ACCU-CHEK ® Combo - ACCU-CHEK Insulin Pumps

ACCU-CHEK ® 

Combo 

Training Handbook mmol/L

Congratulations on choosing 

the ACCU-CHEK ® Combo system! 

Your new insulin pump system will help you manage your diabetes easily, quickly and discreetly. 

It will help you to live life the way you want. 

This handbook is provided as part of your training on the new ACCU-CHEK Combo system. It will help 

you set up your insulin pump and your meter so that they quickly become part of your daily life. 

! 

This document is not intended to replace training by a qualified diabetes instructor or the 

User Guide and Owner’s Booklets provided with your new system. 

Before starting therapy with your ACCU-CHEK Combo system, please consult your ACCU-CHEK 

Spirit Combo Insulin Pump User Guide and ACCU-CHEK Aviva Combo Meter Owner’s booklets 

for detailed information regarding warnings and precautions related to their use. 

In this handbook the term “meter” always refers to the ACCU-CHEK 

Aviva Combo blood glucose meter. 

The term “pump” always refers to the 

ACCU-CHEK Spirit Combo insulin pump.

Structure of This Training Handbook 

The chapters explaining the handling of the pump together 

with the meter are highlighted in dark blue and marked with . 

The chapters explaining only the handling of the 

pump are highlighted in light blue and marked with . 

The chapters explaining only the handling of 

the meter are highlighted in green and marked with . 



The handbook is divided into a Standard and an Advanced section. This will enable you to learn all the 

features and functions of your new ACCU-CHEK Combo system easily, whether you are new to pump 

therapy or already experienced. 

In the Standard section, you will learn about the basic functions of your new insulin pump system, 

necessary for successfully starting pump therapy. 

When you have completed the Standard section, you will know how to: 

• Run your ACCU-CHEK Spirit Combo insulin pump with one basal rate 

• Administer a standard bolus 

• Use your meter to remotely control your insulin pump 

• Test your blood glucose (bG) level using your ACCU-CHEK Aviva Combo meter 

After getting some experience in pump therapy, you can move on to the Advanced section, where you will 

learn to use the complete range of convenient and helpful features of your new ACCU-CHEK Combo system. 

When you have completed the Advanced section, you will know how to: 

• Use Bolus Advice 

• Set a variety of reminders 

• Interpret the values of your personal data collection in the meter database 

• Use different bolus types 

• Personalize your pump

Table of Contents 

Standard Lesson 9 

Section 1: Features of Your ACCU-CHEK Combo System 11 

Section 2: Preparation and Start-Up 17 

2.1 Filling the Cartridge 17 

2.2 Site Preparation 21 

2.3 Infusion Site Selection 22 

2.3 Infusion Site Rotation 24 

Section 3: Your ACCU-CHEK Spirit Combo Insulin Pump 27 

3.1 Summary of Functions 28 

3.2 Key Functions 30 

3.3 Inserting / Changing the Battery 32 

3.4 STOP Mode at a Glance 35 

3.5 Setting the Time and Date 36 

3.6 Programming Your Basal Rate Profile 38 

3.7 Copying an Hourly Basal Rate 40 

3.8 Returning the Piston Rod 42 

3.9 Connecting the Cartridge, Adapter and Infusion Set 43 

3.10 Inserting a New Insulin Cartridge 44 

3.11 Priming the Infusion Set 47 

Section 4: Starting and Stopping Insulin Delivery 49 

4.1 Starting Insulin Delivery 49 

4.2 Stopping Insulin Delivery 50 

Section 5: RUN Mode at a Glance 51 

5.1 Programming a Quick Bolus 52 

5.2 Cancelling a Quick Bolus 54 

Section 6: Your ACCU-CHEK Aviva Combo Meter 55 

6.1 Summary of Features and Functions 55 

6.2 Button Functions 57 

Section 7: Preparation and Start-Up 61 

7.1 Setup Wizard 61 

7.2 STANDARD User Menu 68



Section 8: Using Your ACCU-CHEK Combo System 69 

8.1 Using the Meter to Control the Pump 69 

8.2 Operating Your Pump 70 

Section 9: Standard Menu Functions 71 

9.1 Checking Your Pump 71 

9.2 Programming a Standard Bolus 72 

9.3 Cancelling a Standard Bolus 74 

9.4 Programming a Temporary Basal Rate (TBR) 75 

9.5 Cancelling a Temporary Basal Rate (TBR) 77 

9.6 Pump Settings 78 

Section 10: Warnings and Errors 83 

Section 11: Switching Bluetooth ® Communication On / Off 87 

11.1 Switching OFF Bluetooth ® Capability on the Pump 87 

11.2 Switching OFF Bluetooth ® Capability on the Meter 88 

Section 12: Measuring Your Blood Glucose (bG) Level 89 

12.1 Coding Your Meter 89 

12.2 Running a Control Test 90 

12.3 Performing a Blood Glucose (bG) Test 93 

12.4 Summary of Advanced Lesson 97 

Advanced Lesson 99 

Section 13: Getting Bolus Advice from Your Meter 101 

13.1 About Bolus Advice 101 

13.2 Setting Up Bolus Advice 102 

13.3 Using Bolus Advice 111 

13.4 Choosing Your Bolus Type 118 

Section 14: Managing Your Data 121 

14.1 Viewing Your Data 124 

14.2 Editing Your Data 126 

14.3 Adding Data 127 

14.4 Reporting Data 129

Section 15: Using Reminders 141 

15.1 To Set Reminders 142 

15.2 bG Test Reminders – After High bG 143 

15.3 bG Test Reminders – After Low bG 145 

15.4 bG Test Reminders – After Meal 147 

15.5 Alarm Clock 149 

15.6 Date Reminders – Dr. Visit 151 

15.7 Date Reminders – Lab Test 153 

15.8 Date Reminders – Infusion Set Change 155 

Section 16: Changing Your Meter Settings 157 

Section 17: ACCU-CHEK Spirit Combo User Menus 161 

Section 18: Choosing Your Bolus Type 163 

18.1 Programming an Extended Bolus 164 

18.2 Cancelling an Extended Bolus 166 

18.3 Programming a Multiwave Bolus 167 

18.4 Cancelling a Multiwave Bolus 170 

Section 19: Additional Basal Rate Profiles 173 

19.1 Setting Basal Rate Profiles 173 

19.2 Selecting a Basal Rate Profile 175 

Section 20: Therapy Settings 177 

20.1 Adjusting the Bolus Increment 177 

20.2 Adjusting the Prime Amount 179 

20.3 Locking Basal Rate Profiles 180 

20.4 Automatic Off 182 

Section 21: Setting a Reminder on the Pump 185 

Section 22: CUSTOM User Menu 189 

Section 23: Transferring Your Pump Data to a Computer 191 

Section 24: Pairing Your Pump with the Meter 193 

24.1 Pairing the Pump and Meter 193 

24.2 Troubleshooting the Bluetooth ® Connection 196



Appendixes 199 

Appendix A: Calculating a Bolus 201 

Appendix B: Bolus Advice Calculations 207 

Appendix C: The Mathematical Basis for Bolus Calculations 223 

Appendix D: Errors, Warnings and Reminders 227 

Appendix E: Controlling Pump Functions Through the Pump Menu 233 

E9 Standard Menu Functions 235 

E9.1 Checking Your Pump 235 

E9.2 Programming a Standard Bolus 236 

E9.3 Cancelling a Standard Bolus 238 

E9.4 Programming a Temporary Basal Rate (TBR) 239 

E9.5 Cancelling a Temporary Basal Rate (TBR) 241 

E9.6 Pump Settings 242 

E17 ACCU-CHEK Spirit Combo User Menus 247 

E18 Choosing Your Bolus Type 249 

E18.1 Programming an Extended Bolus 250 

E18.2 Cancelling an Extended Bolus 252 

E18.3 Programming a Multiwave Bolus 253 

E18.4 Cancelling a Multiwave Bolus 256 

E19 Additional Basal Rate Profiles 259 

E19.1 Setting Basal Rate Profiles 259 

E19.2 Selecting a Basal Rate Profile 261 

E20 Therapy Settings 263 

E20.1 Adjusting the Bolus Increment 263 

E20.2 Adjusting the Prime Amount 265 

E20.3 Locking Basal Rate Profiles 266 

E20.4 Automatic Off 268 

E21 Setting a Reminder on the Pump 271

On your mark. 

Get set. 

Go! 

Standard Lesson

1. Features of Your ACCU-CHEK Combo System 

ACCU-CHEK Aviva 

Combo meter 

Features of your ACCU-CHEK Combo System 

ACCU-CHEK Spirit Combo 

insulin pump 

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Your ACCU-CHEK Spirit Combo Insulin Pump

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Delivers insulin 24 hours a day, 365 days a year, according to your daily insulin 

need. Basal insulin delivered every 3 minutes (20 intervals per hour) to best 

simulate physiological insulin supply. 

Five basal rate profiles to match varying daily routines. 


Administers 4 different types of boluses, covering your insulin needs for all 

kinds of food intake as well as for a variety of health-related situations. 

Adapts to your knowledge and experience in managing your diabetes, offering 

3 different user menus, from basic to advanced. 

Communicates with the meter to enable remote control and shared data handling. 

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Your ACCU-CHEK Aviva Combo Meter

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Measures your blood-glucose (bG) level within 5 seconds. 

Enables remote control of your ACCU-CHEK Spirit Combo insulin pump. 

Manages your diabetes-related data in a diary and reports them as graphs 

and statistics. 

Provides you with bolus advice. 


Facilitates bG test, Bolus Advice and bolus delivery in less than 1 minute. 

Reminds you about a great variety of therapy-related tasks. 

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2. Preparation and Start-Up 

2.1 Filling the Cartridge 

1 

2 

3 

Prepare the materials: 

• A 10 mL insulin vial at room temperature 

• An ACCU-CHEK Spirit 3.15 mL cartridge system 

• A disinfectant solution or tissue 

Wash your hands. 

Unpack the cartridge system. 

Preparation and Start-Up 

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18 

4 

5 

6 

7 


Clean the rubber membrane of the insulin 

vial with a disinfectant wipe. 

Pull the plunger of the cartridge back until 

you feel some resistance. 

Push the cartridge onto the insulin vial until 

it snaps into place. 

Press the plunger to its stop-point and hold 

it in this position.

8 

9 

10 

11 

Slowly turn the complete system upside 

down, carefully holding all components 

in place. 

Slowly release the plunger to let the insulin 

flow into the cartridge. If the cartridge is not 

filled completely, pull the plunger gently to 

draw more insulin. 

Remove any air bubbles by tapping the 

cartridge, pushing them back into the vial. 

Then pull the vial from the cartridge system. 

Remove the plunger by turning it 

counter-clockwise. 


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20 

12 

13 


Remove the filling aid while turning it 

counter-clockwise and pulling at the 

same time. 

For storage, push the protective cap 

onto the cartridge tip until it clicks. 

The plunger and the filling aid can be 

disposed of as household waste.

2.2 Site Preparation 

General Practices to Teach Patients 

Aseptic technique 

• Start with clean hands. 

Proper hand washing 

technique involves using an 

antibacterial soap and warm 

water for 2 minutes, then 

drying hands completely 

with a clean towel. 

• To cleanse the insertion area, start in the center 

of the area and wipe with a cloth moistened 

with antibacterial soap and warm water, sterile 

prep pad or alcohol swab in an outward and 

circular motion, cleaning an area about the size 

of a tennis ball. 

• Allow the area to air dry for at least 60 seconds; 

do not blow on the site to help it dry faster. 

Body hair 

• Trim the hair around the insertion area or use an 

electric razor; using other means of hair removal 

may lead to irritation and/or infection. 

Special Challenges for Some 

Pump Users 

Excessive perspiration 

or humidity 

• Use extra-strength 

adhesives. 

• When using products, make 

sure the skin is clean and 

dry between all applications 

and before insertion. 

• Sandwich technique — cleanse the skin using 

an adhesive wipe, allow to dry, apply a sterile 

dressing, insert the set into the dressing, and 

cover the set with another sterile dressing to 


“sandwich” the infusion set. It may be desirable 

to cut a hole in the center of the top sterile dressing 

to allow for easy disconnection. 

Athletes, children and very active people 

• Follow same procedure as for excessive 

perspiration or humidity. 

• Place the set in an area that will not be affected 

by the activity. 

People prone to infection 

• People prone to infection and pumpers on 

immunosuppressive agents or anti-rejection 

medications should perform a triple preparation 

procedure or as recommended by their physician 

or healthcare worker: 

• Wash the area with an antibacterial soap and 

let dry. 

• Cleanse the area with an antibacterial solution 

and let dry. 

• Apply an antiseptic and adhesive wipe to the 

area and let dry. 

• Pump users should supervise their infusion site 

more frequently and consider using the infusion 

set for a shorter time period than the maximum 

time specified in the user manual. 

Needle phobia 

• Numb the site 

• Numbing can be achieved with a topical 

anesthetic (numbing can take up to 30 

minutes with some products). If no anesthetic 

is available, the infusion site can be numbed 

by cooling for instance with ice. 

• It is important that the pump user is capable of 

inserting the set without numbing the skin for an 

emergency set change. 

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2.3 Infusion Site Selection 

Examples of recommended infusion sites 

Choose a site away from the waistline, bones, scar tissue, 

belly button and recent infusion sites. 

recommended 

possible

Recommended Areas & Absorption Differences 


Insulin absorption can vary according to infusion site. After choosing a new infusion site, close 

blood glucose monitoring will show any differences and help to adjust insulin requirements 

settings accordingly. 

Abdominal area 

• best absorption area 

Hips and buttocks 

• slower absorption than in the abdominal area, but an excellent location for people who are 

very active or who have low body fat 

Outer thighs 

• slower absorption than in the abdominal area, but absorption may increase with activity 

• use of the interior thigh area is not recommended since it can increase the risk of irritation 

and infection 

Back of the arms 

• slower absorption than abdomen, but absorption may accelerate with activity 

• this area is also more difficult to use if two hands are required for insertion 

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2.4 Infusion Site Rotation 

Abdominal Site Rotation Patterns 

• Using a pattern can help you manage site rotation 

• Choose a new site at least 2 inches (5 cm) from a recent site 

• Use any rotation pattern that fits your body and lifestyle 

• Avoid the area within 2 inches (5 cm) of your belly button 

• Avoid areas under waistbands 

Horizontal Pattern Curve Pattern 

Zigzag Pattern Crisscross Pattern 

Sites to Avoid 

• 2 inches around belly button • Scar tissue/surgical scars 

• High-sensitivity areas • Fatty tissue overgrowth 

• Under a waistband • Bruised areas 

• Areas exposed to rubbing or bumping • Liposuction 

• Over a bone • Body piercings 

• Blood vessels • Tattoos 

If unsure, contact your healthcare team before using a new site.

Site Rotation 

• Essential to successful insulin pump therapy 

• Change site location with every cannula 

change 

• Plan your rotation pattern to ensure sites have 

time to heal 

Benefits of Site Rotation 

• Lower infection risk 

• Optimized insulin absorption 

• Reduced potential for fatty tissue overgrowth 

• Reduced potential for scarring 

• Reduced variability in blood sugar levels 

Site Rotation Frequency 

• Immediately 

- Pain, irritation or bleeding at the infusion site 

- Two correction boluses fail to reduce high 

blood sugar level 

- Ketones are present in your blood or urine 

- Blood appears in the infusion set tubing or 

around the cannula 

• Every 24-48 hours 

- Steel cannula 

- Pregnancy 

• Every 48-72 hours 

- Soft cannula 

Note: Do not change your infusion set before 

going to bed since your blood glucose must be 

measured 1 to 3 hours after insertion. 


Infusion Set Change 

• If your blood glucose level is unexplainably high or 

your pump sounds an occlusion alarm, check for 

clogs and leaks 

• If in doubt, change your entire infusion set 

Potential Consequences of Poor Site Rotation 

Front View Side View 

• Increased risk of infection 

• Unpredictable insulin absorption 

• “Pump bumps” found at the point of insertion 

• Scar tissue 

• Lipohypertrophy—enlargement in the infusion site area 

- Can result in poor insulin absorption and increased 

insulin use 

- Infusion sites outside of the lipohypertrophy area 

may 

absorb insulin differently. Frequent blood sugar monitoring 

is recommended. 

Tip: Write the date on the infusion set adhesive dressing 

as a reminder to change your infusion set. 

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3. Your ACCU-CHEK Spirit Combo Insulin Pump 

Pump details and accessories 

Battery cover Battery 

Battery key 

Infrared window 

(next to battery cover) 

Piston rod 

End plate 

Your ACCU-CHEK Spirit Combo Insulin Pump 

Cartridge compartment 

Cartridge 

Cartridge plunger 

Adapter 

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3.1 Summary of Functions 

Three different menus adapted to your knowledge, experience 

and personal needs: 

STANDARD: Designed to be easy for beginners or those who want 

basic functions 

ADVANCED: Versatile—for more experienced users 

CUSTOM: Customizable by you or your healthcare professional in line 

with your personal needs and preferences 

Four bolus types to match your insulin needs in a variety of situations: 

• Quick bolus 

• Standard bolus 

• Extended bolus 

• Multiwave bolus 

Variable increments can be set for the Quick bolus 

(0.1, 0.2, 0.5, 1.0, 2.0 units) 

Communication with the ACCU-CHEK Combo meter using Bluetooth ® 

wireless technology enables remote control of the pump by the 

meter, as well as transfer of data such as bolus history for subsequent 

management in the meter database.

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Five basal rate profiles to match your varying daily routines. 

Temporary basal rate changes possible on a percentage basis. 

Alkaline, lithium or rechargeable batteries (AA, 1.5 V). 

Use of self-filled ACCU-CHEK Spirit 3.15 mL cartridge system. 

Warning and error messages signaled by beeps and/or vibrations. 

Fully adjustable volume of beep tone—from silent to loud. 

Key lock prevents accidental pressing of keys. 

Screen display shows text and symbols, and can be rotated 180 degrees. 

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3.2 Key Functions 

Key Name Function 

d Menu 

f OK 

f OK key 

d Menu key 

• Move through menus, function screens 

and information screens 

• Select a menu 

• Save changes and exit the function and information screens 

• View the Quick Info screen 

a Up key 

s Down key


a Up 

s Down 

• Move forward in the information screens 

• Increase a setting 

Combination Function 

d + a 

d + s 

• Turn on the backlight 

• Turn off the STOP warning 

(press and hold for 3 seconds until you hear a melody) 

• Move backward in the information screens 

• Decrease a setting 

• Turn off the STOP warning 

(press and hold for 3 seconds until you hear a melody) 

• Exit menus, function screens and information screens 

without saving your changes 

• Move to a previous menu 


• Unlock the keys; press and hold both buttons until 

the screen changes 

a + s • Copy an hourly basal rate to the following hour 

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1 

2 

3 


3.3 Inserting/Changing the Battery 

Remove the battery cover, using the 

battery key to turn the battery cover 

counter-clockwise. 

Insert the battery, negative (–) end down, 

positive (+) end up, into the compartment. 

Place the cover on the positive end and 

gently push the battery in while turning 

the cover clockwise to partially tighten it.

4 

The start-up process begins 

1 

2 

3 

4 


Use the battery key to fully tighten the 

battery cover. 

The screen shows the software version. 

The screen shows the ACCU-CHEK logo. 

The SELF-TEST screen appears. 

The BEEP TEST screen appears and the pump 

beeps. Listen for the beeps. 

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5 

6 

7 

8 

9 

10 


The VIBRATION TEST screen appears and the 

pump vibrates. Check the vibrations. 

The screen goes blank. 

Check that the screen is completely blank. 

The screen shows a pattern. 

Check that the pattern is even. 

The screen turns black. 

Check that the screen is completely black. 

After the self-test, press a or s to 

select the type of battery you inserted. 

Press f to confirm. 

The end of the start-up process is signaled 

by a melody, and the pump displays the 

STOP screen.

3.4 STOP Mode at a Glance 

In STOP mode your pump does not deliver insulin. For safety reasons some menus—for example, 

CARTRIDGE CHANGE or INFUSION SET PRIMING—are only accessible in STOP. 

STOP 


These menus can be accessed through the Pump menu on the meter. 

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3.5 Setting the Time and Date 

1 

2 

3 

4 


Press d to move to the TIME AND DATE 

SETTINGS screen. 

Press f to select. The HOUR screen is 

displayed. Press a or s to set the hour. 

Press d to move to the MINUTE screen. 

Press a or s to set the minute. 

Press d to move to the YEAR screen. 

Press a or s to set the year.

5 

6 

Use d, a and s to set: 

• MONTH 

• DAY 

• TIME FORMAT (12-hour or 24-hour clock) 

• DATE FORMAT (European format is day/month/year; 

U.S. format is month/day/year) 

Press f to save and exit. 


When you set up your new ACCU-CHEK Combo system, it’s a good idea to set the pump time 

and date first, since this will be adopted by the meter! 

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3.6 Programming Your Basal Rate Profile 

Make sure that your pump is in STOP mode and the infusion set is NOT connected to your body. 

1 

2 

3 

4 


Press d to move to the BASAL RATE 

PROGRAMMING 1 (2, 3, 4 or 5 accordingly) 

screen. 

Press f to select. 

The daily BASAL RATE TOTAL is displayed. 

Press d to move to the first hour. 

This is always 12 AM – 01 AM 

(00:00 – 01:00 if 24-hour format is used). 

Press a or s or scroll to set the hourly basal 

rate given by your doctor or healthcare team. 

The increments shown depend on the programmed basal rate: it will be 0.01U up to 1.00U/hour, 

0.05U up to 10.0U/hour and 0.1U up to 25.5U/hour.

5 

6 

7 


Press d to move to the next hour. 

Continue using d and a or s to set the hourly basal rates for 

the remaining hours. This allows you to program your individual 

basal rate profile on an hour-by-hour basis. Continue until all 

24 hours are programmed. 

To learn how to copy an hourly basal rate, see section 3.7. 

Press f to confirm. The new daily BASAL 

RATE TOTAL is displayed. 

Press f to save the profile and exit. 

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3.7 Copying an Hourly Basal Rate 

If your basal rate is the same for multiple hours in a row, you can save time by copying an hourly basal 

rate to one or more hours. 

1 

2 

3 

4 


Press d to move to the BASAL RATE 

PROGRAMMING 1 (2, 3, 4 or 5 accordingly) 

screen. 


The daily BASAL RATE TOTAL is displayed. 

Press d to move to the hourly basal rate you 

want to copy. 

Press a and s simultaneously. 

A special beep confirms that you are pressing 

the keys correctly. The same hourly basal rate 

is copied to the next hour.

5 

6 


If you want to copy the rate to multiple hours, press a and s 

repeatedly, or press and hold a and s (scroll). 


Check the new daily BASAL RATE TOTAL. 


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3.8 Returning the Piston Rod 


1 

2 

3. 3 

4 

5 


Remove the cartridge, if there is one: 

unscrew carefully, and DO NOT PULL the 

cartridge out until it is completely unscrewed. 

Press d to move to the CARTRIDGE CHANGE 

screen. Press f to select. 

Press and hold f for 3 seconds, until you 

hear a melody. 

The piston rod begins to return. 

When the piston rod has returned completely, 

the CARTRIDGE VOLUME screen displays the 

maximum volume, 315 U.

3.9 Connecting the Cartridge, Adapter and Infusion Set 

Have the following materials ready: 

1 

2 

3 

4 

• A filled ACCU-CHEK 3.15 mL cartridge system with luer-lock 

• An ACCU-CHEK Spirit Combo insulin pump adapter 

• A new ACCU-CHEK infusion set 


Remove the protective cap from 

the cartridge. 

Push the adapter (thread-part first) all the 

way onto the cartridge tip to the stop. 

Carefully prepare a new ACCU-CHEK 

infusion set, following the instructions 

supplied for use. 

Hold the adapter and twist the infusion set 

luer-lock connection by hand, clockwise 

into the adapter. Do not overtighten. 

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3.10 Inserting a New Insulin Cartridge 

1 

2 

3 

4 


see Step 2 

see Step 3 

Hold the pump upright. Hold the new filled 

cartridge so that the connected adapter and 

infusion set point upward, are parallel and are 

close to the cartridge compartment. 

Make sure that the top edge of the threaded 

part of the adapter is level with the top part 

of the cartridge compartment. 

Press a or s to move the piston rod 

forward until the end plate of the piston rod is 

level with the bottom of the cartridge plunger. 

The CARTRIDGE VOLUME decreases 

accordingly on the screen. 

Tip: To prevent air bubbles move the piston rod 

5 units less than amount in cartridge (e.g., set 

piston to 310U for a cartridge filled to 315U).

5 

6 

7 

8 


If you are sure that your cartridge is completely filled with insulin and has no air bubbles, you 

can start at step 5. 

Holding the pump upright, insert the cartridge 

into the cartridge compartment. 

Twist (do not push) the adapter clockwise until 

it is correctly seated against the cartridge 

compartment. 

The cartridge is correctly inserted when the 

end plate of the piston rod is correctly seated 

against the cartridge plunger. 

If the end plate of the piston rod is not 

correctly aligned with the cartridge plunger, 

remove the cartridge from the cartridge 

compartment and repeat steps 1 to 6. 

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9 

10 

11 


Check that the infusion set luer-lock connector 

is still correctly connected to the adapter. 

Tighten the infusion set by hand clockwise 

until it sits tightly in the adapter. 

Press f after correctly inserting 

the cartridge. 

Your pump performs a self-test. 

When the self-test is finished, the INFUSION 

SET PRIMING screen is displayed. 

Press f and move to step 2 of section 3.11 

Priming the Infusion Set.

3.11 Priming the Infusion Set 


1 

2 

3 

4 

Press d to move to the INFUSION SET 

PRIMING screen. 



The priming amount of 25 units is shown 

on the screen. 

Press and hold f for 3 seconds, until you 

hear a melody. The priming process begins. 

To ensure that any air bubbles are removed, 

always hold your pump upright. 

After the insulin has entered the tubing, 

gently tap the pump’s bottom part with the 

palm of your hand. 

A count-up is shown on the screen. Your 

pump stops priming after 25 units. You can 

stop the priming process by pressing f. 

To adjust the prime amount, see section 20.2. 

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4. Starting and Stopping Insulin Delivery 

When your pump is not delivering insulin, this is called STOP mode. When it is delivering insulin, 

this is called RUN mode. 

4.1 Starting Insulin Delivery 

1 

2 

Starting and Stopping Insulin Delivery 

In STOP mode, press d to move to the START 

YOUR PUMP screen. 

Press f. Your pump switches to RUN mode 

and starts delivering insulin. 

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4.2 Stopping Insulin Delivery 

1 

2 

Starting and Stopping Insulin Delivery 

Turning off the STOP warning 

In RUN mode, press d to move to the STOP 

YOUR PUMP screen. 

Press f. Your pump switches to STOP mode 

and stops delivering insulin. 

As long as your pump is in STOP mode, it emits 2 short beeps and vibrates once every minute to remind 

you that no insulin is being delivered. 

To turn off the STOP warning, press either a or s on the pump for 3 seconds. You then hear a melody 

and/or feel a vibration, confirming that the Stop warning has been turned off.

5. RUN Mode at a Glance 

In RUN mode, your pump is delivering insulin to your body according to your basal rate settings and the 

boluses you program. Some functions such as STANDARD BOLUS and TEMPORARY BASAL RATE are 

only accessible in RUN. 

RUN 

RUN Mode at a Glance 

These menus can be accessed through the Pump menu on the meter. 

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5.1 Programming a Quick Bolus 

For discreet and convenient bolus programming without your meter, you can use the Quick Bolus feature 

on your pump. 

1 

2 

3 

4 


From the RUN screen, press and hold s until 

you hear a beep sequence and feel a vibration. 

This activates the Quick Bolus function. 

Note: You can begin programming a Quick Bolus with either a or s. The step listed above starts with 

s to activate the Quick Bolus function. You can also activate this function (in Step 1) with a, in which 

case you must use s for Step 2. 

Press a once for each increment until the 

required bolus amount is reached. 

Each time you press the key, your 

pump beeps and vibrates once for each 

programmed bolus increment. 

Five seconds after the last press of s, 

the pump confirms the total bolus amount 

with one beep and vibration for each bolus 

increment programmed.

5 

6 


The standard bolus symbol blinks for 

5 seconds (the bolus delivery start delay). 

After the bolus delivery start delay, the pump beeps 3 times and/or 

vibrates once and then begins to deliver the total bolus amount 

programmed. A countdown of the remaining bolus amount appears 

on the display. 

By default the increment for the Quick Bolus is 0.5 U per key press. Ask your trainer or 

healthcare professional to change the increment to 0.1, 0.2, 1.0 or 2.0 U per key press 

if necessary. You will learn how to do that yourself in the advanced part of the training. 

53

54 


5.2 Cancelling a Quick Bolus 

During 

Quick Bolus 

programming 

During 

confirmation 

and the 

start delay 

During 

bolus 

delivery 

Press a (s)—the key you used to enter 

the Quick Bolus programming option. This will 

reset the bolus amount to 0.0 units. You hear 

a melody. If no new bolus is programmed, your 

pump returns to the RUN screen and beeps 

3 times after 5 seconds. 

Press a or s. You hear a melody and 

the pump returns to the RUN screen. A W8: 

BOLUS CANCELLED warning occurs. 

Press f twice to snooze and confirm 

the warning. 

Press and hold a or s until you hear 

a melody (about 3 seconds). A W8: BOLUS 

CANCELLED warning occurs. 


the warning. 

No bolus is 

delivered 

No bolus is 

delivered 

Bolus delivery 

interrupted

6. Your ACCU-CHEK Aviva Combo Meter 

6.1 Summary of Features and Functions 

Features 

j 

j 

j 

j 

Convenient blood glucose (bG) testing. 

Test results in 5 seconds. 

Small sample size that allows testing from the fingertip as well as from 

other sites (e.g., palm or forearm).* 

*Talk with your doctor before deciding if alternate site testing is right for you. 

Your ACCU-CHEK Aviva Combo Meter 

Remote control of your ACCU-CHEK Spirit Combo insulin pump 

using Bluetooth ® wireless technology for discreet and convenient 

pump therapy. 

55

56 

j 

j 


Functions 

All pump functions can be controlled from the meter except: 

j 

• Changing the cartridge (including returning piston rod) 

• Infusion set priming 

• Data transfer 

• Display orientation and display contrast 

• Bluetooth communication settings 

• Unlocking the key lock 

Data Management and Reports 

Collects all your diabetes-related data—such as bG values, boluses and 

health events—within a reliable and synchronized timescale, and reports 

them as statistics, graphs and tables. 

Bolus Advice 

Calculates a bolus recommendation based on your bG level, time of 

day, planned food intake, active insulin and personal settings, such as 

insulin-to-carbohydrate ratio and correction factor. 

Optional Reminders 

Helps you remember a great variety of therapy-related tasks: 

• Event reminders (visit to the doctor, lab test, infusion set change) 

• Blood glucose test reminders (after high bG, after low bG, after meal) 

• Alarm clock can be set for up to 8 individual tasks

6.2 Button Functions 

= Enter 

x Up 

z Down 

> Right 

< Left 

The button functions are a bit different when you are in the Pump menu of the meter. 

See section 8.2 for more details. 

+ Power on / off button 


, . Left / right soft button 

* Backlight button 

Test strip slot 

57

58 



+ 

Power 

on / off 

* Backlight 

< 

> 

x 

z 

Left 

arrow 

Right 

arrow 

Up 

arrow 

Down 

arrow 

• Turn the meter on and off 

• Adjust the backlight level (low, medium, high) 

• Switch Bluetooth ® communication on and off 

• Move through screens 

• Scroll left in an information screen 

• Move through screens 

• Scroll right in an information screen 

• Move through menus, functions and information screen 

• Scroll up in an information screen 

• Increase a value in a setting screen 

• Move through menus, functions and information screen 

• Scroll down in an information screen 

• Reduce a value in a setting screen


= Enter 

, 

. 

, . 

* + 

Left soft 

button 

Right soft 

button 

Press 

and hold 

Press 

and hold 

• Select a menu or option 

• Save changes 

• Exit 


• Select a menu on the display above the button 

• Select a menu on the display above the button 

• Enables key lock / disables key lock 

• Enables pairing mode for Bluetooth ® 

wireless technology 

59

7. Preparation and Start-Up 

Remove the protective film from the meter display. 

7.1 Setup Wizard 

You must complete the Setup Wizard before you can use your meter. 

For the standard setting, you need to set up: 


• Language (your local language should be set by default) 

• Time (your meter should adopt the time and date from the pump as soon as you switch it on) 

• Units for carbohydrates 

• Warning limit for low bG level (hypoglycemia) 

• Warning limit for high bG level (hyperglycemia) 

• One time block 

For the standard setup, do not set up Bolus Advice or reminder settings. These 

settings can be set up later, according to the procedure described in the Advanced 

Lesson of this training handbook. 

61

62 

1 

2 

3 


Warning 

Time 

Mismatch 

Meter time has been 

changed by more than 5 

minutes to match Pump 

OK 

Language 

Language English 

Language 


Deutsch 

English 

Press enter to display 

Españiol 

available options 

Français 

Cancel 



Next 

Press + until the meter turns on. 

The ACCU-CHEK screen appears for 

a few seconds. 

You may be prompted with a warning that the time and date on 

your meter have been changed by more than 5 minutes, due to 

the synchronization with the pump. 

Press . to select OK. 

The Language screen appears. If you wish to 

keep the default language, press . to select 

Next and continue with step 6. 

Otherwise press = to display the 

language options.

4 

5 

6 

7 

8 

Language 


Deutsch 

English 


Españiol 


Français 

Cancel 

Language 


Time/Date 

Time Format 

Time 

12 hr 

10 24 00 hram 

HH MM 

Date 1 Jan 08 

DD MMM YY 

Cancel 

Next 

Time/Date 

Time Format 12 hr 

Time 10 00 am 

HH MM A/P 

Date 2 Feb 08 

DD MMM YY 

Back Next 

Time/Date 

Time Format 

Time 

12 hr 

10 12 00 hram 

HH MM 

Date 1 Jan 08 

DD MMM YY 

Cancel 

Press x or z to select the language. 

Press = to save the setting. 

Press . to select Next. 

The Time / Date screen appears. If you wish to 

keep the default time, press . to select Next 

and continue with step 12. 

Otherwise press = to change Time Format. 

Press x or z to select 12-hour or 24-hour 

Time Format. 

Press = to save the changes. 


63

64 

9 

10 

11 

12 


Time/Date 

Time Format 

Time 8HH 

00 30 

MM 

12 hr 

am 

A/P 

Date 1 Jan 08 

DD MMM YY 

Cancel 

Time/Date 

Time Format 

Time 10HH 

00 30 

MM 

12 hr 

am 

A/P 

Date 1 Jan 08 

DD MMM YY 

Cancel 

Time/Date 


Time 10 30 am 

HH MM A/P 

Date 2 Feb 08 

DD MMM YY 

Back 

Carbs 

Units 

Next 

Grams 

Back Next 

Press = to change the hour. 

Press x or z to select the hour and = to save. 

Continue using =, x, z and = to set: 

• Minutes 

• AM or PM, if needed 

• Day 

• Month 

• Year 


The Units screen appears. 

Press . to select Next if you wish to keep 

the default settings and continue with step 14.

13 

14 

15 

16 

17 

! 

Carbs 

Cancel 

Hyper 

Hypo 

Units 

Grams 

Grams 

BE 

KE 

CC 

Warning Limits 

16.6 mmol/L 

3.3 mmol/L 

Select the upper (Hyper) 

and lower (Hypo) 

limits of your bG 

Back Next 


Hyper 16.6 mmol/L 

Hypo 12.23.3 mmol/L 

mmol/L 




Cancel 


Hyper 12.2 mmol/L 

Hypo 3.13.3 mmol/L 




mmol/L 

Cancel 

Setup 

Would you like to 

receive bolus advice 

from your Meter? 

No Yes 

Otherwise, press = to change the units for 

carbohydrates and continue using x, z and = 

to select and save. 


The Warning Limits screen appears. 

Use =, x, z and = to set the Hyper 

(high bG) Warning Limit. 

Use =, x, z and = to set the Hypo 

(low bG) Warning Limit. 


“Would you like to receive bolus advice from 

your Meter?” appears. 

Press , to select No. 


65

66 

18 

19 

20 

21 


Setup 

Edit at least one 

time block by selecting 

a time block 

and pressing enter 

Back Next 

Time Blocks 

12:00 am 4:00 am 

3.9 

Cancel 

mmol/L 7.8 mmol/L 

Time Blocks 

12:00 am 4:00 am 

4.4 

Cancel 

mmol/L 7.8 mmol/L 

Time Blocks 

12:00 am 4:00 am 

Target Range 

4.4 mmol/L 6.7 140 mg/dL mmol/L 

Cancel 

The next screen asks you to edit at least 

one Time Block. The main purpose for this 

is to edit your bG Target Range. If you have 

different Target Ranges for different times 

of the day, edit the Time Blocks and Target 

Ranges accordingly. 


Press = to move to the first Time Block. 

Press = again to save the default ending 

time. Press = again to enter the lowest blood 

glucose value for the Target Range. 

Press x or z to select the lowest blood 

glucose value for the Target Range. 

Use =, x and z to enter and edit the highest 

blood glucose value for the Target Range. 

Press = to confirm.

22 

23 

! 

24 

25 

Time Blocks 

12:00 am 4:00 am 

Target Range 

4.4 mmol/L 

Cancel 

Setup 

6.7 mmol/L 


set up bG Test 

Reminders? 

Save 

No Yes 

Setup 

Setup Completed 

Successfully 

Next 

10:02 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

Press . once to save the changes. 

Press . again to select Next. 

“Setting copied to all Time Blocks …” appears. 

Press . to select Save. 

“Would you like to set up bG Test 

Reminders?” appears. 

Press , to select No. 

The Setup Wizard is complete. 

Press . to select Next and enter 

the main menu. 


Now you can use your meter to continue 

setting up your pump. 

Before you can test your bG level with your meter you must code it with the code chip 

accompanying the test strip container. You should also perform a control test. 

67

68 


7.2 STANDARD User Menu 

The following is a list of menu options from the STANDARD user menu. To view the order in which they 

appear on the display, refer to the menu diagram below: 

• Press d to move forward 

• Press d + a simultaneously to move backward 

RUN 

only accessible on pump. 

f 

STOP

8.1 Using the Meter to Control the Pump 

System behavior 

If you do not press any key for more than 20 seconds, the pump screen goes blank to save battery life. 

In this state, your pump is also ready to communicate with the meter. 

Using Your ACCU-CHEK Combo System 

8. Using Your ACCU-CHEK Combo System 

You can reactivate the screen by pressing any of the pump keys, but then for safety reasons the 

communication with the meter is interrupted. 

As soon as you turn on your meter, while the pump screen is blank, the devices start to communicate. 

Time and date settings are synchronized according to pump time and date settings, and the event 

history files, such as bolus history, are updated. While the pump and the meter are communicating, 

the pump screen displays the Bluetooth ® symbol. 

The pump and the meter cannot talk to each other when they are too far 

apart. The distance should not be more than 2 meters. 

69

70 

8.2 Operating Your Pump 

1 

2 

3 

Using Your ACCU-CHEK Combo System 

10:59 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

While the pump screen is blank, press + to 

switch on the meter. 

In the main menu screen press x or z to 

move to Pump. 

Press = to enter the Pump menu. 

Now you see the currently active menu 

screen of the pump on the meter display. 

In the lower half of the display, you see the relationship of the pump keys to the meter buttons: 

a s d f 

x z < > 

You can also perform the following procedures directly on the pump using the related pump keys. 

For detailed information, please refer to Appendix E or to the ACCU-CHEK Spirit Combo Insulin 

Pump User Guide.

9. Standard Menu Functions 

9.1 Checking Your Pump 

1 

2 

3 

4 

10:59 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

Make sure your pump screen is blank. 

Select Pump in the meter main menu. 

The RUN screen appears. 

Press > to view the BOLUS DATA screen. 

Press z to view older bolus data. 

Press > to return to RUN screen. 

Standard Menu Functions 

Press > to view the QUICK INFO screen. 

71

72 

9.2 Programming a Standard Bolus without using 

Bolus Advice 

1 

2 

3 


10:59 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

Make sure your pump is in RUN mode and 

the screen is blank. Select Pump in the meter 

main menu. 

Press < until the STANDARD BOLUS 

screen appears. 

Press > to select. The BOLUS AMOUNT 

screen appears.

4 

5 


Press x or z to increase or decrease 

the value until the required bolus amount 

is adjusted. 

Press > to confirm and the bolus delivery 

is activated. 

The bolus symbol flashes for 5 seconds 

before the bolus delivery starts. 

If you do not confirm within 20 seconds, the pump automatically returns to RUN without delivering a bolus. 

73

74 


9.3 Cancelling a Standard Bolus 

During 

programming 

you can 

During the 

delivery 

start delay 

During 

bolus 

delivery 

Press . on the meter or d and a on 

the pump to return to the STANDARD BOLUS 

screen or wait 20 seconds until the pump 

returns to RUN automatically or set 

the BOLUS AMOUNT to 0.0 and press >. 

Press and hold x or z until you hear 

a short beep. A W8: BOLUS CANCELLED 

warning occurs. 

Press > twice to snooze and confirm 

the warning. 

Press and hold x or z until you hear 



Press > twice to snooze and confirm 

the warning. 

No bolus 

has been 

delivered 

No bolus 

has been 

delivered 


has been 

interrupted

9.4 Programming a Temporary Basal Rate (TBR) 

1 

2 

3 

10:59 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 


Make sure your pump is in RUN mode and the 

screen is blank. Select Pump from the meter 

main menu. 

Press < to move to the TEMPORARY BASAL 

RATE screen. 

Press > to select. The TBR PERCENTAGE 


75

76 

4 

5 



the percentage. 

Press < to move to the TBR DURATION screen. 

Press x or z to set the duration. 

Press > to save and exit. 

When the duration of the TBR has ended, a W7: TBR OVER warning occurs. Press > twice to snooze and 

confirm the warning.

9.5 Cancelling a Temporary Basal Rate (TBR) 

Either: 

Or: 

• Press < to move to the TEMPORARY BASAL RATE screen. 

• Press > to select. Press x or z to set the percentage to 100%. 

• Press > to confirm. 

• A W6: TBR CANCELLED warning occurs. Press > twice to snooze and confirm the warning. 

Your pump returns to RUN mode. 

• Press < to move to the STOP YOUR PUMP screen. 

• Press > to confirm. 

• A W6: TBR CANCELLED warning occurs. Press > twice to snooze and confirm the warning. 

Your pump returns to STOP mode. 

• Press < to move to the START YOUR PUMP screen. 

• Press > to confirm. Your pump returns to RUN mode. 


77

78 

9.6 Pump Settings 

Turning key lock ON / OFF 

1 

2 

3 

4 


10:59 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

Make sure your pump screen is blank. 


Press < to move to the PUMP SETTINGS screen. 

Press > to select. 

The current key lock status of the pump 

(ON or OFF) appears. 

Press x or z to turn the key lock ON or OFF. 

Press > to save and exit.

If you press any of the pump keys while the keys are locked and the screen is blank, the key lock symbol 

appears on the pump screen. 

The Bluetooth ® communication will not be interrupted. 


To temporarily unlock the pump keys, press d and s simultaneously for 3 seconds. Three 

beeps indicate that you are pressing the keys correctly. While operating the pump keys the 

Bluetooth ® communication will be interrupted. 

Now you can operate the keys on the pump. Remember that the Bluetooth ® communication 

between meter and pump is lost as soon as you press any pump key while the keys are unlocked. 

79

80 

Adjusting the beep volume 

1 

2 

3 


10:59 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

Make sure that your pump screen is blank. 



Press > to enter. 

Press < to move to the SOUND VOLUME 

screen. Press x or z to adjust the 

beep volume. 


Setting for the alarm signals 

1 

2 

3 

4 

10:59 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

Make sure that your pump screen is blank. 




Press < to move to the SIGNAL SETTINGS 

screen. 

Press x or z to set the alarm signals 

(beep only, vibration only, beep and vibrate). 



81

10. Warnings and Errors 

Warnings and Errors 

Warnings and errors emitted by the pump make you aware of situations that require your special attention, 

for example, that the battery is about to expire or the insulin cartridge is almost empty. 

A warning informs you that an action will soon be required. (For example, warning W1: Cartridge Low. 

You will have to change it soon.) 

An error informs you that immediate action is necessary. (For example, error E1: Cartridge Empty. You must 

change it immediately.) 

If an error occurs, your pump will switch to STOP mode, and no more insulin will be 

delivered! Put your pump back in RUN mode after providing the appropriate response 

to the error. 

When your pump signals a warning or error, you can respond to the signal using either the keys of the 

pump or the buttons of the meter. 

83

84 

Handling messages on your pump 

1 

2 


Press f to snooze the signal. 

Press f again to confirm that you are aware 

of the meaning of the warning or error. 

For further information about the meaning of the specific warning or error and appropriate action to take, 

please refer to Appendix D: Errors, Warnings and Reminders at the end of this handbook (page 227).

Handling pump messages using your meter 

1 

2 

3 

Press + to start your meter. 

Press > to snooze the signal. 


When the pump signals a warning or error the meter switches immediately into the 

pump menu and displays the message. 

Press > again to confirm that you are aware of 

the meaning of the warning or error. 

For further information about the meaning of the specific warning or error and appropriate action to take, 

please refer to Appendix D: Errors, Warnings and Reminders at the end of this handbook (page 227). 

85

11. Switching Bluetooth ® Communication On / Off 

Bluetooth wireless technology must be switched off separately on the pump and the meter. 

11.1 Switching OFF Bluetooth Capability on the Pump 

1 

2 

3 

Switching Bluetooth ® Communication On/Off 

Always remember to switch off the Bluetooth communication on the pump and the meter before 

boarding an aircraft. 

Press d to move to the 

BLUETOOTH SETTINGS screen. 

This screen is not accessible in the Pump menu on the meter. You must enter it on the pump. 

Press f to select. The BLUETOOTH ON / OFF 


Press s to select OFF. 


Use the above procedure to switch Bluetooth communication on/off accordingly. 

87

88 

11.2 Switching OFF Bluetooth Capability on the Meter 

1 

2 

3 

4 


10:02 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

10:02 am 2 Feb 08 

Reminders 

Bolus Advice 

Meter 

Sound/Vibrate 

Time/Date 

Time Blocks 

Menu 

Meter 


Key Lock 

Language 

Units 

Bluetooth 

Pair with Pump 

Back 

Bluetooth 

Press and hold backlight button 

until Bluetooth icon changes 

Meter Name: METER12345678 

Back 

From the main menu, press x or z to move 

to Settings. 

Press = to enter. 

Press x or z to move to Meter. 


Press x or z to move to Bluetooth . 


Press and hold * until the Bluetooth icon 

changes (about 3 seconds). 

When Bluetooth communication is switched off, the Bluetooth symbol disappears.

12. Measuring Your Blood Glucose (bG) Level 

Before you measure your blood glucose level with your meter for the first time, you must code your meter 

and should run a control test. 

12.1 Coding Your Meter 

A new code chip is inside each new box of test strips. 

1 

2 

3 

Measuring Your Blood Glucose (bG) Level 

Leave the code chip in the meter until you open a new box of test strips. 

Ensure that the meter is off. 

Turn the meter display side down. Remove the 

old code chip, if there is one, and discard it. 

With the code number facing away from you, 

push the new chip into the meter until it stops. 

89

90 

12.2 Running a Control Test 

You need: 

1 

2 

3 


• A new test strip 

• A control solution level 1 or 2 (sold separately). 

The control level is printed on the bottle label. 

bG Test 

Match Code to Vial 

bG Test 

Apply Sample 

Code 

237 

Place your meter on a flat surface 

(for example, a table), and insert the test 

strip into the test strip slot in the direction 

of the arrow. The meter turns on. 

The “Match Code to Vial” screen appears. 

Make sure the code number on the screen 

matches the code number on the test 

strip container. 

The “Apply Sample” screen appears, 

and a beep indicates that the strip is ready 

for testing.

4 

5 

6 

7 

bG Test 

Analyzing 

Control Result 

10:02 am 2 Feb 08 

6.4 

mmol/L 

Menu Level 


Remove the cap from the control solution 

bottle, and wipe the tip with a tissue. 

Squeeze the bottle until a tiny drop forms at 

the tip. Apply the drop to the front edge of the 

yellow window of the test strip. 

The “Analyzing” screen appears as soon as 

you have applied enough solution. Wipe the 

tip of the control solution bottle, and then put 

the cap on the bottle tightly. 

The “Control Result” screen appears. 

91

92 

8 

9 

10 



10:02 am 2 Feb 08 

Cancel 


10:02 am 2 Feb 08 

6.4 Level 1 

mmol/L Within range 

Menu 

No Entry 

Level 1 

Level 2 

Compare the result to the acceptable range 

shown on the label of the test strip container. 

Press . to display the Control Result screen. 

Press x or z to select the control 

solution level. 

Press = to confirm. 

When the control test result is within range, 

the test strips and meter are working properly. 

Remove and dispose of the test strip.

12.3 Performing a Blood Glucose (bG) Test 

You need: 

1 

2 

3 

• Your lancing device 


bG Test 


Code 

237 


Prepare the lancing device according to 

the instructions provided. Wash and dry 

your hands. 

Place your meter on a flat surface (for example, 

a table), and insert the test strip into the 

test strip slot in the direction of the arrow. 

The meter turns on. 


Make sure that the code number on the screen 

matches the code number on the test strip 

container. 

93

94 

4 

5 

6 

7 

8 


bG Test 

Apply Sample 

bG Test 

Analyzing 

bG Result 

10:02 am 2 Feb 08 

5.8 

mmol/L 

The “Apply Sample” screen appears and a 

beep indicates that the strip is ready for testing. 

Prick your finger with your lancing device. 

Gently squeeze your finger to get a blood drop. 

Apply the blood drop to the front edge of the 

yellow window of the test strip. 


you have applied enough blood. 

Your bG result appears on the display.

9 

10 

bG Result 

5.8 

10:02 am 

mmol/L 

Meal Time 

Carbs 

Health 

Active Insulin --- U 

Menu Bolus 

bG Result 

5.8 

10:02 am No 

mg/dL 

Entry 

Pre Meal 

Meal Post Time 

Meal 

Bedtime Carbs 

Other Health 


Cancel 


About 3 seconds later, the detailed “bG Result” 


Here you can enter information about 

mealtime, the carbs you are planning to eat 

and your current health or activity state. 

Press x or z to move to the Meal Time box, 

and press = to enter. 

Press x or z to select a value. 

Press = to save the value. 

Repeat for Carbs and Health boxes, if desired. 

If you enter values for Carbs and Health here, 

they are adopted to the Bolus Advice screen. 

Press . to select Bolus and move to the 

Bolus Advice screen. 

In the Advanced Lesson, you will learn how to use Bolus Advice after a bG test. 

95

96 


Understanding your bG result 

The colored bar on the bG Result screen indicates the meaning of your bG result: 

If the bar is Your bG level is 

Hyper Blue 

Above Hyper Warning Limit. It is highly recommended that 

you check for ketones and measure your bG level frequently. 

Blue Above your Target Range but below your Hyper Warning Limit. 

Green Within your Target Range. 

Yellow Below your Target Range but above your Hypo Warning Limit. 

Hypo Red 

Below your Hypo Warning Limit. It is highly recommended 

that you eat an appropriate amount of fast-acting 

carbs immediately. 

Discuss appropriate action for each of these situations with your healthcare professional.

12.4 Summary of Advanced Lesson 

In the Advanced Lesson you will receive more information about: 

• Bolus advice 

• Data management 

• Reminder functions 

on your meter 


• Bolus types 

• Using different bolus types 

• Using different basal rates 

• Reminders 

• Therapy settings 

on your pump 

It is essential that you discuss all the settings necessary for setting up bolus advice, reminders and 

additional basal rates with your doctor or healthcare team before setting up these features. 

97

On your mark. 

Get set. 

Go! 

Advanced Lesson

The Bolus Advice function on your meter will provide you with recommendations on the amount of insulin 

for food intake and for correcting bG levels that are not within your target range. In the following chapter, 

you will learn how to program all your individual settings for the bolus advice calculation and how to use 

Bolus Advice in your daily life. 

13.1 About Bolus Advice 

The Bolus Advice function of your meter provides you with bolus recommendations based on your: 

• Current bG test result 

• Expected food intake 

• Current health or activity 

• Individual settings, such as Carb Ratio, Insulin Sensitivity and others that will be explained later in 

this chapter 

When you have programmed these settings, you will only need to: 

• Measure your bG level 

• Enter the amount of carbs you are currently planning to eat 

• Enter your current health or activity state 

Your meter will then calculate the required amount of insulin based on your personal settings. You can 

adjust the calculated dose as appropriate and choose the bolus type you prefer. After confirmation, the 

pump will then deliver the bolus accordingly. 

Using the Bolus Advice function, delivering a bolus is easy, quick and discreet. 

Getting Bolus Advice from Your Meter 

13. Getting Bolus Advice from Your Meter 

If you are interested in details of the calculation for the recommended bolus, please refer to 

Appendixes A–C. 

101

102 

13.2 Setting Up Bolus Advice 

Before you can start setting up the Bolus Advice function, you need to discuss the required setting 

parameters with your healthcare professional. The following settings are necessary: 

Time Block settings 

j 

j 


Time Blocks Split the day into periods to facilitate the 

programming of those settings that change 

throughout the day, such as Insulin 

Sensitivity and Carb Ratio. You only need 

to set the end time of a time block, as this 

is also the starting time of the following 

time block. Five time blocks are set up 

by default, but you can program up to 8, 

if necessary. The following parameters can 

be set up separately for each time block. 

Target Range The range of your blood glucose—consisting 

of a lower and an upper bG value—that is 

considered to be acceptable as long as you 

are fasting (in the morning or before a meal). 

The target bG will be calculated automatically 

as the average between the upper and lower 

bG values.

j 

j 

Carb Ratio The amount of insulin you need to cover 

one unit of carbohydrates. You must program 

the Carb Ratio for each time block you wish 

to set up. 

Health Event settings 

j 

Insulin Sensitivity The amount of insulin you need to lower 

your bG level by a given amount. You may 

know this as the “correction factor.” You 

must program this for each time block 

you wish to set up. 

Health Events Percentages that allow you to adjust the 

calculated insulin amount to allow for 

individual needs and health statuses, 

for example, when you are planning physical 

activity (subtract percentages) or you are ill 

(add percentages). 

You can set percentages for: 

• Exercise 1 


• Stress 

• Illness 

• Premenstrual 

You cannot adjust Fasting. 


103

104 

j 

j 

j 

j 


Advice Option settings 

Meal Rise An increase in your bG level that 

accommodates the expected rise in glucose 

levels in response to food intake. 

Snack Size Defines a certain threshold of carbohydrates 

above which a Meal Rise is triggered. 

Acting Time The total length of time the insulin remains 

effective in lowering glucose. 

Offset Time The length of time after a bolus until 

significant glucose lowering begins.

Setting up Bolus Advice settings 

The following procedure will help you program all necessary settings when you enter the Bolus Advice 

settings for the first time. 

1 

2 

3 

4 

10:02 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

10:02 am 2 Feb 08 

Reminders 

Bolus Advice 

Meter 

Sound/Vibrate 

Time/Date 

Time Blocks 

Menu 

Setup 


receive bolus advice 

from your Meter? 

No Yes 

Setup 

Edit at least one 

time block by selecting 

a time block 

and pressing enter 

Back Next 

From main menu, press x or z to 

select Settings. 


The Settings screen appears. 

Press x or z to select Bolus Advice. 


“Would you like to receive bolus advice 

from your Meter?” appears. 

Press . to select Yes. 

“Edit at least one time block by selecting 

a time block and pressing enter” appears. 



105

106 

5 

6 

7 

8 


Start 

Time Blocks 

End 

12:00 am 5:30 am 

5:30 am 11:00 am 

11:00 am 5:00 pm 

5:00 pm 9:30 pm 

9:30 pm 

Back 

12:00 am 

Time Blocks 

12:00 am 5:30 am 6:00 

Target Range 

3.9 mmol/L 7.8 mmol/L 

Carb Ratio 

1 U for 

--- 

Insulin Sensitivity 

Cancel 

am 

Time Blocks 

12:00 am 6:00 am 

Target Range 

4.4 7.8 mmol/L 

Carb Ratio 

1 U for 

--- 


Cancel 

mmol/L 

Time Blocks 

12:00 am 6:00 am 

Target Range 

4.4 mmol/L 6.7 

Carb Ratio 

1 U for 

--- 


Cancel 

mmol/L 

The Time Blocks screen appears. 

Press = to enter the first time block. 

The first Time Blocks screen appears. 

Press = to enter the end time box. 

Press x or z to select the end time. 

Press = to save the setting and move to the 

lower target limit box. 


Press x or z to select your lower target limit. 

Press = to save and move to the upper target 

limit box. 


Press x or z to select your upper target limit. 

Press = to save and move to the insulin box 

Carb Ratio.

9 

10 

11 

12 

Time Blocks 

12:00 am 6:00 am 

Target Range 


Carb Ratio 

1 U for 

--- 


Cancel 

Time Blocks 

Target Range 


Carb Ratio 

1 U for 121.2 g BE 


1 U for --- 

Cancel 

Time Blocks 

Target Range 


Carb Ratio 

1 U for 12 g 


1 U for 2.5 mmol/L --- 

Cancel Save 

Start 

Time Blocks 

End 

12:00 am 6:00 am 

6:00 5:30 am 11:00 am 

11:00 am 5:00 pm 

5:00 pm 9:30 pm 

9:30 pm 12:00 am 

Back Next 


Press x or z to enter the insulin amount. 

Press = to save and move to the carb box. 


Press x or z to select the amount of carbs 

covered by the amount of insulin. 

Press = to save and move to the insulin box 

for Insulin Sensitivity. 


Press x or z to select the insulin amount. 

Press = to save and move to the bG box. 


Press x or z to select the decrease in bG 

expected for the insulin amount. 


Press . to save and exit to the 

Time Blocks screen. 

Press x or z to move to the next 

time block. 



107

108 

13 

14 

15 

16 

17 


Repeat steps 6 to 12 accordingly to set up additional time blocks. 


Health Events 

Exercise 1 

Exercise 2 

Stress 

Illness 

0% 

0% 

0% 

0% 

Premenstrual 0% 

Back Next 

Health Events 

Exercise 1 

Exercise 2 

Stress 

Illness 

0% 

0% 

0% 

0% 

Premenstrual 0% 

Cancel 

-15 % 

Health Events 

Exercise 1 

-10% 

Exercise 2 

-20% 

Stress 

0% 

Illness 

+20% 

Premenstrual 

0% 

Cancel 

Save 

The Health Events screen appears. 

Press = to enter the Exercise 1 box. 

Press x or z to select the percentage 

as needed. 

Press = to save. 

Use =, x, z and = to set up as many Health Events as needed. 

Press . to save. 

Press x or z to move to the next Health 

Event you wish to set up.

18 

19 

20 

21 

Advice Options 

Meal Rise 5.6 mmol/L 

Snack Size 

--- 

Acting Time 4:00 

Offset Time 1:00 

HH MM 

Back 


Meal Rise 100 mg/dL 

Snack Size 4.4 --- 



HH MM 

mmol/L 

Cancel 



Snack Size 9 --- 



HH MM 

g 

Cancel 



Snack Size 

--- 

Acting Time 4:304:00 


HH MM 

Cancel 

The Advice Options screen appears. 

Press = to enter the Meal Rise box. 

Press x or z to select the Meal Rise level. 

Press = to save and move to the 

Snack Size box. 


Press x or z to select the Snack Size. 

Press = to save and move to the Acting 

Time box. 



Press x or z to select the Acting Time. 

Press = to save and move to the Offset 

Time box. 

109

110 

22 

23 

24 




Snack Size 

9 g 

Acting Time 

Offset Time 

4:30 

1:151:00 

HH MM 

Cancel 

10:02 am 2 Feb 08 

Reminders 

Bolus Advice 

Meter 

Sound/Vibrate 

Time/Date 

Menu 


New Snack Size has 

also been applied to 

After Meal Reminder 

OK 


Press x or z to select the Offset Time. 


Press . to save all settings and select Next. 

If you changed Snack Size, you receive 

the message that the new Snack Size will 

be applied to the After Meal Reminder. 

Press . to select OK. 


Press , to select Menu and return to the 

main menu.

13.3 Using Bolus Advice 

Bolus Advice can only provide a reliable bolus recommendation when a current bG test result is available. 

Therefore, it is highly recommended that you always use Bolus Advice by starting with a bG test. When 

you use Bolus Advice without a current bG test result, you will be prompted with a warning if the last bG 

test result dates back for more than 5 minutes. 

Taking bolus advice from a bG test 

To take bolus advice from a bG test, you need: 

• Your lancing device 



111

112 

1 

2 

3 

4 


bG Test 


bG Test 

Apply Sample 

Code 

237 

Wash and dry your hands. Prepare the lancing 

device according to the instructions provided. 

Place your meter on a flat surface (for example, 

a table) and insert the test strip into the 

test strip slot in the direction of the arrow. 

The meter turns on. 


Make sure the code number on the screen 

matches the code number on the test 

strip container. 

The “Apply Sample” screen appears, and a 

beep indicates that the strip is ready for testing.

5 

6 

7 

8 

bG Test 

Analyzing 

bG Result 

10:02 am 2 Feb 08 

5.8 

mmol/L 


Prick your finger with your lancing device. 

Gently squeeze your finger to get a blood drop. 

Touch the blood drop against the front edge 

of the yellow window of the test strip. 


you have applied enough blood. 

Your result appears on the display. 

113

114 

9 

10 


bG Result 

5.8 

10:02 am 

mmol/L 

Meal Time 

Carbs 

Health 


Menu Bolus 

About 3 seconds later, a detailed “bG Result” 

screen appears. Here you can add information 

about the Meal Time, planned food intake 

or your state of health, for statistical reasons, 

where appropriate. 

If you use the bG result for Bolus Advice, you cannot change entries later on. Therefore, it is 

recommended that you add information about Meal Time here. 

bG Result 

10:02 am 5.8No 

mg/dL 

Entry 

Pre Meal 

Meal Post Time 

Meal 

Bedtime Carbs 

Other Health 


Cancel 

Press x or z to move to the Meal Time box, 

and press = to enter. 

Press x or z to select a value. 

Press = to save the value. 

Repeat for Carbs and Health boxes, if desired. 

If you enter values for Carbs and Health here, 

they are adopted to the Bolus Advice screen. 

Press . to select Bolus and move to the 

Bolus Advice screen.

11 

12 

13 

Bolus Advice 

5.8 mmol/L 

--- U 

15 g20 

Stress 

0.2 U 

Bolus 

0.2 U 

Type Standard 

Cancel Food List 

g 

Bolus Advice 

5.8 mmol/L 

--- U No Entry 0.2 U 

20 g Fasting 

Stress Exercise 1 

Bolus 

Type 

Stress 

0.2 U 

Illness 

Standard 

Cancel Food List 

Bolus Advice 

5.8 mmol/L 

--- U 

0.2 U 

20 g 

1.4 U 

Stress 

0.2 U 

Bolus 

1.8 U 

Type Standard 

Cancel 

Confirm 


Press = to enter the Carbs box. 

Press x or z to select the amount of 

carbohydrates you are planning to eat. 

Press = to save and move to the Health 

box, and press = to enter. 

Press x or z to select your current state 

of health, as appropriate. 

Press = to save and move to the Bolus 

Amount box. 

If you need to change the recommended 

bolus amount, use =, x, z and = to change 

the bolus amount and move to the Type box. 

Otherwise, press z to move to the Type 

box directly. 

115

116 

14 

15 

15a 


Bolus Advice 

5.8 mmol/L /L 

--- U Standard 0.0 U 

20 g 

Multiwave 1.9 1.9 U 

Stress 

Extended -0.1 U 

Manual Pump 

Bolus 

Pen/Syringe 

Type 

Cancel 

Confirm 

You will learn more about using different bolus types in section 13.4. 

Confirm Bolus 

Deliver Bolus? 

Standard Bolus 

1.8 U 

Back Deliver 

Confirm Bolus 

Deliver Bolus? 

Immediate 0.5 U 

Duration 

4:00 

HH MM 

Multiwave Bolus 

1.8 U 

Back Deliver 

Press = to enter, if you wish to select a 

bolus type other than Standard (Extended or 

Multiwave; see explanation in section 13.4). 

Press x or z to select the bolus type. 


Press . to select and move to the Confirm 

Bolus screen. Press . to select Deliver. 

The pump starts delivering the 

bolus accordingly. 

If you choose a bolus type other than 

Standard, press . to confirm and move 

to the Confirm Bolus screen. 

Use =, x, z and = to select and adjust 

immediate bolus and bolus duration, 

as necessary. 

Press . to select Deliver. 

The pump starts delivering the 

bolus accordingly.

16 

Deliver Bolus 

Pump Delivering 

Standard Bolus 

0.5 U 

Stop Bolus OK 


If you need to stop the bolus delivery for any 

reason, press , to select Stop Bolus. 

Otherwise press . to select OK and return 

to the main menu screen. 

If necessary, you can also stop the bolus delivery using the pump keys. Press and hold a 

or s until you hear a short beep (after about 3 seconds). 

117

118 

13.4 Choosing Your Bolus Type 

Three bolus types, each with a different delivery shape, are available: 

j 

j 


Standard The complete bolus amount is delivered 

immediately in one portion. This bolus is 

often used for corrections made during the 

day and when compensating for food intake 

with fast-acting carbohydrates (for example, 

fruit, cake). 

Extended A bolus delivered over a period of time. 

That means you have to program an 

appropriate duration as well as the bolus 

amount. This bolus type can be helpful during 

long meals, dinners or receptions or when 

you have meals that are digested slowly. 

It may also be appropriate for people who 

have gastroparesis (delayed digestion).

j 


Multiwave A bolus designed to better simulate the 

body’s insulin delivery. It combines 

an immediate Standard Bolus delivery 

followed by an Extended Bolus delivery. 

A Multiwave Bolus can be helpful when 

you have meals that include both rapidly 

and slowly absorbed carbohydrates. 

Extended Bolus and Multiwave Bolus are not available in the STANDARD user menu on the pump. 

You will learn how to change from STANDARD to ADVANCED or CUSTOM user menu in section 17. 

119

14. Managing Your Data 

Careful analysis of your bG data is an effective way for you and your healthcare professional to control 

and manage your diabetes. 

Your meter automatically stores up to 1,000 diary records with their time and date. You can review up to 

250 diary records on your meter or up to 1,000 diary records using compatible software (sold separately). 

These records are stored from the newest to the oldest. It is important to have the correct time and date 

set on both devices to ensure that you and your healthcare professional can accurately interpret your 

blood glucose results. 

Each diary record can contain: 

• Date and time 

• bG test result 

• Mealtime (events) 

• Carbs 

• Health event 

• Bolus type 

• Bolus amount 

Managing Your Data 

You can display filtered or sorted diary data in graphical or table format. Your meter generates reports, 

such as bG averages with standard deviations, for the time period you choose (for example, the past 

7 days or the past 30 days). Graphs can be a good way to view your bG results. Your meter can display a 

line graph to depict bG record trends, a graph showing result ranges for the day or week and a pie chart 

with different colors to illustrate the amount of test results within, above or below your bG target range. 

121

122 


The following table depicts the icons used to display your data: 

Date of Record(s) 

Time of bG Test 

bG Icon 

Meal Time Icon 

Icon Icon Name Description 

bG Test 

Meal Time 

Carbs 

Health Event 

Carbs Icon 

bG Value 

Appropriate Bolus Icon 

Health Event Icon 

Icon is displayed when information exists for this 

diary record regarding a blood glucose test. 


diary record regarding Meal Time. 


diary record regarding carbs. 


diary record regarding Health Events.

Icon Bolus Type Delivery Confirmation 

Standard 

Bolus 

Standard 

Bolus 

Extended 

Bolus 

Extended 

Bolus 

Multiwave 

Bolus 

Multiwave 

Bolus 

Pen / Syringe 

Bolus 


Delivery has not been confirmed by the pump. 

Delivery has been confirmed by the pump. 





Bolus has not been delivered by the pump 

but by pen or syringe. 

123

124 

14.1 Viewing Your Data 

1 

2 

3 


10:02 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

10:02 am 

View Data 

Add Data 

Reports 

Data Transfer 

Menu 

2 Feb 08 

From main menu press x or z to select 

My Data. 


The Data screen is displayed and View Data 

is highlighted. 


The View Data screen appears. 

Press x or z to view other records (the screen 

scrolls if there are additional records).

4 

5 

6 

View Data 

1 Feb 08 U 

8:06 pm 

5:33 pm 

bG Value 

2.4 

Bolus 

4:06 pm 

Carbs 

2.2 

1:52 pm 

0.7 

10:02 am 

1.8 

Back 

View Data 

1 Feb 08 

8:06 pm 

U 

5:33 pm 

2.4 

4:06 pm 

6.0 

1:52 pm 

0.7 

10:02 am 

1.8 

Back Select View 

View Detail 

10:02 am 1 Feb 08 

bG Value 5.8 mmol/L 

Meal Time Pre Meal 

Carbs 20 g 

Health Stress 

Bolus 1.8 U 

Back Modify 

The screen shows the bG test results in 

the right column by default, but you can 

also view Bolus or Carb data. 

Press . to select Select View. 

Press x or z to select Bolus or Carbs. 


To view the details of a specific record, 

press x or z to move to the record. 

Press = to select the record. 

The View Detail screen is displayed. 


Press < to view the previous or > to view 

next (newer) record. 

125

126 

14.2 Editing Your Data 

From the View Detail screen in step 6 of the previous procedure. 

1 

2 

3 

4 


View Detail 

4:06 pm 1 Feb 08 

bG Value 8.6 mmol/L 

Meal Time Pre Meal 

Carbs 

60 g 

Health Stress 

Bolus 

6.0 U 

Back Modify 

Modify Data 

4:06 pm 1 Feb 08 

8.6 mmol/L 

Meal Time 

60 g 

Stress 

2.2 

Cancel Save 

Modify Data 

4:06 pm 1 Feb 08 

No Entry No dL 

Meal Pre Meal Time 

Post Meal 60 g 

Bedtime Stress 

Other 2.2 

Cancel 

Press . to select Modify. 

Press x or z to select the field you wish to 

edit, and press = to enter. 

Press x or z to change the entry, and = to 

save the change. 

Edit the other fields in the same way, as necessary. 

Press . to save the changes and exit. 

Warning 

Diary Entry Used 

For Advice 

Diary entry used for 

Advice, modifications not 

allowed 

OK 

You cannot go back and edit data that has 

been used with Bolus Advice!

14.3 Adding Data 

You can add data to a diary record for Carbs, Health, and Bolus, but not for bG Test results. 

1 

2 

3 

4 

10:02 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

10:02 am 

View Data 

Add Data 

Reports 

Data Transfer 

Menu 

Cancel 

Cancel 

Add Data 

10 00 am 

HH MM A/P 

2 Feb 08 

DD MMM YY 

Carbs 

Health 

Bolus 

Add Data 

10 00 am 

HH MM A/P 

2 Feb 08 

DD MMM YY 

Carbs 

Health 

Bolus 

9 

2 Feb 08 

From the main menu, press x or z to select 

My Data. 


Press z to move to Add Data. 


Press x or z to select a field. 


Press x or z to edit the entry. 



127

128 

5 

6 


Cancel 

Add Data 

9 20 am 

HH MM A/P 

2 Feb 08 

DD MMM YY 

45 Carbs 

Health 

Bolus 

g 

Add Data 

9 20 am 

HH MM A/P 

2 Feb 08 

DD MMM YY 

45 g 

Cancel 

Health 

Bolus 

Save 

Use x, z and = to edit other entries 

in the same way. 

Press . to save and return to the 

My Data screen.

14.4 Reporting Data 

In the Reports menu, you can view many different statistics for your bG test results, such as bG averages 

and standard deviations. Standard deviation is a statistical expression that indicates how far the individual 

test results are scattered around the average. 

1 

2 

3 

10:02 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

10:02 am 

View Data 

Add Data 

Reports 

Data Transfer 

Menu 

Reports 

bG Averages 

Trend 

Standard Day 

Standard Week 

Target 

Back 

2 Feb 08 

From main menu, press x or z to select 

My Data. 


The My Data screen appears. 

Press z to select Reports. 


The Reports screen appears. 


129

130 

j 

1 

2 

3 


bG Averages Shows you averages and standard deviations 

for your bG test results for the categories 

Overall, Pre Meal, Post Meal, Bedtime and 

Other. Test results without Meal Time entry 

only occur in the Overall category. You can 

choose whether the averages and standard 

deviations include the results of the last 

7, 14, 30, 60 or 90 days. 

Reports 

bG Averages 

Trend 

Standard Day 

Standard Week 

Target 

Back 

Last 7 days 

mmol 

/L SD Tests 

Overall 9.1 4.5 50 

Pre Meal 7.6 3.7 21 

Post Meal 11.2 7.1 21 

Bedtime 3.1 5 

Other 

Back 

9.7 2.8 3 

Last 30 days 

mmol 

/L SD Tests 

Overall 8.8 4.3 224 

Pre Meal 7.4 4.2 98 

Post Meal 12.3 6.8 94 

Bedtime 4.8 3.1 24 

Other 

Back 

9.9 2.8 8 

From the Reports screen, press = to select 

bG Averages. 

The bG Averages screen appears. 

Press < or > to select the period of time 

included in the calculation. 

Press , to select Back and return to the 

Reports screen.

j 

1 

2 

Trend Combines your bG test results for the 

categories Overall, Pre Meal, Post Meal, 

Bedtime and Other with the entries for Carbs 

and Insulin. You can view them either as a 

table or as a graph. You can choose whether 

the results of the last 8, 24 or 48 hours or 

7 days are included. 

Reports 

bG Averages 

Trend 

Standard Day 

Standard Week 

Target 

Back 

Last 8 hours 

Overall 

25 

20 

U 

mmol 

15 

/L 

10 

120 

5 

g 

0 

2 pm 4 pm 6 pm 

Back Table 

From the Reports screen, press z 

to select Trend. 


The Trend screen appears. 


Press x or z to switch between the selection 

of the included period of time and the Meal 

Time field. 

131

132 

3 

4 

5 


Last 48 hours 

Overall 

25 

20 U 

mmol 

15 

/L 

10 

120 

5 

g 

0 

8 am 8 pm 8 am 

Back Table 

Last 8 hours 

Pre Meal 

25 

20 

mmol 

U 

15 

/L 

10 

5 

0 

2 pm 4 pm 6 pm 

120 

g 

Back Table 

Last 8 hours 

Overall 

2 Feb 08 

mmol 

/L g U 

8:06 pm 3.8 66 

5:33 pm 7.1 60 2.4 

4:06 pm 8.6 20 2.2 

1:52 pm 3.3 60 0.7 

Back Graph 

When the Time field is highlighted, 

press < or > to select the included period 

of time (8, 24 or 48 hours or 7 days). 

When the Meal Time field is highlighted, 

press < or > to select the Meal Time category 

you wish to view (Overall, Pre Meal, Post Meal, 

Bedtime or Other). 

Press . to switch between Graph view 

and Table view. 


Reports screen.

j 

1 

2 

Standard Day Shows you averages and standard deviations 



Other calculated for each time block of 

your Bolus Advice / Time Block setting. 

You can view them either as a table or as a 

graph. You can choose whether the averages 

and standard deviations include the results of 

the last 7, 14, 30, 60 or 90 days. 

Reports 

bG Averages 

Trend 

Standard Day 

Standard Week 

Target 

Back 

25 

20 

mmol 

/L 

Last 7 days 

Overall 

10 

5 

0 

6 am 12 pm 6 pm 

Back Table 

From the Reports screen, press x or z to 

select Standard Day. 


The Standard Day screen appears. 


Press x or z to toggle between selection of 

included period of time and Meal Time field. 

133

134 

3 

4 

5 


25 

20 

mmol 

/L 

25 

20 

mmol 

/L 

Last 30 days 

Overall 

10 

5 

0 

6 am 12 pm 6 pm 

Back Table 

Last 30 days 

Pre Meal 

10 

5 

0 

6 am 12 pm 6 pm 

Back Table 

Last 7 days 

Overall 

12:00 - 4:00 

mmol 

/L 

8.7 

SD 

3.7 

4:00 - 8:00 8.1 2.6 

8:00 - 12:00 11.1 8.1 

12:00 - 4:00 7.4 4.1 

Tests 

3 

4 

4 

9 

Back Graph 



of time (7, 14, 30, 60 or 90 days). 








Reports screen.

j 

1 

2 

Standard Week Shows you averages and standard deviations 



Other, calculated for each day of the week. 

You can view them either as a table or as a 

graphic. You can choose whether the 

averages and standard deviations include 

the results of the last 7, 14, 30, 60 or 90 days. 

Reports 

bG Averages 

Trend 

Standard Day 

Standard Week 

Target 

Back 

25 

20 

mmol 

/L 

Last 7 days 

Overall 

10 

5 

0 

M T W T F S S 

Back Table 


select Standard Week. 


The Standard Week screen appears. 


Press x or z to toggle between the selection 

of included period of time and Meal Time field. 

135

136 

3 

4 

5 


25 

20 

mmol 

/L 

10 

5 

0 

M T W T F S S 

Back Table 

25 

20 

mmol 

/L 

Last 14 days 

Overall 

Last 14 14 days days 

Pre Overall Meal 

10 

5 

0 

M T W T F S S 

Back Table 

Last 7 days 

Overall 

mmol 

/L SD Tests 

Monday 6.3 2.2 5 

Tuesday 6.0 3.9 5 

Wednesday 7.2 5.5 5 

Thursday 5.9 4.0 5 

Back Graph 



of time (7, 14, 30, 60 or 90 days). 








Reports screen.

j 

1 

2 

Target Shows you percentages of your bG test 

results that are above, within or below your 

Target Range (between upper and lower bG 

target limit) and below your Hypo Warning 

Limit. You can view them either as a table 

or as a pie chart. You can choose whether 

the percentages include the results of the 

last 7, 14, 30, 60 or 90 days. 

Reports 

bG Averages 

Trend 

Standard Day 

Standard Week 

Target 

Back 


select Target. 


The Target screen appears. 


Press x or z to switch between the selection 

of included period of time and Meal Time field. 

137

138 

3 

4. 

5 


Above 

Within 

Below 

Hypo 

Last 7 days 

Overall 

13% 

70% 

13% 

4% 

Back Graph 



of time (7, 14, 30, 60 or 90 days). 





Press . to toggle between Graph view 



Reports screen.

Transferring data to a computer 

1 

2 

10:02 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

Position the infrared window of your meter 

opposite the infrared cable connected to your 

computer, and prepare the computer for data 

transfer (for detailed instructions, see the user 

documentation provided with the computer). 

From main menu on the meter, press x or z to 

select My Data. 



For safety reasons, you must transfer pump and meter data separately. You will learn how to 

transfer your pump data in section 23. 

139

140 

3 

4 


10:00 am 

View Data 

Add Data 

Reports 

Data Transfer 

Menu 

Data Transfer 

Transferring Data 

2 Feb 08 

Press x or z to move to Data Transfer. 


The data transfer begins. 

When the data transfer is complete, the 

Data Transfer Complete screen appears for 

3 seconds and then the meter turns off.

15. Using Reminders 

Managing your job, managing your family or managing school often require your full attention. The 

meter can assist you in managing your diabetes. With reminders, it helps you remember a variety of 

diabetes-related tasks. 

Three different types of reminders are available to accommodate different requirements: 

j 

j 

j 

bG Test Reminders Remind you to test your bG level 

in special situations: 

• After a high bG test result 

(hyperglycemia) 

• After a low bG test result 

(hypoglycemia) 

• After a meal 

Using Reminders 

Alarm Clock You can set up to 8 different alarm clock 

reminders per day. 

You can set them to remind you of: 

• A bG test 

• Other events 

Date Reminders Remind you of events like: 

• Dr. visit (sounds at a programmed date) 

• Lab test (sounds at a programmed date) 

• Infusion set change (sounds after a 

1-, 2- or 3-day period) 

141

142 

15.1 To Set Reminders 

1 

2 

3 


10:02 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

10:02 am 2 Feb 08 

Reminders 

Bolus Advice 

Meter 

Sound/Vibrate 

Time/Date 

Menu 

Reminders 

bG Test Reminders 

Alarm Clock 

Date Reminders 

Back 

From the main menu, press x or z to 

select Settings. 



Press = to enter Reminders. 

The Reminders screen appears.

15.2 bG Test Reminders – After High bG 

This reminder will turn on the meter. You can dismiss it by pressing .. 

You can reschedule (snooze) it to occur in 15 minutes by pressing ,. 

1 

2 

3 

Reminders 


Alarm Clock 


Back 


After High bG Off 

After Low bG Off 

After Meal 

Off 

Back 

After High bG 

Reminder 

Off 

bG Threshold 16.7 mmol/L 

Remind After On 0:15 

HH MM 

Off 

Cancel 

From the Reminders screen, press x or z 

to select bG Test Reminders. 


The bG Test Reminders screen appears. 

Press = to enter After High bG. 

The After High bG screen appears. 

Press = to enter Reminder. 


Press x or z to select On or Off as needed. 

Press = to confirm and move to the bG 

Threshold box. The Hyper Warning Limit is 

set as bG threshold for triggering the reminder 

by default. 

143

144 

4 

5 


After High bG 

Reminder 

On 

bG Threshold 14.0 300 mg/dL 

Remind After 0:15 

HH MM 

mmol/L 

Cancel 

After High bG 

Reminder 

On 


Remind After 1:300:15 

HH MM 

Cancel 

To change the bG threshold press =. 

Press x or z to select the bG value as needed. 

Press = to confirm and move to the Remind 

After box. 


Press x or z to change the period after which 

the reminder sounds as needed. 


Press . to save and return to the bG Test 

Reminders screen.

15.3 bG Test Reminders – After Low bG 

This reminder turns on the meter. You can dismiss it by pressing .. 


1 

2 

3 

Reminders 


Alarm Clock 


Back 




After Meal 

Off 

Back 

After Low bG 

Reminder 

Off 


Remind After On 0:15 

HH MM 

Off 

Cancel 





Press x or z to select After Low bG. 


The After Low bG screen appears. 




Press = to confirm and move to the bG 

Threshold box. The Hypo Warning Limit 

is set as bG threshold for triggering the 

reminder by default. 

145

146 

4 

5 


After Low bG 

Reminder 

On 

bG Threshold 3.3 300 mg/dL 


HH MM 

mmol/L 

Cancel 

After Low bG 

Reminder 

On 


Remind After 0:200:15 

HH MM 

Cancel 

To change the bG Threshold press =. 

Press x or z to select the bG value as needed. 

Press = to confirm and move to the Remind 

After box. 


Press x or z to change the period after 

which the reminder sounds as needed. 



Reminders screen.

15.4 bG Test Reminders – After Meal 

This reminder will turn on the meter. You can cancel it by pressing .. 


1 

2 

3 

Reminders 


Alarm Clock 


Back 




After Meal 

Off 

Back 

After Meal 

Reminder 

Snack Size 

Remind After 

Cancel 

On 

20 g 

On 2:00 

HH Off MM 





Press x or z to select After Meal. 


The After Meal screen appears. 



Press = to confirm and move to the 

Snack Size box. 


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148 

4 

5 


After Meal 

Reminder 

On 

Snack Size 10 20 g 


HH MM 

g 

Cancel 

After Meal 

Reminder 

Snack Size 

Remind After 

Cancel 

Snack Size is the same as entered in the Bolus Advice Options. If you change it here, it will also 

be changed in the Bolus Advice settings. If the carbohydrate content consumed is equal to or 

lesser than the snack size, no After Meal reminder will occur, as this is considered a snack, not 

a meal. 

1:30 

On 

20 g 

2:00 

HH MM 


Press x or z to select appropriate 

Snack Size. 


Remind After box. 


Press x or z to select an appropriate period 

of time as needed. 



Reminders screen.

15.5 Alarm Clock 

This reminder turns on the meter. You can cancel it by pressing .. 


1 

2 

3 

Reminders 


Alarm Clock 


Back 

Alarm Clock 

HH MM A/P 

12:00 am 

12:00 am 

12:00 am 

12:00 am 

12:00 am 

Cancel 

Alarm Clock 

HH MM A/P 

9:00 12:00 am 

12:00 am 

12:00 am 

12:00 am 

12:00 am 

Cancel 

am 

Off 

Off 

Off 

Off 

Off 

Save 

Off 

Off 

Off 

Off 

Off 


to select Alarm Clock. 


The Alarm Clock screen appears. 

Press x or z to move to the alarm clock 

you wish to change. 

Press = to enter the time box. 

Press x or z to select the appropriate time 

for the alarm. 


off/purpose box. 


149

150 

4 

5 


Alarm Clock 

HH MM A/P 

9:00 am bG Test Off 

12:00 am Off Off 

12:00 am bG Test Off 

12:00 am 

Other 

Off 

12:00 am Off 

Cancel 

Alarm Clock 

HH MM A/P 

9:00 am bG Test 

12:00 am Off 

12:00 am Off 

12:00 am Off 

12:00 am Off 

Cancel 

Save 


Press x or z to select Off, bG Test or Other 

as needed. 


Where appropriate, repeat steps 2 to 4 

to set more alarms. 

Press . to save and return to the 

Reminders screen.

15.6 Date Reminders – Dr. Visit 

This reminder does not turn on the meter, but sounds as soon as you turn on the meter on the selected 

day. You can cancel it by pressing .. 

1 

2 

3 

Reminders 


Alarm Clock 


Back 


Dr. Visit 

Off 

Lab Test 

Off 

Infusion Set Change Off 

Back 

Dr. Visit 

Reminder 

Appointment Date/Time 

Off 

Date 2 Feb On 08 

Time 

DD MMM 

--:-- am 

Off YY 

(Optional) 

Cancel 

HH MM A/P 


to select Date Reminders. 


The Date Reminders screen appears. 

Press = to enter Dr. Visit. 

The Dr. Visit screen appears. 

Press = to enter the Reminder box. 

Press x or z to select On or Off. 


Press = to confirm and move to the Date line. 

151

152 

4 

5 

6 


Dr. Visit 

Reminder On 


Date 12 2 Mar Feb 08 

Time 

DD MMM 

--:-- am 

YY 

(Optional) HH MM A/P 

Cancel Save 

Dr. Visit 

Reminder Off 


Date 12 Mar 08 

Time 

DD MMM 

--:-- am 

YY 


Cancel 

Save 

Dr. Visit 

Reminder On 



DD MMM 

Time11:3010:00 

am 


YY 

am 

Cancel 

Press = to enter the day box. 

Press x or z to select the day. 

Press = to confirm and enter the month box. 

Press x or z to select the month. 

Press = to confirm and enter the year box. 

Press x or z to select the year. 

Press = to confirm and move to the Time box. 


Press x or z to select the time. 


Press . to save and return to the Date 

Reminders screen.

15.7 Date Reminders – Lab Test 

This reminder does not turn on the meter, but sounds as soon as you turn on the meter on the selected 

day. You can cancel it by pressing .. 

1 

2 

3 

Reminders 


Alarm Clock 


Back 


Dr. Visit 

Off 

Lab Test Off 


Back 

Lab Test 

Reminder 


Off 

Date 2 Feb On 08 

Time 

DD MMM 

--:-- am 

Off YY 

(Optional) 

Cancel 

HH MM A/P 





Press x or z to move to Lab Test. 


The Lab Test screen appears. 




Press = to confirm and move to the Date line. 

153

154 

4 

5 

6 


Lab Test 

Reminder On 


Date 12 2 Mar Feb 08 

Time 

DD MMM 

--:-- am 

YY 


Cancel Save 

Lab Test 

Reminder On 



Time 

DD MMM 

--:-- am 

YY 


Cancel 

Save 

Lab Test 

Reminder On 



DD MMM 

Time 8:3010:00 am 


YY 

am 

Cancel 

Press = to enter the day box. 

Press x or z to select the day. 

Press = to confirm and enter the month box. 

Press x or z to select the month. 

Press = to confirm and enter the year box. 

Press x or z to select the year. 

Press = to confirm and move to the Time box. 


Press x or z to select the time. 



Reminders screen.

15.8 Date Reminders – Infusion Set Change 

This reminder does not turn on the meter, but sounds as soon as you turn on the meter on the 

appropriate day. You can cancel it by pressing .. 

You can reschedule (snooze) it to occur the next time you turn on your meter by pressing ,. 

1 

2 

3 

Reminders 


Alarm Clock 


Back 


Dr. Visit Off 

Lab Test 

Off 


Back 


Reminder 

Off 

Interval 

3 Days 

On 

Off 

Cancel 





Press x or z to move to Infusion Set Change. 


The Infusion Set Change screen appears. 




155

156 

4 

5 



Reminder 

On 

Interval 

1 3 Days 

Cancel Save 


Reminder 

On 

Interval 

1 Days 

1 Day 

2 Days 

3 Days 

Cancel 


Interval box. 


Press x or z to select the interval as needed. 



Reminders screen. 

The reminder will sound every 1, 2 or 3 days after you switch it on, according to the selected 

interval. If you need to reset the starting day, switch the reminder off and then on again.

16. Changing Your Meter Settings 

1 

2 

3 

4 

10:02 am 2 Feb 08 

bG Test 

Bolus Advice 

Pump 

My Data 

Settings 

10:02 am 2 Feb 08 

Reminders 

Bolus Advice 

Meter 

Sound/Vibrate 

Time/Date 

Menu 

From main menu, press x or z to move 

to Settings. 

Use x, z and = to edit the particular setting as needed. 

Where appropriate, press . to save and exit. 

Changing Your Meter Settings 

As your life or health situation may change, you may need to change some of the values in your meter 

settings. Discuss with your healthcare professional before you change settings. 

Press = to enter. The Settings screen appears. 

157

158 


You will find the particular settings as follows: 

Reminders 

Reminders 


Alarm Clock 


Back 

Bolus Advice 

Bolus Advice 

Time Blocks 

Health Events 


Back 

› bG Test Reminders › After High bG 

› After Low bG 

› After Meal 

› Alarm Clock › Alarm Clock 1– 8 

› Date Reminders › Dr. Visit 

› Lab Test 

› Infusion Set Change 

› Time Blocks › End 

› Target Range 

› Carb Ratio 

› Insulin Sensitivity 

› Health Events › Exercise 1 

› Exercise 2 

› Stress 

› Illness 

› Premenstrual 

› Advice Options › Meal Rise 

› Snack Size 

› Acting Time 

› Offset Time

Meter 

Meter 


Key Lock 

Language 

Units 

Bluetooth 


Back 

Sound / Vibrate 

Sound/Vibrate 

Beeper 

Vibrate 

Key Sound 

Time / Date 

Medium 

Off 

On 

Cancel Save 

Time/Date 


Time 10 00 am 

Date 

HH MM 

2 Feb 

A/P 

08 

DD MMM YY 

Cancel Save 

› Warning Limits › Hyper (high) 

› Hypo (low) 

› Key Lock › ON / OFF 

› Language 

› Units › Grams, BE, KE, CC 

Grams is the standard unit of measurement in the United States and Canada. 

› Bluetooth › ON / OFF 

› Pair with Pump 

› Beeper › Off, Low, Medium, High 

› Vibrate › ON / OFF 

› Key Sound › ON / OFF 

› Time Format 

› Time 

› Date 


159

There are 3 user menus to choose from, depending on your knowledge and experience with pump therapy: 

Standard 

For ease of use, this menu features only the basic functions you need for successful insulin pump therapy. 

It is particularly well suited to those beginning insulin pump therapy or those who want simplicity in their 

insulin pump therapy. 

Advanced 

This menu includes all functions from the Standard menu, plus a number of additional functions. This is 

particularly recommended if you are already experienced in insulin pump therapy. 

Custom 

ACCU-CHEK Spirit Combo User Menus 

17. ACCU-CHEK Spirit Combo User Menus 

This menu enables you to organize all the ACCU-CHEK Spirit Combo insulin pump functions according 

to your individual requirements. You or your healthcare team can set up the menu using PC-based 

configuration software (sold separately). 

By default your pump is in Standard user menu. For using Extended or Multiwave bolus, different 

basal rate profiles, changing your Therapy Settings or using reminders, you must change to the 

Advanced user menu. 

161

162 

Selecting a user menu 

As you become more experienced using your pump, you may wish to change to the Advanced user 

menu for additional flexibility and convenience with your pump. 

1 

2 

3 

4 

ACCU-CHEK Spirit Combo User Menus 

Press < to move to the Menu Settings screen. 


The Select User Menu screen appears. 

Press x or z to move to Advanced. 


The Select Profile screen appears. Profile 1 

is selected by default. 

Press x or z to select the appropriate profile. 

Press > to confirm. 

The pump returns to the Stop or Run screen.

18. Choosing Your Bolus Type 

There are 3 bolus types with different shapes of bolus delivery available: 

j 

j 

j 

Choosing Your Bolus Type 


immediately in one portion. This bolus may 

be a good choice for corrections during 

the day and to compensate for food intake 


fruit, cake). 

Extended A bolus delivered over a period of time. That 

means you have to program an appropriate 

duration as well as the bolus amount. This 

bolus type may be helpful during long meals, 

dinners or receptions or when you have 

meals that are digested slowly. It may also be 

appropriate for people who have gastroparesis 

(delayed digestion). 


body’s insulin delivery. It combines a 

Standard (immediate) bolus delivery 

followed by an Extended Bolus delivery. 

A Multiwave Bolus may be helpful when 

you have meals that include both rapidly 

and slowly absorbed carbohydrates. 

163

164 

18.1 Programming an Extended Bolus 

1 

2 

3 


While your meter is in the Pump menu, press 

< to move to the ExTENDED BOLUS screen. 



Press x to increase or z to decrease 

the bolus amount. 

Press < to move to the BOLUS DURATION 

screen.

4 

5 


The duration of the last Extended Bolus 

delivered appears. 

Press x to increase or z to decrease the 

bolus duration. 

Press < to switch between programming the bolus amount and bolus duration. 

Press > to confirm the bolus amount and 

duration. You hear a melody and /or feel a 

vibration. The bolus delivery begins within 

the next 3 minutes. 

Remember that you can also use the corresponding keys of the pump for this procedure 

(Appendix E, page 250). See section 8.2 for the relationship of meter buttons and pump keys. 

165

166 


18.2 Cancelling an Extended Bolus 

During 

programming 

(the bolus 

amount or 

bolus duration 

blinks) 

During 

bolus 

delivery 

You can either: 

• Wait for your pump to return to the 

RUN screen 

• Press . to exit the Function screen 

• Set the bolus amount to 0.0 units and press >. 

If the Extended Bolus delivery has begun, it can 

be cancelled by putting your pump into STOP 

mode. This cancels the bolus delivery and a 

W8: BOLUS CANCELLED warning is displayed. 

Press > twice to confirm and turn off the alert. 

The bolus amount delivered up to the 

cancellation can be reviewed in the 

BOLUS DATA screen. 

No bolus is 

delivered 

Bolus 

delivery is 

interrupted

18.3 Programming a Multiwave Bolus 

1 

2 

3 

4 

While your meter is in the Pump menu, press < 

to move to the MULTIWAVE BOLUS screen. 




the total bolus amount. 

Press < to move to the IMMEDIATE 

BOLUS screen. 

Press x or z to correct and set the 

immediate bolus amount. 


167

168 

5 

6 

7 


Press < to move to the BOLUS 

DURATION screen. 

Press x or z to correct and set the Extended 

Bolus duration in increments of 15 minutes 

for up to 24 hours. 

Press < to loop between programming the total bolus amount, immediate bolus 

and bolus duration. 

Check the total and immediate bolus amounts 

and the Extended Bolus duration programmed 

on the screens. 

Press > to confirm both bolus amounts 

and the bolus duration. The Multiwave Bolus 

symbol blinks for 5 seconds (bolus delivery 

start delay).

8 


The pump beeps 3 times and vibrates, 

and the immediate bolus delivery begins. 

The countdown of the remaining bolus 

continues to appear on the display. 



169

170 


18.4 Cancelling a Multiwave Bolus 

During 

programming 

During the 

start delay 

There are 3 ways to cancel a Multiwave Bolus 

during programming: 

• Do not press any key for 20 seconds. 

The pump returns to the RUN screen. 

• Exit to the Multiwave Bolus screen 

by pressing .. 

• Set the total bolus amount to 0.0 units 

and press >. 

Press z or x. The pump beeps and 

vibrates. The pump returns to the RUN screen. 

This cancels the bolus delivery and a W8: 

BOLUS CANCELLED warning is displayed. 


No bolus is 

delivered 

No bolus is 

delivered

During 

immediate 

bolus 

delivery 

During 

extended 

delivery 

You can cancel immediate delivery by pressing 

and holding z or x for 3 seconds until you 

hear a melody. This cancels the whole bolus 

(immediate and Extended Bolus delivery), and a 

W8: BOLUS CANCELLED warning is displayed. 





You can cancel the extended delivery 

by putting the pump in STOP mode. 

This cancels the Extended Bolus, and a W8: 

BOLUS CANCELLED warning is displayed. 






Bolus 

delivery is 

interrupted 

Bolus 

delivery is 

interrupted 

171

19. Additional Basal Rate Profiles 

Your pump has 5 different basal rate profiles to match your changing insulin needs (for example, Monday 

to Friday, Exercise Day or Sleeping Late Day). 

Discuss additional basal rate profiles with your doctor or healthcare team. Also, consult with your doctor 

or healthcare team before changing basal rate profiles. 

To program basal rate profiles 2–4, you can use the same procedure as for basal rate profile 1. 

19.1 Setting Basal Rate Profiles 

1 

2 

3 

Additional Basal Rate Profiles 

While the meter is in the Pump menu, press < 

to move to the BASAL RATE PROGRAMMING 

1 screen (or 2, 3, 4 or 5 accordingly). 

Press > to enter. The BASAL RATE TOTAL 


Press < to move to the first hour. 

This is always 12 AM – 01 AM 

(00:00 – 01:00 if 24-hour time format is used). 

173

174 

4 

5 

6 

7 


Press x or z repeatedly or scroll to set 

the hourly basal rate given by your doctor 

or healthcare team. 

Press < to move to the next hour. 

Continue using < and x or z to set the hourly basal rates for the 

remaining hours. This allows you to program your individual basal 

rate profile on an hour-by-hour basis. Continue until all 24 hours 

are programmed. 

Press > to confirm. The new daily BASAL 


Press > again to save the profile and exit. 


(Appendix E, page 259). See section 8.2 for the relationship of meter buttons and pump keys.

19.2 Selecting a Basal Rate Profile 

1 

2 

The new basal rate profile is active immediately. 


to move to the BASAL RATE SELECTION screen. 


Press x or z to select a basal rate profile. 

The selected basal rate profile and its daily 

insulin total appear. 





175

20. Therapy Settings 

These settings relate to the therapeutic use of the pump. For settings relating to the practical use of the 

pump, see section 9.6, Pump Settings. 

20.1 Adjusting the Bolus Increment 

Therapy Settings 

Designed for those patients who may need large or small amounts of insulin, the bolus increment for the 

Quick Bolus of your ACCU-CHEK Spirit Combo insulin pump is adjustable. It is initially set to 0.5 units 

per key press, but it can be changed to 0.1, 0.2, 0.5, 1.0 or 2.0 units. 

177

178 

1 

2 



to move to the THERAPY SETTINGS screen. 


Press < to move to the BOLUS INCREMENT 

screen. 

Press x or z to select a bolus increment. 



(Appendix E, page 263). See section 8.2 for the relationship of meter buttons and pump keys.

20.2 Adjusting the Prime Amount 

The prime amount needed to fill an infusion set depends on the length of the infusion set tubing. 

The shorter your infusion set tubing, the less insulin will be required to prime the infusion set. 

The default setting for the prime amount is 25 units of U100 insulin. 

1 

2 




Press < to move to the PRIME AMOUNT 

screen. 

Press x or z to select a prime quantity between 

0.0 and 50.0 units. 





179

180 


20.3 Locking Basal Rate Profiles 

Your ACCU-CHEK Spirit Combo insulin pump allows you to adapt your hourly basal rate profile as 

needed. You can then lock your basal rate profiles to provide additional protection against accidentally 

changing a basal rate during normal operation. If the basal rate lock is set to ON, programming of the 

basal rate profiles 1–5 is blocked. 

If you try to program a basal rate while the basal rate lock is turned ON, the key symbol in the BASAL 

RATE TOTAL screen indicates that basal rate programming is locked. The x and z functions are blocked. 

However, you can still change between the different basal rate profiles 1–5.

1 

2 




Press < to move to the BASAL RATE LOCK 

screen. 

Press x or z to turn the basal rate lock 

on or off. 





181

182 


20.4 Automatic Off 

Automatic Off is a safety feature that stops insulin delivery and triggers an E3: AUTOMATIC OFF error if 

no pump keys are pressed or the pump was operated using the meter within a programmed time period 

in RUN mode. This feature can either be set to OFF or programmed up to 24 hours in 1-hour intervals. 

The factory setting is OFF. 

Discuss using the Automatic Off function with your doctor or healthcare team.

1 

2 

3 




Press < to move to the AUTOMATIC OFF 

screen. 

Press or scroll x to increase or z to 

decrease the duration for the Automatic 

Off in 1-hour intervals. 

If you would like to set the AUTOMATIC OFF 

function to off, press z until “0 h” and 

OFF appear on the display. 





183

21. Setting a Reminder on the Pump 

You can set both single and multiple reminders on your pump. Multiple reminders are repeated at a set time 

every day. You can use this feature to remind you, for example, when you need to test your blood glucose. 

Procedure for setting single or multiple reminders 

1 

2 

Setting a Reminder on the Pump 


to move to the REMINDER SETTINGS screen. 

Press > to select. The current reminder status 

and alarm time appear. 

185

186 

3 

4 

5 


Press x or z to change the reminder setting 

to OFF, ONCE or EVERY DAY. 



Press < to move to the HOUR screen. 

Press x or z to set the hour. 

Press < to move to the MINUTE screen. 

Press x or z to set the minute. 


Turning off the reminder 

When the reminder sounds, the REMINDER screen is displayed. 

Press f twice to snooze and confirm and return to RUN or STOP mode. 




187

22. CUSTOM User Menu 

The CUSTOM user menu is designed to adapt your pump to your special requirements and preferences. 

It allows you or your healthcare provider to display or hide screens and thereby customize the individual 

user menus. By default the following functions are accessible in the CUSTOM menu: 

RUN 

f 

f 

• Press d or < to move forward 

• Press d+a simultaneously or . to move backward 

CUSTOM User Menu 

STOP 

To change the CUSTOM user menu, you or your healthcare provider must use the ACCU-CHEK Spirit 

Combo insulin pump configuration software (available for an additional cost). 

189

Transferring Your Pump Data to a Computer 

23. Transferring Your Pump Data to a Computer 

The built-in infrared interface on the bottom of your ACCU-CHEK Spirit Combo insulin pump enables 

you to transfer data between your pump and a PC. 

The memory of your ACCU-CHEK Spirit Combo insulin pump stores all the events (warnings, 

errors, programming operations and insulin delivery records) up to a total of 4,500 events. These data 

correspond to approximately the last 90 days of use and can be accessed on a personal computer 

using ACCU-CHEK information management products. (For details see the user information provided 

with the software.) 

191

192 

1 

2 

3 

4 

Transferring Your Pump Data to a Computer 

Procedure for transferring your data 

Put your pump in STOP mode. 

Press d to move to the DATA TRANSFER 

screen. 


Press f. A melody signals that your pump 

is transferring data. 

When the data transfer is complete, press f 

to return to the STOP screen. 

If necessary, set up your pump with a cartridge, adapter and a new infusion set, and put it in RUN mode.

24. Pairing Your Pump with the Meter 

After a W10: BLUETOOTH FAULT warning, you must pair the pump and meter before they can communicate 

with each other. 

When pairing your pump with the meter, place both pump and meter on a table or desk, so that you can 

see the displays of both devices clearly. 

You should not perform the pairing process in crowded areas, since the emissions of other electronic devices 

may interfere with the connection. 

24.1 Pairing the Pump and Meter 

1 

2 

Press f to select the ON / OFF screen. 

Press a or s to switch on the 

Bluetooth function. 

Pairing Your Pump with the Meter 

Press d to move to the BLUETOOTH 


193

194 

3 

4 

5 


Pump screen 


Ensure Pump is in 

pairing mode through 

Bluetooth menu on Pump 

Waiting... 

METER574328192 

Meter screen screen 

Press d to display the PAIRED DEVICE 

screen. 

If the pump screen indicates that no 

paired device is available, turn on the meter 

in pairing mode by holding down * and 

simultaneously pressing +. 

When Bluetooth ® communication is turned off, you cannot access the Paired Device menu. 

Pump screen 


Ensure Pump is in 

pairing mode through 

Bluetooth menu on Pump 

Waiting... 

METER574328192 

Meter screen 

Press the d key on the pump to see the ADD 

DEVICE screen, and press f to initiate pairing. 

The pump begins searching and detects 

the meter, displaying its serial number. 

(This process may take several minutes.) 

Press a or s to select the number, which 

is also shown on your meter screen. 

Press f on the pump to confirm that you 

want to pair the meter.

6 

7 

8 

9 

Pump screen 


Enter PIN shown on 

Pump display 

1 

Cancel 

Meter screen 


Pairing completed for 

PUMP12345678 

METER574328192 

Turn Meter off 

Meter screen 

The pump begins the pairing process and 

shows a 10-digit code. Enter the code on the 

meter display, using =, x and z and then = 

to move to the next digit. 

Confirm the complete code with .. 

After the pairing is complete, press + to turn 

off the meter. 

The pump now shows the DEVICE PAIRED 

screen. 

Press f to confirm the pairing. 


The pump displays the PAIRED DEVICE 

screen. You can return to the RUN screen 

by pressing f. 

If the pairing is not successful in the first attempt, wait a few minutes before you repeat the 

procedure in a safe or less-crowded environment. 

195

196 

24.2 Troubleshooting the Bluetooth Connection 

In case of problems with the Bluetooth connection, you will have to repeat the pairing procedure described 

on the previous pages. 

Since only one meter at a time can be paired with your pump, you must delete the old pairing before you 

can pair your pump with a new meter. 

1 

2 

3 

4 


Press d to move to the BLUETOOTH 


Press f to enter the BLUETOOTH ON / OFF 

screen. 

Press d to move to the PAIRED DEVICE 

screen. 

Press d to move to the DELETE DEVICE screen. 

Press f once to delete the pairing and a 

second time to confirm.


197

On your mark. 

Get set. 

Go! 

Appendixes

Appendix A 

Calculating a Bolus 

Calculating a correct bolus is tricky business. 

If you had to work it out yourself, here’s what you would have to do. 

Pumpy’s Recipe for a Ready-to-Use Insulin Bolus 

Ingredients 

• A fresh amount of carbohydrates 

• Your current Insulin-to-Carb Ratio (or carb factor) 

• A fresh blood glucose (bG) test result 

• Your current bG target level 

• Your current insulin sensitivity (also called your correction factor) 

• Your current amount of active insulin 

• The correct time 

• An insulin dose adjustment for exercise, stress, illness or premenstruation (add as needed) 

• Insulin 

Tools 

• A watch or clock 

• A meter 

• A test strip 

• A lancing device 

• An insulin pump, pen or syringe 

Appendix A: Calculating a Bolus 

201

202 


Instructions 

1. Check the time, and divide the carbohydrates by your current Carb Factor. The carbohydrates must 

be new and must not have been used for a previous bolus. 

2. Put the result aside. This is your meal bolus. 

3. Perform a bG test to get a new bG test result. Make sure the result is less than 5 minutes old and 

has not been used for a previous bolus. 

4. Subtract your current bG target level from your bG test result. 

5. Divide the answer by your current insulin sensitivity or carb factor (check the time). This gives you 

the correction bolus. 

6. Add the correction bolus to the meal bolus that you prepared earlier. If the result is less than 0, you 

do not need to inject insulin at the moment. 

7. Add or subtract the health percentage for exercise, stress, illness or premenstruation as required. 

8. Inject the resulting amount of insulin using your pump, pen or syringe. 

Note: Do not reuse the carb amount or bG test result for a second bolus as this could lead to double dosage 

and hypoglycemia.

Thankfully, calculating a correct bolus with the new ACCU-CHEK Combo system 

is so much easier. 

Ingredients 

• A fresh amount of carbohydrates 

• A new bG test result 

• A health percentage for exercise, stress, illness or premenstruation (add as needed) 

Your ACCU-CHEK Combo system automatically considers the current time, your Insulin-to-Carb Ratio 

(or carb factor) for the current time, your current Insulin Sensitivity (also called the correction factor) 

and the percentages for exercise, stress, illness or premenstruation as you entered them in the Setup 

Wizard. Your pump also contains the required insulin. 

Tools 

• Your ACCU-CHEK Combo system 

• A test strip 

• A lancing device 

Instructions 

1. Perform a bG test using your new ACCU-CHEK Combo meter. 

2. Access Bolus Advice from the bG Result screen. 

bG Result 

5.8 

10:02 am 

mmol/L 

Meal Time 

Carbs 

Health 


Menu Bolus 


3. In Bolus Advice, enter mealtime and the amount of carbs you are planning to consume and any 

information about Health Events as required. Bolus Advice will do the calculation for you. 

4. Press the soft key to confirm and deliver the bolus as prepared by your ACCU-CHEK Combo system. 

As long as you are always using your ACCU-CHEK Combo system for bolus advice, it will automatically 

ensure that neither a carb amount nor a bG test result is reused for a second bolus! 

For further details see Appendix B, Bolus Advice Calculations, and Appendix C, Mathematical Basis for 

Bolus Calculations. 

203

204 


Where to find the Bolus Advice settings on the meter 

Manual Calculation On Your Meter 

Time dependence 

of parameters 

(circadian rhythm) 

Insulin-to-carbohydrate 

ratio 

Insulin sensitivity/ 

correction factor 

bG target level 

Time Blocks 

In Settings › Bolus Advice › Time Blocks 

Carb Ratio 

Within each Time Block 

(in Settings › Bolus Advice › Time Blocks) 




Target Range 



The target value is calculated automatically as 

midway between the upper and lower target limits.

Manual Calculation On Your Meter 

Insulin dose 

adjustment for 

exercise, stress, 

illness or 

premenstruation 

Prevention of double 

dosage after meal 

Prevention of double 

dosage after a high bG 

test result 

Health 


In the bG Test Result screen or in 

Bolus Advice (select the value 

in Settings › Bolus Advice › Health Events) 

Meal Rise 

In connection with Acting Time 

and Offset Time (in Settings › Bolus Advice 

› Advice Options) 

Offset Time and Acting Time 

after a correction bolus 

205

Appendix B 

Bolus Advice Calculations 

In this section, you will learn how Bolus Advice recommendations are calculated. To make sure that the 

recommendations meet your needs, you must give the Bolus Advice feature on your meter some extra 

information, as well as the basic blood glucose (bG) and carbohydrate values. As a safety measure, 

Bolus Advice will not work without this information. 

Your healthcare professional will give you the information that you need for the Bolus Advice feature. 

Carbohydrate Units 

Choosing how your carbohydrates will be measured is important. In this way, Bolus Advice can give you 

an accurate result. You just select what carbohydrate units Bolus Advice will use to make its calculations. 

You can choose between: 

• Grams 

• BE (bread exchange): ≈ 12 g 

• KE (Kohlenhydrateinheit): ≈ 10 g 

• CC (cubic centimeter): ≈ 15 g 

The standard unit of measure in Canada is grams. 

Appendix B: Bolus Advice Calculations 

207

208 


Time Blocks 

Your insulin needs may vary depending on the time of day, so using the same values and factors 

throughout the day would probably not suit your metabolism or lifestyle. This could also lead to incorrect 

doses of insulin. 

Start 

Time Blocks 

End 

12:00 am 5:30 am 

5:30 am 11:00 am 

11:00 am 5:00 pm 

5:00 pm 9:30 pm 

9:30 pm 

Back 

12:00 am 

The screen above shows the Time Blocks feature within Bolus Advice. Time blocks consider your timedependent 

requirements when calculating your insulin dose at different times of the day. You can program 

up to eight time blocks, depending on your lifestyle. For example, your insulin needs in the morning or 

evening may not be the same as those in the afternoon or at night, so you can program these different 

periods as time blocks. There are no predefined time blocks that you should follow. You can choose 

when a time block ends to suit your lifestyle.

Within Time Blocks, you will find the following settings: 

Time Blocks 

Target Range 


Carb Ratio 

1 U for 10 g 


1 U for 2.2 mmol/L 

Cancel Save 

Target Range 

Your bG results should be between the lower and upper values of the target range as long as you are 

fasting (in the morning or before a meal). The target bG will be calculated automatically as the average 

between the upper and lower bG values. 

Carb Ratio 

The Carb (carbohydrate) Ratio defines how many carbohydrates are compensated by one unit of insulin. 



The Insulin Sensitivity Factor (ISF) shows how sensitive you are to a dose of insulin. This is how much 

your bG drops in response to a unit of insulin. 

You can define all of these values separately for each time block. The Bolus Advice calculation 

automatically takes these values into account for the time of day. 

209

210 

Without a meal—that means, when you do not enter carbs—these are 

the calculations 

hyper 

hypo 


If your bG level is … 

above Hyper Warning 

between Upper Target 

Limit and Hyper Warning 

between Upper 

and Lower 

Target Limit 

between Lower Target 

Limit and Hypo Warning 

below Hypo Warning 

… the correction bolus calculation is 

(bG – Target bG) ÷ ISF 

Additional recommendation to measure bG 

more frequently and check for ketones. 

(bG – Target bG) ÷ ISF 

No correction bolus necessary. 

No correction bolus recommended. 

Hypo Warning! Recommendation to eat 

fast-acting carbs. 

Bolus advice function not accessible. 

Remember the colored bar in the bG test-result screen tells where your current bG level is 

compared to your target bG.

Before a meal—that means, when you enter carbs—these are the calculations 

The meal bolus will always be calculated as: 

hyper 

hypo 

carbs ÷ Carb Factor 

If your bG level is … 

above Hyper Warning 

between Upper Target 

Limit and Hyper Warning 

between Upper 

and Lower 

Target Limit 

between Lower Target 

Limit and Hypo Warning 

below Hypo Warning 


… the correction bolus calculation is 

Correction bolus + meal bolus. 

Additional recommendation to measure bG 

more frequently and check for ketones. 



Note that correction bolus can be negative. 


Note that correction bolus is negative. 

Hypo Warning! Recommendation to eat 

fast-acting carbs. 

Bolus advice function not accessible. 

211

212 


Health Events 

If your routine was always the same from one day to the next, then Time Blocks would provide enough 

information to calculate the correct boluses. However, sometimes your daily routine may be different, 

and your insulin needs will then change. 

Health Events 

Exercise 1 

-10% 

Exercise 2 

-20% 

Stress 

0% 

Illness 

+20% 

Premenstrual 

0% 

Cancel 

Save 

You can use Health Events to take into account various activities or events that increase or decrease your 

insulin needs. You can choose different Health Events depending on how you are feeling or what you are 

doing. For example, sports or physical activity could decrease your insulin needs, whereas illness or the 

menstrual cycle could increase your insulin needs. 

Many of these activities or events do not occur at regular intervals, and Time Blocks cannot take them 

into account. With Health Events, you can program how much extra insulin (as a percentage of your usual 

bolus) you may need. For example, when exercising, your insulin requirement may be 25 % lower. You 

and your healthcare professional should discuss what percentage to program for each Health Event.

When one of the programmed Health Events occurs in your daily life, you can choose the Health Event 

on your meter so that Bolus Advice can calculate the correct insulin dose. You can program 5 different 

Health Events: 



• Stress 

• Illness 

• Premenstrual 

The Bolus Advice screen and the bG Result screen call these Health and have a icon. 

Bolus Advice 

5.8 mmol/L 

--- U 

0.0 U 

19 g 

1.3 U 

Exercise 1 -0.1 U 

Bolus 

1.2 U 

Type Standard 

Cancel 

Confirm 

Within Health on the Bolus Advice and bG Result screen, you can also select Fasting. However, you 

cannot adjust Fasting by percentage, and it does not scale advice calculations. 

Advice Options—Meal Rise, Snack Size, Acting Time and Offset Time 

Advice Options help to make sure that Bolus Advice does not recommend a second bolus for a bG 

event, such as a meal or a high bG level, that has already been covered by a previous bolus. 

Start 

Time Blocks 

End 

12:00 am 5:30 am 

5:30 am 11:00 am 

11:00 am 5:00 pm 

5:00 pm 9:30 pm 

9:30 pm 

Back 

12:00 am 

bG Result 

5.8 

10:02 am 

mmol/L 

Meal Time 

Carbs 

Health 


Menu Bolus 


213

214 


Meal Rise 

After a meal, bG levels usually increase by a noticeable amount, even in people without diabetes. 

Depending on the type of meal, your bG can reach a maximum about an hour after your meal and return 

to its original level after another 1 to 2 hours. This is a normal process, so Bolus Advice takes this into 

account using Meal Rise. 

Figure 1: Meal Rise 

The dotted line shows how your bG level typically changes after a meal bolus. Bolus Advice tolerates 

an increased bG level within the Meal Rise range (green) without calculating an extra correction bolus. 

Each time you tell Bolus Advice that you have consumed more carbohydrates than the Snack Size, the 

Meal Rise entry is added to the bG target value. How long the Meal Rise lasts (the width of the green 

area) is determined by the Offset Time and the Acting Time.

Snack Size 

The Snack Size defines a certain amount of carbohydrates for which a meal bolus is calculated, but no 

Meal Rise is triggered. No bG level above the Target Range or currently allowed bG is tolerated for this 

amount of carbohydrates, so Bolus Advice will calculate a correction bolus for any increase in bG after 

a snack. 

Acting Time 

Acting Time is the total length of time the insulin remains effective at lowering blood glucose. The Acting 

Time starts afresh for each new bolus. Bolus Advice will not recommend a correction bolus for this time 

if your current bG level is less than the bG level covered by the previous bolus (meal rise or a corrected 

high bG). 

To choose the correct value for the Acting Time, you and your healthcare professional should think about 

the following: 

• Whether you use rapid-acting insulin analog or fast-acting regular 

human insulin (the Acting Time should be longer for regular insulin) 

• Your average bolus amount (the larger your average bolus amount, 

the longer the Acting Time should be) 

You can program the Acting Time from 1½ to 8 hours. 


215

216 


Offset Time 

Offset Time is the length of time after a bolus until a significant reduction in blood glucose begins. 

The Offset Time starts afresh for each new bolus. After the Offset Time, your bG level should decrease 

because of the insulin, and at the end of the Acting Time, it should return to the target level. 

The Offset Time must be at least 45 minutes, and the maximum value will be limited by the Acting Time 

that you choose.

Example 

The following example explains the effect of the Offset Time and Acting Time: 

Target Value 

bG level 

hyper 

hypo 

Figure 2: Example blood glucose curve (bG level) 

Target Range 


Current 

bG values 

Bolus 

You calculate and administer a correction bolus at 12:00. The insulin needs time to become effective, so 

your bG value (dotted line) may not be significantly reduced, even by 2:00. (If you had not administered 

the correction bolus, your bG might even have increased.) You measure your bG at 2:00 and it is nearly 

the same as at 12:00. Between 2:00 and 4:00, the effect of the correction bolus, which is still active, will 

decrease your bG level to a value within the target range. 

217

218 


Target Value 

hyper 

hypo 

Current 

bG values 

Figure 3: Example blood glucose curve—double dosage 

Target Range 

Potential 

bG level 

Bolus 

However, if Bolus Advice took only your current bG value into consideration at 2:00, it would ignore the 

ongoing effect of your correction bolus. It would then recommend an additional bolus to compensate 

for the raised bG value. Two overlapping boluses for the same blood glucose excursion could lead to 

hypoglycemia (red line). 

Therefore, Bolus Advice always compares your bG result with the currently allowed bG value, and not 

just with the target value for the current Time Block.

The currently allowed bG value considers the following factors: 


• The upper limit of the Target Range for your current Time Block 

• Excursions beyond the Target Value that have had a correction bolus that is still active (Acting Time) 

• Blood glucose values that were tolerated as a Meal Rise and which have had a meal bolus that is 

still active (Acting Time) 

• The expected reduction of your bG level due to the effect of insulin during the Acting Time 

(the decrease between the end of Offset Time and end of Acting Time) 

219

220 


Target Value 

bG level 

Current 

bG values 

hyper 

hypo 

Figure 4: Corrected high bG 

Acting Time 

Offset Time 

Bolus 

Target Range 

Bolus 

not required 

The above diagram shows an example of the effect of this rule. The first correction bolus at 12:00 remains 

active during the Acting Time (the width of the blue area). If a measured value at 2:00 falls within the 

currently allowed bG value (height of the blue area), no new correction bolus is calculated. 

Corrected bG 

Currently allowed 

bG value: corrected bG 

Time

Target Value 

bG level 

hyper 

hypo 

Figure 5: Subsequent boluses 

Target Range 


Current 

bG values 

Bolus 

Where the measured value is greater than the currently allowed bG value, the newly calculated bolus 

(light blue) only considers the difference between the current bG value (dotted line) and the currently 

allowed bG value (the height of the dark blue area). During the Acting Time of the first correction bolus 

(the width of the dark blue area), only the currently allowed bG value is used to calculate the second 

bolus. 

221

222 


Target Value 

bG level 

hyper 

hypo 

Current 

bG values 

Meal 

Figure 6: Subsequent meal boluses 

Subsequent meals 

Offset Time 

Acting Time 

Bolus 

Target Range 

Bolus 

not required 

Time 

Meal Rise 

Currently allowed 

bG value: Meal Rise 

If you eat several meals in a row, the Meal Rise will not add up, but start afresh for each new meal bolus.

Appendix C 

The Mathematical Basis for Bolus Calculations 

Below is a list of the most important formulas and principles that Bolus Advice uses to calculate your 

bolus. It is difficult to accurately calculate a bolus yourself using these formulas (remembering to include 

the Acting Time and Offset Time of your most recent boluses). This is why Bolus Advice is so useful. 

It may save you a lot of time and can help you avoid the risk of mistakes in your calculations. 

Carbohydrates 

This calculation is required when the bG result falls below the Hypo Warning Limit. It is based on the 

other values defined for the current Time Block, and the result recommends how much carbohydrate 

you should consume. 

Meal bolus 

The words written in blue in the formula refer to the setting that you find on the meter screen. 

according to block definition 

Appendix C: The Mathematical Basis for Bolus Calculations 

Insulin 

Carbohydrates = ( Target Range average value – Current bG) × × 

Change in bG 

Meal bolus = Carbohydrates intake × 

from Insulin Sensitivity 


Carbohydrates 

from Carb Ratio 

Carbohydrates 


from Carb Ratio 

Many people are more familiar with Carb Factor than Carb Ratio. If you are familiar with Carb Factor, 

the calculation would be: 

Meal Bolus = Carbohydrate Intake ÷ Carb Factor 

For example, if your Carb Factor is 15 and you are eating 60 grams of carbs, your calculation would be: 

Meal Bolus = 60 g ÷ 15 = 4 units of insulin 

223

224 


Currently allowed bG value 

The currently allowed bG value considers all blood sugar excursions that have already been treated by a 

meal and/or correction bolus. For all bG test results below the currently allowed bG value, no correction 

will be recommended. The currently allowed bG value is calculated as follows: 

Currently allowed = Target Range average value + Meal rise + 

bG value 

bG range covered by 

× 

correction bolus 

according to block definition 

currently acting correction boluses 

When no Meal Rise or correction bolus Acting Time is in effect, the value for these in the formula is 0 (zero). 

Correction Bolus 

Generally, a correction bolus is only calculated if your current bG value is above the hypo bG warning 

limit and outside of the Target Range. Additionally, it must be above the currently allowed bG value. 

Only correction boluses greater than 0 (zero) will trigger an Acting Time. 

Correction bolus = (Current bG – Currently allowed bG) × 

Many people are more familiar with Insulin Sensitivity Factor (ISF). If you are familiar with ISF, the calculation 

would be: 

Correction bolus = (current bG - currently allowed bG) ÷ ISF 

For example, if your current bG is 10, your allowed bG is 5.6, and your ISF is 2.2, your calculation would be: 

Correction bolus = (10-5.6) ÷ 2.2 = 2 units of insulin 

∑ 


Change in bG 

from Insulin Sensitivity

The size of the correction bolus depends on the following: 

• If your bG is higher than the currently allowed bG, then: 

Correction bolus = (Current bG – currently allowed bG value) × Insulin Sensitivity Ratio 

• If the current bG is higher than the Hypo Warning Limit, and the current bG is lower than Target Range 

lower limit, then the correction bolus that is subtracted from the meal bolus is: 

Correction bolus = (Current bG – Target Range average value) × Insulin Sensitivity Ratio 

Correction bolus with carbohydrate intake 


Whenever you tell Bolus Advice that you have consumed carbohydrates, the related meal bolus is always 

offset against any (even negative) correction bolus. When you eat a meal, Bolus Advice also calculates 

the correction bolus for bG results that are within the Target Range if your current bG result is below the 

Target Range average value, or if your current bG is above the currently allowed bG value. 

Boluses that are calculated to be less than 0 (zero) are just displayed as 0 (zero). 

225

Appendix D: Errors, Warnings and Reminders 

Errors 

No. Error What you have to do 

E1 Cartridge Empty Change the cartridge. 

E2 Battery Empty Change the battery. 

E3 Automatic Off 

Put your ACCU-CHEK Spirit Combo insulin 

pump into RUN mode if necessary. 

E4 Occlusion Change the cartridge and infusion set. 

E6 Mechanical Error 

E7 Electronic Error 

E8 Power Interrupt 


See the ACCU-CHEK Spirit Combo User Guide, 

or contact ACCU-CHEK Pump Support at the 

number on the back of your pump. 


or contact ACCU-CHEK Customer Care. 



227

228 


No. Error What you have to do 

E10 Cartridge Error 



E11 Set Not Primed Prime your infusion set. 

E12 Data Interrupted Restart the data transfer. 

E13 Language Error 


or contact ACCU-CHEK Customer Care.

Warnings 

No. Warning What you have to do 

W1 Cartridge Low Change cartridge before it is completely empty. 

W2 Battery Low Replace the battery as soon as possible. 

W3 Review Time Set the time and date. 

W4 Call for Update 

W6 

W7 

TBR Cancelled 

(Temporary Basal 

Rate Cancelled) 

TBR Over 

(Temporary Basal 

Rate Over) 


W4 appears after the pump has reached 6 years 

of use. Call ACCU-CHEK Customer Care to ask 

about available updates (if any) for your pump. 


pump into RUN mode if necessary. Ensure the 

cancellation was intended, and program 

a new Temporary Basal Rate if necessary. 

Decide whether a further Temporary Basal 

Rate change is appropriate, and program one 

if necessary. 

229

230 


No. Warning What you have to do 

W8 Bolus Cancelled 

W10 Bluetooth Fault 


pump into RUN mode if necessary. Ensure 

that the cancellation was intended, and program 

a new bolus if necessary. 

Redo pairing procedure for insulin pump 

and meter.

Reminder 

No. Reminder What you have to do 

R1 Reminder 

R2 End of Warranty 



pump into RUN mode if necessary. 

The 4-year warranty covering your insulin 

pump has expired. For any questions and 

concerns about the warranty, contact your 

local pump support (see inside back cover 

of your ACCU-CHEK Spirit Combo Insulin 

Pump User Guide). 

231

Appendix E: Controlling Pump Functions Through the Pump Menu 

Appendix E: Controlling Pump Functions 

Through the Pump Menu 

See sections 9, 17–21 for instructions on using 

the meter to control the pump 

233

E9. Standard Menu Functions 

E9.1 Checking Your Pump 

1 

2 

3 

From RUN screen. 

Appendix E: E9—Standard Menu Functions 

Press f to view the QUICK INFO screen. 

Press f to view the BOLUS DATA screen. 

Press s to view older bolus data. 

Press f to return to RUN screen. 

235

236 

E9.2 Programming a Standard Bolus 

1 

2 


From RUN screen press d until the 

STANDARD BOLUS screen appears. 

Press f to select. The BOLUS AMOUNT 

screen appears.

3 

4 


Press a or s to increase or decrease 

the value until the required bolus amount 

is adjusted. 

Press f to confirm and the bolus delivery 

is activated. 

The bolus symbol flashes for 5 seconds before 

the bolus delivery starts. 

If you do not confirm within 20 seconds, the pump automatically returns to RUN without delivering a bolus. 

237

238 


E9.3 Cancelling a Standard Bolus 

During 

programming 

you can 

During the 

delivery 

start delay 

During 

bolus 

delivery 

Press d and a on the pump to return to 

the STANDARD BOLUS screen or wait 

20 seconds until the pump returns to RUN 

automatically or set the BOLUS AMOUNT 

to 0.0 and press f. 





the warning. 





the warning. 

No bolus 

has been 

delivered 

No bolus 

has been 

delivered 


has been 

interrupted

E9.4 Programming a Temporary Basal Rate (TBR) 

1 

2 


From RUN screen, press d to move to the 

TEMPORARY BASAL RATE screen. 

Press f to select. The TBR PERCENTAGE 


239

240 

3 

4 


Press a or s to increase or decrease 

the percentage. 

Press d to move to the TBR DURATION 

screen. 

Press a or s to set the duration. 


When the duration of the TBR has ended, a W7: TBR OVER warning occurs. Press f twice to snooze 

and confirm the warning.

E9.5 Cancelling a Temporary Basal Rate (TBR) 

Either: 

Or: 


• Press d to move to the TEMPORARY BASAL RATE screen. 

• Press f to select. Press a or s to set the percentage to 100 %. 

• Press f to confirm. 

• A W6: TBR CANCELLED warning occurs. Press f twice to snooze and confirm the warning. 

Your pump returns to RUN mode. 

• Press d to move to the STOP YOUR PUMP screen. 

• Press f to confirm. 

• A W6: TBR CANCELLED warning occurs. Press f twice to snooze and confirm the warning. 

Your pump returns to STOP mode. 

• Press d to move to the START YOUR PUMP screen. 

• Press f to confirm. Your pump returns to RUN mode. 

241

242 

E9.6 Pump Settings 

Turning key lock on / off 

1 

2 

3 


From RUN or STOP screen, press d 

to move to the PUMP SETTINGS screen. 


The current key lock status of the pump 

(ON or OFF) appears. 

Press a or s to turn the key lock on or off. 

Press f to save and exit.

If you press any of the pump keys while the keys are locked and the screen is blank, the key lock symbol 

appears on the pump screen. 

The Bluetooth ® communication will not be interrupted. 


To temporarily unlock the pump keys press d and s simultaneously for 3 seconds. 

Three beeps indicate that you are pressing the keys correctly. While operating the pump keys 

the Bluetooth ® communication will be interrupted. 

Now you can operate the keys on the pump. Remember that the Bluetooth ® communication between 

meter and pump is lost as soon as you press any pump key while the keys are unlocked. 

243

244 

Adjusting the beep volume 

1 

2 


From RUN or STOP screen, press d to 

move to the PUMP SETTINGS screen. 

Press f to enter. 

Press d to move to the SOUND VOLUME 

screen. Press a or s to adjust the 

sound volume. 


Setting for the alarm signals 

1 

2 

3 


move to the PUMP SETTINGS screen. 



Press d to move to the SIGNAL SETTINGS 

screen. 

Press a or s to set the SIGNAL SETTINGS 

(beep only, vibration only, beep and vibrate). 


245

There are 3 user menus to choose from, depending on your knowledge and experience with pump therapy: 

Standard 

For ease of use, this menu features only the basic functions you need for successful insulin pump therapy. 

It is particularly well suited to those beginning insulin pump therapy or those who want simplicity in their 

insulin pump therapy. 

Advanced 

This menu includes all functions from the STANDARD menu, plus a number of additional functions. This 

is particularly recommended if you are already experienced in insulin pump therapy. 

Custom 

Appendix E: E17—ACCU-CHEK Spirit Combo User Menus 

E17. ACCU-CHEK Spirit Combo User Menus 

This menu enables you to organize all the ACCU-CHEK Spirit Combo insulin pump functions according 

to your individual requirements. You or your healthcare team can set up the menu using PC-based 

configuration software (available separately). 

By default your pump is in STANDARD user menu. For using Extended or Multiwave bolus, 

different basal rate profiles, changing your Therapy Settings or using reminders, you must change to 

the ADVANCED user menu. 

247

248 

Selecting a user menu 

As you become more experienced using your pump, you may wish to change to the ADVANCED user 

menu for additional flexibility and convenience with your pump. 

1 

2 

3 

4 

Appendix E: E17—ACCU-CHEK Spirit Combo User Menus 


move to the MENU SETTINGS screen. 


The SELECT USER MENU screen appears. 

Press a or s to move to ADVANCED. 


The SELECT PROFILE screen appears. 

Profile 1 is selected by default. 

Press a or s to select the appropriate 

profile. 


The pump returns to the STOP or RUN screen.

E18. Choosing Your Bolus Type 

There are 3 bolus types with different shapes of bolus delivery available: 

j 

j 

j 

Appendix E: E18—Choosing Your Bolus Type 


immediately in one portion. This bolus may 

be a good choice for corrections during 

the day and to compensate for food intake 


fruit, cake). 

Extended A bolus delivered over a period of time. 

That means you have to program an 

appropriate duration as well as the bolus 

amount. This bolus type may be helpful 

during long meals, dinners or receptions 

or when you have meals that are digested 

slowly. It may also be appropriate for people 

who have gastroparesis (delayed digestion). 


body’s insulin delivery. It combines an 

immediate bolus delivery followed by 

an Extended Bolus delivery. A Multiwave 

Bolus may be helpful when you have 

meals that include both rapidly and slowly 

absorbed carbohydrates. 

249

250 

E18.1 Programming an Extended Bolus 

1 

2 

3 


From RUN screen press d to move 

to the ExTENDED BOLUS screen. 



Press a to increase or s to decrease 

the bolus amount. 

Press d to move to the BOLUS DURATION 

screen.

4 

5 


The duration of the last Extended Bolus 

delivered appears. 

Press a to increase or s to decrease 

the bolus duration. 

Press d to switch between programming the bolus amount and bolus duration. 

Press f to confirm the bolus amount and 

duration. You will hear a melody and /or feel 

a vibration. The bolus delivery begins within 

the next 3 minutes. 

251

252 


E18.2 Cancelling an Extended Bolus 

During 

programming 

(the bolus 

amount or 

bolus duration 

blinks) 

During 

bolus 

delivery 

You can either: 

• Wait for your pump to return to the 

RUN screen 

• Press d + a simultaneously to exit 

the Function screen 

• Set the bolus amount to 0.0 units and press f. 

If the Extended Bolus delivery has begun, it 

can be cancelled by putting your pump into 

STOP mode. This cancels the bolus delivery 

and a W8: BOLUS CANCELLED warning is 

displayed. Press f twice to confirm and 

turn off the alert. 




No bolus 

is delivered 

Bolus 

delivery is 

interrupted

E18.3 Programming a Multiwave Bolus 

1 

2 

3 

4 


From RUN screen press d to move to the 

MULTIWAVE BOLUS screen. 



Press a or s to increase or decrease the 

total bolus amount. 

Press d to move to the IMMEDIATE 

BOLUS screen. 

Press a or s to correct and set the 

immediate bolus amount. 

253

254 

5 

6 

7 


From RUN screen press d to move to the 

BOLUS DURATION screen. 

Press a or s to correct and set the 

Extended Bolus duration in increments of 

15 minutes for up to 24 hours. 

Press d to loop between programming the total BOLUS AMOUNT, IMMEDIATE BOLUS 

and BOLUS DURATION. 

Check the total and immediate bolus amounts 

and the Extended Bolus duration programmed 

on the screens. 

Press f to confirm both bolus amounts and 

the bolus duration. The Multiwave Bolus 

symbol blinks for 5 seconds (bolus delivery 

start delay).

8 


The pump beeps 3 times and vibrates, and 

the immediate bolus delivery begins. The 

countdown of the remaining bolus continues 

to appear on the display. 

255

256 


E18.4 Cancelling a Multiwave Bolus 

During 

programming 

During the 

start delay 

There are 3 ways to cancel a Multiwave Bolus 

during programming: 

• Do not press any key for 20 seconds. 

The pump returns to the RUN screen. 

• Exit to the Multiwave Bolus screen by 

pressing d + a simultaneously. 

• Set the total bolus amount to 0.0 units 

and press f. 

Press s or a. The pump beeps and vibrates. 

The pump returns to the RUN screen. This 

cancels the bolus delivery and a W8: BOLUS 

CANCELLED warning is displayed. Press f 

twice to confirm and turn off the alert. 

No bolus 

is delivered 

No bolus 

is delivered

During 

immediate 

bolus 

delivery 

During 

extended 

delivery 

You can cancel immediate delivery by pressing 

and holding s or a for 3 seconds until you 

hear a melody. This cancels the whole bolus 

(immediate and Extended Bolus delivery), and 

a W8: BOLUS CANCELLED warning is displayed. 

Press f twice to confirm and turn off the alert. 




You can cancel the extended delivery 

by putting the pump in STOP mode. 

This cancels the Extended Bolus, and 

a W8: BOLUS CANCELLED warning 

is displayed. Press f twice to confirm 

and turn off the alert. 





Bolus 

delivery is 

interrupted 

Bolus 

delivery is 

interrupted 

257

E19. Additional Basal Rate Profiles 

Your pump has 5 different basal rate profiles to match your changing insulin needs (for example, 

Monday to Friday, Exercise Day or Sleeping Late Day). 

Discuss additional basal rate profiles with your doctor or healthcare team. Also, consult with your doctor 

or healthcare team before changing basal rate profiles. 

To program basal rate profiles 2–4, you can use the same procedure as for basal rate profile 1. 

E19.1 Setting Basal Rate Profiles 

1 

2 

3 

Appendix E: E19—Additional Basal Rate Profiles 

From RUN or STOP screen, press d to move 

to the BASAL RATE PROGRAMMING 1 screen 

(or 2, 3, 4 or 5 accordingly). 

Press f to enter. The BASAL RATE TOTAL 


Press d to move to the first hour. This 

is always 12 AM – 01 AM (00:00 – 01:00 if 

24-hour time format is used). 

259

260 

4 

5 

6 

7 


Press a or s repeatedly or scroll to set 

the hourly basal rate given by your doctor or 

healthcare team. 

Press d to move to the next hour. 

Continue using d and a or s to set the hourly basal rates 

for the remaining hours. This allows you to program your individual 

basal rate profile on an hour-by-hour basis. Continue until all 

24 hours are programmed. 

Press f to confirm. The new daily BASAL 


Press f again to save the profile and exit.

E19.2 Selecting a Basal Rate Profile 

1 

2 

The new basal rate profile is active immediately. 



to the BASAL RATE SELECTION screen. 


Press a or s to select a basal rate profile. 

The selected basal rate profile and its daily 

insulin total appear. 


261

E20. Therapy Settings 

These settings relate to the therapeutic use of the pump. For settings relating to the practical use of the 

pump, see section 9.6, Pump Settings. 

E20.1 Adjusting the Bolus Increment 

Appendix E: E20—Therapy Settings 

Designed for those patients who may need large or small amounts of insulin, the bolus increment 

for the Quick Bolus of your ACCU-CHEK Spirit Combo insulin pump is adjustable. It is initially set to 

0.5 units per key press, but it can be changed to 0.1, 0.2, 0.5, 1.0 or 2.0 units. 

263

264 

1 

2 



to the THERAPY SETTINGS screen. 


Press d to move to the BOLUS INCREMENT 

screen. 

Press a or s to select a bolus increment. 


E20.2 Adjusting the Prime Amount 

The prime amount needed to fill an infusion set depends on the length of the infusion set tubing. The 

shorter your infusion set tubing, the less insulin will be required to prime the infusion set. The default 

setting for the prime amount is 25 units of U100 insulin. 

1 

2 


to the THERAPY SETTINGS screen. 


Press d to move to the PRIME AMOUNT 

screen. 

Press a or s to select a prime quantity 

between 0.0 and 50.0 units. 



265

266 


E20.3 Locking Basal Rate Profiles 

Your ACCU-CHEK Spirit Combo insulin pump allows you to adapt your hourly basal rate profile as 

needed. You can then lock your basal rate profiles to provide additional protection against accidentally 

changing a basal rate during normal operation. If the basal rate lock is set to ON, programming of the 

basal rate profiles 1–5 is blocked. 

If you try to program a basal rate while the basal rate lock is turned ON, the key symbol in the BASAL 

RATE TOTAL screen indicates that basal rate programming is locked. The a and s functions are 

blocked. 

However, you can still change between the different basal rate profiles 1–5.

1 

2 

From your RUN or STOP screen, press d 



Press d to move to the BASAL RATE LOCK 

screen. 

Press a or s to turn the basal rate lock 

on or off. 



267

268 


E20.4 Automatic Off 

Automatic Off is a safety feature that stops insulin delivery and triggers an E3: AUTOMATIC OFF error if 

no pump keys are pressed or the pump was operated using the meter within a programmed time period 

in RUN mode. This feature can either be set to OFF or programmed up to 24 hours in 1-hour intervals. 

The factory setting is OFF. 

Discuss using the Automatic Off function with your doctor or healthcare team.

1 

2 

3 

From your RUN or STOP screen, press d 



Press d to move to the AUTOMATIC 

OFF screen. 

Press or scroll a to increase or s to 

decrease the duration for the Automatic 

Off in 1-hour intervals. 

If you would like to set the Automatic Off 

function to off, press s until “0 h” and OFF 

appear on the display. 



269

E21. Setting a Reminder on the Pump 

You can set both single and multiple reminders on your pump. Multiple reminders are repeated at a set 

time every day. You can use this feature to remind you, for example, when you need to test your blood glucose. 

Procedure for setting single or multiple reminders 

1 

2 

Appendix E: E21—Setting a Reminder on the Pump 

From RUN or STOP sceen, press d to move 

to the REMINDER SETTINGS screen. 

Press f to select. The current reminder status 

and alarm time appear. 

271

272 

3 

4 

5 


Press a or s to change the reminder 

setting to OFF, ONCE or EVERY DAY. 

Press d to move to the HOUR screen. 

Press a or s to set the hour. 

Press d to move to the MINUTE screen. 

Press a or s to set the minute. 


Turning off the reminder 

When the reminder sounds, the REMINDER screen is displayed. 

Press f twice to snooze and confirm and return to RUN or STOP mode. 


273

ACCU-CHEK, ACCU-CHEK AVIVA COMBO, ACCU-CHEK SPIRIT COMBO, 

ACCU-CHEK TENDER, ACCU-CHEK ULTRAFLEX, COMBO and RAPID are 

trademarks of Roche. 

The Bluetooth word mark and logo are registered trademarks owned by 

Bluetooth SIG, Inc., and any use of such marks by Roche is under license. 

© 2010 Roche. 600-10018V1.0-0410 

Manufactured for and distributed by: 

Roche Insulin Delivery Systems Inc. 

11800 Exit 5 Parkway, Suite 120 

Fishers, IN 46037 

Toll free: 1-800-280-7801 

For technical support call: 

ACCU-CHEK Customer Care: 1-800-688-4578 

ACCU-CHEK Combo 

Roche Diabetes Care AG 

3401 Burgd orf, Switzerland 

accu-chekinsulinpumps-ca.com 

Canadian Address: 

2425 Matheson Blvd. East, Suite 735 

Missasauga, ON L4W 5K4 

00048009762/A

Section 1 

Features of Your ACCU-CHEK 

Combo System 

Section 1

Section 1

Section 2 

Preparation and Start-up 

Section 2

Section 2

Section 3 

Your ACCU-CHEK Spirit 

Combo Insulin Pump 

Section 3

Section 3

Section 4 

Starting and Stopping 

Insulin Delivery 

Section 4

Section 4

Section 5 


Section 5

Section 5

Section 6 

Your ACCU-CHEK Aviva 

Combo Meter 

Section 6

Section 6

Section 7 

Preparation and Start-up 

Section 7

Section 7

Section 8 

Using Your ACCU-CHEK 

Combo System 

Section 8

Section 8

Section 9 


Section 9

Section 9

Section 10 


Section 10

Section 10

Section 11 


Section 11

Section 11

Section 12 

Measuring Your Blood 

Glucose (bG) Level 

Section 12

Section 12

Section 13 

Getting Bolus Advice 

from Your Meter 

Section 13

Section 13

Section 14 


Section 14

Section 14

Section 15 


Section 15

Section 15

Section 16 


Section 16

Section 16

Section 17 

ACCU-CHEK Spirit Combo 

User Menus 

Section 17

Section 17

Section 18 


Section 18

Section 18

Section 19 

Additional Basal 

Rate Profiles 

Section 19

Section 19

Section 20 


Section 20

Section 20

Section 21 

Setting a Reminder 

on the Pump 

Section 21

Section 21

Section 22 

CUSTOM User Menu 

Section 22

Section 22

Section 23 

Transferring Your Pump 

Data to a Computer 

Section 23

Section 23

Section 24 

Pairing Your Pump 

with the Meter 

Section 24

Section 24

Appendix A 

Calculating a Bolus 

Appendix A

Appendix A

Appendix B 

Bolus Advice Calculations 

Appendix B

Appendix B

Appendix C 

The Mathematical Basis 

for Bolus Calculations 

Appendix C

Appendix C

Appendix D 

Errors, Warnings and 

Reminders 

Appendix D

Appendix D

Appendix E 

Controlling Pump Functions 

Through the Pump Menu 

Appendix E

Appendix E

ACCU-CHEK ® Combo - ACCU-CHEK Insulin Pumps

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