Normo Glyco Bot (Insulin Adjustment for Type Diabetes Mellitus)

Normo-Glyco-Bot

Note: The Normo-Glyco-Bot is designed to help adjust insulin for patients with Type 2 Diabetes Mellitus who take both long- and short-acting insulin.  This is also called a 'Basal-Bolus' Plan.  For Part One, it changes Basal (Long Acting) Insulin on the basis of morning/fasting blood sugars.  For Part Two, it makes a mealtime correction sliding scale for Bolus (Short Acting) Insulin on the basis of your Insulin Sensitivity Factor calculated from the total dose of Basal (Long Acting) Insulin.  An even better way to adjust insulin is to use Carb Counting [link memo="*more information*" url="http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/carbohydrate-counting.html"], but this is better than nothing.  Suggestion:  Save and/or print out the result and use Normo-Glyco-Bot to adjust insulin once per week.

[text name="Variable_1" default="0" size=2] <-- What is your current dose of long-acting insulin (in units)
[select name="Variable_2" value="every morning=1|every evening=1|every morning and evening=2"] <-- How often do you take long-acting insulin?

[select name="Variable_3" value="no=0|YES=1"] <-- Have you checked blood sugars before breakfast on three (3) different days recently?
[conditional field="Variable_3" condition="(Variable_3).is('YES=1')"][select name="Variable_4" value="no=0|YES=3"] <-- Were ALL three blood sugar tests above 130 mg/dL?[/conditional]
[conditional field="Variable_3|Variable_4" condition="(Variable_4).is('no=0')&&(Variable_3).is('YES=1')"][select name="Variable_5" value="no=0|YES=-3"] <-- Were ANY of the three blood sugar tests less than 80 mg/dL?[/conditional]
[comment memo="Please skip down to 'Calculate Result' to generate dosing recommendations" memo_color="orange" memo_style="bold"]

------------------------------- PART ONE - RESULT - BELOW -------------------------------
PART ONE: ADJUSTING YOUR OWN INSULIN - BASAL/LONG-ACTING (Detemir, Glargine, or NPH Insulin)

SUGGESTION --> [conditional field="Variable_3|Variable_4" condition="(Variable_4).is('YES=3')&&(Variable_3).is('YES=1')"] New dose is [calc value="scoreA=(Variable_1)+(Variable_4)" memo="xxx"] units [var name="Variable_2" memo="time"] (Dose is INCREASED because of three days ABOVE goal)[/conditional][conditional field="Variable_3|Variable_5" condition="(Variable_5).is('YES=-3')&&(Variable_3).is('YES=1')"] New dose is [calc value="scoreB=(Variable_1)+(Variable_5)" memo="xxx"] units [var name="Variable_2" memo="time"] (Dose is DECREASED because of three days BELOW goal)[/conditional][conditional field="Variable_3|Variable_4|Variable_5" condition="(Variable_3).is('YES=1')&&(Variable_5).is('no=0')&&(Variable_4).is('no=0')"] [calc value="scoreC=(Variable_1)+(Variable_5)+(Variable_4)" memo="xxx"] units [var name="Variable_2" memo="time"] (Dose is UNCHANGED because of three days AT goal)[/conditional][conditional field="Variable_3" condition="(Variable_3).is('no=0')"] Continue [calc value="(Variable_1)" memo="xxx"] units [var name="Variable_2" memo="time"] (Dose is UNCHANGED because there were NO blood sugar checks) [/conditional]
------------------------------- PART ONE - RESULT - ABOVE -------------------------------

------------------------------- PART TWO - RESULT - BELOW -------------------------------
PART TWO: ADJUSTING YOUR OWN INSULIN - BOLUS/SHORT-ACTING CORRECTION SLIDING SCALE (Aspart Insulin)

This Sliding Scale uses your Insulin Sensitivity Factor (ISF): [calc value="score0=((1700)/((Variable_1)*(Variable_2)));score0>0?'':''"][calc value="score1=score0.toFixed(2)" memo="ISF"]
The ISF means that one unit of insulin would be expected to lower the blood sugar by [calc value="score2=score0.toFixed(2)" memo="xxx"] mg/dL.

CORRECTION ASPART INSULIN BEFORE A MEAL
BLOOD SUGAR....................... ACTION
GREATER THAN 400 mg/dL............ Give [calc value="score3a=((270)/(score0));score0>0?'':''"][calc value="score3b=score3a.toFixed(0)" memo="xxx"] units and seek medical attention.
350 TO 399 mg/dL.................. Give [calc value="score4a=((220)/(score0));score0>0?'':''"][calc value="score4b=score4a.toFixed(0)" memo="xxx"] units. 
300 TO 349 mg/dL.................. Give [calc value="score5a=((170)/(score0));score0>0?'':''"][calc value="score5b=score5a.toFixed(0)" memo="xxx"] units. 
250 TO 299 mg/dL.................. Give [calc value="score6a=((120)/(score0));score0>0?'':''"][calc value="score6b=score6a.toFixed(0)" memo="xxx"] units.
200 TO 249 mg/dL.................. Give [calc value="score7a=((70)/(score0));score0>0?'':''"][calc value="score7b=score7a.toFixed(0)" memo="xxx"] units.
150 TO 199 mg/dL.................. Give [calc value="score8a=((20)/(score0));score0>0?'':''"][calc value="score8b=score8a.toFixed(0)" memo="xxx"] units.
LESS THAN 60 mg/dL................ Take 6 ounces of juice and seek medical attention.
------------------------------- PART TWO - RESULT - ABOVE -------------------------------

[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
references: 
The "Rule of 1500" and "Rule of 1700" were developed by Dr. Paul C. Davidson at the Diabetes Center in Atlanta. 
[link url="http://www.ncbi.nlm.nih.gov/pubmed/21544273" memo="#1"] Guthrie DW, Guthrie RA, Hinnen D, Childs BP. It’s time to abandon the sliding scale. J Fam Pract.
[link url="https://www.ncbi.nlm.nih.gov/pubmed/19515182" memo="#2"] Blonde L, Merilainen M, Karwe V, Raskin P; TITRATE Study Group. (2009) Diabetes Obes Metab. 11(6):623-31.[/conditional]