Optimization of Insulin Dosing in Patients with Type 1 Diabetes Mellitus
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abstract
Type I Diabetes Mellitus is a lifelong disease characterized by elevated blood glucose levels due to lack of insulin, resulting from autoimmune mediated destruction of the insulin-producing beta cells of the pancreas. Insulin regulates blood glucose levels by permitting glucose to enter the human cells to provide them with energy. Patients with type I diabetes require exogenous insulin administration to regulate their blood glucose concentration. Optimization of insulin dosing minimizes the risk of possible hypoglycaemia (over-dosing) and avoids hyperglycaemia (under-dosing). Rigorous optimization studies are performed for 10 patients with type 1. DM on an insulin pump, using the UVa/Padova T1DM Simulator as the process model. The insulin bolus, given to compensate for food consumption, is optimized in terms of time to peak maximum effect and also basal and bolus dosing balance during a meal is considered. These results are compared with conventional insulin dosing obtained in the literature and finally the insulin regimen that normalizes the glucose curve more effectively - maintain blood glucose concentration within the normal range - is determined. Additionally, an alternative to bolus insulin dosing is evaluated and the two dosing types are compared, again in terms of their effect on glucose concentration. This study intends to identify the most effective dosing strategy to be further used as a background guideline in closed loop studies. 2014 Elsevier B.V.
