IV Based Insulin: Glucommander Algorithm
While the Yale Insulin Infusion Protocol is widely applied, it is neither computerized and nor is it completely continuous. Implementation of the protocol requires medical personnel to measure the patient’s glucose in intervals ranging from an hour to four hours, depending on the measured stability of the blood glucose level. Lastly the protocol’s insulin dosage calculation is not based on a precise measurement of blood glucose. Instead, the protocol involves placing the blood glucose level into certain categories, thus compromising on effective treatment. Our Glucosystem IV will be able to overcome these shortcomings, through a more effective protocol, first implemented in a software called Glucommander.
The Glucommander is a computer-directed method of inpatient glucose management. It takes in the measurements of the current blood glucose levels and the rate of change in glucose, and then regulates the infusion of IV fluids, through an IV infusion pump, driving the blood glucose level towards a predetermined target range. Once that target blood glucose range is attained, Glucommander’s function then becomes to maintain the blood glucose in that target range. Unlike the Yale Infusion Protocol, the Glucommander’s protocol is based on an algorithm involving the exact blood glucose level, and not on the range in which the measured blood glucose belongs to. The Glucommander algorithm is as follows:
IV Insulin Infusion Rate (units of insulin/hour) = (Blood Glucose - 60) * multiplier
1. Initiate IV Insulin drip by applying the current blood glucose and the multiplier, 0.02, to the above formula
2. If the current blood glucose is greater than 110 and has not dropped at least 15% over the previous blood glucose, increase the multiplier by 0.01
3. If the current blood glucose is greater than 110 and has dropped at least 15% over the previous blood glucose, use the same multiplier
4.If the blood glucose is between 80 and 110, do not change the multiplier but continue adjusting the drip rate according to the formula
5. If the blood glucose is less than 80, refer to the hypoglycemia algorithm (not shown)
Because the Glucommander is computerized, it calculates the exact insulin dosage based on the input of blood glucose level values every hour. The newest Glucommander based product (Glucommander IV) also intravenously infuses the patient with the measured insulin dosage. Our Glucosystem IV follows a modified version of the Glucommander algorithm. Whereas the infusion rate for Glucommander is calculated every hour, our Glucosystem infusion must be updated every five minutes. Therefore, assessing a 15 % drop or rise in blood glucose over an hour must be calibrated so that we are now assessing whether there was a 1.25% drop or rise every five minutes (since there are exactly twelve 5-minute intervals in an hour, and 15/12 = 1.25). Glucommander addresses hypoglycemia (lower than normal blood glucose level) by using a separate algorithm based on IV infusion of dextrose (a kind of sugar). Thus, Glucommander is essentially a meal-less algorithm, based on a medical device taking care of the patient’s meal and insulin needs. In contrast, our Smart IV Insulin Infusion System incorporates meal-based and meal-less algorithms. For example, our “Food Request”/ “Food Request Accepted” protocol simulates a patient having a meal, which is followed by our modified Glucommander algorithm calculating the appropriate insulin dosage following a meal. At the same time, if patient’s blood glucose drops to hypoglycemic levels, our program simulates an automatic dosage of dextrose (a kind of sugar) to normalize the patient’s blood glucose levels (an example of a meal-less algorithm).
Back to introduction
IV Insulin Infusion Rate (units of insulin/hour) = (Blood Glucose - 60) * multiplier
1. Initiate IV Insulin drip by applying the current blood glucose and the multiplier, 0.02, to the above formula
2. If the current blood glucose is greater than 110 and has not dropped at least 15% over the previous blood glucose, increase the multiplier by 0.01
3. If the current blood glucose is greater than 110 and has dropped at least 15% over the previous blood glucose, use the same multiplier
4.If the blood glucose is between 80 and 110, do not change the multiplier but continue adjusting the drip rate according to the formula
5. If the blood glucose is less than 80, refer to the hypoglycemia algorithm (not shown)
Because the Glucommander is computerized, it calculates the exact insulin dosage based on the input of blood glucose level values every hour. The newest Glucommander based product (Glucommander IV) also intravenously infuses the patient with the measured insulin dosage. Our Glucosystem IV follows a modified version of the Glucommander algorithm. Whereas the infusion rate for Glucommander is calculated every hour, our Glucosystem infusion must be updated every five minutes. Therefore, assessing a 15 % drop or rise in blood glucose over an hour must be calibrated so that we are now assessing whether there was a 1.25% drop or rise every five minutes (since there are exactly twelve 5-minute intervals in an hour, and 15/12 = 1.25). Glucommander addresses hypoglycemia (lower than normal blood glucose level) by using a separate algorithm based on IV infusion of dextrose (a kind of sugar). Thus, Glucommander is essentially a meal-less algorithm, based on a medical device taking care of the patient’s meal and insulin needs. In contrast, our Smart IV Insulin Infusion System incorporates meal-based and meal-less algorithms. For example, our “Food Request”/ “Food Request Accepted” protocol simulates a patient having a meal, which is followed by our modified Glucommander algorithm calculating the appropriate insulin dosage following a meal. At the same time, if patient’s blood glucose drops to hypoglycemic levels, our program simulates an automatic dosage of dextrose (a kind of sugar) to normalize the patient’s blood glucose levels (an example of a meal-less algorithm).
Back to introduction