Towards Defence In Depth In Diabetes Glucose Self-Management
type: CreativeWork
description: Diabetes is a disease characterized by insufficient capacity to regulate the blood glucose level. In insulin-dependent diabetes, multiple daily injections of insulin have to be administered. In-between scheduled visits to the care provider, the patient has to manage the glucose control independently. Insulin dosing is a non-trivial task and many patients find it difficult. This is reflected in the health statistics, that indicate that a majority of patients with diabetes have poor metabolic control with associate risks of several short and long term complications. In this thesis, building blocks of a defence-in-depth approach to glucose self-management in insulin-dependent diabetes are investigated. Defence-in-depth is a concept where technical and administrative systems work in cohort to divert potentially dangerous conditions and events. In the context of insulin-dependent diabetes this amounts to avoiding low (hypoglycemia) and high (hyperglycemia) glucose values. Data from the European DIADvisor project and from a local trial conducted with patients from Skåne University Hospital were used in the thesis. A basis for improved glucose control is understanding and knowledge of the glucose-lowering effect of insulin, the insulin action, and the corresponding glucose-elevating effect produced by meal intake. Individualized models of these impacts, and methods to improve the predictive capacity of these models, were developed. Interesting properties, such as, time-variability and nonlinear effects, were found. The models allow for the glucose level to be predicted and different meal and bolus scenarios to be simulated. Using the models, the possibility to foresee and prevent nocturnal hypoglycemia was validated with good performance in a retrospective analysis on the collected data. Recent advances in sensor technology have allowed for commercial systems where the glucose level is measured with a high sampling rate in the interstitial fluid. However, a known deficienc…
abstract: Diabetes is a disease characterized by insufficient capacity to regulate the blood glucose level. In insulin-dependent diabetes, multiple daily injections of insulin have to be administered. In-between scheduled visits to the care provider, the patient has to manage the glucose control independently. Insulin dosing is a non-trivial task and many patients find it difficult. This is reflected in the health statistics, that indicate that a majority of patients with diabetes have poor metabolic control with associate risks of several short and long term complications. In this thesis, building blocks of a defence-in-depth approach to glucose self-management in insulin-dependent diabetes are investigated. Defence-in-depth is a concept where technical and administrative systems work in cohort to divert potentially dangerous conditions and events. In the context of insulin-dependent diabetes this amounts to avoiding low (hypoglycemia) and high (hyperglycemia) glucose values. Data from the European DIADvisor project and from a local trial conducted with patients from Skåne University Hospital were used in the thesis. A basis for improved glucose control is understanding and knowledge of the glucose-lowering effect of insulin, the insulin action, and the corresponding glucose-elevating effect produced by meal intake. Individualized models of these impacts, and methods to improve the predictive capacity of these models, were developed. Interesting properties, such as, time-variability and nonlinear effects, were found. The models allow for the glucose level to be predicted and different meal and bolus scenarios to be simulated. Using the models, the possibility to foresee and prevent nocturnal hypoglycemia was validated with good performance in a retrospective analysis on the collected data. Recent advances in sensor technology have allowed for commercial systems where the glucose level is measured with a high sampling rate in the interstitial fluid. However, a known deficienc…
author: Ståhl, Fredrik
language: eng
keywords: Medical Engineering, Control Engineering, Diabetes, model, insulin action, postprandial glucose
date published: 2015
date modified: 2026-07-24T02:59:49Z
provider: University of Lund
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: Department of Automatic Control, Lund Institute of Technology, Lund University