Personal Computer Programs to Assist with Self-Monitoring of Blood Glucose and Self-Adjustment of Insulin Dosage

Abstract

We have developed computer programs in compiled BASIC for the IBM-PC and compatible microcomputers for use by physicians, paramedical personnel, and/or patients to assist with self-monitoring of blood glucose (SMBG) and self-adjustment of insulin dosage. The programs can potentially assist with patient education and motivation, and provide: (1) a customized “electronic notebook” for storage and retrieval of information on blood glucose, insulin dosage, hypoglycemic reactions, urinary ketones, diet, activity, weight, illness, apparent explanations for hypoglycemic reactions or glucose values outside target ranges, and comments; (2) graphic displays of glucose and insulin versus date, and of a “glucose profile” versus time of day or versus day of the week; (3) simple and detailed statistical analyses; (4) a legible summary of data; (5) a facility to permit the physician to prepare a “customized treatment plan” for each patient, involving a choice of six regimens, target levels for each of eight time periods, four supplement tables (when well or sick, before meals, or at bedtime), rules to reduce insulin in response to hypoglycemic reactions or documented hypoglycemia, rules to increase routine insulin doses in response to persistent unexplained hyperglycemia, and rules when the patient should call the physician; (6) suggestions regarding compensatory supplements and adjustments of routine insulin dosage; (7) explanations why various insulin dosages should or should not be altered, and why various glucose values should be tested; (8) comparisons of the insulin dosage administered by the patient and the recommendations of the program, together with explanations for discrepancies offered by the patient, to help evaluate compliance. The program is “user-friendly,” easy to learn, and easy to use. A detailed plan for introduction of the program to the patient has been developed. Use of the program is flexible: it could be used several times a day (when monitoring glucose and adjusting insulin dosage), once a day (e.g., to enter the day's data and obtain suggestions for the following day), once every week or two (for data storage, evaluation of the recent degree of control, and analysis of patterns in the daily glucose profile), or once every 1–3 mo (before office visits, to prepare summaries, graphs, statistical analyses, and for retrospective comparison of patient's decisions with the program's recommendations). The advantages and limitations of the present program, approach, and design philosophy are discussed.