It might help to remember that Insulin Therapy AnalysisTM is endorsed and used by a current member of the Board of Directors of the AADE, Dr. Richard Guthrie, MD, CDE. Dr. Guthrie is one of the principal authors of the AADE's "bible" on Diabetes Education: A Core Curriculum for Diabetes Educators. Diabetes Online is extremely proud of such this powerful endorsement.

So here we go...

First, a few warnings:

Do not mistake these results for your regime!

Remember, you are looking "under the hood" to see how ITA handles Kenneth M's personal regime.

If you see things that you think might apply to you, GO SEE YOUR DOCTOR!

Please respect the above WARNINGS, OK?

So here we go...

For your convenience, here is Ken M's real life regime as he submitted it.

Regime	Client's own description
INSULIN Schedule    7:30 AM X units H; 3 hr duration 12:00 PM X+1 units H; 3 hr duration 6:00 PM X+4 units H; 3 hr duration 11 PM 25 units N; 24 hr. duration   FOOD Schedule (grams of Carbohydrates) 7 :30 AM Breakfast 60 grams. 12:00 PM Lunch 90 grams. 6:00 PM Dinner 90 grams. 11:00 PM Snack 15 grams.	Lows tend to be before breakfast 95 Also has lows tend to be before Lunch 95 Highs occur ...2 1/2 hours (after) dinner average about 180. Lows are before breakfast and before lunch with an average around 95. My highest reading in the last month was 233, I think I missed on my carb count (eating out)...   ...."I have never had a reading below 80"

Below is the ITA computer screen of KenM's regime. (This is exactly what you would see on your own computer when you click on the Graphs button).

Another printout from ITA Diabetes Simulation: KenM's regime

This top plot shows simulated blood glucose levels (figure 1a)   This middle plot shows: Carb Loading (figure 2a) This bottom graph shows: Available Insulin (bolus) (figure 3a)

The top plot (figure 1a) is often the most important graphic: It's where YOU would see YOUR expected blood sugar levels if you had typed in YOUR food and insulin.

Then I took that very important top plot, and prettied it up so I could highlight some of the important things that ITA is communicating. Please, compare FIGURE 1A (below) with figure 1a (above) with , you'll see it is exactly that same figure 1a.

This is what medicine expects should happen, based on Ken M's real life food/insulin regime.
	This is the top plot from the ITA simulation. This shows simulated blood glucose levels (figure 1a)
FIGURE 1A: This is KenM's predicted blood sugars (annotated).

This, the middle plot from above (figure 2a), shows CARB LOADING:

	ITA tracks the battle between food pushing his blood sugar levels up..
FIGURE 2A (above), annotated for emphasis and clarity, shows carb loading.
And FIGURE 3A (below) shows available insulin. (bolus)
	..combatted by insulin pushing blood sugar levels down ..
Figure 3A, available insulin, annotated for emphasis and clarity.

WOW!

Now, now THAT'S more like it!

This *feels right*: It even clearly shows how KenM's overlapping insulins compare with coverage for his carbohydrates. This shows him ok in the morning, with wider fluctuation in the afternoons.

....... ITA ENABLES intelligent analysis ......

Yes, with ITA, you can do a "what if" analysis on your computer.

Sorry, but I've chosen NOT to investigate possible improvements to KenM's IDDM regime.

The primary reason revolves around the fact that his existing regime involves a LOT of Humalog, far more than a physician or Lilly would probably recommend.

The following information highlights this "insensitivity" issue:

Looking again at KenM's expected bG levels:

	I think that KenM's Low sensitity to Insulin indicates that KenM is "in the Groove"
Look at the text which shows a very low (15 mg/dl) sensitivity to Insulin.

When I say that KenM is probably "in the groove", I mean that KenM's "body" is probably providing a lot more "dampening" than one could expect from this insulin/food regime. My reasoning can be gleaned from the information presented below:

What are the usual Average sensitivities to food and to insulin?

14 grams Carbs=1unit of Insulin. (Appropriate response if: I eat an extra 14 grams of food, I need one extra unit of insulin.)
40 mg/dl Blood Glucose=1unit of Insulin. (Appropriate response if: I take one extra unit of Insulin, my bG levels will drop about 40 mg/dl.)

The USUAL range of sensitivities are:

Between 8 and 20 grams Carbs=1unit of Insulin

8 = sensitive to food
20 = insensitive to food
Sensitivity used for KenM's regime: 8

Between 30 and 50 mg/dl Blood Glucose=1unit of Insulin

30 = insensitive to Insulin
50 = sensitive to Insulin
Sensitivity used for KenM's regime simulaton: 15

If KenM is THAT insensitive (15 mg/dl bg = 1 unit of Insulin) to insulin, and if he uses THAT much Insulin, then either:

a) some of KenM's Humalog is being used by his body as basal (baseline) insulin. (Published information from Eli Lilly says this is impossible!)

... or

b) KenM's physiology is providing an unusual amount of dampening of the insulin/carb interaction.

... or

c) other...???

Any suggestions here?

This regime does fit into the category of "Poor Man's Insulin Pump" because it uses a 24 hour insulin to handle baseline needs, coupled with "short acting insulin with each meal" to handle bolus requirements. However, since 24 hours is a lot longer that one would expect out of NPH, and since KenM apparently has such a low sensitivity to additional insulin, I think I'll reserve the "Poor Man's Pump" space for a later presentation that involves Ultralente and Regular, or Ultralente and Humalog. I'll try to get that presentation up on the DiabetesOnline web site soon. Keep on checking back!

Part 2 was meant to be a technical discussion touching on some of the medical algorithms and concepts that ITA uses. Please don't be intimidated by 'LOOKING UNDER THE HOOD!" Please, look at Part 1 to see how easy ITA is to use!