AJP - Endocrinology and Metabolism, Vol 269, Issue 6 E1115-E1124, Copyright © 1995 by American Physiological Society
A model for multiple subcutaneous insulin injections developed from individual diabetic patient data
W. R. Puckett and E. N. Lightfoot
Chemical Engineering Department, University of Wisconsin-Madison 53706, USA.
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.
