Optimal control of glucose balance in ICU patients based on GlucoSafe model

Nicole Marheineke,Stefan Schiessl,Ulrike Pielmeier,Thomas Cibis

doi:10.1186/2190-5983-4-3

Nicole Marheineke, Stefan Schiessl + Show 2 more

Open Access

https://doi.org/10.1186/2190-5983-4-3

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Abstract

Model-based medical decision support in terms of computer simulations, predictions and optimization gains increasing importance in health care systems worldwide. This work deals with the control of the glucose balance in intensive care unit (ICU) patients providing nutrition and insulin. The basis of the investigations is the bio-medical model GlucoSafe by Pielmeier et al. (Comput. Methods Programs Biomed. 97(3):211-222, 2010) that describes the temporal evolution of the blood glucose and insulin concentrations in the human body by help of a nonlinear dynamic system of first-order ordinary differential equations. This paper aims at the theoretical analysis and numerical treatment of the arising optimal control problem. Numerical results demonstrate the controllability and applicability of the model, in particular critical hyper- and hypoglycemic initial states are considered.

Highlights

Glucose is the major carbohydrate fuel of the human body
Hypoglycemia poses an immediate threat to life [ ], on the other hand persisting hyperglycemia with concentrations greater than . mmol/l puts a human at risk for renal, vascular and eye diseases
Thereby, we focus on longtime predictions and the control of hyper- and hypoglycemic initial states, in comparison to measurements

Summary

Introduction

Glucose is the major carbohydrate fuel of the human body. Blood glucose refers to the amount of sugar (glucose) circulating in the blood. The maintenance of a normal concentration of blood glucose ( mmol/l; mg/dl) - i.e. only one-fifth of a teaspoon of sugar in a liter of blood - is essential for survival. Mmol/l, hypoglycemia (low blood glucose) develops and compromises the brain function, leading to confusion, disorientation and possibly life-threatening coma. In healthy individuals with a normal insulin response glucose levels are relatively stable and average at different times of day at - mmol/l with a standard deviation of about . In intensive care units (ICUs) worldwide it has become standard practice - for nondiabetic patients - to measure blood glucose concentrations frequently (mostly using measurement intervals of - hours for nondiabetics) and to administer insulin by infusion or injection if the patient is hyperglycemic (> - mmol/l) [ ]

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