US20090143725A1 - Method of Optimizing Efficacy of Therapeutic Agent - Google Patents

Abstract

Method and device for outputting one or more signals associated with a monitored analyte level of an individual, the one or more signals including a substantially real time monitored analyte level and a rate of change information associated with the monitored analyte level, outputting a carbohydrate intake event indication, determining one or more data associated with one or more therapy information related to the monitored analyte level and the meal event indication, and outputting the determined one or more data over the outputted one or more signals associated with the monitored analyte level and the carbohydrate intake event indication are provided.

Description

RELATED APPLICATION
• The present application claims priority under 35 U.S.C. §119(e) to U.S. provisional application No. 60/969,578 filed Aug. 31, 2007, entitled “Method Of Optimizing Efficacy Of Therapeutic Agent”, and assigned to the Assignee of the present application, Abbott Diabetes Care, Inc. of Alameda, Calif., the disclosure of which is incorporated herein by reference for all purposes.
BACKGROUND
• The monitoring of the level of glucose or other analytes, such as lactate or oxygen, in certain individuals is vitally important to their health. High or low levels of glucose or other analytes may have detrimental effects. The monitoring of glucose is particularly important to individuals with diabetes, as they must determine when insulin is needed to reduce glucose levels in their bodies or when additional glucose is needed to raise the level of glucose in their bodies.
• A conventional technique used by many diabetics for personally monitoring their blood glucose level includes the periodic drawing of blood, the application of that blood to a test strip, and the determination of the blood glucose level using calorimetric, electrochemical, or photometric detection. This technique does not permit continuous or automatic monitoring of glucose levels in the body, but typically must be performed manually on a periodic basis. Unfortunately, the consistency with which the level of glucose is checked varies widely among individuals. Many diabetics find the periodic testing inconvenient and they sometimes forget to test their glucose level or do not have time for a proper test. In addition, some individuals wish to avoid the pain associated with the test. These situations may result in hyperglycemic or hypoglycemic episodes. An in vivo glucose sensor that continuously or automatically monitors the individual's glucose level would enable individuals to more easily monitor their glucose, or other analyte, levels.
• A variety of devices have been developed for continuous or automatic monitoring of analytes, such as glucose, in the blood stream or interstitial fluid. A number of these devices use electrochemical sensors which are directly implanted into a blood vessel or in the subcutaneous tissue of a patient. However, these devices are often difficult to reproducibly and inexpensively manufacture in large numbers. In addition, these devices are typically large, bulky, and/or inflexible, and many can not be used effectively outside of a controlled medical facility, such as a hospital or a doctor's office, unless the patient is restricted in his activities.
• Some devices include a sensor guide which rests on or near the skin of the patient and may be attached to the patient to hold the sensor in place. These sensor guides are typically bulky and do not allow for freedom of movement. In addition, the sensor guides or the sensors include cables or wires for connecting the sensor to other equipment to direct the signals from the sensors to an analyzer. The size of the sensor guides and presence of cables and wires hinders the convenient use of these devices for everyday applications. There is a need for a small, compact device that can operate the sensor and provide signals to an analyzer without substantially restricting the movements and activities of a patient.
• The patient's comfort and the range of activities that can be performed while the sensor is implanted are important considerations in designing extended-use sensors for continuous or automatic in vivo monitoring of the level of an analyte, such as glucose. There is a need for a small, comfortable device which can continuously monitor the level of an analyte, such as glucose, while still permitting the patient to engage in normal activities. Continuous and/or automatic monitoring of the analyte can provide a warning to the patient when the level of the analyte is at or near a threshold level. For example, if glucose is the analyte, then the monitoring device might be configured to warn the patient of current or impending hyperglycemia or hypoglycemia. The patient can then take appropriate actions.
SUMMARY
• In one aspect, outputting one or more signals associated with a monitored analyte level of an individual, the one or more signals including a substantially real time monitored analyte level and a rate of change information associated with the monitored analyte level, outputting a carbohydrate intake event indication, determining one or more data associated with one or more therapy information related to the monitored analyte level and the meal event indication, and outputting the determined one or more data over the outputted one or more signals associated with the monitored analyte level and the carbohydrate intake event indication is provided.
• In another aspect, a communication interface configured to receive one or more data associated with a monitored analyte level, and a processor coupled to the communication interface, the processor configured to detect a carbohydrate intake event indication, and to detect a predetermined rate of change of the monitored analyte level based on the received one or more data associated with the monitored analyte level, where the processor is further configured to disable one or more therapy related functions executable by a user when the detected predetermined rate of change deviates from a predefined threshold level are provided.
• The above summary of the present disclosure is not intended to describe each disclosed embodiment or every implementation of the present disclosure. The Figures and the detailed description which follow more particularly exemplify these embodiments.
BRIEF DESCRIPTION OF THE DRAWING
• The disclosure may be more completely understood in consideration of the following detailed description of various embodiments of the disclosure in connection with the accompanying drawings, in which:
• FIG. 1 is a block diagram of one embodiment of a subcutaneous analyte monitor using a subcutaneously implantable analyte sensor, according to the disclosure;
• FIG. 2 is a top view of one embodiment of an analyte sensor, according to the disclosure;
• FIG. 3A is a cross-sectional view of the analyte sensor ofFIG. 2;
• FIG. 3B is a cross-sectional view of another embodiment of an analyte sensor, according to the disclosure;
• FIG. 4A is a cross-sectional view of a third embodiment of an analyte sensor, according to the disclosure;
• FIG. 4B is a cross-sectional view of a fourth embodiment of an analyte sensor, according to the disclosure;
• FIG. 5 is an expanded top view of a tip portion of the analyte sensor ofFIG. 2;
• FIG. 6 is a cross-sectional view of a fifth embodiment of an analyte sensor, according to the disclosure;
• FIG. 7 is an expanded top view of a tip-portion of the analyte sensor ofFIG. 6;
• FIG. 8 is an expanded bottom view of a tip-portion of the analyte sensor ofFIG. 6;
• FIG. 9 is a side view of the analyte sensor ofFIG. 2;
• FIG. 10 is a top view of the analyte sensor ofFIG. 6;
• FIG. 11 is a bottom view of the analyte sensor ofFIG. 6;
• FIG. 12 is an expanded side view of one embodiment of a sensor and an insertion device, according to the disclosure;
• FIGS. 13A,13B,13C are cross-sectional views of three embodiments of the insertion device ofFIG. 12;
• FIG. 14 is a cross-sectional view of one embodiment of a on-skin sensor control unit, according to the disclosure;
• FIG. 15 is a top view of a base of the on-skin sensor control unit ofFIG. 14;
• FIG. 16 is a bottom view of a cover of the on-skin sensor control unit ofFIG. 14;
• FIG. 17 is a perspective view of the on-skin sensor control unit ofFIG. 14 on the skin of a patient;
• FIG. 18A is a block diagram of one embodiment of an on-skin sensor control unit, according to the disclosure;
• FIG. 18B is a block diagram of another embodiment of an on-skin sensor control unit, according to the disclosure;
• FIGS. 19A,19B,19C, and19D are cross-sectional views of four embodiments of conductive contacts disposed on an interior surface of a housing of an on-skin sensor control unit, according to the disclosure;
• FIGS. 19E and 19F are cross-sectional views of two embodiments of conductive contacts disposed on an exterior surface of a housing of an on-skin sensor control unit, according to the disclosure;
• FIGS. 20A and 20B are schematic diagrams of two embodiments of a current-to-voltage converter for use in an analyte monitoring device, according to the disclosure;
• FIG. 21 is a block diagram of one embodiment of an open loop modulation system for use in an analyte monitoring device, according to the disclosure;
• FIG. 22 is a block diagram of one embodiment of a receiver/display unit, according to the disclosure;
• FIG. 23 is a front view of one embodiment of a receiver/display unit;
• FIG. 24 is a front view of a second embodiment of a receiver/display unit;
• FIG. 25 is a block diagram of one embodiment of a drug delivery system, according to the disclosure;
• FIG. 26 is a perspective view of the internal structure of an insertion gun, according to the disclosure;
• FIG. 27A is a top view of one embodiment of an on-skin sensor control unit, according to the disclosure;
• FIG. 27B is a top view of one embodiment of a mounting unit of the on-skin sensor control unit ofFIG. 27A;
• FIG. 28A is a top view of another embodiment of an on-skin sensor control unit after insertion of an insertion device and a sensor, according to the disclosure;
• FIG. 28B is a top view of one embodiment of a mounting unit of the on-skin sensor control unit ofFIG. 28A;
• FIG. 28C is a top view of one embodiment of a housing for at least a portion of the electronics of the on-skin sensor control unit ofFIG. 28A;
• FIG. 28D is a bottom view of the housing ofFIG. 28C;
• FIG. 28E is a top view of the on-skin sensor control unit ofFIG. 28A with a cover of the housing removed;
• FIG. 29 is a flowchart illustrating therapy related management routine in accordance with one embodiment; and
• FIG. 30 is a flowchart illustrating therapy related management routine in accordance with one embodiment.
DETAILED DESCRIPTION
• The present disclosure is applicable to an analyte monitoring system using an implantable sensor for the in vivo determination of a concentration of an analyte, such as glucose or lactate, in a fluid. The sensor can be, for example, subcutaneously implanted in a patient for the continuous or periodic monitoring an analyte in a patient's interstitial fluid. This can then be used to infer the glucose level in the patient's bloodstream. Other in vivo analyte sensors can be made, according to the disclosure, for insertion into a vein, artery, or other portion of the body containing fluid. The analyte monitoring system is typically configured for monitoring the level of the analyte over a time period which may range from days to weeks or longer.
• The following definitions are provided for terms used herein:
• A “counter electrode” refers to an electrode paired with the working electrode, through which passes a current equal in magnitude and opposite in sign to the current passing through the working electrode. In the context of the disclosure, the term “counter electrode” is meant to include counter electrodes which also function as reference electrodes (i.e., a counter/reference electrode).
• An “electrochemical sensor” is a device configured to detect the presence and/or measure the level of an analyte in a sample via electrochemical oxidation and reduction reactions on the sensor. These reactions are transduced to an electrical signal that can be correlated to an amount, concentration, or level of an analyte in the sample.
• “Electrolysis” is the electrooxidation or electroreduction of a compound either directly at an electrode or via one or more electron transfer agents.
• A compound is “immobilized” on a surface when it is entrapped on or chemically bound to the surface.
• A “non-leachable” or “non-releasable” compound or a compound that is “non-leachably disposed” is meant to define a compound that is affixed on the sensor such that it does not substantially diffuse away from the working surface of the working electrode for the period in which the sensor is used (e.g., the period in which the sensor is implanted in a patient or measuring a sample).
• Components are “immobilized” within a sensor, for example, when the components are covalently, ionically, or coordinatively bound to constituents of the sensor and/or are entrapped in a polymeric or sol-gel matrix or membrane which precludes mobility.
• An “electron transfer agent” is a compound that carries electrons between the analyte and the working electrode, either directly, or in cooperation with other electron transfer agents. One example of an electron transfer agent is a redox mediator.
• A “working electrode” is an electrode at which the analyte (or a second compound whose level depends on the level of the analyte) is electrooxidized or electroreduced with or without the agency of an electron transfer agent.
• A “working surface” is that portion of the working electrode which is coated with or is accessible to the electron transfer agent and configured for exposure to an analyte-containing fluid.
• A “sensing layer” is a component of the sensor which includes constituents that facilitate the electrolysis of the analyte. The sensing layer may include constituents such as an electron transfer agent, a catalyst which catalyzes a reaction of the analyte to produce a response at the electrode, or both. In some embodiments of the sensor, the sensing layer is non-leachably disposed in proximity to or on the working electrode.
• A “non-corroding” conductive material includes non-metallic materials, such as carbon and conductive polymers.
Analyte Sensor Systems
• The analyte monitoring systems of the present disclosure can be utilized under a variety of conditions. The particular configuration of a sensor and other units used in the analyte monitoring system may depend on the use for which the analyte monitoring system is intended and the conditions under which the analyte monitoring system will operate. One embodiment of the analyte monitoring system includes a sensor configured for implantation into a patient or user. For example, implantation of the sensor may be made in the arterial or venous systems for direct testing of analyte levels in blood. Alternatively, a sensor may be implanted in the interstitial tissue for determining the analyte level in interstitial fluid. This level may be correlated and/or converted to analyte levels in blood or other fluids. The site and depth of implantation may affect the particular shape, components, and configuration of the sensor. Subcutaneous implantation may be preferred, in some cases, to limit the depth of implantation of the sensor. Sensors may also be implanted in other regions of the body to determine analyte levels in other fluids. Examples of suitable sensor for use in the analyte monitoring systems of the disclosure are described in U.S. patent application Ser. No. 09/034,372, incorporated herein by reference.
• One embodiment of theanalyte monitoring system40 for use with animplantable sensor42, and particularly for use with a subcutaneously implantable sensor, is illustrated in block diagram form inFIG. 1. Theanalyte monitoring system40 includes, at minimum, asensor42, a portion of which is configured for implantation (e.g., subcutaneous, venous, or arterial implantation) into a patient, and asensor control unit44. Thesensor42 is coupled to thesensor control unit44 which is typically attached to the skin of a patient. Thesensor control unit44 operates thesensor42, including, for example, providing a voltage across the electrodes of thesensor42 and collecting signals from thesensor42. Thesensor control unit44 may evaluate the signals from thesensor42 and/or transmit the signals to one or more optional receiver/display units46,48 for evaluation. Thesensor control unit44 and/or the receiver/display units46,48 may display or otherwise communicate the current level of the analyte. Furthermore, thesensor control unit44 and/or the receiver/display units46,48 may indicate to the patient, via, for example, an audible, visual, or other sensory-stimulating alarm, when the level of the analyte is at or near a threshold level. In some embodiments, a electrical shock can be delivered to the patient as a warning through one of the electrodes or the optional temperature probe of the sensor. For example, if glucose is monitored then an alarm may be used to alert the patient to a hypoglycemic or hyperglycemic glucose level and/or to impending hypoglycemia or hyperglycemia.
The Sensor
• Asensor42 includes at least one workingelectrode58 formed on asubstrate50, as shown inFIG. 2. Thesensor42 may also include at least one counter electrode60 (or counter/reference electrode) and/or at least one reference electrode62 (seeFIG. 8). Thecounter electrode60 and/orreference electrode62 may be formed on thesubstrate50 or may be separate units. For example, the counter electrode and/or reference electrode may be formed on a second substrate which is also implanted in the patient or, for some embodiments of the implantable sensors, the counter electrode and/or reference electrode may be placed on the skin of the patient with the working electrode or electrodes being implanted into the patient. The use of an on-the-skin counter and/or reference electrode with an implantable working electrode is described in U.S. Pat. No. 5,593,852, incorporated herein by reference.
• The working electrode orelectrodes58 are formed usingconductive traces52 disposed on thesubstrate50. Thecounter electrode60 and/orreference electrode62, as well as other optional portions of thesensor42, such as a temperature probe66 (seeFIG. 8), may also be formed usingconductive traces52 disposed on thesubstrate50. These conductive traces52 may be formed over a smooth surface of thesubstrate50 or withinchannels54 formed by, for example, embossing, indenting or otherwise creating a depression in thesubstrate50.
• A sensing layer64 (seeFIGS. 3A and 3B) is often formed proximate to or on at least one of the workingelectrodes58 to facilitate the electrochemical detection of the analyte and the determination of its level in the sample fluid, particularly if the analyte can not be electrolyzed at a desired rate and/or with a desired specificity on a bare electrode. Thesensing layer64 may include an electron transfer agent to transfer electrons directly or indirectly between the analyte and the workingelectrode58. Thesensing layer64 may also contain a catalyst to catalyze a reaction of the analyte. The components of the sensing layer may be in a fluid or gel that is proximate to or in contact with the workingelectrode58. Alternatively, the components of thesensing layer64 may be disposed in a polymeric or sol-gel matrix that is proximate to or on the workingelectrode58. Preferably, the components of thesensing layer64 are non-leachably disposed within thesensor42. More preferably, the components of thesensor42 are immobilized within thesensor42.
• In addition to theelectrodes58,60,62 and thesensing layer64, thesensor42 may also include a temperature probe66 (seeFIGS. 6 and 8), a mass transport limiting layer74 (seeFIG. 9), a biocompatible layer75 (seeFIG. 9), and/or other optional components, as described below. Each of these items enhances the functioning of and/or results from thesensor42, as discussed below.
The Substrate
• Thesubstrate50 may be formed using a variety of non-conducting materials, including, for example, polymeric or plastic materials and ceramic materials. Suitable materials for aparticular sensor42 may be determined, at least in part, based on the desired use of thesensor42 and properties of the materials.
• In some embodiments, the substrate is flexible. For example, if thesensor42 is configured for implantation into a patient, then thesensor42 may be made flexible (although rigid sensors may also be used for implantable sensors) to reduce pain to the patient and damage to the tissue caused by the implantation of and/or the wearing of thesensor42. Aflexible substrate50 often increases the patient's comfort and allows a wider range of activities. Suitable materials for aflexible substrate50 include, for example, non-conducting plastic or polymeric materials and other non-conducting, flexible, deformable materials. Examples of useful plastic or polymeric materials include thermoplastics such as polycarbonates, polyesters (e.g., Mylar™ and polyethylene terephthalate (PET)), polyvinyl chloride (PVC), polyurethanes, polyethers, polyamides, polyimides, or copolymers of these thermoplastics, such as PETG (glycol-modified polyethylene terephthalate).
• In other embodiments, thesensors42 are made using a relativelyrigid substrate50 to, for example, provide structural support against bending or breaking. Examples of rigid materials that may be used as thesubstrate50 include poorly conducting ceramics, such as aluminum oxide and silicon dioxide. One advantage of animplantable sensor42 having a rigid substrate is that thesensor42 may have a sharp point and/or a sharp edge to aid in implantation of asensor42 without an additional insertion device.
• It will be appreciated that formany sensors42 and sensor applications, both rigid and flexible sensors will operate adequately. The flexibility of thesensor42 may also be controlled and varied along a continuum by changing, for example, the composition and/or thickness of thesubstrate50.
• In addition to considerations regarding flexibility, it is often desirable thatimplantable sensors42 should have asubstrate50 which is non-toxic. Preferably, thesubstrate50 is approved by one or more appropriate governmental agencies or private groups for in vivo use.
• Thesensor42 may include optional features to facilitate insertion of animplantable sensor42, as shown inFIG. 12. For example, thesensor42 may be pointed at thetip123 to ease insertion. In addition, thesensor42 may include abarb125 which assists in anchoring thesensor42 within the tissue of the patient during operation of thesensor42. However, thebarb125 is typically small enough that little damage is caused to the subcutaneous tissue when thesensor42 is removed for replacement.
• Although thesubstrate50 in at least some embodiments has uniform dimensions along the entire length of thesensor42, in other embodiments, thesubstrate50 has adistal end67 and aproximal end65 withdifferent widths53,55, respectively, as illustrated inFIG. 2. In these embodiments, thedistal end67 of thesubstrate50 may have a relativelynarrow width53. Forsensors42 which are implantable into the subcutaneous tissue or another portion of a patient's body, thenarrow width53 of thedistal end67 of thesubstrate50 may facilitate the implantation of thesensor42. Often, the narrower the width of thesensor42, the less pain the patient will feel during implantation of the sensor and afterwards.
• For subcutaneouslyimplantable sensors42 which are designed for continuous or periodic monitoring of the analyte during normal activities of the patient, adistal end67 of thesensor42 which is to be implanted into the patient has awidth53 of 2 mm or less, preferably 1 mm or less, and more preferably 0.5 mm or less. If thesensor42 does not have regions of different widths, then thesensor42 will typically have an overall width of, for example, 2 mm, 1.5 mm, 1 mm, 0.5 mm, 0.25 mm, or less. However, wider or narrower sensors may be used. In particular, wider implantable sensors may be used for insertion into veins or arteries or when the movement of the patient is limited, for example, when the patient is confined in bed or in a hospital.
• Returning toFIG. 2, theproximal end65 of thesensor42 may have awidth55 larger than thedistal end67 to facilitate the connection betweencontact pads49 of the electrodes and contacts on a control unit. The wider thesensor42 at this point, the larger thecontact pads49 can be made. This may reduce the precision needed to properly connect thesensor42 to contacts on the control unit (e.g.,sensor control unit44 ofFIG. 1). However, the maximum width of thesensor42 may be constrained so that thesensor42 remains small for the convenience and comfort of the patient and/or to fit the desired size of the analyte monitor. For example, theproximal end65 of a subcutaneouslyimplantable sensor42, such as thesensor42 illustrated inFIG. 1, may have awidth55 ranging from 0.5 mm to 15 mm, preferably from 1 mm to 10 mm, and more preferably from 3 mm to 7 mm. However, wider or narrower sensors may be used in this and other in vivo applications.
• The thickness of thesubstrate50 may be determined by the mechanical properties of the substrate material (e.g., the strength, modulus, and/or flexibility of the material), the desired use of thesensor42 including stresses on thesubstrate50 arising from that use, as well as the depth of any channels or indentations formed in thesubstrate50, as discussed below. Typically, thesubstrate50 of a subcutaneouslyimplantable sensor42 for continuous or periodic monitoring of the level of an analyte while the patient engages in normal activities has a thickness of 50 to 500 μm and preferably 100 to 300 μm. However, thicker andthinner substrates50 may be used, particularly in other types of invivo sensors42.
• The length of thesensor42 may have a wide range of values depending on a variety of factors. Factors which influence the length of animplantable sensor42 may include the depth of implantation into the patient and the ability of the patient to manipulate a smallflexible sensor42 and make connections between thesensor42 and thesensor control unit44. A subcutaneouslyimplantable sensor42 for the analyte monitor illustrated inFIG. 1 may have a length ranging from 0.3 to 5 cm, however, longer or shorter sensors may be used. The length of the narrow portion of the sensor42 (e.g., the portion which is subcutaneously inserted into the patient), if thesensor42 has narrow and wide portions, is typically about 0.25 to 2 cm in length. However, longer and shorter portions may be used. All or only a part of this narrow portion may be subcutaneously implanted into the patient. The lengths of otherimplantable sensors42 will vary depending, at least in part, on the portion of the patient into which thesensor42 is to be implanted or inserted.
Conductive Traces
• At least oneconductive trace52 is formed on the substrate for use in constructing a workingelectrode58. In addition, otherconductive traces52 may be formed on thesubstrate50 for use as electrodes (e.g., additional working electrodes, as well as counter, counter/reference, and/or reference electrodes) and other components, such as a temperature probe. The conductive traces52 may extend most of the distance along alength57 of thesensor50, as illustrated inFIG. 2, although this is not necessary. The placement of the conductive traces52 may depend on the particular configuration of the analyte monitoring system (e.g., the placement of control unit contacts and/or the sample chamber in relation to the sensor42). For implantable sensors, particularly subcutaneously implantable sensors, the conductive traces typically extend close to the tip of thesensor42 to minimize the amount of the sensor that must be implanted.
• The conductive traces52 may be formed on thesubstrate50 by a variety of techniques, including, for example, photolithography, screen printing, or other impact or non-impact printing techniques. The conductive traces52 may also be formed by carbonizing conductive traces52 in an organic (e.g., polymeric or plastic)substrate50 using a laser. A description of some exemplary methods for forming thesensor42 is provided in U.S. patent application Ser. No. 09/034,422, incorporated herein by reference.
• Another method for disposing the conductive traces52 on thesubstrate50 includes the formation of recessedchannels54 in one or more surfaces of thesubstrate50 and the subsequent filling of these recessedchannels54 with aconductive material56, as shown inFIG. 3A. The recessedchannels54 may be formed by indenting, embossing, or otherwise creating a depression in the surface of thesubstrate50. Exemplary methods for forming channels and electrodes in a surface of a substrate can be found in U.S. patent application Ser. No. 09/034,422. The depth of the channels is typically related to the thickness of thesubstrate50. In one embodiment, the channels have depths in the range of about 12.5 to 75 Tm (0.5 to 3 mils), and preferably about 25 to 50 Tm (1 to 2 mils).
• The conductive traces are typically formed using aconductive material56 such as carbon (e.g., graphite), a conductive polymer, a metal or alloy (e.g., gold or gold alloy), or a metallic compound (e.g., ruthenium dioxide or titanium dioxide). The formation of films of carbon, conductive polymer, metal, alloy, or metallic compound are well-known and include, for example, chemical vapor deposition (CVD), physical vapor deposition, sputtering, reactive sputtering, printing, coating, and painting. Theconductive material56 which fills thechannels54 is often formed using a precursor material, such as a conductive ink or paste. In these embodiments, theconductive material56 is deposited on thesubstrate50 using methods such as coating, painting, or applying the material using a spreading instrument, such as a coating blade. Excess conductive material between thechannels54 is then removed by, for example, running a blade along the substrate surface.
• In one embodiment, theconductive material56 is a part of a precursor material, such as a conductive ink, obtainable, for example, from Ercon, Inc. (Wareham, Mass.), Metech, Inc. (Elverson, Pa.), E.I. du Pont de Nemours and Co. (Wilmington, Del.), Emca-Remex Products (Montgomeryville, Pa.), or MCA Services (Melbourn, Great Britain). The conductive ink is typically applied as a semiliquid or paste which contains particles of the carbon, metal, alloy, or metallic compound and a solvent or dispersant. After application of the conductive ink on the substrate50 (e.g., in the channels54), the solvent or dispersant evaporates to leave behind a solid mass ofconductive material56.
• In addition to the particles of carbon, metal, alloy, or metallic compound, the conductive ink may also contain a binder. The binder may optionally be cured to further bind theconductive material56 within thechannel54 and/or on thesubstrate50. Curing the binder increases the conductivity of theconductive material56. However, this is typically not necessary as the currents carried by theconductive material56 within the conductive traces52 are often relatively low (usually less than 1 μA and often less than 100 nA). Typical binders include, for example, polyurethane resins, cellulose derivatives, elastomers, and highly fluorinated polymers. Examples of elastomers include silicones, polymeric dienes, and acrylonitrile-butadiene-styrene (ABS) resins. One example of a fluorinated polymer binder is Teflon® (DuPont, Wilmington, Del.). These binders are cured using, for example, heat or light, including ultraviolet (UV) light. The appropriate curing method typically depends on the particular binder which is used.
• Often, when a liquid or semiliquid precursor of the conductive material56 (e.g., a conductive ink) is deposited in thechannel54, the precursor fills thechannel54. However, when the solvent or dispersant evaporates, theconductive material56 which remains may lose volume such that theconductive material56 may or may not continue to fill thechannel54. Preferredconductive materials56 do not pull away from thesubstrate50 as they lose volume, but rather decrease in height within thechannel54. Theseconductive materials56 typically adhere well to thesubstrate50 and therefore do not pull away from thesubstrate50 during evaporation of the solvent or dispersant. Other suitableconductive materials56 either adhere to at least a portion of thesubstrate50 and/or contain another additive, such as a binder, which adheres theconductive material56 to thesubstrate50. Preferably, theconductive material56 in thechannels54 is non-leachable, and more preferably immobilized on thesubstrate50. In some embodiments, theconductive material56 may be formed by multiple applications of a liquid or semiliquid precursor interspersed with removal of the solvent or dispersant.
• In another embodiment, thechannels54 are formed using a laser. The laser carbonizes the polymer or plastic material. The carbon formed in this process is used as theconductive material56. Additionalconductive material56, such as a conductive carbon ink, may be used to supplement the carbon formed by the laser.
• In a further embodiment, the conductive traces52 are formed by pad printing techniques. For example, a film of conductive material is formed either as a continuous film or as a coating layer deposited on a carrier film. This film of conductive material is brought between a print head and thesubstrate50. A pattern on the surface of thesubstrate50 is made using the print head according to a desired pattern of conductive traces52. The conductive material is transferred by pressure and/or heat from the film of conductive material to thesubstrate50. This technique often produces channels (e.g., depressions caused by the print head) in thesubstrate50. Alternatively, the conductive material is deposited on the surface of thesubstrate50 without forming substantial depressions.
• In other embodiments, the conductive traces52 are formed by non-impact printing techniques. Such techniques include electrophotography and magnetography. In these processes, an image of the conductive traces52 is electrically or magnetically formed on a drum. A laser or LED may be used to electrically form an image. A magnetic recording head may be used to magnetically form an image. A toner material (e.g., a conductive material, such as a conductive ink) is then attracted to portions of the drum according to the image. The toner material is then applied to the substrate by contact between the drum and the substrate. For example, the substrate may be rolled over the drum. The toner material may then be dried and/or a binder in the toner material may be cured to adhere the toner material to the substrate.
• Another non-impact printing technique includes ejecting droplets of conductive material onto the substrate in a desired pattern. Examples of this technique include ink jet printing and piezo jet printing. An image is sent to the printer which then ejects the conductive material (e.g., a conductive ink) according to the pattern. The printer may provide a continuous stream of conductive material or the printer may eject the conductive material in discrete amounts at the desired points.
• Yet another non-impact printing embodiment of forming the conductive traces includes an ionographic process. In the this process, a curable, liquid precursor, such as a photopolymerizable acrylic resin (e.g., Solimer 7501 from Cubital, Bad Kreuznach, Germany) is deposited over a surface of asubstrate50. A photomask having a positive or negative image of the conductive traces52 is then used to cure the liquid precursor. Light (e.g., visible or ultraviolet light) is directed through the photomask to cure the liquid precursor and form a solid layer over the substrate according to the image on the photomask. Uncured liquid precursor is removed leaving behindchannels54 in the solid layer. Thesechannels54 can then be filled withconductive material56 to form conductive traces52.
• Conductive traces52 (andchannels54, if used) can be formed with relatively narrow widths, for example, in the range of 25 to 250 μm, and including widths of, for example, 250 μm, 150 μm, 100 μm, 75 μm, 50 μm, 25 μm or less by the methods described above. In embodiments with two or moreconductive traces52 on the same side of thesubstrate50, the conductive traces52 are separated by distances sufficient to prevent conduction between the conductive traces52. The edge-to-edge distance between the conductive traces is preferably in the range of 25 to 250 μm and may be, for example, 150 μm, 100 μm, 75 μm, 50 μm, or less. The density of the conductive traces52 on thesubstrate50 is preferably in the range of about 150 to 700 μm/trace and may be as small as 667 μm/trace or less, 333 μm/trace or less, or even 167 μm/trace or less.
• The workingelectrode58 and the counter electrode60 (if a separate reference electrode is used) are often made using aconductive material56, such as carbon. Suitable carbon conductive inks are available from Ercon, Inc. (Wareham, Mass.), Metech, Inc. (Elverson, Pa.), E.I. du Pont de Nemours and Co. (Wilmington, Del.), Emca-Remex Products (Montgomeryville, Pa.), or MCA Services (Melbourn, Great Britain). Typically, the workingsurface51 of the workingelectrode58 is at least a portion of theconductive trace52 that is in contact with the analyte-containing fluid (e.g., implanted in the patient).
• Thereference electrode62 and/or counter/reference electrode are typically formed usingconductive material56 that is a suitable reference material, for example silver/silver chloride or a non-leachable redox couple bound to a conductive material, for example, a carbon-bound redox couple. Suitable silver/silver chloride conductive inks are available from Ercon, Inc. (Wareham, Mass.), Metech, Inc. (Elverson, Pa.), E.I. du Pont de Nemours and Co. (Wilmington, Del.), Emca-Remex Products (Montgomeryville, Pa.), or MCA Services (Melbourn, Great Britain). Silver/silver chloride electrodes illustrate a type of reference electrode that involves the reaction of a metal electrode with a constituent of the sample or body fluid, in this case, Cl⁻.
• Suitable redox couples for binding to the conductive material of the reference electrode include, for example, redox polymers (e.g., polymers having multiple redox centers.) It is preferred that the reference electrode surface be non-corroding so that an erroneous potential is not measured. Preferred conductive materials include less corrosive metals, such as gold and palladium. Most preferred are non-corrosive materials including non-metallic conductors, such as carbon and conducting polymers. A redox polymer can be adsorbed on or covalently bound to the conductive material of the reference electrode, such as a carbon surface of aconductive trace52. Non-polymeric redox couples can be similarly bound to carbon or gold surfaces.
• A variety of methods may be used to immobilize a redox polymer on an electrode surface. One method is adsorptive immobilization. This method is particularly useful for redox polymers with relatively high molecular weights. The molecular weight of a polymer may be increased, for example, by cross-linking.
• Another method for immobilizing the redox polymer includes the functionalization of the electrode surface and then the chemical bonding, often covalently, of the redox polymer to the functional groups on the electrode surface. One example of this type of immobilization begins with a poly(4-vinylpyridine). The polymer's pyridine rings are, in part, complexed with a reducible/oxidizable species, such as [Os(bpy)₂Cl]^+/2+ where bpy is 2,2′-bipyridine. Part of the pyridine rings are quaternized by reaction with 2-bromoethylamine. The polymer is then crosslinked, for example, using a diepoxide, such as polyethylene glycol diglycidyl ether.
• Carbon surfaces can be modified for attachment of a redox species or polymer, for example, by electroreduction of a diazonium salt. As an illustration, reduction of a diazonium salt formed upon diazotization of p-aminobenzoic acid modifies a carbon surface with phenylcarboxylic acid functional groups. These functional groups can then be activated by a carbodiimide, such as 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide hydrochloride. The activated functional groups are then bound with a amine-functionalized redox couple, such as the quaternized osmium-containing redox polymer described above or 2-aminoethylferrocene, to form the redox couple.
• Similarly, gold can be functionalized by an amine, such as cystamine. A redox couple such as [Os(bpy)₂(pyridine-4-carboxylate)Cl]^0/+ is activated by 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide hydrochloride to form a reactive O-acylisourea which reacts with the gold-bound amine to form an amide.
• In one embodiment, in addition to using the conductive traces52 as electrodes or probe leads, two or more of the conductive traces52 on thesubstrate50 are used to give the patient a mild electrical shock when, for example, the analyte level exceeds a threshold level. This shock may act as a warning or alarm to the patient to initiate some action to restore the appropriate level of the analyte.
• The mild electrical shock is produced by applying a potential between any twoconductive traces52 that are not otherwise connected by a conductive path. For example, two of theelectrodes58,60,62 or oneelectrode58,60,62 and thetemperature probe66 may be used to provide the mild shock. Preferably, the workingelectrode58 and thereference electrode62 are not used for this purpose as this may cause some damage to the chemical components on or proximate to the particular electrode (e.g., the sensing layer on the working electrode or the redox couple on the reference electrode).
• The current used to produce the mild shock is typically 0.1 to 1 mA. Higher or lower currents may be used, although care should be taken to avoid harm to the patient. The potential between the conductive traces is typically 1 to 10 volts. However, higher or lower voltages may be used depending, for example, on the resistance of the conductive traces52, the distance between theconductive traces52 and the desired amount of current. When the mild shock is delivered, potentials at the workingelectrode58 and across thetemperature probe66 may be removed to prevent harm to those components caused by unwanted conduction between the working electrode58 (and/ortemperature probe66, if used) and the conductive traces52 which provide the mild shock.
Contact Pads
• Typically, each of the conductive traces52 includes acontact pad49. Thecontact pad49 may simply be a portion of theconductive trace52 that is indistinguishable from the rest of thetrace52 except that thecontact pad49 is brought into contact with the conductive contacts of a control unit (e.g., thesensor control unit44 ofFIG. 1). More commonly, however, thecontact pad49 is a region of theconductive trace52 that has a larger width than other regions of thetrace52 to facilitate a connection with the contacts on the control unit. By making thecontact pads49 relatively large as compared with the width of the conductive traces52, the need for precise registration between thecontact pads49 and the contacts on the control unit is less critical than with small contact pads.
• Thecontact pads49 are typically made using the same material as theconductive material56 of the conductive traces52. However, this is not necessary. Although metal, alloys, and metallic compounds may be used to form thecontact pads49, in some embodiments, it is desirable to make thecontact pads49 from a carbon or other non-metallic material, such as a conducting polymer. In contrast to metal or alloy contact pads, carbon and other non-metallic contact pads are not easily corroded if thecontact pads49 are in a wet, moist, or humid environment. Metals and alloys may corrode under these conditions, particularly if thecontact pads49 and contacts of the control unit are made using different metals or alloys. However, carbon andnon-metallic contact pads49 do not significantly corrode, even if the contacts of the control device are metal or alloy.
• One embodiment of the disclosure includes asensor42 havingcontact pads49 and acontrol unit44 having conductive contacts (not shown). During operation of thesensor42, thecontact pads49 and conductive contacts are in contact with each other. In this embodiment, either thecontact pads49 or the conductive contacts are made using a non-corroding, conductive material. Such materials include, for example, carbon and conducting polymers. Preferred non-corroding materials include graphite and vitreous carbon. The opposing contact pad or conductive contact is made using carbon, a conducting polymer, a metal, such as gold, palladium, or platinum group metal, or a metallic compound, such as ruthenium dioxide. This configuration of contact pads and conductive contacts typically reduces corrosion. Preferably, when the sensor is placed in a 3 mM, and more preferably, in a 100 mM, NaCl solution, the signal arising due to the corrosion of the contact pads and/or conductive contacts is less than 3% of the signal generated by the sensor when exposed to concentration of analyte in the normal physiological range. For at least some subcutaneous glucose sensors, the current generated by analyte in a normal physiological range ranges from 3 to 500 nA.
• Each of theelectrodes58,60,62, as well as the two probe leads68,70 of the temperature probe66 (described below), are connected to contactpads49 as shown inFIGS. 10 and 11. In one embodiment (not shown), thecontact pads49 are on the same side of thesubstrate50 as the respective electrodes or temperature probe leads to which thecontact pads49 are attached.
• In other embodiments, the conductive traces52 on at least one side are connected through vias in the substrate to contactpads49aon the opposite surface of thesubstrate50, as shown inFIGS. 10 and 11. An advantage of this configuration is that contact between the contacts on the control unit and each of theelectrodes58,60,62 and the probe leads68,70 of thetemperature probe66 can be made from a single side of thesubstrate50.
• In yet other embodiments (not shown), vias through the substrate are used to provide contact pads on both sides of thesubstrate50 for eachconductive trace52. The vias connecting the conductive traces52 with thecontact pads49acan be formed by making holes through thesubstrate50 at the appropriate points and then filling the holes withconductive material56.
Exemplary Electrode Configurations
• A number of exemplary electrode configurations are described below, however, it will be understood that other configurations may also be used. In one embodiment, illustrated inFIG. 3A, thesensor42 includes two workingelectrodes58a,58band onecounter electrode60, which also functions as a reference electrode. In another embodiment, the sensor includes one workingelectrode58a, onecounter electrode60, and onereference electrode62, as shown inFIG. 3B. Each of these embodiments is illustrated with all of the electrodes formed on the same side of thesubstrate50.
• Alternatively, one or more of the electrodes may be formed on an opposing side of thesubstrate50. This may be convenient if the electrodes are formed using two different types of conductive material56 (e.g., carbon and silver/silver chloride). Then, at least in some embodiments, only one type ofconductive material56 needs to be applied to each side of thesubstrate50, thereby reducing the number of steps in the manufacturing process and/or easing the registration constraints in the process. For example, if the workingelectrode58 is formed using a carbon-basedconductive material56 and the reference or counter/reference electrode is formed using a silver/silver chlorideconductive material56, then the working electrode and reference or counter/reference electrode may be formed on opposing sides of thesubstrate50 for ease of manufacture.
• In another embodiment, two workingelectrodes58 and onecounter electrode60 are formed on one side of thesubstrate50 and onereference electrode62 and atemperature probe66 are formed on an opposing side of thesubstrate50, as illustrated inFIG. 6. The opposing sides of the tip of this embodiment of thesensor42 are illustrated inFIGS. 7 and 8.
Sensing Layer
• Some analytes, such as oxygen, can be directly electrooxidized or electroreduced on the workingelectrode58. Other analytes, such as glucose and lactate, require the presence of at least one electron transfer agent and/or at least one catalyst to facilitate the electrooxidation or electroreduction of the analyte. Catalysts may also be used for those analyte, such as oxygen, that can be directly electrooxidized or electroreduced on the workingelectrode58. For these analytes, each workingelectrode58 has asensing layer64 formed proximate to or on a working surface of the workingelectrode58. Typically, thesensing layer64 is formed near or on only a small portion of the workingelectrode58, often near a tip of thesensor42. This limits the amount of material needed to form thesensor42 and places thesensing layer64 in the best position for contact with the analyte-containing fluid (e.g., a body fluid, sample fluid, or carrier fluid).
• Thesensing layer64 includes one or more components designed to facilitate the electrolysis of the analyte. Thesensing layer64 may include, for example, a catalyst to catalyze a reaction of the analyte and produce a response at the workingelectrode58, an electron transfer agent to indirectly or directly transfer electrons between the analyte and the workingelectrode58, or both.
• Thesensing layer64 may be formed as a solid composition of the desired components (e.g., an electron transfer agent and/or a catalyst). These components are preferably non-leachable from thesensor42 and more preferably are immobilized on thesensor42. For example, the components may be immobilized on a workingelectrode58. Alternatively, the components of thesensing layer64 may be immobilized within or between one or more membranes or films disposed over the workingelectrode58 or the components may be immobilized in a polymeric or sol-gel matrix. Examples of immobilized sensing layers are described in U.S. Pat. Nos. 5,262,035, 5,264,104, 5,264,105, 5,320,725, 5,593,852, and 5,665,222, U.S. patent application Ser. No. 08/540,789, and PCT Patent Application No. US98/02403 entitled “Soybean Peroxidase Electrochemical Sensor”, filed on Feb. 11, 1998, incorporated herein by reference.
• In some embodiments, one or more of the components of thesensing layer64 may be solvated, dispersed, or suspended in a fluid within thesensing layer64, instead of forming a solid composition. The fluid may be provided with thesensor42 or may be absorbed by thesensor42 from the analyte-containing fluid. Preferably, the components which are solvated, dispersed, or suspended in this type ofsensing layer64 are non-leachable from the sensing layer. Non-leachability may be accomplished, for example, by providing barriers (e.g., the electrode, substrate, membranes, and/or films) around the sensing layer which prevent the leaching of the components of thesensing layer64. One example of such a barrier is a microporous membrane or film which allows diffusion of the analyte into thesensing layer64 to make contact with the components of thesensing layer64, but reduces or eliminates the diffusion of the sensing layer components (e.g., a electron transfer agent and/or a catalyst) out of thesensing layer64.
• A variety of different sensing layer configurations can be used. In one embodiment, thesensing layer64 is deposited on theconductive material56 of a workingelectrode58a, as illustrated inFIGS. 3A and 3B. Thesensing layer64 may extend beyond theconductive material56 of the workingelectrode58a. In some cases, thesensing layer64 may also extend over thecounter electrode60 orreference electrode62 without degrading the performance of the glucose sensor. For thosesensors42 which utilizechannels54 within which theconductive material56 is deposited, a portion of thesensing layer64 may be formed within thechannel54 if theconductive material56 does not fill thechannel54.
• Asensing layer64 in direct contact with the workingelectrode58amay contain an electron transfer agent to transfer electrons directly or indirectly between the analyte and the working electrode, as well as a catalyst to facilitate a reaction of the analyte. For example, a glucose, lactate, or oxygen electrode may be formed having a sensing layer which contains a catalyst, such as glucose oxidase, lactate oxidase, or laccase, respectively, and an electron transfer agent that facilitates the electrooxidation of the glucose, lactate, or oxygen, respectively.
• In another embodiment, thesensing layer64 is not deposited directly on the workingelectrode58a. Instead, thesensing layer64 is spaced apart from the workingelectrode58a, as illustrated inFIG. 4A, and separated from the workingelectrode58aby aseparation layer61. Theseparation layer61 typically includes one or more membranes or films. In addition to separating the workingelectrode58afrom thesensing layer64, theseparation layer61 may also act as a mass transport limiting layer or an interferent eliminating layer, as described below.
• Typically, asensing layer64, which is not in direct contact with the workingelectrode58a, includes a catalyst that facilitates a reaction of the analyte. However, thissensing layer64 typically does not include an electron transfer agent that transfers electrons directly from the workingelectrode58ato the analyte, as thesensing layer64 is spaced apart from the workingelectrode58a. One example of this type of sensor is a glucose or lactate sensor which includes an enzyme (e.g., glucose oxidase or lactate oxidase, respectively) in thesensing layer64. The glucose or lactate reacts with a second compound (e.g., oxygen) in the presence of the enzyme. The second compound is then electrooxidized or electroreduced at the electrode. Changes in the signal at the electrode indicate changes in the level of the second compound in the fluid and are proportional to changes in glucose or lactate level and, thus, correlate to the analyte level.
• In another embodiment, two sensinglayers63,64 are used, as shown inFIG. 4B. Each of the two sensinglayers63,64 may be independently formed on the workingelectrode58aor in proximity to the workingelectrode58a. Onesensing layer64 is typically, although not necessarily, spaced apart from the workingelectrode58a. For example, thissensing layer64 may include a catalyst which catalyzes a reaction of the analyte to form a product compound. The product compound is then electrolyzed in thesecond sensing layer63 which may include an electron transfer agent to transfer electrons between the workingelectrode58aand the product compound and/or a second catalyst to catalyze a reaction of the product compound to generate a signal at the workingelectrode58a.
• For example, a glucose or lactate sensor may include afirst sensing layer64 which is spaced apart from the working electrode and contains an enzyme, for example, glucose oxidase or lactate oxidase. The reaction of glucose or lactate in the presence of the appropriate enzyme forms hydrogen peroxide. Asecond sensing layer63 is provided directly on the workingelectrode58aand contains a peroxidase enzyme and an electron transfer agent to generate a signal at the electrode in response to the hydrogen peroxide. The level of hydrogen peroxide indicated by the sensor then correlates to the level of glucose or lactate. Another sensor which operates similarly can be made using a single sensing layer with both the glucose or lactate oxidase and the peroxidase being deposited in the single sensing layer. Examples of such sensors are described in U.S. Pat. No. 5,593,852, U.S. patent application Ser. No. 08/540,789, and PCT Patent Application No. US98/02403 entitled “Soybean Peroxidase Electrochemical Sensor”, filed on Feb. 11, 1998, incorporated herein by reference.
• In some embodiments, one or more of the workingelectrodes58bdo not have acorresponding sensing layer64, as shown inFIGS. 3A and 4A, or have a sensing layer (not shown) which does not contain one or more components (e.g., an electron transfer agent or catalyst) needed to electrolyze the analyte. The signal generated at this workingelectrode58btypically arises from interferents and other sources, such as ions, in the fluid, and not in response to the analyte (because the analyte is not electrooxidized or electroreduced). Thus, the signal at this workingelectrode58bcorresponds to a background signal. The background signal can be removed from the analyte signal obtained from other workingelectrodes58athat are associated with fully-functional sensing layers64 by, for example, subtracting the signal at workingelectrode58bfrom the signal at workingelectrode58a.
• Sensors having multiple workingelectrodes58amay also be used to obtain more precise results by averaging the signals or measurements generated at these workingelectrodes58a. In addition, multiple readings at a single workingelectrode58aor at multiple working electrodes may be averaged to obtain more precise data.
Electron Transfer Agent
• In many embodiments, thesensing layer64 contains one or more electron transfer agents in contact with theconductive material56 of the workingelectrode58, as shown inFIGS. 3A and 3B. In some embodiments of the disclosure, there is little or no leaching of the electron transfer agent away from the workingelectrode58 during the period in which thesensor42 is implanted in the patient. A diffusing or leachable (i.e., releasable) electron transfer agent often diffuses into the analyte-containing fluid, thereby reducing the effectiveness of the electrode by reducing the sensitivity of the sensor over time. In addition, a diffusing or leaching electron transfer agent in animplantable sensor42 may also cause damage to the patient. In these embodiments, preferably, at least 90%, more preferably, at least 95%, and, most preferably, at least 99%, of the electron transfer agent remains disposed on the sensor after immersion in the analyte-containing fluid for 24 hours, and, more preferably, for 72 hours. In particular, for an implantable sensor, preferably, at least 90%, more preferably, at least 95%, and most preferably, at least 99%, of the electron transfer agent remains disposed on the sensor after immersion in the body fluid at 37° C. for 24 hours, and, more preferably, for 72 hours.
• In some embodiments of the disclosure, to prevent leaching, the electron transfer agents are bound or otherwise immobilized on the workingelectrode58 or between or within one or more membranes or films disposed over the workingelectrode58. The electron transfer agent may be immobilized on the workingelectrode58 using, for example, a polymeric or sol-gel immobilization technique. Alternatively, the electron transfer agent may be chemically (e.g., ionically, covalently, or coordinatively) bound to the workingelectrode58, either directly or indirectly through another molecule, such as a polymer, that is in turn bound to the workingelectrode58.
• Application of thesensing layer64 on a workingelectrode58ais one method for creating a working surface for the workingelectrode58a, as shown inFIGS. 3A and 3B. The electron transfer agent mediates the transfer of electrons to electrooxidize or electroreduce an analyte and thereby permits a current flow between the workingelectrode58 and thecounter electrode60 via the analyte. The mediation of the electron transfer agent facilitates the electrochemical analysis of analytes which are not suited for direct electrochemical reaction on an electrode.
• In general, the preferred electron transfer agents are electroreducible and electrooxidizable ions or molecules having redox potentials that are a few hundred millivolts above or below the redox potential of the standard calomel electrode (SCE). Preferably, the electron transfer agents are not more reducing than about −150 mV and not more oxidizing than about +400 mV versus SCE.
• The electron transfer agent may be organic, organometallic, or inorganic. Examples of organic redox species are quinones and species that in their oxidized state have quinoid structures, such as Nile blue and indophenol. Some quinones and partially oxidized quinhydrones react with functional groups of proteins such as the thiol groups of cysteine, the amine groups of lysine and arginine, and the phenolic groups of tyrosine which may render those redox species unsuitable for some of the sensors of the present disclosure because of the presence of the interfering proteins in an analyte-containing fluid. Usually substituted quinones and molecules with quinoid structure are less reactive with proteins and are preferred. A preferred tetrasubstituted quinone usually has carbon atoms inpositions 1, 2, 3, and 4.
• In general, electron transfer agents suitable for use in the disclosure have structures or charges which prevent or substantially reduce the diffusional loss of the electron transfer agent during the period of time that the sample is being analyzed. The preferred electron transfer agents include a redox species bound to a polymer which can in turn be immobilized on the working electrode. The bond between the redox species and the polymer may be covalent, coordinative, or ionic. Useful electron transfer agents and methods for producing them are described in U.S. Pat. Nos. 5,264,104; 5,356,786; 5,262,035; and 5,320,725, incorporated herein by reference. Although any organic or organometallic redox species can be bound to a polymer and used as an electron transfer agent, the preferred redox species is a transition metal compound or complex. The preferred transition metal compounds or complexes include osmium, ruthenium, iron, and cobalt compounds or complexes. The most preferred are osmium compounds and complexes. It will be recognized that many of the redox species described below may also be used, typically without a polymeric component, as electron transfer agents in a carrier fluid or in a sensing layer of a sensor where leaching of the electron transfer agent is acceptable.
• One type of non-releasable polymeric electron transfer agent contains a redox species covalently bound in a polymeric composition. An example of this type of mediator is poly(vinylferrocene).
• Another type of non-releasable electron transfer agent contains an ionically-bound redox species. Typically, this type of mediator includes a charged polymer coupled to an oppositely charged redox species. Examples of this type of mediator include a negatively charged polymer such as Nafion® (DuPont) coupled to a positively charged redox species such as an osmium or ruthenium polypyridyl cation. Another example of an ionically-bound mediator is a positively charged polymer such as quaternized poly(4-vinyl pyridine) or poly(1-vinyl imidazole) coupled to a negatively charged redox species such as ferricyanide or ferrocyanide. The preferred ionically-bound redox species is a highly charged redox species bound within an oppositely charged redox polymer.
• In another embodiment of the disclosure, suitable non-releasable electron transfer agents include a redox species coordinatively bound to a polymer. For example, the mediator may be formed by coordination of an osmium orcobalt 2,2′-bipyridyl complex to poly(1-vinyl imidazole) or poly(4-vinyl pyridine).
• The preferred electron transfer agents are osmium transition metal complexes with one or more ligands, each ligand having a nitrogen-containing heterocycle such as 2,2′-bipyridine, 1,10-phenanthroline, or derivatives thereof. Furthermore, the preferred electron transfer agents also have one or more ligands covalently bound in a polymer, each ligand having at least one nitrogen-containing heterocycle, such as pyridine, imidazole, or derivatives thereof. These preferred electron transfer agents exchange electrons rapidly between each other and the workingelectrodes58 so that the complex can be rapidly oxidized and reduced.
• One example of a particularly useful electron transfer agent includes (a) a polymer or copolymer having pyridine or imidazole functional groups and (b) osmium cations complexed with two ligands, each ligand containing 2,2′-bipyridine, 1,10-phenanthroline, or derivatives thereof, the two ligands not necessarily being the same. Preferred derivatives of 2,2′-bipyridine for complexation with the osmium cation are 4,4′-dimethyl-2,2′-bipyridine and mono-, di-, and polyalkoxy-2,2′-bipyridines, such as 4,4′-dimethoxy-2,2′-bipyridine. Preferred derivatives of 1,10-phenanthroline for complexation with the osmium cation are 4,7-dimethyl-1,10-phenanthroline and mono, di-, and polyalkoxy-1,10-phenanthrolines, such as 4,7-dimethoxy-1,10-phenanthroline. Preferred polymers for complexation with the osmium cation include polymers and copolymers of poly(1-vinyl imidazole) (referred to as “PVI”) and poly(4-vinyl pyridine) (referred to as “PVP”). Suitable copolymer substituents of poly(1-vinyl imidazole) include acrylonitrile, acrylamide, and substituted or quaternized N-vinyl imidazole. Most preferred are electron transfer agents with osmium complexed to a polymer or copolymer of poly(1-vinyl imidazole).
• The preferred electron transfer agents have a redox potential ranging from −100 mV to about +150 mV versus the standard calomel electrode (SCE). Preferably, the potential of the electron transfer agent ranges from −100 mV to +150 mV and more preferably, the potential ranges from −50 mV to +50 mV. The most preferred electron transfer agents have osmium redox centers and a redox potential ranging from +50 mV to −150 mV versus SCE.
Catalyst
• Thesensing layer64 may also include a catalyst which is capable of catalyzing a reaction of the analyte. The catalyst may also, in some embodiments, act as an electron transfer agent. One example of a suitable catalyst is an enzyme which catalyzes a reaction of the analyte. For example, a catalyst, such as a glucose oxidase, glucose dehydrogenase (e.g., pyrroloquinoline quinone glucose dehydrogenase (PQQ)), or oligosaccharide dehydrogenase, may be used when the analyte is glucose. A lactate oxidase or lactate dehydrogenase may be used when the analyte is lactate. Laccase may be used when the analyte is oxygen or when oxygen is generated or consumed in response to a reaction of the analyte.
• Preferably, the catalyst is non-leachably disposed on the sensor, whether the catalyst is part of a solid sensing layer in the sensor or solvated in a fluid within the sensing layer. More preferably, the catalyst is immobilized within the sensor (e.g., on the electrode and/or within or between a membrane or film) to prevent unwanted leaching of the catalyst away from the workingelectrode58 and into the patient. This may be accomplished, for example, by attaching the catalyst to a polymer, cross linking the catalyst with another electron transfer agent (which, as described above, can be polymeric), and/or providing one or more barrier membranes or films with pore sizes smaller than the catalyst.
• As described above, a second catalyst may also be used. This second catalyst is often used to catalyze a reaction of a product compound resulting from the catalyzed reaction of the analyte. The second catalyst typically operates with an electron transfer agent to electrolyze the product compound to generate a signal at the working electrode. Alternatively, the second catalyst may be provided in an interferent-eliminating layer to catalyze reactions that remove interferents, as described below.
• One embodiment of the disclosure is an electrochemical sensor in which the catalyst is mixed or dispersed in theconductive material56 which forms theconductive trace52 of a workingelectrode58. This may be accomplished, for example, by mixing a catalyst, such as an enzyme, in a carbon ink and applying the mixture into achannel54 on the surface of thesubstrate50. Preferably, the catalyst is immobilized in thechannel53 so that it can not leach away from the workingelectrode58. This may be accomplished, for example, by curing a binder in the carbon ink using a curing technique appropriate to the binder. Curing techniques include, for example, evaporation of a solvent or dispersant, exposure to ultraviolet light, or exposure to heat. Typically, the mixture is applied under conditions that do not substantially degrade the catalyst. For example, the catalyst may be an enzyme that is heat-sensitive. The enzyme and conductive material mixture should be applied and cured, preferably, without sustained periods of heating. The mixture may be cured using evaporation or UV curing techniques or by the exposure to heat that is sufficiently short that the catalyst is not substantially degraded.
• Another consideration for in vivo analyte sensors is the thermostability of the catalyst. Many enzymes have only limited stability at biological temperatures. Thus, it may be necessary to use large amounts of the catalyst and/or use a catalyst that is thermostable at the necessary temperature (e.g., 37° C. or higher for normal body temperature). A thermostable catalyst may be defined as a catalyst which loses less than 5% of its activity when held at 37° C. for at least one hour, preferably, at least one day, and more preferably at least three days. One example of a thermostable catalyst is soybean peroxidase. This particular thermostable catalyst may be used in a glucose or lactate sensor when combined either in the same or separate sensing layers with glucose or lactate oxidase or dehydrogenase. A further description of thermostable catalysts and their use in electrochemical disclosures is found in U.S. Pat. No. 5,665,222 U.S. patent application Ser. No. 08/540,789, and PCT Application No. US98/02403 entitled “Soybean Peroxidase Electrochemical Sensor”, file on Feb. 11, 1998, Attorney Docket No. M&G 12008.8WOI2.
Electrolysis of the Analyte
• To electrolyze the analyte, a potential (versus a reference potential) is applied across the working andcounter electrodes58,60. The minimum magnitude of the applied potential is often dependent on the particular electron transfer agent, analyte (if the analyte is directly electrolyzed at the electrode), or second compound (if a second compound, such as oxygen or hydrogen peroxide, whose level is dependent on the analyte level, is directly electrolyzed at the electrode). The applied potential usually equals or is more oxidizing or reducing, depending on the desired electrochemical reaction, than the redox potential of the electron transfer agent, analyte, or second compound, whichever is directly electrolyzed at the electrode. The potential at the working electrode is typically large enough to drive the electrochemical reaction to or near completion.
• The magnitude of the potential may optionally be limited to prevent significant (as determined by the current generated in response to the analyte) electrochemical reaction of interferents, such as urate, ascorbate, and acetaminophen. The limitation of the potential may be obviated if these interferents have been removed in another way, such as by providing an interferent-limiting barrier, as described below, or by including a workingelectrode58b(seeFIG. 3A) from which a background signal may be obtained.
• When a potential is applied between the workingelectrode58 and thecounter electrode60, an electrical current will flow. The current is a result of the electrolysis of the analyte or a second compound whose level is affected by the analyte. In one embodiment, the electrochemical reaction occurs via an electron transfer agent and the optional catalyst. Many analytes B are oxidized (or reduced) to products C by an electron transfer agent species A in the presence of an appropriate catalyst (e.g., an enzyme). The electron transfer agent A is then oxidized (or reduced) at the electrode. Electrons are collected by (or removed from) the electrode and the resulting current is measured. This process is illustrated by reaction equations (1) and (2) (similar equations may be written for the reduction of the analyte B by a redox mediator A in the presence of a catalyst):
• 
• As an example, an electrochemical sensor may be based on the reaction of a glucose molecule with two non-leachable ferricyanide anions in the presence of glucose oxidase to produce two non-leachable ferrocyanide anions, two hydrogen ions, and gluconolactone. The amount of glucose present is assayed by electrooxidizing the non-leachable ferrocyanide anions to non-leachable ferricyanide anions and measuring the current.
• In another embodiment, a second compound whose level is affected by the analyte is electrolyzed at the working electrode. In some cases, the analyte D and the second compound, in this case, a reactant compound E, such as oxygen, react in the presence of the catalyst, as shown in reaction equation (3).
• 
• The reactant compound E is then directly oxidized (or reduced) at the working electrode, as shown in reaction equation (4)
• 
• Alternatively, the reactant compound E is indirectly oxidized (or reduced) using an electron transfer agent H (optionally in the presence of a catalyst), that is subsequently reduced or oxidized at the electrode, as shown in reaction equations (5) and (6).
• 
• In either case, changes in the concentration of the reactant compound, as indicated by the signal at the working electrode, correspond inversely to changes in the analyte (i.e., as the level of analyte increase then the level of reactant compound and the signal at the electrode decreases.)
• In other embodiments, the relevant second compound is a product compound F, as shown in reaction equation (3). The product compound F is formed by the catalyzed reaction of analyte D and then be directly electrolyzed at the electrode or indirectly electrolyzed using an electron transfer agent and, optionally, a catalyst. In these embodiments, the signal arising from the direct or indirect electrolysis of the product compound F at the working electrode corresponds directly to the level of the analyte (unless there are other sources of the product compound). As the level of analyte increases, the level of the product compound and signal at the working electrode increases.
• Those skilled in the art will recognize that there are many different reactions that will achieve the same result; namely the electrolysis of an analyte or a compound whose level depends on the level of the analyte. Reaction equations (1) through (6) illustrate non-limiting examples of such reactions.
Temperature Probe
• A variety of optional items may be included in the sensor. One optional item is a temperature probe66 (FIGS. 8 and 11). Thetemperature probe66 may be made using a variety of known designs and materials. Oneexemplary temperature probe66 is formed using two probe leads68,70 connected to each other through a temperature-dependent element72 that is formed using a material with a temperature-dependent characteristic. An example of a suitable temperature-dependent characteristic is the resistance of the temperature-dependent element72.
• The two probe leads68,70 are typically formed using a metal, an alloy, a semimetal, such as graphite, a degenerate or highly doped semiconductor, or a small-band gap semiconductor. Examples of suitable materials include gold, silver, ruthenium oxide, titanium nitride, titanium dioxide, indium doped tin oxide, tin doped indium oxide, or graphite. The temperature-dependent element72 is typically made using a fine trace (e.g., a conductive trace that has a smaller cross-section than that of the probe leads68,70) of the same conductive material as the probe leads, or another material such as a carbon ink, a carbon fiber, or platinum, which has a temperature-dependent characteristic, such as resistance, that provides a temperature-dependent signal when a voltage source is attached to the two probe leads68,70 of thetemperature probe66. The temperature-dependent characteristic of the temperature-dependent element72 may either increase or decrease with temperature. Preferably, the temperature dependence of the characteristic of the temperature-dependent element72 is approximately linear with temperature over the expected range of biological temperatures (about 25 to 45° C.), although this is not required.
• Typically, a signal (e.g., a current) having an amplitude or other property that is a function of the temperature can be obtained by providing a potential across the two probe leads68,70 of thetemperature probe66. As the temperature changes, the temperature-dependent characteristic of the temperature-dependent element72 increases or decreases with a corresponding change in the signal amplitude. The signal from the temperature probe66 (e.g., the amount of current flowing through the probe) may be combined with the signal obtained from the workingelectrode58 by, for example, scaling the temperature probe signal and then adding or subtracting the scaled temperature probe signal from the signal at the workingelectrode58. In this manner, thetemperature probe66 can provide a temperature adjustment for the output from the workingelectrode58 to offset the temperature dependence of the workingelectrode58.
• One embodiment of the temperature probe includes probe leads68,70 formed as two spaced-apart channels with a temperature-dependent element72 formed as a cross-channel connecting the two spaced-apart channels, as illustrated inFIG. 8. The two spaced-apart channels contain a conductive material, such as a metal, alloy, semimetal, degenerate semiconductor, or metallic compound. The cross-channel may contain the same material (provided the cross-channel has a smaller cross-section than the two spaced-apart channels) as the probe leads68,70. In other embodiments, the material in the cross-channel is different than the material of the probe leads68,70.
• One exemplary method for forming this particular temperature probe includes forming the two spaced-apart channels and then filling them with the metallic or alloyed conductive material. Next, the cross-channel is formed and then filled with the desired material. The material in the cross-channel overlaps with the conductive material in each of the two spaced-apart channels to form an electrical connection.
• For proper operation of thetemperature probe66, the temperature-dependent element72 of thetemperature probe66 can not be shorted by conductive material formed between the two probe leads68,70. In addition, to prevent conduction between the two probe leads68,70 by ionic species within the body or sample fluid, a covering may be provided over the temperature-dependent element72, and preferably over the portion of the probe leads68,70 that is implanted in the patient. The covering may be, for example, a non-conducting film disposed over the temperature-dependent element72 and probe leads68,70 to prevent the ionic conduction. Suitable non-conducting films include, for example, Kapton™ polyimide films (DuPont, Wilmington, Del.).
• Another method for eliminating or reducing conduction by ionic species in the body or sample fluid is to use an ac voltage source connected to the probe leads68,70. In this way, the positive and negative ionic species are alternately attracted and repelled during each half cycle of the ac voltage. This results in no net attraction of the ions in the body or sample fluid to thetemperature probe66. The maximum amplitude of the ac current through the temperature-dependent element72 may then be used to correct the measurements from the workingelectrodes58.
• The temperature probe can be placed on the same substrate as the electrodes. Alternatively, a temperature probe may be placed on a separate substrate. In addition, the temperature probe may be used by itself or in conjunction with other devices.
• Another embodiment of a temperature probe utilizes the temperature dependence of the conductivity of a solution (e.g., blood or interstitial fluid). Typically, the conductivity of an electrolyte-containing solution is dependent on the temperature of the solution, assuming that the concentration of electrolytes is relatively constant. Blood, interstitial fluid, and other bodily fluids are solutions with relatively constant levels of electrolytes. Thus, asensor42 can include two or more conductive traces (not shown) which are spaced apart by a known distance. A portion of these conductive traces is exposed to the solution and the conductivity between the exposed portions of the conductive traces is measured using known techniques (e.g., application of a constant or known current or potential and measurement of the resulting potential or current, respectively, to determine the conductivity).
• A change in conductivity is related to a change in temperature. This relation can be modeled using linear, quadratic, exponential, or other relations. The parameters for this relationship typically do not vary significantly between most people. The calibration for the temperature probe can be determined by a variety of methods, including, for example, calibration of eachsensor42 using an independent method of determining temperature (e.g., a thermometer, an optical or electrical temperature detector, or thetemperature probe66, described above) or calibrating onesensor42 and using that calibration for all other sensors in a batch based on uniformity in geometry.
Biocompatible Layer
• Anoptional film layer75 is formed over at least that portion of thesensor42 which is subcutaneously inserted into the patient, as shown inFIG. 9. Thisoptional film layer74 may serve one or more functions. Thefilm layer74 prevents the penetration of large biomolecules into the electrodes. This is accomplished by using afilm layer74 having a pore size that is smaller than the biomolecules that are to be excluded. Such biomolecules may foul the electrodes and/or thesensing layer64 thereby reducing the effectiveness of thesensor42 and altering the expected signal amplitude for a given analyte concentration. The fouling of the workingelectrodes58 may also decrease the effective life of thesensor42. Thebiocompatible layer74 may also prevent protein adhesion to thesensor42, formation of blood clots, and other undesirable interactions between thesensor42 and body.
• For example, the sensor may be completely or partially coated on its exterior with a biocompatible coating. A preferred biocompatible coating is a hydrogel which contains at least 20 wt. % fluid when in equilibrium with the analyte-containing fluid. Examples of suitable hydrogels are described in U.S. Pat. No. 5,593,852, incorporated herein by reference, and include crosslinked polyethylene oxides, such as polyethylene oxide tetraacrylate.
Interferent-Eliminating Layer
• An interferent-eliminating layer (not shown) may be included in thesensor42. The interferent-eliminating layer may be incorporated in thebiocompatible layer75 or in the mass transport limiting layer74 (described below) or may be a separate layer. Interferents are molecules or other species that are electroreduced or electrooxidized at the electrode, either directly or via an electron transfer agent, to produce a false signal. In one embodiment, a film or membrane prevents the penetration of one or more interferents into the region around the workingelectrodes58. Preferably, this type of interferent-eliminating layer is much less permeable to one or more of the interferents than to the analyte.
• The interferent-eliminating layer may include ionic components, such as Nafion®, incorporated into a polymeric matrix to reduce the permeability of the interferent-eliminating layer to ionic interferents having the same charge as the ionic components. For example, negatively charged compounds or compounds that form negative ions may be incorporated in the interferent-eliminating layer to reduce the permeation of negative species in the body or sample fluid.
• Another example of an interferent-eliminating layer includes a catalyst for catalyzing a reaction which removes interferents. One example of such a catalyst is a peroxidase. Hydrogen peroxide reacts with interferents, such as acetaminophen, urate, and ascorbate. The hydrogen peroxide may be added to the analyte-containing fluid or may be generated in situ, by, for example, the reaction of glucose or lactate in the presence of glucose oxidase or lactate oxidase, respectively. Examples of interferent eliminating layers include a peroxidase enzyme crosslinked (a) using gluteraldehyde as a crosslinking agent or (b) oxidation of oligosaccharide groups in the peroxidase glycoenzyme with NaIO₄, followed by coupling of the aldehydes formed to hydrazide groups in a polyacrylamide matrix to form hydrazones are describe in U.S. Pat. Nos. 5,262,305 and 5,356,786, incorporated herein by reference.
Mass Transport Limiting Layer
• A masstransport limiting layer74 may be included with the sensor to act as a diffusion-limiting barrier to reduce the rate of mass transport of the analyte, for example, glucose or lactate, into the region around the workingelectrodes58. By limiting the diffusion of the analyte, the steady state concentration of the analyte in the proximity of the working electrode58 (which is proportional to the concentration of the analyte in the body or sample fluid) can be reduced. This extends the upper range of analyte concentrations that can still be accurately measured and may also expand the range in which the current increases approximately linearly with the level of the analyte.
• It is preferred that the permeability of the analyte through thefilm layer74 vary little or not at all with temperature, so as to reduce or eliminate the variation of current with temperature. For this reason, it is preferred that in the biologically relevant temperature range from about 25° C. to about 45° C., and most importantly from 30° C. to 40° C., neither the size of the pores in the film nor its hydration or swelling change excessively. Preferably, the mass transport limiting layer is made using a film that absorbs less than 5 wt. % of fluid over 24 hours. This may reduce or obviate any need for a temperature probe. For implantable sensors, it is preferable that the mass transport limiting layer is made using a film that absorbs less than 5 wt. % of fluid over 24 hours at 37° C.
• Particularly useful materials for thefilm layer74 are membranes that do not swell in the analyte-containing fluid that the sensor tests. Suitable membranes include 3 to 20,000 nm diameter pores. Membranes having 5 to 500 nm diameter pores with well-defined, uniform pore sizes and high aspect ratios are preferred. In one embodiment, the aspect ratio of the pores is preferably two or greater and more preferably five or greater.
• Well-defined and uniform pores can be made by track etching a polymeric membrane using accelerated electrons, ions, or particles emitted by radioactive nuclei. Most preferred are anisotropic, polymeric, track etched membranes that expand less in the direction perpendicular to the pores than in the direction of the pores when heated. Suitable polymeric membranes included polycarbonate membranes from Poretics (Livermore, Calif., catalog number 19401, 0.01 μm pore size polycarbonate membrane) and Corning Costar Corp. (Cambridge, Mass., Nucleopore™ brand membranes with 0.015 μm pore size). Other polyolefin and polyester films may be used. It is preferred that the permeability of the mass transport limiting membrane changes no more than 4%, preferably, no more than 3%, and, more preferably, no more than 2%, per ° C. in the range from 30° C. to 40° C. when the membranes resides in the subcutaneous interstitial fluid.
• In some embodiments of the disclosure, the masstransport limiting layer74 may also limit the flow of oxygen into thesensor42. This can improve the stability ofsensors42 that are used in situations where variation in the partial pressure of oxygen causes non-linearity in sensor response. In these embodiments, the masstransport limiting layer74 restricts oxygen transport by at least 40%, preferably at least 60%, and more preferably at least 80%, than the membrane restricts transport of the analyte. For a given type of polymer, films having a greater density (e.g., a density closer to that of the crystalline polymer) are preferred. Polyesters, such as polyethylene terephthalate, are typically less permeable to oxygen and are, therefore, preferred over polycarbonate membranes.
Anticlotting Agent
• An implantable sensor may also, optionally, have an anticlotting agent disposed on a portion the substrate which is implanted into a patient. This anticlotting agent may reduce or eliminate the clotting of blood or other body fluid around the sensor, particularly after insertion of the sensor. Blood clots may foul the sensor or irreproducibly reduce the amount of analyte which diffuses into the sensor. Examples of useful anticlotting agents include heparin and tissue plasminogen activator (TPA), as well as other known anticlotting agents.
• The anticlotting agent may be applied to at least a portion of that part of thesensor42 that is to be implanted. The anticlotting agent may be applied, for example, by bath, spraying, brushing, or dipping. The anticlotting agent is allowed to dry on thesensor42. The anticlotting agent may be immobilized on the surface of the sensor or it may be allowed to diffuse away from the sensor surface. Typically, the quantities of anticlotting agent disposed on the sensor are far below the amounts typically used for treatment of medical conditions involving blood clots and, therefore, have only a limited, localized effect.
Sensor Lifetime
• Thesensor42 may be designed to be a replaceable component in an in vivo analyte monitor, and particularly in an implantable analyte monitor. Typically, thesensor42 is capable of operation over a period of days. Preferably, the period of operation is at least one day, more preferably at least three days, and most preferably at least one week. Thesensor42 can then be removed and replaced with a new sensor. The lifetime of thesensor42 may be reduced by the fouling of the electrodes or by the leaching of the electron transfer agent or catalyst. These limitations on the longevity of thesensor42 can be overcome by the use of abiocompatible layer75 or non-leachable electron transfer agent and catalyst, respectively, as described above.
• Another primary limitation on the lifetime of thesensor42 is the temperature stability of the catalyst. Many catalysts are enzymes, which are very sensitive to the ambient temperature and may degrade at temperatures of the patient's body (e.g., approximately 37° C. for the human body). Thus, robust enzymes should be used where available. Thesensor42 should be replaced when a sufficient amount of the enzyme has been deactivated to introduce an unacceptable amount of error in the measurements.
Insertion Device
• Aninsertion device120 can be used to subcutaneously insert thesensor42 into the patient, as illustrated inFIG. 12. Theinsertion device120 is typically formed using structurally rigid materials, such as metal or rigid plastic. Preferred materials include stainless steel and ABS (acrylonitrile-butadiene-styrene) plastic. In some embodiments, theinsertion device120 is pointed and/or sharp at thetip121 to facilitate penetration of the skin of the patient. A sharp, thin insertion device may reduce pain felt by the patient upon insertion of thesensor42. In other embodiments, thetip121 of theinsertion device120 has other shapes, including a blunt or flat shape. These embodiments may be particularly useful when theinsertion device120 does not penetrate the skin but rather serves as a structural support for thesensor42 as thesensor42 is pushed into the skin.
• Theinsertion device120 may have a variety of cross-sectional shapes, as shown inFIGS. 13A,13B, and13C. Theinsertion device120 illustrated inFIG. 13A is a flat, planar, pointed strip of rigid material which may be attached or otherwise coupled to thesensor42 to ease insertion of thesensor42 into the skin of the patient, as well as to provide structural support to thesensor42 during insertion. Theinsertion devices120 ofFIGS. 13B and 13C are U- or V-shaped implements that support thesensor42 to limit the amount that thesensor42 may bend or bow during insertion. Thecross-sectional width124 of theinsertion devices120 illustrated inFIGS. 13B and 13C is typically 1 mm or less, preferably 700 μm or less, more preferably 500 μm or less, and most preferably 300 μm or less. Thecross-sectional height126 of theinsertion device120 illustrated inFIGS. 13B and 13C is typically about 1 mm or less, preferably about 700 μm or less, and more preferably about 500 μm or less.
• Thesensor42 itself may include optional features to facilitate insertion. For example, thesensor42 may be pointed at thetip123 to ease insertion, as illustrated inFIG. 12. In addition, thesensor42 may include abarb125 which helps retain thesensor42 in the subcutaneous tissue of the patient. Thebarb125 may also assist in anchoring thesensor42 within the subcutaneous tissue of the patient during operation of thesensor42. However, thebarb125 is typically small enough that little damage is caused to the subcutaneous tissue when thesensor42 is removed for replacement. Thesensor42 may also include anotch127 that can be used in cooperation with a corresponding structure (not shown) in the insertion device to apply pressure against thesensor42 during insertion, but disengage as theinsertion device120 is removed. One example of such a structure in the insertion device is a rod (not shown) between two opposing sides of aninsertion device120 and at an appropriate height of theinsertion device120.
• In operation, thesensor42 is placed within or next to theinsertion device120 and then a force is provided against theinsertion device120 and/orsensor42 to carry thesensor42 into the skin of the patient. In one embodiment, the force is applied to thesensor42 to push the sensor into the skin, while theinsertion device120 remains stationary and provides structural support to thesensor42. Alternatively, the force is applied to theinsertion device120 and optionally to thesensor42 to push a portion of both thesensor42 and theinsertion device120 through the skin of the patient and into the subcutaneous tissue. Theinsertion device120 is optionally pulled out of the skin and subcutaneous tissue with thesensor42 remaining in the subcutaneous tissue due to frictional forces between thesensor42 and the patient's tissue. If thesensor42 includes theoptional barb125, then this structure may also facilitate the retention of thesensor42 within the interstitial tissue as the barb catches in the tissue.
• The force applied to theinsertion device120 and/or thesensor42 may be applied manually or mechanically. Preferably, thesensor42 is reproducibly inserted through the skin of the patient. In one embodiment, an insertion gun is used to insert the sensor. One example of aninsertion gun200 for inserting asensor42 is shown inFIG. 26. Theinsertion gun200 includes ahousing202 and acarrier204. Theinsertion device120 is typically mounted on thecarrier204 and thesensor42 is pre-loaded into theinsertion device120. Thecarrier204 drives thesensor42 and, optionally, theinsertion device120 into the skin of the patient using, for example, a cocked or wound spring, a burst of compressed gas, an electromagnet repelled by a second magnet, or the like, within theinsertion gun200. In some instances, for example, when using a spring, thecarrier204 and insertion device may be moved, cocked, or otherwise prepared to be directed towards the skin of the patient.
• After thesensor42 is inserted, theinsertion gun200 may contain a mechanism which pulls theinsertion device120 out of the skin of the patient. Such a mechanism may use a spring, electromagnet, or the like to remove theinsertion device120.
• The insertion gun may be reusable. Theinsertion device120 is often disposable to avoid the possibility of contamination. Alternatively, theinsertion device120 may be sterilized and reused. In addition, theinsertion device120 and/or thesensor42 may be coated with an anticlotting agent to prevent fouling of thesensor42.
• In one embodiment, thesensor42 is injected between 2 to 12 mm into the interstitial tissue of the patient for subcutaneous implantation. Preferably, the sensor is injected 3 to 9 mm, and more preferably 5 to 7 mm, into the interstitial tissue. Other embodiments of the disclosure, may include sensors implanted in other portions of the patient, including, for example, in an artery, vein, or organ. The depth of implantation varies depending on the desired implantation target.
• Although thesensor42 may be inserted anywhere in the body, it is often desirable that the insertion site be positioned so that the on-skinsensor control unit44 can be concealed. In addition, it is often desirable that the insertion site be at a place on the body with a low density of nerve endings to reduce the pain to the patient. Examples of preferred sites for insertion of thesensor42 and positioning of the on-skinsensor control unit44 include the abdomen, thigh, leg, upper arm, and shoulder.
• An insertion angle is measured from the plane of the skin (i.e., inserting the sensor perpendicular to the skin would be a 90° insertion angle). Insertion angles usually range from 10 to 90°, typically from 15 to 60°, and often from 30 to 45°.
On-Skin Sensor Control Unit
• The on-skinsensor control unit44 is configured to be placed on the skin of a patient. The on-skinsensor control unit44 is optionally formed in a shape that is comfortable to the patient and which may permit concealment, for example, under a patient's clothing. The thigh, leg, upper arm, shoulder, or abdomen are convenient parts of the patient's body for placement of the on-skinsensor control unit44 to maintain concealment. However, the on-skinsensor control unit44 may be positioned on other portions of the patient's body. One embodiment of the on-skinsensor control unit44 has a thin, oval shape to enhance concealment, as illustrated inFIGS. 14-16. However, other shapes and sizes may be used.
• The particular profile, as well as the height, width, length, weight, and volume of the on-skinsensor control unit44 may vary and depends, at least in part, on the components and associated functions included in the on-skinsensor control unit44, as discussed below. For example, in some embodiments, the on-skinsensor control unit44 has a height of 1.3 cm or less, and preferably 0.7 cm or less. In some embodiments, the on-skinsensor control unit44 has a weight of 90 grams or less, preferably 45 grams or less, and more preferably 25 grams or less. In some embodiments, the on-skinsensor control unit44 has a volume of about 15 cm³or less, preferably about 10 cm³or less, more preferably about 5 cm³or less, and most preferably about 2.5 cm³or less.
• The on-skinsensor control unit44 includes ahousing45, as illustrated inFIGS. 14-16. Thehousing45 is typically formed as a single integral unit that rests on the skin of the patient. Thehousing45 typically contains most or all of the electronic components, described below, of the on-skinsensor control unit44. The on-skinsensor control unit44 usually includes no additional cables or wires to other electronic components or other devices. If the housing includes two or more parts, then those parts typically fit together to form a single integral unit.
• Thehousing45 of the on-skinsensor control unit44, illustrated inFIGS. 14-16, may be formed using a variety of materials, including, for example, plastic and polymeric materials, particularly rigid thermoplastics and engineering thermoplastics. Suitable materials include, for example, polyvinyl chloride, polyethylene, polypropylene, polystyrene, ABS polymers, and copolymers thereof. Thehousing45 of the on-skinsensor control unit44 may be formed using a variety of techniques including, for example, injection molding, compression molding, casting, and other molding methods. Hollow or recessed regions may be formed in thehousing45 of the on-skinsensor control unit44. The electronic components of the on-skinsensor control unit44, described below, and/or other items, such as a battery or a speaker for an audible alarm, may be placed in the hollow or recessed areas.
• In some embodiments,conductive contacts80 are provided on the exterior of thehousing45. In other embodiments, theconductive contacts80 are provided on the interior of thehousing45, for example, within a hollow or recessed region.
• In some embodiments, the electronic components and/or other items are incorporated into thehousing45 of the on-skinsensor control unit44 as the plastic or polymeric material is molded or otherwise formed. In other embodiments, the electronic components and/or other items are incorporated into thehousing45 as the molded material is cooling or after the molded material has been reheated to make it pliable. Alternatively, the electronic components and/or other items may be secured to thehousing45 using fasteners, such as screws, nuts and bolts, nails, staples, rivets, and the like or adhesives, such as contact adhesives, pressure sensitive adhesives, glues, epoxies, adhesive resins, and the like. In some cases, the electronic components and/or other items are not affixed to thehousing45 at all.
• In some embodiments, thehousing45 of the on-skinsensor control unit44 is a single piece. Theconductive contacts80 may be formed on the exterior of thehousing45 or on the interior of thehousing45 provided there is aport78 in thehousing45 through which thesensor42 can be directed to access theconductive contacts80.
• In other embodiments, thehousing45 of the on-skinsensor control unit44 is formed in at least two separate portions that fit together to form thehousing45, for example, abase74 and acover76, as illustrated inFIGS. 14-16. The two or more portions of thehousing45 may be entirely separate from each other. Alternatively, at least some of the two or more portions of thehousing45 may be connected together, for example, by a hinge, to facilitate the coupling of the portions to form thehousing45 of the on-skinsensor control unit44.
• These two or more separate portions of thehousing45 of the on-skinsensor control unit44 may have complementary, interlocking structures, such as, for example, interlocking ridges or a ridge on one component and a complementary groove on another component, so that the two or more separate components may be easily and/or firmly coupled together. This may be useful, particularly if the components are taken apart and fit together occasionally, for example, when a battery orsensor42 is replaced. However, other fasteners may also be used to couple the two or more components together, including, for example, screws, nuts and bolts, nails, staples, rivets, or the like. In addition, adhesives, both permanent or temporary, may be used including, for example, contact adhesives, pressure sensitive adhesives, glues, epoxies, adhesive resins, and the like.
• Typically, thehousing45 is at least water resistant to prevent the flow of fluids into contact with the components in the housing, including, for example, theconductive contacts80. Preferably, the housing is waterproof. In one embodiment, two or more components of thehousing45, for example, thebase74 and thecover76, fit together tightly to form a hermetic, waterproof, or water resistant seal so that fluids can not flow into the interior of the on-skinsensor control unit44. This may be useful to avoid corrosion currents and/or degradation of items within the on-skinsensor control unit44, such as the conductive contacts, the battery, or the electronic components, particularly when the patient engages in such activities as showering, bathing, or swimming.
• Water resistant, as used herein, means that there is no penetration of water through a water resistant seal or housing when immersed in water at a depth of one meter at sea level. Waterproof, as used herein, means that there is no penetration of water through the waterproof seal or housing when immersed in water at a depth of ten meters, and preferably fifty meters, at sea level. It is often desirable that the electronic circuitry, power supply (e.g., battery), and conductive contacts of the on-skin sensor control unit, as well as the contact pads of the sensor, are contained in a water resistant, and preferably, a waterproof, environment.
• In addition to the portions of thehousing45, such as thebase74 andcover76, there may be other individually-formed pieces of the on-skinsensor control unit44, which may be assembled during or after manufacture. One example of an individually-formed piece is a cover for electronic components that fits a recess in the base74 orcover76. Another example is a cover for a battery provided in the base74 orcover76. These individually-formed pieces of the on-skinsensor control unit44 may be permanently affixed, such as, for example, a cover for electronic components, or removably affixed, such as, for example, a removable cover for a battery, to thebase74,cover76, or other component of the on-skinsensor control unit44. Methods for affixing these individually-formed pieces include the use of fasteners, such as screws, nuts and bolts, staples, nails, rivets, and the like, frictional fasteners, such as tongue and groove structures, and adhesives, such as contact adhesives, pressure sensitive adhesives, glues, epoxies, adhesive resins, and the like.
• One embodiment of the on-skinsensor control unit44 is a disposable unit complete with a battery for operating the unit. There are no portions of the unit that the patient needs to open or remove, thereby reducing the size of the unit and simplifying its construction. The on-skinsensor control unit44 optionally remains in a sleep mode prior to use to conserve the battery's power. The on-skinsensor control unit44 detects that it is being used and activates itself. Detection of use may be through a number of mechanisms. These include, for example, detection of a change in resistance across the electrical contacts, actuation of a switch upon mating the on-skinsensor control unit44 with a mounting unit77 (seeFIGS. 27A and 28A). The on-skinsensor control unit44 is typically replaced when it no longer operates within threshold limits, for example, if the battery or other power source does not generate sufficient power. Often this embodiment of the on-skinsensor control unit44 hasconductive contacts80 on the exterior of thehousing45. Once thesensor42 is implanted in the patient, thesensor control unit44 is placed over thesensor42 with theconductive contacts80 in contact with thecontact pads49 of thesensor42.
• The on-skinsensor control unit44 is typically attached to theskin75 of the patient, as illustrated inFIG. 17. The on-skinsensor control unit44 may be attached by a variety of techniques including, for example, by adhering the on-skinsensor control unit44 directly to theskin75 of the patient with an adhesive provided on at least a portion of thehousing45 of the on-skinsensor control unit44 which contacts theskin75 or by suturing the on-skinsensor control unit44 to theskin75 through suture openings (not shown) in thesensor control unit44.
• Another method of attaching thehousing45 of the on-skinsensor control unit44 to theskin75 includes using a mounting unit,77. The mountingunit77 is often a part of the on-skinsensor control unit44. One example of a suitable mountingunit77 is a double-sided adhesive strip, one side of which is adhered to a surface of the skin of the patient and the other side is adhered to the on-skinsensor control unit44. In this embodiment, the mountingunit77 may have anoptional opening79 which is large enough to allow insertion of thesensor42 through theopening79. Alternatively, the sensor may be inserted through a thin adhesive and into the skin.
• A variety of adhesives may be used to adhere the on-skinsensor control unit44 to theskin75 of the patient, either directly or using the mountingunit77, including, for example, pressure sensitive adhesives (PSA) or contact adhesives. Preferably, an adhesive is chosen which is not irritating to all or a majority of patients for at least the period of time that aparticular sensor42 is implanted in the patient. Alternatively, a second adhesive or other skin-protecting compound may be included with the mounting unit so that a patient, whose skin is irritated by the adhesive on the mountingunit77, can cover his skin with the second adhesive or other skin-protecting compound and then place the mountingunit77 over the second adhesive or other skin-protecting compound. This should substantially prevent the irritation of the skin of the patient because the adhesive on the mountingunit77 is no longer in contact with the skin, but is instead in contact with the second adhesive or other skin-protecting compound.
• When thesensor42 is changed, the on-skinsensor control unit44 may be moved to a different position on theskin75 of the patient, for example, to avoid excessive irritation. Alternatively, the on-skinsensor control unit44 may remain at the same place on the skin of the patient until it is determined that theunit44 should be moved.
• Another embodiment of a mountingunit77 used in an on-skinsensor control unit44 is illustrated inFIGS. 27A and 27B. The mountingunit77 and ahousing45 of an on-skinsensor control unit44 are mounted together in, for example, an interlocking manner, as shown inFIG. 27A. The mountingunit77 is formed, for example, using plastic or polymer materials, including, for example, polyvinyl chloride, polyethylene, polypropylene, polystyrene, ABS polymers, and copolymers thereof. The mountingunit77 may be formed using a variety of techniques including, for example, injection molding, compression molding, casting, and other molding methods.
• The mountingunit77 typically includes an adhesive on a bottom surface of the mountingunit77 to adhere to the skin of the patient or the mountingunit77 is used in conjunction with, for example, double-sided adhesive tape or the like. The mountingunit77 typically includes anopening79 through which thesensor42 is inserted, as shown inFIG. 27B. The mountingunit77 may also include asupport structure220 for holding thesensor42 in place and against theconductive contacts80 on the on-skinsensor control unit42. The mountingunit77, also, optionally, includes apositioning structure222, such as an extension of material from the mountingunit77, that corresponds to a structure (not shown), such as an opening, on thesensor42 to facilitate proper positioning of thesensor42, for example, by aligning the two complementary structures.
• In another embodiment, a coupled mountingunit77 andhousing45 of an on-skinsensor control unit44 is provided on anadhesive patch204 with anoptional cover206 to protect and/or confine thehousing45 of the on-skinsensor control unit44, as illustrated inFIG. 28A. The optional cover may contain an adhesive or other mechanism for attachment to thehousing45 and/or mountingunit77. The mountingunit77 typically includes anopening49 through which asensor42 is disposed, as shown inFIG. 28B. Theopening49 may optionally be configured to allow insertion of thesensor42 through theopening49 using aninsertion device120 or insertion gun200 (seeFIG. 26). Thehousing45 of the on-skinsensor control unit44 has abase74 and acover76, as illustrated inFIG. 28C. A bottom view of thehousing45, as shown inFIG. 28D, illustratesports230 through which conductive contacts (not shown) extend to connect with contact pads on thesensor42. Aboard232 for attachment of circuit components may optionally be provided within the on-skinsensor control unit44, as illustrated inFIG. 28E.
• In some embodiments, the adhesive on the on-skinsensor control unit44 and/or on any of the embodiments of the mountingunit77 is water resistant or waterproof to permit activities such as showering and/or bathing while maintaining adherence of the on-skinsensor control unit44 to theskin75 of the patient and, at least in some embodiments, preventing water from penetrating into thesensor control unit44. The use of a water resistant or waterproof adhesive combined with a water resistant orwaterproof housing45 protects the components in thesensor control unit44 and the contact between theconductive contacts80 and thesensor42 from damage or corrosion. An example of a non-irritating adhesive that repels water is Tegaderm (3M, St. Paul, Minn.).
• In one embodiment, the on-skinsensor control unit44 includes asensor port78 through which thesensor42 enters the subcutaneous tissue of the patient, as shown inFIGS. 14 to 16. Thesensor42 may be inserted into the subcutaneous tissue of the patient through thesensor port78. The on-skinsensor control unit44 may then be placed on the skin of the patient with thesensor42 being threaded through thesensor port78. If thehousing45 of thesensor42 has, for example, abase74 and acover76, then thecover76 may be removed to allow the patient to guide thesensor42 into the proper position for contact with theconductive contacts80.
• Alternatively, if theconductive contacts80 are within thehousing45 the patient may slide thesensor42 into thehousing45 until contact is made between thecontact pads49 and theconductive contacts80. Thesensor control unit44 may have a structure which obstructs the sliding of thesensor42 further into the housing once thesensor42 is properly positioned with thecontact pads49 in contact with theconductive contacts80.
• In other embodiments, theconductive contacts80 are on the exterior of the housing45 (see e.g.,FIGS. 27A-27B and28A-28E). In these embodiments, the patient guides thecontacts pads49 of thesensor42 into contact with theconductive contacts80. In some cases, a guiding structure may be provided on thehousing45 which guides thesensor42 into the proper position. An example of such a structure includes a set of guiding rails extending from thehousing45 and having the shape of thesensor42.
• In some embodiments, when thesensor42 is inserted using an insertion device120 (seeFIG. 12), the tip of theinsertion device120 or optional insertion gun200 (seeFIG. 26) is positioned against the skin or the mountingunit77 at the desired insertion point. In some embodiments, theinsertion device120 is positioned on the skin without any guide. In other embodiments, theinsertion device120 orinsertion gun200 is positioned using guides (not shown) in the mountingunit77 or other portion of the on-skinsensor control unit44. In some embodiments, the guides, opening79 in the mountingunit77 and/orsensor port78 in thehousing45 of the on-skinsensor control unit44 have a shape which is complementary to the shape of the tip of theinsertion device120 and/orinsertion gun200 to limit the orientation of theinsertion device120 and/orinsertion gun200 relative to theopening79 and/orsensor port78. The sensor can then be subcutaneously inserted into the patient by matching the complementary shape of theopening79 orsensor port78 with theinsertion device120 and/orinsertion gun200.
• In some embodiments, the shapes of a) the guides, opening79, orsensor port78, and (b) theinsertion device120 orinsertion gun200 are configured such that the two shapes can only be matched in a single orientation. This aids in inserting thesensor42 in the same orientation each time a new sensor is inserted into the patient. This uniformity in insertion orientation may be required in some embodiments to ensure that thecontact pads49 on thesensor42 are correctly aligned with appropriateconductive contacts80 on the on-skinsensor control unit44. In addition, the use of the insertion gun, as described above, may ensure that thesensor42 is inserted at a uniform, reproducible depth.
• Thesensor42 and the electronic components within the on-skinsensor control unit44 are coupled viaconductive contacts80, as shown inFIGS. 14-16. The one or more workingelectrodes58, counter electrode60 (or counter/reference electrode),optional reference electrode62, andoptional temperature probe66 are attached to individualconductive contacts80. In the illustrated embodiment ofFIGS. 14-16, theconductive contacts80 are provided on the interior of the on-skinsensor control unit44. Other embodiments of the on-skinsensor control unit44 have the conductive contacts disposed on the exterior of thehousing45. The placement of theconductive contacts80 is such that they are in contact with thecontact pads49 on thesensor42 when thesensor42 is properly positioned within the on-skinsensor control unit44.
• In the illustrated embodiment ofFIGS. 14-16, thebase74 and cover76 of the on-skinsensor control unit44 are formed such that, when thesensor42 is within the on-skinsensor control unit44 and thebase74 and cover76 are fitted together, thesensor42 is bent. In this manner, thecontact pads49 on thesensor42 are brought into contact with theconductive contacts80 of the on-skinsensor control unit44. The on-skinsensor control unit44 may optionally contain asupport structure82 to hold, support, and/or guide thesensor42 into the correct position.
• Non-limiting examples of suitableconductive contacts80 are illustrated inFIGS. 19A-19D. In one embodiment, theconductive contacts80 arepins84 or the like, as illustrated inFIG. 19A, which are brought into contact with thecontact pads49 on thesensor42 when the components of the on-skinsensor control unit44, for example, thebase74 andcover76, are fitted together. Asupport82 may be provided under thesensor42 to promote adequate contact between thecontact pads49 on thesensor42 and thepins84. The pins are typically made using a conductive material, such as a metal or alloy, for example, copper, stainless steel, or silver. Each pin has a distal end that extends from the on-skinsensor control unit44 for contacting thecontact pads49 on thesensor42. Eachpin84 also has a proximal end that is coupled to a wire or other conductive strip that is, in turn, coupled to the rest of the electronic components (e.g., thevoltage source95 andmeasurement circuit96 ofFIGS. 18A and 18B) within the on-skinsensor control unit44. Alternatively, thepins84 may be coupled directly to the rest of the electronics.
• In another embodiment, theconductive contacts80 are formed as a series of conductingregions88 with interspersed insulatingregions90, as illustrated inFIG. 19B. The conductingregions88 may be as large or larger than thecontact pads49 on thesensor42 to alleviate registration concerns. However, the insulatingregions90 should have sufficient width so that a singleconductive region88 does not overlap with twocontact pads49 as determined based on the expected variation in the position of thesensor42 andcontact pads49 with respect to theconductive contacts80. The conductingregions88 are formed using materials such as metals, alloys, or conductive carbon. The insulatingregions90 may be formed using known insulating materials including, for example, insulating plastic or polymer materials.
• In a further embodiment, aunidirectional conducting adhesive92 may be used between thecontact pads49 on thesensor42 andconductive contacts80 implanted or otherwise formed in the on-skinsensor control unit44, as shown inFIG. 19C.
• In yet another embodiment, theconductive contacts80 areconductive members94 that extend from a surface of the on-skinsensor control unit44 to contact thecontact pads49, as shown inFIG. 19D. A variety of different shapes may be used for these members, however, they should be electrically insulated from each other. Theconductive members94 may be made using metal, alloy, conductive carbon, or conducting plastics and polymers.
• Any of the exemplaryconductive contacts80 described above may extend from either the upper surface of the interior of the on-skinsensor control unit44, as illustrated inFIG. 19A-19C, or from the lower surface of the interior of the on-skinsensor control unit44, as illustrated inFIG. 19D, or from both the upper and lower surfaces of the interior of the on-skinsensor control unit44, particularly when thesensor42 hascontact pads49 on both sides of the sensor.
• Conductive contacts80 on the exterior of thehousing45 may also have a variety of shapes as indicated inFIGS. 19E and 19F. For example, theconductive contacts80 may be embedded in (FIG. 19E) or extending out of (FIG. 19F) thehousing45.
• Theconductive contacts80 are preferably made using a material which will not corrode due to contact with thecontact pads49 of thesensor42. Corrosion may occur when two different metals are brought in contact. Thus, if thecontact pads49 are formed using carbon then the preferredconductive contacts80 may be made using any material, including metals or alloys. However, if any of thecontact pads49 are made with a metal or alloy then the preferredconductive contacts80 for coupling with the metallic contact pads are made using a non-metallic conductive material, such as conductive carbon or a conductive polymer, or theconductive contacts80 and thecontact pads49 are separated by a non-metallic material, such as a unidirectional conductive adhesive.
• In one embodiment, electrical contacts are eliminated between thesensor42 and the on-skinsensor control unit44. Power is transmitted to the sensor via inductive coupling, using, for example, closely space antennas (e.g., facing coils) (not shown) on the sensor and the on-skin sensor control unit. Changes in the electrical characteristics of the sensor control unit44 (e.g., current) induce a changing magnetic field in the proximity of the antenna. The changing magnetic field induces a current in the antenna of the sensor. The close proximity of the sensor and on-skin sensor control unit results in reasonably efficient power transmission. The induced current in the sensor may be used to power potentiostats, operational amplifiers, capacitors, integrated circuits, transmitters, and other electronic components built into the sensor structure. Data is transmitted back to the sensor control unit, using, for example, inductive coupling via the same or different antennas and/or transmission of the signal via a transmitter on the sensor. The use of inductive coupling can eliminate electrical contacts between the sensor and the on-skin sensor control unit. Such contacts are commonly a source of noise and failure. Moreover, the sensor control unit may then be entirely sealed which may increase the waterproofing of the on-skin sensor control unit.
• An exemplary on-skinsensor control unit44 can be prepared and used in the following manner. A mountingunit77 having adhesive on the bottom is applied to the skin. An insertion gun200 (seeFIG. 26) carrying thesensor42 and theinsertion device120 is positioned against the mountingunit77. Theinsertion gun200 and mountingunit77 are optionally designed such that there is only one position in which the two properly mate. Theinsertion gun200 is activated and a portion of thesensor42 and optionally a portion of theinsertion device120 are driven through the skin into, for example, the subcutaneous tissue. Theinsertion gun200 withdraws theinsertion device200, leaving the portion of thesensor42 inserted through the skin. Thehousing45 of the on-skin control unit44 is then coupled to the mountingunit77. Optionally, thehousing45 and the mountingunit77 are formed such that there is only one position in which the two properly mate. The mating of thehousing45 and the mountingunit77 establishes contact between the contact pads49 (see e.g.,FIG. 2) on thesensor42 and theconductive contacts80 on the on-skinsensor control unit44. Optionally, this action activates the on-skinsensor control unit44 to begin operation.
On-Skin Control Unit Electronics
• The on-skinsensor control unit44 also typically includes at least a portion of the electronic components that operate thesensor42 and the analytemonitoring device system40. One embodiment of the electronics in the on-skin control unit44 is illustrated as a block diagram inFIG. 18A. The electronic components of the on-skinsensor control unit44 typically include apower supply95 for operating the on-skin control unit44 and thesensor42, asensor circuit97 for obtaining signals from and operating thesensor42, ameasurement circuit96 that converts sensor signals to a desired format, and aprocessing circuit109 that, at minimum, obtains signals from thesensor circuit97 and/ormeasurement circuit96 and provides the signals to anoptional transmitter98. In some embodiments, theprocessing circuit109 may also partially or completely evaluate the signals from thesensor42 and convey the resulting data to theoptional transmitter98 and/or activate an optional alarm system94 (seeFIG. 18B) if the analyte level exceeds a threshold. Theprocessing circuit109 often includes digital logic circuitry.
• The on-skinsensor control unit44 may optionally contain atransmitter98 for transmitting the sensor signals or processed data from theprocessing circuit109 to a receiver/display unit46,48; adata storage unit102 for temporarily or permanently storing data from theprocessing circuit109; atemperature probe circuit99 for receiving signals from and operating atemperature probe66; areference voltage generator101 for providing a reference voltage for comparison with sensor-generated signals; and/or awatchdog circuit103 that monitors the operation of the electronic components in the on-skinsensor control unit44.
• Moreover, thesensor control unit44 often includes digital and/or analog components utilizing semiconductor devices, such as transistors. To operate these semiconductor devices, the on-skin control unit44 may include other components including, for example, abias control generator105 to correctly bias analog and digital semiconductor devices, anoscillator107 to provide a clock signal, and a digital logic andtiming component109 to provide timing signals and logic operations for the digital components of the circuit.
• As an example of the operation of these components, thesensor circuit97 and the optionaltemperature probe circuit99 provide raw signals from thesensor42 to themeasurement circuit96. Themeasurement circuit96 converts the raw signals to a desired format, using for example, a current-to-voltage converter, current-to-frequency converter, and/or a binary counter or other indicator that produces a signal proportional to the absolute value of the raw signal. This may be used, for example, to convert the raw signal to a format that can be used by digital logic circuits. Theprocessing circuit109 may then, optionally, evaluate the data and provide commands to operate the electronics.
• FIG. 18B illustrates a block diagram of another exemplary on-skin control unit44 that also includes optional components such as areceiver99 to receive, for example, calibration data; a calibration storage unit100 to hold, for example, factory-set calibration data, calibration data obtained via thereceiver99 and/or operational signals received, for example, from a receiver/display unit46,48 or other external device; an alarm system104 for warning the patient; and adeactivation switch111 to turn off the alarm system.
• Functions of theanalyte monitoring system40 and thesensor control unit44 may be implemented using either software routines, hardware components, or combinations thereof. The hardware components may be implemented using a variety of technologies, including, for example, integrated circuits or discrete electronic components. The use of integrated circuits typically reduces the size of the electronics, which in turn may result in a smaller on-skinsensor control unit44.
• The electronics in the on-skinsensor control unit44 and thesensor42 are operated using apower supply95. One example of asuitable power supply95 is a battery, for example, a thin circular battery, such as those used in many watches, hearing aids, and other small electronic devices. Preferably, the battery has a lifetime of at least 30 days, more preferably, a lifetime of at least three months, and most preferably, a lifetime of at least one year. The battery is often one of the largest components in the on-skin control unit44, so it is often desirable to minimize the size of the battery. For example, a preferred battery's thickness is 0.5 mm or less, preferably 0.35 mm or less, and most preferably 0.2 mm or less. Although multiple batteries may be used, it is typically preferred to use only one battery.
• Thesensor circuit97 is coupled via theconductive contacts80 of thesensor control unit44 to one ormore sensors42,42′. Each of the sensors represents, at minimum, a workingelectrode58, a counter electrode60 (or counter/reference electrode), and anoptional reference electrode62. When two ormore sensors42,42′ are used, the sensors typically have individual workingelectrodes58, but may share acounter electrode60, counter/reference electrode, and/orreference electrode52.
• Thesensor circuit97 receives signals from and operates thesensor42 orsensors42,42′. Thesensor circuit97 may obtain signals from thesensor42 using amperometric, coulometric, potentiometric, voltammetric, and/or other electrochemical techniques. Thesensor circuit97 is exemplified herein as obtaining amperometric signals from thesensor42, however, it will be understood that the sensor circuit can be appropriately configured for obtaining signals using other electrochemical techniques. To obtain amperometric measurements, thesensor circuit97 typically includes a potentiostat that provides a constant potential to thesensor42. In other embodiments, thesensor circuit97 includes an amperostat that supplies a constant current to thesensor42 and can be used to obtain coulometric or potentiometric measurements.
• The signal from thesensor42 generally has at least one characteristic, such as, for example, current, voltage, or frequency, which varies with the concentration of the analyte. For example, if thesensor circuit97 operates using amperometry, then the signal current varies with analyte concentration. Themeasurement circuit96 may include circuitry which converts the information-carrying portion of the signal from one characteristic to another. For example, themeasurement circuit96 may include a current-to-voltage or current-to-frequency converter. The purpose of this conversion may be to provide a signal that is, for example, more easily transmitted, readable by digital circuits, and/or less susceptible to noise contributions.
• One example of a standard current-to-voltage converter is provided inFIG. 20A. In this converter, the signal from thesensor42 is provided at oneinput terminal134 of an operational amplifier130 (“op amp”) and coupled through aresistor138 to anoutput terminal136. This particular current-to-voltage converter131 may, however, be difficult to implement in a small CMOS chip because resistors are often difficult to implement on an integrated circuit. Typically, discrete resistor components are used. However, the used of discrete components increases the space needed for the circuitry.
• An alternative current-to-voltage converter141 is illustrated inFIG. 20B. This converter includes anop amp140 with the signal from thesensor42 provided atinput terminal144 and a reference potential provided atinput terminal142. Acapacitor145 is placed between theinput terminal144 and theoutput terminal146. In addition, switches147a,147b,149a, and149bare provided to allow the capacitor to charge and discharge at a rate determined by a clock (CLK) frequency. In operation, during one half cycle, switches147aand147bclose and switches149aand149bopen allowing thecapacitor145 to charge due to the attached potential VI. During the other half cycle, switches147aand147bopen and switches149aand149bclose to ground and allow thecapacitor145 to partially or fully discharge. The reactive impedance of thecapacitor145 is analogous to the resistance of the resistor138 (seeFIG. 20A), allowing thecapacitor145 to emulate a resistor. The value of this “resistor” depends on the capacitance of thecapacitor145 and the clock frequency. By altering the clock frequency, the reactive impedance (“resistance value”) of the capacitor changes. The value of the impedance (“resistance”) of thecapacitor145 may be altered by changing the clock frequency.Switches147a,147b,149a, and149bmay be implemented in a CMOS chip using, for example, transistors.
• A current-to-frequency converter may also be used in themeasurement circuit96. One suitable current-to-frequency converter includes charging a capacitor using the signal from thesensor42. When the potential across the capacitor exceeds a threshold value, the capacitor is allowed to discharge. Thus, the larger the current from thesensor42, the quicker the threshold potential is achieved. This results in a signal across the capacitor that has an alternating characteristic, corresponding to the charging and discharging of the capacitor, having a frequency which increases with an increase in current from thesensor42.
• In some embodiments, theanalyte monitoring system40 includes two or more workingelectrodes58 distributed over one ormore sensors42. These workingelectrodes58 may be used for quality control purposes. For example, the output signals and/or analyzed data derived using the two or more workingelectrodes58 may be compared to determine if the signals from the working electrodes agree within a desired level of tolerance. If the output signals do not agree, then the patient may be alerted to replace the sensor or sensors. In some embodiments, the patient is alerted only if the lack of agreement between the two sensors persists for a predetermined period of time. The comparison of the two signals may be made for each measurement or at regular intervals. Alternatively or additionally, the comparison may be initiated by the patient or another person. Moreover, the signals from both sensors may be used to generate data or one signal may be discarded after the comparison.
• Alternatively, if, for example, two workingelectrodes58 have acommon counter electrode60 and the analyte concentration is measured by amperometry, then the current at thecounter electrode60 should be twice the current at each of the working electrodes, within a predetermined tolerance level, if the working electrodes are operating properly. If not, then the sensor or sensors should be replaced, as described above.
• An example of using signals from only one working electrode for quality control includes comparing consecutive readings obtained using the single working electrode to determine if they differ by more than a threshold level. If the difference is greater than the threshold level for one reading or over a period of time or for a predetermined number of readings within a period of time then the patient is alerted to replace thesensor42. Typically, the consecutive readings and/or the threshold level are determined such that all expected excursions of the sensor signal are within the desired parameters (i.e., thesensor control unit44 does not consider true changes in analyte concentration to be a sensor failure).
• Thesensor control unit44 may also optionally include atemperature probe circuit99. Thetemperature probe circuit99 provides a constant current through (or constant potential) across thetemperature probe66. The resulting potential (or current) varies according to the resistance of the temperaturedependent element72.
• The output from thesensor circuit97 and optional temperature probe circuit is coupled into ameasurement circuit96 that obtains signals from thesensor circuit97 and optionaltemperature probe circuit99 and, at least in some embodiments, provides output data in a form that, for example can be read by digital circuits. The signals from themeasurement circuit96 are sent to theprocessing circuit109, which in turn may provide data to anoptional transmitter98. The processing circuit109 may have one or more of the following functions: 1) transfer the signals from the measurement circuit96 to the transmitter98, 2) transfer signals from the measurement circuit96 to the data storage circuit102, 3) convert the information-carrying characteristic of the signals from one characteristic to another (when, for example, that has not been done by the measurement circuit96), using, for example, a current-to-voltage converter, a current-to-frequency converter, or a voltage-to-current converter, 4) modify the signals from the sensor circuit97 using calibration data and/or output from the temperature probe circuit99, 5) determine a level of an analyte in the interstitial fluid, 6) determine a level of an analyte in the bloodstream based on the sensor signals obtained from interstitial fluid, 7) determine if the level, rate of change, and/or acceleration in the rate of change of the analyte exceeds or meets one or more threshold values, 8) activate an alarm if a threshold value is met or exceeded, 9) evaluate trends in the level of an analyte based on a series of sensor signals, 10) determine a dose of a medication, and 11) reduce noise and/or errors, for example, through signal averaging or comparing readings from multiple working electrodes58.
• Theprocessing circuit109 may be simple and perform only one or a small number of these functions or theprocessing circuit109 may be more sophisticated and perform all or most of these functions. The size of the on-skinsensor control unit44 may increase with the increasing number of functions and complexity of those functions that theprocessing circuit109 performs. Many of these functions may not be performed by aprocessing circuit109 in the on-skinsensor control unit44, but may be performed by anotheranalyzer152 in the receiver/display units46,48 (seeFIG. 22).
• One embodiment of themeasurement circuit96 and/orprocessing circuit109 provides as output data, the current flowing between the workingelectrode58 and thecounter electrode60. Themeasurement circuit96 and/orprocessing circuit109 may also provide as output data a signal from theoptional temperature probe66 which indicates the temperature of thesensor42. This signal from thetemperature probe66 may be as simple as a current through thetemperature probe66 or theprocessing circuit109 may include a device that determines a resistance of thetemperature probe66 from the signal obtained from themeasurement circuit96 for correlation with the temperature of thesensor42. The output data may then be sent to atransmitter98 that then transmits this data to at least one receiver/display device46,48.
• Returning to theprocessing circuit109, in someembodiments processing circuit109 is more sophisticated and is capable of determining the analyte concentration or some measure representative of the analyte concentration, such as a current or voltage value. Theprocessing circuit109 may incorporate the signal of the temperature probe to make a temperature correction in the signal or analyzed data from the workingelectrode58. This may include, for example, scaling the temperature probe measurement and adding or subtracting the scaled measurement to the signal or analyzed data from the workingelectrode58. Theprocessing circuit109 may also incorporate calibration data which has been received from an external source or has been incorporated into theprocessing circuit109, both of which are described below, to correct the signal or analyzed data from the workingelectrode58. Additionally, theprocessing circuit109 may include a correction algorithm for converting interstitial analyte level to blood analyte level. The conversion of interstitial analyte level to blood analyte level is described, for example, in Schmidtke, et al., “Measurement and Modeling of the Transient Difference Between Blood and Subcutaneous Glucose Concentrations in the Rat after Injection of Insulin”, Proc. of the Nat'l Acad. of Science, 95, 294-299 (1998) and Quinn, et al., “Kinetics of Glucose Delivery to Subcutaneous Tissue in Rats Measured with 0.3 mm Amperometric Microsensors”, Am. J. Physiol., 269 (Endocrinol. Metab. 32), E155-E161 (1995), incorporated herein by reference.
• In some embodiments, the data from theprocessing circuit109 is analyzed and directed to an alarm system94 (seeFIG. 18B) to warn the user. In at least some of these embodiments, a transmitter is not used as the sensor control unit performs all of the needed functions including analyzing the data and warning the patient.
• However, in many embodiments, the data (e.g., a current signal, a converted voltage or frequency signal, or fully or partially analyzed data) fromprocessing circuit109 is transmitted to one or more receiver/display units46,48 using atransmitter98 in the on-skinsensor control unit44. The transmitter has anantenna93, such as a wire or similar conductor, formed in thehousing45. Thetransmitter98 is typically designed to transmit a signal up to about 2 meters or more, preferably up to about 5 meters or more, and more preferably up to about 10 meters or more. when transmitting to a small receiver/display unit46, such as a palm-size, belt-worn receiver. The effective range is longer when transmitting to a unit with a better antenna, such as a bedside receiver. As described in detail below, suitable examples of receiver/display units46,48 include units that can be easily worn or carried or units that can be placed conveniently on, for example, a nightstand when the patient is sleeping.
• Thetransmitter98 may send a variety of different signals to the receiver/display units46,48, typically, depending on the sophistication of theprocessing circuit109. For example, theprocessing circuit109 may simply provide raw signals, for example, currents from the workingelectrodes58, without any corrections for temperature or calibration, or theprocessing circuit109 may provide converted signals which are obtained, for example, using a current-to-voltage converter131 or141 or a current-to-frequency converter. The raw measurements or converted signals may then be processed by an analyzer152 (seeFIG. 22) in the receiver/display units46,48 to determine the level of an analyte, optionally using temperature and calibration corrections. In another embodiment, theprocessing circuit109 corrects the raw measurements using, for example, temperature and/or calibration information and then thetransmitter98 sends the corrected signal, and optionally, the temperature and/or calibration information, to the receiver/display units46,48. In yet another embodiment, theprocessing circuit109 calculates the analyte level in the interstitial fluid and/or in the blood (based on the interstitial fluid level) and transmits that information to the one or more receiver/display units46,48, optionally with any of the raw data and/or calibration or temperature information. In a further embodiment, theprocessing circuit109 calculates the analyte concentration, but thetransmitter98 transmits only the raw measurements, converted signals, and/or corrected signals.
• One potential difficulty that may be experienced with the on-skinsensor control unit44 is a change in the transmission frequency of thetransmitter98 over time. To overcome this potential difficulty, the transmitter may include optional circuitry that can return the frequency of thetransmitter98 to the desired frequency or frequency band. One example of suitable circuitry is illustrated inFIG. 21 as a block diagram of an openloop modulation system200. The openloop modulation system200 includes a phase detector (PD)210, a charge pump (CHGPMP)212, a loop filter (L.F.)214, a voltage controlled oscillator (VCO)216, and a divide by M circuit (÷M)218 to form the phase-lockedloop220.
• Theanalyte monitoring device40 uses an openloop modulation system200 for RF communication between thetransmitter98 and a receiver of, for example, the one or more receiver/display units46,48. This openloop modulation system230 is designed to provide a high reliability RF link between a transmitter and its associated receiver. The system employs frequency modulation (FM), and locks the carrier center frequency using a conventional phase-locked loop (PLL)220. In operation, the phase-lockedloop220 is opened prior to the modulation. During the modulation the phase-lockedloop220 remains open for as long as the center frequency of the transmitter is within the receiver's bandwidth. When the transmitter detects that the center frequency is going to move outside of the receiver bandwidth, the receiver is signaled to stand by while the center frequency is captured. Subsequent to the capture, the transmission will resume. This cycle of capturing the center frequency, opening the phase-lockedloop220, modulation, and recapturing the center frequency will repeat for as many cycles as required.
• Theloop control240 detects the lock condition of the phase-lockedloop220 and is responsible for closing and opening the phase-lockedloop220. Thetotalizer250 in conjunction with theloop control240, detects the status of the center frequency. Themodulation control230 is responsible for generating the modulating signal. A transmitamplifier260 is provided to ensure adequate transmit signal power. The reference frequency is generated from a very stable signal source (not shown), and is divided down by N through the divide by N block (÷N)270. Data and control signals are received by the openloop modulation system200 via theDATA BUS280, and the CONTROL BUS290.
• The operation of the openloop modulation system200 begins with the phase-lockedloop220 in closed condition. When the lock condition is detected by theloop control240, the phase-lockedloop220 is opened and themodulation control230 begins generating the modulating signal. Thetotalizer250 monitors the VCO frequency (divided by M), for programmed intervals. The monitored frequency is compared to a threshold programmed in thetotalizer250. This threshold corresponds to the 3 dB cut off frequencies of the receiver's intermediate frequency stage. When the monitored frequency approaches the thresholds, theloop control240 is notified and a stand-by code is transmitted to the receiver and the phase-lockedloop220 is closed.
• At this point the receiver is in the wait mode. Theloop control240 in the transmitter closes the phase-lockedloop220. Then,modulation control230 is taken off line, the monitored value of thetotalizer250 is reset, and the phase-lockedloop220 is locked. When theloop control240 detects a lock condition, theloop control240 opens the phase-lockedloop220, themodulation control230 is brought on line and the data transmission to the receiver will resume until the center frequency of the phase-lockedloop220 approaches the threshold values, at which point the cycle of transmitting the stand-by code begins. The ÷N270 and ÷M218 block set the frequency channel of the transmitter.
• Accordingly, the openloop modulation system200 provides a reliable low power FM data transmission for an analyte monitoring system. The openloop modulation system200 provides a method of wide band frequency modulation, while the center frequency of the carrier is kept within receiver bandwidth. The effect of parasitic capacitors and inductors pulling the center frequency of the transmitter is corrected by the phase-lockedloop220. Further, thetotalizer250 andloop control240 provide a new method of center frequency drift detection. Finally, the openloop modulation system200 is easily implemented in CMOS process.
• The rate at which thetransmitter98 transmits data may be the same rate at which thesensor circuit97 obtains signals and/or theprocessing circuit109 provides data or signals to thetransmitter98. Alternatively, thetransmitter98 may transmit data at a slower rate. In this case, thetransmitter98 may transmit more than one datapoint in each transmission. Alternatively, only one datapoint may be sent with each data transmission, the remaining data not being transmitted. Typically, data is transmitted to the receiver/display unit46,48 at least every hour, preferably, at least every fifteen minutes, more preferably, at least every five minutes, and most preferably, at least every one minute. However, other data transmission rates may be used. In some embodiments, theprocessing circuit109 and/ortransmitter98 are configured to process and/or transmit data at a faster rate when a condition is indicated, for example, a low level or high level of analyte or impending low or high level of analyte. In these embodiments, the accelerated data transmission rate is typically at least every five minutes and preferably at least every minute.
• In addition to atransmitter98, anoptional receiver99 may be included in the on-skinsensor control unit44. In some cases, thetransmitter98 is a transceiver, operating as both a transmitter and a receiver. Thereceiver99 may be used to receive calibration data for thesensor42. The calibration data may be used by theprocessing circuit109 to correct signals from thesensor42. This calibration data may be transmitted by the receiver/display unit46,48 or from some other source such as a control unit in a doctor's office. In addition, theoptional receiver99 may be used to receive a signal from the receiver/display units46,48, as described above, to direct thetransmitter98, for example, to change frequencies or frequency bands, to activate or deactivate the optional alarm system94 (as described below), and/or to direct thetransmitter98 to transmit at a higher rate.
• Calibration data may be obtained in a variety of ways. For instance, the calibration data may simply be factory-determined calibration measurements which can be input into the on-skinsensor control unit44 using thereceiver99 or may alternatively be stored in a calibration data storage unit100 within the on-skinsensor control unit44 itself (in which case areceiver99 may not be needed). The calibration data storage unit100 may be, for example, a readable or readable/writeable memory circuit.
• Alternative or additional calibration data may be provided based on tests performed by a doctor or some other professional or by the patient himself. For example, it is common for diabetic individuals to determine their own blood glucose concentration using commercially available testing kits. The results of this test is input into the on-skinsensor control unit44 either directly, if an appropriate input device (e.g., a keypad, an optical signal receiver, or a port for connection to a keypad or computer) is incorporated in the on-skinsensor control unit44, or indirectly by inputting the calibration data into the receiver/display unit46,48 and transmitting the calibration data to the on-skinsensor control unit44.
• Other methods of independently determining analyte levels may also be used to obtain calibration data. This type of calibration data may supplant or supplement factory-determined calibration values.
• In some embodiments of the disclosure, calibration data may be required at periodic intervals, for example, every eight hours, once a day, or once a week, to confirm that accurate analyte levels are being reported. Calibration may also be required each time anew sensor42 is implanted or if the sensor exceeds a threshold minimum or maximum value or if the rate of change in the sensor signal exceeds a threshold value. In some cases, it may be necessary to wait a period of time after the implantation of thesensor42 before calibrating to allow thesensor42 to achieve equilibrium. In some embodiments, thesensor42 is calibrated only after it has been inserted. In other embodiments, no calibration of thesensor42 is needed.
• The on-skinsensor control unit44 and/or a receiver/display unit46,48 may include an auditory or visual indicator that calibration data is needed, based, for example, on a predetermined periodic time interval between calibrations or on the implantation of anew sensor42. The on-skinsensor control unit44 and/or receiver display/units46,48 may also include an auditory or visual indicator to remind the patient that information, such as analyte levels, reported by theanalyte monitoring device40, may not be accurate because a calibration of thesensor42 has not been performed within the predetermined periodic time interval and/or after implantation of anew sensor42.
• Theprocessing circuit109 of the on-skinsensor control unit44 and/or ananalyzer152 of the receiver/display unit46,48 may determine when calibration data is needed and if the calibration data is acceptable. The on-skin sensor control unit44 may optionally be configured to not allow calibration or to reject a calibration point if, for example, 1) a temperature reading from the temperature probe indicates a temperature that is not within a predetermined acceptable range (e.g., 30 to 42° C. or 32 to 40° C.) or that is changing rapidly (for example, 0.2° C./minute, 0.5° C./minute, or 0.7° C./minute or greater); 2) two or more working electrodes58 provide uncalibrated signals that are not within a predetermined range (e.g., within 10% or 20%) of each other; 3) the rate of change of the uncalibrated signal is above a threshold rate (e.g., 0.25 mg/dL per minute or 0.5 mg/dL per minute or greater); 4) the uncalibrated signal exceeds a threshold maximum value (e.g., 5, 10, 20, or 40 nA) or is below a threshold minimum value (e.g., 0.05, 0.2, 0.5, or 1 nA); 5) the calibrated signal exceeds a threshold maximum value (e.g., a signal corresponding to an analyte concentration of 200 mg/dL, 250 mg/dL, or 300 mg/dL) or is below a threshold minimum value (e.g., a signal corresponding to an analyte concentration of 50 mg/dL, 65 mg/dL, or 80 mg/dL); and/or 6) an insufficient among of time has elapsed since implantation (e.g., 10 minutes or less, 20 minutes or less, or 30 minutes or less).
• Theprocessing circuit109 or ananalyzer152 may also request another calibration point if the values determined using the sensor data before and after the latest calibration disagree by more than a threshold amount, indicating that the calibration may be incorrect or that the sensor characteristics have changed radically between calibrations. This additional calibration point may indicate the source of the difference.
• The on-skinsensor control unit44 may include an optionaldata storage unit102 which may be used to hold data (e.g., measurements from the sensor or processed data) from theprocessing circuit109 permanently or, more typically, temporarily. Thedata storage unit102 may hold data so that the data can be used by theprocessing circuit109 to analyze and/or predict trends in the analyte level, including, for example, the rate and/or acceleration of analyte level increase or decrease. Thedata storage unit102 may also or alternatively be used to store data during periods in which a receiver/display unit46,48 is not within range. Thedata storage unit102 may also be used to store data when the transmission rate of the data is slower than the acquisition rate of the data. For example, if the data acquisition rate is 10 points/min and the transmission is 2 transmissions/min, then one to five points of data could be sent in each transmission depending on the desired rate for processing datapoints. Thedata storage unit102 typically includes a readable/writeable memory storage device and typically also includes the hardware and/or software to write to and/or read the memory storage device.
• The on-skinsensor control unit44 may include an optional alarm system104 that, based on the data from theprocessing circuit109, warns the patient of a potentially detrimental condition of the analyte. For example, if glucose is the analyte, than the on-skinsensor control unit44 may include an alarm system104 that warns the patient of conditions such as hypoglycemia, hyperglycemia, impending hypoglycemia, and/or impending hyperglycemia. The alarm system104 is triggered when the data from theprocessing circuit109 reaches or exceeds a threshold value. Examples of threshold values for blood glucose levels are about 60, 70, or 80 mg/dL for hypoglycemia; about 70, 80, or 90 mg/dL for impending hypoglycemia; about 130, 150, 175, 200, 225, 250, or 275 mg/dL for impending hyperglycemia; and about 150, 175, 200, 225, 250, 275, or 300 mg/dL for hyperglycemia. The actual threshold values that are designed into the alarm system104 may correspond to interstitial fluid glucose concentrations or electrode measurements (e.g., current values or voltage values obtained by conversion of current measurements) that correlate to the above-mentioned blood glucose levels. The analyte monitor device may be configured so that the threshold levels for these or any other conditions may be programmable by the patient and/or a medical professional.
• A threshold value is exceeded if the datapoint has a value that is beyond the threshold value in a direction indicating a particular condition. For example, a datapoint which correlates to a glucose level of 200 mg/dL exceeds a threshold value for hyperglycemia of 180 mg/dL, because the datapoint indicates that the patient has entered a hyperglycemic state. As another example, a datapoint which correlates to a glucose level of 65 mg/dL exceeds a threshold value for hypoglycemia of 70 mg/dL because the datapoint indicates that the patient is hypoglycemic as defined by the threshold value. However, a datapoint which correlates to a glucose level of 75 mg/dL would not exceed the same threshold value for hypoglycemia because the datapoint does not indicate that particular condition as defined by the chosen threshold value.
• An alarm may also be activated if the sensor readings indicate a value that is beyond a measurement range of thesensor42. For glucose, the physiologically relevant measurement range is typically about 50 to 250 mg/dL, preferably about 40-300 mg/dL and ideally 30-400 mg/dL, of glucose in the interstitial fluid.
• The alarm system104 may also, or alternatively, be activated when the rate of change or acceleration of the rate of change in analyte level increase or decrease reaches or exceeds a threshold rate or acceleration. For example, in the case of a subcutaneous glucose monitor, the alarm system might be activated if the rate of change in glucose concentration exceeds a threshold value which might indicate that a hyperglycemic or hypoglycemic condition is likely to occur.
• The optional alarm system104 may be configured to activate when a single data point meets or exceeds a particular threshold value. Alternatively, the alarm may be activated only when a predetermined number of datapoints spanning a predetermined amount of time meet or exceed the threshold value. As another alternative, the alarm may be activated only when the datapoints spanning a predetermined amount of time have an average value which meets or exceeds the threshold value. Each condition that can trigger an alarm may have a different alarm activation condition. In addition, the alarm activation condition may change depending on current conditions (e.g., an indication of impending hyperglycemia may alter the number of datapoints or the amount of time that is tested to determine hyperglycemia).
• The alarm system104 may contain one or more individual alarms. Each of the alarms may be individually activated to indicate one or more conditions of the analyte. The alarms may be, for example, auditory or visual. Other sensory-stimulating alarm systems may be used including alarm systems which heat, cool, vibrate, or produce a mild electrical shock when activated. In some embodiments, the alarms are auditory with a different tone, note, or volume indicating different conditions. For example, a high note might indicate hyperglycemia and a low note might indicate hypoglycemia. Visual alarms may use a difference in color, brightness, or position on the on-skinsensor control device44 to indicate different conditions. In some embodiments, an auditory alarm system is configured so that the volume of the alarm increases over time until the alarm is deactivated.
• In some embodiments, the alarm may be automatically deactivated after a predetermined time period. In other embodiments, the alarm may be configured to deactivate when the data no longer indicate that the condition which triggered the alarm exists. In these embodiments, the alarm may be deactivated when a single data point indicates that the condition no longer exists or, alternatively, the alarm may be deactivated only after a predetermined number of datapoints or an average of datapoints obtained over a given period of time indicate that the condition no longer exists.
• In some embodiments, the alarm may be deactivated manually by the patient or another person in addition to or as an alternative to automatic deactivation. In these embodiments, aswitch101 is provided which when activated turns off the alarm. Theswitch101 may be operatively engaged (or disengaged depending on the configuration of the switch) by, for example, operating an actuator on the on-skinsensor control unit44 or the receiver/display unit46,48. In some cases, an actuator may be provided on two ormore units44,46,48, any of which may be actuated to deactivate the alarm. If theswitch101 and or actuator is provided on the receiver/display unit46,48 then a signal may be transmitted from the receiver/display unit46,48 to thereceiver98 on the on-skinsensor control unit44 to deactivate the alarm.
• A variety ofswitches101 may be used including, for example, a mechanical switch, a reed switch, a Hall effect switch, a Gigantic Magnetic Ratio (GMR) switch (the resistance of the GMR switch is magnetic field dependent) and the like. Preferably, the actuator used to operatively engage (or disengage) the switch is placed on the on-skinsensor control unit44 and configured so that no water can flow around the button and into the housing. One example of such a button is a flexible conducting strip that is completely covered by a flexible polymeric or plastic coating integral to the housing. In an open position the flexible conducting strip is bowed and bulges away from the housing. When depressed by the patient or another person, the flexible conducting strip is pushed directly toward a metal contact and completes the circuit to shut off the alarm.
• For a reed or GMR switch, a piece of magnetic material, such as a permanent magnet or an electromagnet, in a flexible actuator that is bowed or bulges away from thehousing45 and the reed or GMR switch is used. The reed or GMR switch is activated (to deactivate the alarm) by depressing the flexible actuator bringing the magnetic material closer to the switch and causing an increase in the magnetic field within the switch.
• In some embodiments of the disclosure, theanalyte monitoring device40 includes only an on-skin control unit44 and asensor42. In these embodiments, theprocessing circuit109 of the on-skinsensor control unit44 is able to determine a level of the analyte and activate an alarm system104 if the analyte level exceeds a threshold. The on-skin control unit44, in these embodiments, has an alarm system104 and may also include a display, such as those discussed below with respect to the receiver/display units46,48. Preferably, the display is an LCD or LED display. The on-skin control unit44 may not have a transmitter, unless, for example, it is desirable to transmit data, for example, to a control unit in a doctor's office.
• The on-skinsensor control unit44 may also include areference voltage generator101 to provide an absolute voltage or current for use in comparison to voltages or currents obtained from or used with thesensor42. An example of a suitable reference voltage generator is a band-gap reference voltage generator that uses, for example, a semiconductor material with a known band-gap. Preferably, the band-gap is temperature insensitive over the range of temperatures that the semiconductor material will experience during operation. Suitable semiconductor materials includes gallium, silicon and silicates.
• A biascurrent generator105 may be provided to correctly bias solid-state electronic components. Anoscillator107 may be provided to produce a clock signal that is typically used with digital circuitry.
• The on-skinsensor control unit44 may also include awatchdog circuit103 that tests the circuitry, particularly, any digital circuitry in thecontrol unit44 to determine if the circuitry is operating correctly. Non-limiting examples of watchdog circuit operations include: a) generation of a random number by the watchdog circuit, storage of the number in a memory location, writing the number to a register in the watchdog circuit, and recall of the number to compare for equality; b) checking the output of an analog circuit to determine if the output exceeds a predetermined dynamic range; c) checking the output of a timing circuit for a signal at an expected pulse interval. Other examples of functions of a watchdog circuit are known in the art. If the watchdog circuit detects an error that watchdog circuit may activate an alarm and/or shut down the device.
Receiver/Display Unit
• One or more receiver/display units46,48 may be provided with theanalyte monitoring device40 for easy access to the data generated by thesensor42 and may, in some embodiments, process the signals from the on-skinsensor control unit44 to determine the concentration or level of analyte in the subcutaneous tissue. Small receiver/display units46 may be carried by the patient. Theseunits46 may be palm-sized and/or may be adapted to fit on a belt or within a bag or purse that the patient carries. One embodiment of the small receiver/display unit46 has the appearance of a pager, for example, so that the user is not identified as a person using a medical device. Such receiver/display units may optionally have one-way or two-way paging capabilities.
• Large receiver/display units48 may also be used. Theselarger units48 may be designed to sit on a shelf or nightstand. The large receiver/display unit48 may be used by parents to monitor their children while they sleep or to awaken patients during the night. In addition, the large receiver/display unit48 may include a lamp, clock, or radio for convenience and/or for activation as an alarm. One or both types of receiver/display units46,48 may be used.
• The receiver/display units46,48, as illustrated in block form atFIG. 22, typically include areceiver150 to receive data from the on-skinsensor control unit44, ananalyzer152 to evaluate the data, adisplay154 to provide information to the patient, and analarm system156 to warn the patient when a condition arises. The receiver/display units46,48 may also optionally include adata storage device158, atransmitter160, and/or aninput device162. The receiver/display units46,48 may also include other components (not shown), such as a power supply (e.g., a battery and/or a power supply that can receive power from a wall outlet), a watchdog circuit, a bias current generator, and an oscillator. These additional components are similar to those described above for the on-skinsensor control unit44.
• In one embodiment, a receiver/display unit48 is a bedside unit for use by a patient at home. The bedside unit includes a receiver and one or more optional items, including, for example, a clock, a lamp, an auditory alarm, a telephone connection, and a radio. The bedside unit also has a display, preferably, with large numbers and/or letters that can be read across a room. The unit may be operable by plugging into an outlet and may optionally have a battery as backup. Typically, the bedside unit has a better antenna than a small palm-size unit, so the bedside unit's reception range is longer.
• When an alarm is indicated, the bedside unit may activate, for example, the auditory alarm, the radio, the lamp, and/or initiate a telephone call. The alarm may be more intense than the alarm of a small palm-size unit to, for example, awaken or stimulate a patient who may be asleep, lethargic, or confused. Moreover, a loud alarm may alert a parent monitoring a diabetic child at night.
• The bedside unit may have its own data analyzer and data storage. The data may be communicated from the on-skin sensor unit or another receiver/display unit, such as a palm-size or small receiver/display unit. Thus, at least one unit has all the relevant data so that the data can be downloaded and analyzed without significant gaps.
• Optionally, the beside unit has an interface or cradle into which a small receiver/display unit may be placed. The bedside unit may be capable of utilizing the data storage and analysis capabilities of the small receiver/display unit and/or receive data from the small receiver/display unit in this position. The bedside unit may also be capable of recharging a battery of the small receiver/display unit.
• Thereceiver150 typically is formed using known receiver and antenna circuitry and is often tuned or tunable to the frequency or frequency band of thetransmitter98 in the on-skinsensor control unit44. Typically, thereceiver150 is capable of receiving signals from a distance greater than the transmitting distance of thetransmitter98. The small receiver/display unit46 can typically receive a signal from an on-skinsensor control unit44 that is up to 2 meters, preferably up to 5 meters, and more preferably up to 10 meters or more, away. A large receiver/display unit48, such as a bedside unit, can typically receive a receive a signal from an on-skinsensor control unit44 that is up to 5 meters distant, preferably up to 10 meters distant, and more preferably up to 20 meters distant or more.
• In one embodiment, a repeater unit (not shown) is used to boost a signal from an on-skinsensor control unit44 so that the signal can be received by a receiver/display unit46,48 that may be distant from the on-skinsensor control unit44. The repeater unit is typically independent of the on-skinsensor control unit44, but, in some cases, the repeater unit may be configured to attach to the on-skinsensor control unit44. Typically, the repeater unit includes a receiver for receiving the signals from the on-skinsensor control unit44 and a transmitter for transmitting the received signals. Often the transmitter of the repeater unit is more powerful than the transmitter of the on-skin sensor control unit, although this is not necessary. The repeater unit may be used, for example, in a child's bedroom for transmitting a signal from an on-skin sensor control unit on the child to a receiver/display unit in the parent's bedroom for monitoring the child's analyte levels. Another exemplary use is in a hospital with a display/receiver unit at a nurse's station for monitoring on-skin sensor control unit(s) of patients.
• The presence of other devices, including other on-skin sensor control units, may create noise or interference within the frequency band of thetransmitter98. This may result in the generation of false data. To overcome this potential difficulty, thetransmitter98 may also transmit a code to indicate, for example, the beginning of a transmission and/or to identify, preferably using a unique identification code, the particular on-skinsensor control unit44 in the event that there is more than one on-skinsensor control unit44 or other transmission source within range of the receiver/display unit46,48. The provision of an identification code with the data may reduce the likelihood that the receiver/display unit46,48 intercepts and interprets signals from other transmission sources, as well as preventing “crosstalk” with different on-skinsensor control units44. The identification code may be provided as a factory-set code stored in thesensor control unit44. Alternatively, the identification code may be randomly generated by an appropriate circuit in thesensor control unit44 or the receiver/display unit46,48 (and transmitted to the sensor control unit44) or the identification code may be selected by the patient and communicated to thesensor control unit44 via a transmitter or an input device coupled to thesensor control unit44.
• Other methods may be used to eliminate “crosstalk” and to identify signals from the appropriate on-skinsensor control unit44. In some embodiments, thetransmitter98 may use encryption techniques to encrypt the datastream from thetransmitter98. The receiver/display unit46,48 contains the key to decipher the encrypted data signal. The receiver/display unit46,48 then determines when false signals or “crosstalk” signals are received by evaluation of the signal after it has been deciphered. For example, theanalyzer152 in the one or more receiver/display units46,48 compares the data, such as current measurements or analyte levels, with expected measurements (e.g., an expected range of measurements corresponding to physiologically relevant analyte levels). Alternatively, an analyzer in the receiver/display units46,48 searches for an identification code in the decrypted data signal.
• Another method to eliminate “crosstalk”, which is typically used in conjunction with the identification code or encryption scheme, includes providing an optional mechanism in the on-skinsensor control unit44 for changing transmission frequency or frequency bands upon determination that there is “crosstalk”. This mechanism for changing the transmission frequency or frequency band may be initiated by the receiver/display unit automatically, upon detection of the possibility of cross-talk or interference, and/or by a patient manually. For automatic initiation, the receiver/display unit46,48 transmits a signal to theoptional receiver99 on the on-skinsensor control unit44 to direct thetransmitter98 of the on-skinsensor control unit44 to change frequency or frequency band.
• Manual initiation of the change in frequency or frequency band may be accomplished using, for example, an actuator (not shown) on the receiver/display unit46,48 and/or on the on-skinsensor control unit44 which a patient operates to direct thetransmitter98 to change frequency or frequency band. The operation of a manually initiated change in transmission frequency or frequency band may include prompting the patient to initiate the change in frequency or frequency band by an audio or visual signal from the receiver/display unit46,48 and/or on-skinsensor control unit44.
• Returning to thereceiver150, the data received by thereceiver150 is then sent to ananalyzer152. Theanalyzer152 may have a variety of functions, similar to theprocessor circuit109 of the on-skinsensor control unit44, including 1) modifying the signals from thesensor42 using calibration data and/or measurements from thetemperature probe66, 2) determining a level of an analyte in the interstitial fluid, 3) determining a level of an analyte in the bloodstream based on the sensor measurements in the interstitial fluid, 4) determining if the level, rate of change, and/or acceleration in the rate of change of the analyte exceeds or meets one or more threshold values, 5) activating analarm system156 and/or94 if a threshold value is met or exceeded, 6) evaluating trends in the level of an analyte based on a series of sensor signals, 7) determine a dose of a medication, and 7) reduce noise or error contributions (e.g., through signal averaging or comparing readings from multiple electrodes). Theanalyzer152 may be simple and perform only one or a small number of these functions or theanalyzer152 may perform all or most of these functions.
• The output from theanalyzer152 is typically provided to adisplay154. A variety ofdisplays154 may be used including cathode ray tube displays (particularly for larger units), LED displays, or LCD displays. Thedisplay154 may be monochromatic (e.g., black and white) or polychromatic (i.e., having a range of colors). Thedisplay154 may contain symbols or other indicators that are activated under certain conditions (e.g., a particular symbol may become visible on the display when a condition, such as hyperglycemia, is indicated by signals from the sensor42). Thedisplay154 may also contain more complex structures, such as LCD or LED alphanumeric structures, portions of which can be activated to produce a letter, number, or symbol. For example, thedisplay154 may includeregion164 to display numerically the level of the analyte, as illustrated inFIG. 23. In one embodiment, thedisplay154 also provides a message to the patient to direct the patient in an action. Such messages may include, for example, “Eat Sugar”, if the patient is hypoglycemic, or “Take Insulin”, if the patient is hyperglycemic.
• One example of a receiver/display unit46,48 is illustrated inFIG. 23. Thedisplay154 of this particular receiver/display unit46,48 includes aportion164 which displays the level of the analyte, for example, the blood glucose concentration, as determined by theprocessing circuit109 and/or theanalyzer152 using signals from thesensor42. The display also includesvarious indicators166 which may be activated under certain conditions. For example, theindicator168 of a glucose monitoring device may be activated if the patient is hyperglycemic. Other indicators may be activated in the cases of hypoglycemia (170), impending hyperglycemia (172), impending hypoglycemia (174), a malfunction, an error condition, or when a calibration sample is needed (176). In some embodiments, color coded indicators may be used. Alternatively, theportion164 which displays the blood glucose concentration may also include a composite indicator180 (seeFIG. 24), portions of which may be appropriately activated to indicate any of the conditions described above.
• Thedisplay154 may also be capable of displaying agraph178 of the analyte level over a period of time, as illustrated inFIG. 24. Examples of other graphs that may be useful include graphs of the rate of change or acceleration in the rate of change of the analyte level over time. In some embodiments, the receiver/display unit is configured so that the patient may choose the particular display (e.g., blood glucose concentration or graph of concentration versus time) that the patient wishes to view. The patient may choose the desired display mode by pushing a button or the like, for example, on anoptional input device162.
• The receiver/display units46,48 also typically include analarm system156. The options for configuration of thealarm system156 are similar to those for the alarm system104 of the on-skinsensor control unit44. For example, if glucose is the analyte, than the on-skinsensor control unit44 may include analarm system156 that warns the patient of conditions such as hypoglycemia, hyperglycemia, impending hypoglycemia, and/or impending hyperglycemia. Thealarm system156 is triggered when the data from theanalyzer152 reaches or exceeds a threshold value. The threshold values may correspond to interstitial fluid glucose concentrations or sensor signals (e.g., current or converted voltage values) which correlate to the above-mentioned blood glucose levels.
• Thealarm system156 may also, or alternatively, be activated when the rate or acceleration of an increase or decrease in analyte level reaches or exceeds a threshold value. For example, in the case of a subcutaneous glucose monitor, thealarm system156 might be activated if the rate of change in glucose concentration exceeds a threshold value which might indicate that a hyperglycemic or hypoglycemic condition is likely to occur.
• Thealarm system156 may be configured to activate when a single data point meets or exceeds a particular threshold value. Alternatively, the alarm may be activated only when a predetermined number of datapoints spanning a predetermined amount of time meet or exceed the threshold value. As another alternative, the alarm may be activated only when the datapoints spanning a predetermined amount of time have an average value which meets or exceeds the threshold value. Each condition that can trigger an alarm may have a different alarm activation condition. In addition, the alarm activation condition may change depending on current conditions (e.g., an indication of impending hyperglycemia may alter the number of datapoints or the amount of time that is tested to determine hyperglycemia).
• Thealarm system156 may contain one or more individual alarms. Each of the alarms may be individually activated to indicate one or more conditions of the analyte. The alarms may be, for example, auditory or visual. Other sensory-stimulating alarm systems by be used includingalarm systems156 that direct the on-skinsensor control unit44 to heat, cool, vibrate, or produce a mild electrical shock. In some embodiments, the alarms are auditory with a different tone, note, or volume indicating different conditions. For example, a high note might indicate hyperglycemia and a low note might indicate hypoglycemia. Visual alarms may also use a difference in color or brightness to indicate different conditions. In some embodiments, an auditory alarm system might be configured so that the volume of the alarm increases over time until the alarm is deactivated.
• In some embodiments, the alarms may be automatically deactivated after a predetermined time period. In other embodiments, the alarms may be configured to deactivate when the data no longer indicate that the condition which triggered the alarm exists. In these embodiments, the alarms may be deactivated when a single data point indicates that the condition no longer exists or, alternatively, the alarm may be deactivated only after a predetermined number of datapoints or an average of datapoints obtained over a given period of time indicate that the condition no longer exists.
• In yet other embodiments, the alarm may be deactivated manually by the patient or another person in addition to or as an alternative to automatic deactivation. In these embodiments, a switch is provided which when activated turns off the alarm. The switch may be operatively engaged (or disengaged depending on the configuration of the switch) by, for example, pushing a button on the receiver/display unit46,48. One configuration of thealarm system156 has automatic deactivation after a period of time for alarms that indicate an impending condition (e.g., impending hypoglycemia or hyperglycemia) and manual deactivation of alarms which indicate a current condition (e.g., hypoglycemia or hyperglycemia).
• The receiver/display units46,48 may also include a number of optional items. One item is adata storage unit158. Thedata storage unit158 may be desirable to store data for use if theanalyzer152 is configured to determine trends in the analyte level. Thedata storage unit158 may also be useful to store data that may be downloaded to another receiver/display unit, such as alarge display unit48. Alternatively, the data may be downloaded to a computer or other data storage device in a patient's home, at a doctor's office, etc. for evaluation of trends in analyte levels. A port (not shown) may be provided on the receiver/display unit46,48 through which the stored data may be transferred or the data may be transferred using anoptional transmitter160. Thedata storage unit158 may also be activated to store data when a directed by the patient via, for example, theoptional input device162. Thedata storage unit158 may also be configured to store data upon occurrence of a particular event, such as a hyperglycemic or hypoglycemic episode, exercise, eating, etc. Thestorage unit158 may also store event markers with the data of the particular event. These event markers may be generated either automatically by the display/receiver unit46,48 or through input by the patient.
• The receiver/display unit46,48 may also include anoptional transmitter160 which can be used to transmit 1) calibration information, 2) a signal to direct thetransmitter98 of the on-skinsensor control unit44 to change transmission frequency or frequency bands, and/or 3) a signal to activate an alarm system104 on the on-skinsensor control unit44, all of which are described above. Thetransmitter160 typically operates in a different frequency band than thetransmitter98 of the on-skinsensor control unit44 to avoid cross-talk between thetransmitters98,160. Methods may be used to reduce cross-talk and the reception of false signals, as described above in connection with the transmitter100 of the on-skinsensor control unit44. In some embodiments, thetransmitter160 is only used to transmit signals to thesensor control unit44 and has a range of less than one foot, and preferably less than six inches. This then requires the patient or another person to hold the receiver/display unit46 near thesensor control unit44 during transmission of data, for example, during the transmission of calibration information. Transmissions may also be performed using methods other than rf transmission, including optical or wire transmission.
• In addition, in some embodiments of the disclosure, thetransmitter160 may be configured to transmit data to another receiver/display unit46,48 or some other receiver. For example, a small receiver/display unit46 may transmit data to a large receiver/display unit48, as illustrated inFIG. 1. As another example, a receiver/display unit46,48 may transmit data to a computer in the patient's home or at a doctor's office. Moreover, thetransmitter160 or a separate transmitter may direct a transmission to another unit or to a telephone or other communications device that alerts a doctor or other individual when an alarm is activated and/or if, after a predetermined time period, an activated alarm has not been deactivated, suggesting that the patient may require assistance. In some embodiments, the receiver/display unit is capable of one-way or two-way paging and/or is coupled to a telephone line to send and/or receive messages from another, such as a health professional monitoring the patient.
• Another optional component for the receiver/display unit46,48 is aninput device162, such as a keypad or keyboard. Theinput device162 may allow numeric or alphanumeric input. Theinput device162 may also include buttons, keys, or the like which initiate functions of and/or provide input to theanalyte monitoring device40. Such functions may include initiating a data transfer, manually changing the transmission frequency or frequency band of thetransmitter98, deactivating analarm system104,156, inputting calibration data, and/or indicating events to activate storage of data representative of the event.
• Another embodiment of theinput device162 is a touch screen display. The touch screen display may be incorporated into thedisplay154 or may be a separate display. The touch screen display is activated when the patient touches the screen at a position indicated by a “soft button” which corresponds to a desired function. Touch screen displays are well known.
• In addition, theanalyte monitoring device40 may include password protection to prevent the unauthorized transmission of data to a terminal or the unauthorized changing of settings for thedevice40. A patient may be prompted by thedisplay154 to input the password using theinput device152 whenever a password-protected function is initiated.
• Another function that may be activated by theinput device162 is a deactivation mode. The deactivation mode may indicate that the receiver/display unit46,48 should no longer display a portion or all of the data. In some embodiments, activation of the deactivation mode may even deactivate thealarm systems104,156. Preferably, the patient is prompted to confirm this particular action. During the deactivation mode, theprocessing circuit109 and/oranalyzer152 may stop processing data or they may continue to process data and not report it for display and may optionally store the data for later retrieval.
• Alternatively, a sleep mode may be entered if theinput device162 has not been activated for a predetermined period of time. This period of time may be adjustable by the patient or another individual. In this sleep mode, theprocessing circuit109 and/oranalyzer152 typically continue to obtain measurements and process data, however, the display is not activated. The sleep mode may be deactivated by actions, such as activating theinput device162. The current analyte reading or other desired information may then be displayed.
• In one embodiment, a receiver/display unit46 initiates an audible or visual alarm when theunit46 has not received a transmission from the on-skin sensor control unit within a predetermined amount of time. The alarm typically continues until the patient responds and/or a transmission is received. This can, for example, remind a patient if the receiver/display unit46 is inadvertently left behind.
• In another embodiment, the receiver/display unit46,48 is integrated with a calibration unit (not shown). For example, the receiver/display unit46,48 may, for example, include a conventional blood glucose monitor. Another useful calibration device utilizing electrochemical detection of analyte concentration is described in U.S. patent application Ser. No. 08/795,767, incorporated herein by reference. Other devices may be used including those that operate using, for example, electrochemical and calorimetric blood glucose assays, assays of interstitial or dermal fluid, and/or non-invasive optical assays. When a calibration of the implanted sensor is needed, the patient uses the integrated in vitro monitor to generate a reading. The reading may then, for example, automatically be sent by thetransmitter160 of the receiver/display unit46,48 to calibrate thesensor42.
• Additional detailed description of the continuous analyte monitoring system, its various components including the functional descriptions of the transmitter are provided in U.S. Pat. No. 6,175,752 issued Jan. 16, 2001 entitled “Analyte Monitoring Device and Methods of Use”, and in application Ser. No. 10/745,878 filed Dec. 26, 2003 entitled “Continuous Glucose Monitoring System and Methods of Use”, each assigned to the Assignee of the present application, and the disclosures of each of which are incorporated herein by reference for all purposes.
• Integration with a Drug Administration System
• FIG. 25 illustrates a block diagram of a sensor-baseddrug delivery system250 according to the present disclosure. The system may provide a drug to counteract the high or low level of the analyte in response to the signals from one ormore sensors252. Alternatively, the system monitors the drug concentration to ensure that the drug remains within a desired therapeutic range. The drug delivery system includes one or more (and preferably two or more) subcutaneously implantedsensors252, an on-skinsensor control unit254, a receiver/display unit256, a data storage andcontroller module258, and adrug administration system260. In some cases, the receiver/display unit256, data storage andcontroller module258, anddrug administration system260 may be integrated in a single unit. The sensor-baseddrug delivery system250 uses data form the one ormore sensors252 to provide necessary input for a control algorithm/mechanism in the data storage andcontroller module252 to adjust the administration of drugs. As an example, a glucose sensor could be used to control and adjust the administration of insulin.
• InFIG. 25,sensor252 produces signals correlated to the level of the drug or analyte in the patient. The level of the analyte will depend on the amount of drug delivered by the drug administration system. Aprocessor262 in the on-skinsensor control unit254, as illustrated inFIG. 25, or in the receiver/display unit256 determines the level of the analyte, and possibly other information, such as the rate or acceleration of the rate in the increase or decrease in analyte level. This information is then transmitted to the data storage andcontroller module252 using atransmitter264 in the on-skinsensor control unit254, as illustrated inFIG. 25, or a non-integrated receiver/display unit256.
• If thedrug delivery system250 has two ormore sensors252, the data storage andcontroller module258 may verify that the data from the two ormore sensors252 agrees within predetermined parameters before accepting the data as valid. This data may then be processed by the data storage andcontroller module258, optionally with previously obtained data, to determine a drug administration protocol. The drug administration protocol is then executed using thedrug administration system260, which may be an internal or external infusion pump, syringe injector, transdermal delivery system (e.g., a patch containing the drug placed on the skin), or inhalation system. Alternatively, the drug storage andcontroller module258 may provide a the drug administration protocol so that the patient or another person may provide the drug to the patient according to the profile.
• In one embodiment of the disclosure, the data storage andcontroller module258 is trainable. For example, the data storage andcontroller module258 may store glucose readings over a predetermined period of time, e.g., several weeks. When an episode of hypoglycemia or hyperglycemia is encountered, the relevant history leading to such event may be analyzed to determine any patterns which might improve the system's ability to predict future episodes. Subsequent data might be compared to the known patterns to predict hypoglycemia or hyperglycemia and deliver the drug accordingly. In another embodiment, the analysis of trends is performed by an external system or by theprocessing circuit109 in the on-skinsensor control unit254 or theanalyzer152 in the receiver/display unit256 and the trends are incorporated in the data storage andcontroller258.
• In one embodiment, the data storage andcontroller module258,processing circuit109, and/oranalyzer152 utilizes patient-specific data from multiple episodes to predict a patient's response to future episodes. The multiple episodes used in the prediction are typically responses to a same or similar external or internal stimulus. Examples of stimuli include periods of hypoglycemia or hyperglycemia (or corresponding conditions for analytes other than glucose), treatment of a condition, drug delivery (e.g., insulin for glucose), food intake, exercise, fasting, change in body temperature, elevated or lowered body temperature (e.g., fever), and diseases, viruses, infections, and the like. By analyzing multiple episodes, the data storage andcontroller module258,processing circuit109, and/oranalyzer152 can predict the course of a future episode and provide, for example, a drug administration protocol or administer a drug based on this analysis. An input device (not shown) may be used by the patient or another person to indicate when a particular episode is occurring so that, for example, the data storage andcontroller module258,processing circuit109, and/oranalyzer152 can tag the data as resulting from a particular episode, for use in further analyses.
• In addition, thedrug delivery system250 may be capable of providing on-going drug sensitivity feedback. For example, the data from thesensor252 obtained during the administration of the drug by thedrug administration system260 may provide data about the individual patient's response to the drug which can then be used to modify the current drug administration protocol accordingly, both immediately and in the future. An example of desirable data that can be extracted for each patient includes the patient's characteristic time constant for response to drug administration (e.g., how rapidly the glucose concentration falls when a known bolus of insulin is administered). Another example is the patient's response to administration of various amounts of a drug (e.g., a patient's drug sensitivity curve). The same information may be stored by the drug storage and controller module and then used to determine trends in the patient's drug response, which may be used in developing subsequent drug administration protocols, thereby personalizing the drug administration process for the needs of the patient.
• In a further embodiment, the one or more of the receiver/display device256 or thedrug administration system260 may be configured to output display, using one or more user interface units such as a display screen, audible output unit, or a vibratory output unit, the individual's current monitored analyte levels in addition to one or more therapy related information substantially simultaneously to assist or aid the individual in his/her therapy management.
• For example, the continuously or semi-continuously monitored analyte levels such as glucose levels may be visually displayed on a display screen of the receiver/display unit256 or on a display screen of an infusion device such an external infusion pump that may be in direct or indirect communication with the receiver/display unit256. In addition, additional therapy related information such as, for example but not limited to, insulin action curve associated with the type of insulin being or administered, insulin on board information associated with the basal profile of the individual, one or more historical information related to the insulin administration, or the like. More specifically, in one aspect, the additional therapy related information may be superimposed for display or provided in an overlay manner with the visual output of the monitored analyte level.
• In this manner, in one embodiment, the user or the patient may be provided with information related to both the current or real time monitored continuous or semi-continuous glucose level information, and the associated insulin related information. In this manner, having both the information related to the current analyte level as well as the insulin dosage information in one embodiment may improve or enhance therapy management. More specifically, as when there is indication that the monitored analyte level displayed for the individual or the user is in an upslope indicating an increase in the glucose level, the individual or the user may decide to take corrective actions such as administration of insulin dosages, for example, by programming the infusion device to administer a correction bolus. Without the additional therapy related information displayed or otherwise provided to the user or the individual, there may be a tendency to over-administer the associated medication such as, for example, resulting in an over-bolusing situation.
• By providing substantially real time therapy related information such as, for example, insulin pharmacodynamics, insulin on board information, basal profile information, hypothetical or calculated insulin action curve, and the like concurrently or substantially simultaneously on a single display unit, for example, in a superimposed or overlay manner, the individual or the user may minimize the risk for hypoglycemia from over-bolusing or over-dosing than actually necessary due to, for example, post-prandial monitored analyte levels displayed or otherwise provided to the individual or the user. Indeed, in one aspect, by providing additional information to the individual or the user related to the on-going therapy, the potential for inappropriate treatment attempt or misconceived hypoglycemic or impending hypoglycemic state may be avoided.
• In a further embodiment, the infusion device or thedrug delivery system250, for example, may be configured to include a lockout feature that may be programmable and includes a temporarily disabling and/or warning indication provided to the user or the individual based on one or more user or individual initiated execution attempt related to the operation of the infusion device or thedrug delivery system250.
• For example, based on the monitored analyte levels of the user or the individual and related data processing, under certain circumstances, providing additional safety indications or having a temporary function disable feature may be desirable. That is, when it is determined that the monitored analyte level is changing beyond a programmed rate of change or threshold level, the infusion device or thedrug delivery system250 may detect such situations, and also, during this time period, when the user or the individual attempts to deliver or administer medication such as insulin, in one aspect, the infusion device or the drug delivery system250 (or alternatively, the receiver/display device256) may be configured to provide one or more additional confirmation request to the user to verify that the user is in fact intending to administer the desired medication dosage.
• Alternatively, the infusion device or thedrug delivery system250 may be configured to temporarily disable the medication delivery when the monitored analyte level deviates from a predetermined threshold level. In this manner, an additional safety feature may be provided in the therapy management system where based on monitored analyte levels, the individual or the user may be unable to temporarily administer insulin by, for example, providing a pump lockout feature that disables the bolus or temporarily basal administration function.
• In addition, within the scope of the present disclosure, other parameters may be defined to increase the performance of the therapy management system and also in preventing potential hypoglycemia, such as, for example, the system including a motion detector that may be associated with the exercise level of the individual or the user, where the system may be configured to determine or estimate a variation or fluctuation in the glucose levels after exercise. Additionally, other parameters may be ascertained by the therapy management system to improve therapy and potentially minimize the risk for hypoglycemia, such as modification or one or more insulin administration related thresholds for situations where an increase in the risk of potential hypoglycemic state is determined, or based on a retrospective analysis using a determined low blood glucose index, or when the infusion device or the therapy management system detects a user or individual initiated determination of a bolus quantity for administration that exceeds a predetermined threshold, and based on a the current or existing basal profile.
• Referring now to the Figures,FIG. 29 is a flowchart illustrating therapy related management routine in accordance with one embodiment of the present disclosure. As shown, monitored or predicted (including, for example estimated or otherwise calculated or projected analyte related information based on one or more predefined parameters such as, but not limited to, patient or user exercise level, physical activity, food intake, insulin or medication administration) analyte information is output (2910). For example, real time analyte information (or estimated/projected analyte information) from the continuous or semi-continuous glucose monitoring system may be output for graphical display, for example, on a display unit. Thereafter, a current therapy information is retrieved from the therapy management system (which may include the continuous or semi-continuous glucose monitoring system) (2920) such as, current basal profile or level, prior bolus dosages administered, insulin on board indicator, and the like. The current therapy information may alternatively be determined or calculated based on one or more individual or patient specific parameters including, for example, but not limited to physical movement or exercise, carbohydrate amount intake, or anticipated activities and/or food consumption).
• Referring back toFIG. 29, the retrieved or determined current therapy information is output to the user or the individual so that it is visually, audibly, vibratorily, or otherwise, provided to the user in conjunction with the outputted monitored or predicted analyte information. By way of non-limiting examples, the substantially real time monitored or predicted analyte information and the current therapy information may be displayed on a single display unit of, for example, an infusion device, a data processing unit or receiver of an analyte monitoring system, or both, substantially concurrently, and/or in a superimposed manner such that both information are readily provided to the user or the individual in a simple effective manner. For example, the retrieved or determined current therapy information may be an icon, a simple visual indicator such as an arrow or a composite indicator that is superimposed over a graphical chart or display showing the real time monitored analyte information. In an alternate embodiment, the therapy information displayed may be text information that is provided or displayed with the monitored analyte information.
• FIG. 30 is a flowchart illustrating therapy related management routine in accordance with one embodiment. Referring toFIG. 30, a rate of change of monitored analyte level is detected (3010), and the detected or predicted (based on a predefined one or more parameters including, such as, for example, a fixed linear function, a curvilinear function, or one or more combination of input patient or user related parameters) rate of change of the monitored analyte level is compared to a predetermined threshold level (3020). Based on the comparison, when it is determined that the detected/predicted rate of change of the monitored analyte level deviates from the predetermined threshold level by a predefined level or amount, one or more executable therapy related functions may be disabled or alternatively, a prompt or alert may be generated and provided to the user or the patient recommending or indicating disabling the one or more executable therapy related functions. For example, one or more functions related to the insulin dosing or administration (such as bolus or temporary basal administration functions) may be disabled temporarily, or the lockout feature for such executable functions may be initiated, or prompted or recommended to be locked out.
• In this manner, in one aspect of the present disclosure, when the monitored analyte level falls below a certain threshold level, the infusion device administering insulin may be configured to temporarily disable customized dosing functions to prevent potential for overdosing.
• Accordingly, a therapy management device in accordance with one embodiment includes a display unit, and a processor operatively coupled to the display unit, the processor configured to display one or more output related to an analyte level of an individual, the processor further configured to output in a superimposed manner therapy related output over the displayed one or more outputs related to the analyte level of the individual.
• The output related to an analyte level of the individual may include a graphical display of a continuous monitored glucose level of the individual.
• The therapy related output may include one or more of an insulin action curve, an insulin on board information, or a current medication delivery profile information.
• Also, there may include an insulin delivery unit, where the display unit is coupled to the insulin delivery unit.
• Additionally, there may include an analyte monitoring unit, where the display unit is coupled to the analyte monitoring unit.
• A method in accordance with another embodiment includes outputting one or more signals associated with a monitored analyte level of an individual, determining one or more data associated with one or more therapy information related to the monitored analyte level, and outputting in a superimposed manner the determined one or more data over the outputted one or more signals associated with the monitored analyte level.
• The output one or more signals may include one or more of a line graph, a bar graph, a 2-dimensional visual display, a three-dimensional visual display, an audible output, a vibratory output, or one or more combinations thereof.
• The determined one or more data may be associated with a medication information for the therapy related to the monitored analyte level.
• The output one or more signals may be associated with substantially real time continuously monitored glucose level of the individual.
• The determined one or more data output in the superimposed matter may include one or more of an insulin action curve, insulin on board information, or a current medication delivery profile information.
• Also, the output one or more signals and the determined one or more data may be substantially simultaneously displayed on a display unit.
• A therapy management device in accordance with still another aspect may include a communication interface configured to receive one or more data associated with a monitored analyte level, and a processor coupled to the communication interface, the processor configured to detect a predetermined rate of change based on the received one or more data associated with the monitored analyte level, where the processor is configured to disable one or more therapy related functions executable by a user when the detected predetermined rate of change deviates from a predefined threshold level.
• The predetermined rate of change may include a decrease in the analyte level of the user.
• The one or more therapy related functions may include one or more medication administration functions.
• The processor may be configured to temporarily disable the one or more therapy related functions until the detected predetermined rate of change substantially falls within the predefined threshold level.
• The predefined threshold level may include a hypoglycemic condition or an impending hypoglycemic condition.
• A method in accordance with yet still another embodiment may include detecting a predetermined rate of change of based on one or more data associated with the monitored analyte level, and disabling one or more therapy related functions of a medical device when the detected predetermined rate of change deviates from a predefined threshold level.
• The disabling may include temporarily disabling one or more executable functions of the medical device related to an infusion of a medication.
• The disabling may include temporarily disabling the one or more therapy related functions of the medical device until the detected predetermined rate of change substantially falls within the predefined threshold level.
• The predefined threshold level may include a hypoglycemic condition or an impending hypoglycemic condition.
• A patient with a pre-prandial glucose value of 240 mg/dL and a rapidly rising glucose, for example, with a rate of glucose change in excess of 2 mg dl⁻¹min⁻¹may need more insulin than a patient with a relative stable glucose level for example, with a rate of change less than 1 mg dl⁻¹min⁻¹, or a patient with a rapidly falling glucose level, for example, with a rate of change less than −2 mg dl⁻¹min⁻¹. Accordingly, in one aspect, the information on the continuous glucose monitor receiver regarding the rate of change of glucose may be used in making more effective therapeutic decisions regarding insulin administration.
• Algorithms in the continuous glucose monitoring system may be configured to propose insulin dose decisions to the subject using the continuous glucose monitor data incorporating the rate of change data into the therapeutic decision. The algorithms make insulin dose recommendations to the user based on both the static and dynamic glucose data. In one embodiment, the therapeutic recommendation may be based on incorporating the rate of change over the preceding period, for example 15 minutes, for example, as indicated by a real time rate of change indicator.
• One aspect of the routine may be described as follows. First, the desired insulin dose level is determined. Thereafter, the determined insulin dose level is adjusted (increased or decreased) on the rate of change of the monitored glucose level. For example, the determined desired insulin dose is increased by 10% when the rate of glucose change indicates a rising glucose level. If the rate of change of the glucose level indicates a relatively faster increase (for example, a steeper angle displayed or output to the user of a trend or rate indicator, increase by 20%. On the other hand, if the rate of change of the glucose level is minimal, then no adjustment to the desired insulin dose level is implemented. Finally, if the rate of change of the glucose level indicates a decrease in the monitored glucose level, the insulin dose level may be decreased by 10%, and if the rate of decrease is greater, the corresponding insulin dose level may be decreased by 20%.
• Alternatively, within the scope of the present disclosure, the adjustment of the insulin dose level may be relative to the insulin requirements for the patient (for example, based on the patient's insulin sensitivity). That is, for a patient with an insulin sensitivity factor of 20 (mg/dL)/Unit of insulin, an increasing rate of blood glucose change may result in an increase of 0.75 U of insulin, while a patient with an insulin sensitivity factor of 60 (mg/dL)/Unit of insulin with the same rate of change of glucose level would only increase by 0.15 U of insulin.
• In another aspect, projected or predicted values for future glucose based on the continuous glucose monitoring data may be used as a basis for insulin dose recommendations. In one aspect, the treatment recommendation may change the insulin adjustment by a factor of the dynamic projected glucose (the “Projected Glucose Correction Factor” may be, for example, one half of the standard insulin correction factor) value and the instantaneous static glucose value. If the instantaneous static glucose is 200 mg/dL and the projectedglucose value 60 minutes into the future is 320 mg/dL, the correction bolus or insulin dose amount may be based on the amount of insulin required to reduce both the current glucose and the future glucose.
• If the target glucose is 100 mg/dL and, for example, the insulin correction factor is 1 unit for every 100 mg/dL, the treatment algorithm may recommend to the patient a 1 unit correction based on the current value plus a 0.6 unit correction based on the projected future value. A table showing the total calculated insulin is shown below:

• Target Glucose:	100 mg/dL
  Current Insulin Correction Factor (Sensitivity):	1 U per 100 mg/dL
  Projected (Future) Insulin Correction Factor (Sensitivity):	1 U per 200 mg/dL

  Current Glucose:	200 mg/dL	Insulin Required:	1 U = (200 − 100)*(1/100)
  Projected Glucose:	320 mg/dL	Insulin Required:	0.6 U = (320 − 200)*(1/200)
  		Total Calculated Insulin Required:	1.6 U

Exemplary Routines for Insulin Dose Determination1) Determining Factors Needed to Calculate the Insulin Dose
• • a) If at a meal or snack time, determine the carbohydrate content to be ingested and determine Insulin-to-Carbohydrate ratio for the patient at that time of day and/or based on the meal or snack content.
  • b) Determine the insulin sensitivity for the patient at that time of day and/or based on the meal or snack content.
  • c) Determine the target glucose for the patient at that time of day and/or based on the meal or snack content.
  • d) Using either a discrete blood glucose measurement or a continuous glucose measurement, determine the current glucose concentration of the patient.
  • e) Using a series of continuous glucose measurements (recent measurements and possibly also measurements determined on different days in similar conditions), determine the rate of glucose concentration change.
  • f) Determine a future glucose concentration based on the current glucose concentration and the rate of glucose concentration change.
  • g) Determine the future insulin sensitivity for the patient at that time of day and/or based on the meal or snack content. This may be related by a ratio, such as 1/2, to the insulin sensitivity. In addition, or alternatively, the future insulin sensitivity may be a function of the current glucose concentration and rate of glucose concentration change.
2) Insulin Dose Determination Example
• • a) Using factors from step 1a (above), determine insulin expected to be needed to compensate for meal or snack.
• 
  I1, U=(Meal Content, g)*(Insulin-to-Carbohydrate ratio, U/g)
• • b) Using factors from step 1b, 1c, and 1d (above), determine the insulin expected to be needed to correct the current glucose concentration to be closer to the target glucose.
• 
  I2, U=(Current Glucose−Target Glucose, mg/dL)*(Insulin Sensitivity, U/(mg/dL)). (I2 may be negative.)
• • c) Using factors from step 1e, 1f, and 1g (above), determine the insulin expected to be needed to correct the Future Glucose Concentration to be closer to the Target Glucose.
• 
  I3, U=(Future Glucose−Target Glucose, mg/dL)*(Future Insulin Sensitivity, U/(mg/dL)). NoteI3 may be negative.
• • d) Add the insulin dose components I1, I2, I3, to determine the necessary insulin dose needed at that time.
• The future projected or predicted glucose (“Future Glucose Concentration”) may be calculated using linear extrapolation methods or other advanced predictive algorithms including auto-regressive methods, time-series methods as well as algorithms based on individualized physiological models of a particular subject's insulin-dose response. Different embodiments of the predictive algorithms may rely on different time intervals of the prior glucose value in order to make future projections (i.e., 30 minute, 1 hour or 2 hours of the immediate preceding historical data). Still other embodiments may combine predictive algorithms with individualized physiological models to make optimized therapeutic recommendations.
• Aspects of the present disclosure may be incorporated with continuous glucose monitoring data into the treatment recommendations provided by the operating system and user interface of subcutaneous insulin infusion systems or insulin pumps, or blood glucose meters, or other devices capable of data communication, processing and user interaction, such as, for example, cellular telephones, personal digital assistants and the like. The algorithm may be adjusted using the time history of insulin administered by the insulin pump, or “insulin on board”.
• Aspects of the present disclosure includes effective use of the rate of change information available from the continuous glucose monitoring system in making insulin dose decisions.
• In a further aspect, the predicted future glucose value may be matched to the insulin action curve of the particular insulin used by a patient. As insulin administration typically includes a delay in subcutaneous insulin absorption as manifest by the onset of insulin action as well as by the time of peak physiological insulin absorption, in one aspect, the insulin action curve as well as the glucose prediction may be considered or factored in to further optimize the therapeutic efficacy of the recommended insulin dose.
• In a further aspect of the present disclosure, the rate of change of the monitored glucose level may be used in conjunction with certain events such as meal events to improve insulin therapy and address postprandial glycemic excursions. For example, in one aspect, meal related glycemic profiles may be obtained or determined for a patient or a user based on the data received from the continuous analyte monitoring system, including, for example, the rate of change of the glucose information obtained therefrom. With the rate information in conjunction with the glycemic profile surrounding meal events, the corresponding determined insulin dosage level (or the basal profile if using an infusion pump, for example) may be modified or adjusted.
• In one aspect, real time glucose fluctuation information such as the rate of change information, in addition to the prior monitored analyte levels, in the context of the particular events such as meal events that have impact upon the glycemic level of the user may be used to determine or improve upon the existing insulin therapy. In one aspect, the monitored glucose level may be output to the user as a graphical display (or in any other suitable manner to easily convey the information the user), where, the real time rate of change information of the glucose level is also provided or output to the user (for example, in a superimposed manner on a display unit). Additionally, event markers or time of day information including certain events future and/or past, such as meals, exercise, and the like, may be also output.
• In this manner, the user or patient may be provided with information related to prior monitored glucose level, current real time information of the glucose level, and anticipated or projected future glucose movement direction, some or all of which may be used in conjunction with particular events such as meal events, to adjust the insulin level administered. For example, in the context of meal events, the various embodiments of the present disclosure provide approaches to address postprandial hypoglycemic or postprandial hyperglycemic conditions.
• Accordingly, a therapy management device in one aspect includes a display unit, and a processor operatively coupled to the display unit, the processor configured to display a carbohydrate intake event indication, and a graphical representation of a monitored substantially real time analyte level and a rate of change information of the monitored analyte level of an individual approaching the meal event indication, the processor further configured to output a therapy related output over the displayed graphical representation of the monitored analyte level of the individual.
• In aspects of the present disclosure, the device may include an infusion pump, a glucose monitoring device, a controller for the pump and/or glucose monitoring device, a blood glucose meter, a cellular telephone, a personal digital assistant, a personal computer, a handheld electronic communication device or any other processor driven devices capable of storing data and instructions for execution by the processor, and further, configured for wireless or wired communication, and including a user interface such as a display unit, a speaker, a vibratory output unit, a keypad or keyboard for entering data or instructions, and the like.
• The output related to an analyte level of the individual may include a graphical display of a continuous monitored glucose level of the individual.
• The therapy related output may include one or more of an insulin action curve, an insulin on board information, a current medication delivery profile information, a modification to the current medication delivery profile information, for example.
• The device in one aspect may include an insulin delivery unit, where the display unit is coupled to the insulin delivery unit.
• The device in another aspect may include an analyte monitoring unit, where the display unit is coupled to the analyte monitoring unit.
• A method in a further aspect includes outputting one or more signals associated with a monitored analyte level of an individual, the one or more signals including a substantially real time monitored analyte level and a rate of change information associated with the monitored analyte level, outputting a carbohydrate intake event indication, determining one or more data associated with one or more therapy information related to the monitored analyte level and the meal event indication, and outputting the determined one or more data over the outputted one or more signals associated with the monitored analyte level and the carbohydrate intake event indication.
• In aspects of the present disclosure, the output one or more signals may include one or more of a line graph, a bar graph, a 2-dimensional visual display, a three-dimensional visual display, an audible output, a vibratory output, or one or more combinations thereof.
• The determined one or more data may be associated with a medication information for the therapy related to the monitored analyte level.
• The carbohydrate intake event indication may be associated with a meal event of the individual. For example, the meal events may be predetermined and associated with a respective time of day information.
• The determined one or more data may be output in a superimposed matter over the outputted one or more signals associated with the monitored analyte level and the carbohydrate intake event indication, the determined one or more data including one or more of an insulin action curve, insulin on board information, a current medication delivery profile information, or a modification to the current medication delivery profile information.
• The output one or more signals and the determined one or more data may be substantially simultaneously displayed on a display unit.
• A device in accordance with yet another aspect of the present disclosure includes a communication interface configured to receive one or more data associated with a monitored analyte level, and a processor coupled to the communication interface, the processor configured to detect a carbohydrate intake event indication, and to detect a predetermined rate of change of the monitored analyte level based on the received one or more data associated with the monitored analyte level, where the processor is further configured to disable one or more therapy related functions executable by a user when the detected predetermined rate of change deviates from a predefined threshold level.
• The predetermined rate of change may include a decrease in the analyte level of the user.
• The one or more therapy related functions may include one or more medication administration functions.
• The processor may be configured to temporarily disable the one or more therapy related functions until the detected predetermined rate of change substantially falls within the predefined threshold level.
• In a further aspect, the predefined threshold level may include a hypoglycemic condition or an impending hypoglycemic condition.
• A method in accordance with still another aspect may include detecting a predetermined rate of change of based on one or more data associated with the monitored analyte level within a predetermined time period of a scheduled meal event, and modifying an insulin administration profile of an insulin infusion device when the detected predetermined rate of change deviates from a predefined threshold level.
• In another aspect, modifying the insulin administration profile may include suspending the infusion of insulin by the insulin infusion device.
• Further, modifying the insulin administration profile may include temporarily suspending the infusion of insulin until the detected predetermined rate of change substantially falls within the predefined threshold level.
• Additionally, the predefined threshold level may include a hypoglycemic condition or an impending hypoglycemic condition.
• In the manner described above, within the scope of the present disclosure, in one aspect, postprandial glycemic excursion is addressed to improve insulin therapy for diabetic conditions based on, for example, real time monitored glucose levels, rate of change of the glucose level information provided, for example, concurrent to the monitored glucose levels, as well as indication of carbohydrate intake events such as meal events which are associated with time of day information. Accordingly, in aspects of the present disclosure, postprandial hyperglycemic or hypoglycemic conditions may be addressed to provider improved treatment of diabetic condition based on glycemic control.
• Various other modifications and alterations in the structure and method of operation of this disclosure will be apparent to those skilled in the art without departing from the scope and spirit of the disclosure. Although the disclosure has been described in connection with specific preferred embodiments, it should be understood that the disclosure as claimed should not be unduly limited to such specific embodiments. It is intended that the following claims define the scope of the present disclosure and that structures and methods within the scope of these claims and their equivalents be covered thereby.

Claims (20)

1. A therapy management device, comprising:

a display unit; and

a processor operatively coupled to the display unit, the processor configured to display a carbohydrate intake event indication, and a graphical representation of a monitored substantially real time analyte level and a rate of change information of the monitored analyte level of an individual approaching the meal event indication, the processor further configured to output a therapy related output over the displayed graphical representation of the monitored analyte level of the individual.

2. The device ofclaim 1 wherein the output related to an analyte level of the individual includes a graphical display of a continuous monitored glucose level of the individual.

3. The device ofclaim 1 wherein therapy related output includes one or more of an insulin action curve, an insulin on board information, or a current medication delivery profile information.

4. The device ofclaim 1 further including an insulin delivery unit, wherein the display unit is coupled to the insulin delivery unit.

5. The device ofclaim 1 further including an analyte monitoring unit, wherein the display unit is coupled to the analyte monitoring unit.

6. A method, comprising:

outputting one or more signals associated with a monitored analyte level of an individual, the one or more signals including a substantially real time monitored analyte level and a rate of change information associated with the monitored analyte level;

outputting a carbohydrate intake event indication;

determining one or more data associated with one or more therapy information related to the monitored analyte level and the meal event indication; and

outputting the determined one or more data over the outputted one or more signals associated with the monitored analyte level and the carbohydrate intake event indication.

7. The method ofclaim 6, wherein the output one or more signals includes one or more of a line graph, a bar graph, a 2-dimensional visual display, a three-dimensional visual display, an audible output, a vibratory output, or one or more combinations thereof.

8. The method ofclaim 6 wherein determined one or more data is associated with a medication information for the therapy related to the monitored analyte level.

9. The method ofclaim 6 wherein the carbohydrate intake event indication is associated with a meal event of the individual.

10. The method ofclaim 6 wherein the determined one or more data is output in a superimposed matter over the outputted one or more signals associated with the monitored analyte level and the carbohydrate intake event indication, the determined one or more data including one or more of an insulin action curve, insulin on board information, or a current medication delivery profile information.

11. The method ofclaim 6 wherein the output one or more signals and the determined one or more data are substantially simultaneously displayed on a display unit.

12. A therapy management device, comprising:

a communication interface configured to receive one or more data associated with a monitored analyte level, and

a processor coupled to the communication interface, the processor configured to detect a carbohydrate intake event indication, and to detect a predetermined rate of change of the monitored analyte level based on the received one or more data associated with the monitored analyte level, where the processor is further configured to disable one or more therapy related functions executable by a user when the detected predetermined rate of change deviates from a predefined threshold level.

13. The device ofclaim 12 wherein the predetermined rate of change includes a decrease in the analyte level of the user.

14. The device ofclaim 12 wherein the one or more therapy related functions includes one or more medication administration functions.

15. The device ofclaim 12 wherein the processor is configured to temporarily disable the one or more therapy related functions until the detected predetermined rate of change substantially falls within the predefined threshold level.

16. The device ofclaim 12 wherein the predefined threshold level includes a hypoglycemic condition or an impending hypoglycemic condition.

17. A method, comprising:

detecting a predetermined rate of change of based on one or more data associated with the monitored analyte level within a predetermined time period of a scheduled meal event; and

modifying an insulin administration profile of an insulin infusion device when the detected predetermined rate of change deviates from a predefined threshold level.

18. The method ofclaim 17 wherein modifying the insulin administration profile includes suspending the infusion of insulin by the insulin infusion device.

19. The method ofclaim 17 wherein modifying the insulin administration profile includes temporarily suspending the infusion of insulin until the detected predetermined rate of change substantially falls within the predefined threshold level.

20. The method ofclaim 17 wherein the predefined threshold level includes a hypoglycemic condition or an impending hypoglycemic condition.

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