Särimner : a computer model for diabetes education

In diabetes mellitus pancreas fails to produce insulin enough to maintain tissue utilisation of blood glucose. To maintain a normalised metabolism many diabetic patients have to provide insulin from injections or an infusion pump. The disease affects some percent of western population. The insulin provided by the patient has to be adjusted to food and physical exercise. This may be achieved by following rules from diabetes professionals, but also by self learning how food, insulin and physical exercise interact and influence the blood glucose. It seems that the patients who have this intuitive knowledge of the interactions are the ones who manages their diabetes treatment best and have the highest quality of life. The learning have, however, been performed by trial and error - to the price of severe inconvenience and bad metabolic control. A combination of computer science and diabetes physiology has resulted in the computer program Särimner. It is created to give the user a possibility to experiment with diabetes treatment. Food, insulin and physical exercise may be varied and the blood glucose is calculated. Sarimner provides a short-cut to obtaining knowledge since it allows experiments, stimulates discussions and let the user by himself formulate and test hypotheses regarding experienced problems. Since Särimner may be adjusted to look more alike an individual, the experiments are driven by the user's own curiosity. He may experiment with situations of importance to himself and finally make himself the expert of his own treatment situation. The way Särimner is designed, allows interested users to get "under the skin" of the model and study details in the physiological processes. This transparency makes it possible to search for explanations to treatment phenomena. One drawback with the model is that it is quite complex and requires some knowledge from a user with the ambition to understand all the processes. To measure the impact of Särimner training, 11 diabetic teenagers were evaluated with respect to metabolic control, emotional adjustment, focus of control, self-esteem and ability to discuss treatment phenomena. No control group was possible to recruit. The results indicated that the education had been useful for some individuals. They increased their knowledge and ability to discuss treatment situations, their sense of control over the diabetes treatment, their self esteem and furthermore Särimner education may have caused a reduction of diabetes related stress. However, an increased level of diabetes related guilt did occur in some individuals, possibly due to either increased knowledge or a more internalised focus of control. The models ability to look alike reality is depending on for which purpose it is used. Even though it would be theoretically possible to fit the model to an individual, such an experiment would not be performable in reality since Särimner requires input data from the physiology which is impossible to measure. The properties of the model are, however, adequate for illustrating several treatment situations on a phenomenological level