Updates to the Manual The following updates were made to this version (40-5506-51C) of the User Manual. The specific pages affected by the changes are shown. For your safety, review the manual carefully, including all warnings and cautions. If you don’t understand something, contact your clinician, your pump provider, or Smiths Medical. The issue date of this manual is printed on the back cover. If your manual is a year or more old, contact Smiths Medical MD, Inc. (or check the web site at www.CozMore.
Table of contents Tips for practical pumping Sick day management....................................................................41 General guidelines..................................................................41 Insulin pump tips during illness...........................................41 Troubleshoot your infusion site/set and your pump during illness...................................................................41 Travel guidelines............................................................
Delivering insulin The CozMore® Insulin Technology System.................................63 CoZmonitor® Blood Glucose Module..................................63 CoZmanager® 2.0 PC Communications Software..............64 Accessories......................................................................................64 Cartridge..................................................................................64 Infusion sets............................................................................
Blood glucose testing Resources Blood glucose testing and history..............................................193 The CoZmonitor® Blood Glucose Module........................193 Using the BG menu..............................................................194 Enter BG value................................................................194 Notes..............................................................................................196 Patient resources for insulin pump therapy....................
Explanation of symbols Glossary of terms 1
Symbols and Glossary of Terms 2
Symbols and Glossary of Terms Explanation of symbols Below is a list of symbols you will see on (or on the packaging of) the Deltec Cozmo® Insulin Pump and accessories, as well as explanations of what the symbols mean. > Serial number g1 Attention, see instructions for use J Type CF equipment (protection from electric shock) IPX8 Watertight when submerged to 8 feet (2.4 meters) for 30 minutes or to 12 feet (3.
Symbols and Glossary of Terms Glossary of terms The following is a list of terms that you should know before reading this manual, because the manual uses these terms often: Aseptic technique: Aseptic technique is used to minimize the risk of infection. Use aseptic technique when working with the cartridge, infusion set, cannula/needle and preparing the infusion site. Wash your hands thoroughly with soap and water.
Symbols and Glossary of Terms Diabetes: A disease resulting in the body not being able to produce or properly use insulin. In Type 1 diabetes, the body no longer produces insulin. In Type 2 diabetes, the body loses the ability to effectively use insulin. Diabetes team: You are the captain of the team that includes one or more of the following: your doctor, diabetes educator, nutritionist and support team.
Symbols and Glossary of Terms Infusion set: The tubing that is attached to the end of the cartridge, through which the insulin is delivered into the body. Infusion site: The area on the body into which the cannula or needle of the infusion set is inserted. Also called the access site. Insulin pump: A small electromechanical medical device designed specifically for delivering precise amounts of insulin into the body in the treatment of diabetes.
Important safety information • Warnings • Cautions 7
Important Information 8
Important Information Important safety information WARNING: Read this entire manual before using the Deltec Cozmo® insulin pump. If you do not understand something or have any questions, ask your healthcare provider, or contact Smiths Medical MD, Inc. Incorrect use of this pump, failure to follow the instructions and important information contained in this manual, or improper/inadequate troubleshooting can lead to death or serious injury.
Important Information • There are potential health hazards associated with improper disposal of batteries, electronics, and contaminated (used) infusion sets and cartridges. Dispose of used batteries, infusion sets, cartridges, and other used accessories, or a pump that has reached the end of its useful life, in an environmentally safe manner, and according to any regulations that may apply.
Important Information • You should receive specific training on programming and delivering a meal bolus. Please carefully read all instructions and talk to your healthcare provider. • You should receive specific training on programming and using basal patterns. Please carefully read all instructions and talk to your healthcare provider. • Discuss your individual insulin needs with your healthcare provider.
Important Information • If you drop the pump or hit it against something hard, always inspect it carefully to make sure it is still working properly. Make sure the display is working correctly, and the cartridge, cartridge cap, battery cap and infusion set are connected correctly.
Important Information • The CoZmonitor® Blood Glucose Module will only function when attached to the Deltec Cozmo® insulin pump and cannot be used as a standalone device or with any other insulin pump. • Use only Deltec Cozmo® 3 mL Insulin Cartridges; other manufacturers’ products will not work with the Deltec Cozmo® insulin pump. • The CoZmonitor® Blood Glucose Module will only function when attached to the Deltec Cozmo® Insulin Pump and cannot be used as a standalone device or with any other insulin pump.
Important Information 14
Preparing for your pump start • Prior to pump start day • Pump start day Deltec Cozmo® Insulin Pump bolus options Carbohydrate counting basics • What is a carbohydrate? • What is carbohydrate counting? • Why count carbohydrate? • How do you count carbohydrates? • Counting grams of carbohydrate • Reading a nutrition label • Counting servings • Managing portions Meal bolus • Insulin to carbohydrate ratio • Adjusting your insulin to carb ratio • Guidelines for adjusting your insulin to carb ratio Correction b
Preparing for CozMore® 16
Preparing for CozMore® Introduction Congratulations! You have selected the Deltec Cozmo® Insulin Pump to help you in the treatment of your diabetes. Preparing for CozMore® This manual provides information on programming, using and maintaining your Deltec Cozmo® Insulin Pump, Model 1800. It is very important that you read the manual carefully, and ask questions if there is something you don’t understand. Basic information about the CoZmanager® 2.
Preparing for CozMore® Preparing for your pump start Prior to pump start day 1 Confirm that you have all of your Deltec Cozmo® insulin pump supplies. Check the contents of your box with your shipping list. Call your supplier if you have questions about the contents of your box.
Preparing for CozMore® Deltec Cozmo® insulin pump bolus options Bolus: A bolus is a pre-meal or pre-snack amount of rapid/short acting insulin given to “match” or “cover” a specific amount of carbohydrate. A bolus of insulin is also used to correct, or reduce, a high blood glucose reading. There are many different ways to deliver bolus insulin. The Deltec Cozmo® insulin pump offers you six distinct ways to program and deliver bolus insulin.
Preparing for CozMore® Carbohydrate counting basics What is carbohydrate? Food contains three nutrients: carbohydrate, protein, and fat. Carbohydrate (sugars and starches) has the greatest impact on blood glucose levels. Ninety to 100% of the carbohydrate we eat appears in the bloodstream as glucose within a few hours after it has been eaten. Carbohydrate foods include breads, grains, cereals, fruit, milk, vegetables and desserts.
Preparing for CozMore® Reading a nutrition label Counting carbohydrate servings The nutrition label has the facts. Nearly everything in the grocery store except fresh produce, meat, poultry and seafood has a nutrition facts panel on the label. When you read the nutrition facts panel, always check the serving size and total grams of carbohydrate. The grams of fiber, sugar, and other carbohydrate are included in the total grams of carbohydrate.
Preparing for CozMore® Meal bolus Insulin-to-carbohydrate ratio The amount of rapid/short actCarbohydrate to Insulin Ratio ing insulin required to cover a 1 unit per specific number of grams of car15.0 carbs Edit or review? No bohydrate is called the insulinto-carbohydrate ratio. This ratio helps you calculate how much insulin you need for the number of grams of carbohydrate you plan to eat. Each person has his or her own insulin-tocarbohydrate ratio.
Preparing for CozMore® How to adjust your insulin-to-carbohydrate ratio and meal bolus When your blood glucose is not within your target level three or more hours after you eat (after the start of your meal or snack), it may be necessary to adjust your insulin-to-carbohydrate ratio (in certain circumstances it may be less than three hours, for instance if you are pregnant; your healthcare provider should let you know if it is less).
Preparing for CozMore® Correction bolus Correction bolus variables The Deltec Cozmo® insulin pump can be used to deliver a Correction Bolus. The purpose of a correction bolus is to lower or correct a high blood glucose level to your target level. Everyone with diabetes occasionally experiences a high blood glucose level. Correcting an elevated blood glucose level helps to maintain tight control.
Preparing for CozMore® Duration of insulin action Example: Time following meal bolus and/or correction bolus Duration of insulin action = 4 hours Target blood glucose = 100 mg/dl (5.6 mmol/L) Correction factor = 25 NovoLog® Insulin 80 60 40 20 0 0 1 2 3 4 Time/Hours 5 6 Meal, meal bolus, plus correction bolus 175 (9.7) 150 (8.3) 125 (6.9) 100 (5.6) from products section of www.novonordisk.
Preparing for CozMore® Insulin on board Insulin on board refers to the amount of insulin that is still active from a previous bolus. The Deltec Cozmo® insulin pump keeps track of and continually calculates your remaining insulin on board (see graph below). The Deltec Cozmo® insulin pump is designed to help prevent over-bolusing (“stacking insulin”), a major cause of low blood glucose, or hypoglycemia.
Preparing for CozMore® Low blood glucose (hypoglycemia) Hypoglycemia (blood glucose level below 70 mg/dl [4 mmol/L]) can result from too much insulin, not enough food, exercise and other causes, such as alcohol. Giving multiple boluses over a short period of time may also lead to hypoglycemia. Your Deltec Cozmo® insulin pump’s duration of insulin action feature may help prevent this. Warning: Hypoglycemia should be treated immediately—without treatment, hypoglycemia may lead to seizures or unconsciousness.
Preparing for CozMore® High blood glucose (hyperglycemia) and ketonuria Hyperglycemia (high blood glucose), can result from incorrect insulin dosing, interruption in insulin delivery, infusion site or set problems, insulin that has lost its potency, stress, illness, or hormonal changes. Ketosis is a serious condition that indicates your body lacks insulin to move glucose into your cells for energy. The body begins to burn stored fat reserves for fuel. Ketones are produced when fat is burned (metabolized).
Preparing for CozMore® Treatment Prompt treatment of hyperglycemia is essential. When your blood glucose is above 250 mg/dl (14 mmol/L): • Bolus using the Deltec Cozmo® insulin pump and your correction factor. You may need to adjust your correction bolus and give yourself a larger bolus than usual when you are ill. You may also want to use the Correction bolus increase feature described on page 110. • Check for ketones and call your healthcare provider regarding results if ketones are positive.
Preparing for CozMore® 30
Infusion site selection and infusion set change • Changing your infusion set • FAQ (frequently asked questions) • Other tips 31
Infusion Sets 32
Infusion Sets Infusion site selection and infusion set change For proper use, refer to the Instructions for Use provided with the infusion set you are using. Insulin is absorbed best in the abdomen, and for this reason, is most preferred for infusion set insertion. A subcutaneous (under the skin) “pinchable” site above or below the belt line can be selected. Choosing an infusion site may take some trial and error. Avoid using the same spot repeatedly because this can lead to thickening of the skin.
Infusion Sets Changing your infusion set • Choose a time of day when you will not be interrupted or disturbed. Changing your infusion set just before you go to sleep is not recommended because you will not be able to detect a site change problem. You will want to know for certain, based on your blood glucose readings, if your insulin is being delivered correctly.
Infusion Sets Remember Daily: Check your site for tenderness and tape/ dressing adherence. Check your tubing for air bubbles. Every two to three days, or as recommended by your healthcare provider: Change your site and infusion set. This will help prevent infection and altered insulin absorption. Frequently asked questions and tips I am thin. What kind of infusion set is best for me? There are many different infusion sets. Most are compatible with your Deltec Cozmo® insulin pump.
Infusion Sets Why would my blood glucose rise soon after changing my infusion set? Your blood glucose may rise after changing your infusion set if you have forgotten to fill your cannula/ needle after attaching the tubing, or you did not fill your tubing completely. This means you will not be receiving part of your hourly basal rate or bolus. If you are using a disconnect set, make sure you fill the cannula or needle after attaching your tubing.
Infusion Sets If dropping your pump is an issue, choose tubing length that is longer than the distance from your infusion site to the floor. If the pump is dropped or falls from your waistband or belt, the infusion set will not come out. If you are a restless sleeper, you may prefer longer tubing. If you don’t disconnect for bathing or showering, longer tubing may also be preferred, as the pump can be placed on the floor or in a soap dish in the tub or shower.
Infusion Sets 38
Sick day management • General guidelines • Pump tips during illness • Troubleshooting during illness Travel guidelines • Airport screening guidelines • Preparing for your trip • Supplies for travel Adjusting for exercise and activity • Personalizing your pump for exercise and activity • General tips • Wearing your pump during exercise/activity • Using temporary rates for exercise • Disconnecting during exercise Emergency room guidelines • Guidelines for physicians Tips for outpatient procedures/ surgeries
Tips for Practical Pumping 40
Tips for Practical Pumping Sick day management Illness, including stress, has an impact on your diabetes. Sick day management requires frequent blood glucose monitoring. It is also very important to check for ketones. Call your healthcare provider for specific instructions. Warning: Never stop taking your insulin because of illness. Even if you are too sick to eat, your body still needs insulin. Follow the guidelines below and any specific instructions given to you by your healthcare provider.
Tips for Practical Pumping • Check the vial of insulin you used to fill your cartridge. Make sure the insulin had been properly stored, not exposed to any extreme temperatures, and is unexpired. Change your cartridge and fill your new cartridge with insulin from a new and properly stored vial. • Assess your Deltec Cozmo® insulin pump to be sure that it is working properly. Review your current basal rates, insulin-to-carbohydrate ratio and correction bolus settings.
Tips for Practical Pumping Travel guidelines The Transportation Safety Administration (TSA) has provided guidelines for the security screening process for people who have diabetes. These tips are not all-inclusive and are simply meant to provide recommendations and advice when wearing the Deltec Cozmo® insulin pump. The guidelines are subject to change, and you should contact specific airlines and railways for the most current regulations.
Tips for Practical Pumping Adjusting for exercise and activity Blood glucose control includes a balance between your food intake, insulin regimen, and exercise and activity. Exercise has many benefits, and may help you control your blood glucose, weight, blood pressure, and cholesterol levels. When you initially begin using your Deltec Cozmo® pump, you may be advised by your healthcare provider to avoid exercise.
Tips for Practical Pumping Personalizing your Deltec Cozmo® insulin pump for exercise and activity Exercise is important for your overall well-being and is a benefit in controlling your blood glucose levels. Exercise can also be a challenge in maintaining your blood glucose target level. Both spontaneous and regularly scheduled exercise as well as the time of day, type, duration, and intensity of the exercise require changes in your food intake and insulin doses.
Tips for Practical Pumping Wearing your Deltec Cozmo® insulin pump during exercise/activity Caution: The CoZmonitor® module is NOT waterproof. Do not immerse the CoZmonitor® module in any liquid. Before bathing, swimming or any other water activity, you must remove the module from the pump. Heavy perspiration could also gain access to internal components. Allowing the CoZmonitor® module to get wet will cause it to stop working.
Tips for Practical Pumping Disconnecting your Deltec Cozmo® insulin pump during exercise/activity • Check with your healthcare provider for individualized instructions. In some cases, such as competitive sports, coaches do not allow devices to be worn. And there may be times when you just won’t want to wear your pump.
Tips for Practical Pumping Emergency room guidelines Provide the following information to the hospital staff during an emergency room visit. Emergency room guidelines for physicians The Deltec Cozmo® insulin pump provides the patient with a continuous basal (baseline) delivery of rapid/short acting insulin to maintain control of blood glucose levels. The patient programs the pump to deliver bolus doses of insulin for food intake or to correct elevated blood glucose levels.
Tips for Practical Pumping Document pump removal or temporary discontinuation of insulin pump therapy. Include in your documentation: • Condition of the infusion site. Note the presence of inflammation, induration, tenderness, or drainage at site. • Condition of the cannula. Was it kinked or broken? • Person placed in charge of safekeeping the pump. Include full name and relationship to patient. Note if the pump is placed in a secured hospital safe.
Tips for Practical Pumping Tips for outpatient procedures and outpatient surgery (Including dental procedures/surgery) Before your procedure or surgery • Notify the physician who manages your diabetes that you are having an outpatient test, procedure, or surgery. • Provide your physician with the date, location, name(s), and phone number(s) of the physician/ technician who is performing your test, procedure, or surgery.
Tips for Practical Pumping After your outpatient procedure/surgery • If you changed any of your pump settings for your procedure or surgery, reprogram your Deltec Cozmo® insulin pump settings. Review your settings to make sure they’re correct. • Increase the frequency of your blood glucose monitoring. When your blood glucose levels are stable and/or within your target, you may be advised to return to your usual blood glucose checking regimen. Follow your physician’s instructions.
Tips for Practical Pumping Inpatient hospital tips Overnight hospital stays have a direct impact on your diabetes control. Continuing insulin pump therapy during hospitalization provides the most efficient and predictable delivery of insulin and, when used appropriately, increases favorable outcomes. Insulin pump therapy in the hospital Insulin pump therapy should generally be maintained if you are alert and able to manage your Deltec Cozmo® insulin pump.
Tips for Practical Pumping taken/given by injection (subcutaneously) or IV (intravenously). When disconnected for any reason, your pump should be stored safely (with the battery removed), preferably at home. If you are unable to get your pump home, it should be locked in the hospital patient safe with the receipt in your chart. Never leave your pump unattended on a bedside table or on your bed, especially if you are not going to be in your room.
Tips for Practical Pumping 54
Introduction • indications • Contraindications Delivery features • Basal rates • Meal bolus • Correction bolus • Disconnect feature • Hypo Manager™ • Other features Pediatric use Pump illustrations Features and buttons The CozMore® Insulin Technology System • CoZmonitor® Blood Glucose Module • CoZmanager® 2.
Introduction to the Pump 56
Introduction to the Pump Indications Delivery features The Deltec Cozmo® insulin pump is a syringe infusion pump designed for continuous subcutaneous insulin infusion (CSII) for the control of diabetes. Contraindications The pump is not indicated for anyone who cannot or will not follow all of the instructions provided in this manual, test blood glucose levels at least 4 times per day, as well as maintain regular contact with their diabetes team.
Introduction to the Pump the CoZmanager® 2.0 software, which you then send to the pump. Then when programming a bolus you can choose among the foods and meals, and the pump calculates the bolus based on the carbs in the food(s) you selected. • The pump also has an “Extended bolus” and a “Combination bolus” feature.
Introduction to the Pump Caution: The CoZmonitor® module is NOT waterproof. Do not immerse the CoZmonitor® module in any liquid. Before bathing, swimming or any other water activity, you must remove the module from the pump. Heavy perspiration could also gain access to internal components. Allowing the CoZmonitor® module to get wet will cause it to stop working. Repeatedly exposing the CoZmonitor® module to liquids will result in you being charged for replacement modules.
Introduction to the Pump • Parents or caregivers can easily recall pump delivery history to view all delivery events. • The pump can be programmed with different insulin-to-carbohydrate ratios and labeled for different meals - breakfast, lunch, dinner, snack. • The amount of meal boluses can be programmed in units of insulin or grams of carbohydrate.
Introduction to the Pump Pump illustrations Features and buttons q q w q Battery cap with w o-ring Holds the battery in place in the battery compartment. The pump uses one AAA (IEC LR03) alkaline battery. The approximate amount of battery life is displayed in the home screen, and an alarm is given when battery power is low. Keep extra batteries on hand. A separate battery cap is supplied with the CoZmonitor® module.
Introduction to the Pump r, t Left and right programming keys i 1 295 u Cozm o 7 #A Basa l: Rate Pattern 1 : 1.15 0 u/h r y t There are 2 keys on the front of the pump right below the display that do not have any names or symbols on them. These are the programming keys. They have different functions, depending on where you are in a menu. In the display right above each key is a short description of what happens if you press it.
Introduction to the Pump Features Vibration alert If you don’t want the pump to beep during alarms and alerts, you can program it to vibrate instead. This feature can be used in meetings, classrooms, etc. If you choose Vibrate, the “beep” that accompanies each key press is also disabled. Occlusion (blockage) sensor The occlusion sensor continuously tests for blockage that prevents insulin from being delivered. Cartridge sensor There is a sensor in the cartridge chamber that has two functions.
Introduction to the Pump CoZmanager® 2.0 PC Communications Software The CoZmanager® 2.0 PC Communications Software is a Microsoft® Windows® based program that allows your pump to communicate with your PC for complete personalization. You can perform all setup for your pump on the PC, then send the program to the pump using the IR windows on the pump. You can also view, print, save and e-mail your pump program and all of the pump’s history reports.
Introduction to the Pump Before using the pump for the first time Before using the pump, you must receive proper training on programming, troubleshooting and using it. Depending on your therapy needs, you may not use all of the features available on the pump.
Introduction to the Pump 3. Place the battery cap back over the compartment. Push down and turn the cap clockwise (right). Again use a smooth-edged coin to tighten the cap. Warning: Make sure that the battery cap is fully tightened to avoid an interruption in battery power which can cause the pump to power down and stop the delivery of insulin. A prolonged interruption in the delivery of insulin can result in serious patient injury or death. Make sure that the battery cap is fully tightened.
Introduction to the Pump Self tests During the self tests, the pump’s internal computer performs tests on all the major hardware, computer, and electronic systems. Warning: If there are any system problems during pump startup, the pump will stop the tests and display an alarm screen letting you know there is a problem. If this happens, do not use the pump.
Introduction to the Pump Practicing cartridge loading Open the cartridge package by peeling back the paper cover from the soft plastic package. The package contains a cartridge with the plunger, a white cap and a needle with a clear cap. You will need to use aseptic, or clean, technique when working with the cartridge and infusion set. This means you need to wash your hands thoroughly with soap and water.
Introduction to the Pump Fill the cartridge with air Load it into the pump • Attach the needle supplied with the cartridge and remove the cap. • Remove the pump’s cartridge cap by turning it left (counterclockwise) approximately ¼ turn. $ :URN NEEDLE ATTACH AI D. Zurn, 2002-10-18 «9-remove-cartridge-cover.eps» • Pull the cartridge plunger backward and forward while turning it to the right (clockwise) a few times to distribute the invisible lubricant throughout the inside. D.
Introduction to the Pump Cartridge Menu Load Fill tubing Fill cannula Reminder • With Load highlighted, press Select. Additional alert screens that may appear ___________________________ * m Q Detach Set from body Install filled cartridge, then press Load
Introduction to the Pump Removing a cartridge from the pump • Remove the cartridge cap by turning it left (counterclockwise) approximately ¼ turn. D. Zurn, 2002-10-18 «9-remove-cartridge-cover.eps» • Remove the used cartridge from the pump by turning it ¼ turn left (counterclockwise) to unlock it from the pushrod. Do not pull the cartridge out without first turning it. D. Zurn, 2002-07-16 «7-insert-cartridge-tip.
Introduction to the Pump The pump display and menus All programming, operating and alarm/alert information is shown in the display. Programming of the pump is menu driven, like a cell phone or ATM. You can also use a PC and the CoZmanager® 2.0 PC Communications Software to customize certain screens and settings on your pump. At the upper left of the Home screen, you can input your name or other information in place of the “Cozmo” name.
Introduction to the Pump Screensaver and backlight Menus You decide the screensaver activation period. The screensaver al10:10 AM 1.150 lows the pump to save on battery power. It displays the current time and the basal rate currently being delivered (or STOPPED in the place of the rate if your pump is stopped, or ALERT if there is an alert present). Press any key on the keypad to deactivate the screensaver and return to the home screen.
Introduction to the Pump q A sample “Home” screen q Insulin remaining icon: amount of insulin in the o 3 7 #A Cozmo 150 u w e r Basal: Pattern 1 Rate: 1.
Introduction to the Pump Navigating the pump main menu ___________________________ #K Meal Bolus Correction Bolus Temporary Rate Basal Pattern k 1 293 u Cozm o 7 #J A Basal: # Rate: 1Pattern 1 .150 u /hr • Press Menu.
Introduction to the Pump #F Basal Pattern Load History Setup k Load History Setup Basal Testing k History Setup Basal Testing Disconnect k • Press Select to enter the Setup menu (see page 76 for information on navigating Setup). Navigating the pump Setup menu ___________________________ #F Basal Pattern Load History Setup k • Press Select to perform a basal test.
Introduction to the Pump Setup Menu QuickStart Pump Settings Personalize Delivery k Personalize Menu Alerts History Regional Settings Display m Personalize Menu History Regional Settings Display Advanced l › Personalize: Press Select. » Choose Alerts then press Select to personalize certain alarm and alert settings. » Choose History then press Select to decide which history reports you want displayed in the History menu.
Introduction to the Pump Conventions used in this manual The instructions in this manual are intended to help you easily navigate through the pump menus when programming and using your pump. All programming begins at the main menu. As stated previously, all items in the main menu are accompanied by an icon symbol. Some menu items, for instance Setup, then have further sub-menus, each containing “programming loops” for specific functions.
Introduction to the Pump Some features on the pump are optional, so you can choose whether or not you want to use them. In those cases if you choose not to use a feature, none of the personalization screens for that feature will appear. For instance, in Setup > Delivery > Temporary Rate, the first screen that appears asks if you want the temporary rate feature to appear in the pump’s menu.
Introduction to the Pump 80
Setup • Choices for programming The QuickStart™ feature • Time and date settings • Meal bolus settings • Correction bolus settings • Current basal pattern settings Delivery • Meal bolus • Correction bolus • Basal patterns • Temporary rate CoZmanager® 2.
Setup 82
Setup Setup Most programming setup on the pump is accomplished in the Setup menu. There are several submenus that are part of the Setup menu. • In the QuickStart™ feature, you can access and setup the basic functions of the pump, including the Time and Date, standard Meal Bolus settings, Correction Bolus settings and current Basal Pattern settings all in one menu.
Setup QuickStart™ feature In QuickStart™ you can access and set up the basic functions of the pump, including the Time and Date, standard Meal Bolus settings, Correction Bolus settings and current Basal Pattern settings all in one menu. (If you prefer, time and date can be set in the Pump Settings menu, meal bolus and correction bolus can be set up in the Delivery menu, and basal patterns in the Delivery and Basal Pattern menus).
Setup You can set up to 24 correction factors, in half hour increments. Factors will be in either mg/dl or mmol/L, depending on which you use to measure your blood glucose, and can be set as follows: 5 to 30 mg/dl in 1 mg/dl increments; 30 to 100 mg/dl in 5 mg/dl increments; 100 to 400 mg/dl in 10 mg/dl increments – or – 0.2 to 1.5 mmol/L in increments of 0.05 mmol/L; 1.5 to 5 mmol/L in increments of 0.25 mmol/L; 5 to 23 mmol/L in increments of 0.5 mmol/L.
Setup Time and Date Time: 08 : 00 AM Date: 05 / 12 / 06 Invalid Date You must specify a valid date. Check your entries OK Program bolus using: Units-Insulin k Insulin to Carb Ratio 1 unit per 15.0 grams No Edit or review? Carb Ratios Time Midnight Carb Ratios Time Midnight
Setup NOTE: You can choose to turn the correction bolus feature on in the main menu and off with a meal bolus through the Setup Delivery menu (see page 111). However, if you choose to access the correction bolus feature through the QuickStart™ menu at a later time, pressing Next or Back when you are on the correction bolus screen will automatically turn on the correction bolus feature in the main menu and meal bolus delivery screen.
Setup Target BG Time Midnight --:- Target BG Time Midnight 10:00AM --:- » To remove a target, press Next until the bold highlight is over the time segment you want to delete, then press b or c until “- - : - -” is displayed, then press Next. Press Done when your target(s) are correct. Target BG Time Midnight mg/dl 150 m
Setup Pump Settings In the Pump Settings menu you do the following pump setup: • In Time and Date you will set the current time and date. • In Beep/Vibrate you specify how you want the pump to notify you of alarms and alerts. You can either have the pump beep or vibrate when an alarm or alert occurs. • You can use Program Lock to prevent anyone who does not know the lock code from opening the pump menu. • In Pump ID you can view the specifics of the software contained in your pump.
Setup Beep or vibrate Pump Settings Menu Time and Date Beep / Vibrate Program Lock Pump ID Time and Date Time: 08 : 00 AM Date: 05 / 15 / 06 Invalid Date You must specify a valid date. Check your entries OK Pump Settings Menu Time and Date Beep / Vibrate Program Lock Pump ID
Setup Alert Choose: Vibrate Volume: High Key Beeps: Yes Alert Choose: Volume: Key Beeps: Pump Settings Menu Time and Date Beep / Vibrate Program Lock Pump ID
Setup Program Lock 0 No Enter code: Lock program: Program Lock Enter code: 17 Lock program: Yes • Press Home. Select> 293 u Basal: Pattern 1 Rate: 1.150 u/hr k Menu> NOTE: If you have the program locked and are performing a blood glucose test using the CoZmonitor module, you will not be offered the option or be able to deliver a bolus from the Blood Glucose result screen.
Setup Pump ID Pump ID Pump ID allows you to easily view the specific software information on your pump. Occasionally you will be asked for this information when communicating with CozMore® Customer Service. 97-xxxx-xxX English A05740 97-xxxx-01X xxxxxxx
Setup Personalize In the Personalize menu you do the following pump setup: • In Alerts you specify how various alarms and alerts work, and also choose whether you want to use various optional alerts. • In History you specify which history reports you want to appear in History in the main menu. • In Regional Settings you specify how the time, date and decimal point will appear on the pump. • In Display you specify how the pump display’s backlight works and also the screensaver activation period.
Setup the alert to occur. (Using the CoZmanager® 2.0 software, you can create custom names for these alerts.) Custom alerts are factory preset to No (not in use). Low Blood Glucose reminder: this optional alert allows you to enter a blood glucose limit and time setting as a reminder to retest your blood glucose when your blood glucose test has a specified low result.
Setup Low Cartridge Alert 20 u k Delivery Limit Alarm 40 u k Glucose Reminder Alert Use alert: After: No 02:00 hr k Glucose Reminder Alert Use alert: Yes After: 02:00 hr k Review or Edit custom alerts? No Custom Alerts BG Alert 1 BG Alert 2 BG Alert 3 BG Alert 4 Custom Alert BG Alert 3 Use alert: No Time: 09:00 PM Type: Single Day(s): Friday k Custom Alert BG Alert 3 Use alert: Yes T
Setup Low Blood Glucose Alert Use alert: Yes Time: 00:15 BG Limit: 70 mg/dl k High Blood Glucose Alert Use alert: No Time: 01:30 BG Limit: 200 mg/dl k High Blood Glucose Alert Use alert: Yes Time: 01:30 BG Limit: 200 mg/dl k High Blood Glucose Alert Use alert: No Time: 01:30 BG Limit: 200 mg/dl k Automatic Off Alarm Use alarm: No After: 08:00 hr k Automatic Off Alarm Use alarm: Yes After: 08:00 hr k Site Reminder
Setup Personalize Menu Alerts History Regional Settings Display History • Press Back. m Setup Menu QuickStart Pump Settings Personalize Delivery #F • Press Home. Basal Pattern Load History Setup 1 7 #A Cozmo 293 u Basal: Pattern 1 Rate: 1.150 u/hr
Setup Basal as Percent of TDD (Total Daily Dose) and Average Basal as Percent of TDD: this shows what percent of the total amount of insulin delivered each day is basal insulin. The average looks at this percentage over a number of days (2 to 30), and calculates an average. BG History and Average BG History: this shows the date, time and result of blood glucose tests either performed using the CoZmonitor® module or entered manually via the BG home screen.
Setup Avg Delivery Summary Yes In menu: Basal as Percent of TDD Yes In menu: Avg Basal as Percent of TDD Yes In menu: Blood Glucose History Yes In menu: Average Blood Glucose History Yes In menu: Display BG home screen? No • If you want the report to appear in the menu, with Yes highlighted press Next or If you do not want the report to appear in the menu choose No then press Next.
Setup Regional settings The regional settings determine how the time, date and number format are displayed on the pump. • Time can be displayed as 12 hour (am and pm) or 24 hour. • The date can be displayed as month/day/year (mm/dd/yy) or day/month/year (dd/mm/yy). • The decimal point can be displayed as either a Period (xx.xx) or as a Comma (xx,xx). When the pump is built, the default settings are: Time format: 12 Hour; Date format: mm/dd/yy; and Number format: Period.
Setup Display Decide how the backlight works. It can be set to light whenever the pump is “awake” (whenever the screensaver is not shown) or only when manually prompted from the screensaver (pressing the c key turns on the screen backlight when the screensaver is displayed). NOTE: Using the “When Awake” setting shortens battery life. Also decide the screensaver activation period.
Setup Advanced Warning: The Advanced features can be complex and may not be suitable for every pump user. Talk to your healthcare provider to determine if these features are suitable for you, and do not use the features until you thoroughly understand how they work. Advanced allows you to turn the Weekly Schedule, Disconnect and Hypo Manager™ features on or off. If turned on, Weekly Schedule and Disconnect are added to the Main menu, allowing you to use them.
Setup #F Basal Pattern Load History Setup Setup Menu QuickStart Pump Settings Personalize Delivery • If you do not want to use the Weekly Schedule feature, with No highlighted press Next or If you want to use the Weekly Schedule feature choose Yes then press Next.
Setup Delivery In the Delivery menu you do the following pump setup: • In Meal Bolus you specify all of the variables that your pump will use when delivering a meal bolus. You will also specify if you want the pump to allow Extended, Combination and Touch Bolus features. • In Correction Bolus you specify all of the variables that your pump will use when delivering a correction bolus.
Setup Bolus duration For some people, a bolus delivered very quickly can cause a burning sensation at the infusion site and/or a blockage alert on the pump. The Bolus Duration feature can be used to avoid this. You can program the pump so that all boluses (meal, correction, and the immediate portion of a combination bolus) are delivered over 1 to 5 minutes. The default setting is 1 minute. CozFoods™ list The CoZmanager® 2.0 software includes a food list called Meal Maker®.
Setup NOTE: CozFoods™ is only part of the Meal Maker® feature if it has been created using the CoZmanager® 2.0 software, sent to the pump and enabled. The Meal Maker® feature allows you to choose among a number of foods (and their carbohydrate amounts), which the pump then uses to calculate the total carbohydrate in your meal. The Meal Maker® feature is available when programming and delivering a meal bolus, Extended bolus and Combination bolus. It is not available when you are delivering a Touch Bolus.
Setup Carb Ratios: Time Midnight 10:00AM » To remove a ratio, press Next until the bold highlight is over the time segment you want to delete, then press b or c until “- - : - -” is displayed, then press Next. Press Done when your carb ratio(s) are correct. Meal Bolus In Menu: Extended: Combination: g/unit 15.0 m When changing bolus, maximum is: 15.00 u When changing bolus, scroll by: 0.
Setup NOTE: Only custom boluses created using CoZmanager® 2.0 software will appear in the Units - Insulin custom bolus menu. Custom Bolus: Pizza Display in Menu: k Custom bolus Pizza m Custom bolus Breakfast Lunch Dinner Midmorn
Setup Correction bolus Warning: It is vital that the settings used by the Correction Bolus are correct. You must work closely with your healthcare provider to correctly program these settings. The Correction Bolus is designed to reduce or lower a high blood glucose level. In order to calculate the amount of a correction bolus, you will need to determine several variables that the pump uses.
Setup 1 293 u Cozm o NOTE: If you access the correction bolus feature through the QuickStart™ menu, pressing Next or Back when you are on the correction bolus screen will automatically turn on the correction bolus feature in the main menu and meal bolus delivery screen. 7 A Basal: # Rate: 1Pattern 1 .150 u /hr • Press Menu.
Setup Correction Factor Time Midnight 10:00AM --:- Correction Factor Time Midnight mg/dl 40 m Target BG Time Midnight
Setup Increase correction bolus based on BG? No Edit increases? Increase correction bolus based on BG? Yes Edit increases? Correction Increase mg/dl >= 250 >= 300 >= 400 >= 500 m Correction Increase Use increase If BG is >= add k Correction Increase Use increase? Yes If BG is >= 250 mg/dl add 1% k Correction Increase Use increase? If BG is >= add
Setup Basal patterns Warning: You should receive specific training on programming and using basal patterns. Please carefully read all instructions and talk to your healthcare provider. The pump allows you to program up to 4 basal patterns, each of which can contain up to 48 time/rate segments.
Setup Delivery Menu Meal Bolus Correction Bolus Basal Pattern Temporary Rate Temporary rate • Press Back. k Setup Menu QuickStart Pump Settings Personalize Delivery #F Basal Pattern Load History Setup 1 7 #A Cozmo 293 u Basal: Pattern 1 Rate: 1.150 u/hr Temporary Rate allows you to temporarily raise or lower your basal rate for a specified period of time.
Setup • Specify how you want to program a temporary rate (Percent or Units/Hr) then press Next. Program Temp Rate using: Percent 1 293 u Cozm o A Basal: # Rate: 1Pattern 1 .150 u /hr When running Temporary Rate Reminder: Yes How often: 00:30 hr Men u> • Press Menu. k When running Temporary Rate Reminder: Yes How often: 00:15 hr #F • Choose Setup then press Select. Basal Pattern Load History Setup k
Setup Custom Temp Rate: Temp Rate 3 In Menu: No Rate: 100 % Duration: 00:30 Name: Temp Rate 3 k » If you do not want the temporary rate to appear in the menu, with No highlighted press Next or If you want the temporary rate to appear in the menu choose Yes then press Next. NOTE: The screen shown at left shows a custom temporary rate programmed using Percent. If you have chosen Units/Hour then the rate will be shown in u/hr.
Setup CoZmanager® 2.0 PC Communication Software The CoZmanager® 2.0 PC Communications Software is a Microsoft® Windows®-based program that allows the pump to communicate with a computer. You can personalize all your pump settings using the CoZmanager® 2.0 software. Installing the CoZmanager® 2.0 software • You must have a Microsoft® Windows®-based PC in order to install the CoZmanager® 2.
Setup q Get from pump button—If enabled, click to get the pump’s current program and load it into the CoZmanager® 2.0 software. If you have previously personalized your pump, you should always first get that program from the pump before making changes using the CoZmanager® 2.0 software. w Open file button—If enabled, click to open the pump program stored in the CoZmanager® 2.0 software. e Send to pump button—If enabled, click to send the program from the CoZmanager® 2.0 software to the pump.
Setup Personalizing the pump program and sending it to the pump . (If you are already at the • If necessary, click Personalize screen, you will not need to perform this step.) • Click on the various folder tabs at the top of the screen to view and program the desired/required settings. to save • Once personalization is complete, click the program to your PC. (This allows you to have a complete record of all of your pump settings.
Setup Meal Maker® feature The Meal Maker® feature is used to create a list of foods which can then be sent to your pump and used when programming and delivering a meal bolus. The Meal Maker® feature contains two food lists, The Master Foods list and the CozFoods list. The Master Foods list is your list of all foods, categories and meals that you would ever want to use in your pump.
Setup q Get from pump button—If enabled, click to get the pump’s CozFoods list and load it into the CoZmanager® 2.0 software. If you have previously personalized your pump, you should always first get that program from the pump before making changes using the CoZmanager® 2.0 software. w Send to pump button—If enabled, click to send CozFoods from the CoZmanager® 2.0 software to the pump. Once you send a program to the pump, whatever personalization was previously on the pump is lost.
Setup ™ 1$ Open—Click to open an existing CozFoods list. 1% Save—Click save Meal Maker® to the PC. 1^ Save As—Click to save Meal Maker® under a new name. 1& Custom Bolus—Click to create a custom bolus for a given entry.
Setup Creating Master Foods and CozFoods™ lists . (If you are already at the Meal If necessary, click Maker screen, you will not need to perform this step.) 1. Review the foods in both lists. 2. Delete the foods you never eat. 3. Add your favorite foods to the Master Foods list along with their carbohydrate (required), fiber, fat, protein, and calorie (all optional) counts. 4. If desired, create meals in the Master Foods list and add foods to them by dragging and dropping. 5.
Setup ™ CozFoods files You can store CozFoods lists in files on your PC’s hard drive. This allows you to store different lists for different purposes. For example, a child may have one list during the school year to accommodate school lunches, and another during the summer. It also allows you to share lists with other pump users. The default CozFoods list is stored in a CozFoods file called CozFoods.xml. This file is write-protected and should not be modified.
Setup Viewing reports View reports is used to view, print, e-mail or save the list as a report (the same procedure is used for history reports when you are in the Personalize and History Reports screen—see page 118 and page 204, respectively). To view reports on screen in the software, click to open the View Report dialog box. A dialog box opens where you can select either the Master Foods list or the CozFoods list to view.
Setup Notes __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________
Setup Notes __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________
Loading a cartridge Stopping and restarting insulin delivery Delivering a bolus • Standard “units of insulin” bolus • Standard “carbohydrate” bolus • Touch bolus • Enhanced Meal Maker® bolus • Extended bolus • Combination bolus • Correction bolus • The Hypo Manager™ feature Weekly schedule • Temporary basal patterns • Edit schedule • Edit basal patterns • Edit meal alerts Disconnect • Reconnecting Editing basal patterns Using basal patterns Using temporary rate 129
Delivering Insulin 130
Delivering Insulin Loading a cartridge The Load feature in the pump menu takes you through each step needed to load a filled cartridge in the pump and start delivering insulin. Warning: Always use the pump’s Load feature when starting a new cartridge. This will assure that the cartridge is properly loaded. Warning: Whenever you load a new cartridge and attach an infusion set, you should test your blood glucose level within one to two hours to make sure that insulin is being properly delivered.
Delivering Insulin Fill the cartridge Use aseptic technique (see page 4). • Fill the cartridge according to the Instructions for Use supplied with the cartridge. Gently lift the cartridge out of the cartridge chamber and dispose of it appropriately. NOTE: You may get the “Cartridge Removed” alert when removing the cartridge; if you do, press OK). The cartridge must be filled with a minimum of 20 units and a maximum of 300 units. Filling the cartridge with less or more can disrupt the loading process.
Delivering Insulin * Cartridge Menu Load Fill tubing Fill cannula Reminder • With Load highlighted, press Select. m Q Detach Set from body Install filled cartridge, then press Load k • Make sure the infusion set is not connected to your body, then press Load (see right for additional screens that may appear*).
Delivering Insulin • Attach the infusion set Luer to the tip of the cartridge and tighten it Do not connect the infusion set to your body yet D. Zurn, 2002-10-18 «12-cartridge-cover-luer.eps» Attach and fill the tubing • Remove the white cap from the cartridge tip Warning: Make sure the connectors are securely tightened.
Delivering Insulin Cartridge Menu Load Fill tubing Fill cannula Reminder k Cartridge Menu Load Fill tubing Fill cannula Reminder • When the cannula has filled the pump returns to the cartridge menu, with Load, Fill tubing and Fill cannula checked (showing these steps are complete).
Delivering Insulin Stopping and restarting insulin delivery You can stop and restart insulin delivery from the home screen. NOTE: Stopping and starting delivery from home screen 2 view or the blood glucose home screen is slightly different. See the following pages for more information. Warning: When stopping delivery, remember that since the pump uses only rapid/short-acting insulin, your insulin level will start to fall and blood glucose level to rise very quickly (in as little as 60 minutes).
Delivering Insulin Stopping insulin delivery from the Blood Glucose home screen Stopping delivery from the Blood Glucose home screen is very similar to stopping from any of the other home screens. ___________________________ 1 293 u Cozm o 7 A Last B at 08:3G: 167 m # BG on 06 0 AM g/dl /20/0 6 < Start -B G k Men u> • Press Start-BG. 1 293 u Cozm o 7 A Last B at 08:3G: 167 m # BG on 06 0 AM g/dl /20/0 6 < Stop -B G k Men u> • Press Stop-BG.
Delivering Insulin Stopping insulin delivery from home screen 2 Stopping delivery from the home screen 2 (bolus history) is very similar to stopping from any of the other home screens. ___________________________ 293 1 u Cozm o PUMP Start -R 7 STOPP ev k #B ED Men u> • Press Start-Rev. 1 293 u Cozm o 7 B Bolus 0.25 ucomplet # - 08:4 ed 2 AM Stop -R ev k Men u> • Press Stop-Rev.
Delivering Insulin Delivering a meal bolus There are several methods available on the pump for delivering a Meal Bolus. Depending on how you have personalized your pump in Setup, not all of the methods that follow will necessarily be available on your pump. Additionally, you may be able to deliver a Correction Bolus with your Meal Bolus if you have personalized your pump to allow it.
Delivering Insulin Delivering Bolus: x.xx u 0.75 u Home> Cancel 1 7 #A Cozmo 293 u Basal: Pattern 1 Rate: 1.150 u/hr • The delivery screen counts up as the bolus is delivered. To cancel a bolus before it is complete, press Cancel. Press Home to return to the home screen. When the bolus is complete, the pump beeps or vibrates twice and returns to the home screen.
Delivering Insulin Carbohydrates 25 gm Carb ratio: 1 unit per 15.0 gm Add Correction Bolus? Yes Add Correction Bolus? No Note: 0.30 u of insulin on board k When all of the grams of carbohydrate for your meal or snack are entered, press Done and the pump returns to Carbohydrates gram screen with the total grams of carbohydrate entered displayed on the screen; press Next.
Delivering Insulin Touch Bolus delivery The Touch Bolus feature allows you to bypass the menu when delivering a meal bolus. It is called the Touch Bolus because you can program and deliver a bolus using sound or vibrations, without having to look at the pump’s screen. The Touch Bolus button, on the side of the pump, is pressed to use Touch Bolus. To activate the Touch Bolus feature, see page 108. Your maximum bolus setting will also be used in Touch Bolus.
Delivering Insulin Q Touch Bolus Administer bolus of 2.50u? Cancel 1 7 #A Cozmo 293 u Basal: Pattern 1 Rate: 1.150 u/hr If the amount is correct, press and hold the Touch Bolus button until the pump beeps or vibrates once (to indicate bolus delivery has started). If the confirmation beeps/vibrations are incorrect, press Cancel (or wait 10 seconds for the screen to clear), then program the correct amount.
Delivering Insulin O.J. 1.0 33 g Servings: Carbs: Serving Size: 10 oz. k D Nutrition Info. O.J. Carbs Fiber Fat Protein Calories 33 g 0g 0g 2g 140 Next>
Delivering Insulin #G • With Meal Bolus highlighted, press Select. Meal Bolus Correction Bolus Temporary Rate Basal Pattern m Extended Bolus Amount: 1.65 u Duration: 02:30 hr • Choose Extended then press Select. Standard Extended l • Press the b key to specify the bolus amount in units of insulin to cover your meal then press Next or 1.
Delivering Insulin Current Blood Glucose 159 mg/dl Target: 150 mg/dl Factor: 1 unit per 25 mg/dl k Bolus to adjust BG 14 mg/dl 0.55 Extended k Cancel 1 7 #A Cozmo 293 u Basal: Pattern 1 Rate: 1.150 u/hr » If you have personalized your pump to allow editing your BG target when programming a correction bolus: choose your BG target then press Next.
Delivering Insulin Combination bolus delivery #G The combination bolus combines the features of the standard and extended bolus, and is best used when you eat foods like pizza that contain both carbohydrate (crust) and protein/fat (meat/cheese), or if you are eating over a long period of time. You program a percentage of the bolus to be delivered immediately, then the remainder over a programmed period of time. Select> Bolus Menu • Choose Combination then press Select.
Delivering Insulin Combination Bolus Amount: 1.65 u Duration: 02:30 hr Immediate: 30 % k Combination Bolus Amount: • Specify the duration (the period of time you want the extended portion of the combination bolus to deliver over; 15 minutes to 08:00 hours) then press Next. Current Blood Glucose 164 mg/dl Target: 150 mg/dl Factor: 1 unit per 40 mg/dl
Delivering Insulin Stopping a combination bolus ___________________________ 1 293 u Cozm o Correction Bolus only appears in the main menu if you have personalized your pump that way. A correction bolus is designed to reduce or correct a high blood glucose level. ___________________________ 7 A Basal: # Rate: 1Pattern 1 .150 u /hr • Press Stop. 1 293 u 7 Cozm o A Basal: # Rate: 1Pattern 1 .
Delivering Insulin Delivering Bolus: 1.68 u 0.75 u Home> Cancel 1 7 #A Cozmo 293 u Basal: Pattern 1 Rate: 1.150 u/hr • The screen counts up as the bolus is delivered. To cancel the correction bolus before it is complete, press Cancel. Press Home to return to the home screen. After the bolus is delivered, the pump beeps or vibrates twice and returns to home screen. The Hypo Manager™ feature Warning: The Hypo Manager™ feature can be complex and may not be suitable for every pump user.
Delivering Insulin ! Hypo Manager BG is below or may drop below target. Fast-acting carbs are suggested.
Delivering Insulin Extended Bolus 17 g suggested Amount: Duration: Alert BG is below target or may drop below target. No bolus suggested. › If you were attempting to deliver an extended bolus with correction bolus: the suggested number of fast-acting carbs you should consume is displayed on a screen like this. Consume the recommended amount of fast-acting carbohydrate or treat the low blood glucose as instructed by your healthcare provider.
Delivering Insulin Basal Pattern Menu Pattern 1 Pattern 2 Pattern 3 Pattern 4 k › This screen only appears if you have chosen more than one pattern to appear in the menu in Setup. Choose the pattern you want to edit then press Select. › Choose Edit then press Select. l Pattern 2 Total 28.80 u Time Midnight --:- Pattern 2 Total ???? u Time u/hr Midnight 1.20 --:-0.00 Pattern 2 Total ???? u Time u/hr Midnight 1.
Delivering Insulin Using basal patterns Many of the screens in the Basal Pattern menu can be personalized by programming the pump or by using the CoZmanager® 2.0 software. If the screens on your pump have been personalized, they will be different than those shown here. It is also possible to program the pump to display only specified basal patterns. When you are running a Temporary Rate, starting a different basal pattern will cancel the remainder of the temporary program.
Delivering Insulin Using the temporary rate Temporary rate only appears in the main menu if you have chosen to have it activated in Setup. Temporary rates can be used to temporarily raise or lower your basal delivery, for instance when you are exercising or sick. You can create custom Temporary Rates using the CoZmanager® 2.0 software; if you have created custom temporary rates the screens on your pump may appear differently than those shown here.
Delivering Insulin Stopping a temporary rate ___________________________ 1 293 7 Cozm u o Basal: Rate: 0Pattern 1 # Temp .230 u/hr Rate A ctive • Press Stop. Select delivery to stop All Delivery Temporary Rate Temporary Rate Remaining Duration: 00:45 hr Stop temp rate? 1 7 #A Cozmo 293 u Basal: Pattern 1 Rate: 1.150 u/hr
Delivering Insulin Weekly schedule In order to use the Weekly Schedule, it must be turned on in Setup > Personalize > Advanced (see page 103). Once turned on, Weekly Schedule will replace Basal Pattern in the main menu. You must then program daily schedules for the pump to use. Using Weekly Schedule, you can personalize the pump to change basal patterns and missed meal bolus alert sets automatically, on a daily basis, to fit your lifestyle.
Delivering Insulin Basal Pattern Menu Pattern 1 Pattern 2 Pattern 3 Pattern 4 k Pattern 2 Total 28.80 u Time u/hr Midnight 1.20 Pattern 2 Total 28.80 u Time Midnight Pattern 2 Total ???? u Time u/hr Midnight 1.20 --:-0.00 Pattern 2 Total ???? u Time u/hr Midnight 1.20 02:30 AM 0.00 Pattern 2 Total ???? u Time u/hr Midnight 1.20 --:-1.35 06:30 AM 1.
Delivering Insulin Edit meal alerts Set 2 Missed meal bolus alert sets can be used to remind you about possible missed meal boluses. You can review or edit missed meal alert sets. On the review screen, a checked box () appears next to sets that are active. To edit a set, press Edit. First, decide whether you want the alert set and, if you do, name the set (included here is a list of preloaded names; if you want to create a name, you may do so using the CoZmanager® 2.0 software).
Delivering Insulin Missed Meal Alert Sets Set 1 Set 2 Set 3 Set 4 m › Continue to enable and edit alert sets and individual alerts as desired. When you have finished reviewing and editing the alerts, press Done.
Delivering Insulin Edit Schedule ------- Thursday-----Basal: Pattern 1 Alerts: None --------- Friday--------Basal: Pattern 2 k • Press the b or c key to specify which alerts you want associated with the specified day then press Next. NOTE: Only those missed meal alert sets you have activated in Weekly Schedule > Edit Meal Alerts will appear here; if you have not enabled any missed meal alert sets your only choice will be None.
Delivering Insulin Weekly Schedule Menu • With Temp Basal Pattern highlighted, press Select. Q • Choose when you want to start the temporary basal rate (Now or Midnight) then press Next. m Start temporary basal pattern: Now
Delivering Insulin Disconnect In order to use the Disconnect feature it must be enabled in Setup > Personalize > Advanced (see page 103). The Disconnect feature allows you to manage being disconnected from the pump. It prompts you to deliver a disconnect bolus before disconnecting, gives a reminder to reconnect, and prompts you to deliver a reconnect bolus.
Delivering Insulin Check blood glucose? Yes k Current Blood Glucose 140 mg/dl Target: 130 mg/dl Factor: 1 unit per 25 mg/dl Bolus for 40% of 1.00u missed basal delivery 0.40 k
Delivering Insulin Check blood glucose? Yes k Current Blood Glucose 140 mg/dl Target: 130 mg/dl Factor: 1 unit per 25 mg/dl › If the Correction Bolus feature is enabled, this screen is displayed. If you want to perform a blood glucose test before reconnecting, with Yes highlighted press Next or If you do not want to perform a blood glucose test now, choose No then press Next.
Delivering Insulin Current Blood Glucose 140 mg/dl Target: 130 mg/dl Factor: 1 unit per 25 mg/dl » If using the CoZmonitor® module, insert a FreeStyle® test strip now and perform a blood glucose test or Perform a blood glucose test with your meter and specify your result, then press Next. NOTE: If you check your blood glucose and it is LOW, you may want to back up to change the percentage of missed basal that you had selected. Press Back, then press Back again. Bolus for 40% of 0.
Delivering Insulin Notes __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ _____________
Delivering Insulin Notes __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ _____________
About alarms Troubleshooting • Alarms and alerts • Other messages Cleaning your pump Servicing your pump Disconnecting from the pump Your basal rates, boluses, and • Your weight • Your level of exercise • Your growth • Your menstrual period • Starting new medications/ supplements If you drop your pump or hit it hard Your pump and • Extreme temperatures • Water • Contact sports 169
Help 170
Help About alarms (beep/vibrate settings) The pump can be set to “Beep” or “Vibrate” when an alert or alarm occurs (see page 90). With Beep selected, you can also choose whether the pump beeps when you press a key. When Vibrate is selected, the pump will not beep (or vibrate) when keys are pressed. NOTE: Vibrate shortens battery life.
Help Troubleshooting Alarms and alerts Message in display ! Alert BG is below target or may drop below target. No bolus suggested. Battery depleted Delivery stopped Insert a new battery ! Battery Low Change battery soon OK ! BG Alert X
Help Alarms and alert—continued Message in display ! Blockage detected No delivery. Check tubing or site for blockage OK ! Bolus Increased Correction increased by xx % Due to BG equal to or above xxx mg/dl Q Bolus interrupted Remaining Amount: Duration: Continue? ! Bolus programming not completed Cartridge empty Insert filled cartridge to continue delivery What it means / Alarm How to make it stop Delivery stops.
Help Alarms and alert—continued Message in display ! Cartridge very low Basal is delivering No bolus allowed or bolus suspended OK ! Cartridge Very Low Reconnect is allowed but no reconnect bolus can be delivered Cartridge Volume Low Change cartridge soon OK ! Check blood glucose Disconnecting. Insert strip now or Press OK and Manually enter BG. ! Check blood glucose Reconnected. Insert strip now or Press OK and manually enter BG.
Help Alarms and alert—continued Message in display Q Check blood glucose Your last blood glucose was low What it means / Alarm It is time to recheck your blood glucose after a low test result. Attention alarm. You are using the optional Low Blood Glucose alert, and your last blood glucose test showed a low result. Press OK and perform another blood glucose test. Treat blood glucose lows as indicated on page 27. While the CoZmanager® 2.
Help Alarms and alerts—continued Message in display ! Hypo Manager BG below or may drop below target. Fast-acting carbs are suggested. ! Hypo Mgr. Not Available Meal bolus must use grams-carbs. Correction must be enabled for meals
Help Alarms and alerts—continued Message in display ! No bolus allowed Cartridge volume is very low What it means / Alarm How to make it stop You attempted to deliver a bolus, but the cartridge volume is too low. Single alarm. Press OK. Load a new cartridge, then deliver the bolus. You attempted to deliver a bolus while the pump was stopped. Single alarm. Press OK. Restart the pump, then deliver the bolus. You have reconnected following a Disconnect.
Help Alarms and alerts—continued Message in display ! Program Defaulted You must program the pump OK ! Pump is Stopped Reconnect is allowed but no reconnect bolus can be delivered.
Help Alarms and alerts—continued Message in display ! Temporary rate complete What it means / Alarm How to make it stop The pump was delivering a Temporary Rate, which is now completed. Attention alarm. Press OK. The pump has returned to the normal basal pattern. This is the Automatic Off alarm. Continuous alarm. If you are able, press OK. This indicates that no keys or buttons were pressed for an extended period (you select the interval when setting the feature).
Help Other messages Message in display ! Active basal set to xxxxxxxx. Temp basal ended xxxxxxxx. What it means / Alarm How to make it stop You have turned the Weekly Schedule feature off while running a Temporary basal pattern. Single alarm. Press OK. If desired, turn the Weekly Schedule feature back on in Setup > Personalize > Advanced. The pump detected: during power up, all basal pattern rates are programmed to zero; or, you selected “Start using” for a pattern in which the rates are all zeros.
Help Messages—continued Message in display ! XXXXX Basal Test Basal test ended. Upload test data for analysis. What it means / Alarm How to make it stop Your Basal Test is complete, and the test data are ready for review. Single alarm. Press OK. If desired, upload your history to the CoZmanager 2.0 software to review the results. You are using the Basal Testing feature, and it is time to take your final blood glucose test. Single alarm.
Help Messages—continued Message in display ! Check BG Now Snooze for 15 minutes or press Next to check BG
Help Messages—continued Message in display ! Editing will end the midnight temporary basal pattern. ! Editing will end today’s temp basal pattern ! Editing weekly schedule will end temporary rate.
Help Messages—continued Message in display Q End Basal Test? Entering the Load menu will end the test. Continue?
Help Messages—continued Message in display ! No cartridge detected Cartridge missing or overfilled Install cartridge to confirm sensor Cancel ! Confirm Not complete Additional programming of this feature is required What it means / Alarm How to make it stop You have attempted to use the “Load” portion of the load cartridge menu, but no cartridge is detected. It may also mean that you filled the cartridge too full (more than 300 units). Single alarm.
Help Messages—continued Message in display Q Temporary Rate Active Changing basal pattern will end remaining temporary rate
Help Cleaning your pump Servicing your pump Routinely clean your pump to prevent buildup of dirt or dried fluids. Try to wipe spills off the pump right away to avoid a sticky buildup, which will be harder to wipe off later. When cleaning your pump, ONLY use a sponge or soft cloth with a solution of warm water and a mild soap, such as liquid dish or hand soap. If your pump becomes damaged or broken, or if it is not working properly, you will need to call Smiths Medical MD, Inc.
Help Disconnecting from your Deltec Cozmo® insulin pump There may be times when you want to disconnect from your pump. Check with your physician/healthcare provider for specific instructions. Some general guidelines are given below. When you disconnect from your Deltec Cozmo® pump for two hours or less • Use the Disconnect feature (see page 163) – or – • Check your blood glucose. • Give a bolus using your Deltec Cozmo® pump according to your correction factor if your blood glucose is above target.
Help Your basal rates, boluses, and Your weight Your weight can have a significant effect on how your body uses insulin. If you experience a significant weight loss or weight gain, contact your healthcare provider. Your basal pattern(s) and boluses may need to be modified. Your level of exercise Exercise can have a significant effect on how your body uses insulin. When you are exercising, your body may need less insulin.
Help If you drop your pump or hit it hard If you drop your pump or hit it against something hard, you will need to immediately look it over carefully to make sure it is not damaged. Disconnect your infusion set from your body and suspend delivery until you have made sure the pump is working correctly (see instructions provided with the infusion set for disconnecting). Remove the battery, then reinsert it. The pump will perform the self-tests, and let you know if there is a problem.
Blood glucose testing and history • The CoZmonitor® Blood Glucose Module • Using the BG menu 191
Blood Glucose Testing 192
Blood Glucose Testing Blood glucose testing and history NOTE: For 10 minutes after a BG reading is manually entered or automatically entered using the CoZmonitor® Blood Glucose Module it will be displayed as the current BG in the Correction bolus programming screen. During this 10 minutes you will not be able to change this value. Once the 10 minutes has expired, your target BG will be displayed in the programming screen and you can increase or decrease the value as desired.
Blood Glucose Testing Using the BG menu NOTE: In order to use the BG home screen you must have it enabled in Setup > Personalize > History (see page 98). In this menu you can enter a 150 u 7 3 blood glucose test result into BG #A Cozmo pump history, review your test Last BG 145 mg/dl at 11:30 AM result history and stop insulin on 06/20/06 delivery.
Blood Glucose Testing Enter current blood glucose 167 mg/dl 1 7 #A Cozmo 293 u BG Last BG 167 mg/dl at 08:30 AM on 06/20/06 • The “Last BG” home screen is updated with the latest information.
Blood Glucose Testing Notes __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________
History on the pump • Viewing history • Bolus summary • View blood glucose history (quick access) • View bolus history (quick access) History using the CoZmananger® 2.
Viewing History 198
Viewing History History The pump stores history in 2 ways: • By the delivery date. The pump stores delivery information for the previous 90 days • As events. The pump stores information for the previous 4000 events. History can be viewed directly on the pump screen, as well as using the CoZmanager® 2.0 PC Communications Software (see page 204 for more information). Only those reports that you have enabled will appear in History in the main menu.
Viewing History Viewing history in the History menu Once the reports are set to display in the menu (see Setup > Personalize > History, page 98), you can view them as part of History in the main menu (bolus history and blood glucose history can also be accessed from the optional home screens). When your pump is new, you must allow enough time for the pump to accumulate history.
Viewing History Bolus Summary Viewing the Bolus Summary is somewhat different than other history reports. Bolus Summary can also be viewed from home screen 2. ___________________________ 1 293 u Cozm o NOTE: The pages available in this report depend on how your pump is personalized. If you are not using the Carbohydrate bolus, the “Carbs” page will not be part of this report. Also, if you are not using the Correction Bolus feature, the BG screen of this report will not appear.
Viewing History View blood glucose history (quick access) E Basal Pattern Load History Setup You can quickly access your blood glucose history using this feature. (Average blood glucose history is only viewable in the History menu.) ___________________________ 1 7 #A Cozmo 293 u Basal: Pattern 1 Rate: 1.150 u/hr 1 293 u Cozm 7 Last Bo at 08:3G 167 mg # BG on 06 0 AM /dl /20/0 6 < A Stop -B G k Men u> • From the BG home screen, press Stop-BG.
Viewing History View bolus history (quick access) You can quickly access your Bolus history using this feature. ___________________________ 1 293 u Cozm o 7 B Bolus 1.00 ucomplet # - 09:0 ed 0 AM Stop -R ev k Men u> • From home screen 2 press Stop-Rev. Bolus History Menu Bolus Summary Bolus History Therapy Scorecard Stop Delivery Bolus History 09:00 AM 06/20/06 Touch Bolus programmed 1.00 units
Viewing History Viewing, saving, printing and e-mailing History Reports using the CoZmanager® 2.0 PC Communications Software You can download all of the history reports stored in your pump’s memory onto your PC. If you use the CoZmonitor® Blood Glucose Module with your pump, there is an additional report available in the CoZmanager® 2.0 software called the Logbook which contains all delivery information as well as information for all blood glucose tests performed.
Viewing History General information about the History view Buttons designated 1, 2 and 4 are not always enabled, or available for use. Button 1 (Get from pump) is only enabled when you have established communications with the pump. Buttons 2 and 4 (View report and Save) are only enabled when you are actually viewing a report. q Get from pump button—If enabled, click to get the pump’s history and load it into the CoZmanager® 2.0 software.
Viewing History Getting history from the pump . (If you are already in the • If necessary, click History Reports screen, you will not need to perform this step.) • Establish communications between the pump and the PC as described previously in Communicating with the pump. . A dialog box appears where you can • Click choose which parts of the CoZmanager® 2.0 software you want to send to the pump. Click the items you want to send then click OK.
Finetuning How to adjust your basal rate(s) • Guidelines for testing your basal rates Basal testing • Test setup • Activating a basal test • Viewing basal test history Therapy effectiveness scorecard 207
Finetuning Your Settings 208
Finetuning Your Settings Finetuning During the first three months and/or as directed by your healthcare provider you should monitor and record: • Blood glucose levels (fasting, pre-meal, two hours after the start of your meal).
Finetuning Your Settings Overnight basal test Test and adjust your overnight basal rate first. If this basal rate(s) is correct, the amount of insulin being delivered compensates for the increase in your fasting blood glucose results. Your blood glucose should remain steady during the night, and typically vary no more than 30 mg/dl (2 mmol/L) from the starting point. If you have a dawn phenomenon, the rate may need to be increased.
Finetuning Your Settings Select Test Morning Afternoon Evening Overnight Overnight BG Limits End test if BG is: Below: 70 mg/dl Above: 200 mg/dl Overnight BG Reminder Times Duration: 09:00PM 09:00 12:00PM hrs:mins 03:00AM 06:00AM Alerts: 4 m Overnight BG Reminder Times Duration: 09:00PM 09:00 12:00PM hrs:mins 03:00AM 06:00AM Alerts: 4 m Overnight BG Reminder Times Duration: 12:00PM 09:00 03:
Finetuning Your Settings Activating a basal test Load History Setup Basal Testing 1 7 #A Cozmo 293 u Basal: Pattern 1 Rate: 1.150 u/hr Once you have set up the desired test, it can be performed at any time. Before beginning, test your blood glucose level and make sure it is within the appropriate range, and that you have not eaten for five hours before beginning the test, or as directed by your healthcare provider.
Finetuning Your Settings Overnight BG Limits Test ends if BG is: Below: 70 mg/dl Above: 200 mg/dl Overnight BG Reminder Times Duration: 09:00PM 09:00 12:00PM hrs:mins 03:00AM 06:00AM Alerts: 4
Finetuning Your Settings Ending a basal test early ___________________________ Basal Testing Current Status Review or Edit End Overnight Test History Load History Setup Basal Testing Men u> • Press Menu. 1 7 #A Cozmo 293 u Basal: Pattern 1 Rate: 1.150 u/hr Load History Setup Basal Testing
Finetuning Your Settings Viewing basal test history l Select> 1 7 #A Cozmo 293 u Basal: Pattern 1 Rate: 1.150 u/hr You can view the results of your basal rate test either directly on the pump screen or using the CoZmanager® 2.0 software. When viewed on the pump, each blood glucose test result is displayed separately, as well as other events relating to the test and any other conditions present during the test. Using the CoZmanager® 2.
Finetuning Your Settings Viewing test history on the pump ___________________________ Load History Setup Basal Testing Basal Testing Activate Review or Edit History
Finetuning Your Settings Therapy effectiveness scorecard The Deltec Cozmo® insulin pump has a Therapy Effectiveness Scorecard report that summarizes delivery-related information. It provides diabetes therapy information at a glance. The Therapy Effectiveness Scorecard report can be accessed through either the Blood Glucose home screen or the home screen 2 (see page 202). The dose information for your current day is not included in the report (only information for complete days is included).
Finetuning Your Settings 7 Day average BG xx.xx mg/dl Tests xx/day Std Dev xx mg/dl Blood Glucose Menu Enter BG value BG History Therapy Scorecard Stop Delivery • Page two of the report shows the Average Blood Glucose History screen, and will be shown in mg/dl or mmol/L, whichever you use to measure your blood glucose.
Finetuning Your Settings means that your readings are very stable around the average (which will hopefully be close to your Target blood glucose). A large standard deviation may indicate that your blood glucose is not in good control, while a small standard deviation can indicate tight control. For an example of this, we could look at two sets of results, from two different periods.
Finetuning Your Settings Notes __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ _______
Topic: Backlight Topic: Battery in pump Topic: Bolus delivery Topic: CoZmonitor® module tips Topic: CoZmanager® 2.
Frequently Asked Questions (FAQ) 222
Frequently Asked Questions (FAQ) Topic: Backlight Topic: Battery in pump How do I turn on my backlight? You can personalize your pump so that the backlight lights in one of two ways: either “manually” when you press the c key from the screensaver, or if you prefer you can have it light whenever the pump is “awake” (not at the screensaver screen). If you choose to have it turn on manually, from the screensaver press 10:10 AM 1.150 c; while you are pressing buttons the backlight will remain on.
Frequently Asked Questions (FAQ) • Make sure that the battery cap is fully tightened. The battery cap is fully tightened when the battery cap o-ring is not visible, the cap fits snug, and when you press on the battery cap the pump does not produce a chirp. If the pump sounds a brief alert (“chirp”), the cap is not fully tightened and should be tightened further. If you are unable to tighten the cap and eliminate this chirp, the pump should not be used. Contact your pump provider or Smiths Medical.
Frequently Asked Questions (FAQ) Topic: Bolus delivery I want to give a meal bolus using grams of carbohydrate instead of units of insulin. If you want to change how the pump delivers a meal bolus, there are two menus on the pump for doing this, the Setup > QuickStart™ menu (see page 84) or the Setup > Delivery > Meal Bolus menu (see page 105).
Frequently Asked Questions (FAQ) Topic: CoZmonitor® module tips NOTE: The CoZmonitor® Blood Glucose Module may not be available in all markets. If you do not have or do not plan to use the CoZmonitor® module you do not need to read any instructions associated with it. When I insert a FreeStyle® test strip into the module it doesn’t turn on. • Verify that the pump is at one of the home screens or the current blood glucose screen before you insert the test strip.
Frequently Asked Questions (FAQ) The CoZmonitor® module doesn’t fit securely against my pump. • Make sure you are using the battery cap that was supplied with the CoZmonitor® module rather than the one originally supplied with your pump. The battery cap supplied with the module is slightly longer than the standard battery cap, so that it holds the module against the pump and still holds the battery in place.
Frequently Asked Questions (FAQ) Topic: CoZmanager® 2.0 PC Communications Software tips Communicating with the pump • Make sure the software is installed on your PC before beginning (see page 118). • Once installed on your computer, an icon is added to your desktop. Double-click the icon to open the software. When launched, the software always opens to the Personalize screen (which is where you personalize the pump program). • If you have a CoZmonitor® Blood Glucose Module attached to the pump, detach it.
Frequently Asked Questions (FAQ) Topic: Infusion sets and cartridges Why do I have site pain with my infusion set? • If the pain occurs at the time of insertion: • Check with your healthcare provider for a product to numb your insertion site such as Emla® or ELA-MAC® cream (you may need a prescription for some products). – or – • Numb the site with an ice cube for a few minutes and then insert the infusion set.
Frequently Asked Questions (FAQ) I have bubbles in the cartridge. • Fill your cartridge with room temperature insulin. If you use cold insulin, as it warms to room temperature it will create bubbles in the cartridge. • When you are filling the cartridge, point the tip straight up and tap the cartridge barrel with your fingernail to cause all the small air bubbles to float to the top into one big bubble. Then push the plunger forward to get rid of the air and continue filling.
Patient resources for pump therapy 231
Resources 232
Resources Patient resources for insulin pump therapy • Advanced Carbohydrate Counting, American Diabetes Association and American Dietetic Association, 2003 • American Diabetes Association Tel : 1-800-DIABETES (1 800.342.2383) Web page: www.diabetes.org • Basic Carbohydrate Counting, American Diabetes Association and American Dietetic Association, 2003 • Complete Guide to Carbohydrate Counting, Warshaw H and Kulkarni K, American Diabetes Association, Second Edition 2004 • Children with Diabetes.
Resources 234
Pump development standards Specifications • General • Delivery Accuracy test results Safety features and fault detection Inspecting the pump Warranty Index 235
Technical Information 236
Technical Information Pump development standards AAMI HE48(1993)—Recommended Practice - Human Factors Engineering Guidelines and Preferred Practices for the Design of Medial Devices” (February 5, 1988 Version) Design guideline. EN 60601-1 (1990)—Medical Electrical Equipment, Part 1. General requirements for safety. Amendment A1 (1993) Amendment A13(1996) Amendment A2 (1995).
Technical Information Guidance and manufacturer’s declaration—electromagnetic emissions The Pump is intended for use in the electromagnetic environment specified below. The customer or the user of the Pump should assure that it is used in such an environment. Emissions test Compliance Electromagnetic environment - guidance RF emissions, CISPR 11 Group 1 The Pump uses RF energy only for its internal function.
Technical Information Guidance and manufacturer’s declaration—electromagnetic immunity The Pump is intended for use in the electromagnetic environment specified below. The customer or the user of the Pump should assure that it is used in such an environment.
Technical Information Specifications General specifications (nominal) Minimum increment of resolution: 0.005 Units per activation Size: 3.2 in × 1.8 in × 0.95 in (80 mm × 47 mm × 24 mm) Weight: Approximately 3.2 ounces (90 g) including battery and cartridge Classification: Type CF J (protection from electric shock) Moisture protection: IPX8 (watertight to a depth of 12 feet [3.64 meters] for 3 minutes, or 8 feet [2.
Technical Information Delivery rate during bolus: Approximately 0.01 units per second minimum, 2.5 units per second maximum (based on bolus amount and bolus delivery time—bolus duration personalizable from 1 to 5 minutes) Delivery rate during Fill tubing/Fill cannula: Approximately 1 unit per second Basal delivery interval: Delivery rates of 0.1 u/hr or higher, every 3 minutes (approximately 1/20 basal rate); delivery rates of less than 0.
Technical Information Temporary Rate If enabled, user can program and #K deliver a temporary basal rate. Meal Bolus Correction Bolus If enabled, any custom temporary Temporary Rate Basal Pattern rates appear in menu. Select> Percent: 0% (zero) or 10% to 250%
Technical Information View: Memory: Reports: last 90 days, arranged from most recent to oldest Events: last 4000 events, arranged from most recent to oldest Averages: User chooses number of days to average over: 2 to 30 days in 1 day increments Default: 7 days Setup User programs all parameters used by the pump. QuickStart™ feature User sets the time and date and programs the necessary parameters to be used by Meal Bolus, Correction Bolus and Basal Pattern.
Technical Information Personalize Personalize is a sub-menu. Setup Menu QuickStart Pump Settings Personalize Delivery Delivery Limit: Alert at 1 unit to 150 units in 1 unit increments . Default: 40 units Glucose Reminder: Yes or No . Default: No . If Yes, user chooses interval: 01:00 to 04:00 hours in 00:15 increments. .
Technical Information Bolus Summary: Yes or No . Default: Yes Regional Settings Time Format: 12-hour or 24-hour . Default: 12-hour Date Format: mm/dd/yy or dd/mm/yy . Default: mm/dd/yy Number format: Decimal shown as Period or Comma . Default: Period Display Turn backlight on: When Awake or Manually .
Technical Information Correction Factor: User may program 1 to 24 separate correction factors in increments of 30 minutes. . Default: A single correction factor, programmable in the following increments: . mg/dl: 5 to 400 mg/dl in the following increments: • 5 to 30 mg/dl in increments of 1 mg/dl • 30 to 100 mg/dl in increments of 5 mg/dl • 100 to 400 mg/dl in increments of 10 mg/dl . Default: 40 mg/dl . mmol/L: 0.2 to 23 mmol/L in the following increments: • 0.2 to 1.5 mmol/L in increments of 0.
Technical Information Basal Testing User programs and conducts basal Load History rate test(s). Setup Tests: Morning, Afternoon, Evening, Basal Testing Overnight Low blood glucose limits: mg/dl: 50 to 100 mg/dl in 1 mg/dl increments Default: 70 mg/dl mmol/L: 2.8 to 5.6 mmol/L in 0.1 mmol/L increments Default: 4 mmol/L High blood glucose limits: mg/dl: 150 to 300 mg/dl in 5 mg/dl increments Default: 200 mg/dl mmol/L: 8.3 to 16.7 mmol/L in 0.
Technical Information Accuracy test results The following graphs are designed to show flow accuracy of the pump against given time periods. All graphs were plotted using a Deltec Cozmo® 3 mL Insulin Cartridge (21-1750) and Unomedical Comfort Infusion Set. Flow rate from startup Time interval: 15 minutes Total time: 1455 minutes (24 hours, 25 minutes) Programmed rate: 2 units/hr ™ Flow rate from startup Time interval: Total time: Programmed rate: &LOW ML HR .
Technical Information Safety features and fault detection the watchdog circuit prevents motor operation if the watchdog timer expires. The software verifies this function during the watchdog test described above. Hardware safety features Voltage detector circuit Key hardware safety features include a watchdog timer circuit, motor driver and motor watchdog circuits, and a voltage detector circuit. Each safety circuit performs a unique function to ensure the overall safety of the pump.
Technical Information Software safety features Hardware-related software safety features Program memory check At power up and regular intervals thereafter, the program memory is tested by calculating a Cyclic Redundancy Code (CRC) on the program and then comparing it with the CRC stored with the program. If the stored and calculated CRC do not match, the software stops insulin delivery, initiates an alarm (either beep or vibrate) and a system fault alarm message appears in the display.
Technical Information Inspecting the pump Other than periodic visual inspection and cleaning of the pump, no testing of the pump is required. The pump’s internal software, hardware and dual microprocessors are constantly checked while the pump is operating, and during the self tests performed during power up. • Visually inspect the pump for any damage to the pump’s outer shell. Look for chips or cracks. If the outer shell is chipped or cracked, the pump will no longer be watertight.
Technical Information this chirp, the pump should not be used. Contact your pump provider or Smiths Medical. • Inspect the pump’s battery cap. The battery cap should be free of damage. If the cap shows signs of wear, such as cracks, or if the slot becomes worn, the battery cap should be replaced before the pump is used. Contact your pump provider or Smiths Medical for a replacement battery cap.
Warranty Limited Warranty Exclusions: Smiths Medical MD, Inc. (the “Manufacturer”) warrants to the Original end-user Purchaser that the Deltec Cozmo Insulin Pump (the “Pump”), excluding accessories, shall be free from defects in materials and workmanship under normal use, if used in accordance with this User’s Manual, for a period of four (4) years from the date of purchase by the Original end-user Purchaser.
Index Index A Accuracy 240, 248 Advanced menu 103, 245 Disconnect bolus 163 Weekly schedule, setup 156, 161 Alerts/Alarms 94, 95, 240 Automatic off alarm 95, 177, 179 Custom reminders 94 Delivery limit 59, 94, 175 Depleted battery 172 Glucose reminder 94, 172 High blood glucose reminder 95, 172, 174 Infusion site change reminder 59, 135, 174, 178 Low battery alert 172 Low blood glucose reminder 95, 172, 175 Low cartridge volume 59, 94, 174 Missed meal bolus alert 59, 176 Occlusion (blockage) 173, 240 Site
Index Extended bolus 5, 19, 58, 175 Delivery 144 Setup 105 F Fill cannula 134 Filling the tubing 134 Fluid path 5 Food database 107 G General specifications 240 Glossary 4 Glucose reminder 94 Infusion site 4, 134 Selection 33 Troubleshooting 41 Infusion site change reminder 59, 135, 174, 178 Inpatient hospital tips 52 Inspecting the pump 251 Insulin on board 26, 172 Insulin on board home screen 72, 110 Insulin-to-carbohydrate ratio 6, 22 Meal Maker 106, 121, 140, 145, 147 CoZfoods 4, 57, 106, 121, 143 F
Index Site reminder alert 89, 95, 97, 174, 178 Site reminder home screen 72, 95 Smiths Medical MD, Inc.
Smiths Medical MD, Inc. St. Paul, MN 55112 USA 1 800.826.9703 (USA) Fax: 1 800.209.2145 (USA) www.CozMore.com @ B Smiths Medical International Ltd. WD24 4LG, UK Tel. +44 (0)1923 246434 Deltec Cozmo, CoZmanager, CozMore, Meal Maker, Cleo, CoZmonitor, Hypo Manager, CozFoods, QuickStart and the Smiths Medical design mark are trademarks of the Smiths Medical family of companies. The symbol indicates the trademark is registered in the U.S. Patent and Trademark Office and certain other countries.
