Try improving these virtual patients' blood sugars!
In collaboration with our partners at the AIDA on-line diabetes simulation Website we bring you some example virtual patients with diabetes. On the table below, click on some of the "Try this case" links to choose a sample case - and follow the instructions on the pop-up screen to see if you can improve the example patient's blood glucose profile!
Try this case This woman is on three injections of short and / or intermediate acting insulin each day, with a split-evening dose. She wants to start a family, but consistently has had quite high blood glucose levels in the early afternoon, despite numerous attempts to normalise her control in anticipation of becoming pregnant. Clearly she could decrease the amount that she eats, but this would not be ideal during pregnancy. See if you can adjust her insulin doses to improve her glycaemic control. Try this case It has taken a lot of effort to stabilise this girl's blood glucose profile. However, she still often goes 'hypo' in the middle of the day, especially between breakfast and lunch. She is on a slightly unusual regimen taking a short acting insulin preparation three times per day, with an intermediate acting preparation twice a day - at lunchtime and before bed. Can you improve her glycaemic control, and get rid of her 'hypo' at 10:00am? Hint: For a start try increasing the carbohydrate content of her breakfast.... Try this case This 35 year old insulin-dependent diabetic man recently switched to using an insulin pen, injecting three 'shots' of short-acting insulin before breakfast, lunch and supper and taking a single dose of long-acting insulin before going to bed. However, he hasn't quite yet got full control of his blood sugars, still tending towards high blood glucose levels overnight. How might you improve his control, adjusting his existing insulin doses? Try this case This man tends to have high blood glucose levels throughout most of the day. He is concerned about this. How might he adjust his insulin regimen to compensate for this? His renal threshold of glucose (RTG) is currently normal. (RTG represents the blood glucose level at which glucose starts to flow from the kidneys into the urine (be excreted) - as a waste product). If his RTG were to rise, his blood glucose level would rise even higher, before glucose started to be passed into the urine. Try changing the RTG from normal to low or high and see the effect on this man's blood glucose profile, as you try to improve his overall metabolic control. Try this case This patient is on twice daily pre-mixed (biphasic) insulin injections. She maintains reasonable glycaemic control with this regimen but is thinking of starting a family and would like to tighten her glycaemic control even further. If she were to try this, she would obviously need to do so cautiously, in consultation with her doctor. See what happens if you gradually increase her injected insulin doses in small steps.... Try this case This woman injects herself twice a day with a premixed (biphasic) insulin preparation. However, on this regimen she has not yet achieved tight glycaemic control. What sort of other premixed insulin preparations could be used - perhaps with different premixed short-to-intermediate acting ratios - to improve her blood glucose profile? Try experimenting with some of the other premixed insulin types which come as standard within AIDA. Hint: you will also have to adjust the dosages..... Try this case This man tends to run high blood sugars throughout the day. He is concerned about this. How might he adjust his insulin regimen to compensate for this? He currently finger pricks himself at least eight times a day which, besides being painful, may not be totally necessary. When should he measure his blood sugars to maximise the information he gets back while keeping the number of finger pricks down? Hint: before meals. Also this man's regimen approximates to an insulin pump regimen. As it is not possible to simulate a proper basal / bolus pump regimen with the current AIDA v4 model - we have given this man two injections of 6 units of long-acting insulin in the morning and evening to provide some basal-like background insulin, and have supplemented this with boluses (injections) of short-acting (regular) insulin before each of his meals. See if you can tighten this man's blood glucose control while keeping him on his pump-like regimen... Try this case This young woman is on a twice daily insulin regimen, injecting a biphasic preparation which has a premixed 30% to 70% ratio of short vs intermediate acting insulin. While this doesn't permit quite as much flexibility in selecting a dose - it does save on having to mix insulin in the syringe. Use the simulator to see what would happen if you switched this woman onto other biphasic preparations with, say, premixed 10/90, 20/80, 40/60, or 50/50 percent constituents.....
The material in this on-line Diabetes / Insulin Tutorial has been drawn from a number of different sources.
However the original Web-based version can be found at the AIDA Website at: http://www.2aida.org/tutorial.