A MODEL FOR MULTIPLE SUBCUTANEOUS INSULIN INJECTIONS DEVELOPED FROM INDIVIDUAL DIABETIC PATIENT DATA

Many diabetic patients taking multiple subcutaneous insulin injections cannot adjust their dosage appropriately to maintain blood glucose wi thin a normal range. It is hard to predict how dosage changes and phys iological fluctuations affect insulin levels and subsequently glucose control. To examine these issues, we have developed a model representi ng the link between dosage and blood insulin levels. Our model adequat ely predicts insulin concentrations for individual patients and could be incorporated into an overall glucose-insulin representation. More i mportantly, parameter and sensitivity analysis results highlight insul in kinetic features that are difficult to isolate in a clinical settin g and that may significantly influence glucose dynamics. For example, large interpatient variation, measured quantitatively by model paramet ers, emphasizes the need for individualized design of insulin regimens . Intrapatient variations are also large in some patients. Improved co ntrol for these patients may only be possible through more frequent sa mpling and control action. The sensitivity coefficient for absorption suggests a significant overlapping injection effect that is not consid ered in present patient management strategies.