Integrated insulin delivery system having delivery safety features

• US 8,579,854 B2
• Filed: 08/31/2012
• Issued: 11/12/2013
• Est. Priority Date: 05/22/2009
• Status: Active Grant

• Current Assignee: Abbott Diabetes Care Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Abbott Diabetes Care Incorporated (Abbott Laboratories Incorporated)
• Inventors: Budiman, Erwin S., Hayter, Gary A., Crouther, Nathan, Taub, Marc B., Harper, Wesley Scott, Wei, Charles
• Primary Examiner(s): Flick, Jason
• Application Number:
  US13/601,944
• Publication Number:
  US 20120330227A1
• Time in Patent Office: 438 Days
• Field of Search: 604/66
• US Class Current: 604/66
• CPC Class Codes: A61B 2562/0295 Strip shaped analyte sensors for apparatus classified in A61B5/145 or A61B5/157 disposable multilayered or laminated electrodes G01N27/307; details of handling chemical test elements G01N33/4875
• CPC Class Codes: A61B 5/14532 for measuring glucose, e.g. by tissue impedance measurement
• CPC Class Codes: A61B 5/1495 Calibrating or testing of in-vivo probes
• CPC Class Codes: A61B 5/4839 combined with drug delivery
• CPC Class Codes: A61M 2005/14208 with a programmable infusion control system, characterised by the infusion program
• CPC Class Codes: A61M 2005/14296 Pharmacokinetic models
• CPC Class Codes: A61M 2205/3569 sublocal, e.g. between console and disposable
• CPC Class Codes: A61M 2205/52 with memories providing a history of measured variating parameters of apparatus or patient
• CPC Class Codes: A61M 2230/201 Glucose concentration
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: G16H 20/17 delivered via infusion or injection

Abstract

An integrated insulin delivery system having safety features for controlling medication delivery includes automatic resumption of basal rate after a particular event, such as termination of a bolus, expiration of a time period, delayed resumption after the bolus has terminated, IOB comparison, and others. Other safety features include overriding a delivery control that may result in hypoglycemia, terminating an extended bolus or temporary basal rate in view of a glucose signal indicating imminent carbohydrate deficiency, and controlling the delivery rate to take an asymmetrical bias range of a glucose sensor into account to avoid hypoglycemia.

Claims

1. A system for the delivery of insulin to a patient, the system comprising:

a continuous glucose sensor configured to sense glucose and to provide a sensor glucose level signal representative of the sensed glucose;

an insulin delivery device configured to deliver insulin to a patient in response to delivery control signals; and

a memory containing a glucose reference value therein, the glucose reference value representing an actual measured glucose level, the memory further containing a range of acceptable glucose sensor bias for acceptable glucose level control relative to the glucose reference value, wherein the range of glucose sensor bias encompasses a range having a lower end at which a sensor is biased toward sensing a lower level of glucose than actually exists and a higher end at which a sensor is biased toward sensing a higher level of glucose than actually exists, wherein the range of acceptable glucose sensor bias is asymmetrical about the glucose reference value;

a controller programmed to store the glucose reference value in the memory, store the asymmetrical range of acceptable glucose sensor bias, receive the sensor glucose level signal, compare the sensor glucose level signal to the glucose reference value, calculate an amount of any sensor bias, compare any calculated sensor bias to the asymmetrical range of acceptable glucose sensor bias, and to provide a delivery control signal to the insulin delivery device to deliver insulin in a manner that accounts for the asymmetrical bias range of the glucose sensor whereby bias inaccuracy in the sensor may be tolerated with limited hyperglycemia while avoiding hypoglycemia.

2. The system for the delivery of insulin to a patient of claim 1, wherein the controller is further programmed to control the insulin delivery device to not deliver insulin if the calculated sensor bias is outside the asymmetric range of acceptable glucose sensor bias for acceptable glucose level control.

3. The system for the delivery of insulin to a patient of claim 2, wherein the controller is further programmed:

to indicate a request for a manual calibration of the continuous glucose sensor when the calculated sensor bias is outside the asymmetric range of acceptable glucose sensor bias for acceptable glucose level control; and

to control the insulin delivery device to not deliver insulin if the calculated sensor bias is outside the asymmetric range of acceptable glucose sensor bias for acceptable glucose level control.

4. The system for the delivery of insulin to a patient of claim 1, wherein the controller is further programmed to provide a prompt to take a reference glucose measurement and store the value in the memory prior to the start of a closed-loop insulin delivery.

5. The system for the delivery of insulin to a patient of claim 1, wherein:

if the comparison by the controller of the glucose level signal to the glucose reference value results in a calculated glucose sensor bias that is lower than a lowest level allowed in the asymmetrical range of acceptable glucose sensor bias;

then the controller is further programmed to provide a delivery control signal to the insulin delivery device to begin delivering insulin, and the controller is further programmed to not provide an indication for a manual calibration of the glucose sensor at that time;

whereby a large low sensor bias caused by an anomalous depressed sensor output will not be used as cause for a sensor calibration, which calibration could result in a very high sensor bias potentially resulting in undesirable levels of hypoglycemia.

6. The system for the delivery of insulin to a patient of claim 5, wherein after delivery of insulin has begun under the condition of a large low sensor bias, the controller will continue to perform comparisons of the continuous glucose sensor level signals against the glucose reference level and if after a predetermined time, the large low sensor bias has not returned to the acceptable range of bias, the controller is further programmed to indicate a request for a manual calibration of the continuous glucose sensor.

7. The system for the delivery of insulin to a patient of claim 1, wherein:

if the comparison by the controller of the sensor glucose level signal to the glucose reference value results in a calculated glucose sensor bias that is lower than a lowest level allowed in the asymmetrical range of acceptable glucose sensor bias;

then the controller is further programmed to indicate a request for a manual calibration before controlling the insulin delivery device to begin closed-loop delivery; and

then schedule a follow up comparison of the sensor glucose level signal to the glucose reference value at a later time to confirm that the manual calibration corrected the low bias of the glucose sensor;

whereby a large low sensor bias caused by an anomalous depressed sensor output will not be used as cause for a sensor calibration, which calibration could result in a very high sensor bias potentially resulting in undesirable levels of hypoglycemia.

8. The system for the delivery of insulin to a patient of claim 1, wherein the memory also contains a maximum rate of insulin delivery;

wherein the controller is programmed to calculate a rate of insulin delivery where the calculated bias falls within a high bias portion of the asymmetrical range of acceptable glucose bias;

wherein the controller is further programmed to compare the calculated rate of insulin delivery to the maximum rate of insulin delivery contained in the memory; and

the controller is further programmed to control the insulin delivery device to deliver insulin at the lower rate of either the calculated rate of insulin delivery or the maximum rate of insulin delivery;

whereby hypoglycemia due to over-delivery of insulin is avoided.

9. The system for the delivery of insulin to a patient of claim 1, wherein the controller is further programmed to establish the asymmetrical range of acceptable sensor bias, then the controller is programmed to determine the sensor bias by comparison to the reference glucose value, and then the controller is programmed to control the insulin delivery device to start delivery if the bias falls within the asymmetrical range of acceptable bias, otherwise the controller is programmed to provide a request for a manual calibration of the glucose sensor.

10. A system for the delivery of insulin to a patient, the system comprising:

a continuous glucose sensor configured to sense glucose and to provide a sensor glucose level signal representative of the sensed glucose;

an insulin delivery device configured to deliver insulin to a patient in response to delivery control signals; and

a memory containing a glucose reference value therein, the glucose reference value representing an actual measured glucose level, the memory further containing a range of acceptable glucose sensor bias for acceptable glucose level control relative to the glucose reference value, wherein the range of glucose sensor bias encompasses a range having a lower end at which a sensor is biased toward sensing a lower level of glucose than actually exists and a higher end at which a sensor is biased toward sensing a higher level of glucose than actually exists, wherein the range of acceptable glucose sensor bias is asymmetrical about the glucose reference value, the memory also containing a maximum rate of insulin delivery;

a controller programmed to provide a prompt to take a reference glucose measurement and store the value in the memory prior to the start of a closed-loop insulin delivery, to store the asymmetrical range of acceptable glucose sensor bias, to receive the sensor glucose level signal, to compare the sensor glucose level signal to the glucose reference value, to calculate an amount of any sensor bias, to compare any calculated sensor bias to the asymmetrical range of acceptable glucose sensor bias, to provide a delivery control signal to the insulin delivery device to deliver insulin if the calculated sensor bias falls within the asymmetrical range of acceptable sensor bias, the controller also programmed to calculate a rate of insulin delivery where the calculated bias falls within a high bias portion of the asymmetrical range of acceptable glucose bias, to compare the calculated rate of insulin delivery to the maximum rate of insulin delivery contained in the memory, and to control the insulin delivery device to deliver insulin at the lower rate of either the calculated rate of insulin delivery or the maximum rate of insulin delivery;

whereby bias inaccuracy in the sensor may be tolerated with limited hyperglycemia while avoiding hypoglycemia.

11. The system for the delivery of insulin to a patient of claim 10, wherein the controller is further programmed to control the insulin delivery device to not deliver insulin if the calculated sensor bias is outside the asymmetric range of acceptable glucose sensor bias for acceptable glucose level control.

12. The system for the delivery of insulin to a patient of claim 11, wherein the controller is further programmed:

to indicate a request for a manual calibration of the continuous glucose sensor when the calculated sensor bias is outside the asymmetric range of acceptable glucose sensor bias for acceptable glucose level control; and

to control the insulin delivery device to not deliver insulin if the calculated sensor bias is outside the asymmetric range of acceptable glucose sensor bias for acceptable glucose level control.

13. The system for the delivery of insulin to a patient of claim 10, wherein:

if the comparison by the controller of the glucose level signal to the glucose reference value results in a calculated glucose sensor bias that is lower than a lowest level allowed in the asymmetrical range of acceptable glucose sensor bias;

then the controller is further programmed to provide a delivery control signal to the insulin delivery device to begin delivering insulin, and the controller is further programmed to not provide an indication for a manual calibration of the glucose sensor at that time;

whereby a large low sensor bias caused by an anomalous depressed sensor output will not be used as cause for a sensor calibration, which calibration could result in a very high sensor bias potentially resulting in undesirable levels of hypoglycemia.

14. The system for the delivery of insulin to a patient of claim 13, wherein after delivery of insulin has begun under the condition of a large low sensor bias, the controller will continue to perform comparisons of the continuous glucose sensor level signals against the glucose reference level and if after a predetermined time, the large low sensor bias has not returned to the acceptable range of bias, the controller is further programmed to indicate a request for a manual calibration of the continuous glucose sensor.

15. The system for the delivery of insulin to a patient of claim 10, wherein:

if the comparison by the controller of the sensor glucose level signal to the glucose reference value results in a calculated glucose sensor bias that is lower than a lowest level allowed in the asymmetrical range of acceptable glucose sensor bias;

then the controller is further programmed to indicate a request for a manual calibration before controlling the insulin delivery device to begin closed-loop delivery; and

then schedule a follow up comparison of the sensor glucose level signal to the glucose reference value at a later time to confirm that the manual calibration corrected the low bias of the glucose sensor;

whereby a large low sensor bias caused by an anomalous depressed sensor output will not be used as cause for a sensor calibration, which calibration could result in a very high sensor bias potentially resulting in undesirable levels of hypoglycemia.

16. A system for the delivery of insulin to a patient, the system comprising:

a glucose sensor configured to sense glucose and to provide a sensor glucose level signal representative of the sensed glucose;

an insulin delivery device configured to deliver insulin to a patient in response to delivery control signals; and

a memory containing a glucose reference value therein, the glucose reference value representing an actual measured glucose level, the memory further containing a range of acceptable glucose sensor bias for acceptable glucose level control relative to the glucose reference value, wherein the range of glucose sensor bias encompasses a range having a lower end at which a sensor is biased toward sensing a lower level of glucose than actually exists and a higher end at which a sensor is biased toward sensing a higher level of glucose than actually exists, wherein the range of acceptable glucose sensor bias is asymmetrical about the glucose reference value, the memory also containing a maximum rate of insulin delivery;

a controller programmed to provide a prompt to take a reference glucose measurement and store the value in the memory prior to the start of insulin delivery, to store the asymmetrical range of acceptable glucose sensor bias, to receive the sensor glucose level signal, to compare the sensor glucose level signal to the glucose reference value, to calculate an amount of any sensor bias, to compare any calculated sensor bias to the asymmetrical range of acceptable glucose sensor bias, to provide a delivery control signal to the insulin delivery device to deliver insulin if the calculated sensor bias falls within the asymmetrical range of acceptable sensor bias, the controller also programmed to calculate a rate of insulin delivery where the calculated bias falls within a high bias portion of the asymmetrical range of acceptable glucose bias, to compare the calculated rate of insulin delivery to the maximum rate of insulin delivery contained in the memory, and to control the insulin delivery device to deliver insulin at the lower rate of either the calculated rate of insulin delivery or the maximum rate of insulin delivery;

whereby bias inaccuracy in the sensor may be tolerated with limited hyperglycemia while avoiding hypoglycemia.

17. The system for the delivery of insulin to a patient of claim 16, wherein the controller is further programmed to control the insulin delivery device to not deliver insulin if the calculated sensor bias is outside the asymmetric range of acceptable glucose sensor bias for acceptable glucose level control.

18. The system for the delivery of insulin to a patient of claim 17, wherein the controller is further programmed:

to indicate a request for a manual calibration of the continuous glucose sensor when the calculated sensor bias is outside the asymmetric range of acceptable glucose sensor bias for acceptable glucose level control; and

to control the insulin delivery device to not deliver insulin if the calculated sensor bias is outside the asymmetric range of acceptable glucose sensor bias for acceptable glucose level control.

19. The system for the delivery of insulin to a patient of claim 16, wherein:

if the comparison by the controller of the glucose level signal to the glucose reference value results in a calculated glucose sensor bias that is lower than a lowest level allowed in the asymmetrical range of acceptable glucose sensor bias;

then the controller is further programmed to provide a delivery control signal to the insulin delivery device to begin delivering insulin, and the controller is further programmed to not provide an indication for a manual calibration of the glucose sensor at that time;

whereby a large low sensor bias caused by an anomalous depressed sensor output will not be used as cause for a sensor calibration, which calibration could result in a very high sensor bias potentially resulting in undesirable levels of hypoglycemia.

20. The system for the delivery of insulin to a patient of claim 19, wherein after delivery of insulin has begun under the condition of a large low sensor bias, the controller will continue to perform comparisons of the continuous glucose sensor level signals against the glucose reference level and if after a predetermined time, the large low sensor bias has not returned to the acceptable range of bias, the controller is further programmed to indicate a request for a manual calibration of the continuous glucose sensor.

21. The system for the delivery of insulin to a patient of claim 16, wherein:

if the comparison by the controller of the sensor glucose level signal to the glucose reference value results in a calculated glucose sensor bias that is lower than a lowest level allowed in the asymmetrical range of acceptable glucose sensor bias;

then the controller is further programmed to indicate a request for a manual calibration before controlling the insulin delivery device to begin closed-loop delivery; and

then schedule a follow up comparison of the sensor glucose level signal to the glucose reference value at a later time to confirm that the manual calibration corrected the low bias of the glucose sensor;

whereby a large low sensor bias caused by an anomalous depressed sensor output will not be used as cause for a sensor calibration, which calibration could result in a very high sensor bias potentially resulting in undesirable levels of hypoglycemia.