The other day, my dad told me that he’d recently hired a woman at his company who has LADA (Latent Autoimmune Diabetes in Adults). She wears an insulin pump, and when he mentioned that I went off my pump this Spring and went back to taking multiple shots a day, the woman was apparently shocked and couldn’t figure out why I would “go backwards.”
It’s true that switching from a pump to multiple daily injections (MDI) isn’t nearly as common as people who switch from shots to a 
pump. But people do it. And I’m one of them. It’s not that I don’t like insulin pumps or that they don’t work. It’s just that when my pump happened to break back in March, I decided to take advantage of the opportunity to have a “pump vacation.”
I’ve discovered that one of the most difficult parts of being off the pump is doing the D-math that my pump used to do for me.
When I first started my break, I used my iPhone’s calculator to do all my calculations. First, I’d enter my blood sugar and figure the correction factor. Then, I would enter my carbs and use my I:C ratio to figure the bolus dose needed. I’d then add them together, do some rounding, and inject. It worked really well for several weeks.
And then I got lazy.
Instead of taking out my calculator, I just started estimating how many units of insulin I needed, and let me tell you, my mental math skills have never been that good. I also could never accommodate for Insulin On Board (IOB) properly, which was frustrating.
Thanks to our columnist, Wil Dubois, another pump renegade, I discovered RapidCalc, a new mobile app designed to work like a Bolus Wizard calculator. A couple of weeks later, I found out about a similar tool, ManageBGL, when the company followed me on Twitter. Apps to replicate a Bolus Wizard? Genius!
These two apps have some similarities: they’re both owned by Australia-based companies, were founded by type 1 PWDs, and the apps essentially calculate your insulin needs the same way a pump-based wizard does. They just have different bells and whistles.
Invented by Ian Gillespie, a PWD for 30 years, the RapidCalc app has a sleek and simple user interface made for a smartphone.
Meanwhile, the ManageBGL is a web-based program right now (but a phone app is being launched by year’s end!) and it was created by Simon Carter, a PWD for 24 years who also has a daughter with diabetes.
Cost is a key for most people and each comes down differently on that aspect. RapidCalc comes in at $7.99, which I think is pretty pricey for an app. The ManageBGL website is free at the moment, but that’s set to change. Starting in March 2013, it will cost $29.95 a year, with the phone app included in the subscription. Big price difference, huh? Well, a lot of that has to do with the different features, so let’s continue…
Set-up and Interfaces
Set-up for both apps is a bit time-consuming. Each app allows customization for ratios, correction facto
rs, and sensitivity to exercise. RapidCalc allows users to adjust for upcoming exercise (less insulin), or to indicate whether you’ve had alcohol or a recent low blood sugar (which eliminates any correction dose). ManageBGL also allows for customization of additional “life factors,” such as menstruation, sick days and stress levels. ManageBGL can also take the glycemic index score of your food into account, and you can also keep track of food favorites in its food directory. That’s certainly more than an insulin pump bolus wizard bothers to do! Once these factors are plugged in, both apps take them into consideration to adjust your recommended insulin dose.
Entering blood sugars into RapidCalc is a bit odd. Although the design is nice, it uses a “slide-and-tap” scrolling horizontal bar for blood sugar and carbs. This means you slide to approximately the right number of carbs, and then you tap the plus or minus sign to select the exact number. Although the company claims this is faster, I find it awkward and annoying. It wasn’t until I looked up their extensive FAQ section that I figured out how it even works.
ManageBGL’s website, on the other hand, is more straightforward. Just enter in the numbers using the keypad and you’re done. The phone app will function the same way, they tell me. The website and app will also allow you to enter in carbs, blood sugars or insulin separately if you choose not to use the bolus wizard calculator.
Although I personally prefer the user interface of RapidCalc, the ManageBGL has an advantage when it comes to caregivers. Since it’s web-based, it can be accessed from anywhere and by anyone who has permission. When I had some questions about using ManageBGL, founder Simon Carter was able to check in on my logs immediately… from almost 10,000 miles away!
A Virtual CGM
ManageBGL’s real uniqueness is its “virtual continuous glucose monitor.” Yes, seriously. Using your current blood sugar, carbohydrates and insulin intake, and any other factors you’ve entered, its algorithms project what your blood sugars might be over the next few hours.
Now, of course, the readings are definitely not meant to be used for any dosing, and Simon acknowledges at the virtual CGM is a bit of a “pipe dream,” but he says it can have a real education benefit for patients.
“What we’re really after is to identify trends, to educate people as to how their insulin is going to act (especially if stacked), to hopefully ward off a few hypos, and arm more people with ratios to give them flexible eating,” he says.
I definitely found it interesting to see what the CGM predicted, but I don’t think it’s something I would pay attention to regularly.
In contrast, RapidCalc has fairly simple features. It sticks to basic insulin calculations, and only takes into consideration exercise, alcohol and previous low blood sugars. The only prediction it makes is A1C (and it was only off by .1% for my last A1C, so I think that’s pretty reliable).
Active Insulin & Other Advantages
Another big difference was how the two apps apply Active Insulin. In RapidCalc, you can manually adjust the percentage of insulin considered to be “in use” for each hour. So for instance, knowing a little about how insulin hits my body, I might set my expected absorption to 15% being used in the first hour, then 35% in the second hour, for a total of 100% in 4 hours. In ManageBGL, Active Insulin is calculated automatically through their algorithms.
If you’re wondering, my personal preference is RapidCalc. It’s the first one I found, and while I really like the features of ManageBGL, right now I don’t need to share my logs with anyone. Having multiple users via the website isn’t as important as having an easy-to-use iPhone app that I can take anywhere, especially when comparing a one-time cost of $7.99 versus $29.95 a year. However, if I were a parent or caregiver, or if I didn’t have a smartphone, I’d likely pick ManageBGL because the data sharing is so much more convenient. Simon, who has an elementary-aged daughter, says it’s been much easier communicating with school staff during the day using the website.
While a bolus wizard app certainly won’t replace an insulin pump, it’s a relief to have some of the more complicated dosing math taken care of. In some instances, like exercise, even more math is done by the app than by the insulin pump! That’s pretty cool!
So if you’re thinking taking a pump vacation or are already on MDIs and frustrated with all the math, don’t worry: there’s an app for that!
Fascinating…. I do have a pump, but have wondered how I’d manage if I needed to return to multiple injections. I had to do that once when my pump died and I had to wait for a replacement. Now I know to do some checking for help online!
Against my wishes, my young adult daughter, who had been pumping for 12 years and used a CGM for two, went back on MDI with no CGM two years ago. Result? A remarkably lower a1c, more acceptance of her daily routine and just plain better health. Maybe some day she’ll switch to the pump again and find the same results. Sometimes, ANY Change is what you need. I’m so glad I did not push my feelings on her and trusted her to try what she felt was best for her. Because she was absolutely right.
I did the same thing a few years ago – but I guess due to having had diabetes already for 40 years – and only been on pump for 3 – it was easier for me to adjust to being back on the MDI (dart board practise ). For those of you tho’ that need help with I:C ratio when off the pump – this is a great app! I actually am going to look into downloading it – to show some of the folks I help with managing their diabetes! Many thanks!
I use a combination of an Omnipod and MDI. Why? Failure rate of Omnipod and my subsequent lack of trust. (I’m also sick of wasting 85 units of insulin when it squeals and doesn’t work at all – twice in last two weeks. They don’t exactly reimburse you for that cost.) So, I use 3 times a day Levemir (3, 2 1/2 and 2 1/2) and use the Omnipod for bolusing when I feel the need.
Insulin on Board CAN NOT work on pumps and I had that conversation with an experienced type 1 rep at Animas. It has no clue what the peak/curve is of insulin. Not to mention, the Omnipod can’t go down to <1.0 hour and only does 1/2 hour increments – not helpful when using Apidra in a thin body part (which IOB can't account for either).
I do math in my head and since glucose meters are so freaking inaccurate, I would never worry about calculating down to .05 units. It's not worth the stress of "why did the meter say this, I entered the exact units, why didn't it work?"
I have seen Manage BGL when I was mentoring someone. It was helpful for me if she entered all the necessary info but one missed variable and I couldn't provide accurate feedback.
I have a Windows Phone and most diabetes apps are only for IPhones and Androids which I don't have an interest in owning. I might consider using it if that changes – for shoots and giggles.
I read Wil’s posting too and found that Rapid Calc is not available for android. I did a little hunting for android apps and found glucosurfer (glucosurfer.org). It has bolus wizard, IOB, menstral cycle, graphing features, and more, (still discovering) Just started using it and fine tuning settings. So far so good. $1.29 at Google Play.
Apps like these have been around for years, but most of them are lacking functionality (for example: the ability to export your glucose, carbs, and insulin to a diabetes diary). This is why I decided to create my own: https://www.icloud.com/photostream/#A55oqs3qqvULD
Hi AllisonN,
This is a response to your article about Diabetes Cure fraud. Please don;t take offense but I totally disagree with your stand on the issue. It is all about the money. Ask yourself why the Pharmaceutical Industry is the only one not concerned about money when the biggest economic problems of today are caused solely by GREED. Their profits are in the hundreds of billions of dollars. Don’t you suppose that they could find a little research money in those numbers. They remind me of the farmer(s) that complain all year about how the weather is making them go broke then shortly after harvest time buying a new Cadillac and a new combine.
Thank You,
Frank Tull
I agree with your comment about pharma. However, you are really far off on farmers, obviously an issue you know nothing about thus making your first point sound irrelevant. Farmers driving expensive cars? My guess is you live in the city.
Hi, Alisson.
I came to the blog following Scott Hanselman advice and found your post.
We, as the other two companies you´ve mentioned, count a type 1 DM as co-founder. In our case, Karla Melo, MD, PhD in endocrinology, and KOL in DM in Brazil. Due to her experience as patient, doctor and researcher, we were able to create Gliconllne
A bit of our history can be seen at http://healthmarketinnovations.org/program/gliconline)
We created GlicOnLine in 2004, to help low education people manage their diabetes. First as a voice portal (2005), later as feature phone/internet application (2007), GlicOnLine automated carbo / fat and dose calculation according to a internet based EMR. Doctors follow´d up and evolved patients through the web. After a clinical trail (2007/2008) we initiated a freeware operation that reached 4000 users.
Last november we introduced the new GlicOnLine for Android (iOs will come later). GlicOnLine now supports all DM therapies (nutritional, OAD, fixed-and adjusted dose insuline terapy ), automating all calculations and keeps automatic log of glycemic levels, diet, medication, body weight and bood pressure.
Doctors, dietitians and caretakers can follow up patients through the web and adjust/progress treatment online.
We restricted GlicOnLine distribution to Brazilian market, since we lack the resources to internationalization, which will mean localization, translation and local regulatory requirements adjustments.
We hope to find investors and companies that can help us help people.
My Mr 12 is Type 1 and doesn’t want a pump. We’ve been using Rapidcalc for a year or so and he loves it. Makes everything so easy and his diabetes team love it too!
Hey Melissa -thanks for the recommendation. Just wrote to the company to see if their app works on Android. It’s now $7.99 but in my eyes – from your write up above – well worth it. I’m taking a pump break (only been pumping 4 years out of my 47 years since diagnosis) – and figured for a change of pace – I’d give my noggin’ a rest – and give this app a test at the same time.
[...] at the ‘Minehave done this. Mike Hoskins says that he does it regularly now that he’s taking a pump hiatus, especially when he’s not in the privacy of his own home. Usually, though, he only stabs himself [...]
Thanks for the objective, balanced look at the two Apps.I was involved in the development of RapidCalc and would like to add to your report as follows:-
- For our hospital trial (small but which went very well) we put together an Excel macro to take the exported data from the Email and put it into a BGL type logbook with all carbs and insulin taken as well as all comments. The Diabetes Educators wanted nothing more! If anybody wants to try this, please contact me on ian.gillespie@gilport.com and I will Email it. It is compatible with Excel 2003 onwards and Excel for Mac 2011.
Secondly RapidCalc has a feature that is not well explained in this version. The BGL slider and Carb slider can be used to test, for example, whether you can safely go to bed on a particular BGl. To do this test and enter your BGL and then move the Carb slider until a dose of insulin is recommended – move it back one notch and that is the amount of carbs you should eat before you retire for the night. Obviously some common sense is needed – you probably would not eat again if you had eaten a low carb meal for example. I use it every night and attribute my lack of even moderate hypos overnight to this.