System and method for distinguishing between hypoglycemia and hyperglycemia using an implantable medical device

• US 7,524,287 B2
• Filed: 05/11/2005
• Issued: 04/28/2009
• Est. Priority Date: 01/25/2005
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Bharmi, Rupinder
• Primary Examiner(s): Evanisko; George R
• Assistant Examiner(s): Kahelin; Michael
• Application Number:
  US11/127,370
• Publication Number:
  US 20060167365A1
• Time in Patent Office: 1,448 Days
• Field of Search: 600/517, 600/365
• US Class Current: 600/365
• CPC Class Codes: A61B 5/14532 for measuring glucose, e.g. by tissue impedance measurement
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/358 Detecting ST segments
• CPC Class Codes: A61B 5/364 Detecting abnormal ECG interval, e.g. extrasystoles, ectopic heartbeats
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36557 controlled by chemical substances in blood
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

Techniques are described for detecting and distinguishing among ischemia, hypoglycemia or hyperglycemia based on intracardiac electrogram (IEGM) signals. In one technique, these conditions are detected and distinguished based on an analysis of: the interval between the QRS complex and the peak of a T-wave (QTmax), the interval between the QRS complex and the end of a T-wave (QTend), alone or in combination with a change in ST segment elevation. By exploiting QTmax and QTend in combination with ST segment elevation, changes in ST segment elevation caused by hypo/hyperglycemia can be properly distinguished from changes caused by cardiac ischemia. In another technique, hyperglycemia and hypoglycemia are predicted, detected and/or distinguished from one another based on an analysis of the amplitudes of P-waves, QRS-complexes and T-waves within the IEGM. Appropriate warning signals are delivered and therapy is automatically adjusted.

Claims

1. A method for use with an implantable medical device for distinguishing between hypoglycemia and hyperglycemia within a patient in which the device is implanted, the method comprising:

tracking with said implantable medical device, amplitude-based parameters within electrical cardiac signals over time corresponding to amplitudes of atrial depolarizations, ventricular depolarizations and ventricular repolarizations;

detecting with said implantable medical device, hyperglycemia upon detection of an increase in atrial depolarization amplitudes, an increase in ventricular depolarization amplitudes and a lack of significant change in ventricular repolarization amplitudes; and

detecting with said implantable medical device, hypoglycemia upon detection of a lack of significant change in atrial depolarization amplitudes, an increase in ventricular depolarization amplitudes and an increase in ventricular repolarization amplitudes.

2. The method of claim 1 wherein tracking amplitude-based parameters comprises tracking one or more of:

the absolute values of the amplitudes or the rate of change in the amplitudes.

3. The method of claim 1 wherein:

tracking amplitudes of ventricular depolarization events over time comprises determining the rate of change of ventricular-depolarization amplitudes; and

detecting one of hypoglycemia and hyperglycemia comprises distinguishing hypoglycemia and hyperglycemia from one another based on the rate of change, wherein a faster rate of change is associated with hyperglycemia rather than with hypoglycemia.

4. The method of claim 1 further comprising controlling therapy based on whether the patient is subject to hypoglycemia or hyperglycemia.

5. The method of claim 4 wherein an implantable drug pump is provided for delivering insulin and wherein, if the patient is subject to hypoglycemia, controlling therapy comprises reducing insulin delivery to the patient using the insulin pump.

6. The method of claim 4 wherein an implantable insulin pump is provided and wherein, if the patient is subject to hyperglycemia, controlling therapy comprises increasing insulin delivery to the patient using the insulin pump.

7. The method of claim 1 further comprising generating a warning signal.

8. The method of claim 1 wherein the implantable device include a defibrillator with defibrillation shock capacitors and wherein, if the patient is subject to hypoglycemia, the method further comprises charging the capacitors.

9. The method of claim 1 further comprising recording diagnostic information based on whether the patient is subject to hypoglycemia or hyperglycemia.

10. The method of claim 9 further comprising examining the recorded diagnostic information to predict episodes of hypoglycemia or hyperglycemia.

11. The method of claim 10 wherein examining the recorded diagnostic information to predict episodes of hypoglycemia or hyperglycemia is performed by identifying a trend in the amplitude-based parameter.

12. The method of claim 11 further comprising issuing a warning signal upon prediction of an episode of hypoglycemia or hyperglycemia.