Unexpectedly Intriguing!
March 17, 2009

8:50 AM PDT: We've been looking for a challenge, and by gosh, we found one this morning as we were catching up with our favorite industrial design blog, Core77. It would seem that Amy Tenderich of the DiabetesMine blog has launched a Design Challenge for 2009:

Welcome to the 2009 DiabetesMine™ Design Challenge, an online competition to encourage creative new tools for improving life with diabetes.

Do you have an idea for an innovative new diabetes device or web application? This is your chance to win up to $10,000 to realize your design concept, and potentially help transform life with diabetes for millions of people.

Sounds pretty good to us! The chance to win ten thousand dollars is a lot of incentive so why not go for it?

Better yet, why not do it "semi-live?" We'll launch this new project this morning, beginning at 8:50 AM Pacific Daylight Time and track our progress as we go from idea to execution. We'll conclude our activities for today with whatever we come up with to officially enter.

The Idea

9:00 AM PDT: The thing that really attracts us to this challenge, aside from the potential for winning prize money, is that the web application aspect falls right into our core competency - we build online tools that solve useful problems, or more specifically, tools that do useful math to solve problems. So that's where we'll direct our attention. Our first question: What kind of math do those with diabetes do on a regular basis?

To find out, we'll go to the Internet's leading tool for finding information: Google, and do a search for "diabetes math."

From here, we reviewed the top three links returned by Google, along with the key takeaways we see:

  1. Math in Medicine

    In the treatment of Diabetes, math is used all of the time. Don't let this title scare you, using math to help treat kids with Diabetes is really quite simple. It's as simple as Carbohydrates and units.

    This site really isn't useful beyond that insight.

  2. Math for Diabetes | Googol Learning

    I [Shayne B., Age 10 of Edmonton, Alberta] was diagnosed with type 1 diabetes two years ago. I use math every day to decide how much insulin I need and how much food I can eat for my meals.

    I need two injections of insulin each day. Each injection is made up of two types of insulin - fast acting and slow acting. I don't ever change the amount of slow acting insulin, but I have to change the amount of fast acting insulin based upon my blood sugar levels. I need one extra unit for every four points that my blood sugar is above eight. I have to use math to calculate how much extra insulin I need.

    I have to test my blood sugars at least four times every day. If my blood is not in the range of 3.5 to 15, then I have to either eat or have extra insulin. I have to use math to determine if I need to do something.

    I have to have three snacks and three meals each day. I need to measure the amount of carbohydrates in each. I have to read the package and add the carbohydrates together until I get the desired amount for each snack or meal. I have to use math to calculate the amount of carbohydrates per portion and add these portions together to get the right total.

    I really do use a lot of math in my life. Without knowing math, I wouldn't be able to live life as well as I can now.

    Math would appear to be highly necessary for diabetes patients - it's literally a quality of life issue....

  3. American Diabetes Association, Novo Nordisk Inc. Announce Grant ...

    American Diabetes Association, Novo Nordisk Inc. Announce Grant Recipients

    Award Winners to Conduct Educational and Behavioral Research

    Alexandria, VA (January 26, 2005) — The American Diabetes Association Research Foundation today announced two recipients of a $600,000 grant from Novo Nordisk Inc. The gift was presented to the Association to support peer-reviewed research on educational and behavioral approaches to diabetes management with an ultimate goal to improve the health outcomes of people with the disease.

    The recipients are Victor Montori, MD of the Mayo Clinic in Rochester, Minnesota and Russell Rothman, MD of Vanderbilt University in Nashville, Tennessee. Dr. Montori will investigate the use of a new tool, called Insulin Choice, designed to help patients and clinicians overcome the barriers that might prevent patients with type 2 diabetes from considering insulin therapy earlier in the course of treatment. Patients who require insulin, but do not opportunely incorporate it into their treatment plan, may be more likely to develop the serious complications of diabetes including heart disease, stroke, kidney disease, blindness, and nerve damage leading to amputations. Dr. Montori and his team anticipate that a decision-making tool such as Insulin Choice will lead to more opportune consideration of insulin therapy, resulting in improved patient outcomes.

    Dr. Rothman’s research will address the challenge of patient care for people with diabetes who have low literacy and/or numeracy (math) skills. These skills are particularly important to patients with diabetes because caring for diabetes often requires the daily application of math and reading skills, such as for counting carbohydrate grams, interpreting blood glucose monitoring, and applying insulin regimens. Dr. Rothman and his team will test the reliability and validity of a new scale, the Diabetes Numeracy Test, to measure diabetes related math skills in patients within the primary care setting. They also plan to demonstrate that a new educational program that teaches diabetes management skills that compensate for poor reading and math ability among diabetes patients will lead to better diabetes management..

    "This is an extremely important and often overlooked area of diabetes research," said Don Wagner, Chair of the American Diabetes Association Research Foundation. "We look forward to seeing the results of this innovative work which has the potential to lead to more effective strategies to improve diabetes management, as well as the overall health of people with diabetes.” He added, “We certainly appreciate the generous support of Novo Nordisk in making this research possible.”

    Diabetes is a chronic disease and a silent killer. 18.2 million Americans have diabetes and 1.3 million are newly diagnosed each year. Diabetes is the nation's fifth leading cause of death by disease, killing more than 213,000 people annually. A major risk factor for heart disease and stroke, diabetes is also the leading cause of blindness, kidney failure and non-traumatic limb amputations.

    This press release demonstrates both the need and the potential for an aid for doing the math related to treating diabetes with insulin.

Taking all these things together, it seems to us that a online web application that aid those with diabetes with determining what amount of insulin they need might be an ideal focus for our efforts. That's where we'll go next....


9:18 AM PDT: The next phase of this project is to see what kind of math an individual with diabetes needs to do to find their correct insulin dosage. But before we can go any farther, are there any online tools that already exist? Another Google search is in order, this time, we'll look for "insulin dosage calculator."

Here, we scanned through several pages of results. The top returned link "Free Insulin and Nutrition Tools surprisingly doesn't offer any online tools for calculating insulin dosage levels, so we may have hit on a promising area.

We find the "Mealtime Insulin Dose Calculator, which is an Excel spreadsheet - this one cries out for conversion to a web-based tool with a simple interface!

We also find a number of applications for calculating initial insulin dosages, which probably wouldn't apply to an individual who is already taking insulin and just needs to maintain certain levels of it in their bloodstream for optimal health. Ditto for intravenous insulin dose calculators, which would most likely be medically supervised. We also find a number of software applications that can be downloaded, but that are device specific, which limits their utility.

There's a patent application for an "Insulin-Dose Calculator Disk" from 2003, which once again suggest to us an opening for an online application - something that can be accessed anywhere the Internet is, from any device capable of accessing the Internet, such as a mobile phone. Doing a separate search for such a disk on the market, we find the InsuCalc Insulin Dosage Wheel, which considers some 12 different combinations of insulin-to-carbohydrate ratios and blood glucose correction scales. The device appears to have been available since 2005, but only to and through diabetes healthcare professionals, "who can instruct their patients on the proper use of the device and monitor its effectiveness".

We find that Medtronic has something called the "Bolus Wizard® Calculator," which appears to be a feature offered on the company's insulin pumps.

Finally, we hit "A Simple Insulin Dosage Calculator", in an article by Neil Bason. This device is essentially a programmed calculator, but the beauty here is that Neil provides an example of the math the calculator does! We'll use this math to build a "proof-of-concept" prototype of the kind of tool we envision.

Proof of Concept Prototype

9:53 AM PDT: This is where we'll be doing the magic that we do best. Ready. Set. Go....

10:09 AM PDT: Done. Here's the prototype interface:

Blood Sugar, Carbohydrate and Expected Activity Data
Input Data Values
Your Current Blood Sugar Reading
Your Target Blood Sugar Reading Level
Your Carbohydrate Intake [grams]
Your Ratio of Carbohydrates to Insulin Units
Your Expected Level of Physical Activity

Calculated Results Values
Number of Insulin Units for Dosage

And that's it. The prototype tool above represents a proof-of-concept of how we might be able to create an online application for calculating insulin dosage levels that would be accessible from any Internet-access capable device, from PCs to game consoles to mobile phones to electronic readers, etc.

In the meantime though, we ask that individuals currently treating their own diabetes condition continue to use whatever method their medical providers have specified for calculating insulin dosages. As we indicated in the research section, there are a lot of different factors that go into determining insulin dosage factors, which our proof-of-concept tool may not cover (for example, our "default" unit insulin dose reduces blood sugar by 55 points - other types of insulin dosages may affect blood sugar levels by a higher or lower amount.) Plus, there's an entire review process that this tool will need to pass through before it might be considered to be an appropriate method of calculating an individual's correct insulin dosage level.

From this point, all that's left for us is to assemble an entry package to submit to the contest. We'll see what comes of it!

Update (18 March 2008): Did some minor editing to better clarify:

  1. Where patients might obtain an InsuCalc insulin dosage wheel, and
  2. That there are other types of insulin that affect blood sugar levels to varying degrees, while
  3. Also specifying to what extent the "unit" insulin dosage used as the default for our tool reduces blood sugar levels.

What can we say? The endorphin rush of innovation really mucks up our ability to write as clearly as we can!

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