Enhanced modelling of the glucose–insulin system and its applications in insulin therapies

It is well known that Michaelis–Menten kinetics is suitable for the response function in chemical reaction, when the reaction rate does not increase indefinitely when an excess of resource is available. However, the existing models for insulin therapies assume that the response function of insulin clearance is proportional to the insulin concentration. In this paper, we propose a new model for insulin therapy for both type 1 and type 2 diabetes mellitus, in which the insulin degradation rate assumes Michaelis–Menten kinetics. Our analysis shows that it is possible to mimic pancreatic insulin secretion by exogenous insulin infusions, and our numerical simulations provide clinical strategies for insulin–administration practices.

Mathematical modeling and qualitative analysis of insulin therapies

Several insulin therapies are widely in clinical use with the basic strategy that mimics insulin secretion in a normal glucose-insulin endocrine metabolic regulatory system. In this paper, we model the insulin therapies using a delay differential equation model. We study the dynamics of the model both qualitatively and quantitatively. The analytical results show the existence and uniqueness of a stable periodic solution that corresponds to ultradian insulin secretion oscillations. Numerically we simulate the insulin administration based on our model. The numerical simulation results are in agreement with findings of clinical studies.

Why and how to use insulin therapy earlier in the management of type 2 diabetes

Most patients with type 2 diabetes are inadequately controlled on their current therapy. Suboptimal glycemic control can have devastating consequences, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease that may ultimately lead to mortality. Most patients eventually need insulin therapy, and initiating insulin earlier in the course of type 2 diabetes may lead to optimal glycemic control and prevent or delay diabetes-related complications. Although insulin therapy is the most effective method of managing hyperglycemia, it is often delayed owing to concerns about the complexity and inconvenience of treatment regimens; fear of injections, hypoglycemia or weight gain; and the time required to learn how to effectively manage insulin therapy. The development of insulin analogs, biphasic insulin analogs, and more convenient insulin delivery systems may make insulin therapy more manageable and help more patients achieve their treatment goals.

Glycaemic control with modified intensive insulin injections (MII) using insulin pens and premixed insulin in children with type-1 diabetes: a randomized controlled trial

The objective of this study was to compare glycemic control and insulin dosage in children with type 1 diabetes treated by a modified intensified insulin therapy MII using insulin pens (and premixed and regular insulin) with those on conventional insulin therapy. This was a longitudinal, randomized controlled trial for 6 months or more. From a cohort of 125 children with previously diagnosed type-1 diabetes (more than a year after diagnosis) two groups were randomly selected Group AI (n=20) and Group B (n=20). Group AI children and 10 children with recently diagnosed type 1 diabetes (Group AII) were allocated to MII using regular insulin and premixed insulin (30/70 and 40/60 and 50/50). Group B patients continued their conventional insulin therapy for the whole period of the trial. The main outcome measures were glycemic control measured by mean blood glucose concentration and percentage of glycated haemoglobin and total daily insulin dose. Mean blood glucose concentrations before the three main meals, and at midnight, (148, 147, 179 and 127 mg/dl, respectively) were lower in children receiving intensified MII compared with those receiving conventional insulin therapy (192, 174, 194 and 179 mg/dl, respectively) (standardized mean difference 34+/-15 mg/dl), equivalent to a difference of 1.9+/-0.8 mmol/l. This improved control during MII was achieved with no change in the average daily insulin dose in group-AI. In group-AII insulin dose decreased significantly during their first 6 moths of treatment (honeymooning). Glycemic control is better during MII using insulin pens and premixed and regular insulin compared with conventional insulin therapy, without any significant change in insulin dose needed to achieve this level of control. The difference in glycemic control between the two methods is significant and could reduce the risk of micro-vascular complications.