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Improving IV Insulin Administration in a Community Hospital

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Preventing hypoglycemia using predictive alarm algorithms and insulin pump suspension.

Bruce Buckingham¹, Erin Cobry, Paula Clinton

¹Department of Pediatric Endocrinology, Stanford University, Stanford, California 94305-5208, USA. buckingham@stanford.edu

Diabetes Technology & Therapeutics

|October 24, 2009

Summary

This study explored using real-time continuous glucose monitoring (CGM) to predict and prevent nocturnal hypoglycemia in type 1 diabetes by temporarily stopping insulin pumps. Algorithms showed promise in preventing some hypoglycemia events without rebound hyperglycemia.

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Area of Science:

Endocrinology
Diabetes Management
Biomedical Engineering

Background:

Nocturnal hypoglycemia is a frequent complication for individuals with type 1 diabetes, often occurring during sleep.
Existing real-time continuous glucose monitoring (CGM) systems with alarms are frequently ineffective as patients sleep through them.
A significant portion of hypoglycemia events (50-75%) occur overnight, posing a serious risk.

Purpose of the Study:

To evaluate the feasibility of using real-time CGM data to predict and prevent nocturnal hypoglycemia.
To assess the effectiveness of algorithm-driven insulin pump suspension in mitigating hypoglycemic events.
To investigate potential rebound hyperglycemia following insulin pump cessation.

Main Methods:

Twenty-two participants with type 1 diabetes underwent two clinical research center admissions.
Basal insulin was adjusted in the first admission to induce hypoglycemia (<60 mg/dL).
Hypoglycemic prediction algorithms were tested in the second admission, utilizing a 90-minute insulin pump shutoff to prevent hypoglycemia and assess rebound hyperglycemia.

Main Results:

A statistical prediction algorithm (80 mg/dL threshold, 30-min horizon) prevented hypoglycemia 60% of the time.
A linear prediction algorithm (80 mg/dL threshold, 45-min horizon) prevented hypoglycemia 80% of the time.
No rebound hyperglycemia was observed after insulin pump suspension.

Conclusions:

Algorithm-based insulin pump suspension shows potential for preventing nocturnal hypoglycemia in type 1 diabetes.
Further refinement of prediction algorithms is necessary to achieve complete prevention of hypoglycemic episodes.
The tested method did not result in adverse rebound hyperglycemia.