Calculation of the best basal-bolus combination for postprandial glucose control in insulin pump therapy

Intensive insulin therapy in type 1 diabetes is based on the well-established practice of adjusting basal and bolus insulin independently. Basal insulin delivery is designed to optimize glucose concentrations between meals and overnight, while bolus insulin delivery is designed to optimize postprandial glucose concentrations. However, this strategy shows some limitations in the postprandial glucose control, especially for meals with high carbohydrate content. Strategies based on coordinating basal and bolus insulin in the postprandial period help in overcoming these limitations. An algorithm, based on mathematically guaranteed techniques (interval analysis), is presented in this paper. It determines, given the current glycemic state of the patient and the meal to be ingested, a basal-bolus combination that will yield a tight postprandial glycemic control according to the International Diabetes Federation guidelines. For a given meal, the algorithm reveals which bolus administration mode will enable a good postprandial performance: standard, square-wave, dual-wave, or temporal basal decrement. The algorithm is validated through an in silico study using the 30 subjects in the educational version of the Food and Drug Administration accepted University of Virginia simulator.