BASREP: a method for maintaining euglycemia during somatostatin suppression of pancreatic secretion.
A glucagon infusion algorithm has been developed to reestablish basal glycemia when pancreatic insulin and glucagon secretion are inhibited by somatostatin (SRIF). When insulin alone is infused intraportally during SRIF to replace endogenous hormone release, hypoglycemia is generated by the combined actions of both peptides. In the presence of SRIF infusion, the normal physiologic response to hypoglycemia, i.e. stimulation of glucagon secretion and glucagon-induced increase in hepatic glucose production, has been prevented. Our computer algorithm, "BASREP", was designed to mimic the normal pancreatic counterregulatory response by substituting endogenous alpha-cell secretion with exogenous intraportal infusion. Sequential measurements of glucose concentration are analyzed with a minimal mathematical model of glucose disappearance, adapted to include a variable to describe glucagon stimulation of hepatic glucose production. Based upon the observed change in plasma glucose, BASREP computes after every sample the infusion rate of glucagon necessary to stimulate glucose production and maintain desired glucose level. This method minimizes instabilities and should prove useful in future investigations of glucose metabolism.
Institute of System Dynamics and Bioengineering (LADSEB-CNR), Padova, Italy.
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Pacini
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Ader
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Bergman
D000465:Algorithms; D000818:Animals; D001786:Blood Glucose / Q000032:analysis / Q000187:drug effects*; D003936:Diagnosis, Computer-Assisted / Q000295:instrumentation / Q000379:methods / Q000592:standards; D004285:Dogs; D005069:Evaluation Studies as Topic; D005934:Glucagon / Q000008:administration & dosage / Q000627:therapeutic use*; D007003:Hypoglycemia / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D012985:Software Design; D013004:Somatostatin / Q000493:pharmacokinetics / Q000494:pharmacology*; D013813:Therapy, Computer-Assisted / Q000295:instrumentation / Q000379:methods / Q000592:standards*
D001786:Blood Glucose; D007328:Insulin; D013004:Somatostatin; D005934:Glucagon