A new software for initiating and optimising insulin treatment of out-patients

Two computer programs were developed, program I to optimise insulin treatment using six injections per day, and program II to convert these insulin profiles into less frequent injections of mixtures of regular and NPH insulin. The first software in an HP 41 CV pocket computer uses iterative adjustments during the day and on subsequent days to determine the optimal timing and dosage of insulin. Six self-monitored glucose values at 3 h intervals, insulin doses, and the effects of insulin on plasma glucose are memorised for calculations. The calculated insulin doses were applied by Optipen as five s.c. injections of regular insulin and one bedside injection of NPH insulin. After 5 days the optimised individual insulin profiles with six daily injections were processed by program II. It applies the pharmacokinetics of regular and NPH insulin to make suggestions for a more conventional insulin therapy with one, two, three or four daily injections of regular insulin, NPH insulin, or varying mixtures of both insulins. The procedure was well tolerated in eight insulin-dependent diabetes mellitus out-patients. Insulin therapy with two or three injections, fitted by the second program and selected according to the quality score, produced plasma glucose profiles as satisfactory as those obtained with six injections. The system allows the fine tuning of insulin therapy to out-patients with their individual diets and physical activities.