Patent Publication Number: US-10772550-B2

Title: Autonomous, ambulatory analyte monitor or drug delivery device

Description:
This application is a continuation application of U.S. patent application Ser. No. 13/669,366, filed Nov. 5, 2012, issued as U.S. Pat. No. 9,603,562 on Mar. 28, 2017, which is a continuation of U.S. patent application Ser. No. 11/311,667, filed Dec. 20, 2005, issued as U.S. Pat. No. 8,303,518 on Nov. 6, 2012, which is a continuation of U.S. patent application Ser. No. 10/131,268, filed Apr. 23, 2002, issued as U.S. Pat. No. 7,004,928 on Feb. 28, 2006, the disclosures of which are hereby incorporated by reference in their entireties, and each of which claims the benefit of Provisional Patent Application Ser. No. 60/355,195, filed Feb. 8, 2002. 
    
    
     The invention relates to the field of analyte monitoring and/or drug (pharmaceutical agent) delivery devices and in particular relates to an analyte monitoring, or drug delivery device that provides for ambulatory operation. 
     Home analyte monitoring is most widely used to monitor glucose by those who have diabetes mellitus. In the most serious form of diabetes mellitus, Type 1 or insulin dependent diabetes mellitus (IDDM), the pancreas fails to produce insulin. For those who have Type 1 diabetes, glucose levels must be frequently monitored in order to provide, by injection, the appropriate amount of insulin. The widespread use of home glucose monitoring reflects the fact that clinical trials have shown that frequent glucose monitoring, and good insulin maintenance, significantly reduces the loss of quality of life, and corresponding cost of care, associated with diabetes mellitus. There is a need for frequent and accurate self-testing of glucose. However, the discomfort (pain) from use of lancets and the need for manipulation of lancets, strips and hand-held monitors, often in public, significantly reduce the frequency of self-testing for glucose. 
     United States Patent Application No. 2002/0006355 discloses a test strip for use in the determination of the concentration of a chemical in blood. The test strip has a plurality of microneedles in fluid communication with a common test area. The microneedles are adapted to puncture skin and to draw blood. The test area contains a reagent adapted to produce a reaction indicative of the concentration of the chemical in blood. 
     However, in operation, the user is required to initiate a blood glucose measurement by pressing the microneedle patch onto the user&#39;s skin. Each of the microneedles lances the skin. A quantity of blood is moved by capillary action from the collection point of each microneedle to the test area. The glucose in the blood reacts with a reagent incorporated into the test chamber producing a signal indicative of the blood glucose concentration. That signal is then measured by the user with an appropriate sensor in a blood glucose analyzer (e.g., a handheld device) to determine the concentration of glucose in the user&#39;s blood. Once the blood glucose analyzer measures the signal produced by the reaction, the test strip (and microneedle patch) is discarded. Improvements in the field of analyte monitoring and/or drug delivery devices are needed. 
     Moreover, in the area of drug delivery, the biotechnology industry has produced important therapeutics which have unique drug delivery issues. Currently protein and peptide therapeutics are almost exclusively delivered by injection. The parenteral route, although an effective means of delivery is often viewed as complex and inconvenient to the patient. There is no better example of this that the delivery of insulin. 
     Accordingly, the invention relates to an analyte monitoring/drug (pharmaceutical agent) delivery device. The invention is suited for monitoring various blood constituents such as glucose. The device has a housing that at least partially encloses a plurality of microneedles disposed on a carrier and an electronics portion. Each microneedle is in fluid communication with a corresponding microchannel. Each microneedle is individually addressable. That is, each microneedle can be extended and retracted individually via an actuator. The electronics portion includes a processor and associated circuitry (e.g., memory, supporting electronics and the like), a motor or the like, a sensor, a power supply (e.g., battery) and optionally an interface. 
     In general, the processor controls the operation of the device and is data communication with the actuator, motor, sensor and interface. The invention provides for autonomous operation, that is, without intervention of the user. The invention can optionally provide for calibration without intervention of the user. The invention can also provide for semi-continuous monitoring for day and night time. The invention can provide for up to four, or more, weeks of operation. The invention can provide for a device that is relative small in size, and therefore unobtrusive. The invention can also provide for device with remote control and interactive electronics. The invention may be also used for the delivery of various pharmaceutical agents including high potency drugs to minimize patient intervention and minimize discomfort. 
     SUMMARY OF THE INVENTION 
     The invention relates to an analyte monitoring device operable to draw a fluid sample from a subject. The device has a first plurality of microneedles and a plurality of monitoring microchannels. Each of the first plurality of microneedles is at least intermittently in fluid communication with a corresponding monitoring microchannel. Each monitoring microchannel is also associated with a reagent. The device has at least one actuator operable to extend each microneedle to draw the fluid sample from the subject. The device also has a controller operable to initiate analyte testing of the fluid sample. 
     In a preferred aspect of the invention the actuator is operable to extend at least one of the first plurality of microneedles omnidirectionally. In another preferred aspect of the invention each of the first plurality of microneedles has an internal diameter in the range of about 25 to 200 micrometers. In another preferred aspect of the invention each of the first plurality of microneedles is fabricated from at least one of metal, plastic, glass and crystal. In another preferred aspect of the invention each of the first plurality of microneedles has a distal end that is operable to penetrate into a skin surface to a maximum of about 2.5 mm. 
     Preferably, the fluid sample is substantially blood. In another preferred aspect of the invention each of the first plurality of microneedles is at least intermittently in fluid communication with a monitoring microchannel via a conduit. In another preferred aspect of the invention each monitoring microchannel is operable to store the fluid sample and accumulation of the fluid sample in the monitoring microchannel is entirely dependent on capillary forces. 
     In another preferred aspect of the invention each of the monitoring microchannels has at least one internal surface that is at least partially coated with at least one insoluble material to enhance the capillary forces and minimize coagulation. In another preferred aspect of the invention the plurality of monitoring microchannels are fabricated in an array. In another preferred aspect of the invention the monitoring microchannels are fabricated in an array having approximately 50-150 microchannels formed in a maximum diameter of approximately 5 cm. In another preferred aspect of the invention each of the first plurality of microneedles is dimensioned for volumes of fluid in the range of about 50-500 nanoliters. 
     The device can be provided with a detector operable to determine when the fluid sample completely fills at least one monitoring microchannel such that the accumulation of the fluid sample with the associated microneedle may be terminated. In another preferred aspect of the invention at least one monitoring microchannel is in fluid communication with at least one reagent operable to assay for analytes selected from the group of (a) glucose, (b) cholesterol, (c) ethanol, (d) digoxin, (e) HDL cholesterol, (f) lithium, (g) sodium, (h) phenytoin, (i) theophylline, (j) cyclosporine, (k) cancer chemotherapy drugs, (l) DNA, (m) RNA, (n) extended phenytonin sodium, (o) warfarin sodium, and (p) proteins derived from blood. 
     Optionally, at least two monitoring microchannels are associated with a single microneedle so that multiple assays can be performed using a single microneedle. In another preferred aspect of the invention a second plurality of microneedles and a plurality of calibration microchannels filled with calibration fluid, wherein at least one assay is initiated for calibration purposes. 
     Optionally, the device can include a third plurality of microneedles and a plurality of pharmaceutical agent delivery microchannels wherein each pharmaceutical agent delivery microchannel is at least partially filled with a pharmaceutical agent. In another preferred aspect of the invention at least one monitoring microchannel is sealed with a polymer. 
     In another preferred aspect of the invention the controller is operable to initiate analyte testing based on a time schedule. In another preferred aspect of the invention the controller is operable to adjust the analyte testing time schedule. 
     In another preferred aspect of the invention the controller is operable to couple to a portable computing device. In another preferred aspect of the invention the portable computing device is a PDA. In another preferred aspect of the invention the controller and the portable computing device is operable to select or modify times for analyte testing. 
     In another preferred aspect of the invention the plurality of microneedles and plurality of monitoring microchannels are disposable. In another preferred aspect of the invention the controller and the actuator are reusable. In another preferred aspect of the invention the plurality of microneedles, plurality of monitoring microchannels, actuator and controller are portable. 
     The device can also include a heating source operable to heat at least one injection site prior to extending a microneedle. In another preferred aspect of the invention the heating source is an optical heating source. 
     The device can include a housing at least partially coated with an adhesive operable to attach the housing to a surface, wherein the housing at least partially enclosing the plurality of microneedles and the monitoring microchannels. In another preferred aspect of the invention the device includes a generally disc shaped housing at least partially enclosing the plurality of microneedles and the monitoring microchannels. 
     The invention is also directed to a pharmaceutical agent delivery device operable to deliver a pharmaceutical agent to a subject. The device has a first plurality of microneedles and a plurality of pharmaceutical agent delivery microchannels. Each of the first plurality of microneedles is at least intermittently in fluid communication with a corresponding pharmaceutical agent delivery microchannel. Each pharmaceutical agent delivery microchannel is at least partially filled with a pharmaceutical agent. The device has at least one actuator operable to extend each microneedle to deliver the pharmaceutical agent to the subject, and. The device also has a controller operable to initiate delivery of the pharmaceutical agent. 
     In a preferred aspect of the invention the actuator is operable to extend at least one of the first plurality of microneedles omnidirectionally. In another preferred aspect of the invention each of the first plurality of microneedles has an internal diameter in the range of about 25 to 200 micrometers. In another preferred aspect of the invention each of the first plurality of microneedles is fabricated from at least one of metal, plastic, glass and crystal. In another preferred aspect of the invention each of the first plurality of microneedles has a distal end that is operable to penetrate into a skin surface to a maximum of about 2.5 mm. 
     Preferably, the fluid sample is substantially blood. In another preferred aspect of the invention each of the first plurality of microneedles is at least intermittently in fluid communication with a pharmaceutical agent delivery microchannel via a conduit. In another preferred aspect of the invention the delivery of the at least one pharmaceutical agent delivery is at least partially dependent on hydraulic forces, preferred aspect of the invention the plurality of pharmaceutical agent delivery microchannels are fabricated in an array, preferred aspect of the invention the pharmaceutical agent delivery microchannels are fabricated in an array having approximately 50-150 microchannels formed in a maximum diameter of approximately 5 cm, preferred aspect of the invention each of the first plurality of microneedles is dimensioned for volumes of fluid in the range of about 50-500 nanoliters. 
     The device can include a detector operable to determine when the pharmaceutical agent delivery microchannel is empty. The device can also include a third plurality of microneedles and a plurality of monitoring microchannels wherein each monitoring microchannel is associated with a reagent. Preferably, at least one pharmaceutical agent delivery microchannel is sealed with a polymer. 
     In another preferred aspect of the invention the controller is operable to initiate pharmaceutical agent delivery based on a time schedule. In another preferred aspect of the invention the controller is operable to adjust the pharmaceutical agent delivery time schedule. 
     In another preferred aspect of the invention the controller is operable to couple to a portable computing device. In another preferred aspect of the invention the portable computing device is a PDA. In another preferred aspect of the invention one of the controller and the portable computing device is operable to select or modify times for analyte testing. 
     In another preferred aspect of the invention the plurality of microneedles and plurality of pharmaceutical agent delivery microchannels are disposable. In another preferred aspect of the invention the controller and the actuator are reusable. In another preferred aspect of the invention the plurality of microneedles, plurality of pharmaceutical agent delivery microchannels, actuator and controller are portable. 
     The device can include a heating source operable to heat at least one injection site prior to extending a microneedle. In another preferred aspect of the invention the heating source is an optical heating source. 
     The device can also include a housing at least partially coated with an adhesive operable to attach the housing to a surface, wherein the housing at least partially enclosing the plurality of microneedles and the pharmaceutical agent delivery microchannels. The device can also include a generally disc shaped housing at least partially enclosing the plurality of microneedles and the pharmaceutical agent delivery microchannels. 
     The invention is also directed to the combination of a device having an analyte monitor portion operable to draw a fluid sample from a subject and a pharmaceutical agent delivery portion operable to deliver a pharmaceutical agent to the subject. The device has a first plurality of microneedles and a plurality of monitoring microchannels. Each of the first plurality of microneedles is at least intermittently in fluid communication with a corresponding monitoring microchannel. Each monitoring microchannel is associated with a reagent. The device also has a second plurality of microneedles and a plurality of pharmaceutical agent delivery microchannels. Each of the second plurality of microneedles is at least intermittently in fluid communication with a corresponding pharmaceutical agent delivery microchannel. Each pharmaceutical agent delivery microchannel is at least partially filled with a pharmaceutical agent. The device has at least one actuator operable to extend each microneedle to either draw the fluid sample from the subject or deliver the pharmaceutical agent to the subject. The device also has a controller operable to initiate analyte testing of the fluid sample and delivery of the pharmaceutical agent. 
     The device can also include a third plurality of microneedles and a plurality of calibration microchannels filled with calibration fluid, wherein at least one assay is initiated for calibration purposes. 
     The invention it also directed to a method for automated analyte monitoring. The method includes providing a first plurality of microneedles and a plurality of monitoring microchannels. Each of the first plurality of microneedles is at least intermittently in fluid communication with a monitoring microchannel. Each monitoring microchannel is associated with a reagent. The method includes sequentially extending a microneedle thereby obtaining a fluid sample from a subject and then initiating analyte testing of the fluid sample. A controller is provided to automatically repeat the sampling and testing steps. 
     The invention is also directed to a method for automated pharmaceutical agent delivery. The method includes providing a first plurality of microneedles and providing a plurality of pharmaceutical agent delivery microchannels. Each of the first plurality of microneedles is at least intermittently in fluid communication with a corresponding pharmaceutical agent delivery microchannel. Each pharmaceutical agent delivery microchannel is at least partially filled with a pharmaceutical agent. The method includes extending a microneedle thereby delivering the pharmaceutical agent to a subject. A controller is provided to automatically repeat the pharmaceutical agent delivery step. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWING 
         FIG. 1  is a pictorial view of a portion of an analyte monitoring/drug delivery device in accordance with the invention. 
         FIG. 2  is a pictorial view showing additional structural details of the carrier microneedles, microchannels and conduit in accordance with  FIG. 1 . 
         FIG. 3  is a pictorial view showing additional structural details of the carrier microneedles, microchannels and conduit in accordance with  FIGS. 1 and 2 . 
         FIG. 4  shows an alternate embodiment of an analyte monitoring/drug delivery device in accordance with the invention. 
         FIG. 5  shows another alternate embodiment of an analyte monitoring/drug delivery device similar to the device shown in  FIG. 4  also incorporating a fluidic capture and processing site in accordance with the invention. 
         FIG. 6  is a pictorial view showing additional details of the embodiment shown in  FIG. 5  in accordance with the invention. 
         FIG. 7  is a pictorial view showing additional details of the embodiment shown in  FIGS. 5 and 6  in accordance with the invention. 
         FIG. 8  is a pictorial view showing additional details of the embodiment shown in  FIGS. 5-7  in accordance with the invention. 
         FIG. 9  shows another alternate embodiment of an analyte monitoring/drug delivery device in accordance with the invention. 
         FIG. 10  is a pictorial diagram showing a lead-screw drive mechanism for microneedle motion in accordance with the invention. 
         FIG. 11  is a pictorial diagram showing a straight microneedle with orthogonal entry in accordance with the invention. 
         FIG. 12  is a pictorial diagram showing a curved microneedle with orthogonal entry shown in three sequential positions in accordance with the invention. 
         FIG. 13  is a pictorial diagram showing a straight microneedle with angled entry shown in three sequential positions in accordance with the invention. 
         FIG. 14  is a pictorial diagram showing a curved microneedle with angled entry shown in three sequential positions in accordance with the invention. 
         FIG. 15  is a pictorial diagram showing a straight microneedle with a non-rectilinear motion shown in four sequential positions in accordance with the invention. 
         FIG. 16  is a pictorial diagram showing the basic configuration for improved sensitivity in accordance with the invention. 
         FIGS. 17 a  and 17 b    are pictorial diagrams showing an exemplary configuration for enhanced light collection using a spherical mirror to improve sensitivity in accordance with the invention. 
         FIGS. 18 a  and 18 b    are pictorial diagrams showing another exemplary configuration for enhanced light collection using a lenses and/or a prism to improve sensitivity in accordance with the invention. 
         FIGS. 19 a  and 19 b    are pictorial diagrams showing yet another exemplary configuration for enhanced light collection using a lenses and/or a prism to improve sensitivity in accordance with the invention. 
         FIG. 20 a    is a pictorial diagram showing enhanced blood collection by localized heating of capillary structures (blood) near puncture site in accordance with the invention. 
         FIG. 20 b    is a pictorial diagram showing an alternative structure for enhanced blood collection by localized heating of capillary structures (blood) near puncture site in accordance with the invention 
         FIG. 21  is a block diagram showing a feedback loop from blood sensor to control logic to control the depth of microneedle penetration in accordance with the invention. 
         FIG. 22  is a pictorial diagram showing force applied to the proximal end of a microneedle to cause the distal portion to project into multiple directions in accordance with the invention. 
         FIG. 23  is a graph showing the error in the volume of a 1 cm length of a nominal 88 micrometer tube by increased tube diameter. 
         FIG. 24  is a pictorial diagram showing an exemplary PDA display showing test times in accordance with the invention. 
         FIG. 25  is a pictorial diagram showing an exemplary PDA display showing dietary recommendations in accordance with the invention. 
         FIG. 26  is a pictorial diagram showing how data is entered into a Recommender System in accordance with the invention. 
         FIG. 27  is a pictorial diagram showing an exemplary PDA, Disposable and Reusable module in accordance with the invention. 
         FIG. 28  is a pictorial diagram showing exemplary locations on the body for placement of a device in accordance with the invention. 
         FIGS. 29 a -29 c    are pictorial diagrams showing an exemplary embodiment suitable for location on the wrist. 
         FIGS. 30 a -30 b    are pictorial diagrams showing an exemplary embodiment suitable for location on the waist. 
         FIGS. 31 a -31 b    are pictorial diagrams showing an exemplary embodiment suitable for location on the arm. 
         FIGS. 32 a -32 b    are pictorial diagrams showing an exemplary embodiment suitable for adhesive mounting in a variety of locations including the leg. 
         FIGS. 33 a -33 c    are pictorial diagrams showing an exemplary embodiment suitable for strap mounting a device in accordance with the invention to the leg. 
         FIGS. 34 a -34 c    are pictorial diagrams showing an exemplary embodiment suitable for clip and/or adhesive mounting a device in accordance with the invention to the waist via an undergarment. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       FIG. 1  shows a pictorial diagram of a portion of a analyte monitoring/drug (pharmaceutical agent) delivery device  10  in accordance with the invention. The device has a housing (lower portion only shown)  12  that at least partially encloses a plurality of microneedles  14  disposed on a carrier  16  and an electronics portion  18 . The carrier  16 , as shown in  FIG. 1 , is generally a planar substrate having a circular profile. It is understood that the carrier  16  can be formed with variety of different geometric shapes without departing from the invention. 
     A plurality of microchannels  20  are disposed on the carrier  16 . Each microneedle  14  is in fluid communication with at least one microchannel  20 .  FIG. 1  shows an embodiment in which each microneedle  14  is in fluid communication with a single microchannel  20 . Each microneedle  14  is individually addressable. That is, each microneedle  14  can be extended and retracted individually via an actuator. A variety of actuators are compatible with the invention. 
       FIG. 1  shows an embodiment in which each microneedle  14  can be extended and retracted via an actuator (a portion of which is not shown) including an arm  22  having a proximal end  24  supported by a hub  26  located generally in the center of the carrier  16 . The arm  22  also has a distal end  28  that is generally disposed above a single microneedle  14 . 
     The device also includes an electronics portion  18  having a processor  30  and associated circuitry (e.g., memory, supporting electronics and the like), a motor  32  or the like, a sensor  34 , a power supply (e.g., battery)  36  and optionally an interface  38 . In general, the processor  30  controls the operation of the device and is in data communication with the actuator, motor  32 , sensor  34  and interface  38 . Operation of the processor  30  and associated software is discussed in more detail below. 
     In the embodiment shown in  FIG. 1 , carrier  16  is movable so that each microneedle  14  is individually addressable (i.e., can be extended and retracted individually). The carrier  16  is rotatably mounted via hub  26  and is generally driven by motor  32 . The connection between motor  32  and the carrier  16  can be accomplished via gears, belts and the like as discussed in more detail below. The interconnection of movable carriers and drive mechanisms suitable for use in conjunction with the invention based on the disclosure herein is well within the scope of one skilled in the art. 
       FIG. 2  shows some of the structural details of the carrier  16  shown in  FIG. 1 . The carrier  16  has a plurality of microneedles disposed generally adjacent to an edge  40 . Microneedle  14 ′ is shown in the extended position (the actuator is not shown). Each microneedle  14  generally has an internal bore in fluid communication with a microchannel  20  via a conduit  42 .  FIGS. 1 and 2  show microchannels that are generally disposed along a radial line extending between the hub  26  (disposed on a central axis) and the associated microneedle. The microchannels are generally shown in a nested configuration (i.e., two rows). This configuration is advantageous since it allows for microchannels that are generally wider than the microneedles and provides for increased microneedle density (i.e., more closely spaced microneedles) at the peripheral edge  40  of the carrier  16 . It is understood that microchannels  20  can be positioned in a variety of geometric configurations without departing from the scope of the invention. It is also understood that conduits  42  can be routed in a variety of geometric configurations as necessary to link with the microchannels  20 . 
       FIG. 3  shows additional structural details of the carrier  16 , microneedles  14 , microchannels  20  and conduits  42  generally in accordance with  FIGS. 1 and 2 . Microchannel  20  is preferably provided with a cover  88 . Preferably the cover is at least partially translucent or transparent to facilitate optical detection of assays. The cover generally protects the contents of the microchannel from contamination. The cover can be generally rigid or flexible as discussed in more detail below. 
     Each microneedle  14  is formed with a proximal end  44  that interfaces with the microchannel  20 , and a distal end  46  operable to penetrate the tissue or skin (for collecting a sample of blood or delivering a drug or pharmaceutical agent). The proximal end  44  is formed with an opening  48  that generally couples to the conduit  42 . 
     In operation, a single microneedle  14  is moved into the extended position and penetrates the skin. Opening  48  is aligned with conduit  42  coupling the microneedle  14  with the microchannel  20  in fluid communication. The device is generally operable to function as a monitor and collect a sample of blood to be analyzed. The device is also operable to deliver a drug or pharmaceutical agent. Each microneedle  14  can be designated for monitoring or drug delivery. For monitoring, microneedle  14  is preferably associated with a “monitoring microchannel” configured for a specific assay technique (e.g., having a reaction layer) as discussed in more detail below. For drug delivery, microneedle  14  is preferably associated with a “pharmaceutical agent delivery microchannel” that is at least partially filled with the drug or pharmaceutical agent to be delivered as discussed in more detail below. 
       FIG. 4  shows an alternate embodiment of a device. In this embodiment, the plurality of microneedles  114  and the carrier (not shown) are generally stationary with respect to the housing (not shown). The microchannels are not shown although the location and interconnection of microchannels for use in conjunction with this embodiment of the invention based on the disclosure herein is well within the scope of one skilled in the art. 
     Each microneedle  114  has a proximal end  144  extending towards a central axis  178  and distal end  146  directed downward (i.e., directed at the skin or tissue). The proximal end  144  of each microneedle  114  is preferably anchored or coupled to the carrier. Each microneedle  114  generally includes a curve or bend  176  thereby defining a ramp portion  160  formed between the proximal and distal ends. In this embodiment, the anchored proximal end  144  and ramp portion provide an incline used to extend the microneedle  114  as well as a spring biasing of the microneedle in the retracted position. Other arrangements for spring biasing the microneedle are readily apparent to those skilled in the art. 
     The actuator includes a cam  162 , a track  164  formed with slots  166  and a slider  168  having an index pin  170 . The actuator also includes a motor (not shown) or the like for driving or rotating the cam about the central axis  178 . The connection between such a motor and the cam  162  can be accomplished via gears, belts and the like as discussed in more detail below. The interconnection of cam and drive mechanisms suitable for use in conjunction with the invention based an the disclosure herein is well within the scope of one skilled in the art. 
     The slider  168  is movable between a retracted position (closer to the central axis) and an extended position (further from the central axis). In the retracted position, the slider is disposed generally above the ramp portion  160  of at least one microneedle  114  and preferably does not contact the microneedle. The slider is also preferably biased or spring loaded in the retracted position. Biasing mechanism or springs are not shown. However, the biasing mechanisms or spring loading of a slider for use in conjunction with the invention based on the disclosure herein is well within the scope of one skilled in the art. The slider shown in  FIG. 4  is generally shown between the retracted and extended position. 
     As cam  162  rotates, it pushes the slider  168  outward along the track  164 . The slider has a lower portion  172  operable to contact a single microneedle  114  as the slider moves from the retracted position to the extended position. The index pin  170  is slidably engaged in slots  166 , thereby restricting the slider to motion along a linear path (along the ramp portion  160  of a single microneedle  114 ). As the slider moves along the ramp portion  160 , the distal end  146  of the microneedle  114  is forced downward (e.g., into the tissue for collecting a sample or delivering a pharmaceutical agent). Once the cam reaches its maximum lobe height  174 , the slider  168  returns to the retracted position allowing microneedle  114  to respond to spring biasing forces and withdraw from the tissue. 
     The track  164  generally has a proximal end  165  that is pivotally engaged along the central axis. Once the slider  168  returns to the retracted position allowing microneedle  114  to spring out of the tissue, track  164  is then advanced (i.e., rotated clockwise or counter-clockwise) to index or address to the next microneedle  114 . The cycle can then be repeated. 
     It is understood that microneedles  114  do not have to be continuous in structure. For example, a fluidic capture and processing site can be located at the bend  176  of each microneedle  144 . This site can interface with a fluidic layer positioned below the microneedles. When the microneedle is fully depressed, it preferably aligns with the fluidic processing layer forming a continuous fluid path. This path preferably remains sealed until the microneedle  114  is pressed down. 
       FIG. 5  shows another alternative embodiment of a device incorporating a fluidic capture and processing site as discussed above. In this embodiment, the plurality of microneedles  214  and the carrier  216  are generally stationary with respect to the housing (not shown). Each microneedle  214  has a distal end  246  directed downward (i.e., directed at the skin or tissue) and a proximal end  244  engaged in fluidic capture site  280 . A spring member  261  is coupled between the fluidic capture site  280  and the carrier  216  thereby defining a spring biased ramp portion  260 . 
     The actuator includes a cam  262  having a tooth  284 , a track  264  formed with at least one slot  266  and a slider  268  having an index pin  270 . The actuator also includes a ring gear  282  that is coupled to housing (not shown) and is generally stationary with respect to the track  264 . As discussed above, the track  264  is pivotable around the central axis  278 . The actuator also includes an idler gear  286  that driven by the tooth  284  as discussed in more detail below. Idler gear  286  has a pivot point that is anchored to the track  264 , and generally moves the track in an incremental fashion, to index or address successive microneedles  214 . 
     The slider  268  is movable between a retracted position (closer to the central axis) and an extended position (further from the central axis). In the retracted position, the slider is disposed generally above the ramp portion  260  of at least one microneedle  214  and preferably does not contact the microneedle. The slider is also preferably biased or spring loaded in the retracted position. Biasing mechanism or springs are not shown. However, the biasing mechanisms or spring loading of a slider for use in conjunction with the invention based on the disclosure herein is well within the scope of one skilled in the art. The slider shown in  FIG. 5  is generally shown in the retracted position. Microneedles  214 ′ and  214 ″ are shown in an intermediate position and the extended positions respectively for illustrative purposes only. 
     As cam  262  rotates (clockwise), it pushes the slider  268  outward along the track  264 . The slider has a lower portion operable to contact a single microneedle  214  as the slider moves from the retracted position to the extended position. The index pin  270  is slidably engaged in slot  266 , thereby restricting the slider to motion along a linear path (along the ramp portion  260  of a single microneedle  214 ). As the slider moves along the ramp portion  260 , the distal end  246  of the microneedle  214  is forced downward (e.g., into the tissue for collecting a sample or delivering a pharmaceutical agent). 
     Once the cam reaches its maximum lobe height, the slider  268  returns to the retracted position allowing microneedle  214  to spring out of the tissue. Tooth  284  engages the idler gear  286  and advances the gear by one tooth. Track  264  is then advanced (i.e., rotated counter-clockwise) to index or address to the next microneedle  214 . The number of teeth on idler gear  286  and ring gear  282  are selected so that each single tooth movement of the idler gear  286  results in the proper angular displacement of the track  264  to precisely index or address the next microneedle  214 . The cycle can then be repeated. 
       FIGS. 6-8  are pictorial views showing additional details of the embodiment shown in  FIG. 5 . Continuing with the discussion above, once microneedle  214  is in the extended position, the proximal end of the microneedle  244  and fluidic capture site  280  interfaces with a microchannel  220 . The fluidic capture site is formed with an opening that generally couples to a conduit  234  and ultimately microchannel  220  as discussed with respect to  FIG. 3 . 
     In a monitoring configuration, depression of microneedle  214  results in the collection of blood in microchannel  220 . Microchannel  220  is preferably configured for a specific assay technique (e.g., having a reaction layer) as discussed in more detail below. The reaction is preferably monitored by sensor  234  mounted to the  268  slider generally disposed above microchannel  220 . 
     Microchannel  220  is preferably provided with at least some form of cover. Preferably the cover is at least partially translucent or transparent to facilitate optical detection of assays. See e.g., cover  88  in  FIG. 3 . The cover generally protects the contents of the microchannel from contamination. The cover can be generally rigid or flexible. For delivery of a drug or pharmaceutical agent, the drug is preferably fluid is stored in a compressible microchannel (e.g., a microchannel having a flexible cover). As the slider  268  moves towards the extended position it preferably presses the microneedle  214  into the skin or tissue. As the microneedle is inserted the slider can at least partially compressing microchannel  220  and forcing the fluid out through the conduit  242  and ultimately the microneedle  214  and into the skin or tissue. It is understood that both monitoring and drug delivery be carried out within the same device by allocating a portion of microneedles  214  for each task. 
     It is also understood that other mechanisms can be used to facilitate delivery of pharmaceutical agents. For example, a small fluidic pump can provide positive pressure to the microchannel. The pharmaceutical agent contained in the microchannel is then expelled through the through the microneedle. Optionally, a capacitance detector can be used to sense that the microchannel is empty and can signal that the fluidic pump should be turned off, thereby controlling the possibility of air entering the delivery system. 
       FIG. 9  shows another alternative embodiment of a device  310  in accordance with the invention. The device has a housing (only partially shown)  312  that at least partially encloses a plurality of microneedles  314  disposed on a carrier  316 . The carrier  316  is generally a planar substrate having a ring-like profile. It is understood that the carrier  16  can be formed with variety of different geometric shapes without departing from the invention. 
     A plurality of microchannels  320  are disposed on the carrier  316 . In this embodiment, the  388  cover is arranged on an inside edge  340  of the substrate  316 . Each microneedle  314  is preferably in fluid communication with a single microchannel  320 . Each microneedle  314  is individually addressable. 
       FIG. 9  shows an embodiment that is somewhat similar to  FIG. 1  in that each microneedle can be extended and retracted via an actuator (a portion of which is not shown) including an arm  322  having a proximal end supported by a hub  326  located generally in the center of the device. The arm  322  also has a distal end  328  that is generally disposed above a single microneedle  314 . 
     The device also includes an electronics portion having a processor  330  and associated circuitry (e.g., memory, supporting electronics and the like), a motor or the like (not shown), a sensor  334 , a power supply or battery (not shown) and optionally an interface (not shown). 
     In the embodiment shown in  FIG. 9 , the plurality of microneedles  414  and the carrier  316  are generally stationary with respect to the housing  312 . The connection between the drive motors and the arm  322  is not shown. This can be accomplished via gears, belts and the like as discussed above. The interconnection of the microchannels  320 , microneedles  414 , conduits, drive mechanisms and the like in conjunction with the invention based on the disclosure herein is well within the scope of one skilled in the art. 
     Exemplary System Segmentation 
     Three exemplary system modules have been identified to optimally meet the requirements of a user friendly, diagnostically relevant, and low cost analyte monitoring/drug (pharmaceutical agent) delivery system. The analyte monitoring/drug (pharmaceutical agent) delivery system, is preferably partitioned into a Disposable Module, a Reusable Module and a PDA Module. See e.g.,  FIG. 27 . This configuration optimally distributes functionality amongst these three configurations to achieve certain advantages. However the invention is not limited to this configuration. For example, a one-unit disposable device including all electronics, microneedles, chemistry, mechanics and user interface may be alternatively employed. Or, more relevantly, the design of the invention allows for any distribution of components between one or more system modules. For example, components may be partitioned among one or more system modules based on the overall system cost, user safety and/or performance concerns. 
     The Disposable Module 
     This module contains those components that once used must be discarded to maintain biological safety and diagnostic accuracy. This module preferably includes any structural or mechanical elements to maintain integrity, sterility and an electromechanical interface to any reusable components. Therefore this system module preferably includes: microneedles, a microfluidic assembly, membrane, reagent chemistry and associate housing materials. This module can also include retaining mechanisms for establishing and maintaining intimate contact with the body thereby providing mechanical retention of the analyte monitoring/drug (pharmaceutical agent) delivery system. 
     The Reusable Module 
     This module preferably contains those components that control, automate motion, measure the glucose reaction, alarm the user, transmit data to the PDA module. This module can also include retaining mechanisms for establishing and maintaining intimate contact with the body thereby providing mechanical retention for the analyte monitoring/drug (pharmaceutical agent) delivery system. Preferably, this module includes: a microprocessor with associated circuitry (e.g., memory, supporting electronics and the like), a sensor (e.g., an electro-optical sensor) for evaluating the products of any reactions (e.g., glucose reactions), drive mechanisms such as motors or the like, a sensor, a power supply (e.g., battery)  36  and an interface operable to communicate with a portable computing device or PDA. The interface can be RF, magnetic or inductive, optical or the like. Using magnetic or inductive coupling rather than RF coupling is advantageous since it can potentially avoid FCC restrictions or limitations. The reusable module can also an audible or vibration alarm to notify the user that user action intervention is required. 
     The PDA Module 
     This module preferably includes a separate user interface via a portable computing device such as a personal digital assistant (PDA), handheld computer or the like for controlling and/or interacting with the device. A typical portable computing device includes a processor, memory, associated circuitry, a display (e.g., monochrome or color LCD) and an input device such as a key pad, touch screen (e.g., integrated with the display) or the like and an operating system. Previously available glucose monitors were specifically designed for handling the paper test strips, for viewing numerical values of the glucose measurements and for setting other parameters of the meter such as its calibration. These custom designed units had limited functionality and relatively crude user interfaces. 
     Today, portable computing devices with improved operating system software and user interfaces are readily available. These devices provide the potential for richer and extended functionality. For example a typical PDA includes a relatively large viewing screen (important to the many diabetic elderly) and can also include wireless communications mechanisms, a sophisticated operating system and a variety of business and personal software (calendars, scheduling, etc.). Accordingly, a PDA provides a robust platform for developing diabetic related software. Recently the FDA approved the first PDA for monitoring EKG activity. The invention preferably includes the use of a PDA to provide the proprietary software (programs) for autonomous operation with an improved user interface. 
     To this end, the PDA module preferably provides the user with software that facilitates informed decisions to help the diabetic user more optimally adjust either drug or dietary consumption to more optimally control glucose. The PDA configuration provides a user interface and preferably allows users the ability to program and or control testing. The user can view individual glucose measurements and graphically display glucose value trends by the day, week or custom time period. The PDA can be used to display any and all of the measurements recorded by the system. Using the proper software, the user can be provided with recommendations for drug regiment modification (insulin or other). The user can also be provided with recommendations for dietary changes. See  FIG. 25 . The PDA can also store grocery lists for daily menus. The grocery list can be viewed by the user as needed to ensure proper dietary intake. 
     The user can preferably program the times when their analyte tests are to be taken. Preferably, the user can also set the upper and lower limits for alerts. As shown, a graphic showing a clock can be easily used to select or modify times for testing. See  FIG. 24 . 
     Whenever the user makes changes and with verification from the user, the information is wirelessly downloaded to the system. During the day the user will not need to use the PDA unless alerted by the system to check for an analyte reading. The user can initiate a test from the PDA if wanting to make an immediate measurement. Once the user selects this command, verifies it, and transmits it to the Reusable, a confirmation is made back to the PDA. 
     An increased number of tests per day can be accommodated for a shorter use life. For example, a newly diagnosed diabetic can have a 24 test per day regiment for the first 6 days to ascertain maximum peaks and lows with various daily regiments of exercise, stress and food types. Then with the user profiled, the caregiver may reduce the number of tests to an appropriate level. Additional aspects of the PDA module and associated software is discussed below. 
     Exemplary Microneedle Structures 
     The invention encompasses mechanisms operable to extend a microneedle that is smaller than most used today for injection or blood extraction (referred to herein as a microneedle). The use of microneedles allows for the extraction of blood with minimal discomfort or pain. It has been noted that blood extraction by the mosquito is efficient. This insect has managed to do what man cannot, that is, to extract blood essentially without pain while drawing blood through a micrometer hollow member. 
     The mosquito accomplishes blood extraction by use of a proboscis which consists of two tubes surrounded by two pairs of cutting stylets that are together in a tight bundle. This bundled entity is called the fascicle and the bundle is about 40 to 60 micrometers in diameter. The fascicle breaks the skin surface of the victim with its stylets. Once below the surface, the fascicle bends at a sharp angle to begin exploring for blood. With each insertion, the mosquito attempts to hit a venule or arteriole. On each try, the mosquito will withdraw the fascicle slightly while leaving it in the original hole, and angle it in a different direction. Once blood is found, the mosquito may draw blood for about ninety seconds and will draw a few micrograms, e.g., 5 microliters, of blood. The invention encompasses technology that mimics the function of the mosquito and within the disclosed analyte monitor/drug delivery system. 
     The diameter of a microneedle is, for example, optimally about 40 to 120 micrometers, approximately the size of the mosquito&#39;s proboscis. Preferably, the microneedle is driven into the skin or tissue to a depth to yield a sample that is mostly blood with minimal interstitial fluid. The microneedle preferably has an internal diameter of about 25 to 100 micrometers, sufficient for blood to flow freely and, preferably, to flow by capillary action. Needles of this type have been demonstrated by Kumetrix, Inc. (e.g., a MEMS based silicon microneedle having an internal microfluidic channel approximately 25 micrometers in width, providing very strong capillary forces but allowing the erythrocytes to flow without difficulty). 
     The invention is alternatively operable with standard hypodermic tubing rather than silicon MEMS microneedles (e.g., to achieve sufficient strength at low cost). Hypodermic tubing is currently available in sizes down to 75 micrometers in diameter. Alternatively the microneedles can be made from glass and drawn to thin diameters similar to the way hollow capillary tubing is drawn. It is understood that microneedles suitable for use in conjunction with the invention can be fabricated by a variety of methods. It is also understood that microneedles suitable for use in conjunction with the invention can be fabricated from a variety of materials including, but not limited to, metal, plastic, glass and crystal (e.g., quartz). 
     The microneedle can be either straight or curved and enter the skin rectilinearly, curvilinear or obliquely. Orthogonal entry with rectilinear motion is potentially the simplest to achieve, advantageously requiring a minimal length of tubing below the epidermis. See  FIG. 11 . A potential disadvantage is that the minimum length may fail to erupt or puncture enough blood vessels to cause blood to flow in sufficient volume. Entering the skin obliquely increases the number of potential blood vessels skewered but may aggravate more nerve endings. Making the microneedle curved also tends to access more tissue and can enhance collection by crossing more blood vessels without penetrating deeply. The orthogonal method will be optimal where blood is acquired readily and where nerve ending are rich. The oblique or curved microneedle approach is optimal where nerve fibers are less dense. 
     As an alternative to a straight microneedle having an orthogonal entry, a curved microneedle can be used with orthogonal entry. See  FIG. 12 . In the alternative, a straight microneedle can be used with angled entry. See  FIG. 13 . In the alternative, a curved microneedle can be used with rotational entry. See  FIG. 14 . In the alternative, a straight microneedle can be used with a non-rectilinear motion. See  FIG. 15 . The alternate approach shown in  FIG. 15  utilizes motion that does not match the shape of the microneedle. This results in the microneedle penetrating one layer of tissue with minimum disruption while producing more disruption at other depths. This effect can be used to minimize pain while still disrupting enough blood vessels to enable sufficient sample collection.  FIG. 15  shows a straight microneedle with circular motion, steps 1 to 4, where the center of the motion is well above the surface of the skin. Other motion forms are anticipated including complex forms. 
     The microneedle is preferably extended and retracted mechanically. Microneedle extension and retraction can be powered by a single device or a combination of devices. For example, a DC motor can be used to drive an extending means and a spring can provide the return force. Alternatively, a powered source such as a DC motor can both drive the microneedle into and out from the skin. The later is a preferred approach in that it provides optimal control over the microneedle position. 
     The additional advantage of the articulated microneedle drive is that it mimics the exploratory motion of the mosquito. The microneedle can be driven to a maximal depth in one area and then, without removing it from the skin, reciprocate the microneedle and cause it to move in a new direction. In order to cause a new direction at a remote point on a penetrating microneedle, a stress must be imposed on the microneedle external to the skin while the distal end of the microneedle is still in the skin. See  FIG. 22 . 
     It is understood that various techniques can be used to drive the microneedles in accordance with the invention. Aside from the techniques discussed above, extending and retracting the microneedle can be accomplished using a micro-miniature DC motor and associated gear train. See e.g.,  FIG. 10 . In this embodiment rotational output of the motor (not shown) is transferred through a gear train  492  to an internally threaded gear  494  located above the microneedle  414 . The rotation of the gear causes a ‘leadscrew’  490  to move linearly to gear rotation. Thus the motor causes a drive to extend or retract the microneedle  414 . This design can achieve the penetration forces necessary, a value that is dependent on skin type, thickness and physical microneedle parameters, typically in the range of 0.01 to 0.07 Newtons. 
     The lead screw drive mechanism is preferably driven by a captured nut forcing the screw to travel co-linear with the intended microneedle travel. The lead screw engages with the microneedle assembly, pushes the microneedle into the tissue, pulls the microneedle out and disengages from coupling  496 . The drive mechanism preferably pivots to engage the next microneedle assembly. The nut can be driven by gears as shown in  FIG. 10 , or a belt or other motion transfer mechanisms. The back end of the microneedle can be accessed by various techniques including but not limited to an opening in the engagement mechanism, an opening in the microneedle side or a bend in the microneedle exposing the proximal opening. Incorporation of a leadscrew mechanism suitable for use in conjunction with the invention based on the disclosure herein is well within the scope of one skilled in the art. 
     Other motion generating sources or motion conveyance can alternatively be used. For example, the motor can drive a cam device with features that cause the microneedle to extend downward with a predetermined rate profile. Cam features, or springs, can be used to retract the microneedle. Also, a shape memory alloy material (SMA) can be used to cause the microneedle to extend down and back. The heating and cooling of the SMA can cause the appropriate amount of force and displacement. A solenoid type device can be used to either drive the microneedle directly or index the microneedle. Such a device can be used like a motor. 
     Having articulated motion allows the microneedle to be extended into the skin incrementally to the correct depth. This invention is suitable for use on skin surfaces where a relatively flat surface is available equal to or larger than the a real dimension of a wrist. Although, the invention can be configured to acquire blood from more curving surfaces such as a finger. The invention is preferably configured to acquire blood from specific places such as the upper arm, wrist, abdomen, back, thigh or lower leg. The invention can be disposed or worn beneath clothing to render it inconspicuous. 
     Exemplary device configurations for differing body locations are discussed in more detail below. Depending on the location selected, the thickness of the skin surface and depth to the capillary bed is variable. For example, the epidermis varies in thickness from 0.02 mm at the eyelids to 1.4 mm on the soles of the feet. The dermis likewise varies from 0.6 to 2.5 mm. The invention is preferably configured to have a distal end of the microneedle reside into the vascular plexus but not go to a depth sufficient to penetrate the deep dermal vascular plexus. Accordingly, the invention preferably operates over a range of about 1.0 to 2.0-mm penetration into the skin surface. 
     Exemplary Sensor Structures 
     Various sensor structures are compatible with the invention. For example, optical detection can be achieved by techniques such as colorimetry and fluorescence.  FIG. 16  shows basic configuration having a microchannel  520  and a reaction layer  521  in fluid communication with a microneedle  514 . The reaction layer can be a membrane that is coated with a chemically active components that provide a change in color in the presence of the desired analyte (e.g., glucose) for colorimetric measurements. A fluid sample is collected via microneedle  514  and is stored in microchannel  520 . The appropriate reagent is preferably contained within the microchannel  520  so that a reaction is initiated upon collection of the fluid sample. The sensor is disposed generally above the microchannel  520  and has an emitter  535  operable to illuminate the reaction layer with an appropriate frequency of light. The sensor also has a detector  537  operable to detect light reflected off of the reaction layer as shown by arrows  539 . The detector  537  can be implemented using a photodiode with single or multiple picture elements (pixels). The example of such a device is a CMOS or CCD imager. The emitter and detector are preferably controlled by the processor (not shown). The detector output is preferable read by the processor and is further processed in order to determine the results of the reaction.  FIGS. 17 a  and 17 b    show an enhanced collection configuration to improve sensitivity. This sensor configuration includes a spherical mirror  541  for reflecting light from one or more emitter  535  to the detector  537 . 
       FIGS. 18 a  and 18 b    show alternative sensor configurations.  FIG. 18 a    shows a microchannel  520  and a reaction layer  521  in fluid communication with a microneedle  514 . Also shown in  FIG. 18 a    is a cover  588  as discussed above. The reaction layer  521  can be a membrane or porous media that is coated with a chemically active component that changes color in the presence of the desired analyte (e.g., glucose) for colorimetric measurements. A fluid sample is collected via microneedle  514  and is stored in microchannel  520 . The appropriate reagent is preferably contained within the microchannel  520  so that a reaction is initiated upon collection of the fluid sample. The sensor is disposed generally above the microchannel  520  and has an emitter  535  operable to illuminate the reaction layer with the appropriate frequency of light. The sensor also has a detector  537  operable to detect light reflected off of the reaction layer  521 . Lenses  543  are disposed between the between the emitter  535  and the reaction layer  521  as well as between the detector  537  and the reaction layer  521 . Lenses  535  generally focus the light for improved illumination of the reaction layer  521  and light collection at the detector  537 .  FIG. 18 b    is similar to  FIG. 18 a    but includes a coupling prism  589  disposed on the cover to improve performance of the detector. 
       FIGS. 19 a  and 19 b    show further alternative sensor configurations.  FIG. 19 a    shows a microchannel  520  and a reaction layer  523  in fluid communication with a microneedle  514 . Also shown in  FIG. 19 a    is a cover  588  as discussed above. The reaction layer  523  is shown as a generally thin layer having assay reagents mixed in a support matrix applied to the microchannel  520 . A fluid sample is collected via microneedle  514  and is stored in microchannel  520 . The appropriate reagent is preferably contained within the microchannel  520  so that a reaction is initiated upon collection of the fluid sample. The sensor is disposed generally above the microchannel  520  and has an emitter  535  operable to illuminate the reaction layer with the appropriate frequency of light. The sensor also has a detector  537  operable to detect light reflected off of the reaction layer  523 . Lenses  543  are disposed between the between the emitter  535  and the reaction layer  523  as well as between the detector  537  and the reaction layer  523 . Lenses  535  generally focus the light for improved illumination of the reaction layer  523  and light collection at the detector  537 .  FIG. 19 b    is similar to  FIG. 18 a    but includes a coupling prism  589  disposed on the cover to improve performance of the detector. It is understood that the microchannel cover  588  can be enhanced with a variety of optical properties such as lenses, filters, reflective structures, refractive structures and the like without departing from the invention. 
     Enhanced Blood Collection 
     The invention also encompasses various techniques for enhanced blood collection.  FIGS. 20 a  and 20 b    show the use of heating sources (e.g., infrared emitting LED) to heat the tissue near the collection site. Heating the capillary structure of the tissue at the collection site can lead to improve the blood supply and enhanced collection using microneedles.  FIG. 20 a    shows an exemplary microneedle  514  inserted in skin or tissue. Heating source  598  is located to one side of the microneedle and is directed towards the tissue thereby heating the tissue in which the microneedle is inserted.  FIG. 20 b    shows an alternate embodiment in which the heating source  599  is generally ring shaped and is located coaxially around the microneedle  514 . 
     Automatic Detection of Blood 
     To simplify the acquisition of blood and to assure that an adequate sample is taken this invention encompasses the use of a blood detection sensor. The blood detection sensor provides control over the penetration and extraction control. The sensor feedback loop works by incrementally driving the microneedle into the skin, waiting an appropriate time for blood to fill the microneedle and sensor and then retracting the microneedle. See  FIG. 21 . If no blood is detected within a reasonable period of time, then the motor can further drive the microneedle to a greater depth. When blood has been acquired the microneedle is retracted. 
     The blood-sensor can be located at various points along the blood path (e.g., microneedle, microfluidic channel, microfluidic well or at the reaction site) of the test device or preferably, the test means itself is the sensor. The optical sensor for the colorimetric test can detect the appearance of blood, prior to making a reading to ascertain the glucose level. This provides dual function of the sensing device and provides a feedback loop without additional cost. Alternatively, a capacitance, conduction or resistive sensor can be used in the microfluidic channel or well to determine when liquid is present. 
     Since the depth and rate at which blood is acquired are site, user and time specific there is need to have these variables stored in the system. Since it is envisioned that this device be used with a cartridge containing a multiplicity of microneedles, and since each blood acquisition is a repetitive search and detect methodology, it is helpful to the user if the system could optimize itself to achieve minimal blood acquisition time. 
     Analyte Testing and Delivery of Pharmaceutical Agents 
     Since 1987, the American Diabetes Association (ADA) has provided criteria for the statistical assessment of self-monitoring blood glucose (SMBG) meters. In 1987, the ADA recommended blood glucose measurements should be within 15% of the reference and that future SMBG meters should have less than 10% variability. By 1993, it was evident new technologies, at this time, were not achieving the 1987 goals. However, in 1996, the ADA recommended less than 5% variability for future SMBG meters. 
     In comparison to this standard, recent evaluation of the relative accuracy of selected, available SMBG meters, representing visual, colorimetric and amperometric detection, showed that current products vary from a reference by approximately −5 to +20%. The significance of statistical errors for SMBG meters depends on clinical assessment, that is, whether the error results in inappropriate clinical management. 
     Recognizing that SMBG meters using relatively large microliter volumes of blood show large statistical errors. The invention contemplates the use of small (e.g., nanoliter) volumes for samples. This helps to achieve the small size of the device necessary for ambulatory monitoring. The requirement of new design and precision manufacturing approaches, as noted, are the subject of this invention, i.e., to achieving better accuracy. The invention contemplates the use of small (e.g., nanoliter) volumes for samples. In addition to achieving better accuracy, this also helps to achieve the small size of the device necessary for ambulatory monitoring. The requirement of new design and precision manufacturing approaches, as noted, are the subject of this invention. 
     In order to support small volume fluid assays, the invention incorporates microfluidic channels with a reagent membrane for a plurality of blood analyte testing.  FIG. 3  shows an exemplary array of microchannels  20  each with precise dimensions, that is, micrometer dimension tolerances. A membrane can be bonded onto the array to prevent the migration of red blood cells, but not liquid blood constituents. The unbonded side of the membrane is preferably coated with assay reagents either uniformly or in spatial defined locations, that is, the channel locations. When blood enters an individual microchannel, the dimension of the microchannel determines the volume. This is critical to the precision of the assay, that is, filling the microchannel provides the analytical volume for assay. Subsequent to filling, the blood constituents migrate through the “reaction layer” (e.g., a polymer) and initiate, by wetting, the assay chemistries within the reaction layer as discussed herein. 
     The polymer for the reaction layer, may be any commercial polymer suitable for the desired assay whereby, by wetting, the assay chemistries may be initiated within or on the other side of the polymer layer. Preferred polymers include hydroxyethyl cellulose, sodium alginate and gelatin. The reaction layer is preferably cast on polymers such as styrene or any polymer of high liquid transmittance and capability for sealing. The polymer and reaction layer is preferably sealed to the capillary well using a device with precision dimensions to surface bond the polymer and reaction layer using adhesive bonding by heat, adhesive materials or other means or agents. 
     The need for precision in the dimension of the device is evident from  FIG. 23 . This figure shows the error in the volume of a 1 cm length of a nominal 88 micrometer tube when the tube diameter is increased (e.g., a 5% error occurs with a nominal 91 micrometer diameter tube). It can be seen that a change in diameter of less than 3 micrometers in a nominal 88 micrometer diameter tube can result in an approximately 5% error in volume. Accordingly, the tolerance required to control volume to less than 5% is on the order of &lt;3 micrometers. 
     The assay chemistries can be based on widely used techniques such as the Trinder reaction. The Trinder reaction is based on a coupling reaction between two dye precursos, viz.,
 
beta-D-glucose+O 2 +H 2 O=D-gluconic acid+H 2 O 2   (1)
 
2H 2 O 2 +4-aminoantipyrine+1,7-dihydroxynaphthalene=red dye  (2)
 
in the presence of glucose oxidase for the first reaction and in the presence of a peroxidase for the second reaction. The Trinder reaction is widely used for glucose assays. The important features of the Trinder reaction are the long history of use, the stability of the dye precursors with elevated temperatures and the availability, and thermal stability, of the enzymes. The 1,7-dihydroxynaphthalene is soluble only in alcohol and a water soluble aromatic is preferred. This aromatic is preferably one of the water soluble reagents identified in U.S. Pat. No. 4,350,762—DeLuca, et al., for example, the sodium salt of 2,4-dichlorophenyl sulphonate.
 
     The specific configuration of the invention differs from prior technology in a number of ways including but not limited to the examples discussed below. The invention incorporates micromachined, or micromolded, microchannels with precise dimensions, that is, micrometer dimension tolerances. The accumulation or delivery of fluid (e.g., blood, pharmaceutical agent . . . ) is direct, that is from a microneedle. The accumulation of fluid in the microchannel is entirely dependent on capillary forces. The microchannel surfaces may be thinly coated with insoluble materials, such as various polymers, to enhance the capillary forces and minimize blood coagulation. The microchannels can be fabricated as an array in large number, e.g., 150 on a 1.5″ diameter. The microchannels can be dimensioned for minimal fluid volumes (e.g., 100-500 nanoliters of fluid or less). 
     The microchannels can be provided with a mechanism to detect when the fluid completely fills the device such that use of the associated microneedle can be terminated (i.e., the microneedle can be retracted), as discussed below. The microchannels and assay chemistries may be applied to assays for analytes other than glucose. The invention can be modified to provide multiple channels for multiple assays using a single blood sample. So called “calibration microchannels” may be initially filled with calibration fluid and the assay initiated for calibration purposes as discussed in more detail below. This aspect of the invention can only be realized with the structures disclosed herein as discussed in more detail below. The microchannels may be filled with drug and used to deliver drugs used in small doses (high potency). The capability to deliver drug and or monitor blood analytes in an automated fashion using a portable device can only be realized with the structures disclosed herein. 
     Ultimately, the invention encompasses the combination of both the monitoring and pharmaceutical agent delivery system within one unit (preferably a disposable unit). For example, military personnel may be unknowingly exposed to a toxin. The device can periodically extract blood and assay for predetermined toxins. If a toxin is detected, the device can deliver antidote. 
     Self Calibration 
     In order to increase the accuracy of an enzymatic test, it has been found helpful in current SMBG meters to provide, with each batch of test strips, a calibration factor that is a correction factor to be used to more accurately determine the correct result. Two calibrations are needed—one to compensate for instrument components and secondly to compensate for the particular sensitivity of a specific batch of chemical components. Various techniques have been developed to achieve this in an automated fashion. 
     The invention preferably incorporates autonomous self-calibration functions so that no user actions are required. One or more calibration microneedles (i.e., associated with a calibration microchannels) are preferably incorporated in the microfluidic structure. When the calibration microneedle is actuated, it is pushed down but no microneedle extends from the disposable unit. In the fully extended position, the unit releases a calibration fluid into the microfluidic channel. For example, in the extended position the calibration fluid travels through the conduit and fills the microchannel. The assay system provides a measure of the glucose in the calibration solution and compares this measure value with the known value. Preferably, a correction factor is derived from the calibration process. The correction factor is preferably stored electronically and is utilized during subsequent analyte testing. 
     A plurality of calibration microneedles can be used to compensate for any change in reagent or instrument properties. Thus the first measurement taken with the insertion of a new Disposable is to calibrate the meter. Subsequent measures are made on a timed basis and are used by the system software to compensate for change in reagent properties at room temperature. 
     Testing for Other than Glucose 
     The invention can be utilized to test for a variety of constituents including but not limited to enzymes, antibodies, alcohol level and other blood constituents. The invention can be designed to also incorporate HbAlc (glycosylated hemoglobin) blood testing, which is a test diabetics should have done about twice a year or more and provides a measure of long term effectiveness in regulating blood glucose levels. Virtually any blood test that has chemistries that can be used at or near body temperature can be incorporated within this system. It is also envisioned that the invention can provide Polymerase Chain Reaction (PCR) testing to genetically identify foreign bodies within the blood. A relatively small heating element can be provided for resting that utilizes heat melts of duplex nucleic acid. Insulation can also be provided to minimize any heating of surrounding structure. 
     4. Alternate Assay Technologies 
     A review of the literature shows, by select examples, that a variety of colorimetric, electrochemical and fluorescent assay methods are available. Of these methods, U.S. Pat. No. 6,118,126—Zanzucchi discloses fluorescence assay techniques and this technology may be used as an alternate method of assay for the device of this invention. This technology allows for the enhancement of fluorescence from textured surfaces. In connection with the invention, enhanced fluorescence can provide improved sensitivity for the assay of small samples. It is understood that a variety of other assay techniques can be used without departing from the scope of the invention. 
     Use of a Neural Network to Optimize the Acquisition of Blood 
     In order to make the system more user friendly, a simple learning algorithm, using artificial intelligence (AI) schemes such as neural networks, can be used by the system&#39;s computer. The algorithm can infer from historical data of multiple blood acquisitions the parameters that are specific to an individual. These additional variables can be; location on the body, time from last meal, time since last exercise and time of day (capillaries are more blood rich during the day and particularly during times of physical activity). These data can then be used to infer the probability of blood acquisition and therefore the optimal microneedle depth and dwell time. 
     Since physical activity is closely related to the metabolism of glucose in the body, this invention also encompasses the inclusion of an accelerometer within the ambulatory device. Both the accumulative motion and time since last physical activity can provide critical data to assist in the predictive ability. Software, such as the “Recommender” may also be included in this invention. See  FIG. 26 . This software can provide the user better recommendations as to how to control their glucose with drug or dietary regiments, e.g., in the case of type 2, or noninsulin dependent, diabetes. 
     The invention is preferably operable to be linked to an external computing device such as a PDA. Preferably, the PDA can also store in memory the schedule of the person as additional information with respect to activity. This additional information may be used with the software to anticipate fluctuations of glucose in the user and to support recommendations on diabetes control. 
     Drug Modification 
     One of the major reasons for noncompliance is that there is not a tight feedback loop between the glucose measurement and compensatory actions. The invention can provide not only a reading of glucose level but recommendations for more or less insulin, or oral medication or nutritional supplements. 
     Often critical is insulin use. All people with Type 1 diabetes need to use it. Many people with type 2 or gestational diabetes also use insulin for good control. For Type 1 diabetics taking insulin injections, the need is to inject the appropriate mix of rapid or short acting insulin (lispro) and intermediate or long acting insulin (Lente or Ultralente). ADA recommends about four injections a day. If on an insulin pump, the need is to achieve a basal delivery to maintain fasting glucose levels and anticipate the need for bolus injections before meals. The invention can be coupled to either regiment and make the decision and estimating process easier. 
     Diet and Nutrition Modification 
     Automated diabetes management software has previously been developed to assist diabetics to control blood glucose levels—most have failed due to the complexity of the model and the unmet need for more glucose readings. Diabetic management software attempts to recommend changes to a diabetic&#39;s drug dosage or dietary regiment to minimize the occurrence of hyperglycemic or hypoglycemic events. These systems require extensive historical and real time data to accurately predict how an individual&#39;s blood glucose will behave with some level of intervention. Unfortunately, these systems have failed because user&#39;s behavior and physiological response is too unpredictable—only short term predictions based on real time blood glucose measurements can be used to help modify outcome. 
       FIG. 25  shows an exemplary PDA display showing dietary recommendations.  FIG. 26  shows pictorially how data are typically entered into a Recommender System. Since mathematical modeling of any biological system becomes difficult due to the numerous metabolic mechanisms, researches have investigated the use of artificial intelligence (AI) including neural networks, fuzzy logic and expert systems. 
     Incorporation of as Alarm in the System 
     Since the invention is to be worn in a discrete place, it would be inconvenient for the user to have to physically or visually access it while wearing it to determine a glucose measure. It should also not be necessary for the user to be constantly interrogating the PDA to determine if the user&#39;s glucose is exceeding a predefine level, or has gone below a lower predefined level. It is more convenient, ergonomic and socially acceptable to use a wireless personal digital assistant, such as that produced by Palm or Handspring, that is modified to communicate directly with the Reusable unit. 
     Therefore it is envisioned with this invention that the wearable component or Reusable include an alarm to alert the user that their glucose reading is outside some predefined range. The alarm can be of the audible or vibration mode as commonly found in pager type devices. The invention is to the software to monitor the data and provide the alarm. 
     Timing System to Allow Flexible Predefined Testing Times 
     A timing system is preferably incorporated in the system software to provide for a flexible testing schedule. As discussed above, the user can program the times when their glucose test are to be taken and for setting the upper and lower limits for alerting the user. Whenever the user makes changes and with verification from the user, the information is preferably wirelessly downloaded to the system. During the day the user will not need to use the PDA unless alerted by the system to check for a glucose reading. The user can initiate a test from the PDA if wanting to make an immediate measurement. Once the user selects this command, verifies it, and transmits it to the Reusable, a confirmation is made back to the PDA. 
     Alternative Forms for Locating the Device on the Body 
     The invention includes the ability to locate the device at various regions on the body.  FIG. 28  is a pictorial diagram showing exemplary locations on the body for placement of a device in accordance with the invention. 
       FIGS. 29 a -29 c    are pictorial diagrams showing an exemplary embodiment suitable for location on the wrist. This configuration includes a strap optionally containing a battery that binds the disposable/reusable module to the wrist similar to a wrist watch. 
       FIGS. 30 a -30 b    are pictorial diagrams showing an exemplary embodiment suitable for location on the waist. This configuration includes a mounting housing with associated straps operable to hold the disposable/reusable module against the waist.  FIGS. 31 a -31 b    are pictorial diagrams showing an exemplary embodiment suitable for location on the arm. This configuration includes an arm band optionally fitted with book and loop fasteners for attaching to the arm similar to a blood pressure cuff. 
       FIGS. 32 a -32 b    are pictorial diagrams showing an exemplary embodiment suitable for adhesive mounting in a variety of locations including the leg. This configuration includes an adhesive backed disk that covers the disposable/reusable module, holding against the skin.  FIGS. 33 a -33 c    are pictorial diagrams showing an exemplary embodiment suitable for strap mounting a device in accordance with the invention to the leg. This configuration includes a mounting housing with associated straps operable to hold the disposable/reusable module against the leg. 
       FIGS. 34 a -34 c    are pictorial diagrams showing an exemplary embodiment suitable for clip and/or adhesive mounting a device in accordance with the invention to the waist via an undergarment. This configuration includes a mounting housing operable to hold disposable/reusable module and formed with a spring joint similar to a clothes pin. The disposable/reusable module is at least partially covered with an adhesive. The spring joint is placed over the edge of an undergarment and the adhesive is pressed against the skin (e.g. along the waist). It is understood that various other configurations are possible without departing from the scope of the invention. 
     While this invention has been described with an emphasis upon preferred embodiments, it will be obvious to those of ordinary skill in the art that variations in the preferred devices and methods may be used and that it is intended that the invention may be practiced otherwise than as specifically described herein.