title: Accuracy and optimization of a subcutaneous insulin model for less acute critical care patients.
abstract: Extending safe, effective glycemic control to the general wards requires a simple approach using subcutaneous (SC) insulin. However, this approach can increase relative risk compared to intravenous insulin due to the increased variability of SC insulin appearance. This paper evaluates the accuracy of a SC plasma insulin model and optimizes its parameters using measured plasma insulin data from 6 less acute critical care patients treated with SC insulin. The SC plasma insulin model used captures the dynamics of regular SC insulin well. However, there appears to be a positive bias leading to an overall median [IQR] residual error of -28.3 [-37 - 19] mU/L. The optimized model reduced the RMS residual error by 20-70% for each patient. The distinct inter- and intra-patient, and cohort variation seen in this data highlights the importance to of understanding how SC insulin appearance dynamics may be affected by the subject condition.
authors.forename: Felicity
authors.initials: F
authors.lastname: Thomas
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dickson
authors.forename: Chris
authors.initials: C
authors.lastname: Pretty
authors.forename: Kent
authors.initials: K
authors.lastname: Stewart
authors.forename: Liam
authors.initials: L
authors.lastname: Fisk
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Shaw
authors.forename: J Geoffrey
authors.initials: JG
authors.lastname: Chase
mesh_terms: D001786:Blood Glucose; D015331:Cohort Studies; D003422:Critical Care; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin
chemical_list: D001786:Blood Glucose; D007328:Insulin