Development and Simulation of an Automated Control Algorithm for Insulin Therapy of Hyperglycemic Emergencies in Diabetes
DOI:
https://doi.org/10.17488/RMIB.41.2.1Keywords:
Insulin infusion system, closed-loop glucose control, diabetes complications, diabetic ketoacidosis, artificial pancreasAbstract
This paper describes the development and simulation of an algorithm for the automatic control of insulin infusion, in the glycemic management of patients with diabetic ketoacidosis (CAD) and hyperglycemic hyperosmolar state (EHH). An algorithm was programmed to calculate the requirement insulin for a glycemic decrease of 50 mg/dL/h until reach 250 mg/dL in blood glucose levels, and thus maintaining it at 220 mg/dL until the pathology remission. The software simulation was performed using glycemic records of 10 patients with CAD managed in the Hospital Juárez de México. The results of the simulation showed a lower incidence of hypoglycemia, as well as a lower insu-lin requirement within the treatment, without differences in the average glucose decreases per hour between real and simulated measurements. This software proposes an innovative use of the artificial pancreas in hyperglycemic emergencies, and also implementing the use of insulin sensitivity as a variable for their function. The results show that the algorithm could be able to achieve glycemic management attached to the treatment guidelines, generating lower insulin expenditure and avoiding hypoglycemia during therapy, with a possible application in autonomous biomedical devices.
Downloads
References
Fayman M, Pasquel FJ, Umpierrez G. Management of hyperglycemic crises. Med Clin N Am. 2017; 103(3): 587-606.DOI: 10.1016/j.mcna.2016.12.011
Gosmanov AR, Gosmanova EO, Kitabchi AE. Hyperglycemic crises: Diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar state (HHS). Endotext [Internet]. 2018 May. Available from:https://www.ncbi.nlm.nih.gov/books/NBK279052/
Escobedo J, Rico B. Incidencia y letalidad de las complicaciones agudas y crónicas de la diabetes mellitus en México. Salud Públ Méx. 1996; 38(4): 236-242.
Domínguez M, Calderón MA, Matías R. Características clínico epidemiológicas de las complicaciones agudas de la diabetes en el servicio de urgencias del Hospital General de Atizapán. Rev Fac Med. 2013; 56(2): 25-36.
Karslioglu-French E, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ. 2019; 365: I1114. DOI: 10.1136/bmj.l1114
Kibachi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009; 32(7): 13 35 -13 45 . DOI: 10.2337/dc09-9032
Ghimire P, Dhamoon AS. Ketoacidosis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534848/
Dhatariya KK, Vellanki P. Treatment of diabetic ketoacidosis (DKA)/ Hyperglycemic hyperosmolar state (HHS): Novel advances in the management of hyperglycemic crises (UK versus USA). Curr Diab Rep. 2017; 17(5). DOI: 10.1007/s11892-017-0857-4
Goguen J, Gilbert J. Hyperglycemic emergencies in adults. Can J Diabetes. 2018; 42: S109-S114. DOI: 10.1016/j.jcjd.2017.10.013
Fernández J, Galindo C, Barbacho J, Luque A. Automatic control systems in biomedical engineering. 1a ed. Springer International Publishing; 2018. DOI: 10.1007/978-3-319-75717-9
Thabit H, Hovorka R. Closed-loop insulin delivery in type 1 diabetes. Endocrinol Metab Clin N Am. 2012; 41: 105-117.DOI: 10.1016/j.ecl.2011.12.003
Waugh N, Adler A, Craigie I, Omer T. Closed loop system in type 1 diabetes. BMJ. 2018; 361: K1613. DOI: 10.1136/BMJ.K1613
Steil GM, Rebrin K, Darwin C, Hariri F, Saad MF. Feasibility of automating insulin delivery for the treatment of type 1 diabetes. Diabetes. 2006; 55(12): 3344-3350. DOI: 10.2337/db06-0419
Huyett LM, Dassau E, Zisser HC, Doyle FJ. Design and evaluation of a robust PID controller for a fully implantable artificial pancreas. Ind Eng Chem Res. 2015; 54(42): 10311-10321.DOI: 10.1021/acs.iecr.5b01237
Hu R, Li C. An improved PID algorithm based in insulin-on-board estimate for blood glucose control with type 1 diabetes. Comput Math Method M. 2015; 2015: 281589. DOI: 10.1155/2015/281589
Pisker JE, Lee JB, Daussau E, Seborg DE, Bradley PK, Gondhalekar R, et al. Randomized crossover comparison of personalized MPC and PID control algotihms for the artificial pancreas. Diabetes Care. 2016; 39(7): 1135-1142. DOI: 10.2337/dc15-2344
Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, Wall BM. Management of hyperglycemic crisis in patients with diabetes. Diabetes Care. 2001; 24(1): 131-153.DOI: 10.2337/diacare.24.1.131
Luzi L, Barrett FJ Groop LC, Ferrannini F, DeFronzo RA. Metabolic effects of low-dose insulin therapy on glucose metabolism in diabetic ketoacidosis. Diabetes. 1988; 37(11): 1470.DOI: 10.2337/diab.37.11.1470
Davidson PC, Hebblewhite HR, Steed RD, Bode BW. Analysis of guidelines for basal-bolus insulin dosing: basal insulin, correction factor, and carbohydrate to insulin ratio. Endocr Pract. 2008; 14(9): 1095-1101. DOI: 10.4158/EP.14.9.1095
Steil GM, Palerm CC, Kurtz N, Voskanyan G, Roy A, Paz S, Kandeel FR. The effect of insulin feedback on closed loop glucose control. J Clin Endocrinol Metab. 2011; 96(5): 1402-1408.DOI: 10.1210/jc.2010-2578
Rasmussen CH, Roge RM, Ma Z, Thomsen M, Thorisdottir RL, Chen J-W, et al. Insulin aspart pharmacokinetics: An assessment of its variability and underlying mechanisms. Eur J Pharm Sci. 2014; 62: 65-75 . DOI: 10.1016/j.ejps.2014.05.010
Soeborg T, Rasmussen CH, Mosekilde E, Colding-Jorgensen M. Absorption kinetics of insulin after subcutaneous administration. Eur J Pharm Sci. 2009; 36(1): 78-90.DOI: 10.1016/j.ejps.2008.10.018
Mosekilde E, Jensen KS, Binder C, Pramming S, Thorsteinsson B. Modeling absorption kinetics of subcutaneous injected soluble insulin. J Pharm Biopharm. 1989; 17(1): 67-87.DOI: 10.1007/bf01059088
Flores E, Miranda MG, Villasís MA. El protocol de investigación VI: cómo elegir la prueba estadística adecuada. Estadística inferencial. Rev Alerg Mex. 2017; 64(3): 364-370.DOI: 10.29262/ram.v64i3.304
Jacobs PG, Youssef JE, Castle JR, Engle JM, Branigan DL, Johnson P, el al. Development of a fully automated closed loop artificial pancreas control system with dual pump delivery of insulin and glucagon. 33rd Annual International Conference of the IEEE EMBS; 2011 Aug 30 – Sep 03; Massachusetts, USA: IEEE; 2011.DOI: 10.1109/iembs.2011.6090127
Raghupathy P. Diabetic ketoacidosis in children and adolescents. Indian J Endocrinol Metab. 2015 (Suppl 1); S55-S57.DOI: 10.4103/2230-8210.155403
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Revista Mexicana de Ingeniería Biomédica
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Upon acceptance of an article in the RMIB, corresponding authors will be asked to fulfill and sign the copyright and the journal publishing agreement, which will allow the RMIB authorization to publish this document in any media without limitations and without any cost. Authors may reuse parts of the paper in other documents and reproduce part or all of it for their personal use as long as a bibliographic reference is made to the RMIB. However written permission of the Publisher is required for resale or distribution outside the corresponding author institution and for all other derivative works, including compilations and translations.
