Using future technologies to create a system that helps individuals manage a chronic condition.

1. Diabetes Management
Using future technologies to create a system to help
individuals manage a chronic condition.
Noam Zomerfeld

2. Roger
Roger is a 66 year old man that has been living with
type 2 diabetes for the past 20 years.
He is retired and loves cooking. Roger and his husband
also eat out 1-3 times a a week. Roger’s eating habits
vary a lot and he does not keep to a strict diet.
Roger’s husband takes an active role in keeping Roger on
track with his diabetes management.

3. Current System – High Blood Glucose
Feedback Loop Diagram
Noam Zomerfeld
InjectsInforms
Whichlowers
measuredbya
raise
Blood glucose
meter
Roger Insulin
Blood Glucose
Level
Carbohydrates,
Sugars, Starches
lower
Insulin, diet,
physical activity
Acceptable blood
glucose level:
80-120 mg/dL
Current
reading
Planned
meal
Insulin
Dosage
+ =
Goal: Keep blood
glucose levels stable
Frequency:
4 times a day

4. Goal: Keep blood
glucose levels stable
Current System – High & Low Blood Glucose
Feedback Loop Diagram
Noam Zomerfeld
Consumes
Whichlowers
Whichraises
measuredby
raise
Roger
Insulin
FoodFeeling loopy
Blood Glucose
Level
Carbohydrates,
Sugars, Starches
lower
Insulin, diet,
physical activity
Acceptable blood
glucose level:
80-120 mg/dL
Current
reading
Planned
meal
Insulin
Dosage
+ =
Injects
InformsBG meter
Frequency:
4 times a day
Frequency:
Constant

5. Issues
Roger finds testing his blood to be painful and complex.
Choosing the required Insulin level is both predictive
and reactive. It’s based on the most recent reading and
on an estimate of the future intake of carbohydrates,
sugars and starches.
Roger only tests his blood 4 times a day, those are the
only solid indications he has for his BGL and his
opportunities to balance it.

6. Care Giving Network
Noam Zomerfeld
Visits
Kaiser - Medical Relationships
Marriage
Friend circles
Roger Husband
Yearly retina scan
Optometrist
Meet every 2-3 years
or as needed
Initially provided
training on a more
frequent basis
Personal Care Manager
(Diabetes specialist)
Calls several times a
day to check up
Reminds, verifies insulin
and keeps schedule
Takes blood sample
when Roger’s is too low
Moderates diet
•
•
•
•
Call and check up
occasionally
Remind about insulin
on social events
Respond to
emergencies
•
•
•
2 full blood work labs a year
Primary Care Physician Friends
Roger’s family and friends play an
important role in keeping him healthy.

7. Diabetes Management
Range and outcomes
80
120
blood glucose level
(BGL)
requires immediate intervention
requires monitoring and long term
change of habits and behavior
shaky, sweaty
cranky
confused, loopy, sleepy
passed out
death
Too low
Too high
acceptablerange
mg/dL
Long term effects
fatigue, kidney damage,
heart disease, poor circulation,
retinal damage, death
thirst, nausea,
frequent urination
Short term effects
Being on different sides of the BGL range has different
outcomes for Roger:
Having high blood glucose levels leads to serious
complications over time.
Having low blood glucose levels creates immediate
consequences and dangers.

8. Can we offload Roger’s
Insulin adjusting tasks?

9. Diabetes Management
Ecosystem
Noam Zomerfeld
Shows number
Light and buzz
Weekly Insulin delivery / pickup.
Or – optional weekly maintenance
by trained professional in-store.
Shows number
no light
Instantly adjusts
insulin level -
mini injections
just under normal
When high
Low / slightly low but
for a while now
...
(other, personalized
mid-states)
Very low
Blood glucose level
Number value
High / low / normal
Trend
Time in current status
Number value
Location
Coordinates
Insulin usage
Quantity
Timestamps for
injections
Low events
Timestamps
Response time
Blood glucose level
Line graph
Messages partner /
husband / wife
Calls ambulance
Ring Sensor Insulin pump
husband
Walgreens
/ CVS
Care
Manager
(doctor / nurse)
self
hospital
Low events:
requires immediate intervention
When Normal: High Events:
requires monitoring and long term
change of habits and behavior
Twice a year review
of data, adjustment
of Insulin and / or
of Roger’s diet

10. Diabetes Management
Ecosystem
Noam Zomerfeld
Shows number
no light
Instantly adjusts
insulin level -
mini injections
When high
Blood glucose level
Number value
High / low / normal
Trend
Time in current status
Number value
Location
Coordinates
Ring Sensor Insulin pump
Roger wears a ring on his finger that constantly measures his
blood glucose levels (CGM).
It displays the current BGL level. No light / color.
When his BGL goes over his range, it sends a signal to his
pump to deliver a mini dose of Insulin and stabilize his BGL.
In fact – when this system is operational, Roger no longer has
to worry about high BGL events.

11. Diabetes Management
Ecosystem
Noam Zomerfeld
Shows number
Light and buzz
Shows number
no light
just under normal
Blood glucose level
Number value
High / low / normal
Trend
Time in current status
Number value
Location
Coordinates
Ring Sensor
When Roger’s BGL drops below his range (80 mg/dL), the ring
vibrates and turns the display red – notifying Roger he needs
to consume food or glucose tablets to resolve it.

12. Diabetes Management
Ecosystem
Noam Zomerfeld
Shows number
Light and buzz
Shows number
no light
just under normal
Low / slightly low but
for a while now
Blood glucose level
Number value
High / low / normal
Trend
Time in current status
Number value
Location
Coordinates
Messages partner /
husband / wife
Ring Sensor
husband
self
If Roger’s BGL remains low for a period of time, the system
notifies Roger’s husband via text message / phone call to
check up on Roger and to make sure that the situation is
taken care of.

13. Diabetes Management
Ecosystem
Noam Zomerfeld
Shows number
Light and buzz
Shows number
no light
just under normal
Very low
Blood glucose level
Number value
High / low / normal
Trend
Time in current status
Number value
Location
Coordinates
Calls ambulance
Ring Sensor
self
hospital
If Roger’s BGL is so low he might be in immediate danger or
unconscious, the system alerts emergency services and
provides them with Roger’s condition and his location.
(Note: other triggers and settings between the ones described
in this document can be set-up in the system.)

14. Diabetes Management
Ecosystem
Noam Zomerfeld
Twice a year review
of data, adjustment
of Insulin and / or
of Roger’s diet
Instantly adjusts
Insulin level -
mini injections
Insulin usage
Quantity
Timestamps for
injections
Low events
Timestamps
Response time
Blood glucose level
Line graph
Insulin pump
Care
Manager
(doctor / nurse)
Roger meets up with his doctor or care manager twice a
year to review his Insulin usage and check up on other
health issues that might arise, especially now that his diet
is unrestricted by his diabetes.

15. Diabetes Management
Ecosystem
Noam Zomerfeld
Weekly Insulin delivery / pickup.
Or – optional weekly maintenance
by trained professional in-store.
Insulin pump
Walgreens
/ CVS
Roger gets his Insulin capsules delivered to him or he can
pick them up at a pharmacy. For other patients that are less
self-reliant or just dislike the procedure – an option exists to
get all maintenance done at the local pharmacy by trained
professionals on staff, a quick 30 minutes procedure.
Other regular maintenance of sensor and pump is also
performed at the pharmacy, as needed.

16. New System Conceptual Model
Conceptual Model
Noam Zomerfeld
has
Person Blood Glucose Level (BGL)
Exact level
Status
Trend
Time in current status
Number value
High / Normal / Low
Rising / Falling
Time Value
Viewed / Shared /
Automatically updated
Viewed / Replaced
Sent
Set up
Set up
Seen / felt / heard
Seen
Automatically updated
/ Sent with alerts
Full name
Number value
Content
Number value
Latitude
Longitude
If <condition>
then <action>
On / Off
Color (red / neutral)
Examples:
If 75 < BGL < 80 for
the last 10 minutes
then notify husband.
If BGL < 70 and
trend is falling
then notify husband.
Text Message
Example:
Roger’s blood sugar
level has been
below 80 for the
past 10 minutes.
Please follow up
with him.”
Quantity (percentage)
Timestamp
Dosage
Sensor
Pump
Insulin
History
Communication
Triggers
Local Alert
Ambient alert
Family Contact
Name
Phone Number
Family Alert
Emergency Service
Location
Phone Number
Coordinates
Objects Properties User Actions
Shared / Viewed
has a
is a
are
are
can be either
can be either
has a
has a
has
is a
is a
includes
is a
can be either
Set up
can be
“

17. Diabetes Management
Ecosystem
Noam Zomerfeld
Shows number
Light and buzz
Weekly Insulin delivery / pickup.
Or – optional weekly maintenance
by trained professional in-store.
Shows number
no light
Instantly adjusts
insulin level -
mini injections
just under normal
When high
Low / slightly low but
for a while now
...
(other, personalized
mid-states)
Very low
Blood glucose level
Number value
High / low / normal
Trend
Time in current status
Number value
Location
Coordinates
Insulin usage
Quantity
Timestamps for
injections
Low events
Timestamps
Response time
Blood glucose level
Line graph
Messages partner /
husband / wife
Calls ambulance
Ring Sensor Insulin pump
husband
Walgreens
/ CVS
Care
Manager
(doctor / nurse)
self
hospital
Low events:
requires immediate intervention
When Normal: High Events:
requires monitoring and long term
change of habits and behavior
Twice a year review
of data, adjustment
of Insulin and / or
of Roger’s diet