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49 changes: 26 additions & 23 deletions docs/EN/GettingHelp/ProfileTuning.md
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Expand Up @@ -6,15 +6,15 @@ Please work with your care team for support and advice on your diabetes manageme
Use this guide only once you have [set up your **Profile** correctly](../SettingUpAaps/YourAapsProfile.md), following all **AAPS** objectives.
```

This guide explains the logic of the OpenAPS algorithm results with a given __Profile__, and provides information about which values to adjust when certain situations are observed. The suggestions about basal testing below may diverge from what your care team advises
This guide explains the logic of the OpenAPS algorithm results with a given __Profile__, and provides information about which values in **AAPS** may be adjusted when certain situations or patterns are observed. The suggestions about basal testing below may diverge from what your care team advises.

Using **closed loop** may make basal testing easier and may significantly reduce the hypo risk if your __Profile__ basal is too strong.
Using **closed loop** may make basal testing easier and may significantly reduce the hypo risk if your __Profile__ basal is too strong.

## **Changing profile's settings, how to proceed**

1. Ensure you have read and understand __AAPS’__ recommended settings and advice below. Not following this advice will make the whole process problematic and less likely to get a well tuned __Profile__
1. Ensure you have read and understand __AAPS’__ recommended settings and advice below. Not following this advice may make the adjusting process problematic and less likely to get a well tuned __Profile__
2. Carefully observe and compare, **over several days**, what is happening with your __BG__ and __IOB__.
3. Keep an eye out for patterns that happen around the same time (almost) everyday.
3. Keep an eye out for patterns with **AAPS** that happen around the same time (almost) everyday.
4. It's important to do this over several days. Poor results tend to be yielded from using data observed on a single day to make __Profile’s__ adjustment decisions.
5. After you have observed a repeatable pattern of behavior, e.g. at 1PM you see a spike in __BG__ or a negative __IOB__ value, only then start to make small changes to your __Profile__.
6. It's important to limit the changes you make to one thing at a time. E.g. increase your basal by 10% around 1PM.
Expand All @@ -31,34 +31,37 @@ Don't rush, go slow!
- Do not make manual user actions (manual bolus, temp targets etc…) while testing: let the system use the **Profile** settings only.
- For the [additional graphs](#AapsScreens-section-g-additional-graphs): on graph 1, use Insulin On Board, Carbs On Board (and Sensitivity change). On graph 2, use Deviations and Blood Glucose Impact. When asking for advice, always include those on your screenshots.
- COB=0[*](#profiletuning-cob-zero)
Other considerations and ideally avoided in order influenicng the data and resulting in poor data include:
- No physical activities.
- No stress.
- No illness.
- No extreme weather like high or low temperatures.
- If your [basal rate profile](#your-aaps-profile-basal-rates) is correct, when you are on target with COB=0[*](#profiletuning-cob-zero) and IOB=0, you will remain constantly on target whatever your ISF (ISF is only used when you are higher than your target).
- You need to check the actual IOB but also, the IOB chart to see how the IOB was during the past few hours.
- No failed pump or cgm.
- No unannouced carbs.
- If your [basal rate profile](#your-aaps-profile-basal-rates) is correct, when you are on target with COB=0[*](#profiletuning-cob-zero) and IOB=0, you will remain constantly on target whatever your **ISF** (**ISF** is only used when you are higher than your **BG** target).
- You need to check the actual **IOB** but also, the **IOB** chart to see observe the **IOB** data was during the past few hours.

(profiletuning-cob-zero)=

***COB = 0**

Meaning that the meal is digested, and there are no more carbs in your body.

AAPS might indicate [COB=0 while you still have carbs on board](../DailyLifeWithAaps/CobCalculation.md).
**AAPS** might indicate [COB=0 while you still have carbs on board](../DailyLifeWithAaps/CobCalculation.md).

## **[Profile](../SettingUpAaps/YourAapsProfile.md) definitions**

A too **strong Profile** indicates some combination of the following:

- [ISF](#your-aaps-profile-insulin-sensitivity-factor) number is too small
- The [basal](#your-aaps-profile-basal-rates) number is too big
- [I:C](#your-aaps-profile-insulin-to-carbs-ratio) number is too small
- [ISF](#your-aaps-profile-insulin-sensitivity-factor) number is too small.
- The [basal](#your-aaps-profile-basal-rates) number is too big.
- [I:C](#your-aaps-profile-insulin-to-carbs-ratio) number is too small.

## **IOB Observations**

*Note: you can also use Loopalyzer IOB graph in Nightscout reports to view IOB on several days.*

If you observe the following patterns after a few days, consider the following changes
If you observe the following patterns after a few days, consider the following changes:

### **IOB positive**

Expand All @@ -68,8 +71,8 @@ If you observe the following patterns after a few days, consider the following c

### **IOB negative**

- Default basal too strong
- May be the effect from past exercise/physical activity
- Default basal too strong.
- May be the effect from past exercise/physical activity.

![Negative IOB](../images/troubleshooting/profiletuning/NegativeInsulin.png)

Expand All @@ -81,11 +84,11 @@ If you observe the following patterns after a few days, consider the following c

### **Stuck High**

- __ISF__ ‘s number is high and not strong enough (calculated insulin is too weak)
- __ISF's__ number is high and not strong enough (calculated insulin is too weak)

![Stuck High](../images/troubleshooting/profiletuning/StuckHigh.png)

- __Profile__ basal might not be strong enough (SMBs do not have enough "basal stock" to use)
- __Profile__ basal might not be strong enough (**SMBs** do not have enough "basal stock" to use)
- A security ([MaxIOB](#Open-APS-features-maximum-total-iob-openaps-cant-go-over)?) might have kicked in and is limiting insulin injection. Verify in the [SMB](#Open-APS-features-super-micro-bolus-smb) tab.
- Technical issue: site absorption, infusion set, ...

Expand All @@ -104,27 +107,27 @@ If you observe the following patterns after a few days, consider the following c

### **Fast rise and BG going high**

- Food contains fast carbs
- Consider doing a pre-bolus
- Bolus (IC or injected %) not strong enough
- Food contains fast carbs (like fruit jucie).
- Consider doing a pre-bolus or a slight earlier pre-bolous.
- Bolus (IC or injected %) not strong enough.

![Rise High](../images/troubleshooting/profiletuning/FastRise.png)

### **Fast rise and then BG going low**

- Consider doing a pre-bolus, profile might be too aggressive (over correction of the raise)
- Bolus too strong
- Consider doing a pre-bolus, your **Profile** might be too aggressive (over correction of the raise)
- Bolus too strong.



## **[How to calculate your I:C](#your-aaps-profile-insulin-to-carbs-ratio)**

1. First, you need the correct default basal settings in your **Profile**.
2. Start on target, better without negative IOB.
3. Record the total insulin given in the pump tab (or pump history) and call it Start insulin C4. Very accurately measure a known portion of carbs, and record the start time and Start IOB. Then enter carbs and bolus information into AAPS using the wizard (with the current configured CI). Don't forget to eat the carbs ;)
3. Record the total insulin given in the pump tab (or pump history) and call it Start insulin C4. Very accurately measure a known portion of carbs, and record the start time and Start IOB. Then enter carbs and bolus information into **AAPS** using the wizard (with the current configured CI). Don't forget to eat the carbs);
4. After some hours, when COB=0[*](#profiletuning-cob-zero) and you're back on target, record end time, and note down the End IOB, check the total insulin given as before and call it End insulin.
*NOTE: The time frame is NOT important, as long as it is longer than your digestion*
5. From the difference between Start and End insulin amount, subtract/add the difference end IOB - start IOB. Then subtract the basal insulin calculated from your profile settings.
5. From the difference between Start and End insulin amount, subtract/add the difference end IOB - start IOB. Then subtract the basal insulin calculated from your **Profile's** settings.
6. If __BG__ is in target, you'll have the total insulin used to “digest” your carbs. Calculate your **I:C**.

### **Explanations for the I:C calculations**
Expand All @@ -134,4 +137,4 @@ If you observe the following patterns after a few days, consider the following c
- If the time frame is too short, there will be carbs undigested, thus your "insulin needed for the carbs" will be wrong.
- If the time frame is too long, nothing bad will happen. You'll use all your carbs and you'll get more basal. At the end, you'll subtract the basal from the total insulin used, the extended time frame (with more basal use) will not affect the result.

Originally written up by @Robby (Discord) on tips and tricks to help tune your AAPS Profile, reviewed and edited by the community (thank you!).
Originally written up by @Robby (Discord) on tips and tricks to help tune your **AAPS Profile**, reviewed and edited by the community (thank you!).
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