A model for multiple subcutaneous insulin injections developed from individual diabetic patient data.

Many diabetic patients taking multiple subcutaneous insulin injections cannot adjust their dosage appropriately to maintain blood glucose within a normal range. It is hard to predict how dosage changes and physiological fluctuations affect insulin levels and subsequently glucose control. To examine these issues, we have developed a model representing the link between dosage and blood insulin levels. Our model adequately predicts insulin concentrations for individual patients and could be incorporated into an overall glucose-insulin representation. More importantly, parameter and sensitivity analysis results highlight insulin kinetic features that are difficult to isolate in a clinical setting and that may significantly influence glucose dynamics. For example, large interpatient variation, measured quantitatively by model parameters, emphasizes the need for individualized design of insulin regimens. Intrapatient variations are also large in some patients. Improved control for these patients may only be possible through more frequent sampling and control action. The sensitivity coefficient for absorption suggests a significant overlapping injection effect that is not considered in present patient management strategies.