Welcome To Choices & Patterns Inc

FAQs for My-Diabetes-Success™ Version 1.0 and Version 2.0

Our goal is to provide the best tools to children, teenagers and adults who are living with diabetes. We specialize in helping you spot problems early -- with independence and confidence! However, we will also provide guidance so you know when to reach out for assistance.

To help you more effectively utilize MyDiabetesSuccess™, we have provided these diabetes FAQs (frequently asked questions) to assist you in having more success in managing your diabetes … rather than having your diabetes manage you!

Patterns are the accumulation of your day-to-day management of your meals, snacks, exercise, medications and the effect these have on your blood glucose readings. They are all related and affect each other. Depending on how well the relationship among them is managed, either positive results produce health or negative results cause poor health and illness.

Food is fuel for cells to burn for energy to live and be active. The process of cells burning food as fuel is called metabolism. In diabetes, the usual pathways for metabolism are adversely affected by different causes. Blood glucose levels contribute to good, fair, poor or very poor Metabolic Control.

Patterns give a cumulative overview of daily health. Patterns are the basis for determining needed changes in diet, medications or activity/exercise as well as changes in lifestyle choices, habits and behavior. Your Healthcare Team may more efficiently use patterns to diagnose, treat and personalize your education and care.

The purpose of MyDiabetesSuccess™ is to easily gather and analyze your information, then turn the information into patterns. You have the choice of several ways to see your patterns over time. The goal is to help you more easily interpret your information to support quick response and prompt action if changes in daily management are needed to meet your blood glucose target range and health goals.

Before meals and 1 and/or 2 hours after meals to see the effect of food on your blood glucose level or reading. Also before, during and/or after exercise when participating in strenuous activity or sports.

MyDiabetesSuccess'™ professional clinical diabetes and technology team designed the management functions and features to assist you in planning a personal daily living schedule to remain or become healthy. The idea is to fit your diabetes management into your usual daily activities, not mold your life to a rigid diabetes regimen.

Yes, immediate reporting and analysis of your symptoms will guide you to respond with confidence and understanding in your decisions and actions to quickly as possible return to your prescribed blood glucose target range.

Most of the time an “Other” category is provided where you can enter through the on-screen keyboard or record your voice message.

No, your favorite glucose meter can be used. Just dial in your glucose reading and enter additional information if you have out of target range, for example, blood glucose levels below 70 and above 180. The pathways for entering additional information for low and high blood glucose information are color coded; violet for low, orange for high.

The MyDiabetesSuccess™ Diabetes App is designed to show you the ‘patterns of your life’ so you can gain the insights and knowledge to make the best choices on how to adjust your medication, the food you eat or your activity levels. We draw the LINES and CONNECT the dots … with My Diabetes Success™, but you make the choices on ‘what’ to do to stay on course with your prescribed blood glucose target range and health management plan.

The MyDiabetesSuccess™ information and communication System, made up of NutrientCalc and the Impact Chartwas designed by healthcare professionals with expertise in diabetes to help you track your personal information (food, activity, medication) so you can establish and maintain a daily schedule that will keep you healthy across time given that diabetes is a progressive condition with age. The important piece for people with diabetes is to understand how your blood glucose levels can change based on your meals, activity/exercise and medication. To stay healthy, the goal is to stay within the prescribed blood glucose target range personalized to you. The goal is to stay within this range -- most of the time.

Usually, after entering three baseline blood glucose readings in relation to the food, activity/exercise and medication associated with those readings, you will begin to see your personal patterns emerge as you continue to enter your personal information. Our goal is give you information so that you can confidently "decide" the best course of self-management in decisions and actions. Our goal is to allow you to spot problems early to be able to respond more quickly. However, it is also important for you to know when to contact your Healthcare Team.

No, absolutely not! We want to support you ‘in between’ your visits, and to allow you to provide your personal information in the MyDiabetesSuccess™ App to your Healthcare Team, so they can provide you with personalized education, advice or recommendations. Now, you won’t have to remember everything – it’s all in the System, NutrientCalc and the Impact Chart.

Your Healthcare Team will be pleased with your achievements in self-management and results from using MyDiabetesSuccess™ if used systematically and completely to reveal your health patterns. It will enrich your relationship with your care team. Instead of having to remember what led to good or bad results or outcomes, you have the facts on your smartphone. False memory that leads to errors in prescribing care are obviated. Their time, by receiving your accurate information between clinic visits, can be focused on your specific questions and needs, they will be prepared.

In the near future.MyDiabetesSuccess™ specializes in real-time, person-centered healthcare. It is the data and information gathering tool for a comprehensive educational diabetes management program under the medical direction of Stephen C. Duck, MD, former Head of Pediatric Endocrinology, Northshore University Health System, Skokie, Illinois and Clinical Associate Professor of Pediatrics at the University of Chicago Pritzker School of Medicine. MyDiabetesSuccess™ has adapted Dr. Duck’s American Diabetes Association recognized pediatric diabetes management program to also serve adults with diabetes.

This App can only be downloaded from the Apple Store® and is best used on the iPhone, iPad or iPod/Touch at this point in time. Other SmartPhones and tablets will be covered in the future. Additionally, it cannot be used with a 'land line' phone.

It is easy to use and engaging. It is interesting to figure out what patterns result in your personal best health. While not a video game, it can have similar appeal.

If you have other questions you would like us to answer in these Diabetes FAQs for MyDiabetesSuccess™, please send us an email to info@my-diabetes-success.com with ‘Diabetes FAQs’ in the subject line. We will then identify how best to incorporate your suggestions into this Diabetes FAQs page for MyDiabetesSuccess™.

If the title of the screen is underlined, tapping the title will display what we call “hints.”

As soon as you enter your first event, the example events will go away. Note that the description and time of events are such that you know the events are not yours. The purpose of the home screen is to list all your most recent events. This serves as a short term memory of events with the most current events listed first. This list of events shows you which events have been entered and can be used as the first step in analysis.

My-Diabetes-Success™ provides a feature that will enable you to safely transfer information from the iPhone to a central information repository where it is stored. This feature is only provided with your permission and you are able to turn if off at any time. The information associated with this feature enables Choices & Patterns to monitor usage and provide for additional analysis. Your information will not be disclosed or transferred to any other organization without your permission.

The 2.0 version enables you to record them independently as they occur. This avoids having to remember values that could lead to recording poorly remembered values; thus, avoiding false memory issues. You can choose to record, for example, only medications or exercise. These events are still shown on the Impact Chart.

Patterns are time based. Time is important in analyzing the relationship between events and your blood glucose levels. Over time, you will grow to better understand relationships (patterns) that influence your blood glucose levels. These patterns are displayed on the Impact Chart.

You can add them; thus, personalizing your App even more.

You can add them; thus, personalizing your App even more.

Yes. You can choose the category of information you wish to share. The email addresses must be in your contact list.

No. It is possible for intermediaries, for example, various routers containing malware, to capture your personal information. Your healthcare provider or others on your healthcare team my provide you with a secure email client or service. If this is the case, you can just cut and paste the report from MyDiabetesSuccess™ into the email client or service.

The Impact Chart shows graphically the relationship between your blood glucose level and food, exercise and medications. They are all shown on one daily chart. You can change days by tapping previous or next. In addition, food, exercise and medications show the duration of the effect. This helps you understand that consuming food, or doing exercise or consuming medications are not just instantaneous events but also have a lingering effect. For example taking Afrezza medication is usually effective for 6 hours with its effectiveness being time dependent. Each medication has its own time release and is reflected on the Chart. It is the shape or length of the duration graphs, not the height of the graphs that are important. This will help you avoid improper stacking of medications, hypoglycemia due to excessive exercise, hyperglycemia due to improper dosage, etc. Remember, this type of pattern analysis is not a substitute for communicating and visiting with your healthcare team.

FAQs for NutrientCalc v 1.0

Many persons with diabetes mellitus notice that their blood glucose levels rise after certain mixed meals of fat, protein and carbohydrates and stay elevated. This is even though the insulin treatment selected was “in line” with that recommended by their Healthcare Team. This App in the Choices & Patterns information and communication System provides insights to discuss with your Healthcare Team in order to arrive at a more appropriate insulin dose or insulin releasing medication.

Read the Welcome page.

In the Settings: NutrientCalc app: decide if you want the 3 application starting screens and questions to appear every time you open up the App.

Welcome! After reading this opening screen once or twice, no benefit is likely to be worth the time to reopen it. Turn off [showing White].

Show insulin pump question! If you are likely to stay with an insulin pump, then you probably do not want to be asked every time you open the app if you are giving your insulin exclusively by insulin pump. Turn off [showing White].

Using Insulin pump! This is the important to answer if you are using an insulin pump to administer your insulin or you take your insulin by injection or pre-filled pen. Leave Green if you are using an insulin pump. Turn off [showing White] if you are not using an insulin pump to administer insulin.

Read the Disclaimer. This App is not intended to give medical advice but to improve your knowledge and options to achieve the best blood glucose control!

Please fill out the Identification. This includes First and Last Name, birthday, and Nickname or ID

Answer the questions that will allow you to carry forward the common “ratios” used by persons with diabetes mellitus between sessions. This can eliminate the frustration of repeating entry of the same constants over and over again.”

You must select which of two Meal types you are about to eat. The choice can change as often as you want, but the choice is very important.

1. "Balanced meal" with usual carbohydrate, fat and protein content [ADA approved]:

Only the carbohydrate content and the current blood glucose values are needed.

The grams of protein and of fat are omitted so that you are not confused.

The insulin dosing suggestions are presented for your consideration and for discussion with your health care team.

2. "Meals with extra large amounts of protein and fat"

These are only the meals, like “pizza”, that drive up your blood glucose hours after you have eaten those foods!

These are the meals that your “usual” doses of insulin have already proven do not control your glucose at all!

You must calculate and enter the contents [in grams] of carbohydrate, and protein, and fat for that meal.

The “extra” insulin is suggested in several ways. The times to give that “extra” insulin are suggested in several ways. Please discuss each with your health care team before proceeding.

So now you must select one:

Meal type: this one is best described as…

o Balanced meal [ADA approved]

o Meal with extra amounts of protein and fat

If you do not want the App to remember any of these values, then do nothing.

If you want the App to remember the insulin to carbohydrate ratio [Insulin sensitivity ratio] then exit the App, open up the Settings menu, locate and open the NutrientCalc selection [towards the bottom of the Settings menu]; select the third choice among the “General Info” titled “remember data between settings.” You may have the App “remember” any or all of the following:

Insulin to Carbohydrate ratio! Many persons with diabetes use the same ratio and the last ratio will be remembered going forward. However if you use different “ratios” depending upon the time of day or activity to be done, simply overwrite the currently remembered value. This overwrite will be “remembered” going forward but can be changed [changed back] as easily as the first change was made.

In addition to the Insulin-to-glucose ratio, most persons with diabetes calculate the insulin needed to lower or to “correct an existing, elevated” glucose level. This latter ratio requires knowing two other unique values:

Mg/dl above! Persons with insulin requiring diabetes know how much one unit of rapid acting insulin is expected to lower the blood glucose that is already too elevated even before the meal or snack is eaten. For instance: one unit of fast acting insulin will lower my elevated blood glucose “so many” mg/dl “points”. If turned on, the App will remember that correction sensitivity for every ongoing calculation. If the sensitivity were to change, merely write the new value in over the current value remembered by the App and continue.

Threshold! This is “threshold” or the level above which I believe that my glucose is too high. Another way of saying this is the level of blood glucose to where I want to reduce my glucose by the time I am ready for my next meal or snack. For instance: I want my glucose to be below 130 mg/dl [7.2 mmol/dl] when I am done. Then the value of 130 mg/dl [7.2 mmol/dl] is my desired threshold. The App can be set-up to remember that threshold value for each calculation. As noted above, to change the threshold value merely requires overwriting the current, remembered number in the App.

Persons with diabetes understand that eating carbohydrates [complex sugars, refined sugars, starches, etc.] require the presence of adequate insulin levels in the blood. Were one to take too little [or no] insulin in relationship to eating these carbohydrates, the blood glucose level is expected to go up and remain elevated if adequate insulin were not provided.

Doctors understand that protein requires insulin to properly be processed and stored. They also know that insulin is not required to process fat since fat cannot be converted to glucose.

The amount of insulin needed for protein is less than the amount of insulin needed for the same number of grams of carbohydrate. The Insulin-to-Carbohydrate ratio [Insulin sensitivity ratio] often is able to “cover” the recommended amount of protein [as per the American Diabetes Association meal plan]. However, when a meal is enriched with added protein the standard Insulin sensitivity ratio is inadequate.

While fat in a meal does not increase the glucose level directly, it will increase that glucose level and for many hours due to indirect ways that fat interacts with the liver, muscle and fat cells of the body. These indirect ways prevent or slow the normal action of insulin to lower the blood glucose levels. If given sufficient, additional insulin for a longer period of time after the meal, the elevation in blood glucose values that are directly due to the presence of enhanced fat in the meal can be lowered or “dampened” to normal.

The short answer is that no one yet knows absolutely. Doctors are actively studying this and are slowly coming to a better understanding.

What is becoming obvious to all working in the field is that “more” and sometimes “a lot more” is required depending upon the “enhancement” of fat and protein in the meal or snack.

NurtientCalc App offers the current best suggestions to discuss with your Healthcare Team. The App offers suggestions based on the amount of added grams of protein and of fat that you are planning to eat for a meal or snack. NutrientCalc App is currently reflecting the more widely used research guidelines. Therefore the results are to be discussed with your Healthcare Team.

NutrientCalc allows the person with diabetes to enter the GRAMS of fat and of protein that are to be consumed for any meal or snack. This is chosen because persons with diabetes already are comfortable with entering GRAMS of carbohydrate.

The information for fat and protein can be found in the same manner as the grams of carbohydrate: package labels. The fat is recorded as Total Fat [grams]. The protein is recoded as Protein. Resources such as CalorieKing or Smart Diet Scale (smartdietscale.com) are just two of the widely available resources. Choices & Patterns continues to research additional methods of automating fat, protein and carbohydrates to make it easier to provide data to NutrientCalc.

You must answer all the requested data fields. If you are aware that there is no [zero] grams of carbohydrate, or of protein, or of fat in the food you are planning to eat, then enter the correct number: “0”.

Tapping the first data field will automatically bring up the Number pad.

To advance to the next data field, merely finger tap that field. Tapping “Done” on the number pad closes the Number pad but does not advance to the next data field.

Tap and enter the Insulin-to-Carbohydrate ratio value. At that point, when the information is keyed in, select DONE on the number pad. Only then will the App calculate the suggested insulin dose based on the information you provided on that page.

When the units of fast acting insulin are displayed at the bottom of the Nutrients page, press NEXT to advance to the next page.

At the top of the BG [blood glucose] page, touch and enter the values used when correcting elevated blood glucose prior to a meal or snack time.

Tap and use the Number pad to enter the real time blood glucose reading obtained at the time of the meal or snack.

Only AFTER the real time glucose is entered, press ENTER at the top right hand corner of the App. Doing so then displays the additional units of insulin [if any] that will be suggested to correct an already elevated glucose.

The final [orange] data on that page displays the suggested entire dose of insulin to consider taking for all three components of the food to be consumed plus the current glucose.

Tapping NEXT brings up the CHOICE page. The user can choose to display the suggested insulin dosing and administration in one of two ways:

1. My meal is balanced [according to the ADA dietary guidelines] so I only want to use Total Carbohydrate to direct the insulin dose. If so, select YES. If not interested, select NO.
2. My meal is enriched in extra amounts of protein and fat so I want to consider all 3-food components to calculate the insulin dose. If so, select YES. If not interested, select NO.

You can have both selected as YES; you can have one selected as YES and the other selected as NO. But you cannot have both selected as NO.

If the CHOICE page has ONLY carbohydrate [#1] as YES, the next page is SIMPLE PLAN.
If the CHOICE page has ONLY carbohydrate [#1] as NO, the next page is RESULTS.

The SIMPLE PLAN is the most common way to choose giving extra insulin. It requires consultation with your health care team. The first number to be entered is the percentage [%] of added insulin above and beyond that amount of insulin that you have determined when you took into consideration the 3 components of your meal and your current blood glucose. You may enter any whole number from 10% up to 200%. Your health care team will direct you as to choosing “how much” for which food situations.
When you press DONE, the amount of insulin to be given is presented as two pieces:

1. The bolus of fast acting insulin to be given now before eating the meal or snack.
2. The second or “follow up” bolus of fast acting insulin to be given after that first bolus. That second bolus may be administered by a single shot or by delayed infusion settings on the insulin pump. The time delay or method of giving the delayed insulin is to be confirmed with your health care team.

Now, when you press the NEXT in the upper right corner, the RESULT page is displayed.

The information displayed on the RESULTS page is a repeat of the information gathered earlier. First is the grand total of rapid acting insulin suggested by expected meal and current glucose value. This is then broken out into the subtotals defined by Carbohydrates only, Fat and Protein only, and Current elevated glucose levels. The total of these 3 numbers is the same as the Grand total. This display provides an excellent way to discuss your findings with your Health care team.
Tapping NEXT opens the INSULIN PLAN page. The information presented on the Insulin Page will depend on if you take your insulin by (a) an insulin pump device or (b) an insulin pen or syringe device. At this point, you are to discuss these suggestions with your Healthcare team.
If you take your insulin by an INSULIN PUMP, two suggestions are listed. Both are considered “reasonable” but neither is yet “proven.” Be sure to discuss these suggestions with your health care team. Also review carefully with your health care team the ratio of “insulin to carbohydrate” that you are currently using.
If you take your insulin by SIMPLE INJECTION, one suggestion is listed. This suggestion is “reasonable” but not yet “proven.” Be sure to discuss these suggestions with your health care team. Also review carefully with your health care team the ratio of “insulin to carbohydrate” that you are currently using.

Tapping DONE at this point returns the user to the NUTRIENTS page. All data fields that were not “saved” in the Settings are cleared. The data fields that were “saved” are automatically repopulated.

NutrientCalc is focused on offering information to the person with diabetes to discuss with his or her health care team.

The first issue will focus on what food groups will I consider. It is certain that more than the usual insulin is needed.

However, will I plan to “count” just the total carbohydrates in this meal? Or will I want to include all 3 (the “extra” amounts of protein and fat together with the total carbohydrate) in this meal?

NutrientCalc allows you to consider either alone or both choices!

You may choose just total carbohydrate or all 3-food groups.

The second issue must be made on choosing to consider ONLY the total carbohydrate content of the meal.

Experience of eating such a generous or super-sized meal but only giving the “usual insulin” confirmed that the “usual” was not good enough. More is needed! How much more? That can vary and for any person the “how much more” is unknown until proven to be “right.”

At this point you are allowed to select for yourself a percentage of the original insulin dose to give as the “extra dose” that will be given 2-3 hours after eating in order to control your blood glucose profile. The “extra dose” can reflect a percentage from 10% more up to 200% more. That extra dose is calculated for you once you decide what extra percentage you choose.

The third issue will be discuss the results with your health care team and decide on a plan to “find your answer.”

Any and all “solutions” are only suggestions. The research in the medical field currently remains divided on the “better” choice for calculating and dividing the insulin dose.

Those with current insulin pump devices can administer insulin not only as a BOLUS over a short period of time, but also as an EXTENDED WAVE over an even longer period of time. The extended wave function can be called “dual wave” or “square wave” depending on the manufacturer.

By using an insulin pump, the amount and the length of time for infusion of the Bolus can be adjusted. Furthermore, the Extended wave can be adjusted for the amount of insulin to be administered and also the length of time for that infusion to occur.

In NutrientCalc App, the two choices for those using an insulin pump grow up from the scientific research reported to date. As such, they are suggestions. As such, they are both observed to be more effective in controlling meals “enriched” in fat and or in protein than not. As such, they are to be discussed with your Healthcare Team.

The causes for elevated glucose levels following any meal or snack are many.The “usual suspects” include: faulty calculation of food intake, faulty coverage of insulin, failure to adequately assess blood glucose levels prior to eating, failure to “wait” the requisite time between injecting the bolus insulin and taking the first bites of food, failure to be active or exercise, and intercurrent illness.

Those notwithstanding, the suggested formulas are suggestions, works in progress. Success in persons with diabetes is always a process of trial and error. It is a process of reaction or learning from prior experience.

If one suggestion did not bring success, discuss with your Healthcare team the utility of trying the other. If neither “suggestion” brings the desired outcome, discuss how each of the standard ratios could be adjusted to allow for more insulin for carbohydrates or to lower ambient glucose levels.

The causes for low blood sugars (hypoglycemic glucose levels) following any meal or snack are many. The “usual suspects” include: faulty calculation of food intake, faulty coverage of insulin, failure to adequately assess blood glucose levels prior to eating and excessive activity or exercise.

An observation to consider is that among those who are well focused on tight control of glucose levels, the current Insulin-to-Carbohydrate (I to C ratio)level may be set too high! As observed by many, the Insulin-to-Carbohydrate ratios are calculated to cover a certain amount of excess carbohydrate and excess protein.

Once the precise intake of protein is identified and entered into formulas to enhance insulin coverage, the “standard I-to-C ratios” may be revealed as too generous. The correct I-to-C ratio should be reduced when calculating “enriched” meals. Such a reduction in that standard ratio will automatically reduce the added insulin anticipated for the “enriched” meals of added excess carbohydrate and protein.

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