1. Relationship between Optimum Mini-doses of Glucagon and Insulin Levels when Treating Mild Hypoglycaemia in Patients with Type 1 Diabetes - A Simulation Study
- Author
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Kirsten Nørgaard, Carsten Boye Knudsen, Sten Madsbad, Signe Schmidt, Jens J. Holst, John Bagterp Jørgensen, Henrik Madsen, Sabrina Lyngbye Wendt, and Ajenthen Ranjan
- Subjects
Adult ,Blood Glucose ,medicine.medical_specialty ,Hormone Replacement Therapy ,Injections, Subcutaneous ,medicine.medical_treatment ,Expert Systems ,030209 endocrinology & metabolism ,030204 cardiovascular system & hematology ,Toxicology ,Models, Biological ,Glucagon ,Drug Administration Schedule ,Young Adult ,03 medical and health sciences ,Insulin Infusion Systems ,0302 clinical medicine ,Bolus (medicine) ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,Computer Simulation ,PK/PD models ,Pharmacology ,Type 1 diabetes ,Dose-Response Relationship, Drug ,business.industry ,Computational Biology ,General Medicine ,Middle Aged ,medicine.disease ,Hypoglycemia ,Dose–response relationship ,Regimen ,Diabetes Mellitus, Type 1 ,Endocrinology ,Female ,Drug Monitoring ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
Hypoglycaemia remains the main limiting factor in type 1 diabetes management. We developed an insulin-dependent glucagon dosing regimen for treatment of mild hypoglycaemia based on simulations. A validated glucose-insulin-glucagon model was used to describe seven virtual patients with insulin pump-treated type 1 diabetes. In each simulation, one of ten different and individualised subcutaneous insulin boluses was administered to decrease plasma glucose (PG) from 7.0 to ≤3.9 mmol/l. Insulin levels were estimated as ratio of actual to baseline serum insulin concentration (se/ba-insulin), insulin on board (IOB) or percentage of IOB to total daily insulin dose (IOB/TDD). Insulin bolus sizes were chosen to provide pre-defined insulin levels when PG reached 3.9 mmol/l, where one of 17 subcutaneous glucagon boluses was administered. Optimum glucagon bolus to treat mild hypoglycaemia at varying insulin levels was the lowest dose that in most patients caused PG peak between 5.0 and 10.0 mmol/l and sustained PG≥3.9 mmol/l for 2 hr after the bolus. PG response to glucagon declined with increasing insulin levels. The glucagon dose to optimally treat mild hypoglycaemia depended exponentially on insulin levels, regardless of how insulin was estimated. A 125-μg glucagon dose was needed to optimally treat mild hypoglycaemia when insulin levels were equal to baseline levels. In contrast, glucagon doses >500 μg were needed when se/ba-insulin >2.5, IOB >2.0U or IOB/TDD >6%. Although the proposed model-based glucagon regimen needs confirmation in clinical trials, this is the first attempt to develop an insulin-dependent glucagon dosing regimen for treatment of insulin-induced mild hypoglycaemia in patients with type 1 diabetes. This article is protected by copyright. All rights reserved.
- Published
- 2017