滑动尺胰岛素无法控制非糖尿病患者的类固醇诱导性高血糖，无论怎样调整参数
Sliding-scale Insulin Does Not Control Steroid-induced Hyperglycemia in a Non-diabetic Patient, No Matter How You Tune It
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中文总结 AI 辅助
针对类固醇诱导高血糖，滑动尺胰岛素因内源性分泌代偿而失效，参数调整无法修复，需改用连续输注并每日调整。
中文摘要 AI 辅助
滑动尺校正胰岛素是医院应对高血糖的标准措施。其常数源自不分泌胰岛素的人群，却常被用于自身胰岛素分泌功能完好的患者。我们将该校正规则表示为带死区的比例控制器，每四小时采样一次，作用于基于已发表生理学数据构建的、包含胰腺反馈的葡萄糖模型。我们推导了外源性胰岛素对葡萄糖的敏感性，在覆盖已发表参数范围的4,995名虚拟患者中进行了评估，并将模型校准至一名接受大剂量皮质类固醇和肠外营养的非糖尿病青少年，使用了45次床旁血糖测量数据。我们在此表明，内源性调节以11.5分钟的时间常数恢复葡萄糖，而注射胰岛素达到峰值需64分钟，因此每次剂量的绝大部分替代了患者自身的分泌，所下达的规则使平均血糖变化不足1.5 mg/dL。在每一名虚拟患者中，所下达的校正因子均超过单位效价。由于随着血糖升高效价下降，在99.5%的虚拟患者中，不存在一个恒定的校正因子既能在190 mg/dL时有效，又能在110 mg/dL时无超调；在79%的患者中，不匹配度超过25%，并随半最大分泌葡萄糖水平升高而增大。四小时采样与药物稀释液中的葡萄糖相位锁定，会错过由此产生的血糖波动。当内源性分泌功能完好时，滑动尺因结构性原因而失效，重新调整参数无法解决。与葡萄糖同时输注的连续胰岛素输注，每日根据平均血糖调整一次，可与四小时监测所能测量的结果相匹配。
英文摘要
Sliding-scale insulin is the default hospital response to high blood glucose. Its correction factor was designed for patients who make no insulin, yet it is routinely ordered for patients whose pancreas still works, including those on high-dose steroids. We treat the sliding scale as what it is, a proportional controller sampled every four hours, acting on a patient who already contains a working glucose controller of her own. We test it in a non-diabetic adolescent on high-dose corticosteroids and parenteral nutrition, and in 4,995 virtual patients. It fails for three structural reasons, and no choice of correction factor fixes any of them. First, the patient's own loop settles in 11.5 minutes while injected insulin takes 64 minutes to peak, so most of each dose simply replaces insulin she would have secreted; in simulation the ordered scale moved her mean glucose by less than 1.5 mg/dL. Second, one unit lowers glucose twice as much at 110 mg/dL as at 190, so any correction factor strong enough to work when glucose is high overshoots when it is low; in 99.5% of virtual patients no constant factor does both. Third, four-hour sampling is far below the Nyquist rate, so successive readings are uncorrelated and each dose responds to a value that does not persist. Even the argument that correction doses rest the beta cells, taken on its own terms, favors continuous delivery. We propose replacing the scale with a continuous insulin infusion co-delivered with the dextrose and adjusted once a day on mean glucose, the one quantity four-hour monitoring can measure.
发表机构
- Regev Labs, LLC（Regev Labs有限责任公司）
机构由 AI 辅助整理，请以论文原文为准。
