The Importance of Managing Residual Insulin

While dosing protocols may be carefully calculated, a hospitalized patient’s need for insulin may change quickly based on a wide range of factors. Insulin therapy must follow suit.

Compared to paper protocols and lookup tables, computerized insulin management solutions enhance ease of use and accuracy. However, many computerized systems rely on the same imprecise protocols as manual methods and fall short of achieving optimal glycemic control. To truly manage glucose care, hospitals should not only computerize treatment, but individualize treatment.

One of the major factors that affects insulin dosing is estimated residual extracellular insulin (EREI), often referred to as insulin on board. EREI is simply residual insulin in the body from a previous method of insulin therapy, which will continue to act on blood sugar levels for some time going forward. Without accounting for this, excess insulin builds up and results in insufficient blood sugar levels.

Failure to properly account for the effect of EREI is one of the major causes of hypoglycemia and ongoing glucose blood level swings.

In 2011, a Canadian study compared the effects of a computer-directed intravenous insulin system to a traditional paper-based nonogram for cardiovascular patients. It found significant improvements in glucose control but at the same time were faced with higher hypoglycemia episodes. The inability to accurately control for on board insulin figured prominently into the cause. Patient-specific factors related to insulin and glucose metabolism also played a role.

To deal with this, EndoTool Glucose Management System takes computerized insulin dosing a step beyond traditional management by incorporating an EREI calculation. It estimates how much insulin remains in the body from prior dosing, based on a patient’s unique physiology and prior insulin response before calculating the next dose. If the patient has significant EREI, the insulin dose may be reduced. If current EREI levels cannot be supported by circulating glucose, EndoTool may also recommend a counter-balancing dextrose dose. Unlike simple computerization of existing protocols, EndoTool also assesses a patient’s overall glucose state on an ongoing basis and incorporates this information into dosing.

That’s a major step towards personalized medicine and individualized treatment.