A simulation model of insulin saturation and glucose balance for glycemic control in ICU patients

• Published in: Computer methods and programs in biomedicine 2010-03, Vol.97 (3), p.211-222
• Main Authors: Pielmeier, Ulrike, Andreassen, Steen, Nielsen, Birgitte S, Chase, J. Geoffrey, Haure, Pernille
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Blood Glucose - analysis; Critical care; Glucose control; Humans; Hyperglycemia; Insulin - administration & dosage; Intensive Care Units; Internal Medicine; Medical sciences; Metabolic modelling; Models, Biological; Other; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Technology. Biomaterials. Equipments. Material. Instrumentation
• ISSN: 0169-2607; 1872-7565
• DOI: 10.1016/j.cmpb.2009.06.004

Abstract Consistent tight blood sugar control in critically ill patients has proven elusive. Properly accounting for the saturation of insulin action and reducing the need for frequent measurements are important aspects in intensive insulin therapy. This paper presents a composite metabolic model, ‘Glucosafe’, that integrates models and parameters from normal physiology and accounts for the reduced rate of glucose gut absorption and saturation of insulin action in patients with reduced insulin sensitivity. Particularly, two different sites of reduced insulin sensitivity, before and after the non-linearity of insulin action, are explored with this model. These approaches are assessed based on the model’s accuracy in retrospectively predicting blood glucose measurements of 10 randomly chosen, hyperglycemic intensive care patients. For each patient, median absolute percent error is