Glucose Response to Fast- and Long-Acting Insulin in People with Type 2 Diabetes

Abstract

In type 2 diabetes (T2D), injections with long-acting insulin can become necessary to regulate blood glucose and avoid long-term complications. However, finding a safe and effective insulin dose, a process known as titration, is both challenging and time demanding. In this paper, we propose a new method for safe and rapid identification of a personalized insulin dose with long-acting insulin through short-term use of fast-acting insulin in an artificial pancreas (AP). To illustrate this novel concept, we simulate our method by modelling the glucose response to fast-and long-acting insulin in people with T2D. We apply a simple control-algorithm for the AP to adjust the insulin infusion rate during fasting periods. In this case-study, we simulate an insulin naïve T2D patient on AP treatment for one week, gradually adjusting the insulin infusion rate. After one week, we convert the insulin infusion rate, unit-to-unit, to a daily injection of long-acting insulin. We compare our method to titration with the standard of care 2-0-2 algorithm. Our simulations indicate that we can reduce the titration period from five weeks to a single week, whilst easing the burden on the patient.