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

Figure 2

(a) Data entry screen for AIDA software showing the information stored by the program and used to generate its simulations. It recounts for “Penelope Vincent”—Case Scenario number 0033 in the AIDA database—that “This young woman, who is very overweight, runs reasonably high blood sugars during the course of the day. At present she is only injecting herself twice daily with two “shots” of intermediate-acting insulin. How might you add in a short-acting insulin preparation to her regimen to tighten her glycaemic control? Alternatively, see if you can decrease her carbohydrate intake—thereby perhaps helping her to lose weight—and at the same time improving her blood glucose control….” (b) Baseline simulation for “Penelope Vincent” Case Scenario number 0033 in the AIDA database using the data shown in Figure 2(a). On the lower graph insulin intake (Insulatard) twice per day is shown as white bars with the simulated plasma insulin profile superimposed. Also shown as brown bars are the carbohydrate intake. On the upper graph the simulated blood glucose profile is shown, with an estimated glycosylated haemoglobin level (HbA_1c) of 9.2%. (c) shows the effect on Penelope Vincent’s blood glucose (BG) profile of adding 5 units of a short-acting (Actrapid) insulin injection at 6 : 45 am. The baseline simulation from Figure 2(b) is shown as the red curve (for comparison). As can be seen, the addition of 5 IU of short-acting insulin reduces the BG profile during the day—and leads to an improvement in the estimated medium-term index of the patient’s simulated glycaemic control with an HbA_1cof 8.6% (reduced from 9.2% for the simulation shown in Figure 2(b)). However, please note that, while this improves Penelope’s BG profile, this adjustment does not correct the high BG level in the evening.

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