US20230393088A1 - System and method for optimizing insulin dosages for diabetic subjects - Google Patents

Abstract

A method and system for optimizing insulin dosages for diabetic subjects which includes a processor for calculating basal and bolus dosages to be recommended for meal types including breakfast, lunch, dinner, snack, or at miscellaneous times. The bolus calculations are specifically directed to time periods which are taken from either pre-meal, post-meal, bedtime, mid-sleep or miscellaneous times. The processor calculates an optimized bolus for a specific time period and meal type based upon prior basal dosages, prior glucose doses, hypoglycemia thresholds, mid-point of target ranges, and subject insulin sensitivity factors. A display is provided to the subject for sensing the optimized insulin dosage recommended at a specific time period and for a specific meal type.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• This U.S. patent application is a continuation of, and claims priority under 35 U.S.C. § 120 from, U.S. patent application Ser. No. 17/474,001, filed on Sep. 13, 2021, which is a continuation of U.S. patent application Ser. No. 15/862,819, filed on Jan. 5, 2018, which is a continuation of U.S. patent application Ser. No. 13/610,287, filed on Sep. 11, 2012. The disclosures of these prior applications are considered part of the disclosure of this application and are hereby incorporated by reference in their entireties.
TECHNICAL FIELD
• This invention is directed to a system and method for optimizing the control of blood glucose for diabetic subjects. In particular, this invention is directed to a system incorporating a processor whose logic optimizes the control of the blood glucose of the diabetic subject based upon a subject blood glucose level reading at a particular time period and a meal type having been ingested or to be ingested. Still further, this invention pertains to an optimized control of the blood glucose level for developing a recommended insulin dosage dependent upon a time period defined as a pre-meal, post-meal, bedtime, mid-sleep, or miscellaneous blood glucose reading taken with a standard glucometer. Additionally, this invention pertains to a system which takes into account both the meal type such as breakfast, lunch, dinner, or snack. Further, this invention is directed to a system which utilizes the past history of the subject for a particular meal type and time period to optimize the blood glucose level for the diabetic subject. Still further, this invention pertains to optimization of blood glucose levels based upon estimated carbohydrates to be ingested by the subject at a particular meal type in association with whether or not the subject is on a meal plan.
BACKGROUND
• Diabetes is a growing problem in the world. Conventional treatment for diabetes requires that the patient measures his/her blood glucose several times a day with a glucometer. The patient then estimates the number of units of insulin that should be injected to prevent either hypoglycemia (too low blood glucose) or hyperglycemia (too high blood glucose) based upon the blood glucose reading and the type of food that the patient has ingested or expects to ingest. This generally is a trial and error solution which may have deleterious effects.
• Diabetes or diabetes mellitus is a generally chronic disorder of glucose or sugar metabolism. This is generally caused by the inadequate production of insulin or inadequate use of the insulin generated. Insulin is a hormone produced in specialized cells in the pancreas which permits the body to use and store glucose. Diabetes is a leading cause of death in the World.
• Lack of insulin for a subject results in the inability to metabolize glucose and the capacity to store glycogen in the liver and active transport of glucose across cell membranes are impaired.
• Symptoms of diabetes or diabetes mellitus results in elevated sugar levels in the urine and blood, as well as increased urination, thirst, hunger, weakness, and weight loss. Prolonged excess blood glucose levels (hypoglycemia) leads to increased protein and fat catabolism which may cause premature vascular degeneration and atherosclerosis. Where diabetes is not controlled, such leads to diabetic acidosis where ketones are built up in the blood.
• Diabetes affects the body handling of fats which may lead to fat accumulation in the arteries and potential damage to the kidneys, eyes, heart, and brain. Thus, there is a great need for accuracy in controlling the blood glucose level of a diabetic subject to optimize the blood glucose level and have the subject maintain a stable blood glucose level within safe limits.
• The optimization of blood glucose levels for a diabetic subject is a function of numerous interdependent parameters associated with time periods, meal types, ingested food products, prior history of the diabetic subject at respective time periods and meal types being ingested or to be ingested, as well as the physical condition of the subject. In order to optimize the insulin dosage to be administered to a subject, the interdependent parameters each having an effect on the other, have to be taken into account to produce a recommended insulin dosage level.
• Thus, the subject system has been developed in order to optimize the insulin dosage recommended for a subject at a particular time period and further associated with a meal type based upon the above-referenced interrelated parameters.
PRIOR ART
• Prior systems for recommending insulin dosage suffer from the fact that the previous history of the subject are not generally taken into account with respect to a particular time period and meal type either ingested or to be ingested
• Conventional treatments for diabetes require that the patient measure his/her blood glucose a predetermined number of times during a day with a standard glucometer. The patient may then estimate the number of units of insulin that he/she should inject for prevention of either hypoglycemia or hyperglycemia.
• It is difficult for the diabetic subject to accurately estimate the number of grams of carbohydrates that he/she will ingest and in general the interrelated aforementioned parameters are not taken into account for optimizing glycemic control.
• Thus, there is a great need for a system which calculates an optimized blood glucose level and insulin dosage to be recommended to the subject based upon a current blood glucose reading in association with a meal type, time period, physical condition, and previous history of blood glucose levels.
SUMMARY
• One aspect of the disclosure provides [an independent claim].
• The subject system provides a system and method for optimizing the glycemic control of a diabetic subject based upon his/her past glycemic history and provides an optimized guidance as to the number of units of insulin or insulin dosage to be injected at any time depending on an extended set of factors. Each of these factors can affect the patient's need for insulin.
• The diabetic patient or caregiver inserts base data into a computer system for estimating the number of grams of carbohydrates that the patient is about to ingest or has ingested at a particular meal type. The meal type and time period is further input as manual data inserted into the computer system.
• Based upon the input data as to the current blood glucose reading and the aforementioned input data, the subject system calculates an insulin dosage which is optimized for the patient's particular condition at the current time.
• One of the features of the subject system is that such provides for the patient the optimum number of units of insulin to be injected dependent on the subject's past history of blood glucose results under similar circumstances. As an example, if the subject measures a blood glucose rating of 100 mg/dl, such is input into the system and indicates to the system that there is an estimated ingestion of 30 grams of carbohydrates to be ingested or has previously been ingested, and the system states that 15 units of insulin should be injected, and then the next reading of blood glucose is 70 mg/dl, such would result in an undesirably low reading. At a subsequent time that the subject takes the same or similar blood glucose reading and the number of grams of carbohydrates to be eaten is inserted, then the system knowing that 15 units of insulin is too high a dose, the system may suggest 13 units of insulin to prevent a low reading of blood glucose. Thus, an important feature of the subject system is that the patient's prior glycemic history is stored by the system and subsequently used in calculations for recommending insulin to be injected dependent upon prior results experienced by the specific subject.
DESCRIPTION OF DRAWINGS
• FIG.1 is a broad flow block diagram of the computer system for processing and calculating insulin dosages to be administered to a subject responsive to a particular meal type and a predetermined time period;
• FIG.2 is a logic block diagram providing a broad logic flow of the logic associated with the computer system and modules dependent upon whether the meal type is pre-meal, post-meal, bedtime, mid-sleep, or miscellaneous;
• FIG.3 is an information flow block diagram associated with processing a physical condition of the subject;
• FIG.4 is a flow block diagram associated with determining a correction dosage to be administered to the subject dependent upon input data provided by the subject associated with the meal type and the time period;
• FIG.5 is a logic flow diagram for calculation of the current bolus associated with an adjustment factor;
• FIG.6 is a flow block diagram showing the processing for calculating updated basal dosages; and,
• FIG.7 is a flow block diagram showing the adjustment factor calculations based upon current blood glucose levels.
DETAILED DESCRIPTION
• Referring now toFIG.1, there is shown blood glucose in insulindosage administering system100 for determining an insulin dosage value to be administered to a subject. In particular,system100 is directed to calculating, processing and recommending blood glucose levels for diabetic subjects at specific times prior to or subsequent to ingestion of food or other nutrients and calculating a recommended insulin dose to be administered.System100 is designed to provide the subject with calculated insulin dosage instructions based upon nutritional and physical information in combination with the personal history of previous insulin administration and resulting blood glucose levels.
• The following definitions of the terminology used in the following paragraphs are as follows:
• Mid-point target blood glucose range (T_m) shall refer to the mid-point of a target blood glucose range (or other blood glucose value within the range) inserted intoremote processor114 by a physician or caregiver for a subject. Although referring to “mid-point” of the blood glucose range, the mid-point target data may be inserted as a function of the mid-point of the mid-point target blood glucose range or some other input deemed appropriate by the subject's physician or caregiver.
• Time periods shall refer to the time that a subject is taking a blood glucose reading with a standard glucometer and further refers to a pre-meal time period, a post-meal time period, a bedtime period, a mid-sleep time period, or some miscellaneous time period when the subject is taking the blood glucose reading.
• Meal type shall refer to either breakfast, lunch, dinner, snack, or miscellaneous associated with when the subject is taking the subject's blood glucose reading.
• Blood glucose reading shall be the blood glucose reading taken at a predetermined time period and associated with a meal type.
• Bolus shall refer to recommended insulin dose administered for a meal type and a time period.
• Basal Dose shall refer to a total basal dosage of insulin to be taken for one day.
• Hypoglycemia threshold shall refer to a lower blood glucose value for a particular subject provided by a physician or other caregiver.
• Prior blood glucose doses and/or levels shall refer to previous blood glucose doses and/or levels taken or calculated at previous time periods associated with a respective meal type.
• Basal insulin type shall refer to the type or brand of long acting insulin used with basal dose calculations.
• Bolus insulin type shall refer to the type or brand of short acting insulin used with meal bolus and correction doses of insulin.
• Basal dose distribution shall refer to the frequency and distribution of basal doses for a particular day such as (1) once a day (SID); (2) twice a day (BID); or, (3) three times a day (TID).
• Physical condition parameter shall refer to a physical condition of the subject at the time that the blood glucose reading is being taken such as whether or not the subject is exercising or plans to exercise.
• Intermediate blood glucose correction dosage shall refer to a first calculation byprocessor116 shown inFIG.1.
• Carbohydrate to insulin ratio is a subject specific factor based upon a function of the total daily dose of insulin based upon the subject's weight at the time of initialization of thesystem100 processes.
• Meal plan shall refer to whether or not the subject is limited to ingesting a known number of carbohydrates for each meal type. When a subject is “on” a meal plan, the subject is generally prescribed a predetermined number of carbohydrates to be ingested at a selected meal type.
• Miscellaneous time period shall refer to blood glucose calculations at a time period which is not associated with the time periods of breakfast, lunch, dinner, or snack. Such a miscellaneous time period may be associated with a subject fasting period when blood glucose calculations are being processed.
• Mid-sleep time period shall refer to blood glucose readings taken at a time during a time period when the subject is normally asleep, generally at some point during a sleeping cycle of the subject.
• Insulin sensitivity factor shall refer to a subject specific sensitivity to insulin, generally determined by a physician or care giver and inserted as a portion of the data stored in the remote processor.
• System processor shall refer to an on-site processor which calculates a user's recommended insulin dosage value to be taken at a selected time period and a selected meal type.
• Remote processor shall refer to a processor which is coupled to the system processor and stores a first set of a subject's blood glucose parameters and includes but is not limited to prior basal and bolus dosages, prior or previous blood glucose readings for selected meal types and time periods, subject specific hypoglycemia thresholds, prescribed mid-point of a subject's target range, a subject specific insulin sensitivity factor, basal insulin type, bolus insulin type, basal dose distributions, and the number of carbohydrates a subject is recommended to ingest for a selected meal type. The remote processor is generally locationally removed (but in communication) with the system processor, however in some cases the remote processor may be incorporated with the system processor.
• Referring now toFIG.1, there is shownblood glucose system100 for calculating, processing, determining, and displaying a recommended insulin dosage value (bolus) to be administered to a subject. The broad block diagram shown inFIG.1 includes a glucometer reading (BG) which is inserted by the subject inblock102. The subject takes his/her blood glucose value with a standard glucometer well-known in the art and commercially available. The glucometer generally provides the subject's current blood glucose reading in mg/dl.
• Further, data is inserted by the subject inblock101 as to the physical condition of the subject at the time of the taking of the blood glucose value. The data inserted inblock101 will further be described throughout the flow process and in particular with regard toFIG.3. In general, data inserted intoblock101 includes whether the subject is currently exercising or plans to exercise. Further, data is stored inremote processor114 associated with prior basal dosages, prior blood glucose doses administered for particular meal types and time periods (bolus), a subject specific hypoglycemia threshold determined by the physician. Data to be included inblock105 is the estimated number of carbohydrates the subject will be ingesting at a particular meal type if the subject is not on a meal plan, as well as the number of carbohydrates recommended to be ingested for a particular meal type if the subject is on a prescribed meal plan. Further included in the data stored inremote processor114 is the mid-point target blood glucose range and the mid-point (T_m) inserted by a physician or other caregiver for a particular subject.
• The blood glucose reading taken inblock102 and the subject physical condition inblock101 is inserted intoprocessor116 online118. Withinblock103, a determination of the physical condition of the subject is made independent of further calculations withinprocessor116 to be further detailed in relation toFIG.3.Block103 directsprocessor116 to decision block302 inFIG.3 where the subject indicates whether his condition is exercise. If the condition indecision block302 is that the subject is not exercising and does not plan to exercise, the information flows oninformation line320 back to block104 inFIG.1 for further calculations to be further described in following paragraphs. Fromblock104, the information then flows todosing adjustment108 detailed inFIG.4 and then tosubject display110 and toremote processor114 for storing the data.
• If the condition is an exercise condition, found indecision block302 ofFIG.3, the logic moves online326 to decision block320 where it is determined whether the blood glucose level read inblock102 from the glucometer reading is less than or equal to the mid-point target blood glucose range stored inremote processor114. If the blood glucose level is equal to or greater than the mid-point target blood glucose range, information is directed online322 to block104 inFIG.1 for further calculations and passes subsequently to display110 andremote processor114.
• If the blood glucose level value indecision block320 is found to be less than the mid-point target blood glucose range, information is directed online326 to block318 where the subject is instructed to eat a predetermined amount of carbohydrates for each predetermined minutes of exercise being planned or having been accomplished. This instruction is then provided to the patient onsubject display110 online324 and the information is additionally sent toremote processor114 for storage of the instructions.
• Thus, whether the condition is exercise determined indecision block302, or whether or not the blood glucose level is less than the mid-point of the target blood glucose range determined indecision block320, all logic then passes to blood glucosetime period block104 shown inFIG.1 where the processing ofblock104 is initiated inFIG.2.
• Once an intermediate processing or correction dosage calculation is completed inFIG.2 for a particular meal type and time period, the logic flows on line120 (FIG.1) todosing adjustment block108 which is calculated inFIG.4 to be further detailed and described. Once the dosing adjustment inblock108 has been made byprocessor116, information flows online122 tosubject data display110 for providing a visual, audio or other type of sensory indication to the subject as to the recommended insulin dosage to be administered. In overall concept, the information provided online122 todata display110 is then transported toremote processor114 online124 for storage of all data calculated.Remote processor114 stores prior basal dosages, prior administered blood glucose doses (bolus), hypoglycemia threshold, and mid-point target blood glucose range (T_M) which are transmitted toprocessor116 online130 for processing.
• Returning back to block103, which has been detailed in the description ofFIG.3, all information with regard to the physical condition of the subject is additionally transported online126 to subject data display110 simultaneous with the information flowing online128 intoblock104 for determination of the blood glucose time period.
• System processor116 andsubject data display110 may be incorporated within a standard Personal Computer System which has a standard monitor screen for permitting the subject to visually obtain the recommended insulin dosage value being calculated within thesystem processor116 and/or theremote processor114. Thesubject display monitor110 generally provides visual data to the user, however, as is known, audio information may also be transmitted to the subject.
• Referring now toFIGS.2 and4-7, when the information flows intoblock104, the logic initially is directed toFIG.2 where a decision is made as to whether the time period at which the blood glucose level has been taken is determined to be pre-meal, post-meal, bedtime, mid-sleep, or miscellaneous.
• Information flow from withinblock104 ofFIG.1 is inserted on line260 to decision block202 for determining whether the blood glucose reading taken is pre-meal. If the blood glucose reading is taken prior to breakfast, lunch, dinner, or snack, then information flows online262 to decision block204 to determine whether the meal type of the pre-meal time period is breakfast.
• If it is determined indecision block204 that the pre-meal type is breakfast, then the logic is transported online264 to block212 for calculation of a blood glucose correction dosage or intermediate blood glucose correction dosage.Block212 includes the processing of the logic blocks inFIG.4. The information inblock212 is inserted intodecision block402 online424 for determination of whether insulin has been administered within a predetermined time period which is generally 2.0 hours, however, this is adjustable by a physician for a specific subject. If insulin has been administered within a predetermined time period, the logic then moves online426 to block408 where “no correction dose” is recommended and the information returns toFIG.2 for further processing inblock220.
• Where insulin has not been administered within a predetermined time period found indecision block402, information is directed to decision block412 online430 for determination of whether the instant or current blood glucose level reading from the glucometer inblock102 is less than the hypoglycemia threshold value stored inblock114. If the blood glucose reading is equal to or greater than the hypoglycemia threshold value, information is transported online432 to decision block404 where a determination is made whether the blood glucose reading is greater than the mid-point of the target blood glucose range (T_M).
• If it is determined that the blood glucose reading is less than the mid-point of the target blood glucose range, information is directed online434 back to block408 where there is “no correction dose recommended” and the information flows back toFIG.2 for further processing online428 inblock220.
• Where it is determined that the blood glucose reading is greater than the mid-point of the target blood glucose range inblock404, the logic then passes online436 to calculation block410 where the intermediate correction or correction insulin dosage is calculated. The intermediate blood glucose correction dosage calculated inblock410 is a function of the blood glucose reading, the mid-point of the blood glucose target range, and the subject sensitivity factor in accordance with the formula:
• $\begin{array}{cc}\mathrm{CD}=\frac{\left(\mathrm{BG}-T_m\right)}{\left(1700\left(\left(T_m-60\right)\times {\mathrm{<figure-callout\; label="S"\; filenames="US20230393088A1-20231207-D00001.png"\; state="\{\{state\}\}">S</figure-callout>}}_1\times 24\right)\right)}& \left(1\right)\end{array}$$\mathrm{Where}:\mathrm{CD}=\mathrm{correction}\mathrm{dose}\mathrm{calculated}\left(\mathrm{units}\mathrm{of}\mathrm{insulin}\right)$$\mathrm{BG}=\mathrm{blood}\mathrm{glucose}\mathrm{reading}\left(\mathrm{mg}/\mathrm{dl}\right)$$T_m=\mathrm{mid}‐\mathrm{point}\mathrm{of}\mathrm{blood}\mathrm{glucose}\mathrm{target}\mathrm{range}\left(\mathrm{mg}/\mathrm{dl}\right)$${\mathrm{<figure-callout\; label="S"\; filenames="US20230393088A1-20231207-D00001.png"\; state="\{\{state\}\}">S</figure-callout>}}_1=\mathrm{patient}\mathrm{insulin}\mathrm{sensitivity}\mathrm{factor}\left(\mathrm{units}/\mathrm{mg}/\mathrm{dl}\right)$
• Once the blood glucose correction dosage is determined incalculation block410, information is directed to decision block480 online438. Since the correction dosage and associated logic ofFIG.4 is used in conjunction with all time periods where the blood glucose value is taken including pre-meal, post-meal, bedtime, mid-sleep, and miscellaneous, as well as meal types, breakfast, lunch, dinner, snack, bedtime and mid-sleep, the information online438 is inserted into thedecision block480 where it is once again determined whether the meal type and the time period is breakfast and pre-meal.
• If both of the conditions are met (e.g., meal type is pre-meal and time period is breakfast), information then is directed online440 to transfer block422 which is representative ofFIG.6. Referring now toFIG.6, information fromtransitional block422 passes online424 intodecision block426 to determine whether a previous mid-sleep blood glucose level has been determined and stored in eithersystem processor116 and/orremote processor114. If there is no previous mid-sleep blood glucose level available or the subject does not take mid-sleep blood glucose readings, information passes online428 to transferblock642 for further processing inFIG.5.
• If there is a previous mid-sleep blood glucose level availability, information is directed online430 to decision block602 to determine whether the previous mid-sleep blood glucose level was less than the previous breakfast blood glucose level reading stored inremote processor114. If the previous mid-sleep blood glucose level is less than or equal to the previous breakfast blood glucose level, the logic passes online614 to calculation block604 for calculating an adjustment factor using the previous mid-sleep blood glucose level.
• Calculation of the adjustment factor using the previous mid-sleep blood glucose level is shown inFIG.7 to be further detailed.Block604 calculations decision blocks are made in702,706,710, and714, as well ascalculation block718 which provides for a particular adjustment factor associated with the blood glucose reading. The information is then passed to block608 inFIG.6 for a Basal dose to be calculated based upon the adjustment factor.
• If the previous mid-sleep blood glucose level is greater than the previous breakfast blood glucose level indecision block602, information is transported online630 to processing block606 where the adjustment factor is calculated using the previous breakfast blood glucose level in accordance with the adjustment factor found inFIG.7. Thus, in bothprocessing block604 and606, an adjustment factor is calculated in the logic flow associated withFIG.7.
• Calculation blocks604 and606 are calculated inFIG.7 where the information flows online722 toinitial decision block702 to determine whether the blood glucose level is greater than or equal to 181 mg/dl. If the blood glucose level is greater than 181 mg/dl, then an adjustment factor is set inblock704 as being 1.2. If the blood glucose level is not greater than or equal to 181 mg/dl, then information flows online724 to decision block706 where it is determined whether the blood glucose level is within the range of 141 mg/dl to 180 mg/dl. If the blood glucose level is within the range defined indecision block706, the adjustment factor is set to be 1.1 inblock708. If the blood glucose level is not within the range determined indecision block706, information is transported online726 to decision block710 where it is determined whether the blood glucose level is greater than or equal to 101 mg/dl and less than or equal to 140 mg/dl. If the blood glucose level is within the range defined inblock710, the adjustment factor is set inblock712 as 1.0. If the blood glucose level does not fall within the range associated withdecision block710, information is directed online728 to decision block714 where it is determined whether the blood glucose level is within the range of 71 mg/dl to 100 mg/dl. If the blood glucose level is within the range defined inblock714, the adjustment factor is set inblock716 to be 0.8. If the blood glucose level is not within the range associated with the decision made indecision block714, the blood glucose level must be less than or equal to 70 mg/dl as shown inblock718 and in this case, the adjustment factor is set inblock720 as 0.8. The adjustment factors set inblocks704,708,712,716, and720 are dimensionless.
• Once the proper adjustment factor is defined inblocks704,708,712,716, or720 information flows onrespective lines722,724,726,728, or730 to transfer block732 where information returns to eitherblocks604 or606 inFIG.6.
• As stated, the adjustment factor after being calculated inFIG.7, the information returns toFIG.6 and in particular toblocks604 and606. The information inblock604 and606 respectively pass onlines632 or634 to calculation block608 where the new basal dose is calculated. The new basal dose calculated inblock608 is the previous basal dose multiplied by the adjustment factor and this value is inserted intoblock610 to recommend the basal dose at the configured time interval. Information then flows online636 to block638 to insert the recommended basal dose to thesubject data display110 and storage in thesystem processor116 and/orremote processor114, as well as being returned online640 for further calculations of either the breakfast, lunch, dinner, or snack bolus associated with the logic flow inFIG.5.
• Thus, as shown inFIG.4, if it is determined that both conditions of the time period being pre-meal and the meal type is breakfast, information is passed online440 to transferblock422 for calculations inFIG.6 and then the information is inserted intotransfer block488 for processing in accordance with the logic described inFIG.5.
• Returning now toFIG.4, where once the correction dosage has been calculated inblock410, and the information passed to decision block480, if it is determined inblock480 that both conditions of the time period being pre-meal and the meal type being breakfast are not met, logic flows online492 todecision block490.Decision block490 determines whether the time period is pre-meal. If the time period is pre-meal the logic moves online496 to transferblock488 for processing inFIG.5. If the time period is not pre-meal then the logic flow is directed to block110 inFIG.1 and the correction dose is inserted in accordance with the calculations made incalculation block410.
• Returning back toFIG.4 anddecision block412, if it is determined indecision block412 that the blood glucose level is less than the hypoglycemia threshold level, information flows online450 to decision block414. In decision block414, it is determined whether the subject has impaired consciousness, and if the subject does not have impaired consciousness information flows online452 to block420 where the subject is instructed to be given a predetermined dosage of oral glucose and data is then sent directly todata display block110. If the subject has impaired consciousness found in decision block414, information flows online454 to decision block416 where it is determined whether there is IV access. If there is IV access, information online456 is inserted intoblock418 where instructions are provided to give a D50IV=(100−BG)×0.04 amount to the subject. If there is no IV access, glucogen is then recommended to be administered inblock422. Information fromblocks420,422, and418 are passed onlines458,460, and462 for information input todata display110 and subsequently inserted intoremote processor114 ofFIG.1.
• Returning now toFIG.2, once the basal dose has been adjusted inblock220 as associated with the processing inFIGS.6 and7, for a time period which is pre-meal and a meal type which is breakfast, information is directed to block228 for calculation of the recommended insulin dosage at breakfast or breakfast bolus.
• Similarly, if the time period is pre-meal and meal type is lunch, calculations of the intermediate blood glucose correction dosage for lunch is calculated inFIG.4. If the time period is pre-meal and the meal type is dinner, calculation of the intermediate blood glucose correction dosage is made inblock216. Similarly, if it is determined that the time period is pre-meal and that the meal type is a snack indecision block210, a calculation of the blood glucose correction dosage for the snack is calculated inblock218.
• In all processing and calculation blocks212,214,216, and218, the calculations are provided in association with the previous logic flow description given for the logic blocks inFIG.4.
• Information fromFIG.2 processing blocks228,222,224, and226 are calculated in accordance with the logic flow inFIG.5. Calculation of the breakfast, lunch, dinner, or snack bolus is shown inFIG.5 with information passing fromblocks228,222,224, and226 online530 to decision block502 where it is once again determined whether the pre-meal time period is breakfast. If the pre-meal time period is breakfast, information passes to calculation block510 online532 for calculation of the adjustment factor as previously detailed in the logic flow provided forFIG.7.
• If the time period is pre-meal and the meal type is breakfast, calculation of the adjustment factor is made inblock510 in accordance withFIG.7 as previously discussed. Information then passes to decision block562 where there is a determination of whether the subject is on a fixed meal plan. If it is determined that the subject is on a fixed meal plan, such as substantially the same number of carbohydrates to be ingested at each time period and meal type, information then passes online564 to calculation block518 which calculates the current bolus in accordance with the equation:
• 
  CB=CB_i×AF  (2)
• Where:
• • CB=current bolus (units of insulin)
  • CB_i=previous bolus administered at the previous Meal type and time period (units of insulin)
  • AF=adjustment factor (dimensionless)
• The current bolus is then passed online554 tosubject data display110 and eventually toremote processor114 as provided inFIG.1. If it is determined that the subject is not on a fixed meal plan indecision block562, information is directed throughline566 to calculation block586 where a number of calculations are performed. Initially, the total prescribed daily basal dose of insulin in units of insulin per day is calculated (TDD) in accordance with the formula:
• 
  TDD=TDD_M×W_S  (3)
• Where:
• • TDD=total prescribed daily basal dose of insulin (units of insulin)
  • W_S=weight of subject (Kg.)
  • TDD_M=subject's Total Daily Dose Multiplier (a weighting factor having dimensions of (units per Kg/day). Typically 0.25 for pediatric subjects, 0.3 for subjects with renal insufficiency, 0.5 for adult subjects, or another subject specific number)
• Once the total prescribed daily basal dose is calculated in equation (3), withinblock586, the meal of bolus (CB) is calculated by first calculating the carbohydrate to insulin ratio (dimensionless) in accordance with the formula:
• 
  CIR=450×TDD  (4)
• Where:
• • CIR=current carbohydrate to insulin ratio (dimensionless)
  • TDD=total prescribed basal dose of insulin (units of insulin)
• Using the previous selected pre-meal CIR to calculate the instant CIR for a particular meal type is made in accordance with the formula:
• $\begin{array}{cc}{\mathrm{CIR}}_{B,L.D,S}=\frac{{\mathrm{CIR}}_{P_{B,L,D,S}}}{\mathrm{AF}}& \left(5\right)\end{array}$
• • Where: CIR_B,L,D,S=instant carbohydrate to insulin ratio for a selected meal type of breakfast, lunch, dinner, or snack
  • CIR_B,L,D,S=previous carbohydrate to insulin ratio for previous selected meal type of breakfast, lunch, dinner or snack
  • AF=adjustment factor Finally, the current bolus to be recommended is derived from the Equation:
• $\begin{array}{cc}\mathrm{CB}=\frac{C_{\mathrm{EST}}}{{\mathrm{CIR}}_{B,L.D,S}}& \left(6\right)\end{array}$
• • Where: C_EST=estimated number of carbohydrates to be ingested at the pre-meal time period for the current meal type (mg.)
  • CIR_B,L,D,S=calculated carbohydrate to insulin ratio calculated in Equation 5
• Subsequent to the calculation of the current bolus inblock518 or block586, information passes onrespective lines554 and555 tosubject data display110 and then toremote processor114.
• If it is determined indecision block502 that the meal is not breakfast, information is directed online536 to decision block504 where a decision is made as to whether the meal is lunch. If the pre-meal is lunch, then information is passed online538 to calculation block512 for calculation of the adjustment factor inFIG.7 as previously discussed. Once the adjustment factor has been determined from the logic flow inFIG.7, information then is transported online540 to fixed mealplan decision block568.Decision block568, similar to decision block562, determines whether the subject is on a fixed meal plan and if the subject is on a fixed meal plan, information passes online570 to calculation block520 where the current bolus is calculated in accordance withEquation 2. Where the subject is not on a fixed meal plan as determined indecision block568, information passes online572 to calculation block588 which calculates the lunch bolus in accordance with Equations 3, 4, 5 and 6 as previously discussed. Subsequently, information passes either online556 or557 tosubject display data110 andremote processor114.
• If it is determined that the meal type is not lunch indecision block504, information is transported online542 to decision block506 where it is determined whether the meal type is dinner. If the meal type is dinner, information is inserted to calculation block514 online544 for calculation of the adjustment factor provided by the logic inFIG.7. Once the adjustment factor inFIG.7 has been calculated, information passes online546 to decision block574 determining whether the subject is on a fixed meal plan. Thedecision block574 is similar to decision blocks562 and568. If it is determined that the subject is on a fixed meal plan, information is then sent to calculation block522 online576 for calculation of the current bolus (CB) in accordance withEquation 2. If the subject is not on a fixed meal plan as determined indecision block574, the information enterscalculation block590 for calculation of the dinner meal bolus in accordance with Equations 3, 4, 5 and 6. Information is then sent from either calculation block522 or block590 onrespective lines558 and559 tosubject data display110 and then toremote processor114.
• If it is determined indecision block506 that the meal is not dinner, information then flows online548 to decision block508 where it is determined whether the meal type is a snack. If it determined indecision block508 that the meal is a snack, information passes online550 to calculation block516 where the adjustment factor is calculated in accordance withFIG.7. Information then passes online552 to decision block580 which determines whether the subject is on a fixed meal plan. If the subject is on a fixed meal plan as determined indecision block580, information passes online582 to calculation block524 where the current bolus is calculated based uponequation 2. If the subject is not on a fixed meal plan, the logic flows throughline584 to calculation block592 where the current meal bolus is calculated in accordance with Equations 3, 4, and 6. Information fromblock524 or block592 is then transported on eitherLine560 or562 to subjectdata display system110 and then toremote processor114.
• In this manner, when the blood glucometer reading is taken as represented byblock102, and the physical condition is input by the subject as represented byblock101, when the time period of the blood glucose reading is taken is pre-meal as is determined indecision block202, a breakfast, lunch, dinner, and snack bolus is calculated bysystem100.
• If the meal type is not a snack, then the time period is miscellaneous and passes online598 to transfer block599 where logic is transferred toline288 inFIG.2. Processing is then provided incalculation block258 in accordance with the logic flow inFIG.4.
• Returning toFIG.2, assuming that the blood glucose time period has been determined not to be a pre-meal time period indecision block202, the information passes online280 to decision block230 wheredecision block230 determines whether the time period is a post-meal time. If the time period is determined to be post-meal, information is transported online282 to decision block232 where a decision is determined whether this is a breakfast post-meal glucometer reading. If the inputs provided by the subject is to a time period which is post-meal and the meal type is breakfast, information is then transmitted to calculation block240 inFIG.2. In this instance, there is no adjustment of the basal dose as was the case when the time period was pre-meal (previously described) and the meal type was breakfast.
• Calculation block240 directs the information toFIG.4 where a correction dose is calculated incalculation block410. All logic blocks have been previously detailed, however, in overview, if insulin has not been given within a predetermined period of time, for example two hours as indicated indecision block402, and the blood glucose reading is equal to or greater than the hypoglycemia threshold value (Hi) as determined indecision block412, the information is directed to decision block404 and if the blood glucose reading is determined to be greater than the mid-point target blood glucose range reading, the correction dose is calculated incalculation block410. Responsively, subsequent to the calculations provided incalculation block240, the results and calculation of the post-meal breakfast correction is transmitted online284 tosubject display110 andremote processor114 for storage of the data calculated.
• Similarly, as has previously been described for the pre-meal type calculations in decision blocks206,208, and210, a decision is made as to the fact whether the post-meal blood glucose reading is taken subsequent to lunch indecision block234, dinner indecision block236, or a snack indecision block238. If it is determined that the post-meal blood glucose reading is subsequent to lunch indecision block234, the information then is inserted intocalculation block242 for calculation of the post-meal lunch correction as associated with the logic flow previously described forFIG.4.
• If the decision indecision block234 is that the post-meal was not lunch, the information then is directed to decision block236 for determination of whether the post-meal blood glucose reading was dinner and if it is dinner, the logic flows to block244 and correction dosage as well as the subject meal bolus is made in association withFIG.4.
• If the blood glucose post-meal reading is a snack determined indecision block238, similarly as previously described, the information is directed to calculation block246 for calculation in the same manner as previously described for the post-meal breakfast, lunch and dinner decisions. Information fromblocks240,242,244, and246 are then provided online284 to bothsubject display110 andremote processor114 for storage of the data and display of the recommended correction reading.
• If it is determined indecision block230 that the blood glucose time period is neither a pre-meal nor a post-meal, the information is directed online290 to decision block248 where it is determined whether the blood glucose taken is at the time period of bedtime (prior to sleep).
• With the blood glucose reading provided inblock101, the information is directed to calculation block254 for insert into the logic flow ofFIG.4. The logic inFIG.4 in overall view, passes into correctiondose calculation block410. The bolus for bedtime is then provided on line286 (FIG.2) to bothsubject display system110 andremote processor114 as shown inFIG.1.
• Assuming that the blood glucose type is not found to be bedtime indecision block248, information is then inserted online292 to decision block250 where the blood glucose reading time period is taken as “mid-sleep”. If the blood glucose reading is taken as a mid-sleep type reading, information then is inserted intocalculation block256 where the calculation correction is transmitted to the logic previously detailed forFIG.4 and then inserted online286 tosubject display system110 andremote processor114 as shown inFIG.2.
• In the event that the blood glucose reading provided inblock101 is not a mid-sleep reading as determined indecision block250, the information then passes online294 to calculation block252 where the meal type is defined as miscellaneous since it is neither for a breakfast, lunch, dinner, or snack reading. The information in252 is then directed to calculation block258 where the bolus is calculated in accordance withFIGS.4,5, and7.
• In the event that the blood glucose reading meets the time criteria period of a pre-meal, but is not at breakfast, lunch, dinner, or snack as determined in decision blocks204,206,208, and210, then the meal type must be “miscellaneous” and the information passes online288 intoblock252 and258 for calculation of the correction dosage. As seen inFIG.2, if the blood glucose reading is post-meal, but is not for breakfast as determined indecision block232, lunch as determined indecision block234, dinner as determined indecision block236, or the snack as determined indecision block238, again, the information is directed online288 to252 since the reading must be a “miscellaneous” reading. In all cases subsequent to the bolus being determined in254,256, and258, information calculated is then inserted for display insystem display110 and stored inremote processor114 for further use.
• In overall concept, there is provided inFIGS.1-7 a system for determining the insulin dosage value to be administered to a subject dependent on many interrelated parameters. Input tosystem100 includes a glucometer reading taken by the subject at a time period defined by whether the blood glucose reading is taken pre-meal, post-meal, bedtime, or at some miscellaneous time.Remote processor114 maintains in storage, prior basal dosages, hypoglycemia thresholds, target ranges and mid-points of target ranges, and subject insulin sensitivity factor. The subject provides a manual input online118 as represented byblock105 as to the particular time period, whether such is pre-meal, post-meal, bedtime, or at some miscellaneous time. Additionally, the meal type such as breakfast, lunch, dinner, or snack is inserted as represented byblock105 for insert intoprocessor116 for determination of the appropriate correction factors and bolus to be calculated.
• System100 provides the patient with calculated insulin dosage instructions based on nutritional and physical information, as well as personal history of insulin administration and resulting blood glucose levels as previously described. The calculated insulin dosage instructions are output to the subject onsubject data display110 which can be the monitor of a PC or through some other type of audio or sensory indication to the subject. The resulting data is then inserted intoremote processor114 for storage of the data where prior basal dosages, prior blood glucose doses, hypoglycemia thresholds, subject insulin sensitivity factor, whether a meal plan is in effect, and mid-point of target ranges are maintained in storage.
• Once the user has manually input the current glucometer reading of his/her blood glucose level fromblock102 along with the time period and meal type as represented inblock105, the subject further includes input as to a physical condition fromblock101. All of this data is then inserted intoprocessor116 where the physical condition is initially calculated independent of the further processing to be accomplished byprocessor116. The physical condition may require administration of a predetermined amount of carbohydrates as calculated inFIG.3 for each time period of exercise which has been accomplished or is being planned and such is inserted intosubject data display110. Prior basal dosages and prior BG doses of the subject for previous time periods of pre-meal, post-meal, bedtime, or miscellaneous as well as prior BG doses associated with specific time periods and meal types is stored inremote processor114 along with the hypoglycemia threshold and the mid-point of the target range (T_m). All of this is inserted intoprocessor116 online124 for calculations inblocks104 and108.
• System100 then processes all data drawing on the preset conditions and subject history for determining optimum dosage levels of the subject's current condition where all calculated data is then displayed as represented byblock110 and the calculated data is then stored inremote processor114.
• FIG.2 is representative of the calculation blocks104 and108 in a further breakdown of the processor calculation procedures. Thesystem100 processes patient input of dietary events inFIG.2 where initially the subject indicates whether the current blood glucose level read from glucometer reading102 is a time period of a pre-meal (decision block202), post-meal (decision block230), prior to bedtime (decision block248), or mid-sleep cycle (decision block250). If the time period is neither pre-meal, post-meal, bedtime, or during the mid-sleep cycle, then the time period is miscellaneous as represented byinput block252. Thus, all time periods are then represented and appropriate calculations can be processed. Each of the decision blocks202,204,206,208,210 or203,232,234,236,238, or248 and250 define individual series of decision blocks. A positive indication for one decision block implies a negative indication for other decision blocks in each series. This type of event oriented organization permits the subject to expeditiously enter important information.
• If the time period is pre-meal as determined indecision block202, the patient elects or indicates whether the pre-meal reading is breakfast as shown indecision block204. As previously described, if the pre-meal is not breakfast, the election is made for lunch indecision block206, dinner inblock208, or a snack indecision block210. An algorithm withinprocessor116 calculates the dosage correction for the planned meal using the calculation algorithm as previously described inFIG.4 in association with sub-algorithms provided inFIGS.5-7 and in overall block diagram shown inblocks212,214,216, and218 ofFIG.2.
• In the time period of pre-meal and breakfast, the basal dose is adjusted as indicated inblock220 in association with the logic flow shown inFIG.6.
• For all pre-meals such as breakfast, lunch, dinner, snack, or miscellaneous, the pre-meal bolus or recommended insulin dosage is calculated in associatedblocks228,222,224, and226. If the meal type is neither breakfast, lunch, dinner, or a snack, then it is defined as a miscellaneous time period and the calculations for the bolus are input intoblock252 and the calculated correction is made inblock258 as previously detailed. All recommended optimum doses to be taken in any of the time periods is then displayed to the subject ondisplay110 and the data inserted intoremote processor114 for further use for subsequent blood glucose readings at specific meal types and time periods.
• Mealtime nutritional information may be input by the subject and a post-meal bolus correction is calculated for correcting unacceptable blood glucose levels within the logic ofprocessor116 as indicated byblock108 inFIG.1 in association withFIG.5. logic.
• In the event that the time period of the blood glucose reading is post-meal and determined indecision block230, once again the meal type is determined from the decision blocks232,234,236, or238 for respective calculation of the post-meal type correction inrespective blocks240,242,244, and246. Each of the decision blocks230,232,234,236, and238 determine a series of decision blocks where a positive indication for one decision block defines a negative indication for other decision blocks in this series.
• As shown inFIG.2, if the time period is bedtime as determined indecision block248, a pre-sleep blood glucose correction dose is calculated incalculation block254 associated with calculations performed in the logic steps as provided inFIG.4. In the event that the blood glucose reading is mid-sleep as determined indecision block250, where it has been determined indecision block248 that the time period is not bedtime, the logic blows intodecision block250 where it is determined whether the time period is mid-sleep and if the time period is mid-sleep, calculations are made inblock256 in accordance with the logic flow inFIG.4. All information is then inserted online286 for insert intosubject display110 andremote processor114.
• In the event that one of the meal types previously discussed are found for either the pre-meal, post-meal, mid-sleep or bedtime calculations, the meal type is defaulted to input block252 where it is determined that the meal type is miscellaneous and then passes to calculation block258 for calculation in accordance with the calculations processed inFIG.4. Once again, the information fromblock258 is inserted ontoline286 for display and storage of the data inrespective blocks110 and114. As previously discussed, if the information exiting decision blocks210 and238 indicate that the meal type was neither breakfast, lunch, dinner, or a snack, the information is directed to input block252 and then inserted intoblock258 for calculation in accordance with the logic associated withFIG.4.
• FIG.4 is a sub-system which takes information fromFIG.2 and is associated with the calculation blocks212,214,216, and218 for the pre-meal blood glucose reading time period, as well as logic blocks240,242,244, and246 for the post-meal time period and blocks254,256, and258 for the time periods of bedtime, mid-sleep or miscellaneous. The calculation blocks ofFIG.2 are read intodecision block402 for determination of whether insulin has been administered within a predetermined time interval of the taking of the blood glucose reading and if insulin has been given within this predetermined time, there is no correction dosage recommended bysystem100 and the information is returned toFIG.2 for further processing.
• If the insulin has not been given within the predetermined period of time (which is generally two hours), it is determined indecision block412 whether the subject's blood glucose level is below a pre-set hypoglycemia risk level (Hi) (hypoglycemia threshold). If it is not below the Hi, information then is directed to decision block404 where it is determined whether the blood glucose reading is greater than the mid-point of the target range and if it is not, information is then sent back to block408 where no correction dose is recommended and the system returns toFIG.2.
• If the blood glucose reading is greater than the mid-point of the target range as determined indecision block404, the information then is directed to block410 where a correction dosage is calculated as previously discussed in relation to the correction dosage equation. The correction dosage is then inserted intodecision block480 where it is determined whether the time period is pre-meal and whether the meal type is breakfast. If the data corresponds to both of these two criteria, the information is then inserted intoFIG.6 for calculation of the recommended basal dose based upon previous mid-sleep blood glucose levels and adjustment factors inFIG.7. The logic then flows online486 toFIG.5 as shown bytransfer block488. If the information does not correspond to both a breakfast and pre-meal time period indecision block420, the information then goes directly toFIG.5 for further calculations as previously discussed.
• In overall concept, if the decision indecision block412 determines that the blood glucose level is below Hi, the system requests input in decision block414 regarding the consciousness of the subject. If consciousness is not impaired, the data then flows to block420 for administration of a predetermined amount of oral glucose (generally 15 grams). If the subject does have impaired consciousness, the physician or caregiver is then instructed to either administer glucogen inblock420 or if there is IV access, for intravenous insertion of an insulin based upon a 50% saline solution and insulin in accordance with the previously defined equations.
• Sub-system500 shown inFIG.5 illustrates the logic flow withinprocessor116 associated with adjustment factors calculated insub-system700 shown inFIG.7 which are incorporated into the meal time bolus calculations in the respective calculation blocks228,222,224, and226 ofFIG.2. For respective meal types, calculation adjustment factors are calculated in the logic flow ofFIG.7 and then the current bolus is calculated as a function of the previous meal type bolus times the adjustment factor for each of the meal types inrespective blocks518,520,522, and524 as well as a determination of whether the subject is on a meal plan. Information is then sent tosubject display110 andremote processor114 subsequent to the calculations made.
• Sub-system600 shown inFIG.6 describes thesystem100 processing for incorporating the patient's personal fasting glucose levels into the adjustment factor (FIG.7) for an increased defective recommended basal dose. A determination is made if it is determined that this is a breakfast and pre-meal meal type and time period inFIG.4, the information is sent to block422 where it then is transmitted online424 to thedecision block426 to determine whether a mid-sleep glucose level has been taken and indecision block426 and if it has not, such returns toFIG.2 for calculation of the breakfast bolus incalculation block228. If the mid-sleep glucose level has been taken, the adjustment factor it is determined whether the previous mid-sleep blood glucose level is less than the previous breakfast blood glucose level indecision block602 and if it is then the adjustment factor is calculated inblock604 from the adjustment factors inFIG.7. If the previous mid-sleep blood glucose level is equal to or greater than the previous breakfast blood glucose level, then the adjustment factor is calculated fromFIG.7 inblock606 and in this case, the adjustment factor is calculated using the previous breakfast blood glucose level. In either cases, information flows from either block604 or606 intoblock608 onrespective lines632 and634 for calculation of the new basal dosage being the previous basal dose multiplied by the adjustment factor. Once again, the recommended basal dose at a particular time period is then provided in data block610 which is then again sent to thesubject display110 andremote processor114 as well as back to insertion into the system inFIG.5.
• Although this invention has been described in connection with specific forms and embodiments thereof, it will be appreciated that various modifications other than those discussed above may be resorted to without departing from the spirit or scope of the invention as defined in the appended claims. For example, functionally equivalent elements may be substituted for those specifically shown and described, certain features may be used independently of other features, and in certain cases, particular locations of elements, steps, or processes may be reversed or interposed, all without departing from the spirit or scope of the invention as defined in the appended claims.

Claims (20)

What is claimed is:

1. A computer-implemented method when executed on data processing hardware causes the data processing hardware to perform operations comprising:

receiving a current glucose measurement of a patient;

determining a glucose time period associated with a time of measuring the current glucose measurement is within a pre-meal time period before the patient consumes food or other nutrients;

determining a meal type associated with the pre-meal time period of the glucose time period is breakfast;

retrieving a previous day basal dose that was administered to the patient and a previous breakfast glucose measurement of the patient from memory hardware;

setting an adjustment factor to a preconfigured adjustment factor associated with a pre-configured range of values that includes the previous breakfast glucose measurement;

calculating a new basal dose of insulin for the patient by multiplying the previous day basal dose times the adjustment factor;

retrieving a configured time interval for administering the calculated new basal dose of insulin to the patient from the memory hardware; and

administering the calculated new basal dose of insulin to the patient by transmitting the calculated dose administering system having a patient display at the configured time interval, the patient display configured to display the calculated new basal dose of insulin.

2. The method ofclaim 1, wherein the operations further comprise:

retrieving a target glucose range for the patient from the memory hardware;

comparing the current glucose measurement to a mid-point of the target glucose range greater than the hypoglycemia threshold; and

determining the current glucose measurement is greater than the mid-point of the target glucose range;

retrieving an insulin sensitivity factor for the patient from the memory hardware;

calculating a correction dose of insulin based on the current glucose measurement, the mid-point of the target glucose range, and the insulin sensitivity factor; and

administering the calculated correction dose of insulin to the patient by transmitting the calculated correction dose to the dose administering system having the patient display configured to display the calculated correction dose of insulin.

3. The method ofclaim 2, wherein the correction dose is calculated as:

$\mathrm{CD}=\frac{\left(\mathrm{BG}-T_m\right)}{\left(1700\left(\left(T_m-60\right)\times S_1\times 24\right)\right)}$

wherein CD is the correction dose of insulin, BG is the current glucose measurement, T_mis the mid-point of the target glucose range, and S₁is the insulin sensitivity factor.

4. The method ofclaim 1, wherein the operations further comprise:

retrieving a hypoglycemia threshold from the memory hardware;

comparing the current glucose measurement to the hypoglycemia threshold; and

determining the current glucose measurement is less than the hypoglycemia threshold; and

determining one of:

a recommend dosage of oral glucose for oral ingestion by the patient;

a recommended dosage of glucagon for administration to the patient; or

a recommended dosage of saline and insulin for intravenous insertion to the patient.

5. The method ofclaim 4, wherein the operations further comprise:

receiving a user input, the user input indicating that the consciousness of the patient is not impaired;

determining the recommended dosage of oral glucose for the patient to ingest; and

transmitting the recommended dosage of oral glucose to the patient display, the patient display configured to display the recommended dosage of oral glucose.

6. The method ofclaim 4, wherein the operations further comprise:

receiving a user input, the user input indicating that the consciousness of the patient is impaired;

determining the recommended dosage of glucagon for administration to the patient; and

transmitting the recommended dosage of glucagon to the patient display, the patient display configured to display the recommended dosage of glucagon.

7. The method ofclaim 4, wherein the operations further comprise:

receiving a user input, the user input indicating whether the consciousness of the patient is impaired;

determining the recommended dosage of saline and insulin for intravenous insertion to the patient; and

transmitting the recommended dosage of saline and insulin to the patient display, the patient display configured to display the recommended dosage of saline and insulin.

8. The method ofclaim 1, wherein the operations further comprise:

retrieving a previous meal bolus administered by the patient for the associated meal type from the memory hardware;

setting a meal bolus adjustment factor to a preconfigured meal bolus adjustment factor associated with the pre-configured range of values that includes the current glucose measurement;

calculating a current meal bolus for the patient based on the meal bolus adjustment factor and the previous meal bolus; and

administering the calculated current meal bolus to the patient by transmitting the calculated current meal bolus to the dose administering system having the patient display, the patient display configured to display the calculated current meal bolus.

9. The method ofclaim 8, wherein calculating the current meal bolus comprises:

when the patient is on a fixed meal plan, calculating the current meal bolus by multiplying the previous meal bolus times the meal bolus adjustment factor; or

when the patient is not on a fixed meal plan:

receiving an estimated number of carbohydrates to be ingested by the patient for the associated meal type from the user interface;

obtaining a current carbohydrate to insulin ratio for the associated meal type; and

calculating the current meal bolus by dividing the estimated number of carbohydrates by the current carbohydrate to insulin ratio for the associated meal type.

10. The method ofclaim 9, wherein obtaining the current carbohydrate to insulin ratio for the associated meal type comprises:

retrieving a previous carbohydrate to insulin ratio for the associated meal type from the memory hardware, the previous carbohydrate to insulin ratio associated with the previous meal bolus; and

calculating the current carbohydrate to insulin ratio for the associated meal type by dividing the previous carbohydrate to insulin ratio by the meal bolus adjustment factor.

11. A system comprising:

a glucose measuring device measuring glucose measurements of a patient;

memory hardware; and

data processing hardware in communication with the glucose measuring device and the memory hardware, the data processing processor performing operations comprising:

receiving a current glucose measurement of a patient;

determining a glucose time period associated with a time of measuring the current glucose measurement is within a pre-meal time period before the patient consumes food or other nutrients;

determining a meal type associated with the pre-meal time period of the glucose time period is breakfast;

retrieving a previous day basal dose that was administered to the patient and a previous breakfast glucose measurement of the patient from memory hardware;

setting an adjustment factor to a preconfigured adjustment factor associated with a pre-configured range of values that includes the previous breakfast glucose measurement;

calculating a new basal dose of insulin for the patient by multiplying the previous day basal dose times the adjustment factor;

retrieving a configured time interval for administering the calculated new basal dose of insulin to the patient from the memory hardware; and

administering the calculated new basal dose of insulin to the patient by transmitting the calculated dose administering system having a patient display at the configured time interval, the patient display configured to display the calculated new basal dose of insulin.

12. The system ofclaim 11, wherein the operations further comprise:

retrieving a target glucose range for the patient from the memory hardware;

comparing the current glucose measurement to a mid-point of the target glucose range greater than the hypoglycemia threshold; and

determining the current glucose measurement is greater than the mid-point of the target glucose range;

retrieving an insulin sensitivity factor for the patient from the memory hardware;

calculating a correction dose of insulin based on the current glucose measurement, the mid-point of the target glucose range, and the insulin sensitivity factor; and

administering the calculated correction dose of insulin to the patient by transmitting the calculated correction dose to the dose administering system having the patient display configured to display the calculated correction dose of insulin.

13. The system ofclaim 12, wherein the correction dose is calculated as:

$\mathrm{CD}=\frac{\left(\mathrm{BG}-T_m\right)}{\left(1700\left(\left(T_m-60\right)\times S_1\times 24\right)\right)}$

wherein CD is the correction dose of insulin, BG is the current glucose measurement, T_mis the mid-point of the target glucose range, and S₁is the insulin sensitivity factor.

14. The system ofclaim 11, wherein the operations further comprise:

retrieving a hypoglycemia threshold from the memory hardware;

comparing the current glucose measurement to the hypoglycemia threshold; and

determining the current glucose measurement is less than the hypoglycemia threshold; and

determining one of:

a recommend dosage of oral glucose for oral ingestion by the patient;

a recommended dosage of glucagon for administration to the patient; or

a recommended dosage of saline and insulin for intravenous insertion to the patient.

15. The system ofclaim 14, wherein the operations further comprise:

receiving a user input, the user input indicating that the consciousness of the patient is not impaired;

determining the recommended dosage of oral glucose for the patient to ingest; and

transmitting the recommended dosage of oral glucose to the patient display, the patient display configured to display the recommended dosage of oral glucose.

16. The system ofclaim 14, wherein the operations further comprise:

receiving a user input, the user input indicating that the consciousness of the patient is impaired;

determining the recommended dosage of glucagon for administration to the patient; and

transmitting the recommended dosage of glucagon to the patient display, the patient display configured to display the recommended dosage of glucagon.

17. The system ofclaim 14, wherein the operations further comprise:

receiving a user input, the user input indicating whether the consciousness of the patient is impaired;

determining the recommended dosage of saline and insulin for intravenous insertion to the patient; and

transmitting the recommended dosage of saline and insulin to the patient display, the patient display configured to display the recommended dosage of saline and insulin.

18. The system ofclaim 11, wherein the operations further comprise:

retrieving a previous meal bolus administered by the patient for the associated meal type from the memory hardware;

setting a meal bolus adjustment factor to a preconfigured meal bolus adjustment factor associated with the pre-configured range of values that includes the current glucose measurement;

calculating a current meal bolus for the patient based on the meal bolus adjustment factor and the previous meal bolus; and

administering the calculated current meal bolus to the patient by transmitting the calculated current meal bolus to the dose administering system having the patient display, the patient display configured to display the calculated current meal bolus.

19. The system ofclaim 18, wherein calculating the current meal bolus comprises:

when the patient is on a fixed meal plan, calculating the current meal bolus by multiplying the previous meal bolus times the meal bolus adjustment factor; or

when the patient is not on a fixed meal plan:

receiving an estimated number of carbohydrates to be ingested by the patient for the associated meal type from the user interface;

obtaining a current carbohydrate to insulin ratio for the associated meal type; and

calculating the current meal bolus by dividing the estimated number of carbohydrates by the current carbohydrate to insulin ratio for the associated meal type.

20. The method ofclaim 19, wherein obtaining the current carbohydrate to insulin ratio for the associated meal type comprises:

retrieving a previous carbohydrate to insulin ratio for the associated meal type from the memory hardware, the previous carbohydrate to insulin ratio associated with the previous meal bolus; and

calculating the current carbohydrate to insulin ratio for the associated meal type by dividing the previous carbohydrate to insulin ratio by the meal bolus adjustment factor.

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