scholarly journals Blood Glucose Control Using a Novel Continuous Blood Glucose Monitor and Repetitive Intravenous Insulin Boluses: Exploiting Natural Insulin Pulsatility as a Principle for a Future Artificial Pancreas

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Nils K. Skjaervold ◽  
Dan Östling ◽  
Dag R. Hjelme ◽  
Olav Spigset ◽  
Oddveig Lyng ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glucose Control ◽  
Artificial Pancreas ◽  
Blood Glucose Control ◽  
Calibration Procedure ◽  
Target Range ◽  
Glucose Levels ◽  
Intravenous Insulin ◽  
Oscillatory Pattern ◽  
Blood Glucose Monitor

The aim of this study was to construct a glucose regulatory algorithm by employing the natural pulsatile pattern of insulin secretion and the oscillatory pattern of resting blood glucose levels and further to regulate the blood glucose level in diabetic pigs by this method. We developed a control algorithm based on repetitive intravenous bolus injections of insulin and combined this with an intravascular blood glucose monitor. Four anesthetized pigs were used in the study. The animals developed a mildly diabetic state from streptozotocin pretreatment. They were steadily brought within the blood glucose target range of 4.5–6.0 mmol/L in 21 to 121 min and kept within that range for 128 to 238 min (hypoglycemic values varied from 2.9 to 51.1 min). The study confirmed our hypotheses regarding the feasibility of this new principle for blood glucose control, and the algorithm was constantly improved during the study to produce the best results in the last animals. The main obstacles were the drift of the IvS-1 sensor and problems with the calibration procedure, which calls for an improvement in the sensor stability before this method can be applied fully in new studies in animals and humans.

scholarly journals Problems and methods of a closed-loop blood glucose control system construction

2021 ◽  
Vol 2091 (1) ◽  
pp. 012020
Author(s):  
E L Litinskaia ◽  
K V Pozhar ◽  
N M Zhilo
Keyword(s):  
Control System ◽  
Blood Glucose ◽  
Glucose Control ◽  
Closed Loop ◽  
Experimental Testing ◽  
Blood Glucose Control ◽  
Control Object ◽  
Target Range ◽  
Glucose Levels ◽  
Adaptive Adjustment

Abstract The automation of the insulin therapy in the closed-loop blood glucose control system is accompanied by such problems as delays of the feedback and the controlling action effect on blood glucose dynamics, difficulties in low and high glucose levels advance detection and timely compensation, a human factor, complexity of a mathematical model of control object building, evaluation of blood glucose control efficiency. In the paper, these automation problems and methods for their compensation are considered. The closed-loop system based on the model predictive control, adaptive adjustment of the controlling action and decision-making support was developed. Experimental testing with UVA/Padova Type 1 Diabetes Mellitus Simulator showed that the application of suggested methods in the closed-loop allows increasing the efficiency of the blood glucose maintaining in the target range.

Evolution Of β-Tg Level In Diabetic Patients Undergoing Artificial Pancreas Treatment

1981 ◽  
Author(s):  
Ph Voisin ◽  
D Rouselle ◽  
C Guimont ◽  
P Drouin ◽  
J F Stoltz
Keyword(s):  
Blood Glucose ◽  
Glucose Control ◽  
Healthy Subjects ◽  
Artificial Pancreas ◽  
Blood Glucose Control ◽  
Specific Protein ◽  
Diabetic Patients ◽  
Glucose Levels ◽  
Insulin Dependent ◽  
Insulin Dependent Diabetic

Plasma β-thromboglobulin was measured at 0, 24 and 48 hours on 27 healthy subjects and 22 insulin-dependent diabetic patients undergoing a 48-hour artificial pancreas treatment (Biostator).Before treatment all the diabetic patients revealed β-TG levels which were significantly higher than those measured in healthy subjectsOn average, after 24 hours of blood glucose control, β-TG levels in the diabetic patients were not significantly reduced in comparison with the original β-TG levels. In contrast, after 48 hours of blood glucose control, plasma β-TG levels were significantly reduced.As β-TG is a platelet-specific protein, which is considered to be an indicator of the cell’s release reaction, these results suggest that short-term control of blood glucose levels is likely to influence platelet activation in diabetic patients.

Adherence to and Efficacy and Safety of an Insulin Protocol in the Critically Ill: A Prospective Observational Study

2007 ◽  
Vol 16 (6) ◽  
pp. 599-608 ◽  
Author(s):  
Sandra G. Oeyen ◽  
Eric A. Hoste ◽  
Carl D. Roosens ◽  
Johan M. Decruyenaere ◽  
Stijn I. Blot
Keyword(s):  
Blood Glucose ◽  
Critically Ill ◽  
Glucose Control ◽  
Blood Glucose Control ◽  
Target Range ◽  
Efficacy And Safety ◽  
Protocol Implementation ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Implementation Time

Background Blood glucose control during acute illness has been associated with improved outcomes. Objectives To evaluate adherence to and efficacy and safety of an insulin protocol for critically ill patients with target blood glucose levels between 81 and 110 mg/dL and to determine factors associated with adequate daily blood glucose control. Methods In a prospective observational study, blood glucose levels were determined in 30 patients in intensive care units of a tertiary care university hospital during a 2-month period. All glucose measurements and corresponding insulin infusion rates were evaluated for adherence to and efficacy and safety of the insulin protocol. Linear regression analysis was used to determine factors associated with adequate daily blood glucose control, defined as time in the target range. Results A total of 6016 blood glucose measurements were obtained during 352 protocol implementation days. Adherence to the protocol was 71%. Blood glucose levels were in the desired range 42% of the total protocol implementation time. Sixty percent of the patients experienced at least one hypoglycemic event. Adherence to the protocol (P < .001), high bilirubin level (P < .001), low daily insulin dose (P = .002), and low C-reactive protein level (P = .048) were independently associated with adequate daily blood glucose control. Conclusions Protocol adherence was positively associated with daily time in the target range, but efficacy during the total protocol implementation time remained poor. Because of the frequency of hypoglycemia, protocols to maintain blood glucose levels between 81 and 110 mg/dL in critically ill patients may not be recommended.

Blood Glucose Control by a Model Predictive Control Algorithm with Variable Sampling Rate Versus a Routine Glucose Management Protocol in Cardiac Surgery Patients: A Randomized Controlled Trial

2007 ◽  
Vol 92 (8) ◽  
pp. 2960-2964 ◽  
Author(s):  
Roman Hovorka ◽  
Jaromir Kremen ◽  
Jan Blaha ◽  
Michal Matias ◽  
Katerina Anderlova ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Glucose ◽  
Model Predictive Control ◽  
Predictive Control ◽  
Glucose Control ◽  
Insulin Infusion ◽  
Sampling Rate ◽  
Blood Glucose Control ◽  
Target Range ◽  
Management Protocol

Abstract Context: Elevated blood glucose levels occur frequently in the critically ill. Tight glucose control by intensive insulin treatment markedly improves clinical outcome. Objective and Design: This is a randomized controlled trial comparing blood glucose control by a laptop-based model predictive control algorithm with a variable sampling rate [enhanced model predictive control (eMPC); version 1.04.03] against a routine glucose management protocol (RMP) during the peri- and postoperative periods. Setting: The study was performed at the Department of Cardiac Surgery, University Hospital. Patients: A total of 60 elective cardiac surgery patients were included in the study. Interventions: Elective cardiac surgery and treatment with continuous insulin infusion (eMPC) or continuous insulin infusion combined with iv insulin boluses (RMP) to maintain euglycemia (target range 4.4–6.1 mmol/liter) were performed. There were 30 patients randomized for eMPC and 30 for RMP treatment. Blood glucose was measured in 1- to 4-h intervals as requested by each algorithm during surgery and postoperatively over 24 h. Main Outcome Measures: Mean blood glucose, percentage of time in target range, and hypoglycemia events were used. Results: Mean blood glucose was 6.2 ± 1.1 mmol/liter in the eMPC vs. 7.2 ± 1.1 mmol/liter in the RMP group (P < 0.05); percentage of time in the target range was 60.4 ± 22.8% for the eMPC vs. 27.5 ± 16.2% for the RMP group (P < 0.05). No severe hypoglycemia (blood glucose < 2.9 mmol/liter) occurred during the study. Mean insulin infusion rate was 4.7 ± 3.3 IU/h in the eMPC vs. 2.6 ± 1.7 IU/h in the RMP group (P < 0.05). Mean sampling interval was 1.5 ± 0.3 h in the eMPC vs. 2.1 ± 0.2 h in the RMP group (P < 0.05). Conclusions: Compared with RMP, the eMPC algorithm was more effective and comparably safe in maintaining euglycemia in cardiac surgery patients.

scholarly journals Survey about do-it-yourself closed loop systems in the treatment of diabetes in Germany

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243465
Author(s):  
Anna Laura Herzog ◽  
Jonas Busch ◽  
Christoph Wanner ◽  
Holger K. von Jouanne-Diedrich
Keyword(s):  
Blood Glucose ◽  
Glucose Control ◽  
Closed Loop ◽  
Artificial Pancreas ◽  
Direct Interaction ◽  
Loop System ◽  
Closed Loop System ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Do It Yourself

Continuous glucose monitoring (CGM) improves treatment with lower blood glucose levels and less patient effort. In combination with continuous insulin application, glycemic control improves and hypoglycemic episodes should decrease. Direct feedback of CGM to continuous subcutaneous insulin application, using an algorithm is called a closed-loop (CL) artificial pancreas system. Commercial devices stop insulin application by predicting hypoglycemic blood glucose levels through direct interaction between the sensor and pump. The prediction is usually made for about 30 minutes and insulin delivery is restarted at the previous level if a rise in blood glucose is predicted within the next 30 minutes (hybrid closed loop system, HCL this is known as a predictive low glucose suspend system (PLGS)). In a fully CL system, sensor and pump communicate permanently with each other. Hybrid closed-loop (HCL) systems, which require the user to estimate the meal size and provide a meal insulin basis, are commercially available in Germany at the moment. These systems result in fewer hyperglycemic and hypoglycemic episodes with improved glucose control. Open source initiatives have provided support by building do-it-yourself CL (DIYCL) devices for automated insulin application since 2014, and are used by a tech-savvy subgroup of patients. The first commercial hybrid CL system has been available in Germany since September 2019. We surveyed 1054 patients to determine which devices are currently used, which features would be in demand by potential users, and the benefits of DIYCL systems. 9.7% of these used a DIYCL system, while 50% would most likely trust these systems but more than 85% of the patients would use a commercial closed loop system, if available. The DIYCL users had a better glucose control regarding their time in range (TIR) and glycated hemoglobin (HbA1c).

scholarly journals Correlation Between Blood Glucose Control And Decrease Of Peripheral Vascularization In Diabetes Mellitus Patient

2018 ◽  
Vol 4 (1) ◽  
pp. 18
Author(s):  
Fitria Endah Janitra ◽  
Dinda Sandika
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Glucose Control ◽  
Diabetes Management ◽  
Blood Glucose Control ◽  
Nursing Intervention ◽  
Tissue Ischemia ◽  
Control Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels

Introduction: Diabetes mellitus (DM) is a metabolic disorder characterized by elevated blood glucose levels. Chronic complications of DM affect coronary circulation, peripheral vascularization, and blood vessels of the brain. Decrease in peripheral vascularization increases the risk of tissue ischemia and weakens functional status, therefore it is necessary to control blood glucose levels. Islam teaches to its believers to control their diet, where diet is one of the four pillars of diabetes management. Methodology: this is analytic descriptive research with cross sectional methods in 67 respondents taken by consecutive sampling technique. Results: There was a significant correlation within blood glucose control and decreased peripheral vascularization in DM patients (p-value 0.010). Discussion: need further research regarding nursing intervention to control blood glucose.

Changes in corneal and lens autofluorescence and blood glucose levels in diabetics: parameters of blood glucose control

1997 ◽  
Vol 16 (6) ◽  
pp. 534-538 ◽  
Author(s):  
Fumihiko Mori ◽  
Satoshi Ishiko ◽  
Tohru Abiko ◽  
Norihiko Kitaya ◽  
Yuji Kato ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glucose Control ◽  
Blood Glucose Control ◽  
Glucose Levels ◽  
Blood Glucose Levels
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