a good normal sugar rate. Rhapsodie has had those carb shots and sugar hit her body dramatically after a low, for her the results are high sugar with all the high sugar blood pressure problems also. When the brain with a low sugar coma is suffering reperfusion injuries like with stroke victims, the high flow of sugar increasing blood pressure is also likely to increase lack of recovery as well as more dangerous problems with ischemia injury to the brain.

NON-coma low sugar recovery

With low sugars while an individual is still awake, there are also issues that can impact brain health, but since the brain is awake the individual injury aspects are likely to be a lot lower than they can be with a person suffering a coma. The sped up recovery process is not the best thing, but in some cases, like with epileptic body actions it’s much better to get the sugar into the person to reduce injury. BUT if a person hasn’t reached a shaky level it’s often better to use a higher protein slower processing carbohydrate, like milk OR a nutrition drink higher in protein which will stick with the person with the same digestive processes of a simple sugar and less low sugar follow up possibilities’.]

Insulin & Sugar level Variations for repercussion treatments & avoiding ischemia injuries

This information is not tested yet, so Rhapsodie hopes these will be utilized for her to assist in avoiding excess medications and side effects from those with her injury treatments. The numbers added here are pertinent for others as well, but the numbers can be varied with different equipment also. For Rhapsodie these uses may not need the higher sugars. Tests for blood coagulation and more with sugar variables can impact the plans for surgical treatments and recoveries also. Different individuals may have various level valuations because of life styles, normal sugar levels, other in use drugs and side effects, and blood valuations with individual’s health which shift the blood values for people. I’m not sure if these impacts can work with non-insulin dependent diabetics, but they may in some ways using the insulin as the medication.

Glucose Levels and Insulin Uses

Insulin pump diabetics have machines which hold the glucose and correction rates of insulin for them. The endocrinologists and modern diabetic doctors also have math formulas for figuring out the general values of sugar uses for ‘unknown’ patients. BUT over time patients with insulin uses and their bodies have shifted insulin uses and results with glucose levels.

Generic setups

These setups utilize the basal rates generally being used plus body weight levels, BUT it’s probable that generic setups are used to assist in determining correct insulin use values. Rhapsodie began insulin pump uses years ago with:

10 carbohydrates= 1 unit of insulin= 40 change in sugar levels.

This would mean that the percentage of change would also gradually increase carb amounts over time like for treatment of diabetic comas more above. Please remember these insulin evaluations above are only samples each individual has different numbers in use, so different calculations are needed with the same patterns of uses.

Lower sugar levels repercussion treatment & ischemia reduction action ideas

As the general reduced sugar info above discusses some more about lower sugar, with Rhapsodie, plus there are various results with sugar levels that may be utilized with surgical situations like are discussed above and below.

Lower sugar levels like between 55 and 70 can also help keep the blood thinner without body reactions that could make surgery more difficult, AND extreme Serrapeptase Enzyme uses could also possibly help, along with ginger as an anti-inflammatory.
- Diabetics with low sugar suffer thinner blood, this impacts bruising as well as injury potentials.
The thinner blood has less coagulation value, it flows faster but it’s not as thick.
This causes the individual with lower sugars to feel cold more easily also.

Possible treatments with low sugar against ischemia-

When the blood flow return to the ‘starved’ areas hits the body…lower sugar can be continued for days if the process is planned using modified for lower sugar insulin pump goal target levels. More below.
With some options including decrease in body temperature a value for ischemia treatments, it could be that the lower blood sugar isn’t really a value until closer to the end of the surgical treatments. For treaters it can be useful that normal room temperatures make the patient still feel cool, because they aren’t having normal nutrition blood levels.
More below discussing how to do this with uses of the insulin levels and insulin pumps like the Paradigm.

Higher sugar levels

As the common higher sugar info above discusses some more about higher sugar situations with Rhapsodie and others, plus there are various results with sugar levels that may be utilized with surgical situations like are discussed above and below. This may not be of use with surgeries, it will make the process of shifting to lower blood sugar levels more difficult and longer, but also more extreme, which may be a value.

Higher sugar levels like between 180 and 220 are uncomfortable for Rhapsodie.
- Plus because these thicken her blood with the sugars, she normally works to reduce her sugars as fast as possible.
- The coagulation values are unknown because the ‘blood health’ isn’t as good as it should be with extra carb and less other blood action values, these sugars increase blood pressure levels, damage from ischemia is found with patients running high sugars constantly because of blood vessel body damage from the sugar fat cells with limited nutrition for body health. With the thicker blood an individual has discomfort because the blood cells throughout the body aren’t processing as they should be, but this could assist surgical treatments before ischemia issues are reached.

Pre & During Surgical Treatments having higher sugar levels

For surgical treatments that can cause repercussion injuries, it can be useful to perform the surgeries with higher sugars, then within 2 to 3 hours before finishing the surgeries, having the sugar levels drop to the lower sugar ranges mentioned above, so that through surgical closures of body areas where blood flow is restricted the blood types are varied to the lower sugar blood levels with less coagulation and other blood enzymes hitting the ‘starved’ from ischemia zones. Reasons for this as a value are because:

Rhapsodie feels hotter in the same environment that she would be comfortable normally OR cold with low sugars. Her heart, organs, and body doesn’t feel as cool as quickly because her blood is sugar fat not normal.
- This could mean with working to do therapeutic hypothermia the higher sugars can also reduce body movements, like shivers because of the higher sugars.
This means the air could be at normal OR even cooler temperature and the patient doesn’t get as chilled, but the surgeons will suffer the cold more.
BUT since this can also mean ischemia issues switching to the lower levels should be planned as part of the surgical insulin processes with the time frames of insulin impact added to the result plans.
- It could be that aspects of the thicker blood also include alternate coagulation and flow factors that could impact surgical situations, because the sugar isn’t the same as normal food for the body, but the sugar may also cause faster processing of blood which can make it harder to deal with ischemia issues if sugars aren’t lowered with reperfusion situations.

Sugar Value Adjustments

With insulin pumps like with a Paradigm Insulin Pump are possible because the pump doesn’t have automatic actions that will make uses with different sugar levels problems. Rhapsodie’s 670g is a problem because if her sugar reaches 65 it’s often beeping and screaming with alarm noises saying her sugar is at 55 or lower. Because CGM is still of use in reading the blood sugar levels it’s useful to have that system in use, but not for controlling sugar levels through these processes.

Reduced Ischemia with Lower Sugar Levels for extended time periods

The value for surgical treatment with an individual like Rhapsodie is that with the insulin pump sensor in use, the insulin levels keeping the blood sugar at a lower level, the blood will be thinner and less coagulation will be happening through this time period. Levels of lower sugar continued for days can assist in keeping this value in use; gradual sugar level rises can assist with body re-composition. BUT in order to do so well a pump that doesn’t yell about low sugars is necessary, PLUS it’s good to setup the insulin pump processes for the lower OR even the higher sugar levels as goal target ranges.

Discussions below are based on insulin pumps as controls for insulin deliveries, but doctors that don’t have patients with the insulin pumps may also utilize in hospital pumps to learn patient insulin rates and adjustments, like with temporary uses for days to weeks before the surgeries. Then they can use those calculations with IV insulin setups and more, OR if the patient tests the pump and finds uses determines to get one those ‘test values’ can lead to the new setups they get in use. The sugar change factors are able to be done with better insulin control, so the individuals taking long term insulin and shots are less likely to have patterns of body uses with insulin that can assist the raising and lowering of sugars to reduce ischemia risks.

Insulin Pumps & Insulin Use Paradigm Insulin Pump Goal target Range Setup Variations

These values in the Paradigm insulin pump are located in the Bolus Wizard Setup, this is the same with the 670g, but there are additional setups with the sensor. The lowest level sugars can be at with the 670g is 50 then the low sugar warning system is fully activated and unable to be turned off. Even if an individual, having anything like up to 20% different can set this off. This means that levels at 60 can do that, so for lower sugars with surgeries use of different insulin pump systems can be much better, but any pump will work for higher sugar levels. BUT these varied goal targets should be setup and used as medically necessary for the results that are best for the patient.

The notes above are how to reduce ischemia problems by utilizing different sugar levels with insulin delivery systems. The insulin pumps in use aren’t the only systems that can be used, but this will also require knowledge of the system processes as well as having ‘sugar sensor’ setups that can assist the surgical teams to vary insulin ranges for sugar variations. BUT the great value of an insulin pump with an individual that has their body variable insulin uses ordered, there can be shifts of goal target ranges while not having to modify the system in other ways for uses.

In some cases like with acetaminophen in use, the sensor of the 670g reads higher sugars than are actually with the body.
- This means that with the sensor in use and the 670g connected for insulin delivery OR even just being used for the sensor values, there could be goal target range variations to reduce the problems with low sugars that are the actual results not the drugging results of the body sugars.
- Because the sensor results are never trusted for use as glucose readings with insulin deliveries the Paradigm doesn’t have sensor issues.
- More about the 670g with sensor and insulin uses below.

Goal target range variations & reasons general INFO

When utilizing the lower sugar ranges individuals that have better insulin use values more consistently, like Rhapsodie, can be better for longer times because they have knowledge of how their insulin base, basal, rates are at different times through the month. With goal target ranges on an insulin pump the processes can allow food as well as drink like normal while still keeping sugar levels within the lower levels at least with non-high carb foods which act like helium hot air balloons rising fast and also dropping fast when poked. The goal target range values are easier to utilize if the patient has more consistently horizontal sugar levels most of the time. This means the various goal targets won’t have to shift the insulin setups, just the goal targets for uses of the normal sugar levels. BUT other stuff like drugs, medicines, food types, and more have different delivery aspects that charts can demonstrate, so CGM’s are nice to keep in use.

The Minimed 670g is only one of the insulin pumps that also have CGM systems. These values in the 670g insulin pump are located both within the Bolus Wizard Setup plus with the sensor within the sensor goal target setups. The lowest level sugars can be at with the 670g is what the sensor says is 50 then the low sugar warning system is fully activated and unable to be turned off. Please return to the 670g for additional info about pump uses and setups including uses of the sensor even if the insulin delivery is being done with the Paradigm.

1. Altering sugar values with uses of some CGM options BUT no Automode

The use of the sensor with the system provides value to 670g users without AUTOMODE being active and this can correspond in some ways with other systems. The sensor readouts do allow users to be more accurate as well as more consistent with their basal setups and evaluations of physical actions and food intakes as long as they learn how to use the information accurately. This with a system uses both the basal and bolus factors but there are still variables depending on users and their bodies plus what they are consuming &/OR doing. The graph watching and basal changes became better for Rhapsodie as soon as she returned to using the Paradigm for insulin deliveries.

The ‘illegal’ remote controllers with the 670g were adjusting insulin rates, changing basal levels, stopping bolus deliveries, and adding insulin amounts based on their stupid thinking that Rhapsodie was a generic user. SHE HATED THOSE ACTIONS AND WILL NEVER USE THE 670g WITHOUT ABUSER FEARS. Her sugar goal targets were never as high as the automode AND her body wasn’t working correctly with automode so it wasn’t used for more than unsuccessful trials. BUT remote users were ignorantly playing on their computer systems; cell phones fiddling with her, so they are likely fiddling with others also…

This is illegal AND not part of the diabetic care where the diabetic is to work with their doctor. The doctors have remained ignorant of these invasive actions and Minimed continues to deny the ability to have that happen with the 670g, they are WRONG! This means that whoever is doing this is not approved by anyone for these actions, and they are likely paid for other work which they are failures at because they are so busy fiddling with other people’s health.

Insulin Amount Setups

Generally medical professionals assist individuals in prepping their systems with insulin uses, over time with systems and setups the insulin levels shift and vary. Experienced diabetics often learn and do things that work for them more often than their doctors realize. The AUTOMODE 670g records should have these levels listed, but if the system doesn’t do that the diabetic who goes off automode can have a lot of problems because of insulin variations auto setup by the insulin pump without sharing that info with users. There are basal, base insulin amounts that are not influenced by food, but are influenced by activities and actions, more below. Then there are the bolus insulin levels which are correction factors influenced by sugar levels, goal target ranges, insulin use times, and amounts of food carbohydrates put into the pump, more is below. The way the insulin is used depends on the delivery system consistency and accuracy of delivery amounts with times and users.

Insulin Insertion Setups

Rhapsodie’s body has varied a lot with age AND with Whoops Disease. Insulin delivery with the insulin pump acts on the body like IV deliveries building more scar tissue around insertion zones, but because of the fattier locations there are less issues with blood vessel damage than there was with shots in locations like legs and arms. The less frequency of the insulin insertions is both a value and a hassle, that’s why it’s best that only 2 to 3 days is allowed for an insertion. The insertion locations also vary the insulin uses, this is dependent on an individual’s body as well as their body composition.

Through Whoops Disease with 93.3% of Rhapsodie’s body as water, it means that there looks like a larger fat area BUT there is a lot less fat so the inserts are not within a higher level of body tissue. This has meant that deliveries act a lot faster than normal, so body sugars change fast also. The fatter a person is the slower the insulin will work for them, the more muscles &/OR water a body has the faster the body utilizes the insulin, but water is faster than muscle. Rhapsodie has found that the water build ups above her belly button have caused alternate insulin use amounts than below her belly button. These variations have also influenced the type of insertion sets for use.

Sensor Uses

There are different styles of sensors some insert straight, some insert at angles, some work with cell phones & tablets, some work with insulin pumps, some work with combinations of devices. There are also various sensor lengths as well as body composition variables that impact the uses and the users. In addition there are different sensor locations that shift the results with the body locations depending on the body portions and person’s bodies.

2. Sensor Accuracy Variations with Normal & Alternate Goal target Ranges

Because the sensor accuracy is worse the further from the goal target ranges an individual is there are more problems having the 670g setup with goal targets in normal ranges because the differences grow from distance away from the goal targets. Here’s one of the math reason for better understandings, additional measures are shared below with different goal targets calculated:

Normal goal target range 96 to 104
- Sugar at 75 but sensor at 52 the variation is actually=
  - (75/96) – (52/96) = 0.78 – 0.54= 0.24 (24%) difference while the difference between 75 and 52 only equals 23.
    - BUT for the exact same percentage of difference above the goal target ranges, there are much greater amounts.
  - So sugar levels on sensor at 243 with numbers at sensor as 193 are=
    - (104/243)- (104/193) = 0.427 – 0.538 = 0.111 (11.1%) difference while the difference between 243 and 193 equals 50.

This can mean that with lower goal target ranges and higher goal target ranges the percentage of variation differences with the sensors will be varied. BUT with the amounts lower than goal targets the percentages will still be greater than the differences with amounts above because the range of percentages are greater within smaller amounts than they are from larger amounts above goal target ranges.

Surgical Setup Goal target Range Differences and variables

Goal target range variables for surgical and recoveries of diabetics can impact the setups as well as the sensor percentages found with the goal target differences. Above the normal goal target range of 96 to 104 was utilized, but with smaller OR larger goal target ranges the percentages of difference will also have various placements and impacts. For the 670g the sensor variations are generally found being further away from the center goal target instead of being closer to the goal target ranges. More info pertaining to goal range variations, which aren’t necessarily like the surgical amount levels are shared below within the A. Interstitial higher sugar modifications heading. Plus additional measures are shared above with the normal goal target ranges calculated:

Higher goal target range 180 -200

Sugar at 75 but sensor at 52 the variation is actually=
- (75/190) – (52/190) = 0.394 – 0.273= 0.121 (12.1%) difference while the difference between 75 and 52 still only equals 23.
  - BUT for the exact same percentage of difference above the goal target ranges, there are much greater amounts.
- So sugar levels on sensor at 243 with numbers at sensor as 193 are=
  - (200/243)- (200/193) = 0.823 – 1.036 = 0.213 (21.3%) difference while the difference between 243 and 193 still equals 50.

More info pertaining to goal range variations, which aren’t necessarily like the surgical amount levels are shared below within the A. Interstitial higher sugar modifications heading.

Lower goal target range 65 -70

Because the 670g alarm system will go off with the sensor at 50 because there are no ways to change that level, it means that lower goal target ranges of 65 to 70 which may not be low enough are about the maximum lows for the system to be able to function correctly without lots of alarm hassles while still allowing space for accuracy tests if the sensor readings are lower BUT wrong. For the 670g the sensor variations are generally found being further away from the center goal target instead of being closer to the goal target ranges.

Sugar at 75 but sensor at 52 the variation is actually=
- (75/65) – (52/65) = 1.15 – 0.8= 0.35 (35%) difference while the difference between 75 and 52 still only equals 23.
  - BUT for the exact same percentage of difference above the goal target ranges, there are much greater amounts.
- So sugar levels on sensor at 243 with numbers at sensor as 193 are=
  - (70/243)- (70/193) = 0.288 – 0.3626 = 0.0746 (7.46%) difference while the difference between 243 and 193 still equals 50.

Surgical Setups Using 670g Sensor

For surgical setups like we discussed above with the Paradigm Pump in use there are aspects that will also impact the results like with different drug impacts, but with insulin deliveries connected also like with the 670g there will have to be fiddling to get the accurate results with uses.

In some cases like with acetaminophen in use, the sensor of the 670g reads higher sugars than are actually with the body.
- This means that with the sensor in use and the 670g connected for insulin delivery OR even just being used for the sensor values, there could be goal target range variations to reduce the problems with low sugars that are the actual results not the drugging results of the body sugars.
- With the AUTOMODE on the 670g turned on the 120 goal target range is sought by the pump utilizing the sensor, BUT we are not adding AUTOMODE actions because our goal target variations can’t work with that function at present times.
  - This means that automode should not be used because goal targets will need to be different to keep the pump from inaccurately reading things and delivering insulin OR treating sugar results inaccurately. For instance if an individual has acetaminophen in use which with the interstitial fluids raises sugar that the body really doesn’t have then the insulin pump will give insulin while the sugar levels are not that high really. This means the only way the system will work is if the automode goal target ranges are able to be varied.
- AND with inaccurate 120 goal target ranges when a person needs lower sugars to resist ischemia AUTOMODE can’t assist in this process.
  - Eventually the company may eventually change the goal target ranges which will make the system better for more users like those having various medications, like acetaminophen that require various goal target ranges for better health results. OR even situations like low sugar recoveries from comas OR ischemia where various sugar levels are necessary for good recovery.

3. 670g Graph with only Sensor in use, NOT Automode

The full display graph images are available with the Automode on, but the squiggly graph box needs to be pressed to show the graph without the over numbers that reduce graph values. The up & down arrow actions lead you through the graph options, which are set with 3, 6, and 9 hours. The Automode visuals are shifted also, because the auto goal target ranges are colored across the graphs. The first 3 hour image below shows the normal screen on display with the 670g while sensor is in use. The image to the right shows the expanded graph. The vertical sections display the spaces of time between hours, the blue circle tells when insulin was delivered, this can also be found with history. The red outlined tear drop point shows the accurate sugar results with glucose tests. Carb values are shared at the bottom with a small yellow rectangle containing a fork plus another tool.

These images display the graphs larger than the pump shows:

3 HOUR GRAPHS

Normal display screen Extra Info Display screen

These graphs indicate that Rhapsodie took insulin around 6:20am, with the full displays using the right & left arrows can take users to the historical info attached to those markings, this can also be located using the history menu of the pump.

6 HOUR GRAPH

This image shows that sugar levels were going up around 3:20 to 3:30, which means without food being consumed these were basal inaccuracies. The insulin after 6 didn’t really influence the results until almost 7am, and there are some variables in how that was happening. At 9:15 the results were at goal target ranges because basals were made more accurate and the insulin brought the inaccurate sugar levels down.

9 HOUR GRAPH

This is the maximum graph time the 670 g has available. The tear drop points show that the sensor results are always inaccurately low. The levels of insulin uses and changes should be based on accurate sugar results not the sensor. Some systems say no sugar checker is needed, but they may not work with individuals like Rhapsodie with extra fluid under the skin influencing the sugar results. These display one of the reasons Rhapsodie will not use Automode, that’s in addition to the inaccurate automode goal targets for her health.

4. General Graph Uses

The graph value allows individuals to see the approximate ways that insulin levels are altering body sugar results, plus the graph lets plans and work with the insulin variations to be modified more accurately for actions and results desired. For Rhapsodie the only 670g values have been the graph with the sensor, BUT the sensor uses with the beeps and inaccurate measures are so annoying she has been tempted to sewer drop it repeatedly.

For insulin variations and changes graph levels assist users to determine how accurate their basal rates are and how accurate their bolus intakes have been based on the food they’ve had. By observing the graph lines and knowing insulin uses, a 3 hour insulin begins processing in about 15 to 30 minutes after insertion, this means that when a line pattern goes up or down on a pump with no bolus insulin in use, a variation in a basal about ½ hour before the resulting change is indicated by the graph. Types of changes vary depending on what insulin levels are and what additional bolus insulins are in use.

Graph Line Results that Display with the 670g

These results are based on the 670g pump graph and Carelink reports, but some CGM systems have graph systems designed with line indications, pattern indications, and other patterns being shared which have various meanings that in some cases can be opposites of the notes below.

GRAPH LINES GRADUATING UP,

These show the sugar levels as sensed rising.

GRAPH LINES GRADUATING UP, show both the raising of sugars as well as the results based on
- Just basals–
  - The steeper, redder, up arrow shown here demonstrates faster changes, which also means more insulin for accurate basal results is needed.
    - Which means raising the basal levels maybe 2 insulin increments through those time frames.
  - The shallower ups may be normal, but if they continue for times they are showing the amount of time that the insulin variations need to be made for.
    - Which means raising the basal levels like only 1 insulin increments through those time frames.
  - Activity variations-
    - If the basals are setup for an individual that is normally active at the times when they are now not being active there can be results showing ups.
    - If it’s just temporary activity variation it may be useful to setup temporary basal, but
    - if the variations are consistent alternate basal patterns can be prepared and utilized.
  - Bolus uses–
    - If the insulin is still active for a food OR a drink the up arrows & down arrows are expected because of the food values and how the body is using those.
    - If the insulin has finished for the food, the compensation to correct sugars towards goal target ranges will demonstrate either:
      - Not enough insulin used, OR
      - Food carbohydrate estimates being wrong.

GRAPH LINES Going Down

These show the sugar levels going down.

GRAPH LINES Going Down, show both the lowering of sugars as well as the results based on
- Activities
  - If the basals are setup for an individual that is normally less active at the times when they are now more active there can be results showing downs.
    - If it’s just temporary activity variation it may be useful to setup temporary basal before the activity, BUT if that’s been missed doing correction actions to raise sugars are likely necessary, but
  - if the variations are regularly consistent alternate basal patterns can be prepared and utilized.
- Bolus uses–
  - If the insulin is still active for a food OR a drink the up arrows & down arrows are expected because of the food values and how the body is using those.
  - If the insulin has finished for the food, the compensation to correct sugars towards goal target ranges will demonstrate either:
    - Not enough insulin used, OR
    - Food carbohydrate estimates being wrong.
  - Just basals–
    - The steeper, green, down arrow shown here demonstrates faster sugar changes, which MAY means less insulin for accurate basal results is needed.
      - Which can mean lowering the basal levels 1 or maybe 2 insulin increments through those time frames.
    - The shallower downs may be normal, but if they continue for times they are showing the amount of time that the insulin variations need to be made if no other insulin OR activity actions are happening that could have caused the variations.

HORIZONTAL GRAPH LINES

These show the sugar levels remaining consistent. There are generally slight variations in the horizontal lines, but those are still considered level because the results aren’t varying much more than a range of 5 to 10 points.

HORIZONTAL GRAPH LINES demonstrate accurate basals, without bolus variations.
- These mean that the basal levels are accurate during the times those are showing horizontally.
- These are the goal targets with the insulin in use, but those goal targets are almost only found in sleeping times after insulin levels are accurately adjusted.
  - The patterns and how much valuation is determined are based on the amount of time with the variations AND the normal range goal targets and reasons for the variations. This is more a sleep pattern than a waking time pattern, often there are greater extremes even with accurate basals when individuals are also eating, drinking, and being active.

5. Variations of Sugar Changes demonstrated with images of Graph Results

Rhapsodie is familiar with these patterns using the 670 G graph system which also shows a chart with lines along defined sugar levels and times above the lines to show when things are happening. It’s likely that other CGM systems will have similar information BUT placements, styles, and uses are probably different.

REGULAR GRAPH RESULTS WITH LIFE SHOWING PATTERN IMAGE EXAMPLES

NORMAL FOOD USE PATTERNS with the graphs the insulin uses through food consumption allow users to note what patterns of food consumption and insulin interactions are.

Correct 3 hour Insulin Levels with Food
- With correct insulin levels for food it’s generally found that the insulin works slower than the food is digested. The pattern of utilization on the graph is of a graduated curve.
  - Insulin uses are shown with the red line above, the food with the blue. The insulin pump shows the insulin uses but at the end of use times you are back to goal target ranges if the insulin was correctly setup for the food.

Heavy food with Light amounts of 3 hour insulin
- With too much food and not enough insulin the graph results and food results don’t return to the goal target range. This is a pattern of that

Notice that the levels aren’t equal at the end of the process, because there wasn’t enough insulin utilized.

The food is shown with the purple line, the insulin with the red line.

Light food with too much 3 hour insulin
- With too much insulin and not enough food sugar results are lower after the insulin finishes than the goal target ranges. In some cases light food is food that doesn’t have a value as stated because it has limited body use, which means that it’s digested way faster than the insulin time frame is.
  - Corn syrup, white flour, sugars, sweets, and many other non-protein high sugar products have light food values with insulin uses lasting longer and being more powerful.
    - For Yoohoos which Rhapsodie uses to correct low sugars, there is no protein, this means a 20 carb box only has a 10 carb use value.
  - The food is shown blue and the insulin in reddish.

Notice that the levels aren’t equal at the end of the process, because there wasn’t enough insulin utilized.

Higher sugar foods with correct 3 hour insulin
- With higher sugar foods, white flour items like pasta and white bread, donuts, cakes, juices, simple no nut candies, and more the higher sugars result from limited protein which adds time to food processing and keeps the sugar levels less but active for longer times. But accurate insulin uses for those the insulin will follow the food a lot more than with normal foods, which means that if the insulin amounts were not accurate there could be drops because the insulin works a lot longer than the food remains active sharing carbs with the body.

The food levels shown in pink go way higher on the sugar level chart, but they drop off in a short time while the insulin, shown in blue continues for some time. So if the insulin is correct the levels end in the accurate goal target ranges, if the levels are inaccurate the ending sugars can be higher OR lower.

Higher fiber foods with correct 3 hour insulin
- Higher fiber foods digest slower than normal foods with the same carb content. Food like oatmeal is one of these.

The food levels in pink, the insulin levels are in blue. The sugar levels with these levels can cause lower sugars followed by higher sugars because the insulin is more active before the food is. Then when the carb reaches high activity sugar results are higher than they should be, but the insulin is still active. Things end well if no corrections are taken with insulin OR foods.

Foods with square wave OR dual wave 3 hour insulin accurately taken for extended times of use
- Square wave insulin is delivered as a bolus but for an extended time frame. The value of square wave bolus is that higher protein and fat foods can take a longer getting digested, this means the insulin if taken immediately can cause sugar drops, but later with corrections taken to fix lows, there are highs because the higher fat OR protein foods are still being digested.

The food levels in pink, the insulin levels are in blue. The extended time frames assist in keeping the peaking levels of the food digestion more consistent with the insulin delivery. With pizza a dual wave bolus is used. This allows portioning of the insulin between immediate delivery and longer term delivery. For normal pizza a 6.5 to 8 hour square wave bolus is generally used with 50% of the full carbohydrate amount.

HIGH Sugar Corrections by 3 hour insulin graphed

When an individual is not using the 670g Automode the only way that goal target ranges are met is by delivering insulin if sugars are high, Automode works to do this based on goal targets, but only after all food insulin is finished. This system doesn’t do any corrections until there is no food insulin active…which means high sugars are common. Depending on how high the sugars are and how the high sugars arose the patterns of dropping vary.
- An inaccurate and low basal that needs to be raised.

The high sugar levels in green, the additional insulin levels are in blue.

An inaccurate insulin amount with more food than insulin was delivered for.

The food levels in pink, the insulin levels are in blue.

LOW Sugar Corrections by 3 hour insulin graphed

When an individual is not using the Automode, the only way automode shifts lower sugars is by suspending insulin, it was programmed dumbly so doesn’t activate or alter temporary basal actions which could work like doing so manually.
The non Automode ways that higher goal target ranges are met are by lowering basal insulin temporarily, if an insulin pump is in use, OR by consuming carbs to correct the low sugar levels. Depending on how low values are and the active insulin in system plus the life situations either of these options may work better.
- Sugar consumed after brushing teeth OR while sleeping will mean additional teeth cleansing to cut teeth rot from low sugar treatments with consumptions.
  - Since Rhapsodie uses cider vinegar & honey to fight acid reflux anything consumed when being awakened to treat low sugar requires also fighting the acid reflux then brushing her teeth to keep them healthy.
- While sleeping when low sugars are noted Rhapsodie often uses a lower temporary basal rate that in hours raises her sugar.
  - Since she is inactive these actions aren’t dangerous. BUT Rhapsodie doesn’t do this when she is active to correct her sugars, but she will do the temporary basal before activity to keep her sugars at good levels.
- Diabetics that have lower sugar that consume treatments have various options with various results:
  - With meals, the protein & fatty foods should be eaten before the sugary treatment is taken, because the heavy protein & fatty food blocks sugar digestion if those are taken first. So depending on sugar levels and needs various actions can be taken:
    - Eating the meal foods, not taking the full insulin amount, the insulin pump automatically calculates this, and waiting for normal food digestion to process the carbs. This depends on how low sugars are AND what is being consumed because lower sugars under 50 shouldn’t be stalled with slower recovery when a person is physically active OR has insulin already in use with no food fighting it;
    - Eating the food for the meal then taking in the sugar treatment of wimpier food value, like sugar water OR Yoohoo’s.
    - Eating the meal foods, not taking the full insulin amount normally, the insulin pump automatically calculates this, instead take the insulin as a square rate, like for 30 minutes to allow a more enjoyable meal with food results having a faster utilization than the insulin .

The choices depends on

how low sugars are AND
what is being consumed because lower sugars under 50 shouldn’t be stalled with slower recovery when a person is physically active OR has insulin already in use with no food fighting it;
how much time it will take to consume the food,
the types of food being consumed and their correction values.
- Some foods like many of Rhapsodie’s healthy homemade meals with vegetables, limited starch, and higher protein & fat contents digest slower with less carb values being found for the body to use.
  - With normal times different products have various calorie, carb, and protein factors which influence how they work and how fast they work.
- Sugar utilization factors are also values to consider,
  - With lower sugars under 50 sucking on a straw makes it easier to get the fluids especially with jitters & shaking. In addition the straw use allows the carbs to hit the back roof mouth which also processes some of those sugars straight to the brain and the blood.
  - Candy bars, sugar tablets, other chew ables take time to chew plus often also require drinking to rinse them away OR to make space for more which could be needed. AND sugar levels rise slower than they do with fluids that are more simple sugars.
- Sugar Drinks of Value

With lower sugars under 50 sucking on a straw makes it easier to get the fluids especially with jitters & shaking. In addition the straw use allows the carbs to hit the back roof mouth which also processes some of those sugars straight to the brain and the blood.

Corn syrup & water OR Yoohoo’s made with corn syrup:
- Are working in 5 to 10 minutes, but don’t stick with the users, so more protein is necessary to keep the carb active. The value of the Yoohoo’s is that they come with a straw and a sealed container. This provides multiple values:
  - The straw;
  - The sealed container while needing to be poked to be used also means that if an individual is shaky or unable to maintain normal body control there is less chance for making a mess.
    - PLUS these containers can be carried in bags and packages for accessibility outside of normal home & office situations where refrigerators are easily accessible.
    - AND being sealed these containers can be placed in multiple access locations for use needs and times.
  - Vanilla Nutrition Plus:
    - Is working in 10 to 20 minutes, comes at 50 carbs in a 8 ounce container and also contains 8 grams of protein, which means one mouth full can be 10 carbs. But without normal physical control this is still not a great sugar treatment when having a straw can be so much better, but these containers can utilize a straw.
  - Milk:
    - Is working in 10 to 20 minutes, it has protein and depending on the grade has various calorie levels if it’s not skim milk. But without normal physical control this is still not a great sugar treatment because pouring into a container is a need and can be harder when having a straw can be so much better. For protein amounts
      - Whole Milk has 8gms per cup & 150 calories;
      - 2% Milk has 6gms per cup & 130 calories;
      - 1% Milk has 4 gms per cup & 110 calories;
      - Skim Milk has 2gms per cup & 90 calories.

[NOT DONE] POSSIBLE RESULT IMAGES WITH MEDICAL SHIFTS CHANGING SUGAR VALUES

Because some of these aspects will vary based on goal target ranges while others will shift because of treatment plans that may mean having modified OR modifying goal target ranges Rhapsodie has work to add those notes as well as a goal aspect to the images for reference to the levels being reached for.

Interstitial higher sugar medications

These medications like acetaminophen do not really change body sugars, but they vary the skin waters to seem higher in sugar which also cause sensors in use to read sugars as being higher than they really are. Likely partially in response to the drug which has impacts on the body, “Acetaminophen is considered the pain and fever reliever of choice for most patients receiving oral anticoagulant therapy like warfarin.” (https://www.rxlist.com/consumer_acetaminophen_tylenol/drugs-condition.htm ) The higher sugar levels of the skin raise internal body temperatures that can assist the body in sweating out poisons and infections that cause fevers. This means that with the sensor in use and the 670g connected for insulin delivery OR even just being used for the sensor values, there could be goal target range variations to reduce the problems with low sugars that are the actual results not the drugging results of the body sugars.

Modified Goal Chart Example

For example with the acetaminophen raising the sensor evaluations, but the real body sugars being lower, the 670g in AUTO MODE with the insulin connected could kill a person. Let’s say that the acetaminophen causes rise in sugar levels of the sensor readings by 20%, this means that taking the normal goal ranges and modifying those at a 20% higher range will keep more low sugars from happening. In addition with insulin corrections use of the pump that has the inaccurate sugar goals will mean that the insulin rates for corrections will need to be increased by 20%.

133

Possible Drug change Goal Range 20% higher than normal,

are rounded to 115 – 125 by multiplying the normal ranges

into 0.20 (or 20%) and adding those results to the normal levels.

104

Rhapsodie’s Normal goal target range 96 to 104

Sensor result levels with the higher goal ranges are shown in blue, accurate sugar test sugar levels shown in brown. With correction actions accurately taken shown with purple.

Raised goal target Ranges modifying insulin uses with Real results for the lower goal target ranges

So having the goal target ranges higher than normal will mean that the sugar target goals & test actions will also need to be modified for accurate insulin uses. BUT for corrections it’s always better to use the median instead of any of the boundaries of goals to make more accurate corrections.

Higher Sugar Test Results
- With the goal ranges of 115 to 125 a sugar test result of 133 will mean only a correction for 13, BUT using the normal ranges of 96 to 104 mean, 96 + 104= 200/2= 100 will cause a correction to be needed of 33.
  - The insulin use values are kept the same, but the change amounts are shifted, so more math is necessary for periods of time with reaching towards normal while the pump delivery system is set for higher results.
    - This means that the accurate insulin use results need to be calculated also, so if 10 carbohydrates= 1 unit of insulin= 40 change in sugar less than a unit of insulin is necessary. Since 1= .25 +.25 + .25 + .25 this calculation means 30 equals 3/4ths of one unit. This is a change of .75 of a unit of insulin for the pump to give the user to keep sugar values close normal ranges. This means an additional .50 amount, should be added onto the pump, for more accurate goal range sugar values.
  - Please remember these insulin evaluations above are only samples each individual has different numbers in use, so different calculations are needed with the same patterns of uses.
    - Let’s redo the amounts above using one insulin pattern from Rhapsodie’s pump on 7-1-20.

Start Time	End Time	Grams of Carbs	Amount of Insulin	Sugar Changes
0:00	3:30	5.1	= 1 =	23
3:30	4:30	5.1	= 1 =	23
4:30	9:00	5.0	= 1 =	22
9:00	10:00	5.0	= 1 =	23
10:00	10:30	4.9	= 1 =	23
10:30	16:00	4.9	= 1 =	22
16:00	16:30	4.9	= 1 =	21
16:30	21:00	4.9	= 1 =	23
21:00	21:30	5.0	= 1 =	23
21:30	22:30	5.0	= 1 =	22
22:30	23:00	5.1	= 1 =	22
23:00	0:00	5.1	= 1 =	23

With the goal ranges of 115 to 125 a sugar test result of 133 will mean only a correction for 13, BUT using the normal ranges of 96 to 104 mean, 96 + 104= 200/2= 100 will cause a correction to be needed of 33.
- With a change of 33 by 23 per unit of insulin, 33/23 = 1.26 meaning there will need to be 1.43 (1.45) units of insulin for the correction to correct the sugar results. With that amount subtracting what the machine will do based on the goal ranges, the amount of 13/23 is .56 which is rounded to .55 will provide correct insulin rate changes.
  - Accurate change 1.45 units,
  - Inaccurate change 0.55 units,
  - Amount of extra insulin for correction 0.90.
- Normal Test Results
  - With the modified higher goal ranges, for the sensor, of 115 to 125, averaged to 120, a sugar test result of 104 with normal ranges of 96 to 104, averaged to 100, will mean NO CORRECTION really NEEDED. But the higher goals will cause less insulin to be used if these normal ranges are associated with food intakes.
    - This means that the accurate insulin use results need to be calculated also, so if 10 carbohydrates= 1 unit of insulin= 40 change in sugar less than a unit if insulin is necessary, but since 1= .25 +.25 + .25 + .25 this means that the difference of 104 to 120 will cause that 16 point change. With a 16 change = 16/40= 0.40. This will mean reducing the units of insulin, by 0.40 if any carbs are to be consumed with insulin being given in compensation.
      - If this isn’t done, it is likely to mean higher sugars resulting closer to the inaccurate higher goal ranges, which will also need work to shift those results back to normal.
    - Please remember these insulin evaluations above are only samples each individual has different numbers in use, so different calculations are needed with the same patterns of uses.
      - Let’s redo the amounts above using one insulin pattern from Rhapsodie’s pump on 7-1-20.

Start Time	End Time	Grams of Carbs	Amount of Insulin	Sugar Changes
0:00	3:30	5.1	= 1 =	23
3:30	4:30	5.1	= 1 =	23
4:30	9:00	5.0	= 1 =	22
9:00	10:00	5.0	= 1 =	23
10:00	10:30	4.9	= 1 =	23
10:30	16:00	4.9	= 1 =	22
16:00	16:30	4.9	= 1 =	21
16:30	21:00	4.9	= 1 =	23
21:00	21:30	5.0	= 1 =	23
21:30	22:30	5.0	= 1 =	22
22:30	23:00	5.1	= 1 =	22
23:00	0:00	5.1	= 1 =	23

With the modified higher goal ranges, for the sensor, of 115 to 125, averaged to 120, a sugar test result of 104 with normal ranges of 96 to 104, averaged to 100, will mean NO CORRECTION really NEEDED. But the higher goals will cause less insulin to be used if these normal ranges are associated with food intakes.
- With a 16 change = 16/23= 0.695 (0.70) units of insulin taken away from any additional insulin prescribed by the pump. This will mean that maintaining normal goal results with the pump set at higher results will be able to be done by reducing the units of insulin, by 0.70 if any carbs are to be consumed.
- Otherwise the levels are perfectly fine, within normal ranges, at present so no other corrections are necessary.
Low Test Results [Not Done]
- With the modified higher goal ranges, for the sensor, of 115 to 125 the average goal is 120. Meaning that with a sugar test result of 85 the raised for needed change higher goal ranges area calculated change amount of 35 will be set by the pump, with that amount being subtracted from any compensation delivery. BUT with the normal goal range average being 100 there’s only a correction for 15 needed.
  - So needed corrections amounts are for a change of 15 with the sugar levels.
  - This means that with the insulin pump doing a correction of 35 there’s a variation of 20 which isn’t needed. This means with 10 carbohydrates= 1 unit of insulin= 40 change that a change for 20 divided by the full amount of change provides the amount of insulin that shouldn’t be taken. And with using that amount to figure out the carbohydrates there can be compensation taken that will raise levels to the correct amount without overdoing it.
    - These amounts can be tested by doing the other math shared previously (120/85= approximately 1.41) – (100/85=1.17)= 0.24 (or 24%) of normal use units that shouldn’t be given. This results as 23 change values x 0.24= 5.52 change values that shouldn’t be given, done another way this is 5.51 carbs x 0.24
  - So with the real correction a value of 20, 20/40= 0.5 which equals ½ a unit of insulin if there wasn’t a compensation done.
  - This means that only 5 carbs are needed because that the amount of the results previously calculated define what food/carb compensation is needed to raise sugars to the accurate levels, not the high levels.
- Please remember these insulin evaluations above are only samples each individual has different numbers in use, so different calculations are needed with the same patterns of uses.
  - Let’s redo the amounts above using one insulin pattern from Rhapsodie’s pump on 7-1-20.

Start Time	End Time	Grams of Carbs	Amount of Insulin	Sugar Changes
0:00	3:30	5.1	= 1 =	23
3:30	4:30	5.1	= 1 =	23
4:30	9:00	5.0	= 1 =	22
9:00	10:00	5.0	= 1 =	23
10:00	10:30	4.9	= 1 =	23
10:30	16:00	4.9	= 1 =	22
16:00	16:30	4.9	= 1 =	21
16:30	21:00	4.9	= 1 =	23
21:00	21:30	5.0	= 1 =	23
21:30	22:30	5.0	= 1 =	22
22:30	23:00	5.1	= 1 =	22
23:00	0:00	5.1	= 1 =	23

With the modified higher goal ranges, for the sensor, of 115 to 125, averaged at 120 with a sugar test result of 85 will mean that with higher goal ranges a correction of 35 will be set by the pump. BUT with the normal goal range being averaged at 100 there’s only a correction for 15 needed.
- The correction of 35-15 is a difference of 20. With 1 unit of insulin being equal to a change of 23 it means that almost one whole unit is unnecessary for the corrections to result in more normal sugar results.
  - So 23/30= .7667 averaged at .75 of a unit of insulin can be subtracted from the machine calculated delivery amount for accurate sugar changes.
- If no extra carbs are to be ingested, the correction factor of the amount of 15 is needed to raise sugars to the normal goal target ranges. This means that with 15/23= 0.65 of the correction carb is needed. With 5.1 carbs per unit of insulin this is 5.1 carbs x 0.65 percentage of unit change, which equals 3.315 carbs to raise sugar levels from 85 into 100.

Retained sugar values in intermediate stages
Lower goal target ranges
Lower sugar issues

To vary sugar goal target ranges on the PARADIGM INSULIN PUMP separate from CGM:

These are the function aspects for all Paradigm insulin pumps, but there are also additional actions if there is a connected sensor use with the Paradigm pump, but I’m describing the use of the 670g below which also has sensor connections.

A1- For All Goal target Ranges with the Paradigm

Click ACT;
Choose Bolus and press ACT again;
- The menu can be moved through using the up and down arrows to the right of the ACT
Arrow down to Bolus Setup and press ACT again;
Choose Bolus WIZARD Setup and press ACT again;
Choose Edit Settings and press ACT again;
Arrow down to BG Target and press ACT again;
- Set the goal target ranges for the times, [more continued following this section of illustrations put into italics.]

A1a- High Sugar into Low Sugar Surgical Goal target Range Example

Like for surgical procedures let’s say Rhapsodie is being brought in for surgery initially at 9am, so
- for at 8am the insulin pump is shifted to a goal target range of 180 to 190.
- Rhapsodie is given corn syrup water to raise her sugar levels before surgery,
At 9am the drugs are given her, which could include acetaminophen which with the sensor of the 670g OR a Paradigm could read higher than her sugars really are, so real sugar tests are needed.
- Let’s say the real test results at 11am are that her sugar is at 240, so that amount is added into the pump to make sugar adjustments to get her into the goal target ranges by:
  - Clicking ACT;
  - Choose Bolus and press ACT again;
  - Choose Bolus WIZARD and press ACT again;
    - Use the UP & Down arrows to enter the sugar if that’s not already in the pump, then press ACT again;
  - Do not enter Food leave it blank, and press ACT again;
  - The pump will provide the insulin delivery estimate details based on the values already in it for Rhapsodie’s body,
  - Press ACT again
  - Choose Normal Delivery,
  - And press ACT 2 more times to deliver the insulin.
- The reason insulin is used instead of a temporary basal is because there is a definite goal target in mind and using the bolus operation will assist the pump in going towards that goal target.

A1b- Into accurately planned goal target range setup

With this preset the only care to get the sugars into the ‘altered’ lower ranges would be to provide insulin as described above, while the new goal target ranges are in place. BUT this process takes up to 3 hours, so there should also be process shift over time plans in the action plans for the patient assistance as well as surgical shifts with the processes. The value of the lower sugars is that the body tissues which are ‘stiffened’ with higher sugars should actually soften and be easier to close and seal with sugars through the 150 to 80 sugar ranges. BUT like is normal this will take time based on the insulin the drugs being used and lots more.

Now let’s say that the surgical time plan was originally prepared for 8 hours, which means that by 5pm Rhapsodie would be out of surgery. In preparations varied goal target rates could have been set, that include medium into lower rates as goal targets starting at 3pm. So this was done previously because of following the instructions shared above:
- Click ACT;
- Choose Bolus and press ACT again;
  - The menu can be moved through using the up and down arrows to the right of the ACT
- Arrow down to Bolus Setup and press ACT again;
- Choose Bolus WIZARD Setup and press ACT again;
- Choose Edit Settings and press ACT again;
- Arrow down to BG Target and press ACT again;
- Set the goal target ranges for the times, [this wasn’t above]
  - This starts at 0:00 (Midnight)
    - Click ACT on the first screen, the lower edge of that goal target range is flashing now and you can change that number with the up and down arrow;
    - follow this by clicking ACT again to the higher goal target edge number and using the arrows to make that go up and down.
    - Click ACT again and you are taken to the next time screen if there is one setup.
  - This starts at the time that is flashing from the previous ACT clicking;
    - The time can be kept OR can be changed with the up & down arrows; then
    - The actions of the range goal target amounts can be set like shared above.
  - The starts at midnight processes are repeated through the whole system until the full 24 hours is assigned goal target ranges.
    - So with our setup above with surgical processes for Rhapsodie:
      - 8am- goal target range 180 to 200;
        
        This means getting the sugar up to these levels also before surgery.
      - 2 to 4pm goal target range 145 to 80;
        
        The lowering will utilize insulin, it generally takes about ½ and hour to 1 hour for results to start being noticed with the sugar levels, so previous levels are maintained for a time.
        
        The amount of gluing/suturing to be done and the body sugar levels will shift how easy these process are versus normal processes.
        
        Once the goal targets are set lower the insulin correction rates will work towards those after insulin bolus deliveries are given with the Paradigm.
        
        If there is a bolus being used to lower sugar from a high to a lower goal target range a 30 minute to 2 hour Square Wave Bolus can extend full insulin delivery from 3 hours to 3.5 to 5 hours, this can allow more procedure time especially if events are complicated.
        
        The temporary basal rates, more below, can allow you more OR less use times with alternate insulin without you needing to take carbs for corrections OR take insulin for corrections. For example if Rhapsodie’s already been given a bolus to get sugars lower, it’s been 2 hours since delivery and the sugar levels are great right now for gluing suturing, it can be useful to note how much insulin is still in use. Go to the bolus screen fake in delivery and see what amount of insulin is remaining as still active. With the basal amounts for an hour and an hour of delivery left it means that if the normal basal is 1.35 and there’s a bolus of 1.20 left then a reduction of the temporary basal to 0.5 for 1 hour starting about ½ hour after the change. This should maintain the present levels of sugar, but these can also mean that more correction of 1.2 is needed in an hour, to keep sugars dropping beyond that time without having sugars shoot up again.
        
        For surgical sessions where there are suturing processes being extended it could be that a normal goal target range temporarily utilized is better in the schedules and insulin goal target setups for those processes, but so can uses of the Square Wave Bolus.
      - 4 to 6 pm goal target range 60 to 70
        
        More insulin is needed to reach these ranges. AND this can be started during OR even within the gluing/suturing processes.
        
        Care is needed to make sure that the sugars don’t go too low from too much insulin being given without the variation time frames already being prepared for. Insulin acts in a bulby way, it is most active towards the center and is less active early and later, but it’s still active.
      - 6pm to next day 6pm goal target range 60 to 70
        
        The reason’s this is being maintained for 1 to 2 days is to reduce the ischemia impacts from the surgical procedures. It’s not normal to have sugars at these levels.
        
        Because the insulin was previously setup for the surgical day(s) these processes will require going into the pump and rearranging all the goal target ranges to maintain these rates for an extended period of time.
        
        These processes with goal target ranges are often the least varied with the insulin pump, but with different medications and sugar impacts it can be a value to set the systems up with varied goal targets at times to assist in keeping the patient healthy while things are happening.
        
        For example with the acetaminophen raising the sensor evaluations, but the real body sugars being lower, the 670g in AUTO MODE could kill a person. So having the goal target ranges higher than normal will mean that the sugar target goals & test actions will also need to be modified for accurate insulin uses, but the pump’s auto actions won’t be endangering the life of the person wearing the insulin pump.

A1c- If surgical schedules are varying

Varied surgical schedules will shift the insulin goal target range time frames, there are a couple of options with this situation, but it’s dependent on the patient and the surgical procedures that include uses of insulin at time periods with the modified goal target ranges already in place.

If the 3pm goal target range is changed to 65 to 75 it means that any insulin corrections should be avoided until approximately 2 to 2.25 hours before the end of the surgical sutures are anticipated to be done. This can mean that sugars can go higher, BUT it also could mean that sugars could drop because of other factors in life.
- This case may mean varying the goal target ranges to other times to reduce the accidental change problems while still keeping sugar levels in goal target areas for most of the surgical procedures will involve following the instructions above under the goal target range time settings changes, heading A1b.
  - Going into the pump and shifting the goal target times for the results of the lower sugars of 65 to 75 about 2 to 2.25 hours before suturing is to be completed.

This should mean that when the suturing is finished the lower goal targets are reached, which will also mean that ischemia issues are likely to be reduced tremendously without additional drugs that can cause more issues with treatments and recoveries.

A1d- With Goal target Ranges how do you Raise Sugars Accurately?

Now as described above with the sugar at 240 the goal target is what the insulin use is working to attain. For food and sugar raising this is almost the same, but there’s a slight variation to the correction process with the insulin pump as described at A1a above:

Let’s say the real test results at 4pm are that her sugar is at 80, but Rhapsodie was given lowering insulin only 1 hour before, meaning there is still 2 hours 2/3rds of the insulin left to act. So a glucose correction is needed for the suturing and to reduce low sugars for a time. So these adjustments are done by:
- Clicking ACT;
- Choose Bolus and press ACT again;
- Choose Bolus WIZARD and press ACT again;
  - Use the UP & Down arrows to enter the sugar if that’s not already in the pump, then press ACT again;
- NOW ENTER the glucose amount as normal with protein based carbs OR as reduced by 50% with simple sugar carbs as Food and press ACT again;
  - For normal sugar corrections like milk OR nutrition plus drinks the carbs amounts with a protein base will last through the insulin uses. The food with goal target factors will give the correct amounts of insulin with the pump setup with the goal targets,
    - For surgical sessions where there are suturing processes being extended it could be that a normal goal target range is better in the schedules and insulin goal target setups for those processes.
  - This means that if 20 carbs are being given, of simple sugars, which get multiplied by 50% OR divided by 0.5 there are only 10 carbs given for the results being worked for.
    - For any corn syrup and sugar waters used Rhapsodie always cuts their correction factors by 50% because they don’t last more than 30 minutes.
  - The pump will provide the insulin delivery estimate details based on the values already in it for Rhapsodie’s body, and the carbohydrate values added within the Food setting.
- Press ACT again
- Choose Normal Delivery OR even Square Wave Bolus which will deliver the insulin during the amount of delivery time chosen.
  - This correction will only impact any incoming insulin, the previous insulin delivery is already being utilized. BUT if there is a bolus being used to lower sugar from a high to a lower goal target range a 30 minute to 2 hour Square Wave Bolus can extend full insulin delivery from 3 hours to 3.5 to 5 hours.
- The ACT click demonstrates the amount of insulin planned into delivery as well as what type of delivery it is.
- Press ACT for a final time to start the delivery.

A2- This is not the only medical variation action that can be taken with the Paradigm insulin pump there are many other options also, like:

[Not done] Regular Basal Changes with the Paradigm Insulin Pump

Basal changes are often just based on previously found body patterns with insulin rates for types of activities and actions, but these changes with medications, so shifting the basals can be vital for assistance with health care. For health care providers the activity valuations will impact which change pattern rates are best to be altered. BUT use of the temporary basals can assist in assigning change levels for diabetics by sharing the ‘percentage’ of change needed once those are found to be accurate or inaccurate after 3 hours of trials.

Regular

[Not Done] Regular Bolus Changes with the Paradigm Insulin Pump

Bolus changes generally follow multiple sets of basal changes, the reason is that the body is utilizing less insulin for the same work, which also means that the amount of food & high sugar compensation to reach the goal target levels change.

Temporary basal rates

Before using suspend when sugars are low and teeth are brushed for the sleep times use of the Temporary basal actions are preferred by Rhapsodie for raising her sugar by reducing the insulin while she continues to sleep. This means calculating the rates of need for the changes against the basal amounts, but it also means waiting 3 hours for sugars to get up to the ‘accurate’ levels, so this function doesn’t work well with the 670g connected to the sensor.

Temporary basal rates; which shift delivery amounts through the use hours, but they aren’t as consistent as established action patterns with goal targets.
- BUT in some cases these may be needed like when drugs increase body sugar levels and the amount of insulin for basals start graduating up or down with the drug uses.
  - If levels on a graph graduate up then more basal is needed, that’s if no food is part of these factors and the insertion areas are working accurately.
  - If the levels on a graph are dropping than less basal is needed, that’s if no bolus insulin is part of these factors and the insertion areas are working accurately.
- The Temporary basal actions with the Paradigm let you enter the amount of insulin for the amount of time which means you can set it at 0% for anything over ½ an hour with only 1 beep per hour.
  - This is done by:
    - Click ACT;
    - Arrow down to Basal and press ACT again;
    - Choose Set/Edit Temp Basal and press ACT again;
    - Arrow up OR down to Set Duration and press ACT again;
      - The menu can be moved through using the up and down arrows to the right of the ACT
    - Set Temp Basal % opens, use the arrows to set the percentage of change from the present basals, and press ACT again;
    - The process starts until you turn it off, alter it to later, OR it ends.

The temporary basal rates can allow you to see the amount of insulin variation for the types of activities you’re doing, in addition it can provide you use times with alternate insulin without you needing to take carbs for corrections OR take insulin for corrections.

There is more info added under the Suspend function because Rhapsodie has found that the temporary basal actions & others are preferable to use of suspend in most cases.

Square Wave Bolus & Dual Wave Bolus

Square Wave Bolus & Dual Wave Bolus rates shift delivery amounts over time by what and whens.
- SO if there is a bolus being used to lower sugar from a high to a lower goal target range a 30 minute to 2 hour Square Wave Bolus can extend full insulin delivery from 3 hours to 3.5 to 5 hours.
- If pizza is being eaten a Dual Wave Bolus allows a portion of the insulin to be given normally and a portion to be extended over the time set like the square wave. For Rhapsodie 6.5 hours with 50% immediate and 50% long term is what she has used for years with normal pizza, but with a thin crust pizza, burritos, hamburgers on buns, or other higher fat and cheap white flour carbs these levels are shifted.

Suspend function

There is also the Suspend function, which stops insulin delivery totally, but it’s not the best function when there are other options that work better in most cases.

Like there is the unplug option, which allows others to disconnect the insulin delivery from the body. When an individual is able to fix this as sugars raise it means that there aren’t the suspend beeps AND there is a physical sign that the insulin is disconnected. But uses of better functions like the Temporary basal offers additional values at times:
- Before using suspend when sugars are low and teeth are brushed for the sleep times use of the Temporary basal actions are preferred by Rhapsodie for raising her sugar by reducing the insulin while she continues to sleep. This means calculating the rates of need for the changes against the basal amounts, but it also means waiting 3 hours for sugars to get up to the ‘accurate’ levels, so this function doesn’t work well with the 670g connected to the sensor.

In addition there is the unplug option, which allows others to disconnect the insulin delivery from the body. When an individual is able to fix this as sugars raise it means that there aren’t the suspend beeps AND there is a physical sign that the insulin is disconnected.

[NOT DONE] Insulin Variations USING CGM Pump Goal target Range Setup (Continuous Glucose Monitoring)

Systems that use blood glucose tests as rates for accuracy with uses of the insulin pumps and systems are considered a value in CGM (Continuous Glucose Monitoring), so users aren’t insulin dependent still find these systems of value. The general values for diabetics with insulin variations OR non-insulin dependent diabetics can be found using the senor and the sytems of the pump for monitoring and varing sugar results. There is more about these systems shared above, BUT because many systems like the 670g require sugar tests for system accuracy it means that pricking is common still.

With the 670g there are as many OR even more sugar pricks with the sensor being used then there are without it being used, partially because of the system regulating when the sensor rates are showing lows, but also because the system inaccuracies often cause multiple checks because the sensor is so wrong so often. This causes multiplied uses to make sure insulin corrections and food consumption insulin uses are accurately arranged. In addition with calibration factors the machine has specified calibration patterns which at times don’t accept the calibration when the machine isn’t ready for it with new setups. In addition if sugars are checked the system doesn’t accept calibration without the buttons being pushed to make it calibrate.

There are alternate options that can assist with the glucose checking more information is included in the NO- Finger Prick Glucose Meters Types document, of highest count, which has some information Rhapsodie has researched. The value of no pricking goes beyond less pricks, but the CGM systems utilize pricks to place sensors under the skin so they aren’t prick free that’s why the document title isn’t titled Prick Free Sugar Meters. But some glucose monitors don’t use any pricking to find sugar levels CNOGA, Gluco-wise, and Glucotrack brands are some of those options Rhapsodie has researched beyond their names, other options are within that paper which is still incomplete.

Because Rhapsodie’s only CGM experience is utilizing the 670g her info below is based on that system and uses in many ways these uses can be paralleled &/OR modified with different CGM systems. The reasons for Goal target range variations are discussed above for this information as well as for that info. Reference to this info assists readers into returning here if they use the link above or scan or click down to this section.

Goal target Range Variations Using the 670g Sensor CGM System

The reasons for Goal target range variations are discussed above for this information as well as for that info. Reference to this info assists readers into returning here if they use the link above or scan or click down to this section.

C. Using 670g without AUTOMODE

Please reference this insulin use info above under the Paradigm info, but return here for the 670g variations along with sensor info.

C1- Reasons Rhapsodie Avoids the 670g for insulin delivery

There are multiple reasons that Rhapsodie hasn’t used AUTOMODE and will not use it.

Automode with the 670g is presently designed to have a goal target target of 120, that’s too high for Rhapsodie. Her goal target range is 96 to 104.
Rhapsodie having the Whoops Disease has a higher than normal body water content level, this means the 670g system has many problems with her that aren’t normal.
- The interstitial body fluids are higher in water content so sugar results are always lower than blood sugar results.
- Plus the fluids block signal sharing, so Rhapsodie sleeping the sensor connected always has the pump disconnecting during sleep, so this system hasn’t been a value for sleep uses.
- Rhapsodie’s sensor values are always extremely WRONG unless they are exactly within the goal target ranges she has defined. They are more than ordinarily wrong because of the excess fluid under her skin which the sensor gets values from.
There are remote controllers that have, illegally, modified and shifted Rhapsodie’s 670g pump setups multiple times, they don’t do that with AUTOMODE in use, but they have ruined Rhapsodie’s desire to trust the pump for uses at all.
The insulin deliveries with the 670g aren’t accurately consistent.
- The early deliveries just after setup with a new reservoir are often too low for 20 to 40 ml of insulin.
- The later use of reservoir, the last 20 units before the low level warnings and after the low level warnings deliver insulin slower than it should be.
  - All insulin pump values are based on deliveries that are exactly consistent based on the levels defined for uses.

The 670g reservoir always, at least outside of hospital temperatures, gets air in it which also causes insulin delivery issues with less insulin than needed when air is being given instead of insulin.
- Rhapsodie has her insulin pumps, both the Paradigm and the 670g, worn upside down so that tapping the air to the back end of the reservoir means it doesn’t get delivered to Rhapsodie.

With the insulin delivery rates shifting through a reservoir of insulin, with the sensor readings always extreme away from the goal targets, with her body acting too fast for the pump sensor to be accurate, and with the remote controllers fiddling with the rates and amounts she sets on the pump she’d never recommend it to other users. BUT many people have this piece of crap for insulin delivery.

C1a- 670g Automode

The 670g automode uses computer processes based on goal targets to deliver the assigned by computer insulin levels for sugar results based on goal targets of the system and user patterns. BUT it doesn’t shift bolus rates or levels. The method options for this process uses a process where a computer program OR process reads the sensor sugar levels and varies insulin rates for sugar goal targets. This system is a dependent system, which means if a user goes off the system, like for eating pizza with a dual wave bolus used, the rates the automode had been using aren’t put into processes for the user, they have to go back to previously established basal patterns and insulin use levels with foods and adjustments. Users find it easier because it’s more like a real pancreas, but it does make them dumber about the insulin pump and their health. No graph is shared with automode, calibration is still a requirement, the goal target ranges are preset by the system and are unable to be modified by the users.

Other CGM systems have different manufacturers and processing systems, but there are similar actions and results with uses of the body if the body uses are accurately being done. Other CGM’s, not the 670g, are as useful OR even better with sensor uses and body actions because they use computers, cell phones, and other blue tooth devices to get the info from the sensor. In addition they also are likely to be varied with insulin uses depending on the type of insulin delivery system and individuals using the insulin. The other devices, that aren’t the 670g, should also allow that the sharing will be able to set up info on larger screens for easier observation in multiple use surgical spaces.

C1b- Sensor Uses with the 670g and Rhapsodie

The additional issues with it could correspond to how her body is working, like how any sensor signal blocking happens with the sensor more than 12 inches from the pump. For uses with the basal setups in surgery it could work great with the higher sugar level goal targets, but it’s likely to be crappy with the lower sugar level goal targets. The lowest level sugars can be at with the 670g is 50 then the low sugar warning system is fully activated and unable to be turned off. Even if an individual, having anything like up to 20% different can set this off.

This means that levels at 60 can do that, so for lower sugars with surgeries use of different insulin pump systems can be much better, but any pump will work for higher sugar levels. The pump doesn’t recognize how the temporary basals are helping a person, because of the slow insulin & body responses, it takes over 3 hours with a temporary basal set at 55% delivery to get sugar levels back to normal. It takes about 1.25 hours with 0% insulin to get sugars back to normal, then sugars go high. The reason is the pump has goal target ranges preset, inaccurately at 120, but it also has no recognition of temp. basals impacts. Which means for treatments it’s a crappy machine to use with the sensor on, unless it’s set off the body, with sensor attached, and it’s removed from the signal zone when it gets to the low warning zone of whatever was set. Rhapsodie’s is normally set at 65 to 60.

Everything reddened below hasn’t been modified for accuracy of information with the 670g insulin pump.

G. To vary sugar goal target ranges on the 670g INSULIN PUMP:

The 670g pump has both

the sensor goal target ranges as well as
the Bolus Wizard insulin changes.

The changes of insulin with the 670 differ in multiple ways beyond the extra button presses and fiddling that are requirements making the pump harder to use than the Paradigm.

A1- For All Goal target Ranges with the 670g

Click ACT;
Choose Bolus and press ACT again;
- The menu can be moved through using the up and down arrows to the right of the ACT
Arrow down to Bolus Setup and press ACT again;
Choose Bolus WIZARD Setup and press ACT again;
Choose Edit Settings and press ACT again;
Arrow down to BG Target and press ACT again;
- Set the goal target ranges for the times, [more continued following this section of illustrations put into italics.]

A1a- High Sugar into Low Sugar Surgical Goal target Range Example

Like for surgical procedures let’s say Rhapsodie is being brought in for surgery initially at 9am, so
- for at 8am the insulin pump is shifted to a goal target range of 180 to 190.
- Rhapsodie is given corn syrup water to raise her sugar levels before surgery,
At 9am the drugs are given her, which could include acetaminophen which with the sensor of the 670g OR a Paradigm could read higher than her sugars really are, so real sugar tests are needed.
- Let’s say the real test results at 11am are that her sugar is at 240, so that amount is added into the pump to make sugar adjustments to get her into the goal target ranges by:
  - Clicking ACT;
  - Choose Bolus and press ACT again;
  - Choose Bolus WIZARD and press ACT again;
    - Use the UP & Down arrows to enter the sugar if that’s not already in the pump, then press ACT again;
  - Do not enter Food leave it blank, and press ACT again;
  - The pump will provide the insulin delivery estimate details based on the values already in it for Rhapsodie’s body,
  - Press ACT again
  - Choose Normal Delivery,
  - And press ACT 2 more times to deliver the insulin.
- The reason insulin is used instead of a temporary basal is because there is a definite goal target in mind and using the bolus operation will assist the pump in going towards that goal target.

A1b- Into accurately planned goal target range setup

Now let’s say that the surgical time plan was originally prepared for 8 hours, which means that by 5pm Rhapsodie would be out of surgery. In preparations varied goal target rates could have been set, that include medium into lower rates as goal targets starting at 3pm. So this was done previously because of following the instructions shared above:
- Click ACT;
- Choose Bolus and press ACT again;
  - The menu can be moved through using the up and down arrows to the right of the ACT
- Arrow down to Bolus Setup and press ACT again;
- Choose Bolus WIZARD Setup and press ACT again;
- Choose Edit Settings and press ACT again;
- Arrow down to BG Target and press ACT again;
- Set the goal target ranges for the times, [this wasn’t above]
  - This starts at 0:00 (Midnight)
    - Click ACT on the first screen, the lower edge of that goal target range is flashing now and you can change that number with the up and down arrow;
    - follow this by clicking ACT again to the higher goal target edge number and using the arrows to make that go up and down.
    - Click ACT again and you are taken to the next time screen if there is one setup.
  - This starts at the time that is flashing from the previous ACT clicking;
    - The time can be kept OR can be changed with the up & down arrows; then
    - The actions of the range goal target amounts can be set like shared above.
  - The starts at midnight processes are repeated through the whole system until the full 24 hours is assigned goal target ranges.
    - So with our setup above with surgical processes for Rhapsodie:
      - 8am- goal target range 180 to 200;
        
        This means getting the sugar up to these levels also before surgery.
      - 2 to 4pm goal target range 145 to 80;
        
        The lowering will utilize insulin, it generally takes about ½ and hour to 1 hour for results to start being noticed with the sugar levels, so previous levels are maintained for a time.
        
        The amount of gluing/suturing to be done and the body sugar levels will shift how easy these process are versus normal processes.
        
        Once the goal targets are set lower the insulin correction rates will work towards those after insulin bolus deliveries are given with the Paradigm.
        
        If there is a bolus being used to lower sugar from a high to a lower goal target range a 30 minute to 2 hour Square Wave Bolus can extend full insulin delivery from 3 hours to 3.5 to 5 hours, this can allow more procedure time especially if events are complicated.
        
        The temporary basal rates, more below, can allow you more OR less use times with alternate insulin without you needing to take carbs for corrections OR take insulin for corrections. For example if Rhapsodie’s already been given a bolus to get sugars lower, it’s been 2 hours since delivery and the sugar levels are great right now for gluing suturing, it can be useful to note how much insulin is still in use. Go to the bolus screen fake in delivery and see what amount of insulin is remaining as still active. With the basal amounts for an hour and an hour of delivery left it means that if the normal basal is 1.35 and there’s a bolus of 1.20 left then a reduction of the temporary basal to 0.5 for 1 hour starting about ½ hour after the change. This should maintain the present levels of sugar, but these can also mean that more correction of 1.2 is needed in an hour, to keep sugars dropping beyond that time without having sugars shoot up again.
        
        For surgical sessions where there are suturing processes being extended it could be that a normal goal target range temporarily utilized is better in the schedules and insulin goal target setups for those processes, but so can uses of the Square Wave Bolus.
      - 4 to 6 pm goal target range 60 to 70
        
        More insulin is needed to reach these ranges. AND this can be started during OR even within the gluing/suturing processes.
        
        Care is needed to make sure that the sugars don’t go too low from too much insulin being given without the variation time frames already being prepared for. Insulin acts in a bulby way, it is most active towards the center and is less active early and later, but it’s still active.
      - 6pm to next day 6pm goal target range 60 to 70
        
        The reason’s this is being maintained for 1 to 2 days is to reduce the ischemia impacts from the surgical procedures. It’s not normal to have sugars at these levels.
        
        Because the insulin was previously setup for the surgical day(s) these processes will require going into the pump and rearranging all the goal target ranges to maintain these rates for an extended period of time.
        
        These processes with goal target ranges are often the least varied with the insulin pump, but with different medications and sugar impacts it can be a value to set the systems up with varied goal targets at times to assist in keeping the patient healthy while things are happening.
        
        For example with the acetaminophen raising the sensor evaluations, but the real body sugars being lower, the 670g in AUTO MODE could kill a person. So having the goal target ranges higher than normal will mean that the sugar tests will also need to be modified for accurate insulin uses, but the pump’s auto actions won’t be endangering the life of the person wearing the insulin pump.

A1c- If surgical schedules are varying

If the 3pm goal target range is changed to 65 to 75 it means that any insulin corrections should be avoided until approximately 2 to 2.25 hours before the end of the surgical sutures are anticipated to be done. This can mean that sugars can go higher, BUT it also could mean that sugars could drop because of other factors in life.
- This case may mean varying the goal target ranges to other times to reduce the accidental change problems while still keeping sugar levels in goal target areas for most of the surgical procedures will involve following the instructions above under the goal target range time settings changes, heading A1b.
  - Going into the pump and shifting the goal target times for the results of the lower sugars of 65 to 75 about 2 to 2.25 hours before suturing is to be completed.

A1d- With Goal target Ranges how do you Raise Sugars Accurately?

Let’s say the real test results at 4pm are that her sugar is at 80, but Rhapsodie was given lowering insulin only 1 hour before, meaning there is still 2 hours 2/3rds of the insulin left to act. So a glucose correction is needed for the suturing and to reduce low sugars for a time. So these adjustments are done by:
- Clicking ACT;
- Choose Bolus and press ACT again;
- Choose Bolus WIZARD and press ACT again;
  - Use the UP & Down arrows to enter the sugar if that’s not already in the pump, then press ACT again;
- NOW ENTER the glucose amount as normal with protein based carbs OR as reduced by 50% with simple sugar carbs as Food and press ACT again;
  - For normal sugar corrections like milk OR nutrition plus drinks the carbs amounts with a protein base will last through the insulin uses. The food with goal target factors will give the correct amounts of insulin with the pump setup with the goal targets,
    - For surgical sessions where there are suturing processes being extended it could be that a normal goal target range is better in the schedules and insulin goal target setups for those processes.
  - This means that if 20 carbs are being given, of simple sugars, which get multiplied by 50% OR divided by 0.5 there are only 10 carbs given for the results being worked for.
    - For any corn syrup and sugar waters used Rhapsodie always cuts their correction factors by 50% because they don’t last more than 30 minutes.
  - The pump will provide the insulin delivery estimate details based on the values already in it for Rhapsodie’s body, and the carbohydrate values added within the Food setting.
- Press ACT again
- Choose Normal Delivery OR even Square Wave Bolus which will deliver the insulin during the amount of delivery time chosen.
  - This correction will only impact any incoming insulin, the previous insulin delivery is already being utilized. BUT if there is a bolus being used to lower sugar from a high to a lower goal target range a 30 minute to 2 hour Square Wave Bolus can extend full insulin delivery from 3 hours to 3.5 to 5 hours.
- The ACT click demonstrates the amount of insulin planned into delivery as well as what type of delivery it is.
- Press ACT for a final time to start the delivery.

A1e- This is not the only action that can be taken with the insulin pump there are many other options also, like:

Temporary basal rates; which shift delivery amounts through the use hours, but they aren’t as consistent as established action patterns with goal targets.
- BUT in some cases these may be needed like when drugs increase body sugar levels and the amount of insulin for basals start graduating up or down with the drug uses.
  - If levels on a graph graduate up then more basal is needed, that’s if no food is part of these factors and the insertion areas are working accurately.
  - If the levels on a graph are dropping than less basal is needed, that’s if no bolus insulin is part of these factors and the insertion areas are working accurately.
- Square Wave Bolus & Dual Wave Bolus rates shift delivery amounts over time by what and whens.
  - SO if there is a bolus being used to lower sugar from a high to a lower goal target range a 30 minute to 2 hour Square Wave Bolus can extend full insulin delivery from 3 hours to 3.5 to 5 hours.
  - If pizza is being eaten a Dual Wave Bolus allows a portion of the insulin to be given normally and a portion to be extended over the time set like the square wave. For Rhapsodie 6.5 hours with 50% immediate and 50% long term is what she has used for years with normal pizza, but with a thin crust pizza, burritos, hamburgers on buns, or other higher fat and cheap white flour carbs these levels are shifted.
- There is also the Suspend function, which stops insulin delivery totally.
  - The Temporary basal actions are preferred by Rhapsodie, because suspension is a temporary measure, beeps every 5 minutes while the pump is in suspend are annoying and reduce battery life very fast. The Temporary basal actions with the Paradigm let you enter the amount of insulin for the amount of time which means you can set it at 0% for anything over ½ an hour with only 1 beep per hour. This is done by:
    - Click ACT;
    - Arrow down to Basal and press ACT again;
    - Choose Set/Edit Temp Basal and press ACT again;
    - Arrow up OR down to Set Duration and press ACT again;
      - The menu can be moved through using the up and down arrows to the right of the ACT
    - Set Temp Basal % opens, use the arrows to set the percentage of change from the present basals, and press ACT again;
    - The process starts until you turn it off, alter it to later, OR it ends.

NOT DONE- To vary sugar goal target ranges on the 670g Insulin Pump:

This is varied depending on how the 670g is working with the individual as well as how the processes on the machine are functioning. For Rhapsodie this has never been an accurate system. With the insulin delivery rates shifting through a reservoir of insulin, with the sensor readings always extreme away from the goal targets, with her body acting too fast for the pump sensor to be accurate, and with the remote controllers fiddling with the rates and amounts she sets on the pump she’d never recommend it to other users. BUT many people have this piece of crap for insulin delivery.

For Rhapsodie the only 670g values have been the graph with the sensor, BUT the sensor uses with the beeps and inaccurate measures are so annoying she has been tempted to sewer drop it repeatedly. The additional issues with it could correspond to how her body is working, like how any sensor signal blocking happens with the sensor more than 12 inches from the pump. For uses with the basal setups in surgery it could work great with the higher sugar level goal targets, but it’s likely to be crappy with the lower sugar level goal targets. The lowest level sugars can be at with the 670g is 50 then the low sugar warning system is fully activated and unable to be turned off. Even if an individual, having anything like up to 20% different can set this off.

BUT it does have the one value of the graph, which allows the sensor results to be monitored. BUT other CGM’s are as useful OR even better with that function because they use other devices also, like the 14 day device which allows cell phones, and other blue tooth devices to get the info from the sensor. The other devices should also allow that the sharing will be able to set up info on larger screens for easier observation in multiple use surgical spaces.

A2- This is not the only medical variation action that can be taken with the insulin pump there are many other options also, like:

[Not done] Regular Basal Changes with the Paradigm Insulin Pump

Regular

[Not Done] Regular Bolus Changes with the Paradigm Insulin Pump

Temporary basal rates

Temporary basal rates; which shift delivery amounts through the use hours, but they aren’t as consistent as established action patterns with goal targets.
- BUT in some cases these may be needed like when drugs increase body sugar levels and the amount of insulin for basals start graduating up or down with the drug uses.
  - If levels on a graph graduate up then more basal is needed, that’s if no food is part of these factors and the insertion areas are working accurately.
  - If the levels on a graph are dropping than less basal is needed, that’s if no bolus insulin is part of these factors and the insertion areas are working accurately.
- The Temporary basal actions with the Paradigm let you enter the amount of insulin for the amount of time which means you can set it at 0% for anything over ½ an hour with only 1 beep per hour.
  - This is done by:
    - Click ACT;
    - Arrow down to Basal and press ACT again;
    - Choose Set/Edit Temp Basal and press ACT again;
    - Arrow up OR down to Set Duration and press ACT again;
      - The menu can be moved through using the up and down arrows to the right of the ACT
    - Set Temp Basal % opens, use the arrows to set the percentage of change from the present basals, and press ACT again;
    - The process starts until you turn it off, alter it to later, OR it ends.

There is more info added under the Suspend function because Rhapsodie has found that the temporary basal actions & others are preferable to use of suspend in most cases.

Square Wave Bolus & Dual Wave Bolus

Square Wave Bolus & Dual Wave Bolus rates shift delivery amounts over time by what and whens.
- SO if there is a bolus being used to lower sugar from a high to a lower goal target range a 30 minute to 2 hour Square Wave Bolus can extend full insulin delivery from 3 hours to 3.5 to 5 hours.
- If pizza is being eaten a Dual Wave Bolus allows a portion of the insulin to be given normally and a portion to be extended over the time set like the square wave. For Rhapsodie 6.5 hours with 50% immediate and 50% long term is what she has used for years with normal pizza, but with a thin crust pizza, burritos, hamburgers on buns, or other higher fat and cheap white flour carbs these levels are shifted.

Suspend function

There is also the Suspend function, which stops insulin delivery totally, but it’s not the best function when there are other options that work better in most cases.

Like there is the unplug option, which allows others to disconnect the insulin delivery from the body. When an individual is able to fix this as sugars raise it means that there aren’t the suspend beeps AND there is a physical sign that the insulin is disconnected. But uses of better functions like the Temporary basal offers additional values at times:
- Before using suspend when sugars are low and teeth are brushed for the sleep times use of the Temporary basal actions are preferred by Rhapsodie for raising her sugar by reducing the insulin while she continues to sleep. This means calculating the rates of need for the changes against the basal amounts, but it also means waiting 3 hours for sugars to get up to the ‘accurate’ levels, so this function doesn’t work well with the 670g connected to the sensor.

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Posts tagged ‘tests’

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Posts tagged ‘tests’

1). Pump Diabetics- Ischemia Treatment Options & Painkiller Works with PUMP & CGM

Sorry everyone

Lower & Higher sugar levels for medical uses

General Reduced sugar levels

Common Higher sugar Levels

Treating Ischemia & Reperfusion Injuries with Sugar Variations, Rhapsodie’s Ideas

LOW BLOOD SUGAR COMA’S, BETTER TREATMENTS

[It can be that sugar level changes can be a reason that diabetics in comas, from low sugar who are treated immediately to raise their sugars can suffer brain injury.

This would mean that the percentage of change would also gradually increase over time.

How to use sugar changes against coma more slowly?

NON-coma low sugar recovery

Insulin & Sugar level Variations for repercussion treatments & avoiding ischemia injuries

Glucose Levels and Insulin Uses

Generic setups

Lower sugar levels repercussion treatment & ischemia reduction action ideas

Possible treatments with low sugar against ischemia-

Higher sugar levels

Pre & During Surgical Treatments having higher sugar levels

Sugar Value Adjustments

Reduced Ischemia with Lower Sugar Levels for extended time periods

Insulin Pumps & Insulin Use Paradigm Insulin Pump Goal target Range Setup Variations

Goal target range variations & reasons general INFO

1. Altering sugar values with uses of some CGM options BUT no Automode

2. Sensor Accuracy Variations with Normal & Alternate Goal target Ranges

3. 670g Graph with only Sensor in use, NOT Automode

4. General Graph Uses

5. Variations of Sugar Changes demonstrated with images of Graph Results

To vary sugar goal target ranges on the PARADIGM INSULIN PUMP separate from CGM:

A1- For All Goal target Ranges with the Paradigm

A2- This is not the only medical variation action that can be taken with the Paradigm insulin pump there are many other options also, like:

[NOT DONE] Insulin Variations USING CGM Pump Goal target Range Setup (Continuous Glucose Monitoring)

Goal target Range Variations Using the 670g Sensor CGM System

C. Using 670g without AUTOMODE

G. To vary sugar goal target ranges on the 670g INSULIN PUMP:

Other Connecting Posts

Diabetic’s and Treatments

Whoops Disease Info

Additional Connecting Information

Pain ASSessment Inaccuracies & Health Issues

Rhapsodie’s Visual PAIN Diary- From September 2013 into April 2017

Rhapsodie’s ideas to improve Medical ASSESSMENTS by doctors

PAIN Variables

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