Systems and methods for determining insulin therapy for a patient

• US 10,046,113 B2
• Filed: 12/21/2012
• Issued: 08/14/2018
• Est. Priority Date: 12/21/2011
• Status: Active Grant

• Current Assignee: Monarch Medical Technologies, LLC (Capital Holdings LLC)
• Original Assignee: Monarch Medical Technologies, LLC (Capital Holdings LLC)
• Inventors: Ruchti, Timothy L., Burgess, William Patrick, Dumas, III, John, Lisiecki, Ronald, Martin, Carol Dian, Santana, Laura, Thornley, John Harrison, Watt, Joanne Marie
• Primary Examiner(s): Sirmons, Kevin C.
• Assistant Examiner(s): Legette-Thompson, Tiffany
• Application Number:
  US13/725,115
• Publication Number:
  US 20130165901A1
• Time in Patent Office: 2,062 Days
• Field of Search: 604504
• CPC Class Codes: A61B 5/14532 for measuring glucose, e.g. by tissue impedance measurement
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: G06Q 50/22 Social work or social welfare, e.g. community support activities or counselling services
• CPC Class Codes: G16H 10/40 for data related to laboratory analysis, e.g. patient specimen analysis
• CPC Class Codes: G16H 20/17 delivered via infusion or injection
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

In example methods and systems described, insulin therapy for a patient can be determined. At least one of a short-acting subcutaneous insulin dosage recommendation, a correction subcutaneous insulin dosage recommendation, an intravenous insulin dosage recommendation, a recommended amount of carbohydrates to be administered to the patient, or combinations thereof, can be determined. In addition, information indicating a confirmation of a nutrition intake for the patient, and a long-acting insulin-on-board for the patient can be received, and based on this information, a required long-acting subcutaneous or intravenous insulin dosage for the patient can be determined. The short-acting subcutaneous or intravenous insulin dosage recommendation can be adjusted based, at least in part, on a difference between the long-acting insulin-on-board and the required long-acting subcutaneous or intravenous insulin dosage.

Claims

1. A non-transitory computer readable medium having stored therein instructions executable by a computing device to cause the computing device to perform functions comprising:

receiving information associated with a glucose measurement value of a patient;

receiving information associated with anticipated nutrition intake for the patient;

receiving information indicating a short-acting insulin-on-board for the patient, wherein short-acting insulin-on-board is associated with an amount of short-acting insulin that remains in the patient due to a prior insulin administration;

based, at least in part, on the information associated with the glucose measurement value of the patient, the anticipated nutrition intake for the patient and the short-acting insulin-on-board, determining a short-acting subcutaneous insulin dosage recommendation;

or an intravenous insulin dosage recommendation;

receiving information indicating the confirmation of a nutrition intake for the patient;

receiving information indicating a long-acting insulin-on-board for the patient, wherein the long-acting insulin-on-board is associated with an amount of long-acting insulin that remains in the patient due to a prior insulin administration;

based, at least in part, on the information associated with the long-acting insulin-on-board for the patient, the glucose measurement value of the patient, and the confirmation of the nutrition intake for the patient, determining a required long-acting subcutaneous insulin dosage or a required intravenous insulin dosage for the patient;

adjusting the short-acting subcutaneous insulin dosage recommendation or intravenous insulin dosage recommendation based on a difference between the long-acting insulin-on-board and the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage, such that;

the short-acting subcutaneous insulin dosage recommendation or intravenous insulin dosage recommendation is lowered if the difference between the lone-acting insulin-on-board and the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage is less than a predetermined value and/or the long-acting insulin-on-board is greater than the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage; and

the short-acting subcutaneous insulin dosage recommendation or intravenous insulin dosage recommendation is increased if the difference between the long-acting insulin-on-board and the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage is greater than the predetermined value and/or the long-acting insulin-on-board is less than the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage; and

outputting an indication of the required long-acting subcutaneous insulin dosage, the short-acting subcutaneous recommendation or intravenous insulin dosage recommendation, or the required intravenous insulin dosage recommendation.

2. The non-transitory computer readable medium of claim 1, wherein the instructions are executable to cause the computing device to further perform functions comprising:

receiving information indicating a confirmation of a last insulin dose given subcutaneously to the patient; and

determining at least one of the short-acting subcutaneous insulin dosage recommendation, the intravenous insulin dosage recommendation, the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage for the patient, or combinations thereof, based at least in part on the confirmation of the last insulin dose given subcutaneously to the patient.

3. The non-transitory computer readable medium of claim 1, wherein the instructions are executable to cause the computing device to further perform functions comprising:

receiving information indicating demographics of the patient;

receiving information indicating a serum creatinine level of the patient;

determining an estimated glomerular filtration rate (eGFR) of the patient based, at least in part, on the demographics and the serum creatinine level of the patient; and

determining at least one of the short-acting subcutaneous insulin dosage recommendation, the intravenous insulin dosage recommendation, the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage, or combinations thereof, for the patient based on the eGFR of the patient.

4. The non-transitory'"'"' computer readable medium of claim 1, wherein the instructions are executable to cause the computing device to further perform functions comprising:

receiving information indicating a total daily dosage amount for the patient of short-acting insulin and long-acting insulin, and determining at least one of the short-acting subcutaneous insulin dosage recommendation, the intravenous insulin dosage recommendation, the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage, or combinations thereof, for the patient based, at least in part, on the total daily dosage amount for the patient of short-acting insulin and long-acting insulin.

5. The non-transitory computer readable medium of claim 1, wherein the instructions are executable to further cause the computing device to perform functions comprising:

receiving information indicating drugs administered to the patient including one or steroids and antibiotics; and

determining at least one of the short-acting subcutaneous insulin dosage recommendation, the intravenous insulin dosage recommendation, the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage, or combinations thereof, for the patient based, at least in part, on the information indicating drugs administered to the patient.

6. The non-transitory computer readable medium of claim 1, wherein the anticipated nutrition intake for the patient includes information indicating a timing and rate of a feeding tube feeding, wherein nutrition administered via the feeding tube has a known concentration of carbohydrates and a known timing and volume rate.

7. The non-transitory computer readable medium of claim 1, wherein the instructions are executable to cause the computing device to further perform functions comprising:

receiving information indicating whether a postprandial emesis has occurred; and

determining at least one of the short-acting subcutaneous insulin dosage recommendation, the intravenous insulin dosage recommendation, the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage, or combinations thereof, for the patient based, at least in part, on the information indicating whether a postprandial emesis has occurred.

8. The non-transitory computer readable medium of claim 1, wherein the instructions are executable to further cause the computing device to perform functions comprising:

receiving information indicating intravenous (IV) therapy provided to the patient; and

determining at least one of the short-acting subcutaneous insulin dosage recommendation, the required long-acting subcutaneous insulin dosage, or combinations thereof, for the patient based, at least in part, on the information indicating IV therapy provided to the patient.

9. The non-transitory computer readable medium of claim 1, wherein the instructions are executable to further cause the computing device to perform functions comprising:

receiving underlying patient-specific control variables for the patient determined based, at least in part, on (i) a therapy provided for the patient and (ii) an observed patient-specific response to the therapy;

based, at least in part, on the underlying patient-specific control variables for the patient, determining an amount of insulin used per day by the patient and an insulin sensitivity factor; and

determining at least one of the short-acting subcutaneous insulin dosage recommendation, the intravenous insulin dosage recommendation, the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage for the patient, or combinations thereof, based, at least in part, on the amount of insulin used per day by the patient and the insulin sensitivity factor.

10. The non-transitory computer readable medium of claim 1, wherein the instructions are executable to further cause the computing device to perform functions comprising:

determining a recommended amount of carbohydrates to be administered to the patient when a value of the short-acting insulin-on-board, long-acting insulin-on-board, or a combination thereof is in excess.

11. The non-transitory computer readable medium of claim 1, wherein the instructions are executable to cause the computing device to further perform functions comprising:

determining the short-acting subcutaneous insulin dosage recommendation when the patient is anticipated to consume a quantity of carbohydrates.

12. The non-transitory computer readable medium of claim 1, wherein the instructions are executable to further cause the computing device to perform functions comprising:

determining a correction subcutaneous insulin dosage recommendation when the glucose measurement value of the patient is not within a target range.

13. The non-transitory computer readable medium of claim 1, wherein the instructions are executable to further cause the computing device to perform functions comprising:

determining a recommended amount of carbohydrates to be administered to the patient when a value of the short-acting insulin-on-hoard is zero and there is a remaining difference between the long-acting insulin-on-board and a required insulin-on-board due to the prior insulin administration.

14. The non-transitory computer readable medium of claim 1, wherein the instructions are executable to further cause the computing device to perform functions comprising:

receiving information indicating total parenteral nutrition (TPN) provided to the patient, and determining at least one of the short-acting subcutaneous insulin dosage recommendation, the intravenous insulin dosage recommendation, the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage, or combinations thereof, for the patient, based, at least in part, on the information indicating TPN provided to the patient.

15. The non-transitory computer readable medium of claim 14, wherein the information indicating the TPN includes a known concentration of carbohydrates and a known concentration of insulin in the TPN provided to the patient at a known volume rate, expressed as milliliters per hour or liters per day.

16. The non-transitory computer readable medium of claim 1, wherein the instructions are executable to further cause the computing device to perform functions comprising:

providing a graphical user interface (GUI) to display information divided based on a category of input, the categories including information;

associated with the glucose measurement value of the patient;

associated with the anticipated nutrition intake for the patient;

indicating the short-acting insulin-on-board for the patient;

indicating a confirmation of a nutrition intake for the patient; and

indicating a long-acting insulin-on-board for the patient, wherein long-acting insulin-onboard is associated with an amount of long-acting insulin that remains in the patient due to a prior insulin administration; and

providing on the GUI a display of the required long-acting subcutaneous insulin dosage, and the short-acting subcutaneous insulin dosage recommendation to be administered to the patient.

17. The non-transitory computer readable medium of claim 16, wherein the instructions are executable to further cause the computing device to perform functions comprising:

providing on the GUI a startup screen including selectable protocols, wherein the selectable protocols include a glucose measurement schedule, an insulin therapy schedule, and a nutritional plan; and

providing the categories of input based, at least in part, on at least one protocol selected.

18. The non-transitory computer readable medium of claim 1, wherein said adjusting the short-acting subcutaneous insulin dosage recommendation or intravenous insulin dosage recommendation based on a difference between the long-acting insulin-on-board and the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage is performed using an insulin effect curve.

19. The non-transitory computer readable medium of claim 18, wherein the insulin effect curve is an eGFR corrected insulin effect curve.

20. A method for determining a patient therapy, the method comprising:

receiving information associated with a glucose measurement value of the patient,

receiving information associated with anticipated nutrition intake for the patient;

receiving information indicating a short-acting insulin-on-board for the patient, wherein short-acting insulin-on-board is associated with an amount of short-acting insulin that remains in the patient due to a prior insulin administration;

based, at least in part, on the information associated with the glucose measurement value of the patient, the anticipated nutrition intake for the patient and the short-acting insulin-on-board, determining a short-acting subcutaneous insulin dosage recommendation, or an intravenous insulin dosage recommendation;

receiving information indicating a confirmation of the nutrition intake for the patient;

receiving information indicating a long-acting insulin-on-board for the patient, wherein long-acting insulin-on-board is associated with an amount of long-acting insulin that remains in the patient due to a prior insulin administration;

based, at least in part, on the information associated with the long-acting insulin-on-board for the patient, the glucose measurement value of the patient, and the confirmation of the nutrition intake for the patient, determining a required long-acting subcutaneous insulin dosage or a required intravenous insulin dosage for the patient;

adjusting the short-acting subcutaneous insulin dosage recommendation or intravenous insulin dosage recommendation based, at least in part, on a difference between the long-acting insulin-on-board and the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage, such that;

the short-acting subcutaneous insulin dosage recommendation or intravenous insulin dosage recommendation is lowered if the difference between the long-acting insulin-on-board and the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage is less than a predetermined value and/or the long-acting insulin-on-board is greater than the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage; and

the short-acting subcutaneous insulin dosage recommendation or intravenous insulin dosage recommendation is increased if the difference between the long-acting insulin-on-board and the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage is greater than the predetermined value and/or the long-acting insulin-on-board is less than the required lone-acting subcutaneous insulin dosage or the required intravenous insulin dosage; and

outputting an indication of the required long-acting subcutaneous insulin dosage, the short-acting subcutaneous insulin dosage recommendation, or the intravenous insulin dosage recommendation.

21. The method of claim 20, further comprising:

receiving information indicating drugs administered to the patient including steroids; and

determining at least one of the short-acting subcutaneous insulin dosage recommendation, the intravenous insulin dosage recommendation, the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage for the patient, or combinations thereof, based, at least in part, on the information indicating drugs administered to the patient.

22. The method of claim 20, further comprising receiving information indicating demographics of the patient;

receiving information indicating a serum creatinine level of the patient;

determining an estimated glomerular filtration rate (eGFR) of the patient based, at least in part, on the demographics and the serum creatinine level of the patient; and

determining at least one of the short-acting subcutaneous insulin dosage recommendation, the intravenous insulin dosage recommendation, the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage for the patient, or combinations thereof based, at least in part, on the eGFR of the patient.

23. A system for determining a patient therapy, the system comprising:

at least one processing unit;

memory storing instructions executable by the at least one processing unit for carrying out functions, the functions comprising;

receiving information associated with a glucose measurement value of the patient;

receiving information associated with anticipated nutrition intake for the patient, receiving information indicating a short-acting insulin-on-board for the patient, wherein short-acting insulin-on-board is associated with an amount of short-acting insulin that remains in the patient due to a prior insulin administration;

based, at least in part, on the information associated with the glucose measurement value of the patient, the anticipated nutrition intake for the patient and the short-acting insulin-on-board, determining a short-acting subcutaneous insulin dosage recommendation, or an intravenous insulin dosage recommendation to be administered to the patient;

receiving information indicating the confirmation of a nutrition intake for the patient, receiving information indicating a long-acting insulin-on-board for the patient, wherein long-acting insulin-on-board is associated with an amount of long-acting insulin that remains in the patient due to a prior insulin administration;

based, at least in part, on the information associated with the long-acting insulin-on-board for the patient, the glucose measurement value of the patient, and the confirmation of the nutrition intake for the patient, determining a required long-acting subcutaneous or a required intravenous insulin dosage for the patient;

adjusting the short-acting subcutaneous insulin dosage recommendation or intravenous insulin dosage recommendation based, at least in part, on a difference between the long-acting insulin-on-board and the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage, such that the short-acting subcutaneous insulin dosage recommendation or intravenous insulin dosage recommendation is lowered if the difference between the long-acting insulin-on-board and the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage is less than a predetermined value and/or the long-acting insulin-on-board is greater than the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage; and

the short-acting subcutaneous insulin dosage recommendation or intravenous insulin dosage recommendation is increased if the difference between the long-acting insulin-on-board and the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage is greater than the predetermined value and/or the long-acting insulin-on-board is less than the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage; and

outputting the required long-acting subcutaneous insulin dosage, the short-acting subcutaneous recommendation or intravenous insulin dosage recommendation, the intravenous insulin dosage recommendation, or combinations thereof to be administered to the patient.

24. The system of claim 23, wherein the instructions are executable to further perform functions of:

receiving information indicating drugs administered to the patient including one or steroids and antibiotics, and determining at least one of the short-acting subcutaneous insulin dosage recommendation, the intravenous insulin dosage recommendation, and the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage for the patient based on the information indicating drugs administered to the patient.

25. The system of claim 23, wherein the instructions are executable to further cause the at least one processing unit to perform functions comprising:

receiving information indicating demographics of the patient;

receiving information indicating a serum creatinine level of the patient;

determining an estimated glomerular filtration rate (eGFR) of the patient based, at least in part, on the demographics and the serum creatinine level of the patient; and

determining at least one of the short-acting subcutaneous insulin dosage recommendation, the intravenous insulin dosage recommendation, the required long-acting subcutaneous insulin dosage or the required intravenous insulin dosage for the patient, or combinations thereof, based, at least in part, on the eGFR of the patient.