Modellig of adrenaline counterregulatory action during hypoglycaemia in Type 1 Diabetes

The risk of hypoglycaemia is still a limiting factor for achieving near-normoglycaemia in subjects with Type 1 Diabetes. From the metabolic perspective, counterregulation has a significant influence in plasma glucose concentration during hypoglycaemia. In Type 1 Diabetes, adrenaline is the first line of counterregulatory hormone response to hypoglycaemia due to the early impairment of glucagon secretion. In a previous work, an adrenaline secretion model was developed. Here, adrenaline counterregulatory action is addressed by means of an extension of the well-known Bergman Minimal Model. The added terms were based on both adrenaline concentration after counterregulatory response begins and the influence of hypoglycaemic levels of glucose in blood. Individual parameters were estimated using data from a eu-hypoglycaemic clamp study by means of global optimization algorithms, in particular CMA-ES. Analysis of plasma glucose prediction accuracy demonstrated the importance of considering counterregulation in predictive algorithms when hypoglycaemic events occur.