Diabetes Management System Project
- 1. Diabetes Management Using future technologies to create a system to help individuals manage a chronic condition. Noam Zomerfeld
- 2. Roger Roger is a 66 year old man that has been living with type 2 diabetes for the past 20 years. He is retired and loves cooking. Roger and his husband also eat out 1-3 times a a week. Roger’s eating habits vary a lot and he does not keep to a strict diet. Roger’s husband takes an active role in keeping Roger on track with his diabetes management.
- 3. Current System – High Blood Glucose Feedback Loop Diagram Noam Zomerfeld InjectsInforms Whichlowers measuredbya raise Blood glucose meter Roger Insulin Blood Glucose Level Carbohydrates, Sugars, Starches lower Insulin, diet, physical activity Acceptable blood glucose level: 80-120 mg/dL Current reading Planned meal Insulin Dosage + = Goal: Keep blood glucose levels stable Frequency: 4 times a day
- 4. Goal: Keep blood glucose levels stable Current System – High & Low Blood Glucose Feedback Loop Diagram Noam Zomerfeld Consumes Whichlowers Whichraises measuredby raise Roger Insulin FoodFeeling loopy Blood Glucose Level Carbohydrates, Sugars, Starches lower Insulin, diet, physical activity Acceptable blood glucose level: 80-120 mg/dL Current reading Planned meal Insulin Dosage + = Injects InformsBG meter Frequency: 4 times a day Frequency: Constant
- 5. Issues Roger finds testing his blood to be painful and complex. Choosing the required Insulin level is both predictive and reactive. It’s based on the most recent reading and on an estimate of the future intake of carbohydrates, sugars and starches. Roger only tests his blood 4 times a day, those are the only solid indications he has for his BGL and his opportunities to balance it.
- 6. Care Giving Network Noam Zomerfeld Visits Kaiser - Medical Relationships Marriage Friend circles Roger Husband Yearly retina scan Optometrist Meet every 2-3 years or as needed Initially provided training on a more frequent basis Personal Care Manager (Diabetes specialist) Calls several times a day to check up Reminds, verifies insulin and keeps schedule Takes blood sample when Roger’s is too low Moderates diet • • • • Call and check up occasionally Remind about insulin on social events Respond to emergencies • • • 2 full blood work labs a year Primary Care Physician Friends Roger’s family and friends play an important role in keeping him healthy.
- 7. Diabetes Management Range and outcomes 80 120 blood glucose level (BGL) requires immediate intervention requires monitoring and long term change of habits and behavior shaky, sweaty cranky confused, loopy, sleepy passed out death Too low Too high acceptablerange mg/dL Long term effects fatigue, kidney damage, heart disease, poor circulation, retinal damage, death thirst, nausea, frequent urination Short term effects Being on different sides of the BGL range has different outcomes for Roger: Having high blood glucose levels leads to serious complications over time. Having low blood glucose levels creates immediate consequences and dangers.
- 8. Can we offload Roger’s Insulin adjusting tasks?
- 9. Diabetes Management Ecosystem Noam Zomerfeld Shows number Light and buzz Weekly Insulin delivery / pickup. Or – optional weekly maintenance by trained professional in-store. Shows number no light Instantly adjusts insulin level - mini injections just under normal When high Low / slightly low but for a while now ... (other, personalized mid-states) Very low Blood glucose level Number value High / low / normal Trend Time in current status Number value Location Coordinates Insulin usage Quantity Timestamps for injections Low events Timestamps Response time Blood glucose level Line graph Messages partner / husband / wife Calls ambulance Ring Sensor Insulin pump husband Walgreens / CVS Care Manager (doctor / nurse) self hospital Low events: requires immediate intervention When Normal: High Events: requires monitoring and long term change of habits and behavior Twice a year review of data, adjustment of Insulin and / or of Roger’s diet
- 10. Diabetes Management Ecosystem Noam Zomerfeld Shows number no light Instantly adjusts insulin level - mini injections When high Blood glucose level Number value High / low / normal Trend Time in current status Number value Location Coordinates Ring Sensor Insulin pump Roger wears a ring on his finger that constantly measures his blood glucose levels (CGM). It displays the current BGL level. No light / color. When his BGL goes over his range, it sends a signal to his pump to deliver a mini dose of Insulin and stabilize his BGL. In fact – when this system is operational, Roger no longer has to worry about high BGL events.
- 11. Diabetes Management Ecosystem Noam Zomerfeld Shows number Light and buzz Shows number no light just under normal Blood glucose level Number value High / low / normal Trend Time in current status Number value Location Coordinates Ring Sensor When Roger’s BGL drops below his range (80 mg/dL), the ring vibrates and turns the display red – notifying Roger he needs to consume food or glucose tablets to resolve it.
- 12. Diabetes Management Ecosystem Noam Zomerfeld Shows number Light and buzz Shows number no light just under normal Low / slightly low but for a while now Blood glucose level Number value High / low / normal Trend Time in current status Number value Location Coordinates Messages partner / husband / wife Ring Sensor husband self If Roger’s BGL remains low for a period of time, the system notifies Roger’s husband via text message / phone call to check up on Roger and to make sure that the situation is taken care of.
- 13. Diabetes Management Ecosystem Noam Zomerfeld Shows number Light and buzz Shows number no light just under normal Very low Blood glucose level Number value High / low / normal Trend Time in current status Number value Location Coordinates Calls ambulance Ring Sensor self hospital If Roger’s BGL is so low he might be in immediate danger or unconscious, the system alerts emergency services and provides them with Roger’s condition and his location. (Note: other triggers and settings between the ones described in this document can be set-up in the system.)
- 14. Diabetes Management Ecosystem Noam Zomerfeld Twice a year review of data, adjustment of Insulin and / or of Roger’s diet Instantly adjusts Insulin level - mini injections Insulin usage Quantity Timestamps for injections Low events Timestamps Response time Blood glucose level Line graph Insulin pump Care Manager (doctor / nurse) Roger meets up with his doctor or care manager twice a year to review his Insulin usage and check up on other health issues that might arise, especially now that his diet is unrestricted by his diabetes.
- 15. Diabetes Management Ecosystem Noam Zomerfeld Weekly Insulin delivery / pickup. Or – optional weekly maintenance by trained professional in-store. Insulin pump Walgreens / CVS Roger gets his Insulin capsules delivered to him or he can pick them up at a pharmacy. For other patients that are less self-reliant or just dislike the procedure – an option exists to get all maintenance done at the local pharmacy by trained professionals on staff, a quick 30 minutes procedure. Other regular maintenance of sensor and pump is also performed at the pharmacy, as needed.
- 16. New System Conceptual Model Conceptual Model Noam Zomerfeld has Person Blood Glucose Level (BGL) Exact level Status Trend Time in current status Number value High / Normal / Low Rising / Falling Time Value Viewed / Shared / Automatically updated Viewed / Replaced Sent Set up Set up Seen / felt / heard Seen Automatically updated / Sent with alerts Full name Number value Content Number value Latitude Longitude If <condition> then <action> On / Off Color (red / neutral) Examples: If 75 < BGL < 80 for the last 10 minutes then notify husband. If BGL < 70 and trend is falling then notify husband. Text Message Example: Roger’s blood sugar level has been below 80 for the past 10 minutes. Please follow up with him.” Quantity (percentage) Timestamp Dosage Sensor Pump Insulin History Communication Triggers Local Alert Ambient alert Family Contact Name Phone Number Family Alert Emergency Service Location Phone Number Coordinates Objects Properties User Actions Shared / Viewed has a is a are are can be either can be either has a has a has is a is a includes is a can be either Set up can be “
- 17. Diabetes Management Ecosystem Noam Zomerfeld Shows number Light and buzz Weekly Insulin delivery / pickup. Or – optional weekly maintenance by trained professional in-store. Shows number no light Instantly adjusts insulin level - mini injections just under normal When high Low / slightly low but for a while now ... (other, personalized mid-states) Very low Blood glucose level Number value High / low / normal Trend Time in current status Number value Location Coordinates Insulin usage Quantity Timestamps for injections Low events Timestamps Response time Blood glucose level Line graph Messages partner / husband / wife Calls ambulance Ring Sensor Insulin pump husband Walgreens / CVS Care Manager (doctor / nurse) self hospital Low events: requires immediate intervention When Normal: High Events: requires monitoring and long term change of habits and behavior Twice a year review of data, adjustment of Insulin and / or of Roger’s diet