Development of AIDA v4.3b Diabetes Simulator: Technical Upgrade to Support Incorporation of Lispro, Aspart, and Glargine Insulin Analogues

Figure 6

(a) shows the Nullsoft Scriptable Install System (NSIS) in operation—which is used to set up and install AIDA v4.3b on Windows XP, Windows Vista, and Windows 7 PCs, as well as on Apple Macs running PC emulation software. (b) shows AIDA v4.3b operating successfully within a window on a PC running the Windows XP operating system. The effect of increasing the 6 : 45 am Insulatard insulin injection dose from 10 IU to 15 IU is shown—with a concomitant reduction in the blood glucose (BG) profile. The resulting estimated HbA_1c is calculated by AIDA v4.3b to be improved at 8.0% (down from 8.6% for the previous simulation from Figure 2(c) which is shown as the red BG curve for comparison). (c) AIDA v4.3b operating successfully within a window on a PC running the Windows Vista operating system. The effect of increasing the 6 : 45 am Insulatard insulin injection dose by 5 more units of insulin to 20 IU is shown—with a concomitant further reduction in the blood glucose (BG) profile. The resulting estimated HbA_1cis calculated by AIDA to be further improved at 7.5%. The previous two simulations from Figures 2(c) and 6(b) are shown as the red BG curves for comparison. A user specifiable normoglycaemic range is also shown demonstrating the target range that the user might aim for. BG values are shown in units of mg/dL—much used in North America and other countries around the world. AIDA can present simulation results in both mmol/L and mg/dL. 1 mmol/L of glucose = 18 mg/dL. (d) AIDA v4.3b operating within a window on a PC running the Windows 7 operating system. The effect of a change in the carbohydrate intake has been simulated, with a reduction in the size of the 4pm snack from 20 grams of carbohydrate to 5 grams of carbohydrate being shown. This change results in a reduction in the estimated HbA_1cto 7.3% (from 7.5% for the simulation shown in Figure 6(c)—the simulation from which is shown as the red blood glucose curve for comparison on this graph). (e) shows a screenshot from the AIDADEMO application demonstrating for “Joy Wilson,” a 70 kg insulin-dependent diabetic patient, the effect of missing her usual morning insulin injection before breakfast with the profound hyperglycaemia (raised blood glucose) that is predicted to occur in the afternoon. (f) shows where the new DOSBox/NSIS packaged release of AIDADEMO is available for freeware download at the AIDA website from http://www.2aida.org/aidademo/. (g) AIDA v4.3b software operating within a window on an Apple Macintosh computer running the Parallels Windows emulation software. The original simulation from Figure 2(b) has been used as the baseline for this example and the effect of reducing each meal and snack by 10 grams of carbohydrate is simulated. As can be seen, this improves the estimated HbA_1c from 9.2% (Figure 2(b)) to 8.3% with a 50 gram per day reduction in carbohydrate intake. (h) A further example of AIDA v4.3b operating within a window on an Apple Macintosh computer running the Parallels Windows emulation software. The simulation from Figure 6(g) is shown as a baseline (in red), and the concomitant effect of increasing the 6 : 45 am Insulatard insulin injection by 5 IU from 10 IU to 15 IU is shown with an improvement in the overall blood glucose profile, with a reduction in estimated HbA_1c from 8.3% (Figure 6(g)) to 7.7%.