Steady-state optimal insulin infusion for hyperglycemic ICU patients

Close control of blood glucose levels significantly reduces vascular complications in diabetes, as well as having beneficial effect for cardiac and other critical care patients. Recent studies have shown that tight regulation of blood glucose level in intensive care unit patients can reduce mortality by as much as 45%. This paper presents an optimal insulin infusion algorithm to tightly regulate blood glucose for ICU and other critical care patients when the glucose input is known. Results show an ideal, flat blood glucose response when subjected to a typical ICU glucose input as well as for a far more extreme case.

[1]  T. Yoneyama,et al.  A robust controller for insulin pumps based on H-infinity theory , 1993, IEEE Transactions on Biomedical Engineering.

[2]  C. Cobelli,et al.  A physiological simulation model of the glucose-insulin system , 1999, Proceedings of the First Joint BMES/EMBS Conference. 1999 IEEE Engineering in Medicine and Biology 21st Annual Conference and the 1999 Annual Fall Meeting of the Biomedical Engineering Society (Cat. N.

[3]  M. Ellmerer,et al.  Continuous ex vivo monitoring of glucose in blood and subcutaneous tissue fluid , 1994, Proceedings of 16th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[4]  M Schetz,et al.  Intensive insulin therapy in critically ill patients. , 2001, The New England journal of medicine.

[5]  R. Ollerton Application of optimal control theory to diabetes mellitus , 1989 .

[6]  P. Zimmet,et al.  Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation , 1998, Diabetic medicine : a journal of the British Diabetic Association.

[7]  J. Skyler,et al.  Algorithms for Adjustment of Insulin Dosage by Patients Who Monitor Blood Glucose , 1981, Diabetes Care.

[8]  D R Worthington The use of models in the self-management of insulin-dependent diabetes mellitus. , 1990, Computer methods and programs in biomedicine.

[9]  B. Bistrian,et al.  Intensive insulin therapy in critically ill patients. , 2002, The New England journal of medicine.

[10]  A. S. Hodel,et al.  Automatic control issues in the development of an artificial pancreas , 1995, Proceedings of 1995 American Control Conference - ACC'95.

[11]  M. Fisher,et al.  A semiclosed-loop algorithm for the control of blood glucose levels in diabetics , 1991, IEEE Transactions on Biomedical Engineering.

[12]  D Rodbard,et al.  A pharmacodynamic approach to optimizing insulin therapy. , 1991, Computer methods and programs in biomedicine.

[13]  E. Kraegen,et al.  Blood Glucose Control by Intermittent Loop Closure in the Basal Mode: Computer Simulation Studies with a Diabetic Model , 1985, Diabetes Care.

[14]  F. Doyle,et al.  Control and modeling of drug delivery devices for the treatment of diabetes , 1995, Proceedings of 1995 American Control Conference - ACC'95.

[15]  E D Lehmann,et al.  Computer assisted diabetes care: a 6-year retrospective. , 1996, Computer methods and programs in biomedicine.

[16]  Nicholas A. Peppas,et al.  Model predictive control for infusion pump insulin delivery , 1996, Proceedings of 18th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[17]  E D Lehmann,et al.  AIDA2: a Mk. II automated insulin dosage advisor. , 1993, Journal of biomedical engineering.

[18]  R N Bergman,et al.  Assessment of insulin sensitivity in vivo. , 1985, Endocrine reviews.

[19]  J. Geoffrey Chase,et al.  Active insulin infusion control of the blood glucose derivative , 2002, 7th International Conference on Control, Automation, Robotics and Vision, 2002. ICARCV 2002..

[20]  Claudio Cobelli,et al.  An integrated mathematical model of the dynamics of blood glucose and its hormonal control , 1982 .

[21]  E. Kraegen,et al.  Insulin responses to varying profiles of subcutaneous insulin infusion: kinetic modelling studies , 1984, Diabetologia.

[22]  P. Wach,et al.  Evaluation of subcutaneous route for closed-loop control of insulin delivery: numerical and experimental studies , 1995, Proceedings of 17th International Conference of the Engineering in Medicine and Biology Society.