CN113539403A - Rule-based insulin supplement amount calculation method - Google Patents
Rule-based insulin supplement amount calculation method Download PDFInfo
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- CN113539403A CN113539403A CN202110811652.3A CN202110811652A CN113539403A CN 113539403 A CN113539403 A CN 113539403A CN 202110811652 A CN202110811652 A CN 202110811652A CN 113539403 A CN113539403 A CN 113539403A
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
- G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
- A61B5/14532—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue for measuring glucose, e.g. by tissue impedance measurement
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
- G16H50/20—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for computer-aided diagnosis, e.g. based on medical expert systems
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
- G16H50/30—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for calculating health indices; for individual health risk assessment
Abstract
The invention discloses a rule-based insulin superaddition amount calculation method, which comprises the following steps: acquiring current physiological data, a control target and type information of a dynamic blood glucose monitoring system of a patient; judging the suggestion according to the scorecard to obtain the insulin dosage b1 needing to be added or subtracted or the carbohydrate nCU needing to be supplemented; calculating a corrected insulin dosage C1 according to the current blood sugar, the arrow information of the blood sugar change trend and the blood sugar control requirement; calculating active insulin R based on the large short acting insulin dose over the first 5 hours; calculating a patient carbohydrate coefficient CF; and calculating the insulin dosage needing to be added or subtracted according to the insulin dosage b1, the corrected insulin dosage C1, the active insulin R1 and the carbohydrate coefficient CF of the patient, or calculating the quantity of the supplementary carbohydrate needed. The present invention enables more accurate insulin bolus calculation or carbohydrate compensation for diabetic patients.
Description
Technical Field
The invention relates to the technical field of diabetes diagnosis and treatment, in particular to a rule-based insulin superaddition amount calculation method.
Background
According to data provided by the international diabetes union (IDF), approximately 4.63 million adults (20-79 years old) had diabetes in 2019; by 2045, this figure has risen to 7 billion. China is the country with the largest number of adult diabetics at present. Insulin therapy is an important means for controlling hyperglycemia, and because oral hypoglycemic drugs fail or contraindications for oral administration exist, the hyperglycemia needs to be controlled by using an insulin injection mode so as to reduce the occurrence of complications.
Continuous glucose monitoring refers to a monitoring technology for indirectly reflecting the blood glucose level by monitoring the glucose concentration of subcutaneous interstitial fluid through a glucose sensor, plays an important role in evaluating the effectiveness and safety of a treatment scheme of a diabetic patient, and is widely popularized and applied clinically. The recent trend in blood glucose can be visually observed by a continuous glucose monitoring device that displays a trend arrow calculated from the glucose reading that reflects the recent 15 minute trend in glucose. The rising trend arrow indicates an increase in glucose concentration, which may require an additional increase in insulin dosage; the downward trend arrow indicates a decrease in glucose concentration, which may require a decrease in insulin injection amount or a carbohydrate supplementation; the horizontal trend arrows indicate that recent blood glucose concentrations are relatively steady. Incorporating the blood glucose trend arrow into the insulin dosage calculation can greatly improve the accuracy of glycemic control.
Blood glucose values, target blood glucose ranges, active insulin, insulin sensitivity coefficients and carbohydrate coefficients of different patients during insulin dose calculation are different, so that the finally given adjustment advice also needs to be individually adjusted according to physiological differences and real-time physiological states of the patients.
The accuracy of the insulin injection amount is a prerequisite for ensuring the therapeutic effect, however, many patients do not have the ability to adjust the insulin dosage using a blood glucose monitoring device in combination with their own state, and it is therefore very necessary to establish a simple and versatile insulin bolus calculation method with the help of a continuous glucose monitoring device and patient-customized physiological parameters.
Disclosure of Invention
The invention aims to solve the technical problem of a rule-based insulin supplement amount calculation method, which can realize more accurate insulin supplement amount calculation or carbohydrate compensation for diabetics.
The invention is realized by the following technical scheme: a rule-based insulin bolus calculation method comprising the steps of:
s1, acquiring current physiological data, control targets and insulin pump type information of the patient;
s2, judging and recommending according to a scorecard to obtain an insulin dose b1 needing to be added or subtracted or carbohydrate nCU needing to be supplemented;
s3, calculating a corrected insulin dose C1 according to the current blood sugar and blood sugar control requirements;
s4, calculating active insulin R according to the large dose short-acting insulin dose in the first 5 hours;
s5, calculating a carbohydrate coefficient CF of the patient;
s6, calculating the needed additional insulin dose or the needed quantity of supplementary carbohydrate according to the needed added and subtracted insulin dose b1, the corrected insulin dose C1, the active insulin R1 and the carbohydrate coefficient CF of the patient.
As a preferred technical solution, the information of the current physiological data, the control target, the insulin pump type and the like in step S1 at least includes: total daily insulin dose (TDD), type of diabetes, type of CGMS, arrow of CGM appearance, current blood sugar, blood sugar control requirement, whether to eat within 3h, large dose of insulin dose and time within 6 hours, age, sex, height, weight, diabetes treatment scheme, blood sugar control requirement.
As a preferred technical scheme, the blood sugar control requirements comprise strict control, general control and loose control, and the judgment standard is shown in the following table:
preferably, the diabetes type includes diabetes, insulin-dependent diabetes, juvenile and childhood diabetes.
As a preferred technical scheme, the CGMS types comprise Yapeiki, Dekang and Meidunli.
As a preferred technical scheme, in step S2, the insulin dosage b1 that should be added or subtracted or the carbohydrate nCU that needs to be supplemented is inquired through the following scorecard.
As a preferred technical solution, before the step S3, the method further includes the following steps:
judging whether the current control target belongs to blood sugar before meal or blood sugar after meal according to the current time and the meal time, if the time is less than 3 hours from the last complete dinner start time, the control target is the blood sugar after meal, otherwise, the control target is the blood sugar before meal;
calculating the current target blood glucose according to the table and the control requirements:
as a preferred technical solution, the specific formula of the calculation of the corrected insulin dose C1 in step S3 is C1 ═ current blood glucose-target blood glucose }/correction factor, wherein: correction factor is 70/TDD.
As a preferred technical solution, the specific formula of the active insulin R in step S4 is as follows: r1+ R2+ R3+ … … Rn, wherein: n is the number of times of injecting large dose of short-acting insulin in 5 hours, Rn is M (1-T/5), M is the large dose of the insulin injected at the nth time, and T (hour) is the time from the current injection.
As a preferred technical solution, a specific calculation formula of the carbohydrate coefficient CF in the step S5 is CF ═ 500/TDD.
As a preferred technical solution, the method for determining and calculating the insulin dose and the carbohydrate in step S6 includes:
finally, if the current blood sugar is less than 3.9mmol/L, the carbohydrate C-nCU CF needs to be supplemented;
calculating an additional insulin dose b2 ═ C1+ b1-R if the current blood glucose ═ 3.9 mmol/L;
if the calculation b2 < -3 and the blood glucose value is between 3.9 and 6, then a 15g carbohydrate supplementation is finally recommended;
if the result of the calculation b2 > -3 and b2 < 0, no insulin supplementation and no carbohydrate supplementation is recommended;
b2 is the last additional insulin dose if the result b2 > -3 and b2 > 0 are calculated.
The invention has the beneficial effects that: the rule-based insulin supplement amount calculating method provided by the invention has the following beneficial effects:
(1) according to the invention, some suggestions are given through scorecards made by distinguishing different diabetes type populations, and the individualized requirements of insulin treatment of patients under different blood sugar baseline levels are also considered, so that the individualized control of different types of patients is realized;
(2) the invention can adjust the insulin dosage by utilizing the blood sugar trend change provided by the CGM device, thereby better controlling the blood sugar;
(3) according to the invention, complete individual parameters such as blood glucose value, target blood glucose range, active insulin, insulin sensitivity coefficient, carbohydrate, blood glucose variation trend and the like are considered in calculation, so that the calculation of insulin dosage is more accurate.
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In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below, it is obvious that the drawings in the following description are only some embodiments of the present invention, and for those skilled in the art, other drawings can be obtained according to the drawings without creative efforts.
FIG. 1 is a schematic flow chart of a rule-based insulin bolus calculation method according to the present invention;
fig. 2 is a schematic diagram of a calculation method of a rule-based insulin bolus calculation method according to the present invention.
Detailed Description
All of the features disclosed in this specification, or all of the steps in any method or process so disclosed, may be combined in any combination, except combinations of features and/or steps that are mutually exclusive.
Any feature disclosed in this specification (including any accompanying claims, abstract and drawings), may be replaced by alternative features serving equivalent or similar purposes, unless expressly stated otherwise. That is, unless expressly stated otherwise, each feature is only an example of a generic series of equivalent or similar features.
In the description of the present invention, it is to be understood that the terms "one end", "the other end", "outside", "upper", "inside", "horizontal", "coaxial", "central", "end", "length", "outer end", and the like, indicate orientations or positional relationships based on those shown in the drawings, and are used only for convenience in describing the present invention and for simplicity in description, and do not indicate or imply that the device or element being referred to must have a particular orientation, be constructed in a particular orientation, and be operated, and thus, should not be construed as limiting the present invention.
Further, in the description of the present invention, "a plurality" means at least two, e.g., two, three, etc., unless specifically limited otherwise.
The use of terms such as "upper," "above," "lower," "below," and the like in describing relative spatial positions herein is for the purpose of facilitating description to describe one element or feature's relationship to another element or feature as illustrated in the figures. The spatially relative positional terms may be intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if the device in the figures is turned over, elements described as "below" or "beneath" other elements or features would then be oriented "above" the other elements or features. Thus, the exemplary term "below" can encompass both an orientation of above and below. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly
In the present invention, unless otherwise explicitly specified or limited, the terms "disposed," "sleeved," "connected," "penetrating," "plugged," and the like are to be construed broadly, e.g., as a fixed connection, a detachable connection, or an integral part; can be mechanically or electrically connected; they may be directly connected or indirectly connected through intervening media, or they may be connected internally or in any other suitable relationship, unless expressly stated otherwise. The specific meanings of the above terms in the present invention can be understood by those skilled in the art according to specific situations.
As shown in fig. 1, a rule-based insulin bolus calculation method of the present invention includes the steps of:
s1, acquiring current physiological data, control targets and insulin pump type information of the patient;
s2, judging and recommending according to a scorecard to obtain an insulin dose b1 needing to be added or subtracted or carbohydrate nCU needing to be supplemented;
s3, calculating a corrected insulin dose C1 according to the current blood sugar and blood sugar control requirements;
s4, calculating active insulin R according to the large dose short-acting insulin dose in the first 5 hours;
s5, calculating a carbohydrate coefficient CF of the patient;
s6, calculating the needed additional insulin dose or the needed quantity of supplementary carbohydrate according to the needed added and subtracted insulin dose b1, the corrected insulin dose C1, the active insulin R1 and the carbohydrate coefficient CF of the patient.
In this embodiment, the information of the current physiological data, the control target, the insulin pump type, and the like in step S1 at least includes: total daily insulin dose (TDD), type of diabetes, type of CGMS, arrow of CGM appearance, current blood sugar, blood sugar control requirement, whether to eat within 3h, large dose of insulin dose and time within 6 hours, age, sex, height, weight, diabetes treatment scheme, blood sugar control requirement.
Wherein, the blood sugar control requirement comprises strict control, general control and loose control, and the judgment standard is shown in the following table:
in this embodiment, the diabetes type includes diabetes, insulin-dependent diabetes, and juvenile and childhood diabetes.
In this embodiment, the CGMS types include Yapeyian, Dekang, and Meindon.
In step S2, the insulin dose b1 that should be added or subtracted or the carbohydrate nCU that needs to be supplemented is queried by the scorecard as follows.
In this embodiment, step S3 is preceded by the following steps:
judging whether the current control target belongs to blood sugar before meal or blood sugar after meal according to the current time and the meal time, if the time is less than 3 hours from the last complete dinner start time, the control target is the blood sugar after meal, otherwise, the control target is the blood sugar before meal;
calculating the current target blood glucose according to the table and the control requirements:
in this embodiment, the specific formula of the calculation of the corrected insulin dose C1 in step S3 is C1 ═ current blood glucose-target blood glucose }/correction factor, where: correction factor is 70/TDD.
In this embodiment, the specific formula of the active insulin R in step S4 is: r1+ R2+ R3+ … … Rn, wherein: n is the number of times of injecting large dose of short-acting insulin in 5 hours, Rn is M (1-T/5), M is the large dose of the insulin injected at the nth time, and T (hour) is the time from the current injection.
In this embodiment, the specific calculation formula of the carbohydrate coefficient CF in step S5 is CF 500/TDD.
The method for judging and calculating the insulin dose and the carbohydrate in step S6 includes:
finally, if the current blood sugar is less than 3.9mmol/L, the carbohydrate C-nCU CF needs to be supplemented;
calculating an additional insulin dose b2 ═ C1+ b1-R if the current blood glucose ═ 3.9 mmol/L;
if the calculation b2 < -3 and the blood glucose value is between 3.9 and 6, then a 15g carbohydrate supplementation is finally recommended;
if the result of the calculation b2 > -3 and b2 < 0, no insulin supplementation and no carbohydrate supplementation is recommended;
b2 is the last additional insulin dose if the result b2 > -3 and b2 > 0 are calculated.
As shown in fig. 2, the specific calculation method is as follows:
firstly, inputting current physiological data, a control target and insulin pump type information of a patient, checking whether blood sugar is less than 3.9mmol/L, if so, calculating carbohydrate coefficient CF (carbon dioxide coefficient) to be 500/TDD, obtaining how many CUs need to be compensated according to an arrow appearing in CGM and a diabetes type check scorecard, and calculating carbohydrate amount recommended to eat to be C (carbon dioxide coefficient) nCU CF;
if not, selecting different tables according to different diabetes types; calculating correction factor of 70/TDD, setting blood sugar control requirement (first use setting), judging whether meal is used within three hours, calculating target blood sugar by table look-up, calculating C1 (current blood sugar-target blood sugar)/correction factor, and finally calculating additional insulin dosage b2 of C1+ b 1-R;
if not, selecting different tables according to different diabetes types; calculating correction factor 70/TDD, calculating an insulin adjustment suggestion b1 according to arrows appearing in different CGMs, a current blood sugar interval and a correction factor scorecard, inputting a large-dose minimum-effect insulin dose within 6 hours, reducing the insulin by 20% per hour, calculating residual active insulin R, and finally calculating an additional insulin dose b2 ═ C1+ b 1-R.
Finally, judging that b2 is less than-3 and the blood sugar is between 3.9 and 6 according to the calculation result, if yes, the supplement of 15g of carbohydrate is recommended, and if not, the insulin dosage b2 is supplemented.
The invention has the beneficial effects that: the rule-based insulin supplement amount calculating method provided by the invention has the following beneficial effects:
(1) according to the invention, some suggestions are given through scorecards made by distinguishing different diabetes type populations, and the individualized requirements of insulin treatment of patients under different blood sugar baseline levels are also considered, so that the individualized control of different types of patients is realized;
(2) the invention can adjust the insulin dosage by utilizing the blood sugar trend change provided by the CGM device, thereby better controlling the blood sugar;
(3) the invention considers complete individual parameters of blood sugar value, target blood sugar range, active insulin, insulin sensitivity coefficient, carbohydrate and the like in the calculation, so that the calculation of insulin dosage is more accurate.
The above description is only an embodiment of the present invention, but the scope of the present invention is not limited thereto, and any changes or substitutions that are not thought of through the inventive work should be included in the scope of the present invention. Therefore, the protection scope of the present invention shall be subject to the protection scope defined by the claims.
Claims (11)
1. A rule-based insulin bolus calculation method, comprising the steps of:
s1, acquiring current physiological data, control targets and information of a dynamic blood glucose monitoring system and types of patients;
s2, judging and recommending according to a scorecard to obtain an insulin dose b1 needing to be added or subtracted or carbohydrate nCU needing to be supplemented;
s3, calculating a corrected insulin dose C1 according to the current blood sugar, the arrow information of the blood sugar change trend and the blood sugar control requirement;
s4, calculating active insulin R according to the large dose short-acting insulin dose in the first 5 hours;
s5, calculating a carbohydrate coefficient CF of the patient;
s6, calculating the needed additional insulin dose or the needed quantity of supplementary carbohydrate according to the needed added and subtracted insulin dose b1, the corrected insulin dose C1, the active insulin R1 and the carbohydrate coefficient CF of the patient.
2. The rule-based insulin bolus calculation method of claim 1, wherein: the information of the current physiological data, the control target, the insulin pump type and the like in step S1 at least includes: total daily insulin dose (TDD), type of diabetes, type of CGMS, arrow of CGM appearance, current blood sugar, blood sugar control requirement, whether to eat within 3h, large dose of insulin dose and time within 6 hours, age, sex, height, weight, diabetes treatment scheme, blood sugar control requirement.
3. The rule-based insulin bolus calculation method of claim 2, wherein: the glycemic control requirements include tight control, general control, and loose control.
4. The rule-based insulin bolus calculation method of claim 2, wherein: the diabetes type comprises diabetes, insulin-dependent diabetes and juvenile and child diabetes.
5. The rule-based insulin bolus calculation method of claim 1, wherein: the CGMS types include Yapeyixian, Dekang and Meidunli.
6. The rule-based insulin bolus calculation method of claim 1, wherein: in step S2, the insulin dose b1 that should be added or subtracted or the carbohydrate nCU that needs to be supplemented is queried by the scorecard as follows.
7. The rule-based insulin bolus calculation method of claim 1, wherein: the step S3 further includes the following steps:
and judging whether the current control target belongs to the blood sugar before meal or the blood sugar after meal according to the current time and the meal time, if the time is less than 3 hours from the last complete dinner start time, the control target is the blood sugar after meal, and if not, the control target is the blood sugar before meal.
8. The rule-based insulin bolus calculation method of claim 1, wherein: the specific formula of the calculation of the corrected insulin dose C1 in step S3 is C1 ═ current blood glucose-target blood glucose }/correction factor, where: correction factor is 70/TDD.
9. The rule-based insulin bolus calculation method of claim 1, wherein: the specific formula of the active insulin R in the step S4 is as follows: r1+ R2+ R3+ … … Rn, wherein: n is the number of times of injecting large dose of short-acting insulin in 5 hours, Rn is M (1-T/5), M is the large dose of the insulin injected at the nth time, and T (hour) is the time from the current injection.
10. The rule-based insulin bolus calculation method of claim 1, wherein: the concrete calculation formula of the carbohydrate coefficient CF in step S5 is CF 500/TDD.
11. The rule-based insulin bolus calculation method of claim 1, wherein: the method for determining and calculating the insulin dose and the carbohydrate in step S6 includes:
finally, if the current blood sugar is less than 3.9mmol/L, the carbohydrate C-nCU CF needs to be supplemented;
calculating an additional insulin dose b2 ═ C1+ b1-R if the current blood glucose ═ 3.9 mmol/L;
if the calculation b2 < -3 and the blood glucose value is between 3.9 and 6, then a 15g carbohydrate supplementation is finally recommended;
if the result of the calculation b2 > -3 and b2 < 0, no insulin supplementation and no carbohydrate supplementation is recommended;
b2 is the last additional insulin dose if the result b2 > -3 and b2 > 0 are calculated.
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2021
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| US20090253970A1 (en) * | 2008-04-04 | 2009-10-08 | Eran Bashan | System for optimizing a patient's insulin dosage regimen |
| CN102395310A (en) * | 2009-02-26 | 2012-03-28 | 莫尔研究应用有限公司 | Method and system for automatic monitoring of diabetes related treatments |
| CN101866387A (en) * | 2009-04-17 | 2010-10-20 | 上海市杨浦区中心医院 | Individual insulin treatment guide instrument for diabetics and application method thereof |
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Application publication date: 20211022 |