WO2001058511A1 - Anordnung und verfahren zur dosierung eines die blutglukose eines patienten regulierenden hormons - Google Patents
Anordnung und verfahren zur dosierung eines die blutglukose eines patienten regulierenden hormons Download PDFInfo
- Publication number
- WO2001058511A1 WO2001058511A1 PCT/EP2001/000625 EP0100625W WO0158511A1 WO 2001058511 A1 WO2001058511 A1 WO 2001058511A1 EP 0100625 W EP0100625 W EP 0100625W WO 0158511 A1 WO0158511 A1 WO 0158511A1
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- WO
- WIPO (PCT)
- Prior art keywords
- hormone
- control device
- arrangement according
- patient
- pilot
- Prior art date
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
- A61M5/168—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body
- A61M5/172—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body electrical or electronic
- A61M5/1723—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body electrical or electronic using feedback of body parameters, e.g. blood-sugar, pressure
-
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2230/00—Measuring parameters of the user
- A61M2230/20—Blood composition characteristics
- A61M2230/201—Glucose concentration
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2230/00—Measuring parameters of the user
- A61M2230/62—Posture
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
- A61M5/142—Pressure infusion, e.g. using pumps
- A61M5/14244—Pressure infusion, e.g. using pumps adapted to be carried by the patient, e.g. portable on the body
Definitions
- the invention relates to an arrangement and a method for dosing a hormone suitable for regulating the blood glucose of a patient, in particular insulin.
- Diabetes mellitus is a metabolic disorder in which the regulation of blood glucose levels to a level corresponding to intermediate metabolic needs is disturbed by a lack of insulin.
- diabetes patients counteract an increase in glucose concentration by injecting insulin that is foreign to the body.
- the amount to be administered is determined empirically on the basis of self-monitoring of blood sugar. It has already been proposed to improve the sugar determination by taking samples continuously or intermittently in the adipose tissue by means of a microdialysis probe and automatically evaluating them to the tissue glucose level as a measure of the blood glucose.
- DD 282 616 A5 describes a device for load-adapted control of infusion pumps, the insulin supply to the diabetic is controlled either automatically by a blood glucose sensor or semi-automatically via patient-specific insulin dosing profiles using a microcomputer.
- a heart rate sensor is coupled to the input side of the microcomputer in order to enable a reversal between the so-called positive and negative insulin-glucose characteristics when a limit value is exceeded.
- an empirical function should be used instead of sensory control. averaged time-dependent reduction of the dosage in the sense of a decrease in the plasma insulin concentration.
- EP-A 0 824 240 it is known to use computer-assisted heart rate data on the basis of a physiological model of the glucose / insulin metabolism to determine so-called individual-specific insulin active equivalents, which should be usable for learning and training programs as well as in further and advanced training ,
- the object of the invention is to specify an arrangement and a method of the type specified at the outset, with which the dosage of a hormone influencing blood glucose is improved and can be optimized taking into account the patient's condition. In particular, this should enable the patient to keep his blood sugar level permanently in the normoglycemic range by using appropriate hormones.
- the essence of the invention is to provide a regulating device for fine regulation of the hormone dosage, while the regulation can only at least partially compensate for influences which can only be detected with a time shift by anticipatory rough pilot control.
- a system according to the invention is proposed with the following features: a measuring device for recording measured values which can be correlated with blood glucose; a control device which comprises a controller for processing the measured values according to a control algorithm and a hormone dosing unit for outputting a hormone dose;
- the control quality can be significantly improved by the rough feedforward control.
- changes in the metabolic state due to external influences or transport processes taking place inside the body can be taken into account with foresight, without dead time, so that deviations from the rule remain limited to a small area and excessive blood glucose values are avoided a priori. In this way, an optimal dosage for normoglycemic adjustment of blood glucose can be achieved.
- pilot control device acts in a pre-controlling manner on the control device in accordance with a sensor-determined influencing variable.
- the extent of a diabetic's physical activity is to be taken into account by the fact that the pilot control device has an activity measuring unit for sensory detection of the degree of physical activity of the patient.
- the pilot control device has a position sensor, in particular a mercury switch or spirit levels.
- the pilot control device has a motion sensor, in particular a pedometer.
- the pilot control device has a sensor for detecting body parameters of the patient, such as heart rate, body temperature or skin conductivity.
- a further preferred embodiment of the invention provides that the pilot control device has a basal control element for the continuous specification of a preferably patient-related basal dose of the hormone. This covers an existing basic requirement, with the controller remaining in a favorable operating point.
- the basal control element has a correction stage for adapting the basal dose to a hormone sensitivity of the patient which is variable during the day.
- the pilot control device has a bolus control element for specifying hormone boluses depending on the patient's food intake. It is also advantageous if the pilot control device has a timer for the time-dependent determination of the basal dose or for the determination of the time of administration of hormone boli.
- the basal control element and / or bolus control element are connected downstream of the activity measuring device.
- the pilot control device has an input unit for data input, in particular of the times of day and bread units of a patient's food intake.
- the control device can be influenced in that the pilot control device has a setpoint output connected to the controller for specifying a reference variable. Further advantageous possibilities are that the pilot control device and the controller are connected on the output side to the hormone metering unit via a summing element, or that the pilot control device has means for selecting the control algorithm or for specifying controller parameters of the controller.
- the pilot control device include a monitoring stage for checking and limiting the hearing if necessary after detection of critical patient conditions such as abnormal body temperature.
- the measuring device has a glucose sensor, preferably operating according to the microdialysis technique, for detecting tissue glucose values as measured values. This makes it possible to continuously record the controlled variable without having to maintain direct access to the bloodstream. This is where pre-control comes into its own, because the glucose transfer between blood and tissue takes place with a certain delay.
- the adjustment range of the controller should be limited to positive values. In principle, it would also be possible to use a negative range by dosing contra-insulin hormones such as glucagon. In any case, it is advantageous if the pilot control device acts on the control device while maintaining a reserve.
- an optimal controller behavior or control result can be achieved in that the controller is designed as a status controller, the control algorithm having a program routine to which the measurement and hormone dose values can be applied as an observer for estimating non-measurable status variables, and the Controller has a proportional integral element for the treatment of disturbance variables.
- the hormone metering unit be formed by a metering pump designed for preferably subcutaneous hormone infusion.
- the control loop can be closed by a deliberate action on the part of the patient, advantageously by the hormone metering unit being a triggering member for the has actual confirmation of an intended hormone dose.
- the hormone metering unit is designed only for indicating and / or providing or measuring a hormone dose to be administered by the patient himself.
- an advantageous embodiment provides that the measuring device, the regulating device and the pilot control device are formed by a small device that can be worn on the patient's body.
- Measured values which can be correlated with the blood glucose are recorded; - The measured values are fed to a control device, a controller processing the measured values according to a control algorithm and a hormone dosing unit delivering a hormone dose;
- the control device (12) provided for fine dosing of the hormone is precontrolled by means of a pilot control device (14) to reduce dead time.
- the invention is explained in more detail below on the basis of an exemplary embodiment shown schematically in the drawing.
- the single figure shows a block diagram of an arrangement or a system for regulated insulin dosing.
- the arrangement shown in the drawing enables the blood glucose of a diabetic patient 10 to be regulated automatically. It essentially consists of a control device 12 for fine adjustment of the insulin application, a pilot control device 14 for rough pilot control of the control device 12 in accordance with at least one of the blood glucose levels influencing variable or disturbance variable influencing the patient 10 and a measuring device 16 for sequential detection of measured values correlated with the blood glucose level.
- the pilot control device 14 has an activity measuring unit 18 for sensory detection of the physical activity level of the patient as an influencing variable.
- the activity measuring unit 18 is connected on the input side to a position sensor 20 which is suitable for detecting the rest states of the patient.
- the position sensor 20 can be formed, for example, by a mercury switch or crossed spirit levels, which can be used to determine whether the patient 10 is lying, sitting or standing via the inclined position.
- a motion sensor 22 is provided for supplying the activity measuring unit 18 with suitable signals for detecting motion states of the patient 10.
- a pedometer can be used to quantify physical activity while walking or running.
- Another sensor 24 is used to record body parameters of the patient, which at least indirectly indicate physical activity, in particular the heartbeat rate, body or skin temperature and skin conductivity.
- the pilot control device 14 further comprises a basal control element 26 for determining a basal rate or basic dose which is suitable for covering the basic requirement of the patient for insulin.
- the basal control element 26 can have a correction stage (not shown specifically) for adapting the basal dose to a time-varying peripheral insulin sensitivity.
- the basal dose can be changed depending on the time of day according to a ramp function.
- the pilot control device 14 has a bolus control element 28, which specifies insulin boluses or insulin doses adapted to the food intake.
- a timer (not shown) or a clock can be used to determine the time of administration of the insulin be or also provided for time-dependent time control of the basal rate.
- the control elements 26, 28 are connected to the activity measurement unit 18 via signal paths 30, 32, so that an activity-related weighting of the basal and bolus doses is possible.
- An input unit 34 of the pre-control device 14 makes it possible, in addition to the signals detected by sensors, to input additional data such as times of day and bread units of a patient's food intake for processing.
- the control signals or output data of the control elements 26, 28 combined via a summing element 36 are optionally supplied to one of the outputs 38, 40, 42 of the pilot control device 14.
- control device 12 comprising a controller 44 and a dosing unit 46 by the pilot control device 14.
- the controller 44 Via the signal path 48, the controller 44 can be fed a reference variable which cannot be influenced by the control and which defines the (time-dependent) setpoint curve.
- the data link 50 allows a suitable control algorithm to be selected or control parameters to be varied.
- the pilot control device 14 can be connected to the control output 56 at the control output 42 via the line 52 and the summing element 54. With the measures mentioned, it is possible to limit the control difference to a smaller area, while the control device takes over the fine metering. In addition, it is advisable to monitor the insulin dose to be dispensed or to check for compliance with plausibility criteria.
- the pilot control device 14 influences the control device 12 in an open sequence of effects, ie the controlled output variable (ultimately the insulin dose) does not affect the controlling influencing variable (for example the degree of activity of the patient). The influence is anticipated or piloted in the sense of an immediate correction of the disruptive effect, without waiting for a change in the controlled variable.
- the control works in principle in a closed circuit, in which the variable to be adjusted reacts on the measured variable.
- the pilot control device 14 and the controller 12 are implemented in hardware by an application-specific integrated semiconductor circuit or a suitable processor system, in particular by a microcontroller in connection with a digital signal processor.
- a state controller of high control quality is implemented on it, in which, in contrast to conventional output variable control, the state variables of the controlled system are fed back.
- the control algorithm has a program routine that can be acted upon as an observer with the insulin measurement values and the output dose values.
- a proportional integral link is used to treat disturbing effects such as exogenous glucose flooding.
- the blood glucose metabolism is described as a mathematical model using a first order linear differential equation system, whereby transport and dead time effects are taken into account by proportional delay ⁇ PT ⁇ terms.
- ⁇ PT ⁇ terms proportional delay ⁇ PT ⁇ terms
- the controller 44 is connected at its input 58 to the measuring device 16.
- the blood glucose level becomes permanent because of the difficulties of an intravenous Access is not recorded directly, but the tissue glucose level in the subcutaneous fat tissue of the patient 10 correlated therewith is measured.
- the measuring device 16 has a glucose sensor 60 which works in a known manner according to the microdialysis technique. A microdialysis probe implanted in the tissue is subjected to a perfusion liquid and the glucose content is recorded sequentially by a downstream electrochemical-enzymatic electrode sensor. The measured values can be derived quasi-continuously or at intervals.
- the metering unit 46 provided as an actuator is formed by an insulin pump, which enables automatic subcutaneous insulin application via an infusion cannula 62, for example in the abdominal region.
- Both the microdialysis probe and the infusion cannula can be implanted by the patient without medical supervision.
- the dead time effects that occur in the control due to the blood / subcutaneous transitions can be overcome with the proposed control strategy without any problems.
- the entire regulation and control arrangement can be accommodated in a small device which can be worn on the patient's body and which thus takes over the function of the pancreas for the normoglycemic metabolic adjustment.
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Veterinary Medicine (AREA)
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- Engineering & Computer Science (AREA)
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- Heart & Thoracic Surgery (AREA)
- Public Health (AREA)
- Physics & Mathematics (AREA)
- Animal Behavior & Ethology (AREA)
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- Pathology (AREA)
- Anesthesiology (AREA)
- Emergency Medicine (AREA)
- Hematology (AREA)
- Optics & Photonics (AREA)
- Biophysics (AREA)
- Vascular Medicine (AREA)
- Diabetes (AREA)
- Molecular Biology (AREA)
- Surgery (AREA)
- External Artificial Organs (AREA)
- Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
- Infusion, Injection, And Reservoir Apparatuses (AREA)
- Investigating Or Analysing Biological Materials (AREA)
Abstract
Description
Claims
Priority Applications (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP2001557619A JP4226823B2 (ja) | 2000-02-10 | 2001-01-20 | 患者の血中グルコースを調節するホルモンを適量投与するための装置および方法 |
DE50109952T DE50109952D1 (de) | 2000-02-10 | 2001-01-20 | Anordnung zur dosierung eines die blutglukose eines patienten regulierenden hormons |
US10/203,673 US7556613B2 (en) | 2000-02-10 | 2001-01-20 | Array and method for dosing a hormone regulating blood sugar in a patient |
EP01951124A EP1255578B1 (de) | 2000-02-10 | 2001-01-20 | Anordnung zur dosierung eines die blutglukose eines patienten regulierenden hormons |
US12/471,150 US7806853B2 (en) | 2000-02-10 | 2009-05-22 | Array and method for dosing a hormone regulating blood sugar in a patient |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE10006044.7 | 2000-02-10 | ||
DE10006044A DE10006044A1 (de) | 2000-02-10 | 2000-02-10 | Anordnung und Verfahren zur Dosierung eines die Blutglukose eines Patienten regulierenden Hormons |
Related Child Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US10203673 A-371-Of-International | 2001-01-20 | ||
US12/471,150 Continuation US7806853B2 (en) | 2000-02-10 | 2009-05-22 | Array and method for dosing a hormone regulating blood sugar in a patient |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2001058511A1 true WO2001058511A1 (de) | 2001-08-16 |
Family
ID=7630556
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/EP2001/000625 WO2001058511A1 (de) | 2000-02-10 | 2001-01-20 | Anordnung und verfahren zur dosierung eines die blutglukose eines patienten regulierenden hormons |
Country Status (7)
Country | Link |
---|---|
US (2) | US7556613B2 (de) |
EP (1) | EP1255578B1 (de) |
JP (1) | JP4226823B2 (de) |
AT (1) | ATE327786T1 (de) |
DE (2) | DE10006044A1 (de) |
ES (1) | ES2264447T3 (de) |
WO (1) | WO2001058511A1 (de) |
Cited By (5)
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US6544212B2 (en) | 2001-07-31 | 2003-04-08 | Roche Diagnostics Corporation | Diabetes management system |
EP1759726A2 (de) * | 2001-12-19 | 2007-03-07 | Medtronic MiniMed, Inc. | Infusionspumpe mit Bolusplaner welcher die Insulinsensitivität berücksichtigt |
EP2108393A1 (de) * | 2008-04-11 | 2009-10-14 | F.Hoffmann-La Roche Ag | Verwaltungsvorrichtung mit Patientenzustandsüberwachung |
WO2010052849A1 (ja) | 2008-11-04 | 2010-05-14 | パナソニック株式会社 | 測定装置、インスリン注入装置、測定方法、インスリン注入装置の制御方法及びプログラム |
EP2231229A1 (de) * | 2007-12-18 | 2010-09-29 | Insuline Medical Ltd. | Wirkstofffreisetzungsvorrichtung mit sensor für geschlossenen kreislauf |
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DE10006044A1 (de) * | 2000-02-10 | 2001-08-16 | Roche Diagnostics Gmbh | Anordnung und Verfahren zur Dosierung eines die Blutglukose eines Patienten regulierenden Hormons |
CN1561241B (zh) * | 2001-07-31 | 2013-07-10 | 斯科特实验室公司 | 滴注给药的装置和方法 |
US6827702B2 (en) | 2001-09-07 | 2004-12-07 | Medtronic Minimed, Inc. | Safety limits for closed-loop infusion pump control |
US20080160107A1 (en) * | 2002-09-10 | 2008-07-03 | Nitric Biotherapeutics, Inc. | Use of nitric oxide gas to treat blood and blood products |
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EP1788931A1 (de) * | 2004-09-03 | 2007-05-30 | Novo Nordisk A/S | System und verfahren zur schätzung der glucosekonzentration im blut |
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EP3043174A1 (de) | 2008-11-04 | 2016-07-13 | Panasonic Healthcare Holdings Co., Ltd. | Messvorrichtung |
EP3315958A1 (de) | 2008-11-04 | 2018-05-02 | Panasonic Healthcare Holdings Co., Ltd. | Messvorrichtung |
US10070822B2 (en) | 2008-11-04 | 2018-09-11 | Phc Holdings Corporation | Measurement Device |
US8597570B2 (en) | 2008-11-04 | 2013-12-03 | Panasonic Corporation | Measurement device, insulin infusion device, measurement method, method for controlling insulin infusion device, and program |
US10687762B2 (en) | 2008-11-04 | 2020-06-23 | Phc Holdings Corporation | Measurement device |
US11751815B2 (en) | 2008-11-04 | 2023-09-12 | Phc Holdings Corporation | Measurement device |
Also Published As
Publication number | Publication date |
---|---|
EP1255578B1 (de) | 2006-05-31 |
ATE327786T1 (de) | 2006-06-15 |
US20030104982A1 (en) | 2003-06-05 |
US7556613B2 (en) | 2009-07-07 |
ES2264447T3 (es) | 2007-01-01 |
DE10006044A1 (de) | 2001-08-16 |
JP4226823B2 (ja) | 2009-02-18 |
JP2004502474A (ja) | 2004-01-29 |
US7806853B2 (en) | 2010-10-05 |
DE50109952D1 (de) | 2006-07-06 |
EP1255578A1 (de) | 2002-11-13 |
US20090254024A1 (en) | 2009-10-08 |
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