Modellig of adrenaline counterregulatory action during hypoglycaemia in Type 1 Diabetes
Abstract
The risk of hypoglycaemia is still a limiting factor for achieving near-normoglycaemia in subjects with Type 1 Diabetes. From the metabolic perspective, counterregulation has a significant influence in plasma glucose concentration during hypoglycaemia. In Type 1 Diabetes, adrenaline is the first line of counterregulatory hormone response to hypoglycaemia due to the early impairment of glucagon secretion. In a previous work, an adrenaline secretion model was developed. Here, adrenaline counterregulatory action is addressed by means of an extension of the well-known Bergman Minimal Model. The added terms were based on both adrenaline concentration after counterregulatory response begins and the influence of hypoglycaemic levels of glucose in blood. Individual parameters were estimated using data from a eu-hypoglycaemic clamp study by means of global optimization algorithms, in particular CMA-ES. Analysis of plasma glucose prediction accuracy demonstrated the importance of considering counterregulation in predictive algorithms when hypoglycaemic events occur.
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Some diabetic patients under high insulin therapy experienced the stage where the counterregulatory response of epinephrine begins to prevent plasma glucose from further decreasing after glucose level falls below activation threshold of epinephrine (around 60 mg/dl).
“Studies have shown some diabetic patients under high insulin therapy experienced the stage where the counterregulatory response of epinephrine begins to prevent plasma glucose from further decreasing after the glucose level falls below the activation threshold of epinephrine (around 60 mg/dl) (43).”
From The progression of secondary diabetes: A review of modeling studies (2022) · cites this paper as [43]
After epinephrine concentration peaks at hypoglycaemic plateau, epinephrine secretion rapidly declines when glucose level starts to recover, returning to basal level.
“After the epinephrine concentration peaks at the hypoglycaemic plateau, epinephrine secretion rapidly declines when the glucose level starts to recover, returning to its basal level.”
From The progression of secondary diabetes: A review of modeling studies (2022) · cites this paper as [43]
The work of Moscardó et al. made it possible to present the physiological behavior during hypoglycemia.
“The work of Moscardó et al. made it possible to present the physiological behavior during hypoglycemia.”
From The progression of secondary diabetes: A review of modeling studies (2022) · cites this paper as [43]
Cites
Bergman, R. N., Phillips, L. S., & Cobelli, C. (1981) · Journal of Clinical Investigation · doi:10.1172/jci110398 · Cited by 1,640 · see citing works
Cryer, P. E., Davis, S. N., & Shamoon, H. (2003) · Diabetes Care · doi:10.2337/diacare.26.6.1902 · Cited by 1,160 · see citing works
Hypoglycaemia: the limiting factor in the glycaemic management of type I and type II diabetes.
Cryer, P. (2002) · Diabetologia · doi:10.1007/s00125-002-0822-9 · Cited by 794 · see citing works
The UVA/PADOVA Type 1 Diabetes Simulator: New Features
Man, C. D., Micheletto, F., Lv, D., Breton, M., Kovatchev, B., & Cobelli, C. (2014) · Journal of Diabetes Science and Technology · doi:10.1177/1932296813514502 · Cited by 791 · cited 2× · see citing works
“[7], where a “paradoxical” increment of glucose utilization during hypoglycaemia is considered.”
BackgroundEffect of intensive insulin therapy on glycemic thresholds for counterregulatory hormone release.
Amiel, S. A., Sherwin, R. S., Simonson, D. C., & Tamborlane, W. V. (1988) · Diabetes · doi:10.2337/diab.37.7.901 · Cited by 393 · see citing works
Hypoglycemia-associated autonomic failure in diabetes
Cryer, P. E. (2001) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.2001.281.6.e1115 · Cited by 152 · cited 1× · see citing works
“During hypoglycaemia, while the glucose concentration is decreasing, central and peripheral glucose sensors activate mechanisms to elicit the neuroendocrine, autonomic and behavioral response (the so-called counterregulatory response) [3].”
BackgroundKovatchev, B. P., Farhy, L. S., Cox, D. J., Straume, M., Yankov, V. I., Gonder-Frederick, L. A., & Clarke, W. L. (1999) · Computational and Mathematical Methods in Medicine · doi:10.1080/10273669908833028 · Cited by 17 · see citing works
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The progression of secondary diabetes: A review of modeling studies
Yang, B., Li, J., Haller, M. J., Schatz, D. A., & Rong, L. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1070979 · Cited by 6 · see citing works
- Authors
- Moscardo, V., Rossetti, P., Ampudia-Blasco, F. J., & Bondia, J.
- ORCID
- Rossetti, P.
- Venue
- 2016 IEEE Conference on Control Applications (CCA)
- Publisher
- IEEE
- Published
- 2016-09
- Pages
- 430-435
- ISSN
- 1085-1992 (ISSN-L)
- OpenAlex
- W2527922775
- Cited by
- 2
- References
- 7
- Citations by year
- 2025: 1 · 2020: 1
- FWCI
- 0.00
- Type
- conference paper
- Language
- en
- Open access
- closed
- Locations
- The proceedings of the IEEE Conference on Control Applications/The proceedings of the ... IEEE Conference on Control Applications (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- epinephrine, counterregulation, hypoglycemia, type 1 diabetes, Bergman minimal model, glucose-insulin dynamics, CMA-ES, parameter estimation, glucagon secretion
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