Presenting the all new mySugr Bolus Calculator

Want to know what makes the new mySugr Bolus Calculator so effective? Here’s a sneak peek behind the scenes of what we’ve been working on...

But first things first…

What is a bolus?

We’re glad you asked. An insulin bolus is a dose given to cover a meal/carbs or to correct a high blood sugar level. Figuring out how much insulin to take for a meal or a correction doesn’t need to be difficult, and that’s where a Bolus Calculator comes into play.

Why did we actually change the algorithm?

Joining the Roche family means we have more opportunities to collaborate and develop new technology for our users. That means you! The Roche Bolus Calculator algorithm has been tested in several clinical studies and is available in many markets worldwide [1-5]. That’s why we, along with the engineers at Roche, decided to introduce this algorithm to mySugr and our users.

Benefits of the new mySugr Bolus Calculator

Target Range

We know that blood sugar levels tend to fluctuate, so constantly keeping your blood sugar level at a fixed value can be a big challenge. 

Now, you can define your own personal Target Range and the new mySugr Bolus Calculator will help you stay in that range (The ADA recommends a lower and upper limit of 80-130mg/dL [6]). 

What’s in it for you? The new mySugr Bolus Calculator will only recommend insulin when you're outside your target range, or when you eat a snack or meal. 

“But what about my target value?” we hear you ask. When you use the new mySugr Bolus Calculator, you still have a target value. In fact, the mySugr Bolus Calculator will recommend insulin with the center of your target range in mind.

Superior handling of meals

It’s normal for your blood sugar to increase after a meal, sometimes even above your target range. This is because your blood sugar can rise faster than the time it takes for your insulin to start lowering your blood sugar levels. If you inject the correct amount of insulin for your meal, you won’t need to inject again and you’ll get back into your target range automatically. Injecting more insulin could even result in a hypo (low blood sugar)  and one thing’s for sure, we definitely don’t like hypos. That’s why our algorithm only recommends additional insulin if your blood sugar rises or stays higher than expected (above the green area in the image below this paragraph). 

There are two new settings for you to adjust according to your personal preference, so the algorithm knows when to recommend more insulin. The first new setting, Meal Rise, takes into account how much you allow your blood sugar level to rise after a meal (bearing in mind this is in addition to your target value). The new mySugr Bolus Calculator will only recommend additional insulin if your blood sugar rises even further. The default value is set to 75 mg/dL which is in line with international recommendations for postprandial (after meal) glycemic targets [6]. 

The second setting, Offset Time, is the acceptable amount of time your blood sugar is able to stay at a higher level after you’ve injected insulin. The new mySugr Bolus Calculator will only recommend additional insulin if your blood sugar doesn’t start to drop and stays high after the offset time. The default value is set to 60 minutes to cover blood sugar lowering effects of commonly used insulins [7].

Active Insulin

The mySugr Bolus Calculator calculates the amount of remaining insulin that can still lower your glucose levels. This is what we call Active Insulin. Active Insulin is subtracted from calculated boluses to prevent insulin stacking and avoid hypoglycemia, so you stay safe and in control. In the following, we explain why mySugr uses Active Insulin instead of Insulin On Board (IOB).

Your meal bolus is calculated to only cover the carbohydrates that you eat. If you injected too little insulin (or ate too much for the amount of insulin that you injected) your glucose will likely go up and stay too high and you should inject an additional correction bolus. 

However, If we would wrongly assume that your meal bolus could cover your carbohydrates and also lower your glucose levels (as other manufacturers do this and call  it insulin on board), the bolus calculator would not suggest an effective correction bolus. It would wrongly assume that there is enough remaining insulin left to also lower your glucose levels but it would keep your glucose levels high for a long time. Therefore, we do not include meal boluses into the Active Insulin but only correction boluses. With this, you get much more accurate and quicker correction boluses to bring your glucose values back into target range.

To ensure that your mySugr Bolus Calculator works as desired, please ensure that your carbohydrate factor is correct and you don’t systematically inject too much meal insulin. If you often experience hypos after meals, try double-checking your parameters. If you’re concerned about hypos, it may be worth increasing your hypo limit setting to get carbohydrate recommendations sooner.

Safely handling hypos

Some Bolus Calculators won’t tell you what to do when you’re experiencing a hypo, but those days are gone thanks to our new update.

When you enter a blood sugar value below your hypo limit , the mySugr Bolus Calculator will not recommend any meal insulin but  calculate carbohydrates to resolve your hypo and bring you back to the center of your target range. When there is remaining Active Insulin, the algorithm will recommend even more carbohydrates to ensure you don’t run into another hypo any time soon. After you have resolved the hypo, use the mySugr Bolus Calculator to calculate your meal bolus. 

Of course, you should always use your own experience and listen to your body when handling a hypo. Eat more carbohydrates if you think it’s necessary and double check your values in short distances.

The mathematician in your pocket

The new mySugr Bolus Calculator helps you to tackle meals, hypers and hypos with confidence. It’s like having a mathematician in your pocket! Using your target range as a reference point, the mySugr Bolus Calculator will calculate the right amount of bolus just for you. It even understands the difference between meal and correction insulin. The mySugr Bolus Calculator helps you to avoid unnecessary insulin injections, quickly resolve  long and annoying hypers after your meal, and pull you out of nasty hypos. Win-win...win!

How to set up the new mySugr Bolus Calculator 

Here is your foolproof guide on how to set up the new mySugr Bolus Calculator. 

These settings determine how your insulin dose is calculated so it’s important to get them right. Please do not choose your settings without consulting your doctor or healthcare professional.

In some locations, we will ask you to unlock the Bolus Calculator before using it for the first time by entering an activation code provided by your healthcare professional .

We’ll start by giving you some important information. Make sure you read this carefully and remember, you can tap the, ‘Read User Manual,’ button to learn more. Then, go ahead and tap, ‘Get started.’ 

Safety first

New feature alert! To ensure your settings remain safe and protected, you will be asked to set a screen lock on your phone. If your mobile device is already secured with authentication, like a password, a fingerprint or a faceID (iOS only), this will keep your Bolus Calculator settings safe. If not, we’ll ask you to set up authentication throughout your user journey. Simply tap, ‘Open Android Settings,’ or open ‘Settings’ on iOS to secure your smartphone.

All about insulin

Begin by selecting the insulin* you will use to inject your bolus recommendations (short-acting human insulin or rapid-acting analog insulin).

Therapy settings 

Here’s where we get into the nitty gritty:

1. Diabetes type. Go ahead and fill in your diabetes type in the required field. If you’ve already set up your mySugr Logbook, your diabetes type will be pre-filled in this field. The value you enter here will also update the settings in your logbook* 

2. Blood sugar unit. Select which unit type you use when measuring your blood sugar.*

3. Hypoglycemia. Select at which value you consider your blood sugar to be too low (Default: 70 mg/dL or 4.0 mmol/L). For existing users this value will be pre-filled according to your mySugr Logbook settings. 

4. Offset Time. New feature alert! The Offset Time describes how long it takes before your blood sugar starts to go down after an insulin injection. It must be at least 45 minutes, and the maximum value will be limited by the acting time that you choose. (Default: 60 minutes). 

5. Acting Time. We’ll then ask you how long your bolus insulin stays effective after you’ve injected it.  (Default: 4 hours and 30 minutes).

6. Maximum Bolus. Let us know the highest amount of insulin you would give yourself in one shot. The mySugr Bolus Calculator will never provide recommendations above 50 units (or 25 in the US) in order to avoid unusually high insulin dosage. You can set an alert to warn you when the bolus recommendation exceeds a certain amount of insulin according to your preferences (Default: 25 U).

7. Insulin Increments. Select how you would like your recommended insulin units to be rounded. Choose between tenth units (0.1 U), half units (0.5 U), and full units (1U).  The parameter is set on full units by default. 

8. Carbs Unit. Let us know how you count your carbs. Select either Grams or Exchanges. Again, this information will be pre-filled from the mySugr Logbook for existing users.*

9. Meal Rise. New feature alert! Here, we’ll ask you to let us know by how much your blood sugar is allowed to increase after a meal before you need additional insulin (bearing in mind this is in addition to your target range). The default for this setting is 75 mg/dL or 4.2 mmol/L. For more information about this topic, please take a look at the section “Superior handling of meals”.

10. Target Range: To set up your optimal Target Range, you’ll be asked to select a lower and upper value range (Default: 80–130 mg/dL or 4.4–7.2 mmol/L).

11. Insulin Correction Factor: Here you’ll be asked to enter how much 1 unit of insulin lowers your blood sugar. It is used by the mySugr Bolus Calculator to calculate the amount of insulin that you need to correct high blood sugar values and bring you back into your target range. You might have different factors at different times of the day, which you can set as needed. 

12. Carbs/Insulin Ratio: Let us know how much insulin you need to cover the carbohydrates. It is used by the mySugr Bolus Calculator to provide you with an accurate insulin recommendation based on the amount of carbs in your meal. 

• If you’re counting carbs by grams, the mySugr Bolus Calculator will ask you, how many grams of carbs can you eat for one unit of insulin.
• If you’re counting carbs by exchanges, the mySugr Bolus Calculator will ask you how many units of insulin you take for one exchange. You will be asked to select how many grams of carbs equal one exchange.

You might have different ratios at different times of the day.

You can use time dependent settings for  your target range, insulin correction factor and carbs/insulin ratio.

• On Android, enable “time- dependent setting” during the setup flow and select the time period and enter/edit the adequate value 
• On iOS, Select “time-dependent” during the setup flow and select the time period and enter/edit the adequate value .

13. Summary Screen: Phew! You’re almost there! Here, we will provide you with an overview of your Bolus Calculator settings. You can either confirm the settings, edit them, or forward them to your healthcare professionals. Once you tap, “Confirm Settings,'' you’ll be asked to authenticate yourself. We ❤️  maximum security.

We ❤️ to double check

To make sure everything runs smoothly, we will ask you to review your mySugr Bolus Calculator settings when...

• You change your Logbook settings and they conflict with your Bolus Calculator settings.
• You’ve had the Bolus Calculator setup for longer than 3 months and have not reviewed your settings during this time. 
• You change your timezone.

If you decide to change your settings, you’ll have to go through the full set-up flow again. This helps to ensure that the settings provide you with reliable recommendations.

How to use the new mySugr Bolus Calculator 

Here are two ways you can use the new mySugr Bolus Calculator on Android:

1. On your homescreen in the app, tap the + icon in the bottom right corner. Then, enter values for ‘Blood sugar’ and ‘Carbs’ and tap ‘Calculate’.
2. To edit your settings, open the sidebar and go to ‘Profile & Settings.’ First, tap ‘Settings,’ and then ‘Bolus Calculator Settings’.

Here are two ways you can use the new mySugr Bolus Calculator on iOS:

1. On your homescreen in the app, tap the + icon on the top right corner. Then, enter values for ‘Blood sugar’ and ‘Carbs’ and tap ‘Calculate.
2. To edit your settings, click on ‘More’ in the navigation bar and click ‘Profile & Settings’. Go to ‘insulin therapy’ and then ‘Bolus Calculator settings’.

Country availability: The new mySugr Bolus Calculator is currently available in 

 Argentina,  Australia,  Austria,  Belgium,  Czech Republic,  Denmark,  Estonia,  Finland,  France,  Germany,  Ireland,  Italy,  Latvia,  Lithuania,  Luxembourg,  Netherlands,  Norway,  Poland,  Portugal,   Romania,  Slovakia,  Slovenia,  Sweden,  Spain,  South Africa,  Switzerland,  United Kingdom,  Virgin Islands, 🇹🇭 Thailand.

Last edited 8/16/2023.

References

1. Ziegler, R., Cavan, D.A., Cranston, I., Barnard, K., Ryder, J., Vogel, C., et al. 2013. Use of an insulin bolus advisor improves glycemic control in multiple daily insulin injection (MDI) therapy patients with suboptimal glycemic control: First results from the ABACUS trial. Diabetes Care. 

2. Schmidt, S., Meldgaard, M., Serifovski, N., Storm, C., Christensen, T. M., Gade-Rasmussen, B., et al. 2012. Use of an automated Bolus Calculator in MDI-treated type 1 diabetes: The BolusCal study, a randomized controlled pilot study. Diabetes Care. 

3. Hommel, E., Schmidt, S., Vistisen, D., Neergaard, K., Gribhild, M., Almdal, T., et al. 2017. Effects of advanced carbohydrate counting guided by an automated Bolus Calculator in Type 1 diabetes mellitus (StenoABC): a 12-month, randomized clinical trial. Diabet Med. 

4. Vallejo-Mora, M del R., Carreira-Soler, M., Linares-Parrado, F., Olveira, G., Rojo-Martínez, G., Domínguez-López, M., et al. 2017. The Calculating Boluses on Multiple Daily Injections (CBMDI) study: A randomized controlled trial on the effect on metabolic control of adding a Bolus Calculator to multiple daily injections in people with type 1 diabetes. J Diabetes. 

5. Gonzalez, C., Picón, M.J., Tomé, M., Pujol, I., Fernández-García, J.C., Chico, A. 2016. Expert Study: Utility of an Automated Bolus Advisor System in Patients with Type 1 Diabetes Treated with Multiple Daily Injections of Insulin—A Crossover Study. Diabetes Technol Ther. 

6. Care, D., 2021. Suppl SS. 6. Glycemic targets: Standards of medical care in diabetes−2021. Diabetes Care.

7. American Diabetes Association., 2011. Practical Insulin. 3rd ed. Virginia. 

8. Bode, B.W., 2011. Comparison of pharmacokinetic properties, physicochemical stability, and pump compatibility of 3 rapid-acting insulin analogues-aspart, lispro, and glulisine. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol.