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Empowering kids with diabetes in rural areas
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Umeå Institute

of Design

How might we give nurses a tool to empower children with diabetes type 1, as well as their families and community, at a distance?

tools & methods






collaboration with 

the team

Laura Bisbe

Sam Zandbergen

Rachel Zheng

Amanda Wallgren (Me)


In rural areas, such as big parts of the north of Sweden, the access to health- and social care is poor due to the long distances. In addition to this, they have an aging population, where about 30% are over 65 years old. This puts a lot of pressure on health care and has raised a wish to work more preventatively in the future- especially when it comes to chronic diseases such as diabetes.


Our final concept Koi supports nurses, aiming to help kids with diabetes type 1 in rural areas in order for them to avoid future complications, by providing tools that can be used at a distance in-between hospital visits. The tools both give practical as well as mental support and can be used by both the patient as well as the people around them, in order for everyone to learn and feel confident in handling diabetes type 1.

my role 

During the first period of this project, I put a lot of focus on research, interviewing and observing, and ideation by building quick prototypes. In the later part, I worked on the look, feel, and character of the Koi Companion as well as its light pattern using Arduino. In addition to this, I explored and designed the final look of the Nurse Platform interface.




Diabetes has increased by 40% in Västerbotten (north of Sweden) between 2009–2019. Diabetes, if not managed well, can lead to devastating complications, such as heart disease, nerve damage, blindness, kidney failure, amputations, AND mental illness.

Our process while creating Koi

Rapid prototypes & acting out scenarios

Simultaneously with conducting interviews we started to build quick prototypes that we used to act out different scenarios. This enabled us to freely discuss, criticize and find the weak parts of each concept as well as give the group something physical to collaborative gather around.

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Concept overview of Koi

Koi consists of a series of Toolboxes that nurses can prescribe to kids to be used in-between hospital visits. Today, clear learning goals for different age groups already exist when it comes to diabetes. We, therefore, envision that there would exist different Toolboxes for kids of different ages following these learning goals. However, for this project, we choose to develop the Toolbox for kids 7-9 years old. This since it is, according to existing learning goals, the age when kids would be expected to start learning by themselves how to handle their diabetes. Furthermore, it is also an age where they would commonly start school and be put in a totally new environment where both they, but also the people around them, eg. teachers would benefit from learning more.

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Refining prototypes

After agreeing on the final concept we continued to develop the prototypes. There was also time to explore how the Koi Companion should communicate with the user which we did by trying out different light and vibration patterns using an Arduino inside the toy.

refining prototypes

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final result: koi

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Through a Toolbox for kids 7-9 years old, diabetes nurses can provide both emotional as well as practical support at a distance.

The Distance Toolbox for kids 7-9 years old

To tackle the main issues found in our research, two products were developed for the Toolbox for Kids 7-9 Years Old: Koi Companion to support emotionally, and the Education Board for practical learning.

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Koi Companion: Emotional Support

This is Koi Companion, the tool that is meant to answer the emotional support the kid might need. It also enables a way for the kid to externalize their disease — by taking care of the Koi Companion they are also taking care of themselves.

When the toy is hugged it reads the values of the glucose sensor (that today most people with diabetes wear on their arm) using an NFC reader. It then retrieves the kid's values and provides haptic and visual feedback through different light- and vibration patterns.

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Blood sugar level is dangerously low

Blood sugar level is good

Blood sugar level is dangerously high

The Education Board: Practical Support

The Education Board answers to the practical learning that the kid needs. One example is learning how to calculate the amount of insulin that is needed depending on what they plan to eat.

The board comes with different tokens, representing different types of food and then connects to a mobile app where the kid will find different challenges. Because everyone's diabetes is different, the kid will participate in both general, as well as customized challenges assigned by their diabetes nurse. 


The overarching Diabetes Nurse platform

The Nurse platform keeps everything together. Here diabetes nurses can keep track of kids' health data while, at the same time, supporting them through their learning journeys at a distance. They can see how the kids are interacting with both the Koi Companion as well as the Education Board, and how this relates to their blood sugar levels at any given time. Later they can use this material as a base for discussion with the kid and their parents during hospital visits.

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Involving the entire community

We envision that besides distributing these different Toolboxes to kids to use at home, we could also send them to schools. For example, The Education Board could be used in class during math lessons since it, besides teaching the basics of diabetes, also aligns with the math goals kids at that age will learn. The Koi Companion can function as a class mascot, that each week a student is allowed to bring home and take care of, also highlighting the conversation of diabetes in their house. While increasing awareness, among teachers and classmates (and their parents) a safety net will be created around the kid living with diabetes.


Koi at world Expo 2020 in Dubai

Due to the COVID-19 pandemic, Expo 2020 was postponed by one year and opened the 1 October 2021 to 31 March 2022. This enabled us to exhibit Koi at the Swedish Pavillion together with the center for Rural Medicin in Storuman.

We heard back from the people at the exhibition that one child visiting the exhibition was a bit "naughty" and played with the KOI material, even though there were signs not to touch. What happened was that the child started to play with the toy in the exact way it was intended without any instructions, a cute story!


-  Learnings & Retrospective  -

This project touched on a quite personal subject for one of the team members who had a family member with diabetes. I however had never before realized the extent of how this disease changes people's lives, and this was a real eye-opener leaving me feeling extremely humbled and grateful for the people that agreed to talk to us about it.
What I learned during this project was the perks of working simultaneously with research, through talking to potential users, at the same time as starting to ideate and build prototypes. We initially started by only conducting user research, however, due to time constraints we were advised to already begin the synthesizing phase and to start making things without completing our research. This at first felt uncomfortable, nevertheless, after only starting the advantages of being able to analyze, through continued research, and synthesize, through making prototypes, at the same time were clear. This approach opened for creativity and made us move faster in the project.
If we would have been able to continue the project I would have loved to move into the next phase of actually testing the concept on potential real users. Both when it comes to the overall concept but also a validation of for example the light and haptic feedback patterns we designed for Koi. The only validation we now received was by talking with patients and medical professionals over video calls. This would probably have guided the project in a new direction which would be interesting to see.

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