Insulin Therapy Simulator. Testing. Part 2
The previous article looked at testing the insulin therapy simulator at the first level of complexity – the pump is set up correctly (UK – carbohydrate coefficient, BP – basal profile and FSI – insulin sensitivity factor).
Today we will consider the second level of complexity in automatic mode (the generated task is not adjusted by the teacher). The task of the second level of complexity is to configure the BP.
Basal profile – this is the amount of insulin that compensates the body for its basic need for insulin, regardless of food intake.
Possible levels of simulator difficulty are shown in the table.
It is assumed that both the doctor and the patient should be able to do this adjustment. This is due to the need to periodically adjust the BP depending on various factors (disease, hormonal changes).
The last column “Pump Interface” means that the BP can only be changed in the pump interface. This is interesting at the first two difficulty levels. At subsequent difficulty levels, bolus administration and basal profile adjustments are carried out in a simplified mode, and all the emphasis is on selecting values.
Let's generate a virtual patient in the task generator and save it under the name “Ivan”. In the task selection menu, we are offered a description and conditions for execution. The first item in the task description is the selection of a basal profile, which is what we need. Item 4 assumes disabling the sensor calibration request. The calibration request is present by default only at the first level, and then it is disabled to focus on the selection of values.
The transition to a pump is always carried out from the option of multiple injections using syringe pens. Therefore, it is high time to use the calculator for switching to pump insulin therapy available in the simulator. We enter our initial data and receive approximate options for setting up the pump. We are only interested in BP 0.45 U/h.
We return to our task in the simulator and configure the power supply.
The total daily base was 10.8 U. Then we start rewinding in time. The glucose value gradually decreases and a message about low GK pops up. Nothing critical yet, we rewind further and by breakfast we get values of 4 mM/l, with an initial 5.5 mM/l.
For breakfast, you can eat some more for further experiments (a little carbohydrate was eaten without a bolus). After eating, the glucose value was 8.6 mM/l. We continue the experiment. The glucose value continues to decrease steadily. It's time to act, let's reduce the value by 0.2 U/h. When trying to rewind the next time, the simulator displays a window about the successful completion of the task. But we were unable to see the straight glucose line.
This task turned out to be very simple for several reasons. Firstly, the task generator made the same base for the entire day, it did not include the “morning dawn” effect.
Morning dawn – a term from the lexicon of endocrinologists, referring to a condition in which a patient with type 1 diabetes requires a very early morning injection of short-acting insulin.
Secondly, to be more connected to life, the task generator has approximately the same logic as the transition calculator, only a small variability within the tolerance has been added. Thirdly, for more interesting tasks, it was possible to manually adjust the BP proposed by the task generator (lower insulin requirement during the day, maximum base in the evening, etc.). The main conclusion that is proposed to be made: the insulin pump therapy simulator is a tool that helps to understand the basics of setting up insulin pumps and the principles of diabetes management.
