A habituating blood glucose control strategy for the critically ill

In the intensive care unit patients benefit from being fed and from having well controlled glucose levels. Insulin and glucose infusion serves as manipulated inputs to regulate blood glucose, while glucose infusion serves as a sole nutritional input. In this paper, a model predictive control strategy, based on simultaneously manipulating glucose and insulin infusion, is developed to improve blood glucose regulation in intensive care unit patients. In the short term, glucose infusion is used for tighter glucose control, particularly for disturbance rejection, while, in the long-term (24 h period), glucose infusion is used to meet nutritional needs. The “habituating control” algorithm is proposed and tested against a model predictive control (MPC) strategy that only manipulates insulin. The simulation results indicate that the Habituating MPC strategy outperforms the single input–single output MPC by providing faster setpoint tracking and tighter glucose control for a patient population, and producing less glucose variability while rejecting disturbances in insulin infusion and insulin sensitivity.

► Tight regulation of blood glucose improves outcomes ICU patients.
► Insulin and glucose are infused to regulate blood glucose and provide nutrition.
► A “habituating” model predictive control (MPC) is proposed.
► Habituating MPC outperforms classical single-input, single-output MPC.