Patent Publication Number: US-2022225906-A1

Title: Insulin pump based expert system

Description:
RELATED APPLICATIONS 
     This application is a continuation of U.S. application Ser. No. 16/560,555 filed Sep. 4, 2019, which in turn is a continuation of U.S. application Ser. No. 15/830,415 filed Dec. 4, 2017, now U.S. Pat. No. 11,298,053 issued Apr. 12, 2022, which in turn is a continuation of U.S. application Ser. No. 14/187,414 filed Feb. 24, 2014, now U.S. Pat. No. 9,833,177 issued Dec. 5, 2017, which in turn application is a continuation of U.S. application Ser. No. 13/465,570 filed May 7, 2012, now U.S. Pat. No. 8,657,779 issued Feb. 25, 2014, which in turn is a division of U.S. application Ser. No. 11/755,480 filed May 30, 2007, now U.S. Pat. No. 8,221,345 issued Jul. 17, 2012, each of which is hereby fully incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     The field generally relates to patient insulin management devices and, in particular, but not by way of limitation, to systems, devices and methods for managing insulin therapy. 
     BACKGROUND 
     People who suffer from diabetes require insulin to keep their blood glucose level as close as possible to normal levels. It is essential for people with diabetes to manage their blood glucose level to within a normal range. Complications from diabetes can include heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy). Insulin is a hormone that reduces the level of blood glucose in the body. Normally, insulin is produced by beta cells in the pancreas. In non-diabetic people, the beta cells release insulin to satisfy two types of insulin needs. The first type is a low-level of background insulin that is released throughout the day. The second type is a quick release of a higher-level of insulin in response to eating. Insulin therapy replaces or supplements insulin produced by the pancreas. 
     Conventional insulin therapy typically involves one or two injections a day. The low number of injections has the disadvantage of allowing larger variations in a person&#39;s insulin levels. Some people with diabetes manage their blood glucose level with multiple daily injections (MDI). MDI may involve more than three injections a day and four or more blood glucose tests a day. MDI offers better control than conventional therapy. However, insulin injections are inconvenient and require a diabetic person to track the insulin doses, the amount of carbohydrates eaten, and their blood glucose levels among other information critical to control. 
     It is important for a diabetic person to be treated with the proper amount of insulin. As discussed previously, high blood sugar can lead to serious complications. Conversely, a person with low blood sugar can develop hypoglycemia. Ideally, insulin therapy mimics the way the body works. An insulin pump is one way to mimic the body&#39;s insulin production. An insulin pump can provide a background or basal infusion of insulin throughout the day and provide a quick release or bolus of insulin when carbohydrates are eaten. If a person develops high blood sugar, a correction bolus can be delivered by the pump to correct it. While insulin pumps improve convenience and flexibility for a diabetic person, they can be sophisticated devices. Some insulin pumps can be difficult to program. Proper use of an insulin pump requires a user to go through a learning curve to properly treat their diabetes using the insulin pump. 
     SUMMARY 
     This document discusses, among other things, devices and methods for managing insulin therapy. A device example includes a pump configured to deliver insulin, an input configured to receive blood glucose data, a user interface, and a controller communicatively coupled to the pump, the input, and the user interface. The controller includes a blood glucose data module to compare the blood glucose data to a target blood glucose level for an insulin pump user. The controller is configured to present a question related to the blood glucose level via the user interface when the blood glucose level is different than the target blood glucose level, receive a response to the question via the user interface, and present a recommended user action based at least in part on the response. 
     A method example includes receiving blood glucose data into a device that includes an insulin pump, presenting a question related to a blood glucose level of an insulin pump user when determining, from the blood glucose data, that the blood glucose level is different from a target blood glucose level, receiving at least one response to the question into the insulin pump device, and presenting a recommended action for a user to take based, at least in part, on the response. 
     A system example includes a first device and a second device. The first device includes a pump configured to deliver insulin, an input that includes a communication port configured to receive blood glucose data, a user interface, and a controller communicatively coupled to the pump mechanism, the input, and the user interface. The controller includes a blood glucose data module configured to compare the blood glucose data to a target blood glucose level for an insulin pump user. The controller is configured for presenting a question related to the blood glucose level when the blood glucose level is different from a target blood glucose level, receiving a response to the question via the user interface, and presenting a recommended action for the user to take based at least in part on the response. The second device includes a user interface, a processor that includes a rule development module configured for developing the rule via the user interface, and a communication port configured to communicate the rule to the first device. 
     This summary is intended to provide an overview of the subject matter of the present patent application. It is not intended to provide an exclusive or exhaustive explanation of the invention. The detailed description is included to provide further information about the subject matter of the present patent application. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIGS. 1A and 1B  illustrate portions of a device that includes an insulin pump. 
         FIG. 2  is a block diagram of an example of portions of an insulin pump device. 
         FIG. 3  shows an example of a method for managing insulin therapy. 
         FIG. 4  shows a portion of an example of a decision tree to determine one or more questions for the user of an insulin pump device. 
         FIG. 5  shows an example of a portion of a system that provides an environment to customize a rule for an insulin pump device. 
     
    
    
     DETAILED DESCRIPTION 
     The following detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention may be practiced. These embodiments, which are also referred to herein as “examples,” are described in enough detail to enable those skilled in the art to practice the invention. The embodiments may be combined, other embodiments may be utilized, or structural, logical and electrical changes may be made without departing from the scope of the present invention. The following detailed description is, therefore, not to be taken in a limiting sense, and the scope of the present invention is defined by the appended claims and their equivalents. 
     In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one. In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. Furthermore, all publications, patents, and patent documents referred to in this document are incorporated by reference herein in their entirety, as though individually incorporated by reference. In the event of inconsistent usages between this document and those documents so incorporated by reference, the usage in the incorporated reference(s) should be considered supplementary to that of this document; for irreconcilable inconsistencies, the usage in this document controls. 
       FIGS. 1A and 1B  illustrate portions of a device  100  that includes an insulin pump. The device  100  includes a cassette or cartridge of insulin. The cartridge is connectable to infusion tubing  140  connectable to a patient such as by a Luer lock  145  or infusion set  142 . The device  100  includes a display  102  and a user interface that may include the display  102  and include one or more keys  104 . Because proper use of an insulin pump requires a user to go through a learning curve to properly treat their diabetes using the pump, it is desirable for a pump to provide assistance to the user, whether the user is a diabetic patient, a caregiver, or a clinician. Providing an expert system in an insulin pump device will provide assistance to the user to effectively treat their diabetes using the insulin pump device. 
       FIG. 2  is a block diagram of an example of portions of an insulin pump device  200 . The insulin pump device  200  includes a pump  205  or pump mechanism to deliver insulin to a subject, such as a positive displacement pump for example. The insulin pump device  200  also includes a user interface  210 , an input  215 , and a controller  220 . The user interface  210  receives manual input from a user and may include one or more pushbuttons or a keypad. The user interface  210  may include a display  202  to provide instructions to the user. The user of the device may be a clinician or a diabetic patient. The display  202  may include a touch-screen. 
     The input  215  is configured to receive blood glucose data of a patient or subject. The input  215  may be coupled to a blood glucose monitor (GM) included in the insulin pump device  200  or the input  215  may include a communication port to receive the blood glucose data from a second separate device. In some embodiments, the communication port  235  is a wireless communication port configured to receive the blood glucose data from the separate device wirelessly. If the GM is a continuous GM, the continuous GM automatically collects the sampled blood glucose data in real time. The insulin pump device  200  may receive the blood glucose in real time as it is obtained or communicated at a later time. If the data is communicated at a later time, a timestamp may be included with the blood glucose data to indicate at what time the data was collected. In some embodiments, the input  215  is coupled to the user interface  210 , and the user may manually input the data into the insulin pump device  200  through a keypad included in the user interface  210 . 
     In some examples, the GM may require a prompt from the user to begin a blood glucose data measurement to obtain the blood glucose data. For example, the GM may require diabetes test strips to take a blood glucose measurement. The controller  220  recurrently presents a prompt to the user to begin a blood glucose measurement using the GM and obtain blood glucose data. In certain examples, the prompt is presented periodically. The prompt may be presented via the display  202 . The prompt may be presented by activating a light emitting diode (LED) included in the insulin pump device  200 . In some examples, the prompt is presented by audibly such as by a transducer or by a speaker instructing the user. The user then provides a new test strip to the GM when prompted during the correction factor test. In another example, the GM may include a drum of diabetes test strips and the user advances the drum to a fresh or unused test strip when prompted by the controller  220 . 
     If the insulin pump device  200  includes a continuous GM, the input  215  may be coupled to blood glucose sensor circuit. The blood glucose sensor circuit includes a blood glucose sensor to produce a blood glucose signal representative of a blood glucose level of the patient. The blood glucose sensor may sense blood glucose concentration from blood or interstitial fluid. The blood glucose sensor circuit may include a sensor interface circuit to sample the blood glucose signal and may provide additional signal processing such as filtering or amplification for example. The blood glucose sensor circuit may provide sampled blood glucose data to the input  215 . A description of a blood glucose sensor circuit can be found in Steil et al., U.S. Pat. No. 6,558,351, filed Jun. 1, 2000. 
     The controller  220  is operatively coupled to the pump mechanism  205 , the input  215 , and the user interface  210 . The controller  220  can be implemented using hardware circuits, firmware, software or any combination of hardware, firmware and software. Examples, include a microcontroller, a logical state machine, and a processor such as a microprocessor, application specific integrated circuit (ASIC), or other type of processor. The controller  220  is configured to perform or execute a function or functions. Such functions correspond to modules, which are software, hardware, firmware or any combination thereof. Multiple functions are performed in one or more modules. 
     The controller  220  monitors the blood glucose data of the subject. The controller  220  includes a blood glucose data module  230 . The blood glucose data module  230  uses the blood glucose data to determine whether a blood glucose level of the subject is different from a target blood glucose level. The target blood glucose level may include a specified range of blood glucose levels and the blood glucose data module  230  may determine whether the blood glucose data indicates the blood glucose of the pump user is outside of a specified range of blood glucose levels. Being outside of a range may include having a blood glucose level that is too high or too low. The blood glucose data module  230  may determine whether a blood glucose level is above an acceptable range of higher blood glucose level, or below an acceptable range of low blood glucose levels. The target or range may be stored in memory and be a programmable parameter available to the blood glucose data module  230 . A clinician would specify the range of blood glucose levels for the patient. The range would depend on various factors for the patient such as weight, age, and level of activity of the patient for example. 
     If the blood glucose data module  230  determines that the blood glucose level of the subject is different from the target or the specified range of blood glucose levels, the controller  220  presents one or more questions related to the blood glucose level via the user interface  210 . Preferably, the question is presented using the display  202 . However, in some examples, the question may be presented audibly. Presenting the question audibly may be useful if the insulin pump user has difficulty seeing the display  202 . The questions are designed to help a user to properly treat their diabetes using the insulin pump device  200  and even by programming the insulin pump device  200 . In some examples, the controller  220  presents different questions according to different blood glucose levels. For example, the controller  220  may present different questions according to whether the blood glucose level of the patient is above 200 mg/dl, or above 300 mg/dl, or above 400 mg/dl. The clinician may program the different levels into the insulin pump device  200 . 
     The user responds to the question through the user interface  210 . Based at least in part on one or more responses, the controller  220  displays at least one recommended action for the user to take. As is discussed below, the recommended action may involve various user actions such as troubleshooting the insulin pump device  200 , delivering insulin using the insulin pump device  200 , initiating a measurement or test using the insulin pump device  200 , or making lifestyle changes for example. In some examples, the recommended action for display may include contacting a physician. In some examples, the recommended action may be different according to the blood glucose level of the patient. For example, the controller  220  may present different actions according to whether the blood glucose level of the patient is above 200 mg/dl, or above 300 mg/dl, or above 400 mg/dl. 
     If the question is presented using a display  202 , the device may include an alarm circuit  245  coupled to the controller  220  to draw the attention of the user to the display  202 . The alarm circuit  245  may include an audible alarm, a visual indication such as a flashing light or flashing icon on the display, or the alarm circuit may mechanically vibrate the insulin pump device to draw attention of the user. The controller  220  activates the alarm circuit  245  if it is determined that the blood glucose level of the subject is outside of the specified range of blood glucose levels. 
       FIG. 3  shows an example of a method  300  for managing insulin therapy. At block  305 , blood glucose data is received into an insulin pump device  200 . At block  310 , at least one question related to a blood glucose level of a patient is presented when determining, from the blood glucose data, that the blood glucose level is outside of a range of blood glucose levels. The question may be presented on a display  202  included with the insulin pump device  200 , or the question may be transmitted to a second device for display, such as a computer for example. This may be useful if a display  202  on the insulin pump device  200  is difficult for the user to read. In some examples, the second device presents the question audibly. The insulin pump and the second device may communicate wirelessly such as by radio frequency (RF) or infrared red (IR) communication. At block  315 , at least one response to the question is received into the insulin pump device  200 . The response may be received through a user interface. At block  320 , at least one recommended action is presented for a user to take based, at least in part, on the response. The action may be presented audibly or visually, such as by a display for example. 
     Returning to  FIG. 2 , in some embodiments, the controller  220  includes a rule module  225  to apply at least one rule to the blood glucose data to determine the question to be presented. In some embodiments, the rule includes a decision tree.  FIG. 4  shows a portion of an example of a decision tree  400  to determine one or more questions for the user of the insulin pump device  200 . In certain examples, the decision tree  400  may implemented with a series of IF-Then logic statements. The controller  220  traverses the decision tree  400  using various information such as the blood glucose data, responses from the user, or other data. If the blood glucose is high, the left portion of the decision tree  400  is traversed at block  405 . The controller  220  may display a recommended action, such as the user taking a correction bolus at block  410 , before asking one or more questions. If the blood glucose is low, the right portion of the decision tree  400  is traversed at block  415 . The controller  220  may display a recommended action, such as the user eating food at block  420  before asking one or more questions. The controller  220  may display a picture or icon of food when making the recommendation. 
     In some examples, the rule module  225  applies the rule to the blood glucose data and to at least one user response to the question to determine the recommended action for display. For example, using the decision tree  400 , if the blood glucose level is high, the controller  220  may display a question asking if the infusion site is red at block  425 . If the user interface  210  receives a response from the user that the site is red, the controller  220  may display a recommendation that the user change the infusion site at block  430 . 
     In some embodiments, the rule module  225  may include a look-up table stored in a memory. For example, if the blood glucose is low, the look up table may include a question as to whether the patient had a high activity level. If the user interface  210  receives a response that the activity level was high, the look up table includes a recommended action corresponding to a table entry for low blood glucose and high activity. The table entry may include a recommended action that the patient eat before the activity or lower a programmable basal rate of insulin before or during the activity. The table may include multiple dimensions to take into account multiple factors, responses, or other data. In some examples, the rule module  225  assigns weights to corresponding table entries. For example, receiving a response that the infusion set has visible blood may by weighted as a stronger indication to change the infusion site than if a response is received that the infusion site is red. In some examples, the rule module  225  uses one or more fuzzy logic rules to determine the question for display and any recommended action. The fuzzy logic rules may be used to blend any weighted questions, responses, or actions. In some examples, the rule module  225  uses a rule involving application of artificial intelligence methods to determine the questions and the actions to be presented. 
     In some examples, the rule module  225  may apply the rule to the blood glucose data and present a recommendation that the user initiate at least one blood glucose measurement. The measurement may be made using a second separate device that includes a GM, or the action may recommend making the measurement with the insulin pump device  200  if the device includes a GM. 
     Note that application of the rule by the rule module  225  may result in a series of questions displayed, responses by the user, and recommend actions. For example, the insulin pump device  200  may receive an indication that a recommended action was taken. The rule module  225  may apply the rule to the blood glucose data, the response to the question, and the indication that the action was taken to determine at least one of a further question and a further recommended action to be presented. 
     In some examples, the rule module  225  may apply the rule to the blood glucose data and present a recommendation that the user initiate a basal rate test. Basal rate refers to a type of twenty-four hour background infusion of insulin by an insulin pump that mimics the continuous background release of insulin from a normal pancreas. It is the rate of insulin delivery the patient normally needs independent of the consumption of meals. If the basal rate is inappropriate, blood glucose concentration levels may result that are out of a recommended or desired range. An insulin pump user may go through several iterations of trial and error before finding appropriate basal rates. Because a patient&#39;s basal insulin needs may change over time, such as with weight change or with a change in fitness level, basal rate testing may be performed periodically to ensure that an appropriate basal rate is being delivered by an insulin pump. Based on the blood glucose level, the rule module  225  determines that a recommendation to run a basal rate test (by either the insulin pump device  200  or a separate device) should be presented (such as by display). As a result of the basal rate test, the controller may display a recommendation to change a programmable basal rate pattern or profile of the insulin pump device  200 . Descriptions of devices and methods that perform a basal rate test are found in Blomquist et al., “Basal Rate Testing Using Frequent Blood Glucose Input,” U.S. patent application Ser. No. 11/685,617, filed Mar. 13, 2007, which is incorporated herein by reference. 
     In some examples, the rule module  225  may apply the rule to the blood glucose data and present a recommendation that the user initiate a carbohydrate ratio test if the blood glucose level is outside a desired range. A carbohydrate ratio refers to the amount of carbohydrates covered by a unit of insulin. It is sometimes referred to as a carbohydrate factor, or carb factor, and is typically specified as grams of carbohydrates per unit of insulin. The insulin pump device  200  may use the carbohydrate ratio to automatically determine a carbohydrate insulin bolus amount required to match a number of carbohydrates ingested by the patient, or at least to keep post-meal blood glucose within a range that is healthy for a patient. For example, the patient may plan to eat seventy grams of carbohydrates. If the carbohydrate ratio is ten grams of carbohydrates per unit of insulin, the insulin pump device  200  would determine that seven units of insulin are required to cover the carbohydrates. 
     The appropriate carbohydrate ratio may vary from person to person, yet it is important for an insulin pump to use an appropriate carbohydrate ratio. If a carbohydrate ratio is too small, the pump may determine a carbohydrate bolus that is too large for the carbohydrates consumed. This may cause a low blood glucose level within a few hours of the carbohydrate bolus (e.g., the blood glucose level drops below 70 mg/dl). If a carbohydrate bolus is too large, the insulin pump device  200  may determine a carbohydrate bolus that is too small for the carbohydrates consumed. This may cause a high blood glucose level within a few hours of a carbohydrate bolus. Based on the blood glucose level, the rule module  225  determines that a recommendation to run a carbohydrate ratio test should be presented. As a result of the carbohydrate ratio test, the controller  220  may present a recommendation to change a carbohydrate insulin bolus pattern or profile delivered by the insulin pump device  200 . For example, the controller  220  may recommend a carbohydrate bolus pattern that includes an extended carbohydrate bolus or a combination bolus. Descriptions of devices and methods that perform a carbohydrate ratio test are found in Blomquist, “Carbohydrate Ratio Testing Using Frequent Blood Glucose Input,” U.S. patent application Ser. No. 11/679,712, filed Feb. 27, 2007, which is incorporated herein by reference. 
     In some examples, the rule module  225  may apply the rule to the blood glucose data and present a recommendation that the user initiate a correction factor test. A correction factor refers to the amount in drop in blood sugar, or blood glucose, for one unit of insulin. It is measured in milligrams per deciliter (mg/dl) per unit in the U.S. and in millimoles (mmol) per unit in other countries. The insulin pump device  200  may use the correction factor to automatically determine a bolus amount required for a high reading or a reduction in a meal bolus for a below-target reading. The insulin pump device  200  may also use the correction factor to calculate the amount of carbohydrates a patient should eat to bring low blood sugar up to a target blood sugar level. An appropriate correction factor brings a high blood glucose reading down using an automatically determined correction bolus without a risk of going low. 
     The appropriate correction factor varies from person to person. It is important for an insulin pump to use an effective correction factor. If a correction factor for a pump is set too high, the blood glucose may not actually be dropping as much as estimated and could lead to high blood glucose levels. If the correction factor is set too low, a correction bolus may provide too much insulin and result in a low blood glucose level. As a result of the carbohydrate ratio test, the controller  220  may display a recommendation to change an insulin correction bolus pattern or profile, such as to include an extended bolus or a combination bolus for example. Descriptions of devices and methods that perform a carbohydrate ratio test are found in Blomquist et al., “Correction Factor Testing Using Frequent Blood Glucose Input,” U.S. patent application Ser. No. 11/626,653, filed Jan. 24, 2007, which is incorporated herein by reference. 
     In some embodiments, the rule module  225  may receive an updated or new rule or a modification to the rule. In certain embodiments, the insulin pump device  200  includes a communication port  235  coupled to the input  215 . The communication port  235  receives the rule into the insulin pump device  200  from a second separate device. In some examples, the communication port  235  is a wireless port and receives the rule wirelessly. The second device may be a computer or a personal data assistant (PDA). The second device may provide an environment (e.g., such as through software) for a diabetes professional, clinician, or other caregiver to customize the rule. In some examples, the environment allows the clinician to customize a decision tree or look up table. 
       FIG. 5  shows an embodiment of a portion of a system  500  that provides an environment to customize rules in the rule module  225 . The system  500  includes an insulin pump device  200  and a computing device  550 . The insulin pump device  200  includes a communication port  235  to communicate information with the computing device  550 . The communication port  235  shown is a wireless port that communicates wirelessly with the computing device  550 , such as a radio frequency (RF) port or infrared (IR) port for example. The communication port  235  may receive blood glucose data from a third device, such as a GM for example. In certain examples, the insulin pump device  200  receives the blood glucose data from a GM when the GM is communicatively coupled to the communication port  235 . The insulin pump device  200  is able to communicate information with the computing device  550  when the GM is not communicatively coupled to the insulin pump device  200 . In some examples, the communication port  235  may be a wired port, such as a serial port for example, to communicate with the computing device  550 . 
     The computing device  550  may be a personal computer (PC), laptop computer, or a personal data assistant (PDA). The computing device  550  includes a user interface  555  that includes a display and may include at least one of a keyboard or keypad and a computer mouse. The computing device  550  also includes a processor  560  communicatively coupled to the user interface  555 . The processor  560  can be a microprocessor, application specific integrated circuit (ASIC), or other type of processor. 
     The processor  560  includes a rule development module  565  that provides doctors or clinical experts the ability to develop and generate a new rule or rule set or modify rules via the user interface  555 . The computing device  550  includes software that provides a flexible framework to create or modify rules such as by updating a graphical decision tree, a multidimensional table, or other type of logical rule. The software may be included in a computer readable medium, such as a compact disc (CD) for example, or the software may be downloaded to the computing device  550  from remote storage, such as from a server for example. The rule development module  565  develops a rule to be applied to the blood glucose data received into the insulin pump device  200 , and may develop a rule that is also applied to at least one of physiologic data, demographic data, patient lifestyle data, insulin delivery history data, and blood glucose history data to generate a recommended action. The computing device  550  includes a communication port  535  to communicate information with the insulin pump device  200 . The computing device  550  uses the communication port  535  to communicate the rule to the insulin pump device  200 . 
     Once a rule is developed, the doctor or clinical expert could publish or otherwise share a rule or set of rules. In some embodiments, rule sets can be stored in remote storage, such as a server for example. The computing device  550  may be connected to a communication network, such as the internet or a cell phone network for example. A doctor or clinical expert may download a rule or rule set from the remote storage and either download the rule set directly from the computing device  550  into the insulin pump device  200  or modify the rule or rule set before downloading the modified rule or rule set to the insulin pump device  200 . 
     Returning to  FIG. 2 , in some embodiments, the user interface  210  and the input  215  receive modifications to the rule that are entered into the insulin pump device  200  manually by the user via the user interface  210 . For example, the user may step through the rule with the aid of the display  202 . The user may then alter the rule with a keypad included in the user interface  210 . For example, the user may enter a new look up table entry using the key pad, or add another branch to a decision tree or edit a branch of the decision tree. In certain embodiments, an entire new rule or rule set is entered manually into the insulin pump device  200  via the user interface  210 . 
     In some embodiments, the insulin pump device  200  stores data to track effectiveness of a new rule or modified rule. For example, the insulin pump device  200  may track the number of times the blood glucose level of the patient returned to the target blood glucose level or to within the target range of levels after application of the rule. The effectiveness may be displayed as a percentage or as X successes out of Y applications on either a display  202  of the insulin pump or uploaded and displayed on a separate device, such as the computing device  550  in  FIG. 5  for example. 
     If a rule or rule set is downloaded into multiple devices, the effectiveness of the rule set for multiple device may be tracked. The stored data related to the effectiveness may be uploaded to a remote server and the server tracks the overall effectiveness of the rule over the multiple devices. The overall effectiveness may be useful to a clinician in determining whether to download a particular rule or rule set to the insulin pump device  200 . 
     In some embodiments, controller  220  determines a rate of change of a blood glucose level of the subject from the blood glucose data. For example, the controller  220  may determine that the blood glucose concentration level is increasing or decreasing at a rate of 2 to 4 mg/dl/min (milligrams per deciliter per minute). The rule module  225  may apply one or more rules to the rate of change of a blood glucose level to determine at least one of a question for display or one or more recommended actions for display. For example, the blood glucose level of the user may not be high, but the rate of change of blood glucose may be increasing at such a rate to indicate there is a risk of the blood glucose level going high. Conversely, the blood glucose level of the user may not be below a blood glucose target, but the rate of change of blood glucose may be decreasing at such a rate to indicate there is a risk of the blood glucose level going low. 
     In some examples, the rule module  225  may apply the rules to at least one of the blood glucose data, the rate of change of blood glucose data, and a response to a question to determine a subsequent question or recommended action for display by the controller  220 . For example, if the blood glucose level is high and increasing at a certain rate, the rule module  225  may apply the rule to determine that a recommended action to take a correction bolus should be presented before presenting a question. In another example, if the blood glucose level is high and decreasing at a certain rate, the rule module  225  may apply the rule to determine that a recommended action to take a correction bolus should not be displayed and proceed to displaying a question such as whether the patient ate something where it was difficult to estimate the carbohydrates. 
     According to some embodiments, the controller  220  may display a recommendation that the patient consume carbohydrates if the blood glucose level is low or there is a risk of blood glucose level going low. In some examples, the memory  240  may store a database of food options in association with a known amount of carbohydrates. The recommended action presented by the controller  220  may include displaying a food option for consumption that is included in the database. 
     In some embodiments, the controller  220  determines an amount of carbohydrates for the patient to consume and presents a food option accordingly. For example, assume that the blood glucose level of a patient is 40 mg/dl below a desired range of blood glucose levels. The correction factor is stored in the insulin pump device  200  and is 1 unit per 80 mg/dl. The controller  220  determines that −0.5 unit of insulin (−40/80) is required to bring the blood glucose level back to the target level or range. Further assume that the carbohydrate ratio of the patient is 20 grams of carbohydrates per unit of insulin (20 g/u). The controller  220  multiplies the amount of insulin by the carbohydrate ratio to determine that the patient should eat 10 grams of carbohydrates [(0.5)(20)]. The insulin calculation module  125  may take into account additional factors such as the health status of the patient and the activity level of the patient in recommending the carbohydrate amount. In some example, the food option may be displayed using an icon or picture of food. 
     According to some embodiments, the input  215  receives physiologic data into the insulin pump device  200  from a separate second device. The data may be received through the input  215  or another input. In some embodiments, the insulin pump device  200  receives the physiologic data through a communication port  235 . In some examples, the insulin pump device  200  receives the physiologic data through the same communication port  235  that receives the blood glucose data. In some examples, the second device includes a temperature monitor and the physiologic data includes a patient temperature. In some examples, the second device includes an activity monitor and the physiologic data includes an indication of a level of patient activity. 
     The rule module  225  may apply one or more rules to the physiologic data to determine a question for display. The rule module  225  may apply one or more rules to the physiologic data and a response to the question to determine one or more recommended actions for display. In some examples, the rule module  225  may apply one or more rules to the physiologic data, the blood glucose data, at least one question response to determine a question or recommended action for display. The controller  220  displays the questions and recommended actions. 
     In some embodiments, the insulin pump device  200  includes a memory  240  communicatively coupled to the controller  220 . The memory  240  may store demographic data of the subject. The demographic data includes such information as a patient&#39;s weight, age, and gender for example. The demographic data may be received from a second device or through the user interface  210 . The rule module  225  may apply one or more rules to the demographic data to determine a question to be presented. The rule module  225  may apply one or more rules to the demographic data and a response to the question to determine and/or adjust one or more recommended actions. In some examples, the rule module  225  may apply one or more rules to the demographic data, the blood glucose data, at least one question response to determine a question or recommended action for display. 
     In some embodiments, the controller  220  adjusts the questions and recommended actions based on the demographic data. For example, the controller  220  may use a different set of questions and recommended actions when the demographic data indicates that the patient is a child than when the demographic data indicates the patient is an adult. 
     In some embodiments, the memory  240  may store lifestyle data of the subject. The lifestyle data includes such information as whether a patient tends to eat high glycemic index foods, drinks alcohol, smokes, eats a bedtime snack, a health status of the patient, whether the patient is typically under stress, whether the patient tends to be active, and the amount time the patient spends exercising, for example. The lifestyle data may be received from a second device or entered through the user interface  210 . The rule module  225  may apply one or more rules to the lifestyle data to determine a question for display. The rule module  225  may apply one or more rules to the lifestyle data and a response to the question to determine one or more recommended actions for display. In some examples, the rule module  225  may apply one or more rules to the lifestyle data, the blood glucose data, at least one question response to determine a question or recommended action for display. 
     A recommended action may include a change to at least one aspect of the patient&#39;s lifestyle, such as to skip the bedtime snack or to eat lower glycemic index meals, for example. In some examples, the recommended action may include recommending patient training. In certain examples, the insulin pump device  200  may present a recommendation that the patient be trained in carbohydrate counting. In certain examples, the insulin pump device  200  may recommend that the patient be trained in managing their exercise. In certain examples, the insulin pump device  200  may recommend that the patient be trained in using the insulin pump when the patient is sick. In certain examples, the insulin pump device  200  may recommend that the patient be trained in proper infusion site care. 
     In some embodiments, the memory  240  may store insulin delivery history data of the patient. Insulin delivery history data may include a time duration since the last meal bolus, how long since the cartridge was changed, and whether there have been any recent changes to programming parameters and what those changes were for example. The rule module  225  may apply one or more rules to the insulin delivery history data to determine a question to be presented. The rule module  225  may apply one or more rules to at least one of the insulin delivery history data, the blood glucose data, and a response to a question to determine one or more recommended actions. 
     In some embodiments, the memory  240  may store blood glucose history data of the subject. Blood glucose history data may include blood glucose data from a previous time period, such as two hours or 24 hours in the past for example. The data may be received from a GM included in the insulin pump device  200  or from a GM included in a separate device. In some examples, the blood glucose history data may be received from a separate computing device such as a PC, laptop, or PDA configured to communicate with the insulin pump device  200 . The controller  220  may generate a prompt to download blood glucose history data from the second separate device, such as a prompt on a display  202 , an LED prompt, or an audible prompt. The rule module  225  may apply one or more rules to the blood glucose history data to determine a question to be presented. The rule module  225  may apply one or more rules to at least one of the blood glucose history data, the blood glucose data collected in real time, and a response to a question to determine one or more recommended actions. 
     The patient may experience trouble with the insulin pump device  200  itself. According to some embodiments, the recommended action presented by the controller  220  includes actions for troubleshooting the insulin pump device  200 . If the blood glucose level is low, the recommended actions may include checking or changing the insulin cartridge, the infusion set, the infusion set tubing, and/or the infusion site. For example, if the insulin pump device  200  stores the time since the cartridge was changed, the rule module  225  may determine that it is time for a new cartridge and display instructions to check whether the cartridge is low or change the cartridge. If it has been a short time since the cartridge was changed, the rule module  225  may eliminate the cartridge as the problem and display instructions to check or change the infusion set or the infusion site. 
     In another example, the user may respond that the cartridge was checked. The rule module  225  may apply the rule to the blood glucose level and the response and eliminate the cartridge as the problem. The insulin pump device  200  and the user may then step through response and actions that instruct the user to troubleshoot the infusion set and site. The controller  220  may also present a recommendation to change the type of insulin. For example, the rule module  225  may determine that the delay for uptake is too slow and recommend that the patient use a type of insulin with faster uptake. The controller  220  may also present a recommendation to change an insulin pump executable program and to see a diabetes professional. The controller may present a question whether the infusion set has visible blood and recommend that the infusion site be changed if there is visible blood. In some examples, the controller  220  may display a device error code and a recommendation to see the diabetes professional rather than present instructions to the user or patient that the pump program should be changed. The diabetes professional interprets the error code to determine the recommended action. 
     According to some examples, the blood glucose data module  230  may determine from the blood glucose data that a blood glucose level of the subject is at a target blood glucose level or within a specified range of blood glucose levels. The rule module  225  may determine one or more recommend actions for the patient to take that are related to maintaining normoglycemia. The rule module  225  may apply the rule to the blood glucose data and at least one of the physiologic data, the demographic data, the lifestyle data, the blood glucose history data, the insulin delivery history data, question responses, and previous actions taken to make the recommendation. The controller  220  displays the recommended action. For example, the controller  220  may ask lifestyle questions when blood glucose data is in the normoglycemic range. The controller  220  may aggregate insulin pump data and answers to the questions from various times when the blood glucose data values were in range and help the patient identify lifestyle or therapy patterns that promote good glycemic control. 
     It is to be understood that the above description is intended to be illustrative, and not restrictive. For example, the above-described embodiments (and/or aspects thereof) may be used in combination with each other. Many other embodiments will be apparent to those of skill in the art upon reviewing the above description. The scope of the invention should, therefore, be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. In the appended claims, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects. 
     The Abstract of the Disclosure is provided to comply with 37 C.F.R. § 1.72(b), requiring an abstract that will allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. In addition, in the foregoing Detailed Description, it can be seen that various features are grouped together in a single embodiment for the purpose of streamlining the disclosure. This method of disclosure is not to be interpreted as reflecting an intention that the claimed embodiments require more features than are expressly recited in each claim. Rather, as the following claims reflect, inventive subject matter lies in less than all features of a single disclosed embodiment. Thus the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own.