Abstract:
The method and system for managing a patient&#39;s blood glucose level predicts an insulin dosing rate to bring a patient&#39;s blood glucose level into a preferred target range within a predetermined time interval. The system includes a processor which actuates a blood glucose computer program to measure and predict the patient&#39;s blood glucose level. An input mechanism allows for insertion of a preferred target range of the patient&#39;s blood glucose level and further permits input of various patient data parameters. The processor calculates the optimum insulin dosing rate for the patient based upon the type of insulin dosing whether it be intravenous dosing and/or subcutaneous dosing. A display mechanism displays the patient dosing parameters and an alarm mechanism alerts a user when the patient&#39;s blood glucose level is outside of the preferred patient blood glucose target range.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     Maintaining blood glucose levels of a patient within a preferred target range is extremely important in the physical well being of a patient. Blood-glucose levels of a patient may be external to a preferred target range for a patient due to a number of factors including a genetic abnormality, trauma due to injury, and conditions arising from surgical procedures as well as a number of other physical factors.  
         [0002]     High blood glucose levels are defined as hyperglycemia which may occur at any time when a patient&#39;s blood glucose level is above a preferred target range. Hyperglycemia may be caused by having too much glucose and/or not enough insulin in the body. Symptoms of diabetes are the same as the symptoms for hyperglycemia where diabetes itself may cause hyperglycemia.  
         [0003]     Hypoglycemia may occur at any time when a patient&#39;s blood glucose is below a preferred target range and is generally caused by not having enough glucose in the body to bring the patient&#39;s blood glucose level into the preferred target range.  
         [0004]     The subject invention concept is directed to an automated system which allows for predicting in an optimal manner the insulin dosing rate to bring a patient&#39;s blood glucose level into a preferred target range over some predetermined time interval.  
         [0005]     Management of a patient&#39;s blood glucose level is extremely important in diabetic patients where blood glucose levels outside of a preferred target range may cause serious health complications including heart disease, blindness, kidney failure and extremity amputations.  
         [0006]     The treatment of diabetes may differ as to the particular type of diabetes from which a patient may be diagnosed. Dosing rates dependent on the type of diabetes will vary and is an important factor in bringing a patient&#39;s blood glucose level into a preferred target range.  
         [0007]     Type 1 diabetes has been referred to as insulin-dependent diabetes mellitus or juvenile-onset diabetes, which is developed when the body&#39;s immune system destroys pancreatic beta cells which make hormone insulin that regulates blood glucose.  
         [0008]     Type 2 diabetes has been previously referred to as non-insulin dependent diabetes mellitus or adult-onset diabetes. This type of diabetes is usually initiated as insulin resistance where the cells do not properly use the insulin provided by the body.  
       FIELD OF THE INVENTION  
       [0009]     This invention is directed to a system and method for measuring and predicting optimal insulin dosing rates in order to bring a patient&#39;s blood glucose level into a preferred target range.  
         [0010]     The subject invention is directed to a system having a computer-directed formula system for evaluation of the current as well as cumulative patient blood glucose values. Based upon the aggregate of the measurements computed by the computer system. A calculation is provided and a recommended insulin dosing rate is predicted to drive the blood glucose level of the patient into the predetermined target range.  
         [0011]     The subject invention is further directed to a portable system whereby the attending physician and/or caregiver is given an alarm or otherwise alerted to the fact that the patient&#39;s blood-glucose level is external to a preferred target range.  
         [0012]     The subject invention further relates to a system and method whereby information derived from the calculated blood-glucose dosing rate may be transmitted automatically to an external station which may be through a wireless transmission or a hard linkage to some remote station printer, computer server, or other information receiving system.  
         [0013]     The invention relates to a computer-directed formula system for evaluation of optimum blood glucose dosing rates to a patient which includes both intravenous and/or subcutaneous dosing conditions for the patient.  
         [0014]     Still further, the subject invention directs itself to a method and system for prediction and management of the blood dosing rate of a patient wherein calculations may be performed as to whether it is a pre-prandial or post-prandial state.  
         [0015]     More in particular, the subject invention system and method is directed to which re-evaluates the patient&#39;s optimum dosing rate dependent upon prior blood glucose readings and predicts a dosing rate to bring the patient&#39;s blood-glucose level within the preferred target range within a predetermined time interval.  
         [0016]     Additionally, the subject invention relates to a method and system where a patient&#39;s diabetes condition, whether a Type 1 or Type 2 diabetic is taken into account in the prediction of the dosing rate to be administered.  
         [0017]     Further, the subject invention directs itself to a method and system where the dosing rate to be administered is calculated to include pre-prandial or post-prandial states.  
       PRIOR ART  
       [0018]     Various systems and methods for measuring and predicting insulin dosing rates have been used in the prior art. In some prior art predictions, a simple equation of the form of blood glucose level of the patient minus a constant which stayed fixed were multiplied by some type of multiplier which was generally protocol dependent based upon the input of the attending physician or the caregiver. Such prior art methods produced predictions of future time interval blood glucose levels which were far out of range of a patient&#39;s standard blood glucose reading.  
         [0019]     In some prior art systems and methods, the attending physician or caregiver provides for a dosing rate which is based upon an initial time interval and does not take into account changes in the patient&#39;s physical parameters during that time interval leading to an over shoot or under shoot of the blood glucose levels of the patient at the end of the time interval.  
         [0020]     In other systems relating to intravenous insulin protocols, there is the disadvantage that the blood glucose levels are required on a variable schedule and are difficult to reproduce without a timing and alarm mechanism.  
         [0021]     With respect to other prior art protocols for intravenous insulin dosing, the patient may not take intermittent meals of carbohydrates since this titrates up the insulin dosing rate which then carries on beyond the availability of the substrate.  
         [0022]     In other prior art systems, methods and protocols used for predicting blood glucose levels of patients, there is no iterative procedure taken for differing time intervals which leads to a non-optimal dosing rate for the blood glucose dosing rate for the patient.  
         [0023]     In other prior art systems and methods, there is no methods for measurements, predictions and protocols for insulin dosing rates, there is no provision made for providing an alarm to the attending physician and/or the caregiver to alert them that a patient&#39;s blood glucose level is out of range of the preferred blood-glucose target range.  
         [0024]     In some other prior art systems and methods for measuring and predicting blood glucose levels in a patient, there is no provision for the portability of the overall system to allow the attending physician and/or caregiver the ability to permit movability from one patient to another.  
         [0025]     In other prior art systems for the measuring and predicting of blood glucose levels in patients, there is no automatic system which transfers the patient&#39;s dosing rate data to an external device at a remote station.  
         [0026]     In some other methods and systems for measuring and predicting the glucose levels in a patient, there is no ability to transfer between intravenous dosing and subcutaneous dosing at the discretion of the attending physician and/or caregiver.  
       SUMMARY OF THE INVENTION  
       [0027]     The subject invention is directed to a system for measuring and predicting optimum insulin dosing rate to bring a patient&#39;s blood glucose level into a preferred target range in order to more effectively manage a patient&#39;s blood glucose levels.  
         [0028]     The measuring and predicting system includes a computer-directed formulation system which evaluates the current and well as cumulative patient blood glucose values and then based upon the aggregate of the measurements, calculates and recommends the insulin dosing rate to drive the patient&#39;s blood glucose level into the preferred blood glucose target range. The computer-directed formulation system may be applied to various devices, including, for example, IV infusion pumps, insulin pumps, glucose meters and glucose sensors.  
         [0029]     The subject system and method includes an iterative process where the patient&#39;s blood glucose level is measured at predetermined time intervals and calculates the recommended dosing rate based upon whether the patient is being treated intravenously or subcutaneously.  
         [0030]     The subject invention is further directed to a blood-glucose monitoring system where the attending physician and/or care provider is provided with alarms both visual and/or audio when the blood glucose level of the patient is external to the preferred target range.  
         [0031]     An object of the subject invention is to provide a system for measuring and predicting an insulin dosing rate dependent upon whether or not an intravenous dosing, a subcutaneous dosing or an intravenous and subcutaneous dosing is applied to the patient.  
         [0032]     A further object of the subject invention is to provide a system and method whereby the dosing of insulin is optimized based upon the blood glucose level of the patient and a preferred target range for the blood glucose level.  
         [0033]     A still further object of the invention is to provide a measurement and prediction system which is portable in nature and can be coupled to a variety of external computer system through either a direct connection or through a wireless transmission to a remote station.  
         [0034]     The subject invention includes a method of measuring and predicting a subcutaneous insulin dosing rate to bring a patient&#39;s glucose level into a preferred target range where a processor is established to actuate a subcutaneous computer program for measurement and prediction of the patient&#39;s blood glucose level.  
         [0035]     The subject invention method includes the input of predetermined patient data into the processor which includes the patient target range as well as the patient&#39;s weight and other physical parameters.  
         [0036]     The subject invention method is directed to the measurement and prediction of a subcutaneous insulin dosing rate which calculates the optimum insulin dosing rate dependent upon whether the calculation is being made for pre-prandial or post-prandial conditions.  
         [0037]     The invention method further includes an optimal measuring and predicting method for intravenous insulin dosing rate in accordance with an intravenous insulin dosing rate formula which includes establishing a processor to actuate an intravenous computer program for measurement and prediction of the patient&#39;s glucose level.  
         [0038]     The subject invention method for measuring and predicting an intravenous insulin dosing rate includes calculation of the optimum dosing rate of the insulin in accordance with the patient&#39;s blood glucose level, a sensitivity factor and constant which is dependent upon whether capillary measurement, arterial measurement, venous measurement or interstitial measurement is being taken.  
         [0039]     The subject invention method is still further directed to a method for optimally measuring and predicting the intravenous insulin dosing rate which includes calculation of the optimum dosing rate at predetermined time intervals.  
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0040]      FIG. 1  is a schematic block diagram of an exemplary system configuration for carrying out aspects of the present invention;  
         [0041]      FIG. 2A  is a computer flow diagram of fundamental method steps of an exemplary embodiment of the present invention;  
         [0042]      FIG. 2B  is a computer continuation information flow diagram in  FIG. 2A ;  
         [0043]      FIG. 3  is a computer flow diagram of fundamental method steps of the express intravenous treatment methodology;  
         [0044]      FIG. 4  is a computer flow diagram of fundamental method steps of the subcutaneous methodology;  
         [0045]      FIG. 5  is a computer flow diagram of fundamental methods steps of the algorithm from  FIG. 2B ;  
         [0046]      FIG. 6A  is a computer flow diagram of fundamental method steps of the IV treatment information page;  
         [0047]      FIG. 6B  is a computer continuation information of the flow diagram from  FIG. 6A ;  
         [0048]      FIG. 7A  is a computer flow diagram of the fundamental method steps of the subcutaneous treatment page; and,  
         [0049]      FIG. 7B  is a computer continuation of information flow diagram from  FIG. 7A .  
     
    
     DESCRIPTION OF PREFERRED EMBODIMENTS  
       [0050]     Referring now to  FIG. 1  there is shown a diagram for a system  400  for measuring and predicting an insulin dosing rate to bring a patient&#39;s blood glucose level into a preferred target range. The measurement and prediction system  400  may be a stand alone system or may be portable to be carried by the attending physician or caregiver from one patient to another, as will be described in following paragraphs.  
         [0051]     Measurement and prediction system  400  includes microprocessor  402  which is used for actuating a computer program for measurement and prediction of the patient&#39;s blood glucose level and further for storing and maintaining the patient&#39;s blood glucose level taken at predetermined time intervals. The microprocessor  402  of the prediction and measurement system  400  may be incorporated with a hard drive  404  and includes a display  406 , which may be in the form of an LCD monitor or some other well known type of display system. The display  406  may incorporate keyboard  416  for input of data from data block  408 . Alternatively, display  406  may be a touch screen type of input device which is well known in the art. The input mechanism  408  inputs a preferred target range for a particular patient&#39;s blood glucose level.  
         [0052]     Measurement and prediction system  400  further includes alarm mechanism  410  which alerts a user when the patient&#39;s glucose level is external to the preferred patient glucose target range. The alarm may be an audio alarm in the form of a buzzer or some like audio sounding mechanism or may be visual in nature to provide a warning message or other type indicia indication on display  406 .  
         [0053]     It is to be understood that microprocessor  402 , input block  408 , alarm  410 , hard drive  404  and display  406  with keyboard  416  may all be incorporated into a single handheld unit comprising system  400 .  
         [0054]     Referring to  FIGS. 2A and 2B , there is shown the overall block diagram associated with the prediction and measurement system  400  as provided in  FIG. 1 . Initially, block  10  refers to a start procedure block where microprocessor  402  and associated display  406  are actuated. Initially, the information flow passes to decision block  14  where there is a decision made as to whether this is the start of a new patient or whether there is a resumption of the IV treatment for the patient which is determined in decision block  16 .  
         [0055]     Referring again to  FIGS. 2A and 2B  showing the overall block diagram for computer actuation programs in processor  402 , the initialization begins in block  10  where the logic inquires as to whether this is the start of a new patient in decision block  14 . If the start of the new patient is to be actuated, logic flows to decision block  22  deciding whether this is an intravenous treatment or subcutaneous treatment. Input may be made on keyboard  46  or directly on display  406  if it is a touch screen actuation.  
         [0056]     If intravenous treatment is input, logic flow extends to the decision block  24  where it is determined whether a standard intravenous dosing is to be provided or whether an express intravenous treatment is to be entered as shown in block  26 . If express intravenous treatment is either chosen by the user or is preset within prediction and measurement system  400 , the logic flow passes to  FIG. 3  through information line  500  where patient information and settings are entered into microprocessor  402  at logic block  64  (shown in  FIG. 3 ). In the express intravenous treatment provided in block  26  much fewer options are needed to be entered by the attending physician or caregiver than the standard options as will be seen in following paragraphs. In block  64  the patient general ID information is provided including patient ID, age, weight and height. Once entered in logic block  64 , the logic flows to decision block  66  where a determination is made as to whether a custom sensitivity factor is to be provided. If a custom sensitivity factor is to be used in the dosing rate, then the logic flows to logic block  68  where the sensitivity factor is entered by the attending physician or caregiver. The initial sensitivity factor is an empirically defined sensitivity factor which may be entered as 0.01, 0.02, 0.03, or 0.04, etc. which defines the speed at which the blood sugar initially falls during a time interval. For older patients a lower sensitivity factor will cause the dosing rate to be adjusted in a slower manner whereas in younger patients there would be a more aggressive approach and a higher initial sensitivity factor would be selected. The sensitivity factor which is entered into processor  402  may be provided by the physician or caregiver.  
         [0057]     Once the sensitivity factor is entered in block  68 , which is the patient&#39;s sensitivity to insulin, the logic flow passes to target range  70  wherein the preferred blood-glucose target range for a particular patient is entered. The target range is the range which would be acceptable for the patient with respect to the blood glucose level. In general, there are options available to choose for an appropriate target range. The choice of an option is dependent upon a patient&#39;s physical state and may generally be between 70-100 mg/dL for a hyperosmoler patient. For a non-hyperosmoler patient the range may be between 120-160 mg/dL. For a pregnant female the range most often chosen is between 90-120 mg/dL. Where the patient&#39;s physical state is improving, the target range is between 100-140 mg/dL. The preferred target range is individualistic between patients and is chosen by the attending physician as a function of the aforementioned variables as well as a particular patient&#39;s history.  
         [0058]     Once the blood-glucose target range has been inserted, the logic flows to logic block  40  on line  510  (shown in  FIGS. 2B and 3 ). In block  40  the patient&#39;s initial blood glucose level is entered into processor  402  and the logic then flows to logic block  42  (in  FIG. 2B ). In block  42  the blood glucose level entered in block  40  is confirmed. If there is a confirmation then the logic flows to block  44  where various parameters external to the patient&#39;s parameters are entered such as the attending physician&#39;s (or nurse/caregiver) name and identification. The logic then flows to block  54  where identification of any changes in the patient&#39;s condition are shown which could affect the blood sugar level. Such changes are then listed and provided on display  406 . Such changes may be the addition or discontinuation of specific medication, physical condition change such as a stroke or myocardial infarction or bleeding or any other condition which must be taken into account by the physician. Also, medications and nutritional changes which may require more or less insulin to offset any nutritional changes is taken into account in block  54 .  
         [0059]     Once all the inputs are inserted into the computer, the logic flows to algorithm block  52  through information line  610  to determine the blood-glucose dosing rate. The algorithm block  52  and subcomponents of the logic flow are seen in  FIG. 5 . A display warning in block  96  is provided if the blood glucose is greater than 250 (which shows diabetic ketoacidosis) in block  98  or blood glucose is greater than 500 (warning for hyperglycemic/hyperosmolarity) in block  100 ; or blood glucose is lower than the range of 30-85 in block  102  (which provides for a hypoglycemia warning). Additionally, a warning is given for a change in the blood glucose level from the last time interval initiation if it shows a change of blood glucose greater than 100 in block  104  providing for a glucose velocity warning; and, if there is an insulin rate high insulin resistance warning in block  106 . All of these are provided in the display warning  96  block and are provided directly to the user as a visual warning or may be transmitted to a server  412  or remote station  414  or some paging system or a text message or e-mail to be sent over the internet.  
         [0060]     If no warning is necessary in blocks  96 ,  98 ,  100 ,  102 ,  104 , or  106  the logic flows to decision block  108  from block  92  which determines whether the blood glucose level is in the target range which has previously been input in decision block  40  in  FIG. 2B .  
         [0061]     If the blood glucose is determined to be within the target range in decision block  108 , logic flows to decision block  116  where it is determined whether the blood sugar level has been within the target range for more than a predetermined time (standardly being three hours). If the blood glucose level has not been within the target range within the predetermined time interval the timer is then set in block  128  to a default time interval (which may be one hour or two hours, etc.). In the event that the blood glucose level has been within the target range for the previous time interval then the logic flows to block  126  where the timer is set to some maximum time interval empirically dependent upon the physician or attending caregiver.  
         [0062]     Referring back to decision block  108 , if the blood glucose level is not within the target range then the logic flows to decision block  110  to determine whether the blood glucose level at this time is greater than the previous blood glucose level.  
         [0063]     If the current blood glucose level is greater than the previous blood glucose level then the logic flows to block  118  where the sensitivity factor is increased between 10%-50% (the actual percentage being protocol dependent).  
         [0064]     Having increased the sensitivity factor by a predetermined amount (either based upon the physician&#39;s or caregiver&#39;s empirical input or protocol), the flow then goes to block  132  where the dosing rate or IV insulin infusion rate is calculated. The calculation is made in accordance with the formula:
 
 DR =( BG−K )× SF   (1)
 
 where: 
 
         [0065]     DR=Dosing/Infusion Rate (units of insulin/time)  
         [0066]     BG=patient blood glucose level (mg./dl.)  
         [0067]     K=constant where 40&lt;K&lt;80  
         [0068]     SF=sensitivity factor (protocol dependent)  
         [0000]     and:  
         [0069]     65&lt;K&lt;80 for capillary measurement  
         [0070]     40&lt;K&lt;70 for arterial measurement  
         [0071]     40&lt;K&lt;70 for venous measurement  
         [0072]     65&lt;K&lt;80 for interstitial measurement  
         [0073]     In the above formula, the constant K may also vary based on rate of blood glucose change and the target blood sugar range, however, such still being in accordance with the constant K being within the range 40&lt;K&lt;80.  
         [0074]     In logic block  134  the carbohydrate insulin ratio is calculated in general as being 0.4-0.6 divided by a sensitivity factor. The carbohydrate insulin ratio is a number used to calculate how much insulin is needed to offset carbohydrate intake so that a patient&#39;s blood glucose level is not affected.  
         [0075]     Once the carbohydrate insulin ratio is determined in block  134 , the logic flows to decision logic block  136  where a determination is made as to whether the blood glucose is less than or equal to the constant K. If the blood glucose in block  136  is less than K then the logic flows to logic block  140  where insulin dosing is terminated. Instructions are then provided in block  146  to administer D50 which is dextrose 50% in accordance with the formula amount of D50=(100−BG)×(0.3-0.5). The timer is then set to the hypoglycemic time interval in block  148  where the hypoglycemic time interval is reset to a predetermined time interval which may be in general 30 minutes.  
         [0076]     In the event that the blood glucose level is greater than K then the logic flows to decision block  138  where it is determined whether the blood glucose is within the range of K&lt;BG&lt;(low end of the preferred blood-glucose target range). If the BG is within the range then the logic flows to block  142  where the timer is set to a time interval to prevent hypoglycemia. If the BG is not within the range of K&lt;BG&lt;(low end of target range) then the logic flows to logic block  128  setting the timer to a default time interval.  
         [0077]     In the event that the blood glucose is not within the target range in decision block  108  the logic flows to decision block  110  where a decision is made as to whether the current blood glucose level is greater than the previous blood glucose level at the previous time interval. If the current blood glucose level is determined to be less than the previous blood glucose level in decision block  110  the logic then flows to logic block  112  where a decision block is provided to determine whether the blood glucose level is above the target range. If the blood glucose level in block  112  is determined to be above the target range, the logic then flows to decision logic block  120  to determine whether the blood glucose decrease is less than 15% from the previous interval.  
         [0078]     If the blood glucose decrease is less than 15% of the previous time interval, the logic flows to logic block  118  which provides for an increase in the sensitivity factor within the range of 10-50% which is empirically entered by the attending physician or caregiver. Once the sensitivity factor has been increased the logic then flows to block  132  as previously discussed to provide for the IV insulin infusion in accordance with the previous formula.  
         [0079]     If the blood glucose decreases between the previous interval and the present time is equal to or greater than 15% than the logic flows to decision block  122  where the blood glucose decrease is determined as to whether it is greater than 66%. If the blood glucose level has decreased greater than 66% then the logic flows to block  130  where the sensitivity factor is decreased in accordance with the protocol of the physician or caregiver. Once the sensitivity factor decrease has been entered the logic then flows to block  132  to determine the insulin dosing rate in accordance with the previously derived formulas.  
         [0080]     If the blood glucose decrease is equal to or less than 66% then the logic flows to block  123  and no sensitivity factor change is provided. Once no sensitivity factor change is inserted, the logic flow then once again passes to IV insulin infusion block  132 .  
         [0081]     Referring back to decision block  112 , if the blood glucose level is below the target range, the data flow passes to decision block  124  where a decision is made as to whether the blood glucose increase between the previous interval and the present time is less than 15%. If the blood glucose increase between the last time interval and the current time is less than 15% then logic flows to block  130  where the sensitivity factor is decreased and the information flow then passes to block  132  for the IV insulin infusion calculation.  
         [0082]     If the blood glucose increase is not less than 15% then the logic flow passes to block  123  where there is no sensitivity factor change and flow of data passes to block  132  for determining the dosage rate in accordance with the previous detailed formulas.  
         [0083]     Returning to  FIG. 2B  and algorithm block  52 , once the insulin dosing rate has been determined, a confirmation is displayed on display  406  as to the insulin and glucose infusion. At this point the attending physician or caregiver may override the dosing in decision block  46 . If the algorithm dosing rate is confirmed and no override is provided in decision block  46  the logic passes to IV treatment information page block  18  which will be detailed in following paragraphs.  
         [0084]     If it is determined to override the dosing rate as provided by algorithm block  52 , the attending physician or caregiver enters the glucose/saline rate in block  48  and the logic passes to a decision block  56  where a display is provided to confirm the override. If the override is canceled, then the logic flows back to block  50  where a confirmation of the insulin and glucose infusion rate from algorithm  42  is confirmed. If override is confirmed in decision block  56 , the logic flows back to block  50  for a confirmation of the insulin and glucose infusion as previously discussed.  
         [0085]     Referring back to  FIG. 2A , if in decision block  24  a standard intravenous route is to be performed, the logic flows to standard intravenous treatment block  28  where the patient information such as patient ID, weight, age, medications, disease state and further identification factors are inserted into microprocessor  402  through the display  406  and keyboard  416  or other touch screen input. Once the patient information has been entered in block  30  the user has the option to go back to standard intravenous treatment block  28  in order to modify the treatment.  
         [0086]     However, once the information has been entered in block  30 , the logic flows to flow block  32  where the insulin concentration and sensitivity factor for the patient is entered. Flow then continues to decision block  34  where it is determined whether a custom sensitivity factor is to be inserted by the user. A custom sensitivity factor may be entered in block  36  based upon the empirical knowledge of the physician or caregiver. In the event there is no custom sensitivity factor to be entered, the flow goes directly to selection of the target range infusion variables in flow block  38 . Thus, whether a custom sensitivity factor is to be entered or a standard sensitivity factor is to be entered, the flow logic ends at information block  38  where a selection of the blood glucose target range is made.  
         [0087]     From block  38  posing on information line  520  (to  FIG. 2B ), the blood glucose level of the patient is provided in flow block  40  in the same manner as derived from the express intravenous treatment block  26  previously discussed.  
         [0088]     Once the blood glucose level of the patient has been entered, the logic flow passes to a confirmation of the blood glucose in block  42 , entering caregiver&#39;s identification in block  44  and then to changes in condition in block  54  prior to passing to algorithm block  52 .  
         [0089]     The algorithm block  52  calculates the dosing rate of the insulin as previously discussed for the express intravenous treatment flow in block  26 . Finally, in accordance with the previously discussed data flow, the information passes to confirmation of the insulin and glucose infusion in block  50  and then to the override dosing decision block  46  and decision block  56 . Where there is no override dosing in decision block  46 , logic flow passes to the intravenous treatment information page block  18 .  
         [0090]     Thus, whether in decision block  16  entitled “resume IV patient” where there is a resumption of the IV patient or in either the express intravenous treatment or standard intravenous treatment calculations, all information flows to IV treatment information page  18  as shown in  FIGS. 2A and 2B . Further discussion of IV treatment information page  18  will be provided in following paragraphs.  
         [0091]     Referring back to  FIG. 2A , what has previously been discussed is the follow on logic flow from decision block entitled “intravenous treatment” where a standard or express intravenous treatment has been entered. In the event that the treatment is to be subcutaneous, the information flow passes from intravenous treatment decision block  22  to subcutaneous block  20  and then enters  FIG. 4  on information line  530 .  
         [0092]     Referring to  FIG. 4 , subcutaneous block  20  (shown on  FIG. 2A ) is provided for information to be entered as to the patient&#39;s physical parameters in block  74 . Once the patient information has been entered in block  74 , a selection of a short acting type subcutaneous treatment is provided in block  76  and a long acting type subcutaneous treatment is entered in block  78 . At the physician&#39;s or caregiver&#39;s directions, both a short-acting type subcutaneous treatment and a long-acting type subcutaneous treatment may be entered.  
         [0093]     From block  78 , the information passes to the subcutaneous algorithm block  84 . With regard to the subcutaneous algorithm block  84 , the calculations made therein are provided in information block  80 , information block  82  and information block  87  dependent upon a decision as to be made in decision block  83  as will be described in following paragraphs.  
         [0094]     The subcutaneous algorithm block  84  acts on both a pre-prandial dosing rate calculation or on a post-prandial dosing rate.  
         [0095]     Where there is a pre-prandial dosing rate to be provided to the patient the calculation is made in accordance with the following formulation:  
             DR   =       C   H     CIR             (   2   )             
 
 where: DR=Dosing Rate (units of insulin/time) 
 
         [0096]     C H =number of carbohydrates to be eaten (grams)  
         [0097]     CIR=carbohydrate insulin ratio 
 
 where:  
             CIR   =       2.8   ⁢     xW   t       TDD             (   3   )             
 
 where: W t =patient weight (grams) 
 
         [0098]     TDD=Total Daily Dosage of insulin (grams/day)  
         [0000]     where: TDD=0.25×W t  for type 1 patient  
         [0099]     TDD=0.6×W t  for type 2 patient  
         [0100]     With regard to a post-prandial dosing rate the subcutaneous algorithm  84  calculates the dosing rate in accordance with the following formula:  
             DR   =       (     BG   -     T   BG       )     CF             (   4   )             
 
 where: BG=Blood Glucose Level of Patient (mg/dL) 
 
         [0101]     T BG =Target Blood Glucose Level of Patient (mg/dL)  
         [0102]     CF=Correction Factor  
             CF   =     CFR   TDD             (   5   )             
 
 where: CFR=correction factor rule empirically chosen between 1500 and 2000 
 
         [0103]     Thus, as far as the logic flow is concerned, the carbohydrate insulin ratio is calculated in block  80  and then the total daily dose (TDD) is calculated or provided in information block  82  dependent upon whether the patient is a Type 1 patient or a Type 2 patient. The Type 1 patient is for a patient who is insulin dependent and a Type 2 patient is for a patient which is non-insulin dependent, such terms well known in the art and discussed above. The information then passes to decision block  83  where it is determined whether this is a post-prandial treatment or a pre-prandial treatment. If it is not a post-prandial treatment the information passes directly back to subcutaneous algorithm block  84  and in the event it is a pre-prandial treatment decision in block  83  it passes to block  87  where a correction factor is provided to the algorithm and then the dosing rate is calculated based upon the correction factor, the blood glucose level, the target blood glucose level of the patient and the correction factor itself.  
         [0104]     From the subcutaneous algorithm block  84 , confirmation is made as to the dosage rate in block  88  which is displayed on display  406  for the physician or caregiver&#39;s review. Once this is confirmed, the information passes to the subcutaneous treatment page  90  on information line  540  ( FIG. 7A ), to be discussed in following paragraphs.  
         [0105]     Referring back to  FIGS. 2A and 2B , whether the resumption of the intravenous patient in decision block  16  is answered “yes” and the override dosing decision in block  46  is answered “no”, then information passes to the IV treatment information page  18 . The IV treatment information page  18  provides for numerous options to be taken by the physician or caregiver as well as a decision as to whether a conversion to subcutaneous treatment is to be made from the intravenous treatment.  
         [0106]     Referring now to  FIGS. 6A and 6B , the intravenous treatment information page  18  is provided as an initialization point and the caregiver can choose to transfer a patient (information) in block  146  and selects a transfer unit in block  152  for transference of the data to the data block  160 . The transfer information block  146  is provided to allow transfer of the information provided to the display  406 , the remote station  414 , to a server  412  or some other transfer unit. The data  160  is stored within the microprocessor  402  or some external transfer device.  
         [0107]     The physician or caregiver may also view the history of the blood glucose level for the particular patient and other parameters of the patient in the view history block  148  and this can be transferred to a display graph in block  150 .  
         [0108]     Additionally, the patient information may be updated in block  154  and inserted into microprocessor  402  in patient information block  156  wherein patient information may be directly sent to the IV treatment information page  18  for viewing or insulin/infusion settings may be provided in block  158  and passed to data block  160 .  
         [0109]     Additionally, data from the IV treatment information page  18  may be passed to a print data information block  162  where a decision is made as to print options in decision block  164  where the information may be printed in block  166  or whether no print information is to be sent back to the information treatment information page block  18 .  
         [0110]     In some cases, the attending physician or caregiver may decide to convert the intravenous settings to a subcutaneous dosing rate through information line  620  to block  172  where the settings in microprocessor  402  are set to a subcutaneous dosing rate. The information then flows to a decision block  174  where it is determined whether the patient is stable or not stable. If the patient is not stable, information passes to information block  168  and then back to the intravenous treatment information page  18  on line  640 .  
         [0111]     If the patient is stable in decision block  174  information then passes to information block  178  where a selection is made as to a long-acting type dosing rate and/or a short-acting dosing rate.  
         [0112]     Once the selection is made in block  178 , information is then passed to the information block  182  where a calculation is made in accordance with the formula:  
                 Basal   ⁢           ⁢   dose     =       (     .1   -   .9     )     ×   TDD       ⁢     
     ⁢       Total   ⁢           ⁢   Daily   ⁢           ⁢     Dose   ⁡     (   TDD   )         =     1000   ×   SF       ⁢     
     ⁢       Correction   ⁢           ⁢     Factor   ⁡     (   CF   )         =     CFR   TDD       ⁢     
     ⁢     CFR   =     1500   +     (       (     0.06   -   SF     )     ×   10   ⁢     ,     ⁢   000     )                 (   6   )             
 
         [0113]     Information then passes to decision block  184  entitled “back to IV/discharge”. If it is decided to maintain the patient on an intravenous dosing rate the information then simply flows back to intravenous treatment information page  18  through information line  650 .  
         [0114]     If the decision is made to discharge the patient from subcutaneous dosing treatment in block  186  information passes to “confirm discharge” block  186 .  
         [0115]     Information is inserted into information block  196  “diagnostic check”. The information then flows to decision block  197  which determines whether the hemoglobin AIC is less than or equal to 7.2. If the hemoglobin AIC in decision block  197  is less then or equal to 7.2 the information passes to block  195  where an alert is displayed to the user recommending that the physician consider oral agent prescription for the patient. Information then passes to block  198  where the patient is discharged and returns to the start block  10 . If the AIC is greater than 7.2 oral agent block  195  is bypassed and information simply enters patient discharged block  198 .  
         [0116]     Another branch of the intravenous treatment information page  18  in  FIG. 6B  is provided where the exit block  188  may be entered on line  620  which is a discharge patient block information data input. The decision to discharge goes to decision block  190  which gives the option to either “exit”, “discharge”, or “cancel”. If it is desired cancel this portion of the program the information passes back to intravenous treatment information page  18  on line  630  for new input to be inserted.  
         [0117]     If the patient is to simply exit the program, the information passes back to the start block  10  for new insert of data as provided in  FIG. 2A . If a discharge of the patient is to be made, the confirmation of discharge is made in block  192  and then passes to decision block  194  where a confirmation is required. If there is no confirmation of the discharge of the patient then the information passes back to exit block  188 .  
         [0118]     If confirmation of the discharge is made in block  194  the information passes once again to diagnostic check  196  and then through decision block  197 , oral agent  195  and then to patient discharge block  198 .  
         [0119]     Referring now to  FIGS. 7A and 7B  there is provided a subcutaneous treatment page  90  which refers back to the subcutaneous treatment page on  FIG. 4 . In the subcutaneous treatment page  90  the user may once again transfer data in block  146  to a selected transfer unit in block  152  for transfer into some external data system  160 . Similarly, the patient&#39;s history may be viewed in block  148  and a graph representation provided in block  150 . The user&#39;s update information may be updated in block  154  with dosing information provided in block  210  and further patient information given in block  156  for passage to the subcutaneous treatment page  90  as shown in  FIG. 7A .  
         [0120]     The usual data options may be chosen by the user in the print data input block  162  and decision block  164  for either printing in block  166  on some external peripheral device or if there is no print the information simply passes back to the subcutaneous treatment page  90 .  
         [0121]     If a decision is made to discharge the patient in block  222  a confirmation of the discharge is made in block  224  and decision block  226  where if there is no confirmation of discharge of the patient, the information passes to the subcutaneous treatment page  90  and alternatively passes to the diagnostic check block  228  in the event of confirmation of the discharge. The patient information as to discharge is then passed to patient discharge block  234  through information line  570  and then back to the initial block “start”  10 .  
         [0122]     If in the subcutaneous treatment page  90  it is decided to exit the subcutaneous phase, the information passes to information block  188  through information line  560  and then to decision block  232  to confirm the exiting. If exit is confirmed the information passes to start block  10  and if is not confirmed then information passes back to subcutaneous treatment page  90  through information line  590  for display of information to the user.  
         [0123]     In the event that dosing rate is to be determined with respect to pre-prandial or post-prandial dosing rates, information passes from the initial block  90  to conformation block  230  through information line  550  and decision block  240 . In information block  230  the user enters whether the blood sugar is pre-prandial or post-prandial blood glucose levels. If the blood glucose level which has been entered is pre-prandial then the logic flows to block  242  where a selection of the meal type is made by the attending physician. The flow of data is determined in block  244  depending upon the type of meal as to whether it is a “snack” or “breakfast”, “lunch”, or “dinner” is made. If this is a snack type meal, the information moves to block  246  where the number of carbohydrates in the meal are entered and confirmed in information block  250 .  
         [0124]     Once the number of carbohydrates has been entered in block  250 , the information is directed to block  257  where the blood glucose level is entered. The confirmation of the blood glucose is made in block  256  and then the information moves to decision block  252  to determine whether the blood glucose is within the target range. If the blood glucose is within the target range then the information moves to block  254  where the instructions are confirmed and all information is then passed back to subcutaneous treatment page  90  through line  600 . If the blood glucose is not within the target range but the blood glucose is less than 60 then the information moves to hypoglycemic block  258 . Once the hypoglycemic treatment is confirmed in block  254  the information then passes back to subcutaneous treatment page  90  through information line  600 .  
         [0125]     If the blood glucose is greater than 250 as found in decision block  252 , information is directed to the “confirm treatment to IV” block  236  and then passes to decision block  238  where it is decided to either continue the subcutaneous treatment or to transition back to IV. If it transitions back to IV the information simply passes back to start block  10 .  
         [0126]     If the decision is made to continue the subcutaneous treatment, the information then passes to confirm instruction block  254  and then back to the subcutaneous treatment page  90 .  
         [0127]     Returning back to decision block  252 , if the blood glucose is not in the target range but is less than 250, the information is passed to correction bolus block  253  where a correction bolus is provided by the attending physician in an empirical manner. Once this is completed, the information then passes to subcutaneous treatment page  90  through information line  580 .  
         [0128]     Going back to decision block  244  where the type of meal is decided by attending physician or caregiver, if the meal is to be a breakfast, lunch or dinner, the information block  248  selects the percentage of the meal which is non-meat. The blood glucose level of the patient is entered in block  251  as previously discussed and the conformation of the blood glucose is made in block  256 . Once again the information passes to decision block  252  where it is determined what range the blood glucose is with respect to the target range. If the blood glucose is less than 250 but external to the target to the target range the information then passes to correction bolus information block  253  and then back to the subcutaneous treatment page  90  on information line  580 .  
         [0129]     If in block  252  the blood glucose is greater than 250 information passes once again to the “conformation treatment to IV block”  236  and then to the decision block  238  where it is either decided to continue the subcutaneous treatment or whether there is a transition to intravenous to be made as previously described.  
         [0130]     If the blood glucose level is less than  60  the information then passes to hypoglycemic treatment block  258  with a confirmation of the instruction being made in block  254  and then passage to the subcutaneous treatment page  90  as previously discussed.  
         [0131]     It would be appreciated by those skilled in the art that changes could be made to the embodiment described above without departing from the broad inventive concept thereof. It is understood, therefore, that this invention is not limited to the particular embodiments disclosed, but to cover modifications within the spirit and scope of the present invention as defined by the appended claims.