Classifications

• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
  • G16H50/20—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for computer-aided diagnosis, e.g. based on medical expert systems
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61J—CONTAINERS SPECIALLY ADAPTED FOR MEDICAL OR PHARMACEUTICAL PURPOSES; DEVICES OR METHODS SPECIALLY ADAPTED FOR BRINGING PHARMACEUTICAL PRODUCTS INTO PARTICULAR PHYSICAL OR ADMINISTERING FORMS; DEVICES FOR ADMINISTERING FOOD OR MEDICINES ORALLY; BABY COMFORTERS; DEVICES FOR RECEIVING SPITTLE
  • A61J7/00—Devices for administering medicines orally, e.g. spoons; Pill counting devices; Arrangements for time indication or reminder for taking medicine
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
  • G16H20/10—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
  • G16H20/10—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients
  • G16H20/17—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients delivered via infusion or injection
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
  • G16H20/60—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to nutrition control, e.g. diets
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
  • G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
  • G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
  • G16H40/63—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for local operation

Definitions

• systems, devices, and methods provided herein can recommend insulin doses (e.g, dosages of long-acting and/or rapid-acting insulin) using any suitable technique.
• recommended insulin dosages may be based upon blood glucose data (e.g.
• methods, systems, and devices provided herein can detect patterns in therapy relevant data and use that data to provide a user with tips, suggestions, alerts, and/or alarms based on the patterns, which may be displayed on a mobile device.
• a mobile device may provide a user with graphical displays regarding the user’s therapy relevant data and/or therapy decisions (e.g., blood glucose data and/or insulin injection times).
• the accessory may be a pen cap accessory adapted to detect pen capping information.
• Pen capping information e.g. , information about when the pen cap is secured to and/or released from the injection pen
• pen capping information may be displayed on the pen cap accessory to a user.
• pen capping information may be announced by a speaker in the pen cap.
• Pen capping information may be used to modify the user experience (e.g., the display or information presented to the user).
• the pen cap adjusts the presentation of the therapy relevant information and/or recommendations provided to the user based on the pen capping information.
• a pen cap may provide bolus recommendations to correct for elevated blood glucose levels based on data from a glucose sensor, but may limit the presentation of such correction bolus recommendations to time periods when the current pen capping duration is greater than a threshold period of time (e.g. , at least 2 hours, at least 3 hours, at least 4 hours, or at least 5 hours).
• the pen cap may provide notifications, alerts, or alarms to the user based on the pen capping information.
• Pen capping information may be stored, displayed, and/or analyzed in combination with glucose data to determine user behaviors, such as, for example, whether the person is appropriately dosing insulin for meals and/or to correct elevated blood glucose levels.
• pen capping information may be presented on a graphical representation of blood glucose data for the user and presented to a user and/or to a healthcare professional.
• blood glucose data from a period of time after each capping event may be evaluated to determine whether the user appropriately dosed insulin for that capping event, e.g., appropriate dose, under dose, or over dose.
• the total decapping time (the time between an uncapping event and the subsequent recapping) for a decapping event may be analyzed in combination with blood glucose data to determine if there was an injection during that decapping event. In some cases, if the total decapping time exceeds a second threshold period of time (e.g., at least 15 minutes, at least 30 minutes, etc.), blood glucose data may be used to determine an approximate time of an injection.
• a second threshold period of time e.g., at least 15 minutes, at least 30 minutes, etc.
• Accessories provided herein may be adapted to obtain blood glucose data for use in providing therapy relevant information and/or therapy recommendations via the accessory (e.g., via a pen cap).
• the therapy relevant information displayed on a pen cap accessory can include a current estimated glucose value (EGV) for the user.
• the therapy relevant information displayed on the pen cap can include a current blood glucose trend or rate of change indicator (e.g, a trend arrow).
• the pen cap can include a recommended dose, which may be based on glucose data or may be based on stored parameters without consideration of the current EGV.
• Accessories provided herein may be configured to that they only retrieve glucose data upon a user interacting with the pen cap.
• a pen cap may be designed so that it needs to be swiped near the CGM or flash glucose monitor or may be designed so that it can only retrieve glucose data when a demand is made by the user (e.g, when a button is pressed).
• a CGM may be in wireless communication with a mobile computing device (e.g, a smartphone, tablet) and data from the CGM only transferred to the pen cap when a button is pressed on the pen cap.
• Accessories e.g., pen caps
• mobile applications can, in some embodiments, provide reminders to a user to obtain glucose data.
• a reminder may be sent to the user to obtain glucose data by swiping the pen cap near the flash glucose monitor.
• reminders to obtain glucose data may be timed based on pen capping information.
• a reminder to obtain blood glucose data may be determined based on a time since the most recent capping (e.g., the current capping duration exceeding a threshold).
• the threshold may be set to reduce the likelihood that a dosage of insulin may cause a hypoglycemic event.
• a pen cap can wirelessly receive blood glucose data and analyze patterns of the blood glucose data in comparison to pen capping information to determine a likelihood of a fiiture hypoglycemic event or a predicted fiiture blood glucose value.
• blood glucose data and pen capping information may be wirelessly transmitted to a remote computing device (e.g, smartphone, tablet, etc.) and analyzed in that remote computing device or in the cloud or other network or device to determine a likelihood of a fiiture hypoglycemic event or a predicted fiiture blood glucose value, which may be used to issue a notification, alert, or alarm and/or to set a reminder to obtain blood glucose data.
• a remote computing device e.g, smartphone, tablet, etc.
• a user or healthcare professional may set typical meal sizes in carbohydrates for breakfast, lunch, and/or dinner. In some embodiments, a user or healthcare professional may set typical meal-based rapid-acting insulin doses for the user for breakfast, lunch, and dinner. In some embodiments, a user or healthcare professional may set characterizations of differently sized meals (small (S), medium (M), large (L)) for different times of day (e.g, 10 g of carbohydrates for S, 25 g for M, and 50 g for L).
• blood glucose data and/or pen capping information may be analyzed to make adjustments to a user’s dosage parameters and/or the meal-based dosage recommendations. In some embodiments, blood glucose data and/or pen capping information may be analyzed to make suggested changes to a user’s dosage parameters and/or the meal-based dosage recommendations to a healthcare professional or to a user.
• accessories provided herein may provide meal-based bolus recommendations based on a time of day and/or meal categories.
• the pen cap may provide different meal-based bolus recommendations based on it being breakfast time (e.g, about 8 am), lunch time (e.g, about noon), or dinner time (e.g, about 6 pm).
• the pen cap may provide different meal-based bolus recommendations for different meal categories, meal preferences, or historical meal statistics, such as, for example, small (S), medium (M), and large (L), which may be based on the number of carbohydrates or the glycemic impact of a meal as estimated or determined by a user. For example, for each therapy
• a user may see a recommended meal-based bolus for a S meal, for a M meal, and for a L meal.
• a user may press a button or user- selectable icon to request a recommendation for a S meal, for a M meal, or for a L meal.
• the meal-based bolus recommendations for each meal category (S, M, and L) can change based on the time of day.
• the systems or methods may include a glucose monitor that may provide blood glucose data via one or more communication (e.g., wireless communication) techniques.
• a glucose monitor of systems or methods provided herein can use multiple wireless communication techniques to transmit blood glucose data.
• a glucose monitor can include a flash near field communication circuit and a wireless radio.
• systems and methods provided herein can have one or more insulin pens or pen accessories receive blood glucose data from a glucose monitor via a first communication technique (e.g, NFC) and have another device (e.g., a mobile device) receive data from the glucose monitor and/or the insulin pens via a second communication technique (e.g, BLE or IMF).
• a first communication technique e.g, NFC
• another device e.g., a mobile device
• smart pen or pen accessories in methods and systems provided herein may communicate with a continuous and/or glucose monitor of methods and systems provided herein only within a first range and the mobile device may be adapted to passively receive data whenever within a second range that is larger than the first range.
• smart pens or pen accessories may be configured so that the smart pen or pen accessories only receive data when the user elects to take action to receive data (e.g. , push a“wake up” button and/or bring the pen or pen accessory within a close proximity to the glucose monitor), but another device (e.g., an associated mobile device) may be adapted to passively receive data regardless of user action if within a range determined by the communication method or link.
• another device e.g., an associated mobile device
• a user interface on the smart insulin delivery device or accessory therefore can include one or more user- selectable buttons or icons.
• a user- selectable button or icon may be used to wake up the smart pen or pen accessory to receive blood glucose data from a blood glucose monitoring/sensor system (e.g., that includes a CGM, BGM, flash glucose monitor, etc.).
• a user- selectable button or icon may be used to wake up a display on the smart pen or pen accessory to display a recommended insulin dosage amount for the insulin in the smart pen or in an insulin pen secured to the pen accessory.
• a user- selectable button or icon may be used to toggle the display between different displays.
• the mobile application 104 may execute on any suitable mobile computing device that can store and execute a mobile application that is adapted to display and input therapy relevant information wirelessly received from the other components of the system as well as from a graphical user interface that enables user to interact with the application.
• the mobile device can also store and execute a trusted mobile application within a trusted execution environment (hardware and/or software) that is not, generally speaking, accessible to users or devices communicating with the mobile device 140 but that is accessible to other applications executing on the mobile device 140.
• Various functions and calculations that relate to the therapy management system, including the alerts and recommendations that are presented to users may be, in part or in whole, performed by the trusted mobile application.
• some or all communication with insulin pens, pen caps, glucose sensors, and other accessories may be restricted to the trusted mobile application.
• the embodiments of the disclosure may use any suitable wireless communication protocol for communication among accessories, manual delivery devices, glucose sensors, and mobile devices.
• suitable wireless communication protocol for communication among accessories, manual delivery devices, glucose sensors, and mobile devices.
• blood glucose data received on the mobile application 104 received directly from the glucose sensor system 101 may include only the most current readings (e.g., from the last 10 minutes), which may be used by the mobile application 104 to issue alarms or alerts based on the most current blood glucose data.
• Accessories 102, 103 can include one or more processors and memory for controlling wireless communications, controlling interfaces for wireless communication, controlling a user interface, and/or determining therapy recommendations.
• an application running at the accessories 102, 103 may execute one or more algorithms to determine estimated glucose values (EGVs) from raw glucose sensor data.
• a glucose sensor system 101 can transmit EGVs to an accessory.
• accessories and/or smart electronics provided herein can include memory that stores user-specific dosage parameters (e.g, a recommended daily dose of long- acting insulin or total daily basal dose (TDBD), insulin sensitivity factor (ISF), carbohydrate-to-insulin ratio (CR), correction amounts based on blood glucose level ranges, total daily insulin dose (TDD), target glucose value, recommended rapid-acting doses for different meal sizes or categories, etc.).
• user-specific dosage parameters e.g, a recommended daily dose of long- acting insulin or total daily basal dose (TDBD), insulin sensitivity factor (ISF), carbohydrate-to-insulin ratio (CR), correction amounts based on blood glucose level ranges, total daily insulin dose (TDD), target glucose value, recommended rapid-acting doses for different meal sizes or categories, etc.
• the mobile application 104 may save insulin therapy related settings with the profile.
• the insulin therapy related settings may include user- specific dosage parameters for a user, delivery characteristics of the device, specific techniques that may be used to determine recommendations.
• each manual delivery device profile may include, or be part of a user profile that includes, pre- configured correction doses for particular blood glucose ranges.
• the pre- configured doses may be entered at the mobile application 104.
• the pre-configured doses may be entered at one of the web services 105 (e.g., by a healthcare provider or parent), and downloaded to the mobile application 104.
• methods, systems, and devices provided herein may be able to detect a dose or possible dose, but not be able to determine a dose amount, thus such systems, methods, and devices may not be able to determine an amount of active insulin (e.g., IOB) remaining in the user, thus such systems may prevent the calculation or suggestion of a correction does for a certain period of time (e.g., at least 2 hours, at least 3 hours, at least 4 hours, or at least 5 hours) after a prior detected dose or detected possible dose of rapid- acting insulin.
• a certain period of time e.g., at least 2 hours, at least 3 hours, at least 4 hours, or at least 5 hours
• a profile may also include or refer to algorithms for calculating meal doses for offsetting the effects on blood glucose levels of small, medium, or large meals.
• the algorithms may be personalized to a user, initially, with physiological information about the user, and over time, personalized using actual glucose sensor data and dosing event information.
• the mobile application 104 is configured to record historical therapy related information, for example, a history of blood glucose levels, dosing amounts, dosed medication, and dosing timing information.
• the following activities may be carried out in the background when the necessary devices are available and online. These activities are described in the following workflow and may vary based on system status.
• the first accessory 102 is associated with long acting insulin delivery and the second accessory 103 is associated with rapid-acting insulin delivery.
• the first accessory 102 may execute software to calculate a user’s required long- acting insulin dose.
• glucose measurement values are sent to a long acting insulin dose recommendation service hosted in the cloud.
• the glucose values may be sent to the cloud services (e.g, via a wireless or cellular connection) at regular intervals such that updates to the therapy parameters may be made, as described in the workflow above.
• the pen cap 1 12 may include wireless or cellular equipment and may send the glucose values to the cloud service via wireless or cellular connection.
• the first accessory 102 may piggyback on the wireless or cellular connection of a mobile device at which the mobile application 104 executes. The first accessory 102 periodically backs up data to the cloud via the mobile application 104 (e.g., via a local connection, such as a BLUETOOTH® or BLE connection).
• the second accessory 103 associated with rapid acting insulin delivery executes the software containing the algorithm to calculate the user’s required rapid-acting insulin dose.
• Glucose values and meal choices may also be sent to a rapid-acting insulin dose recommendation service as well as (e.g. , via a wireless or cellular connection) at regular intervals such that calculations may be made as described in the workflow above.
• the second accessory 103 may include wireless or cellular equipment and may send the glucose values to the cloud service via wireless or cellular connection.
• second accessory 103 may piggyback on the wireless or cellular connection of a mobile device having the mobile application 104 installed and executing thereon. The second accessory 103 periodically backs up data to the cloud via the mobile
• a portal may alert an HCP that a new set of parameters is ready for review. The clinician may then review the values and either approve or reject them. If rejected, the cloud service is notified and no other action occurs.
• therapy management system 10 may assist a PWD (or their caregiver) responsible for determining when to inject insulin and how much insulin to inject.
• System 10 may be configured to provide recommendations to assist the PWD (or caregiver) in determining an appropriate insulin dose based on current data from the glucose sensor, based on stored therapy parameters, and/or based on data about insulin injections.
• the accessories 102, 103 are configured to collect and provide data about insulin injection events.
• manual delivery device 107 may be a long-acting insulin injection pen 110
• manual delivery device 106 may be a rapid-acting insulin injection pen 120 as shown in FIGS. 1B and 1C.
• FIG. 1B shown is an insulin therapy management system 11, insulin pen 110, insulin pen 120, GCM 130, and mobile device 140 which has a therapy management mobile application executing thereon.
• the first accessory 102 may be a pen cap 112 and the second accessory 103 may be a pen cap 122.
• FIG. 1C shown is an insulin therapy management system 12, insulin pen 110 having pen cap 112, insulin pen 120 having pen cap 122, GCM 130, BGM 150, and mobile device 140 which has a therapy management mobile application executing thereon.
• system 12 has the components of system 11 but also has a BGM 150 and a different mobile application display of blood glucose values.
• Pen capping information (z.e., information about when the pen cap is secured to and/or released from an insulin pen - also referred to herein as“capping” and “uncapping” respectively) can include information about a current capping period (e.g., the time since the last capping), information about a duration of one or more uncapping, and the timing (e.g, time-of-day or time elapsed since) of each uncapping and each capping.
• pen capping information may be displayed at an interface of a pen cap to a user.
• pen capping information may be announced by a speaker in the pen cap.
• a pen cap may provide a timer clock that counts up (or a timer that counts down) from the last time the pen cap was secured to an injection pen.
• a pen cap can wirelessly communicate pen capping information to mobile device 140 (e.g. , a smartphone, tablet, etc. running a mobile application).
• a pen cap may provide bolus recommendations to correct for elevated glucose levels based on data from a CGM 130, but may limit the presentation of such correction bolus recommendations to time periods when the current pen capping duration is greater than a threshold period of time (e.g. , at least 3 hours, at least 4 hours, or at least 5 hours).
• the pen caps 112 and 122 may provide notifications, alerts, and/or alarms to the user based on the pen capping information (e.g, based on the amount of time that a pen has been capped and/or uncapped).
• the pen caps 112 and 122 may provide a visual, audible, and/or tactile notification to indicate that the user may have recently used the pen to administer insulin.
• the pen caps 112 and 122 may be in wireless communication with a mobile computing device 140 and one or more notifications, alerts, and/or alarms based on pen capping information may be announced or displayed on the mobile computing device.
• Pen capping information may be stored, displayed, and analyzed in combination with glucose data to determine user behaviors, such as whether the person is appropriately dosing insulin for meals and/or to correct elevated blood glucose levels.
• pen capping information may be presented on a graphical user interface
• a pen uncapping event, pen capping event, or pen recapping event may be disregarded where other information indicates that a dose was not provided. For example, where no change in the dosage selection of the insulin pen (e.g, a dial) was detected, the event may be disregarded.
• the pen caps 112, 122 may track the amount of insulin that remains in an insulin cartridge and determine an amount of insulin associated with a dosing action based on a change of the amount of insulin in an insulin cartridge.
• smart pens or pen accessories can detect the dosages set or administered using other suitable techniques.
• such a temperature sensor may be used in unison with the blood glucose sensor to indicate, where the insulin has been exposed to a select temperature level, that the insulin is not having an expected effect on the subject’s blood glucose level.
• an alarm and/or alert may be provided where the insulin has been exposed to an out of range temperature and where data from the blood glucose monitor data is indicating that the insulin is not having an expected effect on the subject’s blood glucose levels (e.g., less than or more than an expected change).
• methods, systems, and devices provided herein can condition notifications regarding temperature exposure based on additional data that indicates that the effectiveness of the insulin has been compromised or may have been compromised in order to mitigate against the user experiencing notification fatigue.
• the mobile application or the pen caps 112, 122 may trigger a reminder for the user to make a post-injection reading to determine the effectiveness of the insulin that was recently provided to the subject.
• FIG. 3 illustrates a display on a pen cap.
• a display 124 on pen cap 122 can depict a time 125 of the most recent dose (e.g, the time and/or date of the last dose), or“last dose,” which can assist a user in remembering if they bolus for a recent meal and help a user avoid the unintentional stacking of boluses.
• the display can additionally display the number of units of the last dose.
• the timing of the last dose could be a clock that ticks up to indicate how long ago the last dose was administered.
• further input may be entered by or required from the user, such as, for example, an indication of a meal (e.g, where the pen cap 112 may then display a number of meal options, as discussed below) for the user to select.
• button 123 may be progressively pushed to increase the size of the meal, to progressively display larger meal sizes, and/or to highlight different meal sizes.
• the dosage relating to the meal and any correction dose, if necessary, may be provided to the user along with an indication of the size of the meal.
• the indication of the size of the meal may be based on a size of an icon, a displayed number of carbohydrates, and/or a label (e.g., Small or S, Medium or M, Large or L).
• a recommended correction dose may only be valid for a set period of time, for example, because blood glucose levels change due to factors such as basal metabolism, meals, and exercise.
• the pen cap 122 may be configured to display a recommended correction dose for a set period of time (e.g., a period of time from the last scanning event as shown in FIG. 2).
• the set period of time may be user defined or it may be determined based on a confidence level that corresponds to the age of the recommendation and physiological factors of the user.
• a recommended correction dose may have an associated confidence level and“rate of decay” for that confidence level.
• the pen cap 122 may stop displaying a recommended correction dose.
• glucose data transmitted from a glucose sensor system 101 to a pen cap 122 in a single transmission can include data that may be used by the pen cap to determine at least two estimated glucose values (EGVs) for a time period extending for at least 30 minutes.
• a single transmission can include at least 1 hour of glucose data, at least 2 hours of glucose data, at least 4 hours of glucose data, at least 6 hours of glucose data, or at least 8 hours of glucose data.
• a CGM and/or flash glucose monitor such as glucose monitor 130, can transmit multiple hours of glucose data in a single transmission event.
• the display 124 on the pen cap 122 may instruct the user that a new blood glucose reading is needed before an updated recommendation may be made based on the blood glucose data.
• a pen cap that does not have current blood glucose data may provide recommendations based on the meal sizes alone, but may optionally additionally include an indication that the recommendation does not include a correction component.
• FIG. 5 depicts pen cap 122 with meal- related dosing recommendations (referred to herein as“meal recommendations”) l27a-l27c, which may be displayed for differently sized meals that are identified by meal icons 126a- 126c.
• meal recommendations may be based on meal doses that are set by a healthcare professional, the PWD, and/or a caregiver using the mobile application during set up or as updated by the health care professional, the PWD, and/or caregiver.
• the meal recommendations may be based on user- specific dosage parameters that are automatically updated by the system, using any suitable algorithm to update dosage parameters.
• pen caps 112 may refiise to provide a correction dose for a predetermined period of time after a prior dose and/or for a period of time after a prior dose based on a determination of an amount of active insulin (e.g., IOB) in the PWD.
• correction doses may be adjusted based on an estimation of active insulin (e.g., an IOB estimate).
• an IOB may not be known, but an estimated percentage of the prior dose remaining active maybe be determined and displayed to a user.
• a correction dose calculation may be reduced based on an estimated percentage of active insulin remaining being within a predetermined range (e.g., active insulin remaining being determined to be between 5% and 25% results in a 25-75% reduction in correction doses recommended).
• the pen caps 112 may continue to increase a recommended correction dose over time between hours 2 and 4 after a prior dose based on estimated active insulin percentage in the subject.
• the pen cap 122 if pen cap 122 has identified other recent doses (e.g, by detecting a capping action of the pen cap within the last 3 hours, the last 4 hours, or last 5 hours) without knowing the amount of the dose, the pen cap might refuse (e.g, initially refuse, with an optional override) to add a correction component in order to prevent the unintentional stacking of correction boluses.
• meal icons 126a- 126c can indicate whether the recommendation includes a correction component or not.
• additional icons or displays can indicate if there is a recommended correction dose included and/or the size of the recommended correction dose.
• the user can obtain a screen that displays the current blood glucose value, trend information (e.g, a trend arrow), and a recommended correction dose.
• trend information e.g, a trend arrow
• a warning screen might appear next to or over the recommendation to indicate that there has been a recent dose in order to prevent unintentional stacking of insulin.
• a notice icon 128 can appear on pen cap 122 in order to indicate to the user that a more detailed suggestion, tip, alert, or alarm is available for the user in the mobile application on the mobile device 140.
• the display 114 can remind the user about the amount of long- acting insulin 117 (with an appropriate icon 116) that the PWD should inject based on stored therapy parameters (e.g, even without having received a blood glucose reading from an associate blood glucose sensor).
• stored therapy parameters e.g, even without having received a blood glucose reading from an associate blood glucose sensor.
• the display can depict information about when the pen cap 112 was uncapped or other warnings to prevent the unintentional double delivery of long-acting insulin.
• pen cap 112 may provide a notice sound to indicate to a user that it is time to deliver the long-acting insulin based on stored therapy parameters.
• methods, devices, and systems may provide an alarm, alert, or notification to a user (e.g., via a pen cap or via a mobile app) if the user has not taken a dose within a certain threshold period of time of a schedule dose time (i.e., a“missed dose”).
• a suitable therapy titration algorithm may suggest that a user change the stored therapy parameters and/or automatically update the stored therapy parameters relevant to the dosing of long-acting insulin.
• a time threshold parameter may be provided that defines a period of time since a last inferred dosing action.
• the time threshold parameter may be configurable, so a user may set different time periods (e.g., values may be entered by a user or selected from among a list of recommended time periods in a setup screen). If a time since a last inferred dosing action exceeds a time threshold parameter then a missed dose may be inferred and a missed dose alarm, alert, and/or notification may be generated and provided to a user.
• pen cap 112 can interrogate glucose monitor 130 to receive glucose data and/or receive blood glucose data via the mobile device 140 and/or pen cap 122.
• display 114 can depict recent blood glucose data, the time of that data, and/or glucose trend data (e.g, a trend arrow).
• pen cap 122 may be adapted so that it does not display a current blood glucose level in order to avoid a user confusing pen cap 122 with rapid-acting pen cap 112.
• display 114 may include a recommended dose of long- acting insulin 117.
• pen cap 112 may indicate that the user should also deliver a correction dose of rapid- acting insulin using pen 120.
• one or more of the pen caps 112, 122 may track and display the estimated percentage of an administered dose over time.
• the pen caps 112, 122 may track an estimated percentage of active insulin (e.g., IOB) remaining in a subject over time after each dose has been administered.
• IOB active insulin
• an IOB percentage left indicator may be displayed based on the time of the most recent capping (e.g., immediately after capping an IOB percentage left indicator may indicate that the IOB remaining is 100%, but then be reduced over time after the last capping until it hits zero).
• cap 112 can include a rapid- acting insulin active percentage calculation, which may decay over a 3-6 hour period.
• cap 122 can include a long-acting insulin active percentage calculation, which may decay over a 12-36 hour period.
• a pen cap adapted for an intermediate- acting insulin may determine a percentage of active intermediate insulin, which may decay over a 6- 12 hour period.
• pen caps 112 and/or 122 may be adapted to determine an amount of insulin remaining in an insulin injection pen and thus determine dosage amounts and display a real-time estimation of active insulin as a number of units of insulin for each type of insulin.
• FIG. 7 depicts example communications architecture for a system (e.g. , the system 11 depicted in FIG. 1B) showing possible communication links between components of the system.
• the various components can interface with each other via controlled wireless, NFC, or BLE protocols.
• Each of these components display, transmit, and receive information based on the system workflow in-progress at the specified point in time.
• glucose monitor 130 can communicate via NFC with rapid-acting pen cap 122, communication link 231, and/or with mobile device 140, communication link 232.
• a second BLE communication link 232 may be between mobile device 140 and glucose monitor 130, which can permit real-time alarms or alerts based on current blood glucose being received by the mobile device 140 via BLE communications without the need for user action.
• each pen cap 112, 122 can include a processor and memory configured to run algorithms to determine recommended dosages.
• the mobile device 140 can execute therapy recommendation or therapy parameter update algorithms to recommend changes to programmed therapy parameters and/or to automatically update programmed therapy parameters.
• web services 250 can execute algorithms to recommend changes to programmed therapy parameters and/or to
• the timing data from the capping and/or uncapping events may, individually, be referred to herein as“capping events.”
• Another event that generates capping information is an uncapping event followed by a recapping event) of the pen caps 112 and 122 may be included in the algorithms for providing therapy
• initial therapy parameters may be programmed into the mobile application on mobile device 140 and transmitted to the pen caps 112 and 122 via BLE communication links 211 and 221.
• pen cap 122 can use therapy parameters received from the mobile app to recommend correction doses and meal doses.
• the therapy parameters can include meal doses for differently sized meals (e.g, small meal, medium meal, and large meal).
• the therapy parameters can include a therapy parameter for correcting glucose values, such as an insulin sensitivity factor.
• the correction may be based on a linear sliding scale correction, such as discussed below.
• pen cap 112 can receive a therapy parameter indicating a daily amount of long-acting insulin.
• pen cap 112 can receive recommended times for dosing long-acting insulin from the mobile device mobile application 140 (e.g. , every day at 9 p.m, every day at 8 a.m, twice a day at 8 a.m. and 8 p.m, etc.).
• the system can initiate the following workflow. Some of the acts are optional and may not be invoked if particular devices are unavailable or if the user chooses not to use them.
• the user may initiate an NFC transfer from the sensor to the rapid- acting insulin smart cap (RCap) by waking up the pen cap and waving it over the sensor, as shown in FIGS. 2 and 3.
• RCap rapid- acting insulin smart cap
• FIG. 8 shows a correction dose recommendation process, according to an embodiment of the disclosure.
• detected removal of a rapid acting pen cap 122 enables a recommendation mode.
• the pen cap 122 may change from a low power mode to an active mode when then pen cap 122 is removed from an insulin pen.
• a pen cap may display information about the last dosing action, for example, the amount of insulin and/or time of the last dose, such as shown at FIG. 3.
• the glucose measurements may be encrypted or encoded using a proprietary format.
• the user pushes button 123 and the pen cap 122 enables a correction dose recommendation mode responsive to the user asserting the button.
• the pen cap 122 recommends a correction dose at a display on the pen cap 122.
• the correction dose is determined at the pen cap 122.
• the correction dose is determined at another device, such as the mobile device 130 and communicated to the pen cap 122.
• the pen cap 122 may be configured to toggle back and forth between a glucose read mode and recommendation mode, and a user may be able to receive current measurements and current recommendations.
• the pen cap 122 may be configured to change back to a low power mode responsive to a time-out.
• a portion of the system may monitor use of the pens (e.g, based on data inputted by the user regarding usual use of the devices) to detect priming actions (e.g, clicks, such as two sets of clicks, from the pen and/or input from the user regarding the priming or lack thereof) and/or selection of dosages.
• priming actions e.g, clicks, such as two sets of clicks, from the pen and/or input from the user regarding the priming or lack thereof
• methods, systems, and devices provided herein can detect a needle presence to infer priming behavior (i.e., assume priming if the needle was removed and replaced).
• methods, systems, and devices provided herein can assume priming based on dose volume and expected glucose impact.
• FIG. 9 shows a rapid acting dose injection process according to an embodiment of the disclosure.
• the user activates the mobile application and inputs meal information.
• the mobile application presents one or more correction dose recommendations to the user.
• the recommendations are based on a sliding scale of aggressiveness.
• the recommendations may be based on a low, medium, or high glycemic impact of the meal information input by the user.
• the recommendations may be based on a glucose reading and the recommendations may be based on a degree of confidence that the glucose reading is not too old. For example, if three recommendations are presented, the first
• the user uncaps the pen cap 122, which is detected by the pen cap 122.
• the user primes the insulin injection pen 120 to deliver a dose amount.
• the user injects a dose of insulin from the insulin injection pen 120.
• the user replaces the pen cap 122, which the pen cap 122 detects.
• the pen cap 122 records the dose action and time of dose action responsive to the detected capping event.
• the pen cap 122 returns to a low power mode responsive to the capping event. Delivering a long-acting insulin dose
• the system initiates the following workflow. Some of the steps are optional and may not be invoked if particular devices are unavailable or if the user chooses not to use them.
• the user may initiate an NFC transfer from a glucose sensor (typically a CGM) to the long-acting insulin pen cap 112 by waking up the pen cap and waving it over the sensor.
• a glucose sensor typically a CGM
• the pen cap After acquiring the glucose reading, the pen cap presents the user with their current glucose value and a trend- line, along with a recommended long-acting insulin dose. If there is no glucose value available from within the last ten minutes, the pen cap displays only the long-acting insulin dose recommendation, which is tailored to the user’s habits and physiology and may change over time with clinician oversight and approval.
• FIG. 10 shows a correction dose recommendation process, according to an embodiment of the disclosure.
• a user removes a pen cap 112 to enable a recommendation mode.
• the pen cap 112 may change from a low power mode to an active mode when then pen cap 112 is removed from the insulin pen.
• a pen cap may display information about the last long acting insulin dosing action, for example, the amount of insulin and/or time of the last dose, such as shown at FIG. 3.
• the pen cap 112 responsive to the uncapping and being waived near the glucose monitor 130, enables an intermediate mode to read the glucose measurements from the glucose monitor 130, and sends a prompt to the user to swipe the pen cap 112 near the glucose monitor 130.
• the pen cap 112 recommends a correction dose at a display on the pen cap 112.
• the correction dose is determined at the pen cap 112.
• the correction dose is determined at another device, such as the mobile device 130 and communicated to the pen cap 112.
• the pen cap 112 may be configured to toggle back and forth between a glucose read mode and recommendation mode, and a user may be able to receive current measurements and current recommendations.
• the pen cap 112 may be configured to change back to a low power mode responsive to a time-out.
• the user removes pen cap 112 from the insulin pen and installs the needle onto the cartridge.
• the needle is primed and then the user dials their desired dose and injects the insulin.
• the user removes the needle and replaces the cap on the rapid-acting insulin pen.
• the glucose values (if applicable) are transmitted via BLE to the mobile app where they are stored locally on a smartphone. When a connection to the cloud is available via cellular or WiFi, the data is then synced to the cloud.
• a portion of the system may monitor use of the pens (e.g, based on data inputted by the user regarding usual use of the devices) to detect priming actions (e.g, clicks, such as two sets of clicks, from the pen and/or input from the user regarding the priming or lack thereof) and/or selection of dosages.
• priming actions e.g, clicks, such as two sets of clicks, from the pen and/or input from the user regarding the priming or lack thereof
• FIG. 11 shows a rapid- acting insulin injection process according to an embodiment of the disclosure.
• the user activates the mobile application and inputs meal information.
• the mobile application presents one or more correction dose recommendations to the user.
• the recommendations are based on a sliding scale of aggressiveness.
• the recommendations may be based on a low, medium, or high glycemic impact of the meal information input by the user.
• the recommendations may be based on a glucose reading and the recommendations may be based on a degree of confidence that the glucose reading is not too old. For example, if three recommendations are presented, the first
• the pen cap 112 may display the status information responsive to the user’s request. In some embodiments, the pen cap 112 may persistently display the date and time of the last long acting dose when it is in a lower power mode.
• the user can check system status in the following locations :
• FIG. 15 shows a process for checking the status of the system, according to an embodiment of the disclosure.
• the mobile application 104 is started.
• the mobile application 104 presents a prompt for a user, the prompt being to scan the glucose sensor system.
• the mobile application 104 may present the prompt responsive to a request received at the user interface to check system status.
• the mobile device running the mobile application 104 is swiped near one or more glucose sensors.
• the mobile application 104 receives blood glucose data from the one or more glucose sensors.
• the mobile application 104 determines and presents glucose data and trends, typically for a recent time window.
• Methods and systems provided herein can additionally include a mobile application that runs on a mobile device (e.g. , a smartphone or tablet) that is in wireless communication (e.g., via BLE) with one or more pen caps described herein.
• blood glucose data may be transmitted from a glucose sensor system 101 (e.g., from a glucose monitor 130 and/or a blood glucose meter 150), either via the pen caps and/or directly from the glucose sensor system.
• a mobile application can have a user interface that displays a graphical representation of the blood glucose data.
• a graphical display of blood glucose data over time can include indicators communicating pen capping information.
• FIG. 16 shows an example display of the system (e.g, of the mobile device).
• FIG. 16 shows an example user interface for a mobile application that includes a graphical presentation of blood glucose data with markings (e.g., triangles, circles, wedges, or any other suitable icon or indication of a dose) along the x-axis showing the timing of certain actions, such as, for example, re- capping actions, which may be assumed to be the timing of an insulin dosage, and/or other actions, such as the timing of glucose readings.
• markings e.g., triangles, circles, wedges, or any other suitable icon or indication of a dose
• the triangle may be wider to indicate the time during which a dose of insulin might have been administered.
• the icons may be different (e.g, different colors or shapes) depending on the type of insulin associated with the pen cap that had a re-capping action.
• a graphical presentation of blood glucose levels may be toggled between a 3 hour and a 12 hour time frame.
• a home screen can include a simplified presentation of the current EGV, a curve shown prior to 30 minutes of the EGVs, and a curve showing projected EGVs over the next 30 minutes.
• glucose data after or surrounding each capping event may be sent to a healthcare professional to have the healthcare professional update user- specific dosage parameters or recommended dose amounts for that user, which may be based on the time of day.
• data surrounding each capping event may indicate that the user is typically dosing rapid-acting insulin after the meal has begun, and might be adapted to coach the user to pre-bolus for meals when the user intends to eat.
• data surrounding each capping event along with blood glucose levels may be utilized to recommend injection timings relative to when a meal is begun after the injection.
• data surrounding each capping event and/or blood glucose levels may be utilized to recommend the modifications of doses of insulin taken by the subject. Again, such coaching may be automatic, approved by the healthcare professional, and/or developed by a healthcare professional.
• blood glucose levels may further be utilized to track and/or make recommendations for the type of insulin being taken.
• blood glucose levels may be analyzed in conjunction with dose capture data to determine if the wrong insulin was taken.
• blood glucose data in combination with temperature sensor data from a pen cap may be analyzed to determine if the insulin has gone bad., if the wrong insulin was taken (e.g., as discussed above), or if there are other issues with the therapy or associated devices.
• the mobile application may be adapted to enable the user to provide additional information that may be used to determine how often the user is following the recommended doses.
• a user may be provided with the possibility to input dose amounts for each capping event and/or may input multiple doses (e.g, an amount of insulin taken throughout a selected period of time, such as, over a day) into the mobile application or directly into the pen cap.
• the markings along the graph may be tapped by a user to allow a user to enter to dose administered.
• FIG. 17 illustrates another example display 300 of a portion of the system (e.g, of the mobile device, such as mobile device 140 shown in FIG. 7).
• the display 300 may somewhat similar to that shown in FIG. 16 and may include a graphical presentation of blood glucose data with markings (e.g, circles 302) along the x- axis showing the timing of events relating to the system 10, such as, for example, the timing that glucose readings are received from an associated glucose monitor (e.g. , a flash monitor).
• the circles 302 may be connected by (e.g., may overlie) a trend line 304 of the user’s blood glucose levels.
• the data preceding the current data point circle 302 indicating the latest glucose reading may be received from the glucose monitor and populated into the trend line 304.
• another marker e.g, a most recent circle 306
• the latest reading e.g, the most recent circle 302
• the time of the last scan may be displayed on the display 300.
• the horizontal position on the trend line 304 of the most recent circle or marker 306 may also be indicated on the display 300 with a marker (e.g., vertical line 308).
• the meter 312 may decrease or increase over time as the lifespan of the blood glucose sensor approaches zero (e.g., resulting in either a full meter 312 or an empty or outlined meter 312).
• the meter 312 may display other metrics, such as, for example, time since last scan, time until next recommend scan, the percentage remaining of a previously administer dose (e.g., a correction dose), etc.
• the display 300 may enable the user to track previous values on the trend line 304. For example, the user may drag the most recent circle or marker 306 (e.g. , along with the vertical line 308) backward along the trend line to a previous time period. As depicted, the display 300 may track the position of the most recent circle 306 and display the time and blood glucose level of the selected time period.
• the most recent circle or marker 306 e.g. , along with the vertical line 308
• the display 300 may track the position of the most recent circle 306 and display the time and blood glucose level of the selected time period.
• the most recent circle 306 (e.g. , along with the vertical line 308) may be anchored to the most recent data position of the trend line 304 and may jump back to the most current position once the most recent circle 306 is released by the user.
• the vertical line 308 may be deformed into a“slingshot” and spring the circle 306 back to the most current reading position when released by the user.
• a user might be asked to estimate a number of units of insulin remaining in a pen every so often.
• a user might be asked to take a photo of the insulin pen and the app might be adapted to analyze the image of the insulin pen to determine an approximate number of units left in the pen. For example,
• FIG. 19 shows an example user interface where a user might use the smartphone’s camera to take a picture of the pen.
• the user interface may overlay the real time view of the smartphone’ s camera with guiding lines that correspond to features on the pen in order to assist the user with aligning the pen with the smartphone’ s camera.
• the mobile app may be adapted to automatically snap a picture of the pen when features in view of the smartphone’s camera align with the guiding lines 150.
• the guiding lines 150 can include lines showing windows in the pen that permit the viewing of plunger.
• the guiding lines can move in relationship to the position of the pen.
• the device may automatically analyze an insulin vial and infer meal information based on changes to an image of the insulin vial. For example, based on several successive images meal intake and meal times may be inferred based on changes in the amount of insulin in a vial and the type of insulin (i.e., rapid acting).
• the pen may include indicators (e.g., graduated markings) that enable a user to easily identify a position of a portion of the pen (e.g., the plunger) and input an associated value into the application.
• indicators e.g., graduated markings
• Pen caps may be configured to gain insights into which recommended dose the user is likely to be following. For example, as described in U.S. Patent
• a pen cap (whether or not there is any dose capture feature incorporated into the pen cap) can include meal announcement categorizations (such as S, M, L) and data from each announcement might indicate whether the user is likely to have dosed an appropriate amount for a S, M, or L meal.
• meal announcement categorizations such as S, M, L
• data from each announcement might indicate whether the user is likely to have dosed an appropriate amount for a S, M, or L meal.
• a button on pen cap 122 might be pressed multiple times to show recommendations for successively a S meal, a M meal, and a L meal, and methods and systems provided herein may assume that the user dosed insulin based on the last displayed recommendation.
• Therapy management systems may be setup using any suitable method.
• a health care professional can input initial therapy parameters from a web portal or directly into a user’s mobile device (e.g, during an appointment).
• the user may input initial therapy parameters based on advice from a doctor.
• Therapy management systems provided herein provide a way for users to clearly understand their therapy settings so that they gain trust in the system.
• a user may also be asked about whether they use two insulin pens or one, and the product configuration may occur on the fly during setup.
• some therapy settings may be automatically set responsive to selected insulin brands.
• prescription information may be associated with a pen cap (for example, downloaded from a therapy management system or entered by a medical provider), and list of insulin brands may be curated based on the prescription information.
• therapy settings may be automatically set responsive to the prescription information.
• the mobile application might present the screen shown in FIG. 21 where the user is asked to enter their daily dose of long-acting insulin (e.g, in whole or half units or other resolution based on the resolution of the user’s long-acting insulin pen 110).
• the user interface might use, for example, a sliding wheel or a number pad as shown.
• the user might be asked to enter the time (or times) of the day when the user generally injects their long-acting insulin.
• the user can enter their normal dosage amounts for differently sized meals.
• each of these fields may be prefilled with a recommended amount based on the user’s daily dosage of long- acting insulin, which may be based on population models.
• preset amounts may be prefilled based on a relationship as discussed in U.S. Patent Application Serial No. 15/717,805, but the user interface can allow the user to override these prefilled numbers by pressing in the fields to enter their own doses for each meal size.
• the mobile application can show the user examples of meals that fit each category so that the user can compare their mental model regarding what constitutes a small meal, a medium meal, and a large meal to the assumptions of the system.
• FIG. 23 depicts an example user interface for depicting example meals having a portion size that fit the different categories. For example, for the“Small Carbs” meal, each meal depicted would have a similar glycemic impact (e.g., a similar carbohydrate amount).
• the“Medium Carbs” meals and“Large Carbs” meals would also have similar glycemic impacts (e.g., the same amount of carbohydrates) for those depicted in each category.
• the meals depicted for“Small Carbs” could each include about 15- 20 grams of carbohydrates
• the meals depicted for“Medium Carbs” could each include between 35-45 grams of carbohydrates
• the meals depicted for“Large Carbs” could each include between 60-80 grams of carbohydrates.
• FIG. 24 depicts an example user interface where a user can upwardly or downwardly adjust a glucose goal value.
• the glucose goal value can default to a preset number (e.g. , 100 mg/dl, 80 mg/dl, 120 mg/dl, etc.)
• Diabetes management systems provided herein can, in some
• a user interface on the mobile device 140 or available via the cloud from a remote server can permit a health care professional or a PWD to set an ISF or input other data use to determine correction doses.
• a glucose goal value set in FIG. 24 may be used along with an ISF (or increment value) input by or at the direction of a health care professional to produce a linear sliding- scale correction chart.
• the equation that might define the linear sliding- scale correction chart would be as follows:
• Correction dose rounddown (Current Blood Glucose - Glucose Goal)/ISF.
• the glucose goal set in FIG. 24 can define a midrange of a glucose target range and the equation can use the lower bound of the glucose target range to calculate a correction dose.
• the ISF may be inferred from a mathematical relationship between the user’s daily dosage of long-acting insulin.
• FIG. 26 depicts how a sliding scale chart may be determined by an ISF or interval and a glucose goal or target.
• a user interface on the mobile application or in a web portal can generate a sliding scale chart for the PWD, caregiver, or health care professional to review before accepting the summary shown in FIG. 24.
• a sliding scale chart may be included in the therapy summary.
• the sliding scale chart can simplify the user’s understanding of how the system is adjusting their therapy based on real-time blood glucose readings from the glucose sensor.
• a user interface may use a slider to enable a user to update the increment or the start and to have the generated sliding scale correction chart dynamically update in order to enable a health care professional or PWD have the generated chart match their desired therapy settings (e.g. , as shown in FIG. 33).
• FIGS. 27 through 30 depict different options that may be presented to the user via a user interface to enable the mobile application to create a sliding scale (e.g., as shown above in FIG. 18.
• the mobile application may prompt the user (e.g, the subject and/or a caregiver) to enter values relating to actions (e.g, based on historical use) taken by the subject while managing blood glucose levels.
• historical data relating to the amount (e.g., units) of insulin (e.g., rapid- acting insulin) taken in response to a certain blood glucose level range may be inputted to create a user- inputted scale, which may be (e.g., result in) a non-linear scale.
• the mobile application may enable the user to enter a target blood glucose level.
• Methods, devices, and systems provided herein may detect patterns in blood glucose levels and/or patterns of injections that enable the devices or systems to understand the impact of dosing and determine recommended therapy setting changes to improve glycemic outcomes.
• the mobile device can determine appropriate therapy changes.
• a remote server can determine appropriate therapy settings.
• methods, devices, and systems can incrementally automatically adjust dosages for different meal sizes as described in U.S. Patent Application Serial No. 15/717,805, which is hereby incorporated by reference.
• algorithms can update the ISF or the correction doses based on detected patterns.
• methods, devices, and systems can determine if there is a therapeutically relevant change recommended and then use that information to tell the user about the pattern or to tell the user about the pattern with a trigger, a tip, or a suggestion to the user (e.g, a message in the mobile application); examples of which are depicted in FIG. 31.
• messages might be as shown in FIG. 31 and/or displayed on the mobile device as shown in FIG. 32
• the message might include a button to bring the user to a screen that shows the user how to make an appropriate change (e.g, in-app training) and/or to a screen to actually make the change. Pressing this button might bring the user to a screen shown in FIG.
• the user might elect to just change the size of one meal or might desire to change things across the board by changing the bottom slider.
• changing the bottom slider might change an ISF value.
• the settings may be based on time of day (e.g, breakfast time, lunch time, dinner time) and a user can adjust the settings particularly for one of those meal times or all of those meal times.
• diabetes management systems, devices, and methods provided herein may provide notifications, alarms, and/or alerts.
• notifications, alarms, and/or alerts may be automatically triggered on one or more portions of the system, such as, for example, the mobile device, the pen caps, and/or one or more separate alert accessories.
• therapy management systems, devices, and methods provided herein can include a smart pen or pen accessory (e.g, an accessory adapted to be secured to a pen, such as, for example, a pen cap and/or another accessory that is integral with or may be applied and/or coupled to the pen) that is adapted to provide notifications, therapy recommendations, and/or alerts upon the user taking action to retrieve blood glucose data.
• a smart pen or pen accessory e.g, an accessory adapted to be secured to a pen, such as, for example, a pen cap and/or another accessory that is integral with or may be applied and/or coupled to the pen
• therapy management systems, devices, and methods provided herein can include both one or more alert accessories and one or more smart pens or pen accessories that can each wirelessly receive blood glucose data (e.g. , from a continuous glucose monitor).
• therapy management systems, devices, and methods provided herein may have one or more smart pens or pen accessories that communicate with a blood glucose monitoring system (e.g., a continuous glucose monitor) via a first communication technique (e.g., NFC) and have one or more alert accessories that communicate with a blood glucose monitoring system (e.g., the same continuous glucose monitor) via a second communication technique (e.g., UHF, BLE).
• a blood glucose monitoring system e.g., a continuous glucose monitor
• a first communication technique e.g., NFC
• alert accessories that communicate with a blood glucose monitoring system (e.g., the same continuous glucose monitor) via a second communication technique (e.g., UHF, BLE).
• having a smart pen or pen accessory that only receives blood glucose data upon user action can reduce the power consumption for the smart pen or pen accessory, thus reducing the burden on the user to recharge or replace batteries in the smart pen or pen accessory.
• having an alert accessory as provided herein can enable the user to decide when and where to receive disruptive alarms, alerts, and notifications, and further permit the user to not feel a need to carry around their insulin pens between doses.
• an alert accessory can include one or more illuminable icons.
• an alert accessory can include a digital display screen.
• an alert accessory can include one or more speakers and/or vibrational motors.
• alert accessories contemplated herein may be secured to a smartphone (e.g., as a phone case).
• alert accessories contemplated herein may be secured to a keychain.
• alert accessories contemplated herein may be adapted to serve as a bedside alarm clock. In some embodiments, alert accessories are contemplated herein.
• the following example therapy management system includes insulin delivery pens having dose-capture pen caps, but other embodiments are envisioned where the functionality disclosed herein is incorporated into other accessories for an insulin delivery pen or the insulin delivery pen itself Additionally, the following example therapy management system includes a single alert accessory (e.g, a CGM fob), but other embodiments are envisioned that include multiple alert accessories or where the functionality of the alert accessory is merged into a smartphone or other web-connected mobile computing device (e.g., using WiFi or cellular communications).
• a single alert accessory e.g, a CGM fob
• the functionality of the alert accessory is merged into a smartphone or other web-connected mobile computing device (e.g., using WiFi or cellular communications).
• one or more portions of the system may be configured to present one or more of the following alarms or alerts:
• Rapid-acting Insulin Alerts take correction dose, missed rapid acting dose, dangerous rapid- acting dose, dose exceeding threshold
• methods and systems provided herein include an alarm or alert that is triggered if a user removes a long acting pen cap or rapid acting pen cap during a time period when a user should not (or should administer a different dose) administer long-acting insulin or rapid-acting insulin. For example, when an uncapping of a long- acting pen cap is detected, then insulin dose information about a recent dose of long-acting insulin may be reviewed. Reviewed dose information may include dose amount, dose time, type of insulin, and/or brand of insulin. Based on dose information and uncapping information, a risk of a user mistake may be inferred.
• Examples of user mistakes for which a risk may be inferred include, but are not limited to, administering a dose of long acting insulin instead of rapid acting insulin and administering a dose of long acting insulin and/or rapid acting insulin too soon after a previous dose.
• a contemplated operation of methods and systems of this disclosure includes, for example, an uncapping event is detected for a long acting pen cap at 9:30AM. Dosing events corresponding to inferred dosing actions (e.g., based on capping events as described herein) are reviewed and a dosing event for long acting insulin at 8:00AM is identified.
• Dosing information indicates that a dose of long acting insulin was administered at 8:00AM, the amount of insulin administered corresponds to a basal dose, and a risk of a user mistakenly administering a second dose of long acting insulin is inferred (such a risk may also be characterized as a risk of insulin stacking).
• the earlier dose may be confirmed based on blood glucose data, changes in which would be indicative of insulin action on a user’s blood glucose levels.
• an alarm or alert may be generated and presented to a user. For example, a pen cap, injection pen, or mobile device may vibrate or emit an audible sound indicating to a user that there may be an error.
• Diabetes management systems provided herein may be adapted to add or remove components from use and/or to be configured based on the needs of the person with diabetes (PWD).
• FIGS. 34 A- 34D illustrate different systems and the associated communication architecture that permit use for PWDs having different types of diabetes (Type 1 or Type 2, as shown, or additionally including gestational diabetes or other types of diabetes), different progressions of diabetes, and/or different preferences for how to monitor and/or treat their diabetes.
• methods and devices provided herein may be adapted determine when additional therapies are warranted and recommend the addition of additional therapies or devices to the therapy and/or the system.
• FIG. 34 A depicts a system 3410 that includes only a BGM 150, a mobile device having a mobile app 140, a long-acting insulin pen 110, and a long-acting pen cap 112.
• System 3410 can communicate with cloud services 250 via mobile device 140 as discussed above.
• System 3410 may be adapted for use by PWDs that do not require meal time insulin (e.g., early progression of type 2 diabetes and/or gestational diabetes) or PWDs that do not want rapid-acting insulin doses to be tracked.
• BGM 150 is a blood glucose meter adapted to determine estimated glucose values (EGVs) through the use of test strips that analyze in-vitro blood samples.
• BGM 150 can transmit single-point EGVs to pen cap 112 via BLE communications link 3401.
• the EGVs from BGM 150 can then be transmitted from pen cap 112 to mobile application 140 via BLE communications link 3405, and via mobile application 140 to cloud services 250 for analysis via network communications 3409.
• BLE communications link 3405 can also transmit pen capping data to mobile application 140, which can also be transmitted vial link 3409 to web
• Mobile application 140 can display the most recent EGVs and/or a graph of collected EGVs. Recommended doses of long- acting insulin may be displayed on pen cap 112 in a manner similar to that shown in FIG. 6 and in FIG. 35A.
• System 3410 can prompt a use to collect fasting EGVs with BGM 150.
• System 3410 can use fasting EGVs to recommend changes or automatically make change to the displayed recommended doses of long-acting insulin using standard long-acting insulin titration techniques or any other suitable algorithm. In some cases, algorithms may be used in system 3410 to determine if a PWD should add rapid- acting insulin to their therapy.
• FIG. 34B depicts a system 3420 that includes the components of system 3410 but adds a rapid- acting insulin pen 120, and a rapid- acting pen cap 122.
• System 3420 may be adapted for use by PWDs that require both long- and rapid-acting insulin but that wish to monitor EGVs with a BGM instead of a continuous or flash glucose monitor.
• communication link 3401 is eliminated and long- acting pen cap 112 does not receive EGVs from BGM 150 as BGM values are not used in real time to determine an instant dose of long- acting insulin, but may be used to determine a correction dose of rapid- acting insulin.
• BGM 150 can transmit single-point EGVs to pen cap 122 via BLE communications link 3402.
• the EGVs from BGM 150 can then be transmitted from pen cap 122 to mobile application 140 via BLE communications link 3406, and via mobile application 140 to cloud services 250 for analysis via network communications 3409.
• BLE communications links 3405 and 3406 can also transmit pen capping data to mobile application 140, which can also be transmitted via link 3409 to web services 250.
• Mobile application 140 can display the most recent EGVs and/or a graph of collected EGVs. Recommended doses of rapid- and long-acting insulin may be displayed on pen cap 112 in a manner similar to that shown in FIGS. 3-6 and in FIGS. 35A and 35B.
• Embodiment 4 The pen cap of any one of the preceding Embodiments, wherein the wireless communication interface is configured to transmit messages that are associated with an insulin therapy.
• Embodiment 5 The pen cap of any one of the preceding Embodiments, wherein the messages comprise indicators, and the indicators are associated with the insulin therapy.
• Embodiment 7 The reusable accessory of any one of the preceding Embodiments, wherein the first wireless connection has a first communication range and the second wireless connection has a second communication range, wherein the second communication range is greater than the first communication range.
• Embodiment 15 The system of Embodiment 14, wherein the insulin dosage monitoring device comprises a pen cap and the insulin delivery device is an insulin injection pen, wherein the pen cap is adapted to detect deliveries of insulin from the insulin injection pen by detecting pen cap capping events, which may be inferred to be dosing events.
• Embodiment 16 The system of any one of the preceding Embodiments, wherein the insulin dosage monitoring device comprises a pen cap and the insulin delivery device is an insulin injection pen, wherein the pen cap is adapted to detect an amount of insulin remaining in the insulin injection pen to determine a timing of and optionally a dose amount, for each dose.
• Embodiment 19 A method of managing medication therapy by a manual medication delivery device, comprising: receiving analyte measurement data from an analyte sensor system; detecting dosing action events at an accessory configured to reversibly attach to a manual medication delivery device; storing a record for each of the one or more dosing action events, wherein the record comprises a dosing time of a dosing action; and providing one or more medication dose recommendations responsive to the analyte measurement data.
• an adapter configured to reversibly couple to a predetermined portion of the manual medication delivery device.
• Embodiment 26 A system, method or device according to any one of the preceding embodiments, wherein the blood glucose data and/or glucose data is a blood glucose level correlated to an interstitial fluid glucose level.
• Embodiment 1 A diabetes management system comprising: a flash glucose monitor adapted to be secured to a person with diabetes (PWD), the flash glucose monitor comprising: a sensing portion adapted to detect blood glucose data at regular time intervals, the regular time intervals being less than or equal to every 15 minutes; and a wireless communication interface adapted to transmit blood glucose data when the wireless communication interface is activated by a user, wherein the transmitted blood glucose data for each wireless communication transmission comprises a blood glucose data collected over a data transmission window of at least 1 hour; and a user interface device comprising: a UI wireless communication interface adapted to receive the transmitted blood glucose data at irregular intervals governed at least in part by the actions of the user; a display comprising a touch screen; and a processor and memory, the processor being adapted to execute instructions in the memory to display a representation of glucose values comprising: a graphical representation having a time of the day along the bottom of the graphical representation and a curve of glucose values for each time of the day that has been received, where
• Embodiment 5 The diabetes management system of any one of the preceding Embodiments, wherein the portion of the screen corresponding to a position along the time axis is a portion of the screen depicting the curve of glucose values.
• Embodiment 6 The diabetes management system of any one of the preceding Embodiments, wherein the point indicator must be pressed and slid back along the graphical representation to move the point indicator.
• Embodiment 7 The diabetes management system of any one of the preceding Embodiments, wherein the point indicator moves back along the curve of glucose values after a user stops pressing a portion of the graphical representation.
• Embodiment 8 The diabetes management system of any one of the preceding Embodiments, wherein the display lurther depicts a trend arrow adjacent to the single numerical value depicting a rate of change of glucose values at the time of the single numerical value.
• Embodiment 9 The diabetes management system of any one of the preceding Embodiments, further comprising a reusable accessory adapted to be reversibly secured to an insulin injection pen, wherein the reusable accessory comprises an accessory wireless communication interface adapted to be used by a user to interrogate the flash glucose monitor to receive the blood glucose data.
• Embodiment 10 The diabetes management system of any one of the preceding Embodiments, wherein the accessory wireless communication interface is adapted to automatically transmit the blood glucose data to the user interface device.
• Embodiment 11 The diabetes management system of any one of the preceding Embodiments, wherein the reusable accessory is adapted to detect an event associated with an administration of insulin from the insulin injection pen.
• Embodiment 12 The diabetes management system of any one of the preceding Embodiments, further comprising displaying an injection indicator along the time axis of the graphical representation for each detected event.
• Embodiment 13 The diabetes management system of any one of the preceding Embodiments wherein the injection indicator displays an amount of insulin administered.
• Embodiment 14 The diabetes management system of any one of the preceding Embodiments, wherein the injection indicator displays a type of insulin administered.
• Embodiment 15 The diabetes management system of any one of the preceding Embodiments, further comprising a second reusable accessory adapted to be reversibly secured to a second insulin injection pen, the second insulin injection pen retaining a second type of insulin, wherein the graphical representation includes different injection indicators along the time axis for each reusable accessory.
• Embodiment 16 The diabetes management system of any one of the preceding Embodiments, wherein the reusable accessory is a replacement pen cap and the event associated with an administration of insulin from the insulin injection pen is a capping or decapping of the replacement pen cap from the insulin injection pen.
• Embodiment 17 The diabetes management system of any one of the preceding Embodiments, wherein the reusable accessory comprises an accessory display, the accessory display depicting a most recent glucose value received from the flash glucose monitor.
• the graphical representation also includes BGM indicators representing blood glucose measurements from the blood glucose meter.
• Embodiment 20 The diabetes management system of any one of the preceding Embodiments, wherein the single numerical value representing a single blood glucose measurement is adapted to depict the blood glucose measurements from the blood glucose meter or glucose values from the flash glucose monitor.
• Embodiment 22 A system, method or device according to any one of the preceding embodiments, wherein the blood glucose data and/or glucose values are a blood glucose level correlated to an interstitial fluid glucose level.
• Embodiment 5 The reusable accessory for one of Embodiments 1-3, wherein the reusable accessory does not detect or determine a dose amount for each detected event associated with an injection of medication.
• Embodiment 10 The reusable accessory of any one of the preceding Embodiments, wherein the reusable accessory is adapted to send data regarding the event associated with each injection of medication to a mobile computing device via the wireless communication.
• Embodiment 11 The reusable accessory of any one of the preceding Embodiments, wherein the reusable accessory is adapted to receive user- specific dosage parameters from a mobile computing device via the wireless communication.
• Embodiment 14 The reusable accessory of any one of the preceding Embodiments, wherein the wireless communication interface comprise a first wireless connection having a first communication range and a second wireless connection having a second communication range, wherein the first wireless connection is between the reusable accessory and an analyte sensor system, wherein the second wireless connection is between the reusable accessory and a mobile application on a remote computing device, wherein the second communication range is greater than the first communication range.
• Embodiment 15 The reusable accessory of any one of the preceding Embodiments, wherein the wireless communication interface comprises an NFC chip and the first wireless connection consists of NFC communications between the reusable accessory and the analyte sensor system.
• Embodiment 16 The reusable accessory of any one of the preceding Embodiments, wherein the wireless communication interface comprises a wireless radio adapted to permit BLUETOOTH Low Energy communications between the reusable accessory and one or more mobile computing devices.
• Embodiment 17 The reusable accessory of any one of the preceding Embodiments, wherein the analyte sensor system is a flash glucose monitor adapted to provide glucose data via near field communication.
• the analyte sensor system is a flash glucose monitor adapted to provide glucose data via near field communication.
• Embodiment 19 The system of Embodiment 18, wherein the reusable accessory detects or determines a dose of insulin for each event associated with an injection of insulin and the display displays an amount of active insulin remaining in the user as a number of units of insulin, which can optionally include multiple doses of insulin at different times.
• Embodiment 20 The system of any one of the preceding Embodiments, wherein the reusable accessory does not detect or determines a dose of insulin for each event associated with an injection of insulin.
• Embodiment 21 A method of managing a diabetes therapy, comprising: detecting an event associated with an injection of medication from a medication injection pen responsive to an attaching or detaching of a reusable accessory to the medication injection pen; determining a percentage of medication that remains active for the injection of medication based on a current time and time of the event associated with the injection, wherein the event is associated with attaching or detaching a reusable accessory to the medication injection pen.
• Embodiment 22 A smart electronics module integratable with a medication injection pen wherein the reusable accessory is adapted to be reversibly attached to a medication injection pen, the reusable accessory being configured to detect an event associated with an injection of medication from the medication injection pen and determine a percentage of medication that remains active for the injection of medication based on a current time and a time of the event associated with an injection.
• Embodiment 23 A system, method or device according to any one of the preceding embodiments, wherein the blood glucose data and/or glucose data is an interstitial fluid glucose level or based on an interstitial fluid glucose level.
• Embodiment 24 A system, method or device according to any one of the preceding embodiments, wherein the blood glucose data and/or glucose data is a blood glucose level correlated to an interstitial fluid glucose level.
• Embodiment 25 A system, method or device according to any one of the preceding embodiments, wherein the blood glucose data and/or glucose data is a blood glucose level.
• Additional non-limiting embodiments of the disclosure relate, generally, to insulin injection assistance systems, methods, and devices:
• Embodiment 1 A system to assist with the manual dosing of insulin, the system comprising: at least a first glucose sensor system adapted to wirelessly transmit glucose data; at least a first reusable insulin dosing detector adapted to be reversibly connectable to at least a first disposable component comprising a chamber for a first insulin type to form at least part of a first insulin manual delivery assembly, the first reusable insulin dosing detector configured to detect first insulin delivery events associated with the first insulin manual delivery assembly, and a recommendation system comprising a mobile application and a computing device remote from the first reusable insulin dosing detector, wherein the mobile application, while executing at the computing device, is configured to: receive insulin therapy settings, the insulin therapy settings comprising a first insulin type setting; determine first timing data corresponding to one or more first insulin delivery event times of one or more of the first insulin delivery events; analyze the glucose data in combination with the first timing data; and determine an adjustment recommendation or automatic insulin therapy setting change responsive to the analysis.
• Embodiment 2 The
• Embodiment 4 The system of any one of the preceding Embodiments, wherein the mobile application is configured to analyze the first timing data and the glucose data, determine the adjustment recommendation or the automatic insulin therapy setting change responsive to the analysis.
• Embodiment 5 The system of any one of the preceding Embodiments, wherein the first reusable insulin dosing detector is a first reusable accessory, the first disposable component is a first insulin injection pen or a first insulin inhaler, and the first insulin delivery events are associate insulin injection or insulin inhalation, and wherein the first reusable accessory is adapted to reversibly connect to the first insulin injection pen or the first insulin inhaler.
• the first reusable insulin dosing detector is a first reusable accessory
• the first disposable component is a first insulin injection pen or a first insulin inhaler
• the first insulin delivery events are associate insulin injection or insulin inhalation
• the first reusable accessory is adapted to reversibly connect to the first insulin injection pen or the first insulin inhaler.
• Embodiment 6 The system of any one of the preceding Embodiments, wherein the first reusable accessory is a first replacement cap adapted to be placed over a needle of the first insulin injection pen or adapted to be placed over an inhalation pathway of the first insulin inhaler, wherein the first replacement cap is configured to detect capping and/or de-capping events.
• the first reusable accessory is a first replacement cap adapted to be placed over a needle of the first insulin injection pen or adapted to be placed over an inhalation pathway of the first insulin inhaler, wherein the first replacement cap is configured to detect capping and/or de-capping events.
• Embodiment 7 The system of any one of the preceding Embodiments, wherein the first reusable accessory is configured to detect the first insulin delivery events responsive to the one or more capping and/or de-capping events.
• Embodiment 8 The system of any one of the preceding Embodiments, wherein the first reusable insulin dosing detector is a first reusable smart pen or a first smart inhaler and the first disposable component comprises a first insulin cartridge, wherein the first reusable smart pen or the first smart inhaler is configured to receive the first insulin injection cartridge and configured to be actuated by a user to deliver the first insulin type from the first insulin cartridge.
• the first reusable insulin dosing detector is a first reusable smart pen or a first smart inhaler and the first disposable component comprises a first insulin cartridge
• the first reusable smart pen or the first smart inhaler is configured to receive the first insulin injection cartridge and configured to be actuated by a user to deliver the first insulin type from the first insulin cartridge.
• Embodiment 9 The system of any one of the preceding Embodiments, further comprising: at least a second reusable insulin dosing detector adapted to be reversibly connectable to a second disposable component comprising a chamber for a second insulin type to form at least part of a second insulin manual delivery assembly, wherein the second reusable accessory comprises a second wireless communication interface configured to wirelessly receive a second insulin type setting of the insulin delivery settings from the mobile application, wherein the second reusable insulin dosing detector configured to detect second insulin deliver ' events associated with the second insulin manual deliver ⁇ ' assembly, and wherein the recommendation system is configured to: determine second timing data corresponding to one or more second insulin delivery event times for one or more second insulin delivery events; analyze the glucose data in combination with the first timing data and the second timing data; and determine an adjustment recommendation or automatic change to an insulin deliver ⁇ ' setting responsive to the analysis.
• Embodiment 10 The system of any one of the preceding Embodiments, wherein the second reusable insulin dosing detector is configured to wirelessly receive glucose data from the first glucose sensor system.
• Embodiment 11 The system of any one of the preceding Embodiments, wherein the system disables the wireless communication of the glucose data from the first glucose sensor system to the first reusable insulin dosing detector while the first glucose sensor system is in wireless communication with the second reusable insulin dosing detector.
• Embodiment 12 The system of any one of the preceding Embodiments, wherein the second reusable insulin dosing detector is selected from the group consisting of a second smart pen configured to receive a second disposable pen cartridge containing a second insulin type, a second smart inhaler configured to receive a second disposable inhalable insulin cartridge containing a second insulin type, a second replacement pen cap adapted to be secured over a needle of a second disposable insulin injection pen containing the second insulin type, or a second replacement inhaler cap adapted to be secured over an inhalation pathway of an second insulin inhaler.
• the second reusable insulin dosing detector is selected from the group consisting of a second smart pen configured to receive a second disposable pen cartridge containing a second insulin type, a second smart inhaler configured to receive a second disposable inhalable insulin cartridge containing a second insulin type, a second replacement pen cap adapted to be secured over a needle of a second disposable insulin injection pen containing the second insulin type, or a second replacement inhaler cap adapted
• Embodiment 13 The system of any one of the preceding Embodiments, wherein the first insulin type is selected from a group consisting of a long acting insulin, a rapid acting insulin, and a combination long acting and rapid acting insulin.
• Embodiment 14 The system of any one of the preceding Embodiments, wherein the first glucose sensor system is a blood glucose meter adapted to analyze blood in vitro.
• Embodiment 15 The system of any one of the preceding Embodiments, wherein the recommendation system is adapted to analyze the timing data of one or more insulin delivery events and the glucose data to recommend adding a second glucose sensor system selected from the group consisting of continuous glucose monitors and flash glucose monitors.
• Embodiment 16 The system of any one of the preceding Embodiments, wherein the first glucose sensor system is a flash glucose monitor.
• Embodiment 17 The system of any one of the preceding Embodiments, wherein the first glucose sensor system is configured to communicate a limited glucose data set to the mobile application via a first communication technique having a first communication range and to communicate robust glucose data set to the first or second reusable insulin dosing detector via a second communication technique having a second communication range, the first communication range being greater than the second communication range.
• Embodiment 18 The system of any one of the preceding Embodiments, wherein the mobile application can receive glucose data directly from the first glucose sensor system via the first communication technique and the second communication technique.
• Embodiment 20 The system of any one of the preceding Embodiments, wherein the first reusable insulin dosing detector or the mobile application is configured to issue an alert if a detected dose of the first insulin type fails to comply with the first insulin setting.
• Embodiment 21 The system of any one of the preceding Embodiments, wherein the system is adapted to determine one or more insulin dose amounts of the first insulin type associated with each detected first insulin delivery event.
• Embodiment 22 A method of assisted manual dosing of insulin, the method comprising: receiving first insulin delivery events associated with a first insulin manual delivery assembly, the first insulin manual delivery assembly comprising a first reusable insulin dosing detector reversibly connected to a first disposable component and adapted to detect the first insulin delivery events; determining first timing data
• Embodiment 23 The method of Embodiment 22, further comprising receiving the first insulin delivery events at a communication interface configured for wireless communication with the first reusable insulin dosing detector.
• Embodiment 25 The method of any one of the preceding Embodiments, lurther comprising receiving glucose data from the first reusable dosing detector.
• Embodiment 26 The method of any one of the preceding Embodiments, further comprising receiving glucose data from a first glucose sensor system.
• Embodiment 27 A system for remotely assigning with the manual dosing of insulin, the system comprising: receiving first insulin delivery events associated with a first insulin manual delivery assembly, wherein the insulin delivery events are received at a communication interface configured for communication with a reusable insulin dosing detector; determining first timing data corresponding to one or more first insulin delivery event times for one or more first insulin delivery events; analyzing the glucose data in combination with the first timing data; determining an adjustment recommendation or an automatic insulin therapy setting change responsive to the analysis; and providing the adjustment recommendation or the automatic insulin therapy setting change to the communication interface to send to the reusable insulin dosing detector.
• Embodiment 28 An insulin manual dosing assistance system, the system comprising: a recommendation system comprising a mobile application executing at a computing device, the mobile application configured to determine insulin delivery adjustment recommendations and insulin therapy setting changes responsive to glucose data associated with one or more insulin delivery events, the recommendation system fiirther configured to: detect a first reusable insulin dosing detector; create an insulin manual delivery assembly profile responsive to the detection, the insulin manual delivery assembly profile associated with an insulin manual delivery assembly of the first reusable insulin dosing detector; and assign one or more insulin therapy settings to the insulin manual delivery assembly profile.
• Embodiment 29 The system of Embodiment 28, wherein the
• recommendation system is configured to, responsive to one or more physiological parameters associated with a user of the recommendation system, either load the one or more insulin therapy settings from memory, or create the one or more insulin therapy settings.
• Embodiment 30 The system of any one of the preceding Embodiments, wherein the recommendation system is configured to provide a user prompt at a display of the computing device, the user prompt comprising one an approval for pairing with the first reusable insulin dosing detector.
• Embodiment 31 The system of any one of the preceding Embodiments, wherein the recommendation system is configured to send one or more of insulin delivery adjustment recommendations and changes to insulin therapy setting to the reusable insulin dosing detector.
• Embodiment 32 The system of any one of the preceding Embodiments, wherein the recommendation system is further configured to receive an instruction to un pair with a second insulin dosing detector, and, responsive to the instruction to un-pair, delete or deactivate a second insulin manual delivery assembly profile associated with the second insulin dosing detector.
• Embodiment 33 The system of any one of the preceding Embodiments, wherein the recommendation system is fiirther configured to: detect a second reusable insulin dosing detector; create a second insulin manual delivery assembly profile responsive to the detection, the second insulin manual delivery assembly profile associated with a second insulin manual delivery assembly of the second reusable insulin dosing detector; and assign one or more second insulin therapy settings to the second insulin manual delivery assembly profile.
• the recommendation system is fiirther configured to: detect a second reusable insulin dosing detector; create a second insulin manual delivery assembly profile responsive to the detection, the second insulin manual delivery assembly profile associated with a second insulin manual delivery assembly of the second reusable insulin dosing detector; and assign one or more second insulin therapy settings to the second insulin manual delivery assembly profile.
• Embodiment 34 The system of any one of the preceding Embodiments, wherein the recommendation system is configured to send insulin delivery adjustment recommendations and insulin therapy setting changes to the first and the second reusable insulin dosing detector.
• Embodiment 35 The system of any one of the preceding Embodiments, wherein the recommendation system is configured to receive glucose data associated with one or more insulin delivery events of the first and the second reusable insulin dosing detector.
• Embodiment 36 The system of any one of the preceding Embodiments, wherein the first reusable insulin dosing detector and the second reusable insulin dosing detector is each a different one of a reusable accessory, a smart insulin pen, and a smart insulin.
• Embodiment 37 A system to assist with the manual dosing of insulin, the system comprising: at least a first glucose sensor system adapted to wirelessly transmit glucose data; smart electronics coupled with one or more parts of a first insulin manual delivery' assembly, the smart electronics comprising at least a first reusable insulin dosing detector operably connected to at least a first disposable component comprising a chamber for a first insulin type to form at least part of the first insulin manual delivery assembly, the first reusable insulin dosing detector configured to detect first insulin delivery events associated with the first insulin manual delivery assembly; and a recommendation system comprising a mobile application and a computing device remote from the first reusable insulin dosing detector, wherein the mobile application, while executing at the computing device, is configured to: receive insulin therapy settings, the insulin therapy settings comprising a first insulin type setting; determine first timing data corresponding to one or more first insulin delivery event times for one or more first insulin delivery events; analyze the glucose data in combination with the first timing data; and determine an adjustment recommendation or automatic insulin therapy setting change responsive to the analysis
• Embodiment 38 A system, method or device according to any one of the preceding embodiments, wherein the glucose data is an interstitial fluid glucose level or based on an interstitial fluid glucose level.
• Embodiment 39 A system, method or device according to any one of the preceding embodiments, wherein the glucose data is a blood glucose level correlated to an interstitial fluid glucose level.
• Embodiment 40 A system, method or device according to any one of the preceding embodiments, wherein the glucose data is a blood glucose level.
• Additional non-limiting embodiments of the disclosure relate, generally, to pen cap for medication injection pen having temperature sensor:
• Embodiment 1 A replacement pen cap for a medication injection pen comprising at least one temperature sensor, wherein the at least one temperature sensor is configured to monitor a temperature of medication within the medication injection pen while the replacement pen cap is associated with the medication injection pen, wherein the replacement pen cap is adapted to detect possible dosing events, wherein the replacement pen cap is adapted to receive analyte measurement data from an analyte sensor system, wherein the replacement pen cap is adapted to determine if medication in the medication injection pen is denatured based on a combination of data from the at least one temperature sensor and the received analyte measurement data subsequent to each detected possible dosing event.
• Embodiment 2 The replacement pen cap of Embodiment 1, wherein the at least one temperature sensor is configured to monitor ranges of temperature when the pen cap is associated with the insulin pen.
• Embodiment 3 The replacement pen cap of any one of the preceding Embodiments, wherein the pen cap is configured to provide at least one of an alarm or alert to a user when a selected threshold temperature value is sensed, wherein an alert is presented when a threshold is exceeded as a visual display and an audible alarm is triggered when the threshold is exceeded and the pen cap receives glucose values that indicate that one or more prior insulin administrations have been ineffective.
• Embodiment 4 The pen cap of any one of the preceding Embodiments, wherein the pen cap is configured to provide data to a user relating to the temperature exposure of the insulin.
• Embodiment 5 A smart electronics module integratable with a medication injection pen comprising at least one temperature sensor, wherein the at least one temperature sensor is configured to monitor a temperature of medication within the medication injection pen while the smart electronics module is enabled, wherein the smart electronics module is configured to detect possible dosing events, wherein the smart electronics module is configured to receive analyte measurement data from an analyte sensor system, wherein the smart electronics module is configured to determine if medication in the medication injection pen is denatured based on a combination of data from the at least one temperature sensor and the received analyte measurement data subsequent to each detected possible dosing event.
• Embodiment 6 A system, method or device according to any one of the preceding embodiments, wherein the glucose data is an interstitial fluid glucose level or based on an interstitial fluid glucose level.
• Embodiment 7 A system, method or device according to any one of the preceding embodiments, wherein the glucose data is a blood glucose level correlated to an interstitial fluid glucose level.
• Embodiment 8 A system, method or device according to any one of the preceding embodiments, wherein the glucose data is a blood glucose level.
• Embodiment 9 The system of any one of the preceding Embodiments, wherein the plurality of data points each comprises a range of glucose values and an associated correction dose.
• Embodiment 20 A system, method or device according to any one of the preceding embodiments, wherein the glucose data is an interstitial fluid glucose level or based on an interstitial fluid glucose level.

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