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Diabetes Works

Review by Gretchen Becker


Special Notice

I have reviewed a lot of diabetes management programs with an emphasis on my own personal needs. I am a type 2, managing with diet and exercise, and I often test new foods by doing postprandial curves and measuring the area under the curve. Thus I was looking primarily for a program that would (1) download my Profile and OneTouch II meters, (2) allow me to sort the downloaded results according to the 15 Profile Event Codes, (3) graph curves selected by Event Codes as well as by date, and (4) print the graphs. A convenient data dump for printout as a permanent record and a nutritional program were also of interest to me.

As a non-insulin user, I was not able to review the various programs' capabilities for handing insulin or pumps. Furthermore, I often rejected a program because the logbook won't handle more than 4 or 6 entries a day, because I need that feature. The programs I rejected I tended not to spend as much time with.

But insulin users, or people who want to measure their blood glucose at four predetermined times a day and then manipulate that data in various ways might find that a program that I hated is just what they want.

Or a person using a meter that doesn't download to a particular program might find that a program I loved doesn't work for them.

Keep this in mind as you read these reviews. They are very biased toward my own needs. As always, YMMV (your mileage may vary).


SUMMARY
This program has a nonprofessional "look" with numerous homemade-looking instruction "manuals," and spelling errors, but it looks to me as if the Insulin Therapy Analysis could be extremely useful to someone on insulin. Among the commercial programs, this type of program is unique to this package, and if it proves useful to an insulin user, would probably be worth the price of the package.

I find the rest of the items pretty useless. On the other hand, they're listed as "freebies" that come with the ITA, so perhaps one shouldn't criticize them too much.

I would recommend that the author of this program spend less time on the additional freebie programs and concentrate his programing skills on BG predictors like the ITA. For example, perhaps he could develop a similar program for type 2 in which you could measure the AUC and time to return to baseline when you took a specific carb meal and then from that predict your BG from other carb, exercise, and stomach-emptying (ex: fat) inputs.

PRO AND CON
It's divided into 5 separate programs. Most of them are menu-type, with mouse pointing, but not full of fancy pictures. This gives the program an old-fashioned look, but on the plus side, it doesn't take as much memory, 5 megs HD compared with 20 to 40 for some of the programs with fancy stuff..

Diet Analyzer: This allows you to enter the number of exchanges you eat at every meal and then analyzes the result per meal and the total daily intake in terms of carbs, protein, fat, and calories. On the plus side, there's room to enter 9 separate meals, which you can indicate by any time of day. On the minus side, you can only indicate exchanges, which are pretty easy to track without a computer, since the totals are simply the totals of the average exchange, ie, assuming each Starch choice includes 15 g of carb, which is only an approximation. One doesn't need a computer to do math at this level. When you click on each exchange, say Starch, you can show a window listing typical Starch choices. But the number of choices isn't great. On the other hand, maybe the Exchange system isn't as bad as one thinks. I just entered a meal consisting of 3 oz of leg of lamb, 1 cup of cooked collard, and 3 Brazil nuts into this program and Balance. This program didn't mention lamb, so I used a medium-fat meat, and it didn't mention Brazil nuts, so I used the general nuts category to estimate amounts. The totals were: Balance, 10 g carb, 8 g sat fat, 345 calories, 1 g fiber (you are limited to 4 nutrients and these are the ones I chose). This program: 10 g carb, 21 g protein, 14 g fat (total fat), 395 calories. Considering that there are a lot of variables even when you use a sophisticated nutrition program, because the amount of fat in the meat, the nutrients in vegetables, etc., all vary, the Exchange totals aren't far off.

Insulin Therapy. Probably the most interesting part of the program I wasn't really able to test. This involves putting in what time you plan to eat, and how many carbs you plan to eat, how much exercise you plan to do, how much insulin of what types you plan to take, and how many units of each insulin you need to cover how many carbs. Then the program will plot your predicted glucose levels over the day. Since I don't understand insulin standards I couldn't test this. But several times as I was clicking on buttons to try to see if I could get anything logical without any insulin, I got Illegal Function Call and that program shut down.

Dear Diary is simply a program for writing daily diary entries in a simple word processor. Who needs this?

There's also a button for File Manager. Who needs this? Also PaintBrush. Who needs this with a DM program?

Glucose Plotter. This lets you download your meter and plot it. It downloaded my Profile fine. But there are two steps for the Profile. You can download the Profile into a list, which then shows the BG chronologically with all 15 event labels. But you can't plot this data. In order to plot you have to use the OneTouch meter utility (DOS), which was written for OT and OTII and hence includes only the number codes. The utility did successfully (apparently; I haven't been checking all the numbers) download the Profile and indicated codes 1--15, without the labels in words. The program won't download other brands.

Once you have your data downloaded (or enter it manually), you can view it sorted in 1-hour increments, 2-hour increments, or 4-hour increments and then plot the data. This means you can't get an accurate graph of an AUC test, since the 0, 15, 30, and 45-minute readings would all be under the same time slot.

However, at least on the log, multiple entries weren't simply lost as they were in another program. It just entered a second line with the same date, so I had 5 lines for Oct. 4 when I was testing melon.

Then you can see various graphs: the "modal day" type, using either the 1-, 2-, or 4-hour time increments. There's also a polar chart, a bar chart, and a scatter chart. And a line graph. I can't figure out what the polar chart is, and the online instruction manual doesn't give a clue.

I thought you couldn't limit the time period for the various reports, but it turns out you have to click on the Input Data button and then set a time limit. And this deletes all the other dates from the working memory, so unless you've saved them from a file, they're lost. The instructions are not clear. They say "If you are in the main plotting program, you must first click "open" to enter the entry pad, and then click "Open File" to reach the dialog box." But there's no Open button in the "main plotting program" and when I went to the Input Data to try opening different files I kept getting Invalid messages and the program shut down. Sometimes it said the "manualen.exe" file had to be in that folder, and it was in that folder. In other words, I suspect bugs.

Whatever, it's a klunky way of doing things if you want to plot different time periods in one session.

Also the X axis of the line graph had no units. I assume it's days, but it's a sloppy way of doing things.

INTERNET ACCESS. Another relatively useful program that is simply a complicated way to keep Internet addresses. Most people wouldn't use this.

PRO
The "logbook" that you can divide by 1, 2, or 4-hour slots is clean and uncluttered, and it does give a good sense of what numbers you've been having at what times of day. I tried to make a similar chart of my daily BG and gave up because it was too much work. This chart can be printed out, but only with the 2-hour time range. One odd feature is that the times are averaged in the printout, ie, range from 2-4 prints as 3. This saves space on the paper, of course.

It comes with a deinstall.exe program that provides you with a certificate saying you've uninstalled the program, presumably for a refund if you return it. Once you've run this program you can't reinstall the program from disks (presumably unless you're a computer nerd who knows how to figure out how they block reinstallation. But if you are, you'd probably just write your own DM program.)

CON
Program is klunky and slow. It's also "amateurish" with typos and omissions in the popup boxes, and unclear instructions (ex: 1 unit of insulin equals how many mg/ml. But it doesn't say mg/mL of what; no information about the polar chart.)

One file was missing on the disks (it had to do with fonts, so I didn't bother to try it). It installs with a "Launcher," a multibutton list that appears on your desktop whenever you start the computer. It may cover up some of your icons, and although you can make it go away, not everyone wants this type of thing, and it would be better to have it as an option rather than automatic install. One plus is that you can add or delete items to the Launcher, so if you used only two of the five programs, you could get rid of the other bars to make the Launcher smaller.

Also one gets tired of waiting while "cute" graphics move around the screen each time you open a program. With the Insulin Simulator you have to go through disclaimers every time you open it.

Although the Insulin Simulator might be interesting for someone on insulin, I can't think of any other reason for anyone not on insulin to buy this program when others are available. The number of problems in the Glucose Plotter would make me suspect problems in the Insulin Simulator, although it's possible that the author has invested a lot more work in the Simulator.

After you run the OneTouch meter-reading program, it asks if you want to print the list. If you say yes, it tells you that you haven't installed the Print Spooler. I don't know if this is a meter utility problem or a Works problem. But if you save the input to a text file, you can print it from there.

I played with the ITA program, and I'm finding it really quite fascinating.

I finally figured out how to get rid of all the insulin inputs, and that allows me to enter carbs eaten at certain times of day and then see what the predicted BG is.

Now, for a type 2 the predicted BG is misleading, because it assumes you have no insulin, or very little insulin, so even a 6-gram input raises the BG for about 6 or 7 hours. But still, you can see how if this happens, your second meal might come before the first meal was back to baseline and then the total BG would be higher than you might think.

But you can also add exercise at various times of the day and see, for example, that moving your exercise from time A to time B might produce much better results.

You can also change your insulin sensitivity and see how your predicted BG changes.

I'd like to suggest to the author that he modify it for type 2 to allow you to enter (1) how high your BG goes after an input of X grams of carbs and (2) how long it takes you to return to baseline after an input of X grams of carbs. Ideally you'd also be able to indicate approximate kinetics, ie, I always have a shoulder on the curve coming down. I don't know if this is universal or not.

If I input a 50-g breakfast at 5 a.m. and a 50-g supper at 5 p.m., when the breakfast is already down to baseline, his curve has the breakfast food intake (in insulin units, whatever they are) going up slightly higher but coming down slightly faster than the supper BG.

I'm trying more and more things with it. I tried inputting a continuous input of Ultralente insulin that I said lasts 30 hours to try to simulate my endogenous insulin, and the curves started looking more reasonable. If I input the insulin at 10 a.m, it begins to go down at about 5 a.m., which simulates my dawn effect.

One problem is the natural fluctuation of various hormones, which is too complex to model at the present time. If I say my baseline is 85, this program says I'll go down to 30 or 40 a good deal of the time, which maybe would be true if a type 1 had a baseline of 85, which is I guess why some doctor's don't want them to go to even normal ranges. I have a type 2 friend who said when she was 100 her doctor said that was too low.

I think there's a lot this program could do if one got familiar with it, but I really wish the author would modify it for type 2.

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