From London, Ontario, Canada:
Is it possible to create a computer software program that will calculate the amount of insulin a diabetic patient should take at any given time? (This would not be available to the public, I realize the legal issues involved.)
Theoretically yes, and no particular legal issue involved, at least in Europe! I do remember a decade ago a portable calculator was "filled in" with ad hoc algorithms to provide the patient the dose of insulin on the basis of previous stored blood sugars and insulin doses. It disappeared from the scientific community market very soon as it did a computer software program whose name I don't remember. The main reason for their evanescence was the many factors that influence the daily blood sugar fluctuations (such as insulin subcutaneous absorption and food glycemic index), as well as physical activity and caloric intake, whose fine tuning is dependent upon the patient's level of education about self management.
The future implantable pumps will probably be furnished with newer software programs to adjust the dose of insulin released by the pump on the basis of the blood sugar recorded by the pump sensor.
Additional Comment from Dr. O'Brien:There is a Florida-based program called Teledoc or Humalink. This is an algorithm based system which seems to work quite well for stable diabetics who have difficulty with physician or nurse educator access. It would not work for a single family because of the cost and in any case it is ill adapted to the rapid changes that make occurr in childhood. A good reference is Diab.Nutr.Metab. 10:45-59, 1997.
Original posting 16 Nov 97
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