FEEDBACK

CONTROL OF TYPE 1 DIABETES

Sandip D. Kulkarni

By Sandip Kulkarni 1
 Type 1 Diabetes Mellitus
Hyperglycemia: Kidney failure, heart
disease, blindness, brain damage
180 mg/dl

Target
Blood
Glucose (BG)
range

Overcom-
70 mg/dl pensation
Hypoglycemia: Neurological
60 mg/dl damage, unconsciousness,
seizures, death Severe
Hypoglycemia
By Sandip Kulkarni 2
 Glucose Sensing
Self Monitoring of Blood Continuous Glucose
Glucose (SMBG) Monitoring (CGM) Device

Pricks into the

abdominal skin

Finger prick Noisy signals

Provides estimates of blood Delay
glucose (BG) only when the Sensor faults (drift, dropout)
user samples Requires calibration with SMBG
Sensor performance variability
Requires a control solution
(+/- 30% or more observed**)
Inaccurate measurement (+/- FDA-approved only for use with
20% observed*) SMBG
By Sandip Kulkarni 3
 Insulin Delivery Mechanisms
Continuous Subcutaneous Insulin Infusion (CSII)
User entry:

Insulin Basal Rate Insulin Delivery

Profile (Actuation)
Insulin Bolus
SMBG
Meal Size (gCHO)
OPEN LOOP THERAPY

Multiple Daily Insulin Injection (MDI)

Bolus dose
to cover food eaten or correct a high BG
Basal dose
conKnuously infused at an adjustable basal rate
for normal acKviKes
By Sandip Kulkarni 4
 Modeling SimulaKon and Control for Diabetes
Management
System Model of Human
Metabolism
Physiologically acceptable,
Based on years of study and
represent most of the
studied populaKon
Modularizing subcomponent
models to easily plug
improved models in future .
Embedding into a Simulator
System.
Developing and TesKng
Control Algorithms
IntegraKon.

ArKcial Pancreas System

By Sandip Kulkarni (UVA + UCSB +Univ. of Padova) 5
Components of the EnKre System

By Sandip Kulkarni 6
 Linearized discrete-time model
u(k)
insulin infusion GLUCOSE
x(k+1)=Ax(k)+Bu(k)+Gc(k) y(k)=Cx(k) +v(k)
SENSOR
d(k)
meal

States
G glucose
X Insulin sensiKvity

I sc1
Insulin in Intradermal
I sc 2 Compartments
x=
I p Insulin in Plasma

Gsc Infused Glucose
Q
1 Stomach Compartments C = ( 1 0 0 0 0 0 0 0 )
Q2 By Sandip Kulkarni 7
 What happens today...

Meals,
Exercise
INSULIN
PUMP
bolus
basal
Open-loop
Subject
therapy

GLUCOSE
SENSOR

By Sandip Kulkarni 8
 Control Block Diagram

Open-loop bolus Meals,

therapy basal Exercise
INSULIN
PUMP

MPC
bolus
basal + Safety
Mod.
Subject

GLUCOSE
SENSOR

By Sandip Kulkarni 9
 18 Hour Closed Loop Control Experiment in Hospital
4 PM: 30 min low- 7 PM: manual 4.4u pre-meal bolus Overnight maintenance of
220 intensity exercise meal underinsulinized by 40% basal rate 2.2

200 2

Insulin injecKon concentraKon [mg/dl]

Glucose concentraKon [mg/dl]

180 1.8

160 1.6

140 1.4

120 Range 1.2

correc;on
100 compensates 1
under-bolused
80 meal 0.8

60 Safety System 0.6

reduces insulin
40 to prevent 0.4
hypoglycemia
20 0.2

12:00 14:00 16:00 18:00 20:00 22:00 00:00 02:00 04:00 06:00 08:00
Finger SKcks CGM Insulin injecKon

By Sandip Kulkarni 10