title: A quadruply-asymmetric sigmoid to describe the insulin-glucose relationship during intravenous insulin infusion.
abstract: For hospitalized patients requiring intravenous insulin therapy, an objective is to quantify the intravenous insulin infusion rate (IR) across the domain of blood glucose (BG) values at a single timepoint. The algorithm parameters include low BG (70 mg/dL), critical high BG, target range BG limits, and maintenance rate (MR) of insulin infusion, which, after initialization, depends on rate of change of blood glucose, previous IR, and other inputs. The restraining rate (RR) is a function of fractional completeness of ascent of BG (FCABG) from BG 70 mg/dL to target. The correction rate (CR) is a function of fractional elevation of BG (FEBG), in comparison to elevation of a critical high BG, above target. IR = RR + CR. The proposed mathematical model describing a sigmoidal relationship between IR and BG may offer a safety advantage over the linear relationship currently employed in some intravenous glucose management systems.
authors.affiliation: Department of Mathematics, Statistics, and Computer Science, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Braithwaite
authors.affiliation: Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Guillermo E
authors.initials: GE
authors.lastname: Umpierrez
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Braithwaite
mesh_terms: D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis* / Q000378:metabolism; D016883:Diabetic Ketoacidosis / Q000517:prevention & control; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000517:prevention & control; D007003:Hypoglycemia / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008962:Models, Theoretical
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: algorithms; critical Illness; diabetic ketoacidosis; hyperglycemia/drug therapy; hyperglycemic hyperosmolar state; hypoglycemia/chemically induced/prevention & control; insulin/therapeutic use