Those of us living with diabetes, especially type 1, feel like we're never-ending math story problems.
How many units do you take if you want to eat X amount of carbs, at a current blood sugar of Y, with a sensitivity factor of Z that varies due to time of day, amount of sleep, any stress you may be experiencing, or which way the wind is blowing?
We are walking D-Math calculators.
Technology makes it easier, without a doubt. Insulin pumps automatically calculate boluses for meals and corrections, and many keep track of how much active insulin we have working at any given time. Apps can do some D-Math too, but the need to pull out your phone for every bolus is not for everyone.
That's why it was exciting to hear about the new Diabetes Calculator for Kids, a new, online program that can do D-calculations for you.
It's developed by Nationwide Children's Hospital in Columbus, OH. But don't be deceived by the names: this free resource can actually help any PWD, of any age.
After my mom's recent ER and hospital experience that temporarily affected her D-Math ability in a big way, we turned to this online calculator tool to do the calculations for us. And it worked perfectly!
The Diabetes Calculator is apparently the first of its kind -- which is somewhat amazing, because it's really nothing fancy beyond a web-based version of a programmable spreadsheet.
The online tool can be personalized so that any PWD or caregiver can create an individualized, printable chart that displays the calculated bolus amounts for food or insulin corrections, in five easy steps. You just plug in your personal information including name and birth date, caregiver's name, and whether you want doses rounded to the nearest half or whole unit. Then you enter the carb-to-insulin ratio, sensitivity factor for corrections, and target blood sugar... And wallah!
You have a chart that can be referred to in any D-Math situation to assess needed insulin for what you're about to eat. The chart can be printed out or emailed to yourself, caregivers, grandparents, camp counselors, or anyone else you choose.
I talked recently with the calculator's creator, Dr. David Repaske who is chief of endocrinology, metabolism and diabetes at Nationwide Children's. He said this whole idea came from what he'd been doing for many years with his pediatric patients and families -- whipping up a personalized chart for dosing calculations that they can print out.
"I have been practicing for 21 years, and there's a pretty reasonable number of patients who are continually challenged by insulin bolus calculations," he said. "Some people just weren't getting it, as far as the diabetes math. So, I came up with the idea of just building a little Excel spreadsheet to give out to those people to help them better understand what was needed."
He's been using this approach with about 5 to 10% of his patients, he says. People he saw would tell him the chart was valuable and they liked it, and that apparently is what caught the attention of hospital management and marketing. Someone got the idea to broaden this tool and make it a web-based resource that anyone could use, beyond their hospital walls.
"We don't give it to everyone, but if someone's struggling, we suggest this as an option," he said. "We can build it in the office on the computer and print it, or they can do it from home and revise the parameters as they need to."
Repaske said the calculator doesn't retain any of the personal information once you leave the website, so there aren't any concerns about privacy or disclosing personal health information that other data-retaining programs or apps might have.
Something else Repaske is proud of: the D-Calculator can be embedded as a widget on any website, meaning other hospitals and doctor's offices can use it for free and tweak it as they wish.
The hospital put the calculator online in January, and just recently started promoting it nationally. As of June 13, the Calculator on the Nationwide Children's site had been viewed almost 1,300 times by more than 1,000 unique visitors. Hospital marketing specialist Gina Bericchia says that Nationwide has received feedback from physicians in other states, that they're using this tool in their clinics and recommending it to patient-families. Repaske said that he's heard positive feedback from many endo colleagues as well.
When I was up in Michigan recently visiting family, I saw a local news report that actually touched on this D-Calculator. Here's that broadcast from one of the Detroit news stations with news reporter Brandon Roux, who's living with type 1 himself, telling the story:
Repaske says his hospital submitted an abstract on the Calculator to the International Society of Pediatric and Adolescent Diabetes (ISPAD) and they'll be presenting at that group's upcoming October meeting.
I repeat: anyone can use this! I tested it myself, and found it very easy to plug in my personal information and spit out a chart, which now hangs on my refrigerator as a backup visual just in case -- for quick access to dosing calculations when I'm just about to hit the fridge.
As mentioned, my mom had a recent ER experience that left her blood sugars careening, as she was disconnected from her insulin pump for several days. We were doing everything by hand! I had written down a formula to figure out her correction boluses, based on her I:C ratio and insulin sensitivity, but I couldn't be sure that I was doing anything right to help my poor dad. Lying in a guest bed at my parents' house one night, I suddenly remembered this D-Calculator.
I lept out of bed, well after midnight, and proudly pulled up the D-Calculator on the laptop to show my parents. My dad was very impressed, and we quickly created a chart and emailed it to him so that he could print out a handful of copies to keep around.
My mom even snapped an image of her chart on her iPad for quick, easy reference.
So from a personal standpoint, the D-Calculator has been very helpful even for two PWDs who've been using insulin pumps for more than a decade.
We like what you've done here, Nationwide Children's, and hope that many more D-Math-Challenged peeps in the community can get some good use from this.
Or let me put that in math-speak: in this case, X+Y+Z = great idea!