U.S. patent application number 17/114254 was filed with the patent office on 2021-08-26 for machine learning in an artificial pancreas.
The applicant listed for this patent is DexCom, Inc.. Invention is credited to Scott M. Belliveau, Naresh C. Bhavaraju, Rian Draeger, Derek James Escobar, Hari Hampapuram, Apurv Ullas Kamath, Katherine Yerre Koehler, Michael Robert Mensinger, Sumitaka Mikami, Gary A. Morris, Andrew Attila Pal, Nathanael Paul, Nicholas Polytaridis, David Price, Eli Reihman, Peter C. Simpson, Edward Sweeney, Jorge Valdes, Benjamin Elrod West.
Application Number | 20210259591 17/114254 |
Document ID | / |
Family ID | 1000005304013 |
Filed Date | 2021-08-26 |
United States Patent
Application |
20210259591 |
Kind Code |
A1 |
Kamath; Apurv Ullas ; et
al. |
August 26, 2021 |
MACHINE LEARNING IN AN ARTIFICIAL PANCREAS
Abstract
Machine learning in an artificial pancreas is described. An
artificial pancreas system may include a wearable glucose
monitoring device, an insulin delivery system, and a computing
device. Broadly speaking, the wearable glucose monitoring device
provides glucose measurements of a person continuously. The
artificial pancreas algorithm, which may be implemented at the
computing device, determines doses of insulin to deliver to the
person based on a variety of aspects for the purpose of maintaining
the person's glucose within a target range, as indicated by those
glucose measurements. The insulin delivery system then delivers
those determined doses to the person. As the artificial pancreas
algorithm determines insulin doses for the person over time and
effectiveness of the insulin doses to maintain the person's glucose
level in the target range is observed, an underlying model of the
artificial pancreas algorithm may be updated to better determine
insulin doses.
Inventors: |
Kamath; Apurv Ullas; (San
Diego, CA) ; Escobar; Derek James; (Escondido,
CA) ; Mikami; Sumitaka; (San Diego, CA) ;
Hampapuram; Hari; (Portland, OR) ; West; Benjamin
Elrod; (San Diego, CA) ; Paul; Nathanael;
(Knoxville, TN) ; Bhavaraju; Naresh C.; (San
Diego, CA) ; Mensinger; Michael Robert; (San Diego,
CA) ; Morris; Gary A.; (La Jolla, CA) ; Pal;
Andrew Attila; (San Diego, CA) ; Reihman; Eli;
(San Diego, CA) ; Belliveau; Scott M.; (San Diego,
CA) ; Koehler; Katherine Yerre; (Solana Beach,
CA) ; Polytaridis; Nicholas; (San Diego, CA) ;
Draeger; Rian; (San Diego, CA) ; Valdes; Jorge;
(San Diego, CA) ; Price; David; (Carlsbad, CA)
; Simpson; Peter C.; (Cardiff, CA) ; Sweeney;
Edward; (Poway, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
DexCom, Inc. |
San Diego |
CA |
US |
|
|
Family ID: |
1000005304013 |
Appl. No.: |
17/114254 |
Filed: |
December 7, 2020 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
62979347 |
Feb 20, 2020 |
|
|
|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61M 5/1723 20130101;
A61B 5/743 20130101; A61M 2205/3553 20130101; A61M 5/14244
20130101; A61B 5/6801 20130101; A61M 2205/583 20130101; A61B
5/14532 20130101; A61B 5/0004 20130101; A61B 5/7475 20130101; A61B
5/425 20130101 |
International
Class: |
A61B 5/145 20060101
A61B005/145; A61B 5/00 20060101 A61B005/00; A61M 5/172 20060101
A61M005/172; A61M 5/142 20060101 A61M005/142 |
Claims
1. A method implemented by an artificial pancreas controller
executed at a computing device, the method comprising: establishing
a first wireless connection to a wearable glucose monitoring device
worn by a user and a second wireless connection to an insulin
delivery system worn by the user; receiving, via the first wireless
connection, an initial glucose measurement provided by the wearable
glucose monitoring device worn by the user; receiving, via a user
interface, user input describing an amount of carbohydrates to be
consumed by the user as part of a meal; monitoring glucose
measurements provided by the wearable glucose monitoring device
worn by the user after the meal to detect a peak glucose
measurement; determining a carbohydrate-to-glucose ratio for the
user based on the initial glucose measurement, the peak glucose
measurement, and the amount of carbohydrates consumed by the user;
and controlling the insulin delivery system to deliver bolus
insulin doses to the user based at least in part on the
carbohydrate-to-glucose ratio.
2. The method as described in claim 1, wherein the controlling
comprises controlling the insulin delivery system to deliver bolus
insulin doses to the user based at least in part on the
carbohydrate-to-glucose ratio and an insulin sensitivity
factor.
3. The method as described in claim 2, wherein the controlling
further comprises: determining an amount of carbohydrates to be
consumed as part of a future meal; determining a bolus insulin dose
for the user based on the amount of carbohydrates to be consumed as
part of the future meal, the carbohydrate-to-glucose ratio, and the
insulin sensitivity factor; and controlling the insulin delivery
system to deliver the bolus insulin doses to the user by
communicating instructions over the second wireless connection to
the insulin delivery system.
4. The method as described in claim 3, wherein determining the
amount of carbohydrates to be consumed as part of the future meal
comprises estimating the amount of carbohydrates to be consumed as
part of the future meal based on information describing the future
meal.
5. The method as described in claim 4, wherein the information
describing the future meal includes an image of the future
meal.
6. The method as described in claim 5, wherein the information
describing the future meal includes an additional image of any
leftovers of the future meal, the determining the amount of
carbohydrates to be consumed as part of the future meal being based
on a comparison of the image and the additional image.
7. The method as described in claim 1, further comprising:
estimating a bolus insulin dose to drop the user's glucose level
from the peak glucose measurement to a target glucose measurement;
controlling the insulin delivery system to deliver the estimated
bolus insulin dose to the user by communicating instructions over
the second wireless connection to the insulin delivery system;
monitoring glucose measurements provided by the wearable glucose
monitoring device worn by the user after the estimated bolus
insulin dose is delivered to the user via the insulin delivery
system to detect the target glucose measurement; and determining an
insulin sensitivity factor for the user based on an amount of
insulin included in the estimated bolus insulin dose and a
difference between the peak glucose measurement and the target
glucose measurement.
8. The method as described in claim 7, further comprising
associating the carbohydrate-to-glucose ratio and the insulin
sensitivity factor with a user profile of the user maintained in a
database that is accessible to the wearable glucose monitoring
device and the insulin delivery system.
9. The method as described in claim 1, wherein the wearable glucose
monitoring device is a continuous glucose monitoring (CGM)
device.
10. A system comprising: an artificial pancreas controller to:
establish a first wireless connection to a wearable glucose
monitoring device worn by a user and a second wireless connection
to an insulin delivery system worn by the user; receive, via the
first wireless connection, an initial glucose measurement provided
by the wearable glucose monitoring device worn by the user;
receive, via a user interface, user input describing an amount of
carbohydrates to be consumed by the user as part of a meal; monitor
glucose measurements provided by the wearable glucose monitoring
device worn by the user after the meal to detect a peak glucose
measurement; and determine a carbohydrate-to-glucose ratio for the
user based on the initial glucose measurement, the peak glucose
measurement, and the amount of carbohydrates consumed by the user;
and a pump control manager to control the insulin delivery system
to deliver bolus insulin doses to the user based at least in part
on the carbohydrate-to-glucose ratio.
11. The system as described in claim 10, wherein the pump control
manager is further configured to control the insulin delivery
system to deliver bolus insulin doses to the user based at least in
part on the carbohydrate-to-glucose ratio and an insulin
sensitivity factor.
12. The system as described in claim 11, wherein: the artificial
pancreas controller is further configured to: determine an amount
of carbohydrates to be consumed as part of a future meal; and
determine a bolus insulin dose for the user based on the amount of
carbohydrates to be consumed as part of the future meal, the
carbohydrate-to-glucose ratio, and the insulin sensitivity factor;
and the pump control manager is further configured to control the
insulin delivery system to deliver the bolus insulin doses to the
user by communicating instructions over the second wireless
connection to the insulin delivery system.
13. The system as described in claim 12, wherein the artificial
pancreas controller is further configured to estimate the amount of
carbohydrates to be consumed as part of the future meal based on
information describing the future meal to determine the amount of
carbohydrates to be consumed as part of the future meal.
14. The system as described in claim 13, wherein the information
describing the future meal includes an image of the future
meal.
15. The system as described in claim 14, wherein the information
describing the future meal includes an additional image of any
leftovers of the future meal, the amount of carbohydrates to be
consumed as part of the future meal is further determined based on
a comparison of the image and the additional image.
16. The system as described in claim 10, wherein: the artificial
pancreas controller is further configured to: estimate a bolus
insulin dose to drop the user's glucose level from the peak glucose
measurement to a target glucose measurement; monitor glucose
measurements provided by the wearable glucose monitoring device
worn by the user after the estimated bolus insulin dose is
delivered to the user via the insulin delivery system to detect the
target glucose measurement; and determine an insulin sensitivity
factor for the user based on an amount of insulin included in the
estimated bolus insulin dose and a difference between the peak
glucose measurement and the target glucose measurement; and the
pump control manager is further configured to control the insulin
delivery system to deliver the estimated bolus insulin dose to the
user by communicating instructions over the second wireless
connection to the insulin delivery system.
17. The system as described in claim 16, wherein the artificial
pancreas controller is further configured to associate the
carbohydrate-to-glucose ratio and the insulin sensitivity factor
with a user profile of the user maintained in a database that is
accessible to the wearable glucose monitoring device and the
insulin delivery system.
18. One or more computer-readable storage media having instructions
stored thereon that are executable by one or more processors to
perform operations comprising: establishing a first wireless
connection to a wearable glucose monitoring device worn by a user
and a second wireless connection to an insulin delivery system worn
by the user; receiving, via the first wireless connection, an
initial glucose measurement provided by the wearable glucose
monitoring device worn by the user; receiving, via a user
interface, user input describing an amount of carbohydrates to be
consumed by the user as part of a meal; monitoring glucose
measurements provided by the wearable glucose monitoring device
worn by the user after the meal to detect a peak glucose
measurement; determining a carbohydrate-to-glucose ratio for the
user based on the initial glucose measurement, the peak glucose
measurement, and the amount of carbohydrates consumed by the user;
and controlling the insulin delivery system to deliver bolus
insulin doses to the user based at least in part on the
carbohydrate-to-glucose ratio.
19. The one or more computer-readable storage media as described in
claim 18, wherein the controlling comprises controlling the insulin
delivery system to deliver bolus insulin doses to the user based at
least in part on the carbohydrate-to-glucose ratio and an insulin
sensitivity factor.
20. The one or more computer-readable storage media as described in
claim 19, wherein the controlling further comprises: determining an
amount of carbohydrates to be consumed as part of a future meal;
determining a bolus insulin dose for the user based on the amount
of carbohydrates to be consumed as part of the future meal, the
carbohydrate-to-glucose ratio, and the insulin sensitivity factor;
and controlling the insulin delivery system to deliver the bolus
insulin doses to the user by communicating instructions over the
second wireless connection to the insulin delivery system.
21. The one or more computer-readable storage media as described in
claim 20, wherein determining the amount of carbohydrates to be
consumed as part of the future meal comprises estimating the amount
of carbohydrates to be consumed as part of the future meal based on
information describing the future meal.
22. The one or more computer-readable storage media as described in
claim 21, wherein the information describing the future meal
includes an image of the future meal.
23. The one or more computer-readable storage media as described in
claim 22, wherein the information describing the future meal
includes an additional image of any leftovers of the future meal,
the determining the amount of carbohydrates to be consumed as part
of the future meal being based on a comparison of the image and the
additional image.
24. The one or more computer-readable storage media as described in
claim 18, wherein the operations further comprise: estimating a
bolus insulin dose to drop the user's glucose level from the peak
glucose measurement to a target glucose measurement; controlling
the insulin delivery system to deliver the estimated bolus insulin
dose to the user by communicating instructions over the second
wireless connection to the insulin delivery system; monitoring
glucose measurements provided by the wearable glucose monitoring
device worn by the user after the estimated bolus insulin dose is
delivered to the user via the insulin delivery system to detect the
target glucose measurement; and determining an insulin sensitivity
factor for the user based on an amount of insulin included in the
estimated bolus insulin dose and a difference between the peak
glucose measurement and the target glucose measurement.
25. The one or more computer-readable storage media as described in
claim 24, wherein the operations further comprise associating the
carbohydrate-to-glucose ratio and the insulin sensitivity factor
with a user profile of the user maintained in a database that is
accessible to the wearable glucose monitoring device and the
insulin delivery system.
26. The one or more computer-readable storage media as described in
claim 18, wherein the wearable glucose monitoring device is a
continuous glucose monitoring (CGM) device.
27. An apparatus comprising: an establishing means for establishing
a first wireless connection to a wearable glucose monitoring device
worn by a user and a second wireless connection to an insulin
delivery system worn by the user; a first receiving means for
receiving, via the first wireless connection, an initial glucose
measurement provided by the wearable glucose monitoring device worn
by the user; a second receiving means for receiving, via a user
interface, user input describing an amount of carbohydrates to be
consumed by the user as part of a meal; a monitoring means for
monitoring glucose measurements provided by the wearable glucose
monitoring device worn by the user after the meal to detect a peak
glucose measurement; a determining means for determining a
carbohydrate-to-glucose ratio for the user based on the initial
glucose measurement, the peak glucose measurement, and the amount
of carbohydrates consumed by the user; and a controlling means for
controlling the insulin delivery system to deliver bolus insulin
doses to the user based at least in part on the
carbohydrate-to-glucose ratio.
Description
INCORPORATION BY REFERENCE TO RELATED APPLICATION
[0001] Any and all priority claims identified in the Application
Data Sheet, or any correction thereto, are hereby incorporated by
reference under 37 CFR 1.57. This application claims the benefit of
U.S. Provisional Patent Application No. 62/979,347, filed Feb. 20,
2020, and titled "Machine Learning in An Artificial Pancreas". The
aforementioned application is incorporated by reference herein in
its entirety, and is hereby expressly made a part of this
specification.
BACKGROUND
[0002] Diabetes is a metabolic condition affecting hundreds of
millions of people, and is one of the leading causes of death
worldwide. For people living with diabetes, access to treatment is
critical to their survival. With proper treatment, serious damage
to the heart, blood vessels, eyes, kidneys, and nerves, due to
diabetes can be largely avoided. Proper treatment for a person with
Type I diabetes generally involves monitoring glucose levels
throughout the day and regulating those levels--oftentimes using
insulin--so that the levels stay within a target range. Insulin
therapy may also be prescribed for many with Type II diabetes as
part of their treatment.
[0003] Developing an insulin therapy plan and then administering it
typically requires oversight of a health care provider, at least
initially and at regular intervals, e.g., to ensure proper bodily
responses to and effectiveness of the therapy. Conventional insulin
therapy techniques also generally involve rigor on the part of the
person undergoing the therapy. In order to determine a basal rate
of insulin, for example, a person may need to follow an incremental
process of delivering insulin at a particular rate (initially low),
observing how his or her glucose measurements are affected at the
particular rate, and then, until the person's glucose measurements
remain in a target range consistently, manually adjusting the rate
on his or her insulin pump a small amount upward at each increment
by referencing generic adjustment tables. This process can take
months, however, and thus be cumbersome for the person. Determining
bolus insulin doses can also be arduous--doing so may involve
observing the person's glucose several times after eating a same,
measured amount of a particular carbohydrate (e.g., white rice
separately from brown rice) or after eating a same meal (in terms
of food and its amount) and also involve delivering a measured
amount of bolus insulin, which the person may also need to adjust
manually depending on the observed glucose.
[0004] Even after determining basal rates and bolus doses, the
person must remain vigilant to ensure timely delivery of insulin
according to those doses and, further, must continue to monitor his
or her body's ongoing response, i.e., in case further adjustments
to the doses are needed. Some examples of factors for which those
doses may be further adjusted include dietary changes, weight loss,
changes in exercise routine, and various medical conditions (e.g.,
pregnancy), to name just a few. Although insulin therapy can mean
the difference between relatively normal occurrence of negative
health events (experienced by most persons) and very serious ones
(due specifically to diabetes), the process of customizing the
therapy and then administering it can nevertheless be a burden. In
addition and because of this burden, many persons who should
receive insulin therapy avoid it while others neglect to adequately
adhere to the parameters of their therapy.
SUMMARY
[0005] To overcome these problems, machine learning in an
artificial pancreas is leveraged. In one or more implementations,
an artificial pancreas system includes a wearable glucose
monitoring device, an insulin delivery system, and a computing
device, which are communicatively coupled to carry out various
aspects of the system. Broadly speaking, the wearable glucose
monitoring device provides glucose measurements of a person
continuously. The artificial pancreas algorithm, which may be
implemented at the computing device, determines doses of insulin to
deliver to the person based on a variety of aspects and for the
purpose of maintaining the person's glucose level within a target
range, as indicated by those glucose measurements. The insulin
delivery system then delivers the determined doses to the person
for absorption by his or her body to maintain balanced glucose
within the target range. As the artificial pancreas algorithm
determines insulin doses for the person over time, and the
effectiveness of those doses to maintain the person's glucose level
is observed, e.g., based on the glucose measurements, an underlying
model of the artificial pancreas algorithm may be optimized to
better determine insulin doses for the person in the future.
[0006] This Summary introduces a selection of concepts in a
simplified form that are further described below in the Detailed
Description. As such, this Summary is not intended to identify
essential features of the claimed subject matter, nor is it
intended to be used as an aid in determining the scope of the
claimed subject matter.
BRIEF DESCRIPTION OF THE DRAWINGS
[0007] The detailed description is described with reference to the
accompanying figures.
[0008] FIG. 1 is an illustration of an environment in an example
implementation that is operable to employ techniques described
herein.
[0009] FIG. 2 depicts an example of the wearable glucose monitoring
device of FIG. 1 in greater detail.
[0010] FIG. 3 depicts an example of the insulin delivery system of
FIG. 1 in greater detail.
[0011] FIG. 4 depicts an example implementation in which the
wearable glucose monitoring device, the insulin delivery system,
and the computing device of FIG. 1 are configured as an artificial
pancreas.
[0012] FIGS. 5-9 depict example implementations of tables stored in
a shared storage in connection with implementing an artificial
pancreas system.
[0013] FIG. 10 depicts an example implementation of a user
interface displayed for determining a basal insulin dose.
[0014] FIG. 11 depicts an example implementation of user interfaces
displayed for determining a carbohydrate-to-glucose ratio for a
person.
[0015] FIG. 12 depicts an example implementation of user interfaces
displayed for determining insulin sensitivity of a person.
[0016] FIG. 13 depicts an example implementation of user interfaces
displayed for matching an insulin dose to a meal.
[0017] FIG. 14 depicts a procedure in an example implementation in
which an insulin dose is determined and delivered to a user.
[0018] FIG. 15 depicts a procedure in an example implementation in
which a carbohydrate-to-glucose ratio is determined and used to
control delivery of bolus insulin doses.
[0019] FIG. 16 depicts a procedure in an example implementation in
which an insulin sensitivity factor is determined and used to
control delivery of bolus insulin doses.
[0020] FIG. 17 depicts a procedure in an example implementation in
which an artificial pancreas algorithm is trained to determine
insulin doses for a user using one or more machine learning
techniques.
[0021] FIG. 18 depicts a procedure in an example implementation in
which an insulin delivery request is encrypted and communicated for
decryption by an application.
[0022] FIG. 19 depicts a procedure in an example implementation in
which an encrypted insulin delivery request is received, decrypted,
and instructions for delivering insulin a communicated to an
insulin delivery system based on the request.
[0023] FIG. 20 illustrates an example system including various
components of an example device that can be implemented as any type
of computing device as described and/or utilized with reference to
FIGS. 1-19 to implement embodiments of the techniques described
herein.
DETAILED DESCRIPTION
[0024] Overview
[0025] Insulin therapy can mean the difference between relatively
normal occurrence of negative health events experienced by most
persons and very serious ones due specifically to diabetes.
However, the process of customizing the therapy and then
administering it can nevertheless be a burden. In addition and
because of this burden, many persons who should receive insulin
therapy avoid it while others neglect to adequately adhere to the
parameters of their therapy.
[0026] Machine learning in an artificial pancreas is described
herein. In one or more implementations, an artificial pancreas
system includes a wearable glucose monitoring device, an insulin
delivery system, and a computing device, which are communicatively
coupled to carry out various aspects of the system. Broadly
speaking, the wearable glucose monitoring device provides glucose
measurements of a person continuously. The artificial pancreas
algorithm, which may be implemented at the computing device,
determines doses of insulin to deliver to the person based on a
variety of aspects and for the purpose of maintaining the person's
glucose level within a target range, as indicated by those glucose
measurements. The insulin delivery system then delivers the
determined doses to the person for absorption by his or her body to
maintain balanced glucose within the target range.
[0027] As the artificial pancreas algorithm determines insulin
doses for the person over time, and the effectiveness of those
doses to maintain the person's glucose level is observed, e.g.,
based on the glucose measurements, an underlying model of the
artificial pancreas algorithm may be updated to better determine
insulin doses for the person in the future. By programmatically
reinforcing determinations that result in stable glucose
measurements within the target range and programmatically
discouraging determinations that result in unstable measurements
and/or measurements outside the target range, the artificial
pancreas algorithm learns to more often keep the person's glucose
level within the target range and/or more stable than when the
algorithm is first deployed.
[0028] Using machine learning in a fully closed, automated loop
between continuous glucose monitoring and delivery of determined
insulin doses may remove many of the burdens of conventional
systems and processes attendant to insulin therapy. For example,
allowing the artificial pancreas algorithm to be adjusted
automatically based on data patterns present in the continuous
glucose measurements can significantly reduce a time to determine
basal insulin dose rates, e.g., from nearly a year in some cases to
weeks. Not only may the artificial pancreas algorithm determine and
improve bolus insulin doses for a person over time based on user
input of upcoming meals (e.g., grams of carbohydrates), but the
artificial pancreas algorithm may also learn to predict upcoming
events that may affect the person's glucose (e.g., meals and
exercise) and automatically deliver insulin in anticipation of a
predicted upcoming event--without receiving user input for the
particular event. In addition, the artificial pancreas algorithm
may learn to detect the occurrence of events as they happen that
may affect the person's glucose (e.g., meals and exercise) and
automatically deliver insulin to mitigate any effects of such a
detected event--also without receiving user input for the
particular event. These and other advantages of the artificial
pancreas system may be described further below. Moreover, the
artificial pancreas system may be implemented in a modular fashion,
i.e., so that any of a plurality of insulin delivery system
providers approved by a glucose monitoring platform are able to
securely interface with the platform's components comprising the
artificial pancreas system--the wearable glucose monitoring device
and the artificial pancreas algorithm.
[0029] In the following discussion, an example environment is first
described that may employ the techniques described herein. Example
implementation details and procedures are then described which may
be performed in the example environment as well as other
environments. Performance of the example procedures is not limited
to the example environment and the example environment is not
limited to performance of the example procedures.
[0030] Example Environment
[0031] FIG. 1 is an illustration of an environment 100 in an
example implementation that is operable to employ machine learning
in an artificial pancreas as described herein. The illustrated
environment 100 includes person 102, who is depicted wearing a
wearable glucose monitoring device 104, insulin delivery system
106, and computing device 108. The illustrated environment 100 also
includes other users in a user population 110 of the wearable
glucose monitoring device, glucose monitoring platform 112, and
Internet of Things 114 (IoT 114). The wearable glucose monitoring
device 104, insulin delivery system 106, computing device 108, user
population 110, glucose monitoring platform 112, and IoT 114 are
communicatively coupled, including via a network 116.
[0032] Alternately or additionally, the wearable glucose monitoring
device 104, the insulin delivery system 106, and the computing
device 108 may be communicatively coupled in other ways, such as
using one or more wireless communication protocols or techniques.
The wearable glucose monitoring device 104, the insulin delivery
system 106, and the computing device 108 can be communicatively
coupled, for instance, to form an artificial pancreas system as
discussed above and below, and particularly in relation to FIG.
4.
[0033] The wearable glucose monitoring device 104, the insulin
delivery system 106, and the computing device 108 may communicate
with one another using one or more of Bluetooth (e.g., Bluetooth
Low Energy links), near-field communication (NFC), 5G, and so
forth. The wearable glucose monitoring device 104, the insulin
delivery system 106, and the computing device 108 may leverage
these types of communication to form a closed-loop system between
one another, such as an artificial pancreas system. In this way,
the insulin delivery system 106 may deliver insulin based on
sequences of glucose measurements in real-time as those glucose
measurements are obtained by the wearable glucose monitoring device
104.
[0034] In accordance with the described techniques, the wearable
glucose monitoring device 104 is configured to monitor glucose of
the person 102, e.g., continuously. In one or more implementations,
the wearable glucose monitoring device 104 may thus be configured
as a continuous glucose monitoring (CGM) system. Regardless, the
wearable glucose monitoring device 104 may be configured with a
glucose sensor, for instance, that continuously detects analytes
indicative of the person 102's glucose and enables generation of
glucose measurements. In the illustrated environment 100 these
measurements are represented as glucose measurements 118. This
functionality along with further aspects of the wearable glucose
monitoring device 104's configuration are discussed in more detail
in relation to FIG. 2.
[0035] In one or more implementations, the wearable glucose
monitoring device 104 transmits the glucose measurements 118 to the
computing device 108, such as via a wireless connection. The
wearable glucose monitoring device 104 may communicate these
measurements in real-time, e.g., as they are produced using a
glucose sensor. Alternately or in addition, the wearable glucose
monitoring device 104 may communicate the glucose measurements 118
to the computing device 108 at set time intervals, e.g., every 30
seconds, every minute, every 5 minutes, every hour, every 6 hours,
every day, and so forth. Further still, the wearable glucose
monitoring device 104 may communicate these measurements responsive
to a request from the computing device 108, e.g., communicated to
the wearable glucose monitoring device 104 when the computing
device 108 causes display of a user interface having information
about the person 102's glucose level, updates such a display, uses
one of the person 102's glucose measurements (or a sequence of
them) for the purpose of delivering insulin, and so forth.
Accordingly, the computing device 108 may maintain the glucose
measurements 118 of the person 102 at least temporarily, e.g., in
computer readable storage media of the computing device 108.
[0036] Although illustrated as a wearable device (e.g., a smart
watch), the computing device 108 may be configured in a variety of
ways without departing from the spirit or scope of the described
techniques. By way of example and not limitation, the computing
device 108 may be configured as a different type of mobile device
(e.g., a mobile phone or tablet device). In one or more
implementations, the computing device 108 may be configured as a
dedicated device associated with the glucose monitoring platform
112, e.g., with functionality to obtain the glucose measurements
118 from the wearable glucose monitoring device 104, perform
various computations in relation to the glucose measurements 118,
display information related to the glucose measurements 118 and the
glucose monitoring platform 112, communicate the glucose
measurements 118 to the glucose monitoring platform 112, receive
communications from the insulin delivery system 106, control the
insulin delivery system 106 to deliver doses of insulin to the
person 102, and so forth. In contrast to implementations where the
computing device 108 is configured as a mobile phone, however, the
computing device 108 may not include some functionality available
with mobile phone or wearable configurations when configured as a
dedicated glucose monitoring device, such as the ability to make
phone calls, camera functionality, the ability to utilize social
networking applications, and so on.
[0037] Additionally, the computing device 108 may be representative
of more than one device in accordance with the described
techniques. In one or more scenarios, for instance, the computing
device 108 may correspond to both a wearable device (e.g., a smart
watch) and a mobile phone. In such scenarios, both of these devices
may be capable of performing at least some of the same operations,
such as to receive the glucose measurements 118 from the wearable
glucose monitoring device 104, communicate them via the network 116
to the glucose monitoring platform 112, display information related
to the glucose measurements 118, receive communications from the
insulin delivery system 106, control the insulin delivery system
106 to deliver units of insulin to the person 102, and so forth.
Alternately or in addition, different devices may have different
capabilities that other devices do not have or that are limited
through computing instructions to specified devices.
[0038] In the scenario where the computing device 108 corresponds
to a separate smart watch and a mobile phone, for instance, the
smart watch may be configured with various sensors and
functionality to measure a variety of physiological markers (e.g.,
heartrate, breathing, rate of blood flow, and so on) and activities
(e.g., steps) of the person 102. In this scenario, the mobile phone
may not be configured with these sensors and functionality or may
include a limited amount of that functionality--although in other
scenarios a mobile phone may be able to provide the same
functionality. Continuing with this particular scenario, the mobile
phone may have capabilities that the smart watch does not have,
such as a camera to capture images of meals used to predict
effective insulin doses, an amount of computing resources (e.g.,
battery and processing speed) that enables the mobile phone to more
efficiently carry out computations in relation to the glucose
measurements 118. Even in scenarios where a smart watch is capable
of carrying out such computations, computing instructions may limit
performance of those computations to the mobile phone so as not to
burden both devices and to utilize available resources efficiently.
To this extent, the computing device 108 may be configured in
different way and represent different numbers of devices than
discussed herein without departing from the spirit and scope of the
described techniques.
[0039] The computing device 108 also includes functionality (e.g.,
one or more algorithms) to determine insulin doses that are based
on the glucose measurements 118 and that are predicted to prevent
the person 102's future glucose measurements from departing from a
target glucose range. In connection with this, the computing device
108 may control the insulin delivery system 106 to deliver the
determined insulin dose, such as by communicating instructions via
control signals over a wireless connection established with the
insulin delivery system 106, e.g., a Bluetooth Low Energy link. In
one or more implementations, the insulin delivery system 106
includes an insulin reservoir and is configured to deliver doses of
insulin to the person 102 from this reservoir according to the
instructions. This functionality along with further aspects of the
insulin delivery system 106 are discussed in more detail in
relation to FIG. 3.
[0040] As mentioned above, the computing device 108 communicates
the glucose measurements 118 to the glucose monitoring platform
112. In the illustrated environment 100, the glucose measurements
118 are shown stored in storage device 120 of the glucose
monitoring platform 112. The storage device 120 may represent one
or more databases and also other types of storage capable of
storing the glucose measurements 118. The storage device 120 also
stores a variety of other data. In accordance with the described
techniques, for instance, the person 102 corresponds to a user of
at least the glucose monitoring platform 112 and may also be a user
of one or more other, third party service providers. To this end,
the person 102 may be associated with a username and be required,
at some time, to provide authentication information (e.g.,
password, biometric data, and so forth) to access the glucose
monitoring platform 112 using the username. This information, along
with other information about the user, may be maintained in the
storage device 120, including, for example, demographic information
describing the person 102, information about a health care
provider, payment information, prescription information, determined
health indicators, user preferences, account information for other
service provider systems (e.g., a service provider associated with
a wearable, social networking systems, and so on), and so
forth.
[0041] The storage device 120 also maintains data of the other
users in the user population 110. Given this, the glucose
measurements 118 in the storage device 120 include the glucose
measurements from a glucose sensor of the wearable glucose
monitoring device 104 worn by the person 102 and also include
glucose measurements from glucose sensors of wearable glucose
monitoring devices worn by persons corresponding to the other users
in the user population 110. It follows also that the glucose
measurements 118 of these other users are communicated by their
respective devices via the network 116 to the glucose monitoring
platform 112 and that these other users have respective user
profiles with the glucose monitoring platform 112.
[0042] The data analytics platform 122 represents functionality to
process the glucose measurements 118--alone and/or along with other
data maintained in the storage device 120--to generate a variety of
predictions, such as by using various machine learning models.
Based on these predictions, the glucose monitoring platform 112 may
provide recommendations and/or other information about the
predictions. Although depicted as separate from the computing
device 108, portions or an entirety of the data analytics platform
122 may alternately or additionally be implemented at the computing
device 108. The data analytics platform 122 may also generate these
predictions using additional data obtained via the IoT 114.
[0043] It is to be appreciated that the IoT 114 represents various
sources capable of providing data that describes the person 102 and
the person 102's activity as a user of one or more service
providers and activity with the real world. By way of example, the
IoT 114 may include various devices of the user, e.g., cameras,
mobile phones, laptops, and so forth. To this end, the IoT 114 may
provide information about interaction of the user with various
devices, e.g., interaction with web-based applications, photos
taken, communications with other users, and so forth. The IoT 114
may also include various real-world articles (e.g., shoes,
clothing, sporting equipment, appliances, automobiles, etc.)
configured with sensors to provide information describing behavior,
such as steps taken, force of a foot striking the ground, length of
stride, temperature of a user (and other physiological
measurements), temperature of a user's surroundings, types of food
stored in a refrigerator, types of food removed from a
refrigerator, driving habits, and so forth. The IoT 114 may also
include third parties to the glucose monitoring platform 112, such
as medical providers (e.g., a medical provider of the person 102)
and manufacturers (e.g., a manufacturer of the wearable glucose
monitoring device 104, the insulin delivery system 106, or the
computing device 108) capable of providing medical and
manufacturing data, respectively, that can be leveraged by the data
analytics platform 122. Certainly, the IoT 114 may include devices
and sensors capable of providing a wealth of data used to predict
insulin doses to control glucose levels without departing from the
spirit or scope of the described techniques. In the context of
measuring glucose, e.g., continuously, and obtaining data
describing such measurements, consider the following discussion of
FIG. 2.
[0044] FIG. 2 depicts an example implementation 200 of the wearable
glucose monitoring device 104 of FIG. 1 in greater detail. In
particular, the illustrated example 200 includes a top view and a
corresponding side view of the wearable glucose monitoring device
104.
[0045] The wearable glucose monitoring device 104 is illustrated to
include a sensor 202 and a sensor module 204. In the illustrated
example 200, the sensor 202 is depicted in the side view having
been inserted subcutaneously into skin 206, e.g., of the person
102. The sensor module 204 is depicted in the top view as a dashed
rectangle. The wearable glucose monitoring device 104 also includes
a transmitter 208 in the illustrated example 200. Use of the dashed
rectangle for the sensor module 204 indicates that it may be housed
or otherwise implemented within a housing of the transmitter 208.
In this example 200, the wearable glucose monitoring device 104
further includes adhesive pad 210 and attachment mechanism 212.
[0046] In operation, the sensor 202, the adhesive pad 210, and the
attachment mechanism 212 may be assembled to form an application
assembly, where the application assembly is configured to be
applied to the skin 206 so that the sensor 202 is subcutaneously
inserted as depicted. In such scenarios, the transmitter 208 may be
attached to the assembly after application to the skin 206 via the
attachment mechanism 212. Additionally or alternately, the
transmitter 208 may be incorporated as part of the application
assembly, such that the sensor 202, the adhesive pad 210, the
attachment mechanism 212, and the transmitter 208 (with the sensor
module 204) can all be applied at once to the skin 206. In one or
more implementations, this application assembly is applied to the
skin 206 using a separate applicator (not shown). This application
assembly may also be removed by peeling the adhesive pad 210 off of
the skin 206. It is to be appreciated that the wearable glucose
monitoring device 104 and its various components as illustrated are
simply one example form factor, and the wearable glucose monitoring
device 104 and its components may have different form factors
without departing from the spirit or scope of the described
techniques.
[0047] In operation, the sensor 202 is communicatively coupled to
the sensor module 204 via at least one communication channel which
can be a "wireless" connection or a "wired" connection.
Communications from the sensor 202 to the sensor module 204 or from
the sensor module 204 to the sensor 202 can be implemented actively
or passively and these communications can be continuous (e.g.,
analog) or discrete (e.g., digital).
[0048] The sensor 202 may be a device, a molecule, and/or a
chemical which changes or causes a change in response to an event
which is at least partially independent of the sensor 202. The
sensor module 204 is implemented to receive indications of changes
to the sensor 202 or caused by the sensor 202. For example, the
sensor 202 can include glucose oxidase which reacts with glucose
and oxygen to form hydrogen peroxide that is electrochemically
detectable by the sensor module 204 which may include an electrode.
In this example, the sensor 202 may be configured as or include a
glucose sensor configured to detect analytes in blood or
interstitial fluid that are indicative of glucose level using one
or more measurement techniques.
[0049] In another example, the sensor 202 (or an additional sensor
of the wearable glucose monitoring device 104--not shown) can
include a first and second electrical conductor and the sensor
module 204 can electrically detect changes in electric potential
across the first and second electrical conductor of the sensor 202.
In this example, the sensor module 204 and the sensor 202 are
configured as a thermocouple such that the changes in electric
potential correspond to temperature changes. In some examples the
sensor module 204 and the sensor 202 are configured to detect a
single analyte, e.g., glucose. In other examples, the sensor module
204 and the sensor 202 are configured to detect multiple analytes,
e.g., sodium, potassium, carbon dioxide, and glucose. Alternately
or additionally, the wearable glucose monitoring device 104
includes multiple sensors to detect not only one or more analytes
(e.g., sodium, potassium, carbon dioxide, glucose, and insulin) but
also one or more environmental conditions (e.g., temperature).
Thus, the sensor module 204 and the sensor 202 (as well as any
additional sensors) may detect the presence of one or more
analytes, the absence of one or more analytes, and/or changes in
one or more environmental conditions.
[0050] In one or more implementations, the sensor module 204 may
include a processor and memory (not shown). The sensor module 204,
by leveraging the processor, may generate the glucose measurements
118 based on the communications with the sensor 202 that are
indicative of the above-discussed changes. Based on these
communications from the sensor 202, the sensor module 204 is
further configured to generate glucose monitoring device data 214.
The glucose monitoring device data 214 is a communicable package of
data that includes at least one glucose measurement 118.
Alternately or additionally, the glucose monitoring device data 214
includes other data, such as multiple glucose measurements 118,
sensor identification 216, sensor status 218, and so forth. In one
or more implementations, the glucose monitoring device data 214 may
include other information such as one or more of temperatures that
correspond to the glucose measurements 118 and measurements of
other analytes. It is to be appreciated that the glucose monitoring
device data 214 may include a variety of data in addition to at
least one glucose measurement 118 without departing from the spirit
or scope of the described techniques.
[0051] In operation, the transmitter 208 may transmit the glucose
monitoring device data 214 wirelessly as a stream of data to the
computing device 108. Alternately or additionally, the senor module
204 may buffer the glucose monitoring device data 214 (e.g., in
memory of the sensor module 204) and cause the transmitter 208 to
transmit the buffered glucose monitoring device data 214 at various
intervals, e.g., time intervals (every second, every thirty
seconds, every minute, every five minutes, every hour, and so on),
storage intervals (when the buffered glucose monitoring device data
214 reaches a threshold amount of data or a number of instances of
glucose monitoring device data 214), and so forth.
[0052] In addition to generating the glucose monitoring device data
214 and causing it to be communicated to the computing device 108,
the sensor module 204 may include additional functionality in
accordance with the described techniques. This additional
functionality may include generating predictions of glucose levels
of the person 102 in the future and communicating notifications
based on the predictions, such as by communicating warnings when
the predictions indicate that the person 102's level of glucose is
likely to be dangerously low in the near future. This computational
ability of the sensor module 204 may be advantageous especially
where connectivity to services via the network 116 is limited or
non-existent. In this way, a person may be alerted to a dangerous
condition without having to rely on connectivity, e.g., to the
Internet. This additional functionality of the sensor module 204
may also include calibrating the sensor 202 initially or on an
ongoing basis as well as calibrating any other sensors of the
wearable glucose monitoring device 104.
[0053] With respect to the glucose monitoring device data 214, the
sensor identification 216 represents information that uniquely
identifies the sensor 202 from other sensors, such as other sensors
of other wearable glucose monitoring device 104, other sensors
implanted previously or subsequently in the skin 206, and so on. By
uniquely identifying the sensor 202, the sensor identification 216
may also be used to identify other aspects about the sensor, 202
such as a manufacturing lot of the sensor 202, packaging details of
the sensor 202, shipping details of the sensor 202, and so on. In
this way, various issues detected for sensors manufactured,
packaged, and/or shipped in a similar manner as the sensor 202 may
be identified and used in different ways, e.g., to calibrate the
glucose measurements 118, to notify users to change defective
sensors or dispose of them, to notify manufacturing facilities of
machining issues, and so forth.
[0054] The sensor status 218 represents a state of the sensor 202
at a given time, e.g., a state of the sensor at a same time one of
the glucose measurements 118 is produced. To this end, the sensor
status 218 may include an entry for each of the glucose
measurements 118, such that there is a one-to-one relationship
between the glucose measurements 118 and statuses captured in the
sensor status 218 information. Generally speaking, the sensor
status 218 describes an operational state of the sensor 202. In one
or more implementations, the sensor module 204 may identify one of
a number of predetermined operational states for a given glucose
measurement 118. The identified operational state may be based on
the communications from the sensor 202 and/or characteristics of
those communications.
[0055] By way of example, the sensor module 204 may include (e.g.,
in memory or other storage) a lookup table having the predetermined
number of operational states and bases for selecting one state from
another. For instance, the predetermined states may include a
"normal" operation state where the basis for selecting this state
may be that the communications from the sensor 202 fall within
thresholds indicative of normal operation, e.g., within a threshold
of an expected time, within a threshold of expected signal
strength, an environmental temperature is within a threshold of
suitable temperatures to continue operation as expected, and so
forth. The predetermined states may also include operational states
that indicate one or more characteristics of the sensor 202's
communications are outside of normal activity and may result in
potential errors in the glucose measurements 118.
[0056] For example, bases for these non-normal operational states
may include receiving the communications from the sensor 202
outside of a threshold expected time, detecting a signal strength
of the sensor 202 outside a threshold of expected signal strength,
detecting an environmental temperature outside of suitable
temperatures to continue operation as expected, detecting that the
person 102 has rolled (e.g., in bed) onto the wearable glucose
monitoring device 104, and so forth. The sensor status 218 may
indicate a variety of aspects about the sensor 202 and the wearable
glucose monitoring device 104 without departing from the spirit or
scope of the described techniques.
[0057] FIG. 3 depicts an example implementation 300 of the insulin
delivery system 106 of FIG. 1 in greater detail.
[0058] In the illustrated example 300, the insulin delivery system
106 includes an insulin pump 302 and infusion set 304. Although the
infusion set 304 is depicted with tubing 306 connected to the
insulin pump 302, in one or more implementations the infusion set
304 may be tubeless. Broadly speaking, the infusion set 304 is an
apparatus configured to subcutaneously deliver insulin--pumped to
the infusion set 304 by the insulin pump 302--into the person 102
for absorption by the person 102's bloodstream. In this way, the
delivered insulin may be used by the person 102's body to maintain
balanced glucose levels, e.g., within a target range of glucose
measurements. In one or more implementations, the infusion set 304
includes a cannula that is inserted subcutaneously into skin, such
as at infusion site 308 of the person 102 in the illustrated
example 300. Accordingly, the infusion set 304 may administer doses
of insulin through the skin of the person 102, e.g., in a
continuous manner and at programmable rates. As discussed herein,
for instance, basal and/or bolus doses of insulin may be
administered through the skin of the person 102 via the infusion
set 304.
[0059] As illustrated, the infusion set 304 includes an adhesive
pad which affixes the apparatus to the person 102 for a period of
time. In one or more implementations, the infusion set 304 is
applied to the infusion site 308 using a separate applicator (not
shown). In operation, this applicator may inject the infusion set
304's cannula into the person 102's skin at the infusion site 308
and also affix the adhesive pad to the infusion site 308 to secure
the infusion set 304 to the person 102 for a period of use. In at
least some implementations, for instance, infusion sets may be
disposable such that they are designed for removal after a
prescribed and/or recommended period of time and for replacement
with a new set that is applied to the person 102 and attached to
the insulin pump 302. In any case, the insulin pump 302 is
configured to deliver insulin doses to the person 102 via infusion
sets, such as the illustrated infusion set 304.
[0060] In the illustrated example 300, the insulin pump 302
includes communication module 310, insulin delivery controls 312,
insulin reservoir 314, display module 316, safety module 318, and
battery 320. In implementation, the insulin pump 302 may be
configured in various ways, such as with some of these components
while others are housed or otherwise implemented in separate
devices. Alternately or additionally, the insulin pump 302 may
include additional or alternate components without departing from
the spirit or scope of the techniques described herein.
[0061] The communication module 310 is configured to transmit data
to and receive data from other devices, such as the computing
device 108. In one or more implementations, the communication
module 310 establishes communicative couplings with such other
devices to enable transmission and receipt of data. By way of
example, the communication module 310 may establish, or otherwise
facilitate establishing, links or channels of communication with
those other devices. The links or channels may be configured in
various ways, including but not limited to Bluetooth (e.g.,
Bluetooth Low Energy links), Near Field Communication (NFC), 5G or
other cellular, and WiFi, to name just a few. Such communicative
couplings enable the insulin pump 302 to communicate over different
networks, such as the network 116 and/or securely within an
artificial pancreas system as discussed in relation to FIG. 4.
[0062] Once a communicative coupling is established, the
communication module 310 can cause data to be transmitted over the
established coupling and/or can receive data from other devices
over the established coupling. Additionally or alternately, the
communication module 310 may be configured to establish connections
over wired communication channels--such as via a USB cord connected
to the insulin pump 302 and another device--and also configured to
transmit and/or receive data over such a wired coupling. The
communication module 310 may be configured in various ways to
enable the insulin pump 302 to communicate with other devices.
[0063] As one example, the communication module 310 enables the
insulin pump 302 to receive instructions from the computing device
108 for controlling delivery of insulin to the person 102. For
instance, the communication module 310 enables the insulin pump 302
to receive instructions that instruct the insulin pump 302
regarding delivery of a basal rate of insulin to the person 102,
updates to the basal rate of insulin, delivery of bolus doses of
insulin to the person 102 (e.g., an amount to bolus within a
limited time), and so forth. The computing device 108 may send a
variety of communications to the insulin delivery system 106 for
controlling insulin delivery without departing from the spirit or
scope of the techniques described herein.
[0064] The insulin delivery controls 312 represent any hardware,
software, and/or mechanical components of the insulin pump 302 that
cause insulin to be pumped (or otherwise extracted) from the
insulin reservoir 314 so that it flows through the infusion set 304
and into the person 102. Moreover, the insulin delivery controls
312 are further configured to cause the insulin to be pumped or
otherwise extracted from the insulin reservoir 314 in accordance
with insulin dose instructions, e.g., from the computing device 108
which specify one or more deliveries of the insulin. The insulin
reservoir 314 is configured to house an amount of insulin, which by
leveraging the functionality of the insulin pump 302 may be
subcutaneously delivered via the infusion set 304. The insulin
reservoir 314 may be replaceable or otherwise configured so that
the amount of insulin can be replenished in the insulin reservoir
314. The insulin reservoir 314 may be configured in various ways
(e.g., different shapes, different materials, differently
removable, and so on) without departing from the spirit or scope of
the described techniques.
[0065] The display module 316 is configured to cause display of
information via a display device 322 of the insulin pump 302. The
display module 316 may generate one or more user interfaces for
display via the display device 322. By way of example, the display
module 316 may cause display via the display device of a user
interface for setting up a wireless connection with the computing
device 108. Additionally or alternately, the display module 316 may
cause the display device 322 to display glucose measurements (e.g.,
in a similar manner as they are displayed via a glucose monitoring
application of the computing device 108), trend arrows (e.g.,
regarding an identified trend in the glucose measurements), alerts
(e.g., about the glucose measurements, other physiological
conditions, operability of the insulin delivery system 106,
operability of components of an artificial pancreas system, status
of a wireless connection with the computing device 108, and so on),
pump set up interfaces, indications of being out of communication
range from different devices (e.g., the computing device 108 or the
wearable glucose monitoring device 104), and so forth. The display
module 316 may thus cause a variety of information to be displayed
via the display device 322 of the insulin pump 302.
[0066] Safety module 318 is configured to provide one or more
safeguards to control delivery of insulin so that the delivery is
not harmful; in other words, so that the insulin delivered is
safely. By way of example, the safety module 318 may contain or
otherwise enforce delivery limits, such as maximum and minimum
rates of delivery over different periods of time. These limits are
effective to prevent erroneous delivery instructions from the
computing device 108 from harming the person 102, such as when an
error transmitting the instructions affects their contents or when
an error in a prediction made by one or more machine learning
models dangerously affects those instructions. For instance, the
safety module 318 may limit an amount or rate of insulin that the
insulin pump 302 delivers to a threshold amount or threshold rate,
even if instructions received from the computing device 108
instruct the insulin pump 302 to deliver more than the threshold
amount. Similarly, the safety module 318 may also prevent the
insulin pump from delivering less than a threshold amount of
insulin or delivering insulin at less than a threshold rate, even
if instructions received from the computing device 108 instruct the
insulin pump to deliver less than the threshold amount.
[0067] In addition, the safety module 318 is configured to continue
operating the insulin pump 302 in the absence of instructions from
the computing device 108, e.g., in the absence of instructions
describing how much insulin to deliver and when. The safety module
318 may be configured to continue operating the insulin pump 302 to
deliver insulin to the person 102 when the computing device 108 is
out of communication range, for example. The safety module 318 may
have access to logic, default settings, or settings entered as part
of a set up process, to name just a few, that control how much
insulin the insulin pump is to deliver when instructions are not
being received from the computing device 108. The safety module 318
may perform various additional or different safeguards to ensure
that an amount of insulin delivered is not harmful to the person
102.
[0068] The battery 320 is configured to provide power for operating
the insulin pump 302, such as to power the communication module 310
to send and receive data, to power the insulin delivery controls
312 to cause delivery of insulin from the insulin reservoir to the
person 102 via the infusion set, to power the display module 316 to
display information via the display device 322, and so forth. The
battery 320 may be rechargeable (e.g., via a USB charging port) or
replaceable. It is to be appreciated that the battery 320 may be
configured in various ways.
[0069] Although not depicted, the insulin delivery system 106 or
another device (e.g., the wearable glucose monitoring device 104)
may be configured with an insulin sensor. Such an insulin sensor
may be applied to skin or inserted subcutaneously to measure a
systemic level of insulin, e.g., in the person 102. Accordingly,
the insulin sensor may be included as part of the infusion set 304,
the wearable glucose monitoring device 104, or may be separately
applied. In any case, such an insulin sensor may be used in
connection with the safety module 318 and/or with dose prediction
functionality of the computing device 108. In this way, insulin
measurements produced using the insulin sensor can be used to
prevent or detect an overdose in insulin, e.g., to prevent the
person receiving insulin from experiencing an episode of
hypoglycemia. By way of example, the safety module 318 may shut off
insulin delivery by the insulin pump 302 based on the insulin
measurements, e.g., if the safety module 318 detects the level of
insulin surpasses a predetermined threshold. Based on the insulin
measurements, the computing device 108 may also or alternately send
instructions to the insulin delivery system 106, instructing it to
cease insulin delivery. In one or more implementations, the safety
module 318 and/or the computing device 108 may also trigger alerts
if the level of insulin surpasses the predetermined threshold.
Physiologically, different thresholds may be determined for
different persons based on their insulin sensitivities, such that
the above-discussed shut down, alerts, or cease to insulin delivery
may be triggered at different insulin levels for the different
persons. As described in more detail below, the artificial pancreas
system may also use such an insulin sensor to determine various
factors for controlling insulin doses for the person 102, such as
the person 102's carbohydrate-to-glucose ratio and insulin
sensitivity factor.
[0070] Having considered an example environment, example wearable
glucose monitoring device, and example insulin delivery system,
consider now a discussion of some example details of the techniques
for machine learning in an artificial pancreas in a digital medium
environment in accordance with one or more implementations.
[0071] Machine Learning in an Artificial Pancreas
[0072] FIG. 4 depicts an example implementation 400 in which the
wearable glucose monitoring device 104, the insulin delivery system
106, and the computing device 108 of FIG. 1 are configured as an
artificial pancreas.
[0073] In the illustrated example 400, artificial pancreas system
402 includes the wearable glucose monitoring device 104, the
insulin delivery system 106, and the computing device 108, which is
illustrated as a mobile phone in this example. The computing device
108 is further illustrated having artificial pancreas controller
404, which includes insulin module 406, glucose monitoring module
408, and shared storage 410 (e.g., a database). It is to be
appreciated that although the artificial pancreas controller 404
and its components are illustrated as part of the computing device
108, in one or more implementations, portions of the artificial
pancreas controller 404, those modules, and the shared storage 410
may be implemented at other devices, such as other computing
devices (e.g., a smart watch or servers of the glucose monitoring
platform 112), the wearable glucose monitoring device 104, and/or
the insulin delivery system 106. Regardless, the artificial
pancreas controller 404 includes or otherwise has access to the
functionality described in relation to the insulin module 406, the
glucose monitoring module 408, and the shared storage 410.
[0074] In accordance with the techniques described herein, the
wearable glucose monitoring device 104, the insulin delivery system
106, and the computing device 108 may form the artificial pancreas
system 402 as a fully-closed loop system, such that user
interaction to monitor glucose (e.g., finger pricks), determine
insulin doses (e.g., based on past experience, journaling previous
doses and bodily response, referencing dose tables), and actually
select an amount of insulin to deliver and when, is eliminated and
handled instead by the system. Such a closed loop system may be
useful not only daily for persons with Type I and Type II diabetes,
but also at hospitals or other health-care locations temporarily
providing insulin therapy.
[0075] The wearable glucose monitoring device 104 and the insulin
delivery system 106 are communicatively coupled to the computing
device 108 via wireless connections 412, 414, respectively. In one
or more implementations, there is no communicative coupling between
the wearable glucose monitoring device 104 and the insulin delivery
system 106--no wireless connections are established. Instead, the
artificial pancreas controller 404 handles communications on behalf
of these devices to implement the artificial pancreas system 402,
such as by receiving data from the wearable glucose monitoring
device 104 over the wireless connection 412, processing the
received data as discussed above and below, and transmitting
various instructions and/or portions of the processed data to the
insulin delivery system 106 over the wireless connection 414.
Similarly, the artificial pancreas controller 404 can receive data
from the insulin delivery system 106 over the wireless connection
414, process the data received from the insulin delivery system
106, and transmit instructions (e.g., status or data requests,
requests to perform various operations such as provide a current
glucose measurement, and so on) or other data (e.g., algorithm or
firmware updates) to the wearable glucose monitoring device 104
over the wireless connection 412.
[0076] In this way, handling communications between the glucose
monitoring platform 112's wearable glucose monitoring device 104
and different insulin delivery systems, which may be available from
a plurality of third parties to the glucose monitoring platform
112, is offloaded from the wearable glucose monitoring device 104
and the insulin delivery systems. Accordingly, interfacing between
these devices, for the purpose of implementing the artificial
pancreas system 402, may be handled at the software level rather
than being handled by hardware and firmware of the wearable glucose
monitoring device 104 and/or the insulin delivery system 106. By
implementing the artificial pancreas system 402 in this way, the
glucose monitoring platform 112 need not divulge specifics
regarding how the wearable glucose monitoring device 104 and the
computing device 108 communicate, e.g., types of communication
channels used, communication protocols, and/or structures of data
communicated. Rather, the artificial pancreas controller 404 may
include or otherwise have access to a plurality of interfaces,
where each interface converts data for transmission to the insulin
delivery system 106 (e.g., instructions for controlling delivery of
insulin doses or instructions to display various information) to a
specified format accepted by the insulin delivery system 106 and
also converts data received from the insulin delivery system 106
into a specified format for processing by the artificial pancreas
controller 404.
[0077] In one or more implementations, there may be an interface
for each different insulin delivery system 106 authorized for use
as part of the artificial pancreas system 402. In other words,
there may be a different interface for each third-party that sells
an insulin delivery system authorized for use as part of the
artificial pancreas system 402 and/or a different interface for
each different model of insulin delivery system authorized for use
as part of the artificial pancreas system 402. Although the
techniques herein are generally described without establishment and
use of a wireless connection between the wearable glucose
monitoring device 104 and the insulin delivery system 106--for the
purpose of implementing the artificial pancreas system 402--it is
to be appreciated that in some implementations there may be a
wireless connection between the wearable glucose monitoring device
104 and the insulin delivery system 106, such as to communicate
alerts (e.g., detection of soon-occurring hyper-or hypo-glycemia,
device malfunctions, etc.).
[0078] Turning now to a more detailed discussion of the artificial
pancreas controller 404, the insulin module 406 generally
represents functionality to enable communications with the insulin
delivery system 106, determine doses of insulin to deliver, and
control the insulin delivery system 106 to deliver the determined
doses. By way of contrast, the glucose monitoring module 408
represents functionality to enable communications with the wearable
glucose monitoring device 104, such as to receive the glucose
measurements 118, and also to process the data received from the
wearable glucose monitoring device 104 so that the received data
can be used to determine insulin doses. This may include extracting
portions of the glucose monitoring device data 214 received from
the wearable glucose monitoring device 104 (e.g., the glucose
measurements 118) and/or packaging at least some portions of this
data with supplemental data from the computing device 108 (e.g.,
data describing application usage or health-related aspects at a
time correlated to the glucose measurements 118).
[0079] In one or more implementations, the artificial pancreas
controller 404 may be configured to handle pairing between the
wearable glucose monitoring device 104 and the computing device 108
and also between the insulin delivery system 106 and the computing
device 108. It is further to be appreciated that either one or both
of the insulin module 406 and glucose monitoring module 408 may
specifically include this functionality. In some implementations,
only one of those modules may include the functionality to pair the
wearable glucose monitoring device 104 and the insulin delivery
system 106 with the computing device 108. Regardless, the
artificial pancreas controller 404 may pair the devices, in part,
by causing display of a user interface via a display device of the
computing device 108 and by receiving user input via the user
interface, such as user input to select a manufacturer of the
insulin delivery system 106 and/or provide a serial number of the
insulin delivery system 106. It is to be appreciated that the user
interface may also enable the user to use the computing device 108
to capture an image of the manufacturer and/or serial number, such
as by capturing a digital image of that information as affixed to a
housing of the insulin delivery system 106 and/or as included on a
box of the insulin delivery system 106. The artificial pancreas
controller 404 may receive similar user inputs about the wearable
glucose monitoring device 104 to pair it with the computing device
108.
[0080] In one or more implementations, the artificial pancreas
controller 404 may also cause display of educational information
about the artificial pancreas system 402 during the pairing or
while the system is otherwise being setup, e.g., during a "warm up"
time of the wearable glucose monitoring device 104's sensor. The
artificial pancreas controller 404 can also be configured to
generate and cause output of alerts via one or more of the wearable
glucose monitoring device 104, the insulin delivery system 106, the
computing device 108, and remote computing devices, e.g., of a
health care professional associated with the person 102. By way of
example, these alerts may be output responsive to receiving one or
more glucose measurements 118 from the wearable glucose monitoring
device 104 which indicate the person 102's glucose is outside the
target range or is predicted to be outside the target range in the
future. Additionally or alternately, these alerts may be output
responsive to device or functionality failure, e.g., blockage in
the insulin delivery system 106.
[0081] In one or more scenarios, the artificial pancreas controller
404 may also cause these alerts to escalate. For instance, the
artificial pancreas controller 404 may comply with device settings
on a first alert, e.g., by simply causing the insulin delivery
system 106 to vibrate. If the first alert is not acknowledged by
the person 102 (e.g., by providing some user input indicative of
acknowledgment), the artificial pancreas controller 404 may cause
an escalating output for a second alert, e.g., the computing device
108 audibly outputs an alert five minutes later. If the second
alert also is not acknowledged by the person 102, the artificial
pancreas controller 404 may cause a further escalating output for a
third alert, e.g., causing the insulin delivery system 106 to
output an audible alert with medium volume. If the third alert also
is not acknowledged by the person 102, the artificial pancreas
controller 404 may cause an even further escalating output for a
fourth alert, e.g., the computing device 108 again audibly outputs
an alert five minutes later. This escalation may continue until the
person 102 or some other person (e.g., a health care professional)
acknowledges an alert. Indeed, the artificial pancreas controller
404 may escalate alerts among the different devices of the
artificial pancreas system 402 in a variety of ways without
departing from the spirit or scope of the described techniques.
[0082] Regarding the modules of the artificial pancreas controller
404, the insulin module 406 includes artificial pancreas algorithm
416 and pump control manager 418. The artificial pancreas algorithm
416 is configured to generate predictions of insulin doses that
will prevent the person 102's glucose measurements 118 from
departing a target range or, said another way, to keep the person
102's glucose measurements 118 generally within the target range.
Generally, extreme or sustained departures from such a target range
can result in dangerous health conditions and/or damage to a
person's body, e.g., heart, blood vessels, eyes, kidneys, and
nerves. Maintaining glucose levels within the target range, through
timely insulin delivery, can thus help avoid those dangerous health
conditions and bodily damage.
[0083] As discussed in more detail below, the insulin doses
determined using the artificial pancreas algorithm 416 can include
both basal rate changes and bolus doses. It is to be appreciated
that the artificial pancreas algorithm 416 may be configured in a
variety of ways to handle determination of both basal rate changes
and bolus insulin doses. To the extent that basal rate changes and
bolus doses generally apply to different types of scenarios--basal
rate doses correspond to longer acting forms of insulin to keep
glucose levels stable through periods of fasting and bolus doses
correspond to shorter acting insulin to prevent rises of glucose
levels resulting from meals or to immediately correct glucose
levels--determination of these different types of doses may involve
consideration of different aspects of the person 102's context and
thus different inputs. Accordingly, the artificial pancreas
algorithm 416 may comprise a machine learning model or an ensemble
of them. Such machine learning models may be configured according
to various paradigms, such as supervised learning, unsupervised
learning, reinforcement learning, transfer learning, and so on.
[0084] In one or more implementations, the artificial pancreas
algorithm 416 and/or the models it comprises may be trained or
otherwise learned initially using the glucose measurements 118 and
other user data describing characteristics of the user population
110 and maintained in the storage device 120, including delivered
insulin doses, insulin measurements, target glucose ranges, insulin
sensitivities, carb ratios, food consumption data, and activity
data, to name just a few. Further, this other user data may be
correlated with the glucose measurements 118, for instance, based
on timestamps of the glucose measurements 118 and the other data.
The initially trained artificial pancreas algorithm 416 may then be
communicated over connection 420 (which may be wired, wireless, or
a combination) for incorporation with the artificial pancreas
controller 404. Once incorporated, the artificial pancreas
algorithm 416 may be further trained so that it is customized for
the person 102, i.e., the person associated with the computing
device 108 and wearing the particular wearable glucose monitoring
device 104 and the particular insulin delivery system 106.
[0085] In one or more implementations, the further training so that
the artificial pancreas algorithm 416 is customized for the person
102 may include transfer learning to personalize the artificial
pancreas algorithm 416--to personalize it from a state as trained
with training data of the user population 110 to an updated state
trained with additional training data or (update data) describing
one or more aspects of the person 102 and/or describing one or more
aspects of a subset of the user population 110 determined similar
to the person 102. Similarity may be based on a variety of aspects,
such as age, gender, diagnosed medical conditions, glucose
measurements, and other physiological measures, to name just a few.
By way of example, such transfer learning may be used in connection
with calculating the person 102's insulin-carbohydrate ratio and/or
insulin sensitivity factor. Such transfer learning can be
advantageous during initialization of the person 102's system
because while there is still relatively little data about the
person 102 available for personalizing the artificial pancreas
algorithm 416, the algorithm is nevertheless capable of generating
predictions due to the wealth of information from the user
population 110 with which it is initially trained.
[0086] For example, the artificial pancreas algorithm 416 may be
further trained so that it is personalized for the person 102, in
part, by obtaining target measurements, target measurement ranges,
and/or starting doses from a health care provider of the person
102. Starting doses of insulin may be obtained for a basal
titration process, for instance, and through the process adjusted
as described in more detail below. Data for the basal titration
process may be obtained from the health care provider (e.g., via a
health care provider portal of the glucose monitoring platform 112)
and/or via one or more user interfaces displayed via the computing
device 108. Such user interfaces may be displayed in connection
with setting up the artificial pancreas system 402 for use, for
example. In this latter scenario, the computing device 108 may
receive input from a user (e.g., the person 102) via a series or
sequence of these setup interfaces. The artificial pancreas
algorithm 416 may also be further trained using data similar to the
data initially used from the user population 110, but that is
obtained about the person 102, such as the person 102's historical
glucose measurements 118, delivered insulin doses, insulin
measurements, target glucose ranges, insulin sensitivities, carb
ratios, food consumption data, activity data, and so on. Like the
user population 110 data, the glucose measurements 118 of the
person 102 may be correlated with the other data, such as based on
timestamps of the glucose measurements 118 and the other data.
[0087] It is to be further appreciated that the artificial pancreas
algorithm 416 may use the above-noted example initialization
information--target measurements, target measurement ranges, and/or
starting doses obtained from a health care provider--for
determining insulin doses for a predetermined amount of time before
beginning to deviate from the initialization information. By way of
example, the artificial pancreas algorithm 416 may initially output
(e.g., for a first day, first week, first month, etc.) insulin
doses for delivery that correspond to those specified by the person
102's health care provider. After the predetermined amount of time
has lapsed, however, the artificial pancreas algorithm 416 may
deviate from the health care provider specified doses, e.g., by
adjusting those doses based on real-time data received about the
person 102. Rather than wait until a predetermined amount of time
has lapsed, the artificial pancreas algorithm 416 may alternately
wait to deviate from the health care provider specified doses until
a threshold amount of data is collected about the person 102, so
that accurate predictions of the person 102's behavior can be
generated. In scenarios where the artificial pancreas algorithm 416
waits until a suitable amount of data is collected to be able to
generate accurate predictions, a determination of "enough" data
about the person 102 may be based on one or more learning rate
parameters of the artificial pancreas algorithm 416. In general,
the learning rate of the artificial pancreas algorithm 416 may
prevent the algorithm from making too drastic of changes to the
initially specified doses that could be harmful to the person
102.
[0088] With respect to inputs to the artificial pancreas algorithm
416, the insulin module 406 may provide data describing various
characteristics of the person 102 that are relevant to determining
insulin doses. In one or more implementations, these inputs may be
configured as feature vectors, where each feature of the vector is
configured to represent a predetermined characteristic relevant to
determining insulin doses. In operation, each of these features can
be set to a value indicative of the respective characteristic as it
is detected and recorded in relation to the person 102 at the time
of input. The inputs (e.g., corresponding to features of input
feature vectors) may include, for instance, a target glucose range,
an initial basal insulin dose rate, a previously delivered insulin
dose or a sequence of them, one or more sequences of the glucose
measurements 118 (e.g., from the wearable glucose monitoring device
104), one or more sequences of insulin measurements, one or more
sequences of other physiological measurements (e.g., temperature,
heart rate, and so on), data indicative of meals consumed and/or to
be consumed (e.g., images, data input via various editable data
fields of a user interface, selections made via a user interface),
data indicative of exercise (e.g., steps or heart data obtained
from a smart watch, workout data obtained from an exercise bike or
other exercise machine, and so on), subtypes of diabetes, insulin
sensitivity, carb ratio, and so forth.
[0089] In one or more implementations, the inputs to the artificial
pancreas algorithm 416 may describe physiologic insulin sensitivity
of the person 102 and also relative effectiveness of insulin
infusion sites of the person 102 where infusion sets 304 are
applied to the person 102. In this context, "effectiveness" refers
to an ability of the person 102's body to use insulin delivered via
an infusion site to control the person 102's glucose. The more
"effective" a site, the better insulin delivered via the site
controls the person 102's glucose, such that when insulin is
delivered via more effective sites of the person 102, the
effectiveness approaches and/or substantially matches the person
102's physiologic insulin sensitivity. In contrast, insulin
delivered via less effective sites is less effective than an
effectiveness indicated by the person 102's physiologic insulin
sensitivity. Given this, the artificial pancreas system 402 may
measure the physiologic insulin sensitivity of the person 102 and
the effectiveness of an insulin infusion site (e.g., infusion site
308). The artificial pancreas algorithm 416 may then determine
insulin doses to be delivered via at the insulin infusion site
based, in part, on the person 102's insulin sensitivity and on the
effectiveness of the site. By way of example, the artificial
pancreas 416 may determine higher doses of insulin to deliver via
sites that are less effective. Alternately or additionally, the
artificial pancreas system 402 may cause output of messages when an
infusion site is less effective than a threshold effectiveness,
such as messages recommending that the infusion site be changed to
a different infusion site, that the person limit a period of time
that the infusion site is used, and so forth.
[0090] In order to measure a person's physiologic insulin
sensitivity and effectiveness of different infusion sites, the
artificial pancreas system 402 is configured to learn and build a
model of the physiologic insulin sensitivity (which may generally
be stable) and the potentially variable infusion site specific
insulin sensitivity. As part of building this model, the artificial
pancreas system 402 samples the person 102's glucose during use of
different infusion sites. For each different infusion site, the
artificial pancreas system 402 also records amounts of insulin
delivered via the site, times insulin is delivered via the site
(e.g., start time of a delivery, end time, and/or duration), type
of insulin delivered via the site, and so forth. The artificial
pancreas system 402 may also record other information about an
infusion site, including, for example, one or more of a location on
the person 102's body, a time an infusion set is affixed or
otherwise applied to the site, a time the infusion set is removed,
a type of port, and so forth. The artificial pancreas algorithm 416
may use one or more of these different aspects of infusion-site
effectiveness as input when determining insulin doses to
deliver.
[0091] The inputs to the artificial pancreas algorithm 416 may
describe a variety of characteristics relevant to determining
insulin doses without departing from the spirit and scope of the
techniques described herein. Some additional and/or different
inputs to the algorithm are also discussed further below.
[0092] As mentioned, the artificial pancreas algorithm 416 is
configured to output insulin doses. The output of the artificial
pancreas algorithm 416 may also be in the form of a feature vector,
such that at least one of the features is indicative of an amount
of insulin to deliver to the person 102 over some period of time.
As mentioned above, the insulin doses output by the artificial
pancreas algorithm 416 may correspond to basal dose rates and bolus
doses. To this end, the output of the artificial pancreas algorithm
416 may indicate a basal rate dose, e.g., an amount of
longer-acting insulin to be delivered throughout the course of the
day and that may be adjusted infrequently. The output of the
artificial pancreas algorithm 416 may also or alternately indicate
a bolus dose, e.g., an amount of shorter-acting insulin to be
delivered before and/or during a meal. The artificial pancreas
algorithm 416 may generate predictions of bolus doses, for
instance, responsive to user input indicating the user is about to
eat a meal and/or responsive to the algorithm predicting that the
user is about to eat a meal, e.g., based on a current location of
the user (restaurant), recorded previous eating habits, a time of
day, and so forth.
[0093] In scenarios where the artificial pancreas algorithm 416
predicts a bolus dose of insulin in anticipation of a meal, the
algorithm may do so not only based on the location of the user, but
also based on the glucose measurements 118 being received in
real-time, such as based on rising glucose measurements 118 that
indicate the person 102 has already begun eating a meal. As noted
above, the artificial pancreas algorithm 416 may be configured to
detect the occurrence of events that may affect the person 102's
glucose as they happen. Thus, detecting that the person 102 has
already begun eating a meal based on real-time data, is an example
of detection of an event as it happens that may affect the person
102's glucose. Additionally, based on the location of the user
and/or the person 102's glucose measurements 118, the artificial
pancreas algorithm 416 may also predict the meal the person 102 is
eating and predict a corresponding dose of insulin, e.g., if the
person 102 is located at a pizza restaurant, then the artificial
pancreas algorithm 416 may determine an insulin dose that
corresponds to pizza. The ability to predict that the person 102 is
eating a meal or is likely to do so soon in the future and
determine a corresponding bolus dose, may be particularly useful
for users that do not stringently adhere to their insulin therapy,
e.g., by entering data (e.g., amount of carbohydrates) into their
insulin delivery systems in anticipation of upcoming meals (e.g.,
30 minutes before) or computing doses in anticipation of such meals
themselves. Instead, these "non-compliant" users may often not
enter such data, may not do so in a timely manner, and/or simply
may not administer insulin. There may be a variety of sources of
meal data, which can describe meals eaten or characteristics of
meals eaten (e.g., timing, amount of food, etc.) and which can
serve as input to the artificial pancreas algorithm 416 in addition
to or alternately from location data.
[0094] By way of example, a "smart" refrigerator may be configured
to generate and provide meal data for use by the artificial
pancreas algorithm 416. Such a refrigerator may be configured to
track inventory, which may include tracking food added to the
refrigerator and food removed from the refrigerator. To this end,
the refrigerator may generate meal data that describes food removed
by the person 102 and not returned back to the refrigerator. This
may be based further on receipt by the system of information
describing that the user is eating the food removed from the
refrigerator. Alternately or additionally, the refrigerator may be
configured to suggest foods stored within the refrigerator or
recipes involving foods stored within the refrigerator based on the
person 102's glucose measurements, such as at a time the person
interacts with the refrigerator.
[0095] By way of example, the refrigerator may detect that the
person 102 has the wearable glucose monitoring device 104 and also
interacts with the refrigerator, e.g., the person 102 interacts
with the refrigerator controls or opens the refrigerator.
Responsive to this, the refrigerator may obtain the person 102's
glucose measurements 118, e.g., by downloading them from one or
more of the wearable glucose monitoring device 104, the computing
device 108, or the glucose monitoring platform 112. Based on the
obtained glucose measurements, the refrigerator may then determine
which of the foods it is maintaining (or recipes involving those
foods) that, if consumed by the person 102, are predicted to
achieve a desired glucose goal, such as to lower glucose if it is
determined to be above a threshold or rising, to maintain glucose
if it is determined to be within a desired glucose range, or to
raise glucose if it is determined to be below a threshold or
falling. The determined foods or recipes may then be suggested by
the refrigerator, e.g., displayed on the refrigerator, communicated
to the computing device 108 for display, and so forth.
[0096] As noted above, images may also be leveraged to obtain
information about meals consumed by the person 102. In one or more
implementations, the glucose monitoring module 408 may use image
analysis to determine what the person 102 consumed during a meal by
comparing a first and a second image, where the first image is
taken of the meal before it is consumed by the person 102 (e.g., of
a plate with the meal) and the second image is taken of the meal
after it is consumed by the person 102 (e.g., of the plate without
the meal and/or with any portions of the meal that were not
consumed). Although this functionality is discussed in connection
with the glucose monitoring module, it is to be appreciated that
the image analysis, image comparisons, and determinations of
amounts consumed may be performed by some other module than the
glucose monitoring module 408, and the information may simply be
accessible by the glucose monitoring module 408.
[0097] Regardless, a delta between the before- and after-images
allows the system to calculate an actual amount that was eaten,
rather than simply using the before-image which may not accurately
represent an actual amount of food consumed if everything depicted
in the before-image is not consumed. By more accurately determining
an amount eaten due to the comparison of before- and after-images,
the glucose monitoring module 408 can also more accurately
determine carbohydrate and/or nutritional content of meals eaten.
Further, such accurate determination of a meal allows the
artificial pancreas algorithm 416 to predict a correct dose of
insulin that corresponds to the food actually eaten, rather than
predict a dose of insulin that is simply based on an amount of food
depicted in a before-image (e.g., sitting on a plate), which again
may vary from the actual amount eaten.
[0098] The glucose monitoring module 408 may process the before-and
after-images to estimate an amount of carbohydrates and/or fats and
determine a difference between the meal before it is eaten through
completion of the meal. The artificial pancreas algorithm 416 may
then predict one or more doses of insulin in relation to these
determinations to cover the impact of the meal consumed (not merely
pictured before eating) on the person 102's glucose. With the
before- and after-images and detecting patterns of the person 102's
glucose, the artificial pancreas algorithm 416 can rapidly generate
a retrospective response and use the retrospective response to
predict future meal glucose responses.
[0099] In addition to detecting an amount being eaten and/or the
foods being eaten, in one or more implementations, the artificial
pancreas system 402 may leverage one or more sensors to detect when
a person 102 is eating--which can be advantageous for determining
times to deliver insulin and/or rates of insulin delivery. In one
example, for instance, a person may wear a wearable strain sensor
that can be used to detect food consumption, i.e., whether a person
is eating. A wearable strain sensor may be configured in a variety
of ways without departing from the spirit or scope of the described
techniques. By way of example, a wearable strain sensor may be
configured as a flexible substrate (e.g., elastomer, paper, or
reduced graphene oxide, to name just a few) that senses a change in
shape and, responsive to sensing the change, produces a measurable
electrical signal. This measurable electrical signal may be
leveraged to provide the signal or a communication based on the
signal to the artificial pancreas controller 406 (e.g., the insulin
module 406 and/or the glucose monitoring module 408) to indicate
that the user is currently eating. In other words, the wearable
strain sensor can be used to generate meal data that describes
times when users actually eat. The artificial pancreas algorithm
416 may then determine doses of insulin based on an actual times
users are eating rather than other times, such as when users
provide user input indicating they are eating (which may not match
times they actually eat).
[0100] In one or more implementations, such a wearable strain
sensor may be worn by the person 102 on the front of the neck to
sense swallowing, on the jaw to sense chewing, or in the mouth, to
name just a few. The artificial pancreas controller 404 or some
component of the system 402 may include one or more machine
learning models that learn to differentiate between eating and
other actions that generate signals, such as talking or swallowing
without eating anything. Using such machine learning models, the
signals provided to the artificial pancreas algorithm 416 may be
filtered such that only the signals from the wearable strain sensor
that correspond to eating are received by the artificial pancreas
algorithm 416.
[0101] To generate predictions of meals, the artificial pancreas
algorithm 416 may also leverage historical data of the person 102
and/or the user population 110. Alternately or additionally, the
artificial pancreas algorithm 416 may predict these upcoming meals
and corresponding bolus doses using a current time and confidence
intervals, where those intervals are built around when the person
102 has eaten historically. The artificial pancreas algorithm 416
may also predict the person 102's common meal based on the
historical data, e.g., to determine a dose that corresponds to the
predicted meal. In one or more implementations, for instance, the
artificial pancreas algorithm 416 may predict that a meal is
upcoming based on a current time and determine an average bolus
dose, such as an average bolus dose for breakfast, lunch, dinner,
or a snack. In addition or alternatively, the artificial pancreas
algorithm 416 may predict that a meal is upcoming based on a
current time and historical meal times, but the artificial pancreas
algorithm 416 may wait to cause insulin delivery until early signs
of a meal being eaten by the person 102 are detected. In this way,
the artificial pancreas algorithm 416 may deliver insulin earlier
than an algorithm that relies solely on current event detection. In
particular, the artificial pancreas algorithm 416 may use these
signals--historical meal times along with an early sign of a meal
being eaten such as a slight increase in glucose--to provide an
earlier indication that a meal is being eaten than a slight
increase in glucose alone.
[0102] In addition to predicting upcoming meals which may result in
insulin spikes and determining bolus insulin deliveries, the
artificial pancreas algorithm 416 may also predict other events,
such as exercise. The following scenario may correspond to another
example in which the artificial pancreas algorithm 416 detects the
occurrence of an event that affects the person 102's glucose as the
event happens. For example, the artificial pancreas algorithm 416
may use one or more of a current location of the person 102, the
glucose measurements 118 of the person 102, activity data of the
person 102, and so on to predict that the person 102 is exercising
or is about to exercise. To do so, the artificial pancreas
algorithm 416 may have been trained, or an underlying model
otherwise learned, based on data describing historical locations
and activity of the person 102 along with his or her glucose
measurements 118 as correlated to that other data and by using one
or more machine learning techniques. The trained artificial
pancreas algorithm 416 may thus be able to predict the person 102's
activities (e.g., exercise) with data describing his or her current
context based on learning from the historical data. Based on the
predicted activity, the artificial pancreas algorithm 416 may also
determine insulin doses accordingly or that consuming food (e.g.,
juice, candy, etc.) may be needed to raise the person 102's
glucose. In scenarios where food consumption is needed, the
artificial pancreas system 402 may output a recommendation to eat
something, such as via a display of the computing device 108.
[0103] In accordance with the described techniques, the data input
to the artificial pancreas algorithm 416 and output from it in
connection with determining insulin doses is generally stored in
the shared storage 410. As the artificial pancreas algorithm 416
determines insulin doses for the person 102 over time and
effectiveness of these insulin doses to maintain the person 102's
glucose level is monitored, e.g., based on the glucose measurements
118, the insulin module 406 may adjust the underlying model of the
artificial pancreas algorithm 416 to better determine insulin doses
for the person 102, such as by reinforcing (e.g., rewarding)
determinations that resulted in stable glucose measurements within
the target range and discouraging (e.g., penalizing) determinations
that resulted in unstable measurements and/or determinations that
resulted in measurements outside the target range. In this way, the
artificial pancreas algorithm 416 may be configured to learn how to
more often keep the person 102's glucose level within the target
range and/or more stable than when the algorithm is first deployed.
In one or more implementations, the underlying model may be
adjusted by adjusting internal weights of the artificial pancreas
algorithm 416 or by adjusting parameters of one or more functions
used to implement the artificial pancreas algorithm 416. This
adjusting over time, based on monitoring the results of the
artificial pancreas algorithm 416's output, may be referred to as
"learning" or "learning a model," where the underlying model is
learned using machine learning techniques or, in short, is a
machine learning model.
[0104] In any case, losing such learning may generally be
undesirable. This is because it may take an amount of time (e.g., a
number of doses and monitored responses) for the artificial
pancreas algorithm 416 to learn how exactly the person 102's body
responds to determined insulin doses. Moreover, it may be
inconvenient for the artificial pancreas algorithm 416 to take that
amount of time again to relearn such responses--relearning may also
result in the reoccurrence of negative health events that occurred
during previous learning. To this end, the artificial pancreas
algorithm 416 is configured for communication to and storage by
different devices, which may be used to back up the algorithm. By
way of example, the computing device 108 may communicate the
artificial pancreas algorithm 416 over the connection 420 to the
glucose monitoring platform 112 so that it can be maintained in the
storage device 120, such as in connection with a user profile of
the person 102 at the glucose monitoring platform 112. Alternately
or in addition, the artificial pancreas algorithm 416 may be
communicated to the insulin delivery system 106 and/or a service
associated with the computing device 108, such as a backup
cloud-storage service. In this way, when a user begins using a new
device (e.g., a new mobile phone or a new insulin delivery system)
the artificial pancreas algorithm 416 can simply be transferred to
the new device such that the learning is not lost. In other words,
the artificial pancreas algorithm 416 may "pick up where it left
off." In some use cases, one or more of the devices may be
disposable, such as the insulin delivery system--some
configurations are used for only three days then disposed. In these
cases, relearning the underlying model or the parameters of the
artificial pancreas algorithm 416 after every disposal (e.g., every
three days) is simply unsuitable.
[0105] The data stored in the shared storage 410, which, among
other information, includes data input to and output from the
algorithm, may be communicated to other devices in a similar
manner. For instance, the data of the shared storage 410 may be
communicated to the glucose monitoring platform 112 for storage in
the storage device 120, to the insulin delivery system 106, to
remote storage associated with the computing device 108, and so
forth. Accordingly, if a device fails or is replaced, the
artificial pancreas algorithm 416 and/or the data stored in the
shared storage 410 may simply be downloaded, e.g., from the glucose
monitoring platform 112's storage device 120 or cloud storage of
the computing device 108, to the new or replaced device.
[0106] Additionally, when the data of the shared storage 410 is
communicated to the glucose monitoring platform 112, it may be
aggregated by the data analytics platform 122 along with similar
data from the user population 110 to form a massive, aggregated
dataset. This dataset may be used to train a variety of machine
learning models. Additionally or alternately, machine learning
models may be applied to the massive dataset to identify patterns
among the data. In this way, patterns in the data may be used to
improve artificial pancreas systems 402, such as to improve the
initial artificial pancreas algorithm 416 deployed on the person
102's computing device 108. By way of example, the glucose
monitoring platform 112 may, as part of setup of the artificial
pancreas system 402, communicate to the computing device 108 an
artificial pancreas algorithm 416 that is trained using data from
users of the user population 110 that are similar to the person 102
(according to various characteristics of person and those users as
described by data).
[0107] The pump control manager 418 represents functionality to
control the insulin delivery system 106 to deliver the insulin
doses output by the artificial pancreas algorithm 416. By way of
example, the pump control manager 418 may generate instructions,
based on the artificial pancreas algorithm 416's output, that
instruct the insulin delivery system 106 to deliver an amount of
insulin over a time period, e.g., three insulin units (IU)
immediately, 0.15 IU every hour continuously, and so forth. The
pump control manager 418 may also cause these instructions to be
communicated over the wireless connection 414 to the insulin
delivery system 106. In addition to generating instructions based
on output of the artificial pancreas algorithm 416 to control
delivery of insulin doses, the pump control manager 418 is also
configured to connect insulin delivery systems from different
providers (e.g., different manufacturers) so that different pumps
can deliver insulin according to doses determined using the
artificial pancreas algorithm 416. The pump control manager 418 may
connect different insulin systems using dedicated interfaces (e.g.,
for each different insulin delivery system or provider of them) and
communicate secure payload data over the wireless connection 414,
as discussed in more detail below. The pump control manager 418 may
include a variety of functionality for controlling the insulin
delivery system 106 to deliver insulin doses determined using the
artificial pancreas algorithm 416 without departing from the spirit
or scope of the described techniques.
[0108] Although illustrated as being included as part of the
artificial pancreas controller 404, in one or more implementations,
the insulin module 406 and the glucose monitoring module 408 may be
configured as separate computing applications, such that the
insulin module 406 corresponds to a first, insulin application and
the glucose monitoring module 408 corresponds to a second, glucose
monitoring application. Additionally or alternately, the insulin
module 406 may be configured as a plug-in to the glucose monitoring
module 408 when it is configured as an application. Indeed, a
variety of programmatic or logical arrangements are contemplated in
accordance with the described techniques. In scenarios where the
insulin module 406 and the glucose monitoring module 408 are
separate applications, communication of data between these modules
may also be controlled by a secure communication protocol, i.e., so
that payload data is communicated securely between the insulin
module 406 and the glucose monitoring module 408. As noted above,
the process for securing this payload data is described in more
detail below.
[0109] The shared storage 410 is usable by the insulin module 406
and the glucose monitoring module 408 to securely share data, which
enables insulin doses to be provided based, in part, on the glucose
measurements 118 produced by the wearable glucose monitoring device
104. In one or more implementations, the shared storage 410 is
optimized for fast writes. Access to the shared storage 410 may
also be controlled by an application programming interface (API)
(not shown), enabling internal and external data consumers to
access data from the shared storage 410. Additionally or
alternately, access to the shared storage 410 may be limited to
applications authorized to do so based on inclusion in an
application group published by the glucose monitoring platform 112,
e.g., with a signing certificate. The applications included in this
application group may be authorized to access the shared storage
410 by using the API and based on encryption management.
[0110] Additionally or alternately, the shared storage 410 may
include multiple databases, such as a database of the insulin
module 406 and a database of the glucose monitoring module 408.
These multiple databases may be considered shared storage based on
access permissions granted to the other module. For example, the
insulin module 406 may be granted permissions that allow it to
access a portion of the glucose monitoring module 408's database
and the glucose monitoring module 408 may be granted permissions
that allow it to access a portion of the insulin module 406's
database. The portions of the databases accessible to both modules
may comprise the shared storage 410. Database manager 422 is
configured to manage secure access to the shared storage 410 by
different applications, such as by maintaining a database key in a
private keychain of the glucose monitoring module 408. Details
regarding at least one example implementation are discussed in more
detail below.
[0111] Glucose monitoring system manager 424 is generally
configured to manage the wearable glucose monitoring device 104.
This may include, for instance, configuring the wearable glucose
monitoring device 104 for use with the glucose monitoring platform
112, configuring the wearable glucose monitoring device 104 for use
as part of the artificial pancreas system 402, receiving the
glucose monitoring device data 214 from the wearable glucose
monitoring device 104, processing the received glucose monitoring
device data 214 (e.g., to extract the glucose measurements 118 from
the glucose monitoring device data 214 and store them in the shared
storage 410), associating the glucose monitoring device data 214
(or portions thereof) with supplemental data (e.g., data describing
application usage or health-related aspects at a time corresponding
to the glucose measurements), causing at least some of this
supplemental data to be stored at or otherwise accessible via the
shared storage 410, packaging the glucose monitoring device data
214 with the supplemental data for communication over the network
116 via the connection 420 to the glucose monitoring platform 112
and storage in the storage device 120, and so forth. The glucose
monitoring system manager 424 may be configured to manage
interactions involving the wearable glucose monitoring device 104
and the glucose monitoring platform 112 in connection with
implementing the artificial pancreas system 402 in a variety of
ways without departing from the spirit or scope of the described
techniques.
[0112] Having discussed the artificial pancreas system 402 as well
as its different components that are used to determine insulin
doses and also to deliver them to a person without the person
having to monitor his or her glucose and manually inject insulin,
consider the following implementation examples.
[0113] Shared Glucose Monitoring- and Insulin-Module Storage
[0114] One example implementation of the shared storage 410 is
provided in the following discussion. As mentioned above, the
shared storage 410 is configured to securely share data--used in
connection with delivering doses of insulin predicted to keep the
person 102's glucose level within a target range--between the
insulin module 406 (e.g., an insulin application) and the glucose
monitoring module 408 (e.g., a glucose monitoring application).
[0115] In one or more implementations, the insulin module 406 and
the glucose monitoring module 408 encrypt the shared storage 410
using an encryption library. By way of example, the insulin module
406 and the glucose monitoring module 408 use a third party
encryption library to encrypt the shared storage 410, such as by
using SQLCipher. Certainly, other encryption libraries, third-party
and/or proprietary, may be used to encrypt the shared storage 410
without departing from the spirit or scope of the described
techniques. To the extent that a SQL-based encryption library may
be used, the shared storage 410 further may be configured as a
shared database in various implementations, e.g., a SQLite
database. The shared storage 410 may also be configured in other
ways to ensure secure data storage for the insulin module 406 and
the glucose monitoring module 408 in accordance with the described
techniques.
[0116] To ensure security and privacy of the data stored in the
shared storage 410, for instance, the shared storage 410 may be
encrypted with a private key securely held in a shared keychain. By
encrypting the shared storage 410 in this way, the encryption
protects the data stored in the shared storage 410 from
unauthorized modification, intercept or eavesdropping when on the
computing device 108 and/or when one or more service providers
generate an unencrypted backup of the computing device 108 to a
different computing device.
[0117] Generally speaking, the shared storage 410 is configured to
limit access to its data to applications (e.g., that include the
insulin module 406 and/or the glucose monitoring module 408 or
components thereof) that are listed in an application group. The
applications listed in this application group may be controlled by
the glucose monitoring platform 112, such that the glucose
monitoring platform 112 publishes the application group and such
that this application group lists the applications allowed to
access data of the shared storage 410. In other words, the
applications listed by the glucose monitoring platform 112 as part
of the application group are the only applications that are allowed
to access the shared storage 410--other applications are prevented
from accessing the shared storage 410. In one or more
implementations, this application group may include further
information to control access to the shared storage 410, such as
whether a listed application is allowed read and/or write access to
the shared storage 410. In some scenarios, for instance, a given
application may be listed as having read access to the shared
storage 410, but not write access. In other scenarios, a given
application may have both read and write access to the shared
storage 410.
[0118] By using an application group, the computing device 108 may
provide a shared document area that is only accessible to
applications of the application group. Additionally, the
application group may be configured such that the only applications
that can join the group are applications that are published with a
signing certificate of the glucose monitoring platform 112 and/or
that are authorized by a developer-user of the glucose monitoring
platform 112. A developer-user of the glucose monitoring platform
may authorize applications to be part of the application group via
a portal for forming application groups and for enabling
publication with such signing certificates. In addition, the
glucose monitoring module 408, namely, the database manager 422 is
configured to manage an encryption key to the shared storage
410.
[0119] Specifically, the database manager 422 maintains this key to
the shared storage 410 in a private keychain of the glucose
monitoring module 408. Accordingly, the applications in the
application group have access to the above-discussed shared
document area and the shared keychain. However, only applications
that have the private database key can read and write to the shared
storage 410.
[0120] In operation, the insulin module 406 may generate a
public/private key pair during a setup process with the glucose
monitoring module 408. The insulin module 406's public key is
available to the glucose monitoring module 408 in the shared
keychain. In various scenarios, a user may download an insulin
application to the computing device 108 for use with the artificial
pancreas system 402. This application may be downloaded from an
application store, for example, and include the insulin module 406.
During setup of such an application, the user may select to link
the application with the glucose monitoring module 408.
[0121] Based on a selection to link an insulin application to the
glucose monitoring module 408 and based on inclusion of this
insulin application in the above-mentioned application group, the
database manager 422 makes a copy of the glucose monitoring module
408's encryption key by encrypting it with the insulin
application's public key and storing this encrypted version of the
insulin application's public key in the shared keychain. Notably,
each application in the application group has access to the shared
keychain. In order to decrypt an encrypted version of a given
application's public key, though, the corresponding private key is
needed, and only the given application includes such a private key.
Accordingly, an application in the application group is not able to
decrypt the encrypted version of another application's public
key--despite being included in the application group.
[0122] In scenarios where a user selects to unlink an insulin
application, e.g., when switching to a different insulin
application, the database manager 422 removes the encrypted key of
the application from the shared keychain and rekeys the shared
storage 410 to a new encrypted key. The database manager 422 then
updates the encrypted key saved in the private keychain of the
glucose monitoring module 408. When the shared storage 410 is
accessible to the insulin module 406 and/or the glucose monitoring
module 408, though, these modules may leverage a variety of data
persisted in the shared storage 410 (e.g., by reading the data from
or writing the data to the storage), namely, to enable doses of
insulin to be delivered to the person 102 to keep glucose levels
within a target range. In this context consider the following
discussion of FIGS. 5-9.
[0123] FIGS. 5-9 depict examples of tables stored in shared storage
in connection with implementing the artificial pancreas system 402.
Each of these figures depicts the shared storage 410 in more detail
and includes an example of a particular table. By way of example,
FIG. 5 depicts an example implementation 500 of the shared storage
and one example of an active insulin (insulin on board (IOB))
table. In addition to the active insulin (IOB) table 502, the
illustrated example 500 also includes basal delivery table 504,
bolus delivery table 506, insulin profile table 508, and bolus
calculations table 510. The shared storage 410 is illustrated with
ellipses to indicate that more and/or different tables may be
included in the shared storage without departing from the spirit or
scope of the described techniques. The basal delivery table 504,
bolus delivery table 506, insulin profile table 508, and bolus
calculations table 510 are discussed in detail in relation to FIGS.
6-9, respectively.
[0124] In the illustrated example 500, the active insulin (IOB)
table 502 includes a plurality of columns 512-520, where each
column corresponds to a different attribute of the data in the
active insulin (IOB) table 502. The rows in the illustrated
example--except for the topmost row--each represent a data record
in the active insulin (IOB) table 502. It is to be appreciated that
the active insulin (IOB) table 502 may be configured with different
attributes without departing from the spirit or scope of the
described techniques.
[0125] Broadly speaking, the active insulin (IOB) table 502
comprises a history of insulin on board. The table is generated
while doses of insulin are being delivered, such that once the
amount of insulin on board for a given bolus dose reaches zero, no
more records are added to the active insulin (IOB) table 502 until
delivery of a next insulin dose begins. In one or more
implementations, the insulin module 406 may provide data for
insulin on board measurements at an interval of time, causing the
active insulin (IOB) table 502 to update with a new record
according to the interval, e.g., every minute when the IOB changes.
In at least some implementations, changes to insulin on board that
are smaller than a threshold amount may not result in a new record
being added to the active insulin (IOB) table 502, e.g., changes to
insulin on board that are less than 0.1 units of insulin.
[0126] In the context of the illustrated example 500, attribute 512
represents a record identifier. For a given record in the active
insulin (IOB) table 502, the record identifier uniquely identifies
the record from the other records in the table. In the illustrated
example 500, the attribute 512 is labeled with the name
"record_id". In one or more implementations, a type of the
attribute 512 may be an integer primary key. The attribute 512 thus
may be configured as a primary key of a given record.
[0127] Attribute 514 represents a measurement time, e.g., a time at
which a measurement is taken or otherwise determined. For a given
record in the active insulin (IOB) table 502, the measurement time
corresponds to a time a measurement of active insulin, i.e., the
insulin on board, is determined. In the illustrated example 500,
the attribute 514 is labeled with the name
"insulin_system_time_sec". In one or more implementations, a type
of the attribute 514 may be an integer. Further, the measurement
time may correspond to Coordinated Universal Time (UTC), in
seconds.
[0128] Attribute 516 represents an amount of insulin on board. For
a given record in the active insulin (IOB) table 502, the amount of
insulin on board corresponds to a measurement of insulin remaining
on board for delivery and until there are zero units of insulin
left to deliver, e.g., to the person 102. In the illustrated
example 500, the attribute 516 is labeled with the name
"insulin_on_board". In one or more implementations, a type of the
attribute 516 may be an integer. Further, the amount of insulin on
board may correspond to a number of insulin units and be measured
to hundredths of an insulin unit.
[0129] Attribute 518 represents an amount of time until there will
be no insulin remaining on board for a given insulin dose. This
amount may be determined based upon the amount of insulin still on
board (e.g., attribute 516) and also a rate of delivery of the
dose. Alternately or additionally, the amount may be based on a
fixed delivery end time, where the end time has been specified
(e.g., according to output of the artificial pancreas algorithm
416) and the insulin delivery system 106 is instructed to deliver
an entire dose of insulin by the end time. In the illustrated
example 500, the attribute 518 is labeled with the name
"remaining_time_sec". In one or more implementations, a type of the
attribute 518 may be an integer. Further, the amount of time
remaining may correspond to a number of seconds until there is no
insulin remaining on board for the given insulin dose.
[0130] Attribute 520 represents a name of the source device or
application corresponding to the insulin on board measurement,
where "corresponding" may be the device or application that
requests the measurement, performing the measurement, and/or having
the insulin on board that is being delivered. This name may be
determined by processing a data packet or uniform resource locator
(URL) message from the device or application, e.g., extracting the
name from a field, or successfully decrypting the data or message
using a particular key, to name just a few. In the illustrated
example 500, the attribute 520 is labeled with the name
"source_name". In one or more implementations, a type of the
attribute 520 may be text, e.g., a text string. Further, the name
of the source device or application may identify the device or
application corresponding to a given record in relation to other
devices or applications, such as other devices or applications that
are capable of requesting the measurement, performing the
measurement, and/or having insulin on board that can be
delivered.
[0131] FIG. 6 depicts an example 600 of the basal delivery table
504, which includes a plurality of columns 602-616. Here, each of
these columns corresponds to a different attribute of the data in
the basal delivery table 504. The rows in the illustrated example
600--except for the topmost row--each represent a data record in
the basal delivery table 504. It is to be appreciated that the
basal delivery table 504 may be configured with different
attributes without departing from the spirit or scope of the
described techniques.
[0132] Broadly speaking, the basal delivery table 504 comprises a
history of basal rate changes. Each time the artificial pancreas
algorithm 416 determines a change to the person 102's basal rate,
for instance, a new record is added to the basal delivery table
504. Examples of when a record may be added to the basal delivery
table 504 include determination of and delivery according to a
temporary basal rate (e.g., due to vacation, sickness, stress, time
of day, exercise, etc.), suspension of insulin delivery,
administration of prescription drugs, pregnancy, and changes in
health metrics, to name just a few.
[0133] In the context of the illustrated example 600, attribute 602
represents a record identifier. For a given record in the basal
delivery table 504, the record identifier uniquely identifies the
record from other records in the table. In the illustrated example
600, the attribute 602 is labeled with the name "record_id". In one
or more implementations, a type of the attribute 602 may be an
integer primary key. The attribute 602 thus may be configured as a
primary key of a given record.
[0134] Attribute 604 represents a time at which a basal rate of
insulin delivery is changed to deliver basal insulin to the person
102 at a different rate, e.g., based on the events mentioned just
above. For a given record in the basal delivery table 504, this
particular time of change corresponds to a time when the basal
rate, corresponding to the particular record, starts. In the
illustrated example 600, the attribute 604 is labeled with the name
"basal_rate_start_time_sec". In one or more implementations, a type
of the attribute 604 may be an integer. Further, the delivery start
time may correspond to UTC time, in seconds.
[0135] Attribute 606 describes a rate of delivery of insulin. For a
given record in the basal delivery table 504, the rate of delivery
corresponds to a rate to which basal insulin delivery has been
changed, e.g., since the start time described by the attribute 604.
Accordingly, the delivery rate described by the attribute 606 may
be used until the basal rate is again changed, e.g., based on
another one or more of the above-mentioned events. In the
illustrated example 600, the attribute 606 is labeled with the name
"basal_delivery_rate". In one or more implementations, a type of
the attribute 606 may be an integer. Specifically, the
integer-number indicated by the attribute 606 may describe a number
of units of insulin to deliver over a predetermined amount of time,
such as one hour. In this scenario, therefore, if the attribute 606
for a given record has a value of `1.00`, then this may represent
that the rate of delivery of basal insulin is 1.00 insulin units
per hour. Moreover, the number of units of insulin to deliver per
known interval of time may be specified to a known fidelity, such
as to hundredths of an insulin unit. It is to be appreciated that
in different implementations, the fidelity and the interval of time
may be different without departing from the spirit or scope of the
described techniques. For example, the attribute 606 may describe a
number of units of insulin to deliver (specified to tenths of a
unit) over a 24-hour period.
[0136] Attribute 608 represents how much the basal rate described
by the record changes from a basal rate described by a basal
profile of the person 102, such as a basal profile that is
described by a record of the insulin profile table 508 and
corresponds to a current time. The attribute 608 may correspond to
a percentage that the rate, described by the attribute 606, is of a
basal rate described by the person 102's basal profile. In this
context, no change from a basal rate described by such a basal
profile corresponds to one-hundred percent (100%). If the basal
rate doubles from the rate indicated by the basal profile, however,
then the attribute 608 may be set to a value corresponding to
two-hundred percent (200%). For example, if a basal rate indicated
by a basal profile is 1.00 IU/hour and a given record corresponds
to a change to 2.00 IU/hour, then the attribute 608 may be set to a
value corresponding to 200%. Accordingly, if the basal rate is
halved from the rate indicated by the basal profile, then the
attribute 608 may be set to a value corresponding to fifty percent
(50%). For example, if a basal rate indicated by a basal profile is
1.00 IU/hour and a given record corresponds to a change to 0.50
IU/hour, then the attribute 608 may be set to a value corresponding
to 50%.
[0137] In one or more implementations, this attribute 608 may be
set to values other than one-hundred percent only when the change
corresponding to the record is temporary. If, by way of contrast,
the record corresponds to a rate change that also changes the basal
rate described by the person 102's basal profile, then the value of
this attribute 608 may be set to one-hundred percent (100%), even
though the record's rate is different from a previous rate
described by the person 102's basal profile. In the illustrated
example 600, the attribute 608 is labeled with the name
"temp_basal_adjustment". In one or more implementations, a type of
the attribute 608 may be an integer. The difference between a
respective record's rate and a rate described by a basal profile
may be described in ways other than percentage without departing
from the spirit or scope of the described techniques.
[0138] Attribute 610 represents a duration during which insulin is
delivered according to the respective record's rate, e.g., the rate
described by the attribute 606. For a temporary rate change, the
value to which this attribute 610 is set may correspond to a time
when the basal rate returns to a rate described by the person 102's
basal profile. For a rate intended to be used indefinitely--a
change where the rate described by the basal profile is
changed--this attribute 610 may be set to a value indicative of or
reserved for a rate to be used indefinitely. Alternately or
additionally, this attribute 610 may be set to a value that
triggers automatic computation of a new basal rate for the basal
profile, given no interrupting changes. By way of example, this
attribute 610 may be set to a value corresponding to one month,
such that the artificial pancreas algorithm 416 automatically
determines a basal rate of insulin delivery for the person every
month if no other events cause the rate to be otherwise changed
during that time. In the illustrated example 600, the attribute 610
is labeled with the name "insulin_action_duration_sec". In one or
more implementations, a type of the attribute 610 may be an
integer. Further, the duration may correspond to a number of
seconds until delivery of basal insulin according to the record's
rate, as described by the attribute 606, is set to change.
[0139] Attribute 612 describes a generic name of the insulin being
delivered according to the record's rate. In this context, the term
"generic" contrasts with a "trade" name; the term "generic" refers
to an unbranded name of the type of insulin being delivered in
connection with the respective record. One example of a generic
name for a type of long-acting insulin is glargine, which may have
trade names including Lantus.RTM., Toujeo.RTM., Abasaglar.RTM., and
Basaglar.RTM.. In the illustrated example 600, the attribute 612 is
labeled with the name "insulin_generic_name". In one or more
implementations, a type of the attribute 612 may be text, e.g., a
text string of the generic name. Further, this attribute 612 and/or
attribute 614 may optionally be included in the basal delivery
table 504.
[0140] In contrast to the attribute 612, the attribute 614
describes a trade name (if any) of the insulin being delivered
according to the record's rate. The term "trade name" refers to a
branded name of a type of insulin--a branded name of a generic
insulin. In the example mentioned above, for instance, Lantus.RTM.,
Toujeo.RTM., Abasaglar.RTM., and Basaglar.RTM. are trade names of
glargine--the generic name for a type of long-acting insulin which
may be used for basal insulin delivery. In the illustrated example
600, the attribute 614 is labeled with the name
"insulin_trade_name". In one or more implementations, a type of the
attribute 614 may be text, e.g., a text string of the trade name.
Like the attribute 612, this attribute 614 may be optionally
included in the basal delivery table 504.
[0141] Attribute 616 represents a name of the insulin delivery
system delivering the basal insulin according to the record's rate,
e.g., a name of the insulin delivery system 106. This name may be
determined by processing data from the insulin delivery system 106,
based on setup of the artificial pancreas system 402, and so forth.
In the illustrated example 600, the attribute 616 is labeled with
the name "source_name". In one or more implementations, a type of
the attribute 616 may be text, e.g., a text string. Further, the
name of the insulin delivery system may identify the system in
relation to other systems capable of delivering insulin, such as
when a user changes to a different insulin system, e.g., due to
insurance reasons, upgrading, use of multiple systems, and so
forth.
[0142] FIG. 7 depicts an example 700 of the bolus delivery table
506, which includes a plurality of columns 702-716. Here, each of
these columns corresponds to a different attribute of the data in
the bolus delivery table 506. The rows in the illustrated example
700--except for the topmost row--each represent a data record in
the bolus delivery table 506. It is to be appreciated that the
bolus delivery table 506 may be configured with different
attributes without departing from the spirit or scope of the
described techniques.
[0143] Broadly speaking, the bolus delivery table 506 comprises a
history of insulin boluses delivered by insulin delivery systems as
part of the artificial pancreas system 402. By way of example, when
a bolus insulin delivery is determined by the artificial pancreas
algorithm 416 and delivered in anticipation of a meal, at least one
record is added to the bolus delivery table 506 describing the
delivery. In one or more scenarios, multiple records may be added
for split and/or combo bolus insulin doses. For instance, a number
of records may be added corresponding to a number of stages of the
bolus insulin delivery, e.g., two records may be added for a
two-stage insulin delivery.
[0144] In the context of the illustrated example 700, attribute 702
represents a record identifier. For a given record in the bolus
delivery table 506, the record identifier uniquely identifies the
record from other records in the table. In the illustrated example
700, the attribute 702 is labeled with the name "record_id". In one
or more implementations, a type of the attribute 702 may be an
integer primary key. The attribute 702 thus may be configured as a
primary key of a given record.
[0145] Attribute 704 represents a time at which delivery of a bolus
dose of insulin or stage of a bolus dose corresponding to the
respective record starts, e.g., responsive to entry of data
describing an upcoming meal or based on the artificial pancreas
algorithm 416 predicting that the person 102 is likely to eat a
meal in the near future. For a given record in the bolus delivery
table 506, this particular time of delivery corresponds to a time
when the bolus dose or stage corresponding to the particular record
starts being delivered to the person 102. This time may correspond
to a determination of the respective bolus dose by the artificial
pancreas algorithm 416, such that after the artificial pancreas
algorithm 416 determines that a bolus dose of insulin is to be
delivered based on an upcoming meal (specified by a user or
predicted by the algorithm), a record is added to the bolus
delivery table 506. Here, the start time described by the attribute
704 corresponds to a time the artificial pancreas algorithm 416
outputs the determination and/or a time specified in the
algorithm's output. The pump control manager 418 then causes the
determined dose to be delivered via the insulin delivery system 106
in accordance with the added record. In the illustrated example
700, the attribute 704 is labeled with the name
"delivery_start_time_sec". In one or more implementations, a type
of the attribute 704 may be an integer. Further, the delivery start
time may correspond to UTC time, in seconds.
[0146] Attribute 706 represents a time at which delivery of the
bolus dose of insulin or stage of the bolus dose corresponding to
the respective record ends. A duration of the dose or the stage may
thus be determined based on a difference between the values of the
attribute 704 and the attribute 706. This time may correspond to a
determination of the respective bolus dose by the artificial
pancreas algorithm 416, such as described by output of the
artificial pancreas algorithm 416. The artificial pancreas
algorithm 416 may be configured to output a duration of the dose
and/or the actual times the dose is to start and end. In the
illustrated example 700, the attribute 706 is labeled with the name
"delivery_end_time_sec". In one or more implementations, a type of
the attribute may be an integer. Further the delivery end time may
correspond to UTC time, in seconds.
[0147] Attribute 708 represents an amount of insulin to deliver for
the bolus dose or stage of the bolus dose corresponding to the
respective record. For a given record in the bolus delivery table
506, this amount corresponds to a determination made by the
artificial pancreas algorithm 416, e.g., regarding how much insulin
to deliver to the person 102 based on a user-specified meal or a
predicted upcoming meal, how much to deliver for a particular stage
of the dose, and so forth. In the illustrated example 700, the
attribute 708 is labeled with the name "insulin_units". In one or
more implementations, a type of the attribute 708 may be an
integer. Further, the amount of insulin to deliver for the bolus
dose may correspond to a number of insulin units to deliver between
the start time specified by the attribute 704 and the end time
specified by the attribute 706, and the amount may be specified in
terms of insulin units and to hundredths of an insulin unit.
[0148] Attribute 710 represents a duration during which the amount
of insulin described by the attribute 708 is delivered for the
bolus dose or stage that corresponds to the record. This attribute
710 may be determined based on a difference between the times
described by the attributes 704, 706. Alternately or additionally,
the end time described by attribute 706 may be determined by adding
the duration described by the attribute 710 to the start time
described by the attribute 704. To this end, the artificial
pancreas algorithm 416 in one or more implementations may output a
prediction of a bolus dose of insulin to deliver to the person to
match an upcoming or predicted upcoming meal. This prediction may
include not only the amount of insulin to deliver, as described
above, but also start and end times of the bolus or, alternately, a
start time and a duration of delivery or simply a duration with the
start time corresponding to output of the prediction. Indeed, the
output of the artificial pancreas algorithm 416 may specify (e.g.,
in a feature vector) a variety of characteristics of a bolus dose
of insulin without departing from the spirit or scope of the
described techniques. In the illustrated example 700, the attribute
710 is labeled with the name "insulin_action_duration_sec". In one
or more implementations, a type of the attribute 710 may be an
integer. Further, the duration may correspond to a number of
seconds over which an amount of bolus insulin as described by the
attribute 708 is delivered to the person 102, e.g., via the insulin
delivery system 106.
[0149] Attribute 712 describes a generic name of the insulin being
delivered according to the previously discussed attributes of a
respective record in the bolus delivery table 506. As noted above,
the term "generic" contrasts with a "trade" name of insulin. One
example of a generic name for a type of short-acting insulin is
lispro, which may have trade names including Humalog.RTM. and
Admelog.RTM.. In the illustrated example 700, the attribute 712 is
labeled with the name "insulin_generic_name" In one or more
implementations, a type of the attribute 712 may be text, e.g., a
text string indicative of the generic name for the insulin
delivered according to the record's attributes. Further, this
attribute 712 and/or attribute 714 may optionally be included in
the bolus delivery table 506.
[0150] In contrast to the attribute 712, the attribute 714
describes a trade name (if any) of the insulin being delivered
according to the record's attributes. As noted above, the term
"trade name" refers to a branded name of a type of insulin--a
branded name of a generic insulin. In the example mentioned just
above, for instance, Humalog.RTM. and Admelog.RTM. are trade names
of lispro--the generic name for a type of short-acting insulin
which may be used for bolus doses of insulin. In the illustrated
example 700, the attribute 714 is labeled with the name
"insulin_trade_name". In one or more implementations, a type of the
attribute 714 may be text, e.g., a text string indicative of the
trade name. Like the attribute 712, this attribute 714 may be
optionally included in the bolus delivery table 506.
[0151] Attribute 716 represents a name of the insulin delivery
system delivering the bolus dose of insulin or stage of the bolus
dose according to the record's attributes, e.g., a name of the
insulin delivery system 106. This name may be determined by
processing data from the insulin delivery system 106, based on
setup of the artificial pancreas system 402, and so forth. In the
illustrated example 700, the attribute 716 is labeled with the name
"source_name". In one or more implementations, a type of the
attribute 716 may be text, e.g., a text string. Further, the name
of the insulin delivery system may identify the system in relation
to other systems capable of delivering insulin, such as when a user
changes to a different insulin system, e.g., due to insurance
reasons, upgrading, and so forth.
[0152] FIG. 8 depicts an example 800 of the insulin profile table
508, which includes a plurality of columns 802-812. Here, each of
these columns corresponds to a different attribute of the data in
the insulin profile table 508. The rows in the illustrated example
800--except for the topmost row--each represent a data record in
the insulin profile table 508. It is to be appreciated that the
insulin profile table 508 may be configured with different
attributes without departing from the spirit or scope of the
described techniques.
[0153] Broadly speaking, the insulin profile table 508 comprises a
current profile of the person 102 for which the artificial pancreas
system 402 is monitoring various aspects pertinent to dosing
insulin, determining insulin doses, and delivering the doses
according to the determinations. In one or more implementations,
this profile may correspond to a selected profile of a plurality of
different profiles associated with the insulin delivery system 106.
The insulin profile table 508 may also comprise a history of
profile changes. By way of example, when a user changes his or her
insulin profile or the artificial pancreas algorithm 416 does, a
record may be added to the insulin profile table 508 describing the
profile according to the attributes. In the context of a user
change to a profile, this may correspond to selecting a different
preset profile (e.g., to "go back" to a default profile or to
select a "pizza-eating" profile) or modifying a specific attribute
of the profile, i.e., by changing or updating settings. Such
profile changes may be based on a variety of events, such as advice
from a health care provider, lifestyle changes, pregnancy, illness,
improved or worsened health indicators, to name just a few. As an
example of a user-specified change, the user may enter new values
for a target range of glucose based on information from a health
care provider, e.g., new minimum and maximum glucose levels.
[0154] The insulin profile table 508 may also be configured to
account for how a user's body reacts throughout a day to eating,
exercising, sleeping, insulin, and so forth. In this way, the
insulin profile table 508 can account for differences in how the
body reacts throughout the night (e.g., when sleeping), during
mornings, afternoons, and evenings. To this end, a first record in
the insulin profile table 508 may have a start time at zero
(midnight) so that the insulin profile table 508 accounts for an
entirety of a day. In an example where a user has a different
profile for every hour of the day, e.g., 24 hours, there may be 24
records in this table. In any case, the insulin profile table 508
includes at least one record so that insulin can be delivered to
the person 102 using attributes pertinent to dosing insulin.
[0155] In the context of the illustrated example 800, attribute 802
represents a record identifier. For a given record in the insulin
profile table 508, the record identifier uniquely identifies the
record from other records in the table. In the illustrated example
800, the attribute 802 is labeled with the name "record_id". In one
or more implementations, a type of the attribute 802 may be an
integer primary key. The attribute 802 thus may be configured as a
primary key of a given record.
[0156] Attribute 804 represents a start time of day for the profile
described by the record. In one or more implementations, profile
start times can range from midnight to 11:59 PM. For a given record
in the insulin profile table 508, the values of the record's
attributes are thus used for calculating insulin deliveries
beginning at the respective start time and until another profile
having a next chronological start time becomes "active" according
its respective start time. In the illustrated example 800, the
attribute 804 is labeled with the name "start_time_hr_min". In one
or more implementations, a type of the attribute 804 may be an
integer. Further, the profile start time may be configured as
having four digits, such that the first two digits correspond to an
hour (e.g., 0-23) and the second two digits correspond to a minute
(e.g., 0-59). Given this particular implementation, the values may
range from "0000" to "2359," where "0000" corresponds to midnight,
"1200" corresponds to noon, "1800" corresponds to 6:00 PM, and so
forth. It is to be appreciated that various time formats may be
used without departing from the spirit or scope of the described
techniques.
[0157] Attribute 806 represents a target minimum glucose level for
the person 102 when the respective record corresponds to the active
profile. This is a level below which the artificial pancreas system
402 attempts to prevent the person 102's glucose from dropping when
the respective record corresponds to the active profile. In the
illustrated example 800, the attribute 806 is labeled with the name
"glucose_target_min". In one or more implementations, a type of the
attribute 806 may be an integer. Further, the minimum glucose level
may be described in terms of milligrams per deciliter (mg/dL), such
that the artificial pancreas system 402 attempts to prevent the
glucose measurements 118 of the person 102 from dropping below a
number of mg/dL specified by the attribute 806.
[0158] Attribute 808 represents a target maximum glucose level for
the person 102 when the respective record corresponds to the active
profile. This is a level above which the artificial pancreas system
402 attempts to prevent the person 102's glucose from rising when
the respective record corresponds to the active profile. In the
illustrated example 800, the attribute 808 is labeled with the name
"glucose_target_max". In one or more implementations, a type of the
attribute 808 may be an integer. Like the minimum glucose level,
the maximum glucose level may also be described in terms of mg/dL,
such that the artificial pancreas system 402 attempts to prevent
the glucose measurements 118 of the person 102 from rising above a
number of mg/dL specified by the attribute 808. It is to be
appreciated that measurements other than mg/DL may be used to
describe the minimum and maximum glucose levels for a time period
without departing from the spirit or scope of the described
techniques.
[0159] Together, the target minimum glucose level described by the
attribute 806 and the target maximum glucose level described by the
attribute 808 define the "target range" as discussed herein. These
minimum and maximum values may be obtained in a variety of way, for
example, the person 102 may enter them via a user interface (e.g.,
of the computing device 108 or the insulin delivery system 106)
when setting up the artificial pancreas system 402 to automatically
deliver insulin. In some cases, these user-entered minimums and
maximums may correspond to information provided by the person 102's
health care provider. Alternately or additionally, these minimums
and maximums may be obtained by capturing a digital image (e.g., of
a prescription or other health-care provider provided information)
or may be received directly from a health care provider of the
person 102, such as where a portal is exposed to the health care
provider (e.g. by the glucose monitoring platform 112) and the
health care provider enters the minimums and maximums via a user
interface of the portal.
[0160] Attribute 810 represents an insulin sensitivity of the
person 102 when the respective record corresponds to the active
profile. This attribute 810 describes how the person 102's glucose
changes (as indicated by the glucose measurements 118) for each
insulin unit (IU) delivered. Additionally, the insulin sensitivity
described by the attribute 810 may be used by the artificial
pancreas algorithm 416 to compute insulin doses when the respective
record corresponds to the active profile. Insulin sensitivity may
be determined in accordance with the described techniques, as
discussed in more detail below. In the illustrated example 800, the
attribute 810 is labeled with the name "insulin_sensitivity". In
one or more implementations, a type of the attribute 810 may be an
integer. Further, the attribute 810 may describe the insulin
sensitivity in terms of glucose change per insulin unit (e.g.,
mg/DL per IU).
[0161] Attribute 812 represents a carb ratio of the person 102
during time periods when the respective record corresponds to the
active profile. This attribute 812 describes how many carbohydrates
(in terms of a predetermined unit of measurement e.g., grams) are
covered for the person 102 by a single insulin unit (IU). Here,
"covered" refers to maintaining the person 102's future glucose
within a target range corresponding to the attributes 806, 808. The
carb ratio described by the attribute 812 may also be used by the
artificial pancreas algorithm 416 to compute insulin doses when the
respective record corresponds to the active profile. Carb ratio may
be determined in accordance with the described techniques, as
discussed in more detail below. In the illustrated example 800, the
attribute 812 is labeled with the name "carb_ratio". In one or more
implementations, a type of the attribute 812 may be an integer.
[0162] As mentioned above, the attribute may describe the carb
ratio in terms of grams of carbohydrates per insulin unit (e.g.,
g/IU).
[0163] The insulin profile table 508 may include a variety of
additional or different attributes for determining insulin doses in
accordance with the described techniques. These additional or
different attributes may also be used by the artificial pancreas
algorithm 416 to generate predictions of insulin doses for keeping
a person's glucose within the target range. Indeed, the different
or additional attributes may cause the artificial pancreas
algorithm 416 to better predict insulin doses to keep a person's
glucose within the target range. By "better predict" it is meant
that the artificial pancreas algorithm's output insulin doses, when
using the additional and/or different factors, keep the person
102's glucose within the target range more often, even within the
target range keep the person 102's glucose from spiking, avoid
deviations from optimal physiological responses, and so forth. One
example of such an additional or different attribute may be
diabetes subtype.
[0164] While diabetes is often categorized in two types, i.e., Type
I and Type II diabetes, there may be a variety of subtypes under
those two types, and the insulin profile table 508 may include
attributes to capture the subtypes so that they can be used for
prediction of insulin doses by the artificial pancreas algorithm
416. By way of example, research indicates that genetic mutations
in cellular surfaces can affect insulin effectiveness.
Specifically, research indicates the presence of two genetic
mutations, as discussed below. Both genetic mutations can be
present across persons with Type I diabetes and persons with
neither Type I nor Type II diabetes. Accordingly, a person may have
Type I diabetes with a first of these genetic mutations while a
different person may have Type I diabetes with a second of these
genetic mutations while a third person may have Type I diabetes
without either genetic mutation. Thus, there may be three
"subtypes" for people with Type I diabetes. However, there may only
be two "subtypes" for people with Type II diabetes, since the
second genetic mutation generally precludes the onset of Type II
diabetes while the first genetic mutation increases susceptibility
of Type II diabetes. Thus, for Type II diabetes a person may have
the first genetic defect or neither of the genetic defects. These
subtypes may be captured in data of the insulin profile table 508
in a variety of ways, including, for example, similar to the way
different delivery types are captured in the bolus calculations
table 510.
[0165] In any case, the first genetic mutation involves a marker
within a genetic sequence of a person that causes a surface
topology aberration on the cells of the person. This aberration in
surface topology causes a reduced ability for insulin to adhere to
A- and B-receptors on the cell surface. This inhibition (i.e.,
reduced adherence to the A- and B-receptors) reduces insulin's
ability to have its generally observed effects. With this
inhibition, for instance, insulin takes more time than when the
mutation is not present to adhere to cellular surfaces and
therefore the effect of a known volume of insulin is reduced. This
inhibition may also cause insulin to take more time than when the
mutation is not present to adhere to an adequate number of cells to
cause a measurable effect of the insulin on glucose levels--this
may be referred to as "insulin resistance."
[0166] The second genetic mutation may be considered the "opposite"
of the first genetic mutation. The second genetic mutation causes a
surface topology deviation in a person that allows for easier
adherence of insulin to the A- and B-receptors of the person's
cells than for persons without either mutation. As a result, a
person with the second genetic mutation generally has a quicker
cellular response (i.e., opening the cell to glucose) and also a
larger population of cells that respond to insulin than persons
without either mutation or having the first mutation. Not only may
the artificial pancreas algorithm 416 use attributes that capture
these subtypes to more accurately determine insulin doses, but the
artificial pancreas algorithm 416 may also use them to identify how
carbohydrate intake and exercise along with the subtype affect how
much insulin to dose. The techniques described herein may also
involve identifying the presence of these subtypes, such as by
identifying patterns in the user population 110 of users having the
subtypes, identifying that the person 102 exhibits similarities to
users with one of the subtypes, and verifying that the person 102
has the identified subtype based on improved accuracy of insulin
doses that account for predictions assuming the person 102 has the
subtype. The subtype may also be identified in other ways such as
by a health care provider or genetic testing and may thus be
received as input by the artificial pancreas system 402. There may
also be other subtypes accounted for in the insulin profile table
508 in addition to the ones discussed just above.
[0167] FIG. 9 depicts an example 900 of the bolus calculations
table 510, which includes a plurality of columns 902-934. Here,
each of these columns corresponds to a different attribute of the
data in the bolus calculations table 510. The rows in the
illustrated example 900--except for the topmost row--each represent
a data record in the bolus calculations table 510. It is to be
appreciated that the bolus calculations table 510 may be configured
with different attributes without departing from the spirit or
scope of the described techniques.
[0168] Broadly speaking, the bolus calculations table 510 comprises
a history of bolus insulin doses computed, e.g., by the artificial
pancreas algorithm 416, the glucose monitoring module 408, or the
insulin delivery system 106. This contrasts with the bolus delivery
table 506, which describes the bolus doses delivered, e.g., by the
insulin delivery system 106. A given record in the bolus
calculations table 510 describes the parameters input to calculate
a bolus dose and the parameters received as output. In one or more
implementations, these input parameters may be converted into a
feature vector, e.g., for input to the artificial pancreas
algorithm 416. Similarly, these output parameters may be converted
from a feature vector to corresponding attribute values (e.g., via
one or more conversion operations), where this feature vector is
output by the artificial pancreas algorithm 416. Records may be
added to the bolus calculations table 510 based on bolus doses
being determined by any of the insulin delivery system 106, the
insulin module 406 (e.g., the artificial pancreas algorithm 416),
or the glucose monitoring module 408.
[0169] In the context of the illustrated example 900, attribute 902
represents a record identifier. For a given record in the bolus
calculations table 510, the record identifier uniquely identifies
the record from other records in the table. In the illustrated
example 900, the attribute 902 is labeled with the name
"record_id". In one or more implementations, a type of the
attribute 902 may be an integer primary key. The attribute 902 thus
may be configured as a primary key of a given record.
[0170] Attribute 904 represents a time at which a calculation is
performed. For a given record in the bolus calculations table 510,
the time of the calculation may correspond to a time at which a
bolus dose of insulin is determined, e.g., by the artificial
pancreas algorithm 416. In the illustrated example 900, the
attribute 904 is labeled with the name "system_time_sec". In one or
more implementations, a type of the attribute 904 may be an
integer. Further, the time of the calculation may correspond to
UTC, in seconds.
[0171] Attribute 906 represents a name of the source device or
application corresponding to the bolus calculation, where
"corresponding" refers to the device or application determining the
bolus dose. In the illustrated example 900, the attribute 906 is
labeled with the name "source_name". In one or more
implementations, a type of the attribute 906 may be text, e.g., a
text string. Further, the name of the source device or application
may identify the device or application corresponding to a given
record and so as to identify the device or application from other
devices or applications, such as other devices or applications
capable of performing the calculation.
[0172] Attribute 908 represents an amount of carbohydrates for
which the bolus dose corresponding to a respective record is
computed. For a given record in the bolus calculations table 510,
this is the amount of carbs that the computed dose of insulin is
predicted to cover for an upcoming meal--to maintain the person
102's future glucose level within the target range. As noted above
and below, this amount of carbohydrates may be received via one or
more user interfaces or predicted by the artificial pancreas
algorithm 416. Further, this amount of carbohydrates is used by the
artificial pancreas algorithm 416 to compute a corresponding dose
of insulin. In other words, the amount of carbohydrates of an
upcoming meal may be an input to the artificial pancreas algorithm
416 to compute an insulin dose. In the illustrated example 900, the
attribute 908 is labeled with the name "meal_carbs". In one or more
implementations, a type of the attribute 908 may be an integer.
Further, the amount of carbs of the meal may be described in terms
of grams of carbohydrates, such that the attribute describes a
number of grams of carbohydrates in the upcoming meal. It is to be
appreciated that this number of grams may be measured (e.g., on a
scale) by a user and then provided as input, estimated based on a
picture of the meal, and so forth.
[0173] Attribute 910 represents an amount of insulin on board. For
a given record in the bolus calculations table 510, the amount of
insulin on board corresponds to a measurement of insulin remaining
on board for delivery until there are zero units of insulin left to
deliver, e.g., to the person 102. In the illustrated example 900,
the attribute 910 is labeled with the name "insulin_on_board". In
one or more implementations, a type of the attribute 910 may be an
integer. Further, the amount of insulin on board may correspond to
a number of insulin units on board (e.g., the insulin delivery
system 106) for delivery to the person 102 and also may be
specified in terms of insulin units and measured to hundredths of
an insulin unit. Additionally, a measurement of the insulin on
board may be requested in connection with computation of a bolus
dose by the artificial pancreas algorithm 416, such that a record
is added to the active insulin (IOB) table 502 based on the
computation of the bolus dose and such that the attribute 910
corresponds to the attribute 516 of the active insulin (IOB) table
502.
[0174] Attribute 912 represents a carb ratio of the person 102 at a
time when the bolus dose is determined. The carb ratio may be
determined by referencing the insulin profile table 508, such as by
determining which record of the insulin profile table 508
corresponds to the "active" profile at a time the bolus dose is
being determined and by extracting the carb ratio (e.g., the
attribute 812) from the record that corresponds to the active
profile. As mentioned above, this attribute describes how many
carbohydrates (e.g., in terms of grams) are covered for the person
102 by a single insulin unit (IU). The carb ratio described by the
attribute 912 may thus be used by the artificial pancreas algorithm
416 as an input to compute a bolus insulin dose. In the illustrated
example 900, the attribute 912 is labeled with the name
"carb_ratio". In one or more implementations, a type of the
attribute 912 may be an integer. This attribute 912 may describe
the carb ratio in terms of grams of carbohydrates per insulin unit
(e.g., g/IU).
[0175] Attribute 914 represents an insulin sensitivity of the
person 102 at a time when the bolus dose is determined. The insulin
sensitivity may be determined by referencing the insulin profile
table 508, such as by determining which record of the insulin
profile table 508 corresponds to the "active" profile at a time the
bolus dose is computed and by extracting the insulin sensitivity
(e.g., the attribute 810) from the record that corresponds to the
active profile. As mentioned above, this attribute 914 describes
how the person 102's glucose changes (as indicated by the glucose
measurements 118) for each insulin unit (IU) delivered. The insulin
sensitivity described by the attribute 914 may thus be used by the
artificial pancreas algorithm 416 as input to determine a bolus
insulin dose. In the illustrated example 900, the attribute 914 is
labeled with the name "insulin_sensitivity". In one or more
implementations, a type of the attribute 914 may be an integer.
Further, the attribute 914 may describe the insulin sensitivity in
terms of glucose change per insulin unit (e.g., mg/DL per IU).
[0176] Attribute 916 represents a level of glucose at a time when
the bolus dose is determined, such as a current level of glucose of
the person 102. For a given record in the bolus calculations table
510, for instance, the attribute 916 may correspond to a glucose
measurement 118 received from the wearable glucose monitoring
device 104, e.g., a most-recently received measurement, a
measurement requested in connection with computation of the bolus
insulin dose, and so forth. Additionally or alternately, the level
of glucose may correspond to one or more glucose measurements 118
received from the wearable glucose monitoring device 104, such as
an average (e.g., mean or median) glucose measurement computed by
the glucose monitoring module 408 and/or the insulin module 406.
The level of glucose described by the attribute 916 may also be
used by the artificial pancreas algorithm 416 as input to determine
a bolus insulin dose. In the example 900, the attribute 916 is
labeled with the name "glucose_level". In one or more
implementations, a type of the attribute 916 may be an integer.
Further, the level of glucose may be described in terms of
milligrams per deciliter (mg/DL).
[0177] Attribute 918 represents a trend of glucose measurements at
a time when the bolus dose is determined, such as a current trend
in glucose measurements 118 of the person 102 over some amount of
time before the bolus dose is determined, e.g., a trend in glucose
measurements 118 of the person over a last half hour. For a given
record in the bolus calculations table 510, for instance, the
attribute 916 may be determined based on multiple glucose
measurements 118 received from the wearable glucose monitoring
device 104 over the amount of time. It is to be appreciated that
the amount of time may vary without departing from the spirit or
scope of the techniques, including, for instance, a predetermined
amount of time (e.g., a last 5 hours, a last half hour, or a last
minute), an amount of time since a last dose of insulin, a last
glucose measurement, and so forth. The trend of glucose
measurements described by the attribute 918 may also be used by the
artificial pancreas algorithm 416 as input to compute a bolus
insulin dose. In the illustrated example 900, the attribute 918 is
labeled with the name "glucose_trend". In one or more
implementations, a type of the attribute 918 may be an integer.
Further, the trend of glucose measurements may be described in
terms of milligrams per deciliter per minute (e.g., mg/dL/min).
[0178] Attribute 920 represents a target minimum glucose level for
the person 102 at a time when the bolus dose is determined. The
target minimum glucose level may be determined by referencing the
insulin profile table 508, such as by determining which record of
the insulin profile table 508 corresponds to the "active" profile
at a time the bolus dose is determined and by extracting the target
minimum glucose level (e.g., the attribute 806) from the record
that corresponds to the active profile. As mentioned above, this
attribute 920 describes a level below which the artificial pancreas
system 402 attempts to prevent the person 102's glucose from
dropping. The target minimum glucose level described by the
attribute 920 may thus be used by the artificial pancreas algorithm
416 as input to determine a bolus insulin dose. In the illustrated
example 900, the attribute 920 is labeled with the name
"target_glucose_min". In one or more implementations, a type of the
attribute 920 may be an integer. Further, the minimum glucose level
may be described in terms of milligrams per deciliter (mg/dL), such
that the artificial pancreas system 402 attempts to prevent the
glucose measurements 118 of the person 102 from dropping below a
number of mg/dL specified by the attribute 920.
[0179] Attribute 922 represents a target maximum glucose level for
the person 102 at a time when the bolus dose is determined. The
target maximum glucose level may be determined by referencing the
insulin profile table 508, such as by determining which record of
the insulin profile table 508 corresponds to the "active" profile
at a time the bolus dose is determined and by extracting the target
maximum glucose level (e.g., the attribute 808) from the record
that corresponds to the active profile. As mentioned above, this
attribute 922 describes a level above which the artificial pancreas
system 402 attempts to prevent the person 102's glucose from
rising. The target maximum glucose level described by the attribute
922 may thus be used by the artificial pancreas algorithm 416 as
input to compute a bolus insulin dose. In the illustrated example
900, the attribute 922 is labeled with the name
"target_glucose_max". In one or more implementations, a type of the
attribute 922 may be an integer. Like the minimum glucose level,
the maximum glucose level may also be described in terms of mg/dL,
such that the artificial pancreas system 402 attempts to prevent
the glucose measurements 118 of the person 102 from rising above a
number of mg/dL specified by the attribute 922. It is to be
appreciated that measurements other than mg/DL may be used to
describe the minimum and maximum glucose levels without departing
from the spirit or scope of the described techniques.
[0180] In one or more implementations, one or more of the
attributes 908-922 may be used as inputs for determining a bolus
dose of insulin. These attributes may thus be provided as input to
the artificial pancreas algorithm 416 for determining a bolus
insulin dose. By way of contrast, one or more of the attributes
924-934, described in detail below, may correspond to output of the
artificial pancreas algorithm 416. Such outputs may be used to
generate instructions for controlling insulin deliveries to the
person 102 via the insulin delivery system 106. Specifically, the
pump control manager 418 may control the insulin delivery system
106 to deliver insulin in accordance with the output described by
the attributes 924-934, such as by using a request requesting bolus
delivery as described in more detail below.
[0181] In one or more implementations, the attributes 908-922 may
be processed and converted into a feature vector for input to the
artificial pancreas algorithm 416. By way of example, this
processing may include normalizing one or more of the attributes so
that the attributes have numerical values ranging from zero to one,
e.g., using min max feature scaling or other techniques. Similarly,
the artificial pancreas algorithm 416 may output a feature vector,
which may be processed to convert the values of the features to
obtain respective values for the attributes 924-934, e.g., using
one or more post-processing operations. It is also to be
appreciated that the input and the output may correspond to
different attributes without departing from the spirit or scope of
the described techniques, such as to include an attribute
indicative of predicted glucose absent correction with insulin,
diabetes subtypes, and so forth. In the context of "output"
attributes, consider the following discussion.
[0182] Attribute 924 represents an amount of insulin to deliver for
the bolus dose or stage of the bolus dose corresponding to the
respective record and, specifically, corresponds to an amount of
insulin predicted to correct the person 102's glucose level so that
it remains in or is adjusted back into the target glucose range as
defined by the attributes 920, 922. The amount of insulin described
by the attribute 924 may be obtained from output of the artificial
pancreas algorithm 416, such that the value of this attribute 924
is set in the bolus calculations table 510, in part, by processing
the algorithm's output. In the illustrated example 900, the
attribute 924 is labeled with the name "insulin_for_correction". In
one or more implementations, a type of the attribute 924 may be an
integer. Further, the amount of insulin predicted to correct the
person 102's insulin may be described in terms of insulin units and
specified to hundredths of an insulin unit. The pump control
manager 418 may thus control the insulin delivery system 106 to
deliver a bolus dose of insulin including the amount of insulin for
correction.
[0183] Attribute 926 represents an amount of insulin to deliver for
the bolus dose or stage of the bolus dose corresponding to the
respective record and, specifically, corresponds to an amount
predicted to match a meal that is eaten by the person 102. The
amount of insulin described by the attribute 926 may also be
obtained from output of the artificial pancreas algorithm 416, such
that the value of this attribute 926 is set in the bolus
calculations table 510, in part, by processing the algorithm's
output. In the illustrated example 900, the attribute 926 is
labeled with the name "insulin_for_meal". In one or more
implementations, a type of the attribute 926 may be an integer.
Further, the amount of insulin predicted to match the meal eaten by
the person 102 may be described in terms of insulin units and
specified to hundredths of an insulin unit. The pump control
manager 418 may thus control the insulin delivery system 106 to
deliver a bolus dose of insulin including the amount of insulin for
the meal. It is to be appreciated that output of the artificial
pancreas algorithm 416 may indicate amounts of insulin to deliver
for both correction and a meal. In such scenarios, the output may
indicate an amount of zero if no insulin is to be delivered for the
particular purpose, e.g., correction or a meal. By way of example,
if bolus insulin is to be delivered for correction but not a meal,
the output of the artificial pancreas algorithm 416 may indicate a
particular amount for correction and zero for an amount to match a
meal.
[0184] Attribute 928 indicates a type of insulin delivery, such as
whether the bolus dose is to be delivered as a "normal",
"extended", "combo", or "split" delivery. There may be more types
of deliveries without departing from the spirit or scope of the
described techniques. As used herein, a "normal" bolus delivery
refers to a single, immediate dose of insulin with no extended
portion. This type of bolus may be used to cover food intake or to
correct high glucose levels. Broadly speaking, a "normal" bolus
delivery is used for normal meals of carbohydrates, fat, and
protein, e.g., meat with potatoes and vegetables. However, "normal"
bolus deliveries generally do not work for meals with high fat
content, since fat delays the absorption of carbohydrates into the
blood stream. Examples of these non-normal, high-fat-content meals
include pizza, lasagna, and tiramisu, to name just a few. To cover
such meals and various eating formats (e.g., grazing or buffets),
other types of bolus deliveries may be used. As used herein, an
"extended" bolus delivery refers to delivery of small quantities of
insulin over a period of time that is extended in relation to a
normal bolus. An extended delivery may also be referred to as a
"delayed" bolus. As used herein, a "combo" bolus refers to a
combination of "normal" and "extended" boluses. In a combo bolus
delivery of insulin, a normal bolus may be delivered and then
followed with an extended bolus, e.g., when glucose measurements
are high before a meal or when grazing at a buffet or cocktail
party. As used herein a "split" bolus refers to delivering
multiple, immediate doses of insulin with no extended portions. By
way of example, a split bolus may involve delivering two normal
bolus doses some amount of time apart, two single doses which
include one of fast-acting insulin just before a meal and then a
second dose three hours after the meal. Split doses may be split in
various ways, such as 50/50 (e.g., 50% in the first delivery and
50% in the second delivery), 60/40, and so forth. The type of
delivery described by the attribute 928 may be obtained from output
of the artificial pancreas algorithm 416, such that the value of
this attribute 924 is set in the bolus calculations table 510, in
part, by processing the algorithm's output.
[0185] In one or more implementations, these different delivery
types may be represented in the bolus calculations table 510 by
unique values. By way of example, a "1" may represent a "normal"
bolus delivery, a "2" may represent an "extended" delivery, a "3"
may represent a "combo" delivery, and a "4" may represent a "split"
delivery. In one or more implementations, a "0" may represent that
no bolus delivery is in progress. In the illustrated example 900,
the attribute 928 is labeled with the name "delivery_type". In one
or more implementations, a type of the attribute 928 may be an
integer, and may be limited to values that correspond to the
different delivery types available, e.g., as determined by the
artificial pancreas algorithm 416 and/or the types of deliveries
the insulin delivery system 106 is capable of delivering.
[0186] Attribute 930 represents a duration during which the amount
of insulin described by the attributes 924, 926 is delivered for
the bolus dose or stage of the bolus dose that corresponds to the
record. The duration of the delivery described by the attribute 930
may be obtained from output of the artificial pancreas algorithm
416, such that the value of this attribute 930 is set in the bolus
calculations table 510, in part, by processing the algorithm's
output. In the illustrated example 900, the attribute 930 is
labeled with the name "bolus_duration_sec". In one or more
implementations, a type of the attribute 930 may be an integer.
Further, the duration may correspond to a number of seconds during
which an amount of bolus insulin as described by the attributes
924, 926 is delivered to the person 102, e.g., via the insulin
delivery system 106. Attribute 932 represents an amount of insulin
to deliver for a first stage of a bolus dose, e.g., when the type
of delivery is a combo or split dose according to the attribute
928. The amount of insulin described by the attribute 932 may be
obtained from output of the artificial pancreas algorithm 416, such
that the value of this attribute 932 is set in the bolus
calculations table 510, in part, by processing the algorithm's
output. In the illustrated example 900, the attribute 932 is
labeled with the name "insulin_part1". In one or more
implementations, a type of the attribute 932 may be an integer. The
amount of insulin designated for the first stage of the bolus dose
may be described in terms of insulin units and specified to a
hundredth of a unit. The pump control manager 418 may thus control
the insulin delivery system 106 to deliver a first stage of a bolus
dose according to the amount specified by the attribute 932.
[0187] Attribute 934 represents an amount of insulin to deliver for
a second stage of a bolus dose, e.g., when the type of delivery is
a combo or split dose according to the attribute 928. The amount of
insulin described by the attribute 934 may also be obtained from
output of the artificial pancreas algorithm 416, such that the
value of this attribute 934 is set in the bolus calculations table
510, in part, by processing the algorithm's output. In the
illustrated example 900, the attribute 934 is labeled with the name
"insulin_part2". In one or more implementations, a type of the
attribute 934 may be an integer. The amount of insulin designated
for the second stage of the bolus dose may be described in terms of
insulin units and specified to a hundredth of a unit. The pump
control manager 418 may thus control the insulin delivery system
106 to deliver a second stage of a bolus dose according to the
amount specified by the attribute 934. It is to be appreciated that
insulin doses may include more stages, and, therefore, attributes
for more dose "parts" may be added to the bolus calculations table
510 without departing from the spirit or scope of the described
techniques.
[0188] Having discussed example tables that may be maintained in
the shared storage 410 in connection with implementing the
artificial pancreas system 402, consider now a discussion of how
the insulin module 406 and the glucose monitoring module 408 may
connect and interact to handle operations associated with the
artificial pancreas system 402.
[0189] Glucose Monitoring- and Insulin-Module Linking
[0190] One example implementation of how the insulin module 406 and
the glucose monitoring module 408 may connect and interact is
provided in the following discussion. As noted above, the insulin
module 406 and the glucose monitoring module 408 may be configured
as applications, such as an insulin application and a glucose
monitoring application, respectively. The insulin module 406 and
the glucose monitoring module 408 may also be configured in other
ways, such as part of a single application or such that portions of
the insulin module (e.g., the artificial pancreas algorithm 416)
are included in a same application as the glucose monitoring module
408 while other portions of the insulin module are included in a
different application.
[0191] Regardless of the particular configuration, in one or more
implementations, the insulin module 406 and the glucose monitoring
module 408 may use uniform resource locator (URL) application
linking to activate the other module in connection with sending
secure payload data to that other module. Using URL application
linking, the insulin module 406 and the glucose monitoring module
408 can activate the other module with a payload that includes a
request and parameters, such as "show home screen," "show bolus
calculator," "request bolus of 2.0 IU," and so forth. Broadly
speaking, URL application linking may be used for inter-application
communications, which may be communicated when either the insulin
module 406 or the glucose monitoring module 408 switches to
activate the other module, e.g., as a "topmost" application at the
computing device 108. Such switching to activate the other module
may include displaying a user interface of the switched-to module
via a display of the computing device 108 and enabling user
interaction via the displayed user interface.
[0192] In accordance with URL application linking as described
herein, the insulin module 406 and the glucose monitoring module
408 may use public key cryptography to encrypt payload data sent to
the other module via a URL. Use of public key cryptography to
encrypt this payload data ensures privacy of the data exchanged
between the insulin module 406 and the glucose monitoring module
408. Although public key cryptography is discussed in this example
implementation, it is to be appreciated that the insulin module 406
and the glucose monitoring module 408 alternately or additionally
may communicate data securely between one another using different
techniques for secure communications, including blockchain
technologies, for example. This secure communication along with use
of the shared storage 410 may also prevent tampering by users with
the insulin module 406 and the glucose monitoring module 408,
including prevention of tampering with the artificial pancreas
algorithm 416, e.g., tampering so that the algorithm is caused to
consider user-specified data for learning or is implemented with
user-supplied code. The secure communication along with use of the
shared storage 410 also prevents use of unauthorized devices (e.g.,
unauthorized by the glucose monitoring platform 112) in the
artificial pancreas system 402.
[0193] Regardless, by using public key cryptography for
inter-application (or module) communication, the insulin module 406
and the glucose monitoring module 408 ensure that only the target
module (e.g., the module to which a communication is communicated)
is able to decrypt the payload. By ensuring that only the target
module can decrypt the payload, sensitive information (e.g.,
personal data) is protected from intercept, including in cases
where there is an unauthorized replacement of the target module,
where unauthorized applications register for a same URL scheme as
the modules that are permitted (e.g., by the glucose monitoring
platform 112) to communicate data as part of the artificial
pancreas system 402, and so forth.
[0194] To ensure the integrity and authenticity of the payload
data, the module communicating payload data to the other module
configures the payload to include a digital signature. In the
following discussion, the module communicating the payload data may
be referred to as a source module. The module intended by the
source module to receive the payload data may be referred to as a
target module. The digital signature included with conforming
communications allows the target module to verify that the payload
data is not modified or damaged during transit. Using the digital
signature, the target module may also verify that the source of the
payload data is a module that is allowed to send requests to the
target module.
[0195] The insulin module 406 and the glucose monitoring module 408
may share public keys for such digital signatures using a shared
keychain. In some scenarios, the insulin module 406 corresponds to
one of a plurality of insulin applications permitted by the glucose
monitoring platform 112 for use in connection with the artificial
pancreas system 402. In such scenarios, each of the plurality of
applications may be permitted for use in connection with the
artificial pancreas system 402. This permission may be based on
inclusion in a group of shared applications published by the
glucose monitoring platform 112, e.g., published in a list of
shared applications, in a group of them persisted in code (e.g., of
the glucose monitoring module 408), in a group of them persisted in
other data (e.g., a database or table included in the glucose
monitoring module 408 or provided to the computing device 108 in
connection with installing and/or updating the glucose monitoring
module 408), or in a group of them persisted by settings, to name
just a few. The published group of shared applications limits
access to the shared keychain to the applications that are included
in the group--only those applications published in the shared group
have access to the shared keychain.
[0196] The target module may use the digital signature along with
one or more additional identifiers of the source module to verify
that the source module is authorized to send a data payload. By way
of example, the one or more identifiers may include an identifier
(e.g., a bundle_id) that can be provided to the target module by an
operating system of the computing device 108, such as in connection
with communication of a payload and identifying the source module.
In relation to URL application linking, the target module may thus
use a digital signature of a payload along with this identifier of
the source module to confirm that the source module is authorized
to send the communication, e.g., is authorized to send requests to
the target module via URLs. By way of example, this identifier may
enable the target module to retrieve the public key of the source
module and the retrieved public key used to verify the digital
signature provided with the payload data.
[0197] Once the target module determines that the source of a
request is authorized to send such information, the operating
system may switch the target module to a foreground of the
operating system while suspending the source module. As noted
above, these requests and their respective payloads may be sent via
URL. Further, the URLs used for such switching may conform to a
scheme, such as a scheme where the URL identifies the target module
and optionally includes a path portion comprising a single
encrypted payload. The encrypted payload included at the URL may be
decrypted using the digital signature and an identifier as
mentioned above and below.
[0198] With respect to obtaining the keys to implement the
above-discussed shared keychain, the insulin module 406 (any one of
the plurality of applications permitted to carry out the
functionality of the insulin module 406) and the glucose monitoring
module 408 generate a public/private key pair during a first
initialization, e.g., in connection with a setup to link the
modules. These modules may then cause their generated public keys
to be stored in a shared keychain of the group of shared
applications and also cause their generated private keys to be
stored in a respective private keychain of the modules. In one or
more implementations, the public keys may be identified in the
shared keychain by one or more of the identifiers (e.g., bundle_id)
provided by the computing device 108's operating system.
[0199] With respect to the payloads provided via URL, in one or
more implementations, these payloads may include a dictionary of
key value pairs with a request and parameters for the request. In
accordance with the described techniques, this dictionary may be
encoded in binary data, digitally signed, encrypted (e.g., with the
target module's public key), and encoded into a string used as a
path portion of a provided URL. In accordance with public/private
keychain techniques, data encrypted with the public key of the
target module may be decrypted by the target module only, because
the target module alone stores the private key needed for such
decryption. Other modules cannot decrypt such data, even if they
were to intercept the data or eavesdrop, because they do not have
the private key needed for decryption of data encrypted with the
target module's public key. The digital signature provided as part
of the payload thus allows the target module to both verify the
integrity of the payload and also to verify its authenticity.
[0200] To generate the above discussed payloads and their
respective paths, a source module of a URL communication may encode
the dictionary included with the payload in binary format, such as
by using an NSSecureCoding protocol. Further, the source module may
append a digital signature to the binary encoding of the dictionary
by computing a hash value, such as by computing a hash value that
is encrypted with the private key of the source module. It is to be
appreciated that a variety of hashing techniques may be used to
compute such as hash value, including, for instance, the secure
hash algorithm (SHA) to compute a SHA-256 value. The source module
may then encrypt the combined binary data and the digital
signature, e.g., using the public key of the target module. The
source module may then form the path portion of the URL by encoding
the encrypted combination of binary data and digital signature. For
example, the source module may encode this encrypted data to a base
64 string to form the path portion of the URL.
[0201] The target module may process a received URL message in
accordance with the following discussion. The target module may
decode the received base 64 string comprising the path section of
the URL into binary data. The target module may then separate the
payload portion of the binary data from the digital signature
portion of the binary data. The target module may decrypt the
digital signature using the public key of the source module, e.g.,
obtained from the public keychain of the group of shared
applications. The target module may then compare the expected hash
value with a value of the decrypted digital signature to verify
that the payload received is intact and also to authenticate the
source module.
[0202] The following discussion describes example implementation
details of the payload, including details of key/value
dictionaries. As noted above, the payload sent via URL to the
target module contains a dictionary of key/value pairs that has
been encoded. These key/value pairs may be specific to a particular
type of request directed to the target module. These key/value
pairs may specify the type of request and also optionally
respective parameters specific to the type of request. The
different types of requests may include an initial setup screen
request, a show home screen request, a show bolus calculator
request, and a bolus delivery request. It is to be appreciated that
the insulin module 406 and the glucose monitoring module 408 may
communicate additional types of requests with one another without
departing from the spirit or scope of the described techniques.
[0203] Regardless, example dictionaries encoded in connection with
the above-described types of requests may be configured in
accordance with the following discussion. Requests for an initial
setup screen may include a dictionary with a "request" key and a
"date" key. In the following discussion, a value of the "request"
key generally identifies the type of request, such that a specific
value for the request key identifies an initial setup screen
request from a show bolus calculator request and so forth. In the
context of an initial setup screen request, for instance, a value
type of the request key may be a string (e.g., an NSString) and the
value may correspond to a string such as "init," such that "init"
identifies the request as an initial setup screen request from
other types of requests. Based on receiving an initial setup screen
request, the target module initiates a setup and pairing process
with an insulin delivery system (e.g., the insulin delivery system
106) or with the wearable glucose monitoring device 104. A value
type of the date key may be a date (e.g., NSDate) corresponding to
a date and time the request is sent to the target module. In one or
more implementations, the target module is configured to reject
requests that are out of sequence, old, or duplicates, in terms of
this date.
[0204] Requests to show home screen may be configured differently
than other types of requests. By way of example, the source module
may request the target module to show its home screen by
configuring the URL with an empty path portion--when the path
portion is empty, there is no payload. Responsive to receiving a
URL with a path (payload) that is empty, the target module is
configured to display its home or main screen via a display device
of the computing device 108.
[0205] Requests to show bolus calculator may include a dictionary
solely with a "request" key. For a show bolus calculator request, a
value type of the request key may be a string (e.g., NSString) and
the value may correspond to a string such as "calc," such that
"calc" identifies the request as a show bolus calculator request
from other types of requests. Based on receiving a show bolus
calculator request, the target module causes display of its bolus
calculator, e.g., via a display device of the computing device 108.
The displayed bolus calculator may include user interface elements
via which a user can provide input for calculating a bolus dose of
insulin, e.g., a number of carbohydrates in an upcoming meal,
selection of a particular meal (e.g., pizza, buffet, snack, etc.),
an amount of time until an upcoming meal, and so forth. The
elements may also be selectable to initiate, pause, or stop
delivery of a bolus insulin dose (e.g., one computed by the
artificial pancreas algorithm 416 or manually input by a user). A
bolus calculator may include user interface elements for use with a
variety of user actions and may also be configured to display a
variety of information (e.g., glucose measurements) and
visualizations (e.g., indications of trends of the glucose
measurements) without departing from the spirit or scope of the
described techniques.
[0206] Requests that request a bolus delivery may include a
dictionary with a "request" key, a "date" key, a "carbs" key, a
"meal-bolus" key, a "correction" key, a "type" key, a "duration"
key, a "bolus1" key, and "bolus2" key. For a request that requests
a bolus delivery a value type of the request key may be a string
and the value may correspond to a string such as "bolus," such that
"bolus" identifies the request as a bolus delivery request from
other types of requests. Based on receipt of a request that
requests a bolus delivery, the target module causes the insulin
module 406 to initiate delivery of insulin via the insulin delivery
system 106--this may include employing the functionality of the
pump control manager 418 to instruct the insulin delivery system
106 to deliver an insulin dose. In connection with such a request,
the target module may also cause the insulin module 406 to employ
the artificial pancreas algorithm 416 to compute a bolus dose of
insulin and/or a basal rate of insulin. A value type of the date
key for a bolus delivery request may be a date (e.g., NSDate)
corresponding to a date and time the request is sent to the target
module. In one or more implementations, the target module is
configured to reject requests that are out of sequence, old, or
duplicates, in terms of this date.
[0207] A value type of the carbs key may be a number (e.g.,
NSNumber) describing an amount of carbohydrates covered with the
requested bolus delivery. In one or more implementations, the
number may correspond to a number of grams of carbohydrates
accounted for with the requested bolus delivery. This data may be
obtained by the source module from the shared storage 410 to
populate the bolus delivery request and/or may otherwise correspond
to a record in one or more tables, such as the bolus calculations
table 510. A value of the meal-bolus key may be a number (e.g.,
NSNumber) describing an amount of insulin to deliver to cover
carbohydrates of a meal for which the bolus insulin delivery is
requested. In one or more implementations, the number may
correspond to a number of insulin units measured to hundredths of
an insulin unit (IU). A value of the correction key may be a number
(e.g., NSNumber) describing an amount of insulin to deliver to
correct the person 102's glucose level so that it remains within a
target range of glucose measurements. In one or more
implementations, this number may also correspond to a number of
insulin units measured to hundredths of an insulin unit (IU).
[0208] A value type of the "type" key may be a number (e.g.,
NSNumber) that indicates a type of insulin delivery, such as
whether the delivery is "normal", "extended", "combo", or "split".
As discussed in more detail in relation to FIG. 9, a "1" may
represent a "normal" bolus delivery, a "2" may represent an
"extended" delivery, a "3" may represent a "combo" delivery, and a
"4" may represent a "split" delivery. It should be appreciated that
the value type of the "type" key may be different yet nevertheless
capture the type of bolus delivery. A type of the bolus1 key may be
a number (e.g., NSNumber) describing an amount of insulin to
deliver in connection with a first part of a bolus insulin
delivery. This number may correspond to a number of insulin units
to deliver for the first part of the delivery and be specified to
hundredths of an insulin unit (IU). A type of the bolus2 key may be
a number (e.g., NSNumber) describing an amount of insulin to
deliver in connection with a second part of a bolus insulin
delivery. The bolus2 key may be used in connection with combo or
split bolus deliveries--but not with normal or extended deliveries.
This number may correspond to a number of insulin units to deliver
for the second part of the delivery and be specified to hundredths
of an insulin unit (IU).
[0209] It is to be appreciated that the insulin module 406 and the
glucose monitoring module 408 may provide different types of
requests to one another without departing from the spirit or scope
of the described techniques. The requests may alternately or
additionally be configured in ways that are different from the
above-described dictionaries and/or by using different secure
communication techniques to implement the artificial pancreas
system 402.
[0210] Setting Up and Adjusting Insulin Delivery
[0211] As described throughout, the artificial pancreas controller
404 is configured to utilize the artificial pancreas algorithm 416
to accurately predict the user's glucose levels as well as the
insulin doses required to maintain the user's glucose levels within
the target range. This allows flexibility in the user's food
choices because any number of carbohydrates consumed by the user
can be covered by a matching dose of insulin delivered the user by
the insulin delivery system 106. In a healthy person, the pancreas
produces enough insulin to keep the user's blood glucose
measurements within the target range, whether the user is active,
resting, eating, sick, stressed, or sleeping. This means that a
healthy person can eat food at any time of day without their blood
glucose levels changing dramatically. However, people with diabetes
cannot produce or use insulin effectively enough to control their
blood glucose levels. To solve this problem, the artificial
pancreas controller 404 constantly monitors the person 102's blood
glucose level based on the glucose measurements 118 provided by the
wearable glucose monitoring device 104 worn by the person 102, and
then controls the insulin delivery system 106 to deliver the
appropriate insulin doses to the person 102, at the appropriate
time, in order to maintain the person 102's blood glucose levels
within the target range.
[0212] Generally, the artificial pancreas controller 404 controls
the insulin delivery system 106 to deliver two types of insulin
doses to the person 102: basal insulin doses and bolus insulin
doses. Basal insulin doses utilize a long-acting insulin that reach
the person 102's bloodstream several hours after injection and
remain effective for up to 24 hours at a time, but to a lower peak
than a fast-acting, intermediate-acting, or regular-acting insulin.
Thus, the basal insulin dose provides a constant supply of insulin
to bring down the person 102's blood glucose levels. The artificial
pancreas controller 404 can be configured to control the insulin
delivery system 106 to deliver basal insulin doses to a user once
or twice per day in order to lower the user's blood glucose levels
throughout the day. One example of a generic name for a type of
long-acting insulin is glargine, which may have trade names
including Lantus.RTM., Toujeo.RTM., Abasaglar.RTM., and
Basaglar.RTM..
[0213] In contrast, bolus insulin doses act quickly, and thus are
known as "fast-acting" or "rapid" insulin. For example, a bolus
insulin dose delivered by the insulin delivery system 106 may enter
the person 102's bloodstream quickly with a noticeable affect
occurring within 15 minutes and peaking in about an hour. After
peaking, the insulin dose begins to decrease but may continue to
work for two to four hours. One example of a generic type of
short-acting insulin is lispro, which may have trade names
including Humalog.RTM. and Admelog.RTM.. The artificial pancreas
controller 404 is configured to control the insulin delivery system
106 to deliver bolus insulin doses to the person 102 in order to
match the effect of various factors which may cause the person
102's blood glucose levels to move out of the target range, such as
carbohydrate consumption, exercise, stress, or sickness, to name
just a few.
[0214] It is to be appreciated that the artificial pancreas
algorithm 416 may be configured in a variety of ways to handle
determination of both basal and bolus insulin doses. To the extent
that basal and bolus doses generally apply to different types of
scenarios--basal doses correspond to a longer acting form of
insulin to keep glucose levels stable through periods of fasting
and bolus doses correspond to a shorter acting insulin to prevent
rises of glucose levels resulting from meals--determination of
these different types of doses may involve consideration of
different aspects of the person 102's context and thus different
inputs.
[0215] In various implementations, the artificial pancreas
controller 404 provides a protocol to determine an optimal basal
insulin dose for a new user. Attributes corresponding to the
determined basal insulin dose may then be stored in the shared
storage 410 discussed above with regards to FIGS. 5-9. The process
of determining the proper basal insulin dose for a new user is
often referred to as "basal titration". Conventionally, basal
titration is performed with a generic titration chart which
includes an initial basal insulin dose, and an amount to adjust the
dose over time. The use of a generic titration schedule makes it
difficult to determine the optimal basal insulin dose for a new
user due to concerns that an aggressive basal insulin dose may
cause the user's blood glucose level to drop out of the target
range and into a hypoglycemic level. As such, conventional systems
initially prescribe a conservative basal insulin dose that may be
injected manually by the user (e.g., using an insulin pen), and
then slowly increase the basal insulin dose over time as long as
hypoglycemic events are avoided. This conservative process employed
by conventional systems is time consuming for the user and may take
several weeks, or even months, to determine an optimal basal
insulin dose for a new user. The lack of immediate results causes
many patients to give up before realizing an optimal basal insulin
dose.
[0216] In contrast, the techniques described herein may employ a
more aggressive titration schedule because the wearable glucose
monitoring device 104 can alert the person 102 before their blood
glucose level drops to a hypoglycemic level. The more aggressive
titration schedule enables the optimal basal insulin doses to be
determined in a reduced timeframe as compared to conventional
processes. Moreover, the real-time display of blood glucose levels
and alerts by the wearable glucose monitoring device 104 keeps the
person engaged in the process until an optimal basal insulin dose
is learned by the system.
[0217] To determine the optimal basal insulin dose for a new user,
the artificial pancreas controller 404 may control the computing
device 108 to display a user interface configured to receive an
initial basal insulin dose for the user. The initial basal insulin
dose, for example, may be provided by the user's health care
provider as part of an insulin prescription given to the user, and
the user may then enter this dose into the user interface provided
by the artificial pancreas controller 404. By way of example,
consider FIG. 10 which depicts an example 1000 of a user interface
displayed as part of the protocol to determine the basal insulin
dose. In this example, a user interface 1002 is displayed by
computing device 108. The user interface 1002 requests user input
defining the initial basal insulin dose provided by the user's
health care provider and includes a control 1004 to receive user
input. In this example, the control 1004 is depicted as a text box
control, but may be implemented as any type of control that can be
used to define an initial basal insulin dose, such as a dropdown
list. In example 1000, the user provides user input 1006, via the
control 1004, which defines the initial basal insulin dose as 10
units of glargine per day. Responsive to user selection of a submit
control 1008, the user entered basal insulin dose is stored in the
shared storage 410 by the artificial pancreas controller 404.
[0218] Determining an optimal basal insulin dose may also include
identifying time periods qualifying as suitable times for a basal
test, e.g., one or more times at night. In one or more
implementations, the insulin module 406 may monitor patterns in the
person 102's glucose measurements 118 over a time period (e.g., one
week) and during particular times of day (e.g., overnight). Based
on this monitoring, the insulin module 406 may determine whether
the person 102's basal dose is suitable, too high, or too low.
Responsive to the determination, the artificial pancreas algorithm
416 may adjust the person 102's basal dose of insulin accordingly,
e.g., leave the dose if suitable, lower the dose if too high, or
raise the dose if too low. In one or more implementations, the
monitoring may include the insulin module 406 identifying the time
periods that qualify as suitable for basal tests, without providing
any specific instructions to the person 102 (e.g., via display or
audible output), without using information about what the person
102 eats, and/or without using information about bolus doses the
person 102 has administered.
[0219] In some cases, and in order to decrease the risk of the user
incorrectly entering the initial basal insulin dose prescribed by
the user's healthcare provider via the user interface, the user
interface 1002 may be provided to the user's health care provider
instead of the user. Alternately, the artificial pancreas
controller 404 may prompt the user to capture an image of the
prescription written by the user's health care provider, and then
leverage character recognition techniques to verify that the
prescription is valid and determine the amount of the initial basal
insulin dose. The artificial pancreas controller 404 may also
provide prompts for the user or healthcare provider to input the
time of day at which the basal insulin doses are to be delivered to
the user. Notably, the initial basal insulin dose may be determined
or collected in a variety of different ways without departing from
the spirit or scope of the described techniques.
[0220] Regardless of how the initial basal insulin dose is
obtained, the artificial pancreas controller 404 controls the
insulin delivery system 106 to deliver the basal insulin dose to
the user at the indicated times, such as by delivering the basal
insulin dose to the user in the morning and/or at night. The
artificial pancreas controller 404 can then automatically adjust
the basal insulin dose delivered to the person 102 by the insulin
delivery system 106 based on feedback from the wearable glucose
monitoring device, e.g., the glucose measurements 118 provided by
the wearable glucose monitoring device 104 worn by the person 102.
For example, if after a first day the blood glucose levels of
person 102 never dip close to the hypoglycemic range, but instead
person 102 has various blood glucose measurements 118 near the
hyperglycemic range, then the artificial pancreas controller 404
may dynamically increase the basal insulin dose the following day
based on the feedback received from the wearable glucose monitoring
device 104. In contrast, if after a first day the blood glucose
levels of person 102 never rise close to the hyperglycemic range,
but instead person 102 has various blood glucose measurements near
the hypoglycemic range, then the artificial pancreas controller 404
may dynamically decrease the basal insulin dose the following
day.
[0221] The artificial pancreas controller 404 may also adjust the
basal insulin dose each day based on a variety of different
factors, such as exercise, stress, sickness and so forth. In some
cases, the basal insulin dose may also be adjusted based on the
fasting glucose level of person 102 determined from the glucose
measurements 118 provided by the wearable glucose monitoring device
104. For example, the artificial pancreas controller 404 may
increase the basal insulin dose for person 102 when the fasting
glucose level is above a "normal range," whereas the dose may be
decreased on days when the fasting glucose level is below the
"normal range." In any case, the process mentioned just above can
be repeated each day such that the artificial pancreas controller
404 is able to quickly learn the optimal basal insulin dose for
person 102, adjust this dose as needed, and deliver the optimized
basal insulin doses to person 102 each day.
[0222] Moreover, once the basal insulin dose is determined for
person 102, the artificial pancreas controller 404 can detect when
the blood glucose level of person 102 is out of range (when no
bolus insulin dose is in effect) based on the glucose measurements
118 provided by the wearable glucose monitoring device 104. In some
cases, the artificial pancreas controller 404 can determine reasons
for the out-of-range measurements, and indicate these reasons to
person 102, such as lack of exercise, stress, or sickness. As part
of this, the artificial pancreas controller 404 may also generate
targeted recommendations to person 102 indicative of lifestyle
changes that will help stabilize the blood glucose level within the
target range, such as adjusting exercise frequency and/or
intensity, reducing stress, and so forth. In cases where the blood
glucose level of person 102 is out of range for an extended period
of time, then the protocol to determine an optimal basal insulin
dose may be repeated by the artificial pancreas controller 404.
[0223] In various implementations, the artificial pancreas
controller 404 also provides protocols to determine optimal bolus
insulin doses. Notably, carbohydrates and insulin affect people
differently, and thus the artificial pancreas controller 404 is
configured to determine the effect of carbohydrates and insulin on
the blood glucose level of person 102 in order to accurately
predict glucose levels and corresponding bolus doses of insulin to
deliver to maintain the blood glucose level within the target range
in response to various events, such as carbohydrate consumption,
exercise, stress, or illness. As part of this, the artificial
pancreas controller 404 employs a process to learn the
carbohydrate-to-glucose ratio and insulin sensitivity factor for
person 102. Attributes corresponding to the determined
carbohydrate-to-glucose ratio and insulin sensitivity factor may
then be stored in the shared storage 410 discussed above with
regards to FIGS. 5-9.
[0224] The carbohydrate-to-glucose ratio is a measure of the effect
of carbohydrates on blood glucose level. For example, using the
processes described below, the artificial pancreas controller 404
can determine how much the blood glucose level of person 102
increases per one gram of carbohydrate. The insulin sensitivity
factor is a measure of the effect of insulin on blood glucose level
and corresponds to the drop in blood glucose levels (usually
measured in mg/dL) caused by one unit of insulin. High insulin
sensitivity allows the cells of the body to use blood glucose more
effectively thereby reducing blood glucose levels. In contrast, low
insulin sensitivity is known as insulin resistance and occurs when
the user's cells do not absorb as much glucose, which might lead to
excessively high blood glucose levels.
[0225] It is to be appreciated, therefore, that the
carbohydrate-to-glucose ratio can be used by the artificial
pancreas algorithm 416 of the artificial pancreas controller 404 to
accurately predict a future glucose level a short time after
carbohydrates are consumed by person 102 as long as the amount of
carbohydrates consumed is identified. Then, based on the predicted
future glucose level and the insulin sensitivity factor, the
artificial pancreas algorithm 416 can determine the proper bolus
insulin dose to deliver to in order to match the predicted rise in
glucose level.
[0226] As part of the process to determine the
carbohydrate-to-glucose ratio, the artificial pancreas controller
404 determines an initial glucose measurement based on the glucose
measurements 118 provided by the wearable glucose monitoring device
104 worn by person 102, and obtains nutritional information
describing an amount of carbohydrates to be consumed by person 102.
In the context of determining the carbohydrate-to-glucose ratio,
consider FIG. 11 which depicts an example 1100 of user interfaces
displayed by the artificial pancreas controller as part of the
process to determine the carbohydrate-to-glucose ratio for person
102. At 1102, the artificial pancreas controller 404 causes display
of a user interface 1104 by the computing device 108. The user
interface 1104 includes a welcome message that provides information
describing the carbohydrate-to-glucose ratio. Notably, consuming
additional macronutrients (e.g., protein and fat) in addition to
carbohydrates may decrease the accuracy of the test, thus in this
example the user interface 1104 includes a recommendation to select
a food that consists mostly of carbohydrates, such as white
rice.
[0227] At 1106, the artificial pancreas controller controls the
user interface 1104 to display a second screen which indicates an
initial blood glucose level of person 102 is 120 mg/dL, as well as
a control 1108 configured to receive user input defining the amount
of carbohydrates that person 102 will consume. In one or more
implementations, the artificial pancreas controller 404 may ensure
that the initial blood glucose measurement is within a target
range, such as within 100 to 120 mg/dL before allowing the
automated process to begin. For example, if it is determined that
the blood glucose level is outside of the target range, the
artificial pancreas controller 404 may terminate the automated
process and instruct the user to try again at a later time when the
blood glucose level is within range. As part of this, the
artificial pancreas controller 404 may provide a recommendation to
move the blood glucose levels within the target range, such as by
increasing exercise, decreasing stress, and so forth.
[0228] In some cases, the artificial pancreas controller 404 can
determine the carbohydrate-to-glucose ratio more accurately when a
small amount of carbohydrates is consumed as part of the test
(e.g., 5-10 grams of carbohydrates). Thus, at 1106 the user
interface 1104 includes a recommendation to consume 10 grams of
carbohydrates or less. Notably, the range of suggested
carbohydrates may be based on other factors, such as the body
weight or person 102. As such, the suggested amount of
carbohydrates to consume may vary for different users. In some
implementations, the user interface may display an additional
prompt, which instructs the user to enter more detailed
information, such as the type of food consumed, the weight of the
consumed food (e.g., measured in grams or ounces), or the
macronutrient makeup of the consumed food (e.g., amount of
carbohydrates, protein, and fat). In this scenario, the artificial
pancreas controller 404 may factor in the type of food and/or the
amount of other macronutrients when determining the
carbohydrate-to-glucose ratio.
[0229] At 1106, person 102 has provided input, via control 1108,
indicating that 10 grams of carbohydrates will be consumed. At
1110, and in response to the input defining the amount of
carbohydrates to be consumed, the artificial pancreas controller
404 controls the user interface 1104 to display instructions to
consume the carbohydrates. The user interface 1104 also provides an
indication that the blood glucose level of person 102 will be
monitored and used to determine the carbohydrate-to-glucose
ratio.
[0230] After determining the initial blood glucose measurement and
the nutritional information describing an amount of carbohydrates
to be consumed, the artificial pancreas controller 404 monitors the
blood glucose level based on the glucose measurements 118 provided
by the wearable glucose monitoring device 104 worn by person 102.
Notably, after consuming the carbohydrates, the blood glucose
measurements will increase up to a peak glucose measurement, before
decreasing back downwards. In order to determine the peak glucose
measurement, the artificial pancreas controller 404 may monitor the
trend rate of the person's glucose measurements 118 as they
increase and detect the peak glucose measurement when the trend
rate decreases towards a value of 0. This is because the decrease
in the trend rate indicates that the peak glucose measurement,
caused by the consumption of carbohydrates, has been reached.
[0231] Once the peak glucose level is detected, the artificial
pancreas controller 404 determines the carbohydrate-to-glucose
ratio based on the initial glucose measurement, the peak glucose
measurement, and the amount of carbohydrates consumed. For example,
the carbohydrate-to-glucose ratio may be determined by dividing the
number of carbohydrates (measured in grams) by the change in blood
glucose measurements (e.g., the difference between the initial
blood glucose measurement and the peak blood glucose measurement).
In some cases, the results of the carbohydrate-to-glucose ratio is
output by the artificial pancreas controller 404. By way of
example, at 1112, the artificial pancreas controller 404 controls
the user interface 1104 to display the determined
carbohydrate-to-glucose ratio. In this example, the
carbohydrate-to-glucose ratio for person 102 is determined to be
1:5, which signifies that each gram of carbohydrate consumed by
person 102 will raise the blood glucose level of person 102 by 5
mg/dL. This may be determined, for example, by measuring the blood
glucose level using the wearable glucose monitoring device 104 and
detecting a peak glucose level of 170 mg/dL after the 10 grams of
carbohydrates are consumed. Based on this, the amount of
carbohydrates (10 grams) is divided by the change in glucose levels
50 mg/DL (170 mg/dL-120 mg/DL) in order to determine the
carbohydrate to glucose ratio of 1:5. The carbohydrate-to-glucose
ratio is stored in the shared storage 410 by the artificial
pancreas controller 404 and usable by the artificial pancreas
algorithm 416 to determine bolus insulin doses as described
throughout.
[0232] In one or more implementations, the artificial pancreas
controller 404 can determine the insulin sensitivity factor after
detecting the peak glucose level as part of the automated process.
For example, as depicted at 1112, the user interface 1104 may
display a control that asks person 102 whether they would like to
determine their insulin sensitivity factor now. If person 102
selects "yes", the artificial pancreas controller 404 may initiate
the process to determine the insulin sensitivity factor.
Alternately, the artificial pancreas controller 404 can determine
the insulin sensitivity factor as part of a separate automated
process (e.g., if person 102 selects the "no" control depicted in
the user interface 1104 at 1112).
[0233] To determine the insulin sensitivity factor, the artificial
pancreas controller 404 detects a peak glucose measurement, such as
by detecting a leveling of the rate of increase of the glucose
measurements 118 provided by the wearable glucose monitoring device
104 after carbohydrates are consumed by person 102 as part of the
process to determine the carbohydrate-to-glucose ratio. Next, the
artificial pancreas controller 404 estimates a bolus insulin dose
that will drop the blood glucose level from the peak glucose
measurement to a target glucose measurement. The artificial
pancreas controller 404 may calculate a conservative estimate of
the bolus insulin dose to prevent the blood glucose level from
dropping too low into a hypoglycemic range. In some cases, the
bolus insulin dose is estimated to cause the peak glucose
measurement to drop to a target glucose measurement which
corresponds to the initial glucose level of person 102. For
example, if the initial blood glucose level of person 102 is 120
mg/dL and rises to a peak glucose level of 170 mg/DL, then the
bolus insulin dose may be selected to return the blood glucose
level to the initial level of 120 mg/dL.
[0234] The artificial pancreas controller 404 controls the insulin
delivery system 106 to deliver the determined bolus insulin dose to
person 102, and monitors the glucose measurements 118 provided by
the wearable glucose monitoring device 104 worn by person
102--after the estimated bolus insulin dose is delivered to the
person 102 via the insulin delivery system 106--to detect the
target glucose measurement, corresponding to a leveling of the rate
of decrease in the glucose measurements 118. The artificial
pancreas controller 404 determines the insulin sensitivity factor
based on an amount of insulin included in the bolus insulin dose
and the difference between the peak glucose measurement and the
target glucose measurement. For example, the change in the blood
glucose level (from the peak glucose measurement to the base
glucose measurement) may be divided by the units of insulin
delivered in the bolus insulin dose. In some cases, the artificial
pancreas controller 404 may include other factors when calculating
the insulin sensitivity factor, such as the amount of time before
the insulin started to have an effect on the blood glucose level,
when the effect of the insulin peaked, and when the effect of the
insulin began to drop.
[0235] In the context of determining the insulin sensitivity
factor, consider FIG. 12 which depicts an example 1200 of user
interfaces displayed by the artificial pancreas controller 404 as
part of the process to determine the insulin sensitivity factor for
person 102. At 1202, the artificial pancreas controller 404 causes
display of a user interface 1204 by the computing device 108. The
user interface 1204 includes a welcome message which includes
information regarding the insulin sensitivity factor and informs
person 102 that a peak blood glucose level of 170 mg/dL has been
detected. In addition, the user interface 1204 notifies person 102
that an insulin dose will be delivered in order to measure the
insulin sensitivity factor. At 1206, the artificial pancreas
controller 404 controls the user interface 1204 to display a second
screen which includes an indication of the insulin sensitivity
factor determined for person 102. In this example, the determined
insulin sensitivity factor is 1:50 which indicates that one unit of
fast acting insulin will drop the blood glucose level of person 102
by 50 mg/dL.
[0236] Notably, the process to determine the
carbohydrate-to-glucose ratio and insulin sensitivity factor may be
repeated multiple times by the artificial pancreas controller 404
in order to obtain the most accurate values. Additionally, the
artificial pancreas controller 404 may repeat the test at different
times of the day, since a person's insulin sensitivity may vary
from breakfast, to lunch, to dinner, as well as based on other
factors such as exercise or stress. In some cases, the test may be
repeated multiple times to first confirm the results for a first
meal event (e.g., breakfast), and then once confirmed, can be
repeated multiple times to confirm results for other meal events,
such as lunch and dinner.
[0237] The insulin sensitivity factor is stored in the shared
storage 410 by the artificial pancreas controller 404 along with
the carbohydrates-to-glucose ratio. Additionally, the artificial
pancreas algorithm 416 may determine the carb ratio of the person
102 based on the carbohydrate-to-glucose ratio and the insulin
sensitivity factor. As described throughout, the carb ratio
describes how many predetermined units of measurement (e.g., grams)
of carbohydrate are covered for the person 102 by a single insulin
unit (IU), where "covered" refers to maintaining the person 102's
glucose within a target range. The artificial pancreas algorithm
416 may access these parameters from the shared storage 410 and
utilize the carbohydrate-to-glucose ratio and insulin sensitivity
factor to determine the bolus insulin doses that are to be
delivered to the user during the user's day to day activities. The
artificial pancreas controller 404 may provide these values as part
of input to the artificial pancreas algorithm 416, e.g., as values
for features of input feature vectors. For example, based on the
carbohydrate-to-glucose ratio, the artificial pancreas algorithm
416 can predict a peak glucose measurement for a future meal based
on the initial glucose measurement of person 102 and the amount of
carbohydrates to be consumed as part of the meal. Moreover, based
on the insulin sensitivity factor, the artificial pancreas
algorithm 416 may determine the amount of insulin to deliver via
the insulin delivery system 106 in order to decrease the blood
glucose level from the predicted peak glucose measurement back down
to the initial glucose measurement.
[0238] While the carbohydrate-to-glucose ratio and the insulin
sensitivity factor can be utilized by the artificial pancreas
algorithm 416 to accurately predict the peak glucose measurement
and the corresponding dose of insulin to deliver to match the
expected rise in blood glucose levels when the only available
information is an estimate of the amount of carbohydrates consumed,
an even greater level of accuracy may be achieved by matching
insulin doses to commonly consumed meals. Thus, in one or more
implementations the artificial pancreas controller 404 provides an
automated process to match bolus insulin doses to commonly consumed
meals. To do so, the artificial pancreas controller 404 obtains
information describing a meal to be consumed by person 102. This
information may be obtained in a variety of different ways. In some
cases, the information includes a description of the meal, along
with nutritional information indicating the total amount of
carbohydrates included in the meal. Alternately, the nutritional
information may include additional information, such as the total
amount of calories, fat, and protein. In one or more
implementations, the information may include an image of the meal,
from which the artificial pancreas controller 404 can estimate the
amount of carbohydrates and other macronutrients. For example,
person 102 may indicate that the meal is a particular type of
cereal and include a picture of the bowl containing milk and cereal
captured by a camera. From this, the artificial pancreas controller
404 can use various image recognition techniques to determine the
amount of cereal and milk in the bowl. Based on the amount of
cereal and milk estimated using the image recognition techniques,
the artificial pancreas controller 404 can then determine the
nutritional content of the meal (e.g., carbohydrates, protein, and
fat) by accessing nutritional information for the cereal and milk
from a database containing nutritional information for various food
items.
[0239] Regardless of how the nutritional information for the meal
is obtained, the artificial pancreas controller 404 determines a
bolus insulin dose based on the nutritional information. For
example, by calculating the total amount of carbohydrates for the
meal based on the nutritional information, the artificial pancreas
controller 404 can use the artificial pancreas algorithm 416 to
predict the bolus insulin dose that will be needed to counteract
the rise in blood glucose levels caused by consumption of the meal.
The artificial pancreas controller 404 then controls the insulin
delivery system 106 to deliver the determined bolus insulin dose to
person 102. In some cases, the bolus insulin dose should be
delivered 15 to 30 minutes before the meal is consumed which is the
amount of time required for the insulin dose to take effect.
Alternately, the ideal time to begin the meal may be determined by
monitoring the effect of the insulin on the user, such as by
determining when the insulin rate starts to go down. Thus, in some
cases, the artificial pancreas controller 404 can monitor the
effect of the insulin on the user, and then notify the user when it
is time to begin consumption of the meal, such as by sending a
notification to computing device 108.
[0240] After instructing the user to begin consumption of the meal,
the artificial pancreas controller 404 monitors the blood glucose
level based on glucose measurements 118 provided by the wearable
glucose monitoring device 104 worn by person 102. The artificial
pancreas controller 404 may detect the peak glucose measurement,
and then monitor the glucose measurements as the blood glucose
level drops from the peak glucose measurement. The artificial
pancreas controller 404 detects a base glucose level when the trend
rate of the decrease in blood glucose measurements nears a value of
0. The artificial pancreas controller 404 then compares the base
glucose level to the initial glucose level which was measured prior
to delivery of the bolus insulin dose and consumption of the meal.
If the base glucose level is within a predefined error range of the
initial glucose level, then the artificial pancreas controller 404
determines that the meal consumption has been matched, and the
bolus insulin dose is associated with the meal information in the
shared storage 410. In this way, the bolus insulin dose can be
delivered to person 102 for future meals based on an indication
that the particular meal is to be consumed.
[0241] Notably, if the base glucose level is not within the
predefined error range, then the artificial pancreas controller 404
may generate a notification to repeat the test another time. During
the next test for the meal, the artificial pancreas controller will
adjust the bolus insulin dose based on the results of the previous
test. This test can then be repeated multiple times until the bolus
insulin dose is correctly matched to the meal. Additionally, the
artificial pancreas controller 404 can be configured to provide
feedback to person 102 describing how well the process is
working.
[0242] In the context of matching insulin doses to commonly
consumed meals, consider FIG. 13 which depicts an example 1300 of
user interfaces displayed by the artificial pancreas controller as
part of the process to match an insulin dose to a meal. At 1302,
the artificial pancreas controller 404 causes display of a user
interface 1304 by the computing device 108. The user interface 1304
includes a prompt 1306 to receive user input describing nutritional
information for a commonly consumed meal. In this example, person
102 has determined nutritional information for a commonly consumed
meal that includes 8 ounces of chicken breast, 1 cup of white rice,
and 100 grams of broccoli. The person 102 provides input via the
prompt 1306 describing the meal name as "Chicken Bowl", along with
nutritional information for the meal which in this case indicates
that the meal contains 479 calories, 52 grams of carbohydrates, 59
grams of protein, and 3 grams of fat. This nutritional information
may be determined by person 102 in a variety of different ways,
such as by utilizing an online nutritional calculator. However, as
discussed throughout, the nutritional information may be determined
in a variety of different ways without departing from the spirit or
scope of the described techniques.
[0243] At 1308, the artificial pancreas controller 404 controls the
user interface 1304 to indicate that a bolus insulin dose has been
delivered and instructs person 102 to wait for 15 minutes before
beginning consumption of the meal. At 1310, the artificial pancreas
controller 404 controls the user interface 1304 to display an
indication that the determined bolus insulin dose has been matched
to the meal. Providing this feedback may increase user confidence
that the artificial pancreas controller 404 is effectively
controlling the blood glucose levels of person 102, which is likely
to incentivize users to continue to provide meal information to the
system.
[0244] In one or more implementations, the artificial pancreas
controller 404 can automatically set various attributes for a new
user, such as a temporary basal rate to titrate insulin, the
carbohydrate-to-glucose ratio, the insulin sensitivity factor, and
so forth. In other words, rather than requiring user input or a
protocol to determines these attributes, the artificial pancreas
controller 404 may automatically configure these values for the
person 102. Then, based on the glucose measurements received from
the wearable glucose monitoring device 104 worn by the person 102,
the artificial pancreas controller 404 can adjust these attributes
over time so that the attributes are customized to person 102.
Additionally, the artificial pancreas controller 404 can surface
data to the person 102, as well as other users such as the
healthcare provider of person 102, which shows how changes to these
various attribute affect glucose control for person 102. For
example, if the artificial pancreas algorithm 416 lowers the basal
rate for a patient from 0.8 U/hr to 0.7 U/hr from 3 pm to 5 pm, the
artificial pancreas controller 404 may log this change as an event
along with data and analysis that supports this change. Such data
and analysis may include, for example, an identification of the
basal change in a graph of data, along with an overlay showing
previous weeks of glucose data with the time period following the
basal change.
[0245] As described throughout, the various attributes learned by
the artificial pancreas controller 404 using the automated
processes described above can be maintained in the shared storage
410. Subsequently, these attributes can be accessed by the
artificial pancreas algorithm 416 from the shared storage 410 and
utilized to control insulin doses delivered to person 102 by the
insulin delivery system 106. As the insulin doses are delivered to
person 102, the artificial pancreas controller 404 continuously
monitors the blood glucose measurements provided by the wearable
glucose monitoring device 104 worn by person 102. Based on the
blood glucose measurements, the artificial pancreas controller 404
may automatically adjust the various attributes stored in the
shared storage 410 to account for situations in which the blood
glucose levels are not maintained within the target range.
[0246] The artificial pancreas controller 404 may adjust insulin
doses in response to detecting that the blood glucose levels of
person 102 are below the target glucose range (e.g., hypoglycemic)
or above the target glucose range (e.g., hyperglycemic). Out of
range blood glucose levels may be detected by the artificial
pancreas controller 404 after the active time of a delivered bolus
insulin dose as well as within the active time of a delivered bolus
insulin dose. When blood glucose levels outside of the target range
are detected, the artificial pancreas controller 404 may take
various actions to adjust the insulin doses delivered to person 102
by insulin delivery system 106.
[0247] The artificial pancreas controller 404 detects a
hypoglycemic blood glucose measurement that is below the target
range after the active time of a bolus insulin dose when blood
glucose measurements provided by the wearable glucose monitoring
device 104 worn by person 102 indicate that the person's blood
glucose level is within the target range immediately after the
bolus insulin dose has completed its course, but then falls below
the target range when the bolus insulin dose is no longer active.
When the hypoglycemic blood glucose level is detected, the
artificial pancreas controller 404 determines the likely cause of
the low blood glucose level, such as high basal insulin dose,
exercise, and/or alcohol consumption. The artificial pancreas
controller 404 can determine the likely cause of the low glucose
level by analyzing the data stored in the shared storage 410, as
well as various additional data associated with the person 102.
Such additional data, for example, may include activity data (e.g.,
heart rate data or steps data automatically collected by various
wearable devices worn by the user), as well as user provided data
(e.g., data input by the user via various user interfaces provided
by the artificial pancreas controller 404 or other services).
[0248] As an example, by processing the data stored in the shared
storage 410 as well as the various additional data, the artificial
pancreas controller 404 can determine that a high basal insulin
dose is the likely cause for the low glucose levels when low blood
glucose levels are detected multiple times after the active time of
the bolus insulin dose. Similarly, exercise can be identified as
the cause of the low blood glucose level based on a determination
that the low blood glucose level occurs regularly on days in which
the person 102 exercises. In some cases, the artificial pancreas
controller 404 may perform additional pattern analysis, such as by
determining that exercise on certain days is combined with
additional walking while person 102 is at work. Similarly, alcohol
can be identified as the cause of the low blood glucose levels
based on correlated alcohol consumption with the low blood glucose
levels. In cases where the artificial pancreas controller 404 is
unable to determine the likely cause of the out of range reading
based on the available data, the artificial pancreas controller 404
may prompt the user to answer various questions, such as questions
related to exercise, alcohol consumption, sickness, stress, and so
forth.
[0249] Once the cause for the low blood glucose level is
determined, the artificial pancreas controller 404 may
automatically adjust the insulin doses delivered to the person 102,
such as by modifying the attributes describing the basal or bolus
insulin doses in the shared storage 410. Generally, the insulin
doses are adjusted by the artificial pancreas controller 404 when a
pattern for the low blood glucose levels can be determined within
an error threshold. In contrast, the artificial pancreas controller
404 can handle "one time" low blood glucose levels by providing a
low blood glucose alert to person 102.
[0250] The artificial pancreas controller 404 detects a
hypoglycemic blood glucose measurement that is below the target
range during the active time of a bolus insulin dose when blood
glucose measurements provided by the wearable glucose monitoring
device 104 worn by person 102 indicate that the person's blood
glucose level is below the target range while the bolus insulin
dose is active. When the hypoglycemic blood glucose level is
detected during the active time of the bolus insulin dose, the
artificial pancreas controller 404 determines the likely cause of
the low blood glucose level. The artificial pancreas controller 404
can determine the likely cause of the low glucose level by
analyzing the data stored in the shared storage 410, as well as
various additional data associated with the person 102. Such
additional data, for example, may include activity data (e.g.,
heart rate data or steps data automatically collected by various
wearable devices worn by the user), as well as user provided data
(e.g., data input by the user via various user interfaces provided
by the artificial pancreas controller 404 or other services).
[0251] In some cases, the artificial pancreas controller 404 may
determine a mismatch between the carbohydrates of the meal and the
bolus insulin dose. Another possibility is that the bolus insulin
dose is acting before the meal causes the glucose level to rise.
This may be due to consumption of a carbohydrates with a low
glycemic index which causes the carbohydrates to be more slowly
digested by person 102, or due to delayed consumption of the meal
by person 102. Other possible causes include a mismatch between the
exercise factor used in computation of the bolus insulin dose and
the actual exercise completed by person 102.
[0252] Once the cause for the low blood glucose level is
determined, the artificial pancreas controller 404 may
automatically adjust the insulin doses delivered to the person 102,
such as by modifying the attributes describing the basal or bolus
insulin doses in the shared storage 410. Generally, the insulin
doses are adjusted when a pattern for the low blood glucose levels
can be determined. For example, if a low glucose level is measured
multiple times for a specific meal, the artificial pancreas
controller 404 may adjust the bolus insulin dose for the specific
meal by decreasing the dose. In contrast, one time low blood
glucose levels can be handled by providing a low blood glucose
alert to person 102 as described throughout.
[0253] The artificial pancreas controller 404 detects a
hyperglycemic blood glucose measurement that is above the target
range after the active time of a bolus insulin dose when blood
glucose measurements provided by the wearable glucose monitoring
device 104 worn by person 102 indicate that the person's blood
glucose level is within or below the target range immediately after
the bolus insulin dose has completed its course, but then rises
above the target range when the bolus insulin dose is no longer
active. When the hyperglycemic blood glucose level is detected, the
artificial pancreas controller 404 determines the likely cause of
the high blood glucose level, such as an insufficient basal insulin
dose, various health issues or illness, stress, lack of exercise,
consumption of a meal that is high in fat, Gastroparesis, the dawn
phenomenon, or the Simogyi effect, to name just a few.
[0254] Once the cause for the high blood glucose level is
determined, the artificial pancreas controller 404 may
automatically adjust the insulin doses delivered to the user, such
as by modifying the attributes describing the basal or bolus
insulin doses in the shared storage 410. Generally, the insulin
doses are adjusted when a pattern for the high blood glucose levels
can be determined. For example, if a high glucose level is measured
multiple times for a specific meal, the artificial pancreas
controller 404 may adjust the bolus insulin dose for the specific
meal by increasing the dose. With regards to exercise, the basal
insulin dose may have been determined assuming a certain amount and
intensity of exercise by person 102. Subsequently, if the person's
amount or intensity of exercise decreases, then the basal insulin
dose may need to be increased to account for the higher blood
glucose levels caused by the decrease in exercise by person 102. In
contrast, one time high blood glucose levels can be handled by
providing a high blood glucose alert to person 102 as described
throughout. In cases where the artificial pancreas controller 404
is unable to determine the likely cause of the out of range reading
based on the available data, the artificial pancreas controller may
prompt the user to answer various questions, such as questions
related to exercise, alcohol consumption, sickness, stress, and so
forth.
[0255] The artificial pancreas controller 404 detects a
hyperglycemic blood glucose measurement that is above the target
range during the active time of a bolus insulin dose when blood
glucose measurements provided by the wearable glucose monitoring
device 104 worn by person 102 indicate that the person's blood
glucose level is above the target range while the bolus insulin
dose is active. When the hyperglycemic blood glucose level is
detected during the active time of the bolus insulin dose, the
artificial pancreas controller 404 determines the likely cause of
the high blood glucose level. The artificial pancreas controller
404 can determine the likely cause of the high glucose level by
analyzing the data stored in the shared storage 410, as well as
various additional data associated with the person 102. Such
additional data, for example, may include activity data (e.g.,
heart rate data or steps data automatically collected by various
wearable devices worn by the user), as well as user provided data
(e.g., data input by the user via various user interfaces provided
by the artificial pancreas controller 404 or other services).
[0256] In some cases, the artificial pancreas controller 404 may
determine a mismatch between the carbohydrates of the meal and the
bolus insulin dose, in which case the bolus insulin dose for the
meal is increased. Another possibility is that the bolus insulin
dose is acting too late (e.g., the person's blood glucose levels
rise before the insulin starts to act). Once the cause for the high
blood glucose level is determined, the artificial pancreas
controller 404 may automatically adjust the insulin doses delivered
to the user, such as by modifying the attributes describing the
basal or bolus insulin doses in the shared storage 410. Generally,
the insulin doses are adjusted when a pattern for the high blood
glucose levels can be determined. For example, if a high glucose
level is measured multiple times for a specific meal, the
artificial pancreas controller 404 may adjust the bolus insulin
dose for the specific meal by increasing the dose. In contrast, one
time high blood glucose levels can be handled by providing a high
blood glucose alert to person 102 as described throughout.
[0257] Escalating Alerts
[0258] As noted above, the artificial pancreas controller 404 may
be configured to cause output of escalating alerts using the
different devices of the artificial pancreas system 402 (and
potentially other remote devices), e.g., to decrease the occurrence
of damaging health events due to hyper- and/or hypo-glycemia. One
implementation example for providing such alerts is described in
the following discussion.
[0259] The artificial pancreas controller 404 may provide an alert
notification service using the wireless connections 412, 414 (e.g.,
Bluetooth) and by leveraging functionality of the wearable glucose
monitoring device 104, the insulin delivery system 106, and/or the
computing device 108. By way of example, the artificial pancreas
controller 404 may receive an alert that originates at the insulin
delivery system 106 (e.g., due to a measured level of insulin or
device malfunction) over the wireless connection 414 and then cause
the computing device 108 to output an indication of the alert. In
this scenario, the insulin delivery system 106 may output a first
indication of the alert (e.g., responsive to detecting a condition
causing the alert) and the computing device 108 may output a second
indication of the alert based on receipt of the alert by the
artificial pancreas controller 404 and instructions from the
controller to output the second indication. The artificial pancreas
controller 404 is configured to manage alert escalation--so that it
is managed at a single device. Management of this alert escalation
may include determining where alerts are output (which devices),
types of alerts output (e.g., tactile (vibrations), audible, visual
(notifications)), and an order of output. This management also
includes causing the alerts to be output according to the
determination.
[0260] One or more of the wearable glucose monitoring device 104,
the insulin delivery system 106, and/or the computing device 108
may also include functionality for a user (e.g., the person 102,
his or her parent, or a health care provider) to acknowledge these
alerts. As used herein, the term "acknowledging" may refer to
providing user input in a manner that indicates the user has seen
or otherwise sensed (e.g., felt a vibration) an alert and also
indicates that the user is aware of possible effects which may be
related to the alert, e.g., that hypo- or hyper-glycemia may soon
occur if no intervening actions are performed. By way of example,
these alerts can be acknowledged by pushing a physical button,
providing some input in relation to a displayed user interface
element (e.g., slide, press, double tap, and so forth), and/or
providing a verbal acknowledgement, to name just a few. Such
acknowledgement may "clear" the alert from all devices that are
used to implement the alert notification service, such that if
acknowledgment of the alert is received by the computing device
108, then the alert may also be cleared from the insulin delivery
system 106 where the alert originated.
[0261] In one or more implementations, the artificial pancreas
controller 404 may activate an application of the computing device
108, even if that application is not running at the time the alert
is triggered. Examples of the application may include a glucose
monitoring application or an insulin application, which may
correspond to the glucose monitoring module 408 and/or the insulin
module 406 (or various portions thereof). In scenarios where an
alert is associated with a message in text, the text of the alert
may be maintained on a master device (e.g., the device detecting
the condition that caused the alert) such that other devices used
to implement the service need not be exposed to the text (or
translations of the text) in advance of the alert.
[0262] In accordance with the described techniques, consider the
following alert escalation example. The artificial pancreas
controller 404 causes the computing device 108 to vibrate
responsive to detection of a condition associated with an alert. If
no acknowledgement is received within an amount of time, then the
artificial pancreas controller 404 causes the insulin delivery
system 106 to vibrate. If no acknowledgement is received within an
amount of time, then the artificial pancreas controller 404 causes
the computing device 108 to output an alert sound via one or more
speakers associated with the computing device 108. If no
acknowledgement is received within an amount of time, then the
artificial pancreas controller 404 causes the insulin delivery
system 106 to output an alert sound via one or more speakers
associated with the insulin delivery system 106. This process may
continue by subsequently alternating audible output by the
computing device 108 and the insulin delivery system 106 until
acknowledgement is received. It is to be appreciated that the
amount of time between outputs may be the same or may be different
between the different outputs, e.g., the time between outputs may
decrease. Additionally, the artificial pancreas controller 404 may
increase a volume of the audible output as the process continues.
The artificial pancreas controller 404 may escalate alerts among
devices that are part of the artificial pancreas system 402 in a
variety of ways without departing from the spirit or scope of the
techniques described herein.
[0263] Onboard Artificial Pancreas Algorithm Implementation
Example
[0264] As mentioned above, the artificial pancreas algorithm 416
may be implemented at the wearable glucose monitoring device 104,
in one or more implementations. Thus, rather than being implemented
at the computing device 108, as depicted in FIG. 4, the artificial
pancreas algorithm 416 and the pump control module 418 may be
implemented at or otherwise local to the wearable glucose
monitoring device 104--the artificial pancreas algorithm 416 and
the pump control module 418 may be included in computer-readable
media of the wearable glucose monitoring device 104 and they may be
run using one or more processors of the wearable glucose monitoring
device 104. In this way, the artificial pancreas system 402 may
operate using only the wearable glucose monitoring device 104 and
the insulin delivery system 106 over at least one period of time,
without interacting with the computing device 108 or another
computing device. This may be advantageous in a variety of
scenarios in which connecting to a computing device 108, or setting
up a computing device to operate with the artificial pancreas
algorithm 416 and the pump control module 418, is undesirable, such
as when the artificial pancreas system 402 is utilized in a
hospital setting, in scenarios where a user does not have easy
access to power or the network 116 (e.g., camping, hiking, in rural
areas, while driving, etc.), and so forth.
[0265] In such scenarios, the artificial pancreas algorithm 416
may, at the wearable glucose monitoring device 104, determine doses
of insulin to be delivered to the person 102 based on the glucose
measurements 118 produced by the wearable glucose monitoring device
104. The pump control module 418 may then generate instructions at
the wearable glucose monitoring device 104 that instruct the
insulin delivery system 106 to deliver the determined amount of
insulin to the person 102 at one or more times. A transmitter of
the wearable glucose monitoring device 104 may then transmit the
instructions to the insulin delivery system 106 over a communicable
coupling, such as over a Bluetooth Low Energy (BLE) link, near
field communication (NFC) connection, or 5G, to name just a
few.
[0266] At one or more intervals, the artificial pancreas algorithm
416 and/or the pump control module 418 may back up any settings
that changed since a last update, such as by establishing a
communicative coupling with the computing device 108 and
communicating the settings to the computing device 108. The
communicated settings can then be saved by the computing device
108, e.g., by persisting the settings locally on computer-readable
media of the computing device 108 or the settings can be
communicated to the glucose monitoring platform 112 for storage in
the storage device 120. In this way, the person 102's settings may
not simply be discarded when the wearable glucose monitoring device
104 expires, e.g., when it is time to replace the wearable glucose
monitoring device 104 with a new one.
[0267] Examples of the interval at which the settings may be
communicated to the computing device include every 7 days, every 10
days, every 14 days, and at expiration of the wearable glucose
monitoring device 104, to name just a few. When a new wearable
glucose monitoring device 104 is applied to the person, the saved
settings may then be communicated from the computing device 108 to
the new wearable glucose monitoring device 104, such that the
artificial pancreas algorithm 416 and the pump control module 418
can be used from the persisted state. In this way, any learning or
optimizing of the artificial pancreas algorithm 416 and/or the pump
control module 418 may be maintained over time and over the use of
multiple wearable glucose monitoring devices. Alternatively or in
addition, the settings may be backed up at the insulin delivery
system 106.
[0268] In one or more implementations, the artificial pancreas
algorithm 416 and the pump control module 418 may operate in
different modes from the wearable glucose monitoring device 104,
including, by way of example and not limitation, a predictive low
glucose suspend only mode, or a partially closed loop mode (e.g.,
where the person 102 delivers bolus insulin doses for meals), to
name just a few.
[0269] Example Procedures
[0270] This section describes example procedures for machine
learning in an artificial pancreas. Aspects of the procedures may
be implemented in hardware, firmware, or software, or a combination
thereof. The procedures are shown as a set of blocks that specify
operations performed by one or more devices and are not necessarily
limited to the orders shown for performing the operations by the
respective blocks. In at least some implementations the procedures
are performed by an artificial pancreas controller, such as
artificial pancreas controller 404 that makes use of an insulin
module 406 and a glucose monitoring module 408.
[0271] FIG. 14 depicts an example procedure 1400 in which an
insulin dose is determined and delivered to a user.
[0272] A first wireless connection to a wearable glucose monitoring
device worn by a user is established, and a second wireless
connection to an insulin delivery system worn by the user is
established (block 1402). By way of example, an artificial pancreas
controller 404 implemented at computing device 108 establishes a
first wireless connection 412 to a wearable glucose monitoring
device 104 worn by person 102 and second wireless connection 414 to
insulin delivery system 106.
[0273] A sequence of glucose measurements provided by the wearable
glucose monitoring device is received via the first wireless
connection (block 1404). By way of example, the wearable glucose
monitoring device 104 is configured to monitor glucose of the
person 102 continuously. The wearable glucose monitoring device 104
may be configured with a glucose sensor, for instance, that
continuously detects analytes indicative of the person 102's
glucose and enables generation of glucose measurements 118. The
artificial pancreas controller 404 implemented at computing device
108 receives the glucose measurements 118 from the wearable glucose
monitoring device 104. The wearable glucose monitoring device 104
may communicate these measurements in real-time, e.g., as they are
produced using a glucose sensor. Alternately or in addition, the
wearable glucose monitoring device 104 may communicate the glucose
measurements 118 to the computing device 108 at set time intervals,
e.g., every 30 seconds, every minute, every 5 minutes, every hour,
every 6 hours, every day, and so forth.
[0274] An insulin dose is determined using an artificial pancreas
algorithm based at least in part on the sequence of glucose
measurements (block 1406). By way of example, an artificial
pancreas algorithm 416, of the artificial pancreas controller 404,
determines an insulin dose based at least in part on the sequence
of glucose measurements. The artificial pancreas algorithm 416
determines the inulin dose to prevent the person 102's glucose
measurements 118 from departing a target range. Generally, extreme
or sustained departures from such a target range can result in
dangerous health conditions and/or damage to a person's body, e.g.,
heart, blood vessels, eyes, kidneys, and nerves. Maintaining
glucose levels within the target range, through timely insulin
delivery, can thus help avoid those dangerous health conditions and
bodily damage. In some cases, the artificial pancreas algorithm 416
determines the insulin dose based at least in part on previous
insulin doses delivered to the user by the insulin delivery system
(e.g., basal or bolus doses), a trend of glucose measurements
provided by the wearable glucose monitoring device 104, or data
identifying one or more events corresponding to the user, such as
food consumption, carbohydrate consumption, exercise, stress, or
illness. In one or more implementations, the artificial pancreas
algorithm 416 predicts that an event has occurred based on the
sequence of glucose measurements and determines the insulin dose
based at least in part on the predicted event (e.g., food
consumption or exercise).
[0275] The insulin delivery system is controlled to deliver the
insulin dose to the user by communicating instructions over the
second wireless connection to the insulin delivery system (block
1408). By way of example, the pump control manager 418 of the
artificial pancreas controller 404 may generate instructions, based
on the artificial pancreas algorithm 416's output, that instruct
the insulin delivery system 106 to deliver an amount of insulin
over a time period, e.g., three insulin units (IU) immediately,
0.15 IU every hour continuously, and so forth. The pump control
manager 418 may also cause these instructions to be communicated
over the wireless connection 414 to the insulin delivery system
106.
[0276] FIG. 15 depicts an example procedure 1500 in which a
carbohydrate-to-glucose ratio is determined and used to control
delivery of bolus insulin doses.
[0277] A first wireless connection to a wearable glucose monitoring
device worn by a user is established, and a second wireless
connection to an insulin delivery system worn by the user is
established (block 1502). By way of example, an artificial pancreas
controller 404 implemented at computing device 108 establishes a
first wireless connection 412 to a wearable glucose monitoring
device 104 worn by person 102 and second wireless connection 414 to
insulin delivery system 106.
[0278] An initial glucose measurement provided by the wearable
glucose monitoring device worn by the user is received via the
first wireless connection (block 1504) and user input describing an
amount of carbohydrates to be consumed by the user is received via
a user interface (block 1506). By way of example, the artificial
pancreas controller 404 provides a protocol to determine optimal
bolus insulin doses. Notably, carbohydrates and insulin affect
people differently, and thus the artificial pancreas controller 404
is configured to determine the effect of carbohydrates and insulin
on the blood glucose level of person 102 in order to accurately
predict glucose levels and corresponding bolus doses of insulin to
deliver to maintain the blood glucose level within the target range
in response to various events, such as carbohydrate consumption,
exercise, stress, or illness. As part of this, the artificial
pancreas controller 404 employs a process to learn the
carbohydrate-to-glucose ratio and insulin sensitivity factor for
person 102.
[0279] As part of the process to determine the
carbohydrate-to-glucose ratio, the artificial pancreas controller
404 determines an initial glucose measurement based on the glucose
measurements 118 provided by the wearable glucose monitoring device
104 worn by person 102, and obtains nutritional information
describing an amount of carbohydrates to be consumed by person 102.
For example, as depicted in FIG. 11, the artificial pancreas
controller controls the user interface 1104 to display a second
screen which indicates an initial blood glucose level of person 102
is 120 mg/dL, as well as a control 1108 configured to receive user
input defining the amount of carbohydrates that person 102 will
consume.
[0280] Glucose measurements provided by the wearable glucose
monitoring device worn by the user are monitored after the meal is
consumed by the user to detect a peak glucose measurement (block
1508). By way of example, after determining the initial blood
glucose measurement and the nutritional information describing an
amount of carbohydrates to be consumed, the artificial pancreas
controller 404 monitors the blood glucose level based on the
glucose measurements 118 provided by the wearable glucose
monitoring device 104 worn by person 102. Notably, after consuming
the carbohydrates, the blood glucose measurements will increase up
to a peak glucose measurement, before decreasing back downwards. In
order to determine the peak glucose measurement, the artificial
pancreas controller 404 may monitor the trend rate of the user's
glucose measurements 118 as they increase and detect the peak
glucose measurement when the trend rate decreases towards a value
of 0. This is because the decrease in the trend rate indicates that
the peak glucose measurement, caused by the consumption of
carbohydrates, has been reached.
[0281] A carbohydrate-to-glucose ratio for the user is determined
based on the initial glucose measurement, the peak glucose
measurement, and amount of carbohydrates consumed (block 1510). By
way of example, the artificial pancreas controller 404 determines
the carbohydrate-to-glucose ratio based on the initial glucose
measurement, the peak glucose measurement, and the amount of
carbohydrates consumed. For example, the carbohydrate-to-glucose
ratio may be determined by dividing the number of carbohydrates
(measured in grams) by the change in blood glucose measurements
(e.g., the difference between the initial blood glucose measurement
and the peak blood glucose measurement). In some cases, the results
of the carbohydrate-to-glucose ratio is output by the artificial
pancreas controller 404. In FIG. 11, for example, the artificial
pancreas controller 404 controls the user interface 1104 to display
the determined carbohydrate-to-glucose ratio.
[0282] The insulin delivery system is controlled to deliver bolus
insulin doses to the user based at least in part on the
carbohydrate-to-glucose ratio (block 1512). By way of example, the
carbohydrate-to-glucose ratio is stored in the shared storage 410
by the artificial pancreas controller 404 and used by the
artificial pancreas algorithm 416 to determine bolus insulin doses.
The artificial pancreas controller 404 then controls the insulin
delivery system 106 to deliver the determined bolus insulin doses
to the user as described throughout.
[0283] In one or more implementations, the artificial pancreas
controller 404 can determine the insulin sensitivity factor after
detecting the peak glucose level as part of the automated process.
Alternately, the artificial pancreas controller 404 can determine
the insulin sensitivity factor as part of a separate automated
process. In the context of determining the insulin sensitivity
factor, consider FIG. 16 which depicts an example procedure 1600 in
which an insulin sensitivity factor is determined and used to
control delivery of bolus insulin doses.
[0284] A first wireless connection to a wearable glucose monitoring
device worn by a user is established, and a second wireless
connection to an insulin delivery system worn by the user is
established (block 1602). By way of example, an artificial pancreas
controller 404 implemented at computing device 108 establishes a
first wireless connection 412 to a wearable glucose monitoring
device 104 worn by person 102 and second wireless connection 414 to
insulin delivery system 106.
[0285] Glucose measurements provided by the wearable glucose
monitoring device worn by the user are monitored to detect a peak
glucose measurement (block 1604), and a bolus insulin dose to drop
the user's glucose level from a peak glucose measurement to a
target glucose measurement is estimated (block 1606). By way of
example, the artificial pancreas controller 404 detects a peak
glucose measurement, such as by detecting a leveling of the rate of
increase of the glucose measurements 118 provided by the wearable
glucose monitoring device 104 after carbohydrates are consumed by
person 102 as part of the process to determine the
carbohydrate-to-glucose ratio. Next, the artificial pancreas
controller 404 estimates a bolus insulin dose that will drop the
blood glucose level from the peak glucose measurement to the target
glucose measurement. The artificial pancreas controller 404 may
calculate a conservative estimate of the bolus insulin dose to
prevent the blood glucose level from dropping too low into a
hypoglycemic range. In some cases, the bolus insulin dose is
estimated to cause the peak glucose measurement to drop to the
target glucose measurement which corresponds to the initial glucose
level of person 102. For example, if the initial blood glucose
level of person 102 is 120 mg/dL and rises to a peak glucose level
of 170 mg/DL, then the bolus insulin dose may be selected to return
the blood glucose level to the initial level of 120 mg/dL.
[0286] The insulin delivery system is controlled to deliver the
estimated bolus insulin dose to the user by communicating
instructions over the second wireless connection to the insulin
delivery system (block 1608). By way of example, the artificial
pancreas controller 404 controls the insulin delivery system 106 to
deliver the estimated bolus insulin dose to person 102 by
communicating instructions over the second wireless connection to
the insulin delivery system 106.
[0287] Glucose measurements provided by the wearable glucose
monitoring device worn by the user are monitored after the
estimated bolus insulin dose is delivered to the user via the
insulin delivery system to detect the target glucose measurement
(block 1610), and the insulin sensitivity factor for the user is
determined based on an amount of insulin included in the estimated
bolus insulin dose and a difference between the peak glucose
measurement and the target glucose measurement (block 1612). By way
of example, the artificial pancreas controller 404 controls the
insulin delivery system 106 to deliver the estimated bolus insulin
dose to person 102, and monitors the glucose measurements 118
provided by the wearable glucose monitoring device 104 worn by
person 102--after the estimated bolus insulin dose is delivered to
the person 102 via the insulin delivery system 106--to detect a
target glucose measurement, corresponding to a leveling of the rate
of decrease in the glucose measurements 118. The artificial
pancreas controller 404 determines the insulin sensitivity factor
based on an amount of insulin included in the estimated bolus
insulin dose and the difference between the peak glucose
measurement and the target glucose measurement. For example, the
change in the blood glucose level (e.g., the difference between the
peak glucose measurement and the target glucose measurement) may be
divided by the units of insulin delivered in the estimated bolus
insulin dose. In some cases, the artificial pancreas controller 404
may include other factors when calculating the insulin sensitivity
factor, such as the amount of time before the insulin started to
have an effect on the blood glucose level, when the effect of the
insulin peaked, and when the effect of the insulin began to
drop.
[0288] The insulin delivery system is controlled to deliver future
bolus insulin doses to the user based at least in part on the
insulin sensitivity factor (block 1614). By way of example, the
insulin sensitivity factor is stored in the shared storage 410 by
the artificial pancreas controller 404 and used by the artificial
pancreas algorithm 416 to determine bolus insulin doses. The
artificial pancreas controller 404 then controls the insulin
delivery system 106 to deliver the determined bolus insulin doses
to the user as described throughout.
[0289] FIG. 17 depicts an example procedure 1700 in which an
artificial pancreas algorithm is trained to determine insulin doses
for a user using one or more machine learning techniques.
[0290] Historical glucose measurements provided by a wearable
glucose monitoring device worn by a user over a sequence of days
are received (block 1702), and additional data of the user is
received from one or more sources different from the wearable
glucose monitoring device (block 1704). In accordance with the
principles described herein, the other user data may include food
consumption data, activity data, or insulin doses that are
correlated to the glucose measurements, to name just a few.
[0291] An artificial pancreas algorithm is trained to determine
insulin doses for the user based on the historical glucose
measurements and the other user data of the user using one or more
machine learning techniques (block 1706). By way of example, the
artificial pancreas algorithm 416 and/or the models it comprises
may be trained or otherwise learned initially using the glucose
measurements 118 and other user data (e.g., delivered insulin
doses, insulin measurements, target glucose ranges, insulin
sensitivities, carb ratios, food consumption data, activity data,
etc.) of the user population 110 maintained in the storage device
120. Further, this other user data may be correlated with the
glucose measurements 118, for instance, based on timestamps of the
glucose measurements and the other data. The initially trained
artificial pancreas algorithm 416 may then be communicated over
connection 420 (which may be wired, wireless, or a combination) for
incorporation with the artificial pancreas controller 404. Once
incorporated, the artificial pancreas algorithm 416 may be further
trained so that it is customized for the person 102, i.e., the
person associated with the computing device 108 and wearing the
particular wearable glucose monitoring device 104 and the
particular insulin delivery system 106.
[0292] For example, the artificial pancreas algorithm 416 may be
further trained so that it is personalized for the person 102, in
part, by obtaining target measurements, target measurement ranges,
and/or starting doses from a health care provider of the person
102. Starting doses of insulin may be obtained for a basal
titration process, for instance, and through the process adjusted
as described in more detail below. Data for the basal titration
process may be obtained from the health care provider (e.g., via a
health care provider portal of the glucose monitoring platform 112)
and/or via one or more user interfaces displayed via the computing
device 108, e.g., in connection with setting up the artificial
pancreas system 402 for use. In the latter scenario, the computing
device 108 may receive input from a user (e.g., the person 102) via
a series or sequence of these setup interfaces. The artificial
pancreas algorithm 416 may also be further trained using similar
data as is used from the user population 110, but that is obtained
about the person 102, such as the person 102's historical glucose
measurements 118, delivered insulin doses, insulin measurements,
target glucose ranges, insulin sensitivities, carb ratios, food
consumption data, activity data, and so on. Like the user
population 110 the glucose measurements 118 of the person 102 may
be correlated with the other data, such as based on timestamps of
the glucose measurements 118 and the other data. Once trained, the
artificial pancreas algorithm 416 is utilized to by the artificial
pancreas controller 404 to determine insulin doses for the user,
and deliver the insulin doses the user via the insulin delivery
system 106.
[0293] FIG. 18 depicts an example procedure 1800 in which an
insulin delivery request is encrypted and communicated for
decryption by an application.
[0294] An encrypted message is generated by encrypting an insulin
delivery request (block 1802). In accordance with the principles
described herein, the insulin delivery request requests delivery of
insulin by an insulin delivery system to a person wearing the
insulin delivery system. By way of example, the glucose monitoring
module 408 encrypts an insulin delivery request that requests
delivery of insulin by the insulin delivery system 106 to the
person 102. In this example, the glucose monitoring module 408 and
at least the artificial pancreas algorithm 416 may be included as
part of a first application. The glucose monitoring module 408
generates an encrypted message based on the encryption.
[0295] The encrypted message is communicated to an insulin
application for decryption and for further communication of
instructions, based on the insulin delivery request, to the insulin
delivery system (block 1804). By way of example, the glucose
monitoring module 408 communicates the encrypted message generated
at block 1802 to the insulin module 406. Here, at least a portion
of the insulin module 406--the pump control manager 418--may be
included as part of a second application, e.g., corresponding to
the insulin delivery system 106. The pump control manager 418
causes instructions to be communicated to the insulin delivery
system 106 to deliver insulin to the person 102 in accordance with
the instructions.
[0296] FIG. 19 depicts an example procedure 1900 in which an
encrypted insulin delivery request is received, decrypted, and
instructions for delivering insulin are communicated to an insulin
delivery system based on the request.
[0297] An encrypted message comprising an insulin delivery request
is received (block 1902). By way of example, the insulin module 406
receives an encrypted message comprising an insulin delivery
request. The encrypted message is decrypted to reveal the insulin
delivery request (block 1904). By way of example, the insulin
module 406 decrypts the encrypted message received at block 1902 to
reveal the insulin deliver request.
[0298] Instructions are communicated to an insulin delivery system
over a wireless connection (block 1906). In accordance with the
principles discussed herein, the instructions instruct the insulin
delivery system to deliver insulin to a person wearing the insulin
delivery system according to the insulin delivery request. By way
of example, the pump control manager 418 communicates instructions
to the insulin delivery system 106 over the wireless connection 414
to deliver insulin to the person 102 in accordance with the insulin
delivery request revealed at block 1904.
[0299] Having described example procedures in accordance with one
or more implementations, consider now an example system and device
that can be utilized to implement the various techniques described
herein.
[0300] Example System and Device
[0301] FIG. 20 illustrates an example system generally at 2000 that
includes an example computing device 2002 that is representative of
one or more computing systems and/or devices that may implement the
various techniques described herein. This is illustrated through
inclusion of the glucose monitoring platform 112. The computing
device 2002 may be, for example, a server of a service provider, a
device associated with a client (e.g., a client device), an on-chip
system, and/or any other suitable computing device or computing
system.
[0302] The example computing device 2002 as illustrated includes a
processing system 2004, one or more computer-readable media 2006,
and one or more I/O interfaces 2008 that are communicatively
coupled, one to another. Although not shown, the computing device
2002 may further include a system bus or other data and command
transfer system that couples the various components, one to
another. A system bus can include any one or combination of
different bus structures, such as a memory bus or memory
controller, a peripheral bus, a universal serial bus, and/or a
processor or local bus that utilizes any of a variety of bus
architectures. A variety of other examples are also contemplated,
such as control and data lines.
[0303] The processing system 2004 is representative of
functionality to perform one or more operations using hardware.
Accordingly, the processing system 2004 is illustrated as including
hardware elements 2010 that may be configured as processors,
functional blocks, and so forth. This may include implementation in
hardware as an application specific integrated circuit or other
logic device formed using one or more semiconductors. The hardware
elements 2010 are not limited by the materials from which they are
formed or the processing mechanisms employed therein. For example,
processors may be comprised of semiconductor(s) and/or transistors
(e.g., electronic integrated circuits (ICs)). In such a context,
processor-executable instructions may be electronically-executable
instructions.
[0304] The computer-readable media 2006 is illustrated as including
memory/storage 2012. The memory/storage 2012 represents
memory/storage capacity associated with one or more
computer-readable media. The memory/storage component 2012 may
include volatile media (such as random access memory (RAM)) and/or
nonvolatile media (such as read only memory (ROM), Flash memory,
optical disks, magnetic disks, and so forth). The memory/storage
component 2012 may include fixed media (e.g., RAM, ROM, a fixed
hard drive, and so on) as well as removable media (e.g., Flash
memory, a removable hard drive, an optical disc, and so forth). The
computer-readable media 2006 may be configured in a variety of
other ways as further described below.
[0305] Input/output interface(s) 2008 are representative of
functionality to allow a user to enter commands and information to
computing device 2002, and also allow information to be presented
to the user and/or other components or devices using various
input/output devices. Examples of input devices include a keyboard,
a cursor control device (e.g., a mouse), a microphone, a scanner,
touch functionality (e.g., capacitive or other sensors that are
configured to detect physical touch), a camera (e.g., which may
employ visible or non-visible wavelengths such as infrared
frequencies to recognize movement as gestures that do not involve
touch), and so forth. Examples of output devices include a display
device (e.g., a monitor or projector), speakers, a printer, a
network card, tactile-response device, and so forth. Thus, the
computing device 2002 may be configured in a variety of ways as
further described below to support user interaction.
[0306] Various techniques may be described herein in the general
context of software, hardware elements, or program modules.
Generally, such modules include routines, programs, objects,
elements, components, data structures, and so forth that perform
particular tasks or implement particular abstract data types. The
terms "module," "functionality," and "component" as used herein
generally represent software, firmware, hardware, or a combination
thereof. The features of the techniques described herein are
platform-independent, meaning that the techniques may be
implemented on a variety of commercial computing platforms having a
variety of processors.
[0307] An implementation of the described modules and techniques
may be stored on or transmitted across some form of
computer-readable media. The computer-readable media may include a
variety of media that may be accessed by the computing device 2002.
By way of example, and not limitation, computer-readable media may
include "computer-readable storage media" and "computer-readable
signal media."
[0308] "Computer-readable storage media" may refer to media and/or
devices that enable persistent and/or non-transitory storage of
information in contrast to mere signal transmission, carrier waves,
or signals per se. Thus, computer-readable storage media refers to
non-signal bearing media. The computer-readable storage media
includes hardware such as volatile and non-volatile, removable and
non-removable media and/or storage devices implemented in a method
or technology suitable for storage of information such as computer
readable instructions, data structures, program modules, logic
elements/circuits, or other data. Examples of computer-readable
storage media may include, but are not limited to, RAM, ROM,
EEPROM, flash memory or other memory technology, CD-ROM, digital
versatile disks (DVD) or other optical storage, hard disks,
magnetic cassettes, magnetic tape, magnetic disk storage or other
magnetic storage devices, or other storage device, tangible media,
or article of manufacture suitable to store the desired information
and which may be accessed by a computer.
[0309] "Computer-readable signal media" may refer to a
signal-bearing medium that is configured to transmit instructions
to the hardware of the computing device 2002, such as via a
network. Signal media typically may embody computer readable
instructions, data structures, program modules, or other data in a
modulated data signal, such as carrier waves, data signals, or
other transport mechanism. Signal media also include any
information delivery media. The term "modulated data signal" means
a signal that has one or more of its characteristics set or changed
in such a manner as to encode information in the signal. By way of
example, and not limitation, communication media include wired
media such as a wired network or direct-wired connection, and
wireless media such as acoustic, RF, infrared, and other wireless
media.
[0310] As previously described, hardware elements 2010 and
computer-readable media 2006 are representative of modules,
programmable device logic and/or fixed device logic implemented in
a hardware form that may be employed in some embodiments to
implement at least some aspects of the techniques described herein,
such as to perform one or more instructions. Hardware may include
components of an integrated circuit or on-chip system, an
application-specific integrated circuit (ASIC), a
field-programmable gate array (FPGA), a complex programmable logic
device (CPLD), and other implementations in silicon or other
hardware. In this context, hardware may operate as a processing
device that performs program tasks defined by instructions and/or
logic embodied by the hardware as well as a hardware utilized to
store instructions for execution, e.g., the computer-readable
storage media described previously.
[0311] Combinations of the foregoing may also be employed to
implement various techniques described herein. Accordingly,
software, hardware, or executable modules may be implemented as one
or more instructions and/or logic embodied on some form of
computer-readable storage media and/or by one or more hardware
elements 2010. The computing device 2002 may be configured to
implement particular instructions and/or functions corresponding to
the software and/or hardware modules. Accordingly, implementation
of a module that is executable by the computing device 2002 as
software may be achieved at least partially in hardware, e.g.,
through use of computer-readable storage media and/or hardware
elements 2010 of the processing system 2004. The instructions
and/or functions may be executable/operable by one or more articles
of manufacture (for example, one or more computing devices 2002
and/or processing systems 2004) to implement techniques, modules,
and examples described herein.
[0312] The techniques described herein may be supported by various
configurations of the computing device 2002 and are not limited to
the specific examples of the techniques described herein. This
functionality may also be implemented all or in part through use of
a distributed system, such as over a "cloud" 2014 via a platform
2016 as described below.
[0313] The cloud 2014 includes and/or is representative of a
platform 2016 for resources 2018. The platform 2016 abstracts
underlying functionality of hardware (e.g., servers) and software
resources of the cloud 2014. The resources 2018 may include
applications and/or data that can be utilized while computer
processing is executed on servers that are remote from the
computing device 2002. Resources 2018 can also include services
provided over the Internet and/or through a subscriber network,
such as a cellular or Wi-Fi network.
[0314] The platform 2016 may abstract resources and functions to
connect the computing device 2002 with other computing devices. The
platform 2016 may also serve to abstract scaling of resources to
provide a corresponding level of scale to encountered demand for
the resources 2018 that are implemented via the platform 2016.
Accordingly, in an interconnected device embodiment, implementation
of functionality described herein may be distributed throughout the
system 2000. For example, the functionality may be implemented in
part on the computing device 2002 as well as via the platform 2016
that abstracts the functionality of the cloud 2014.
CONCLUSION
[0315] Although the systems and techniques have been described in
language specific to structural features and/or methodological
acts, it is to be understood that the systems and techniques
defined in the appended claims are not necessarily limited to the
specific features or acts described. Rather, the specific features
and acts are disclosed as example forms of implementing the claimed
subject matter.
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