C. De-la-quantité-injectée and .. .. ,

. .. Mise-en-oeuvre,

F. .. Dans-une-boucle-hybride, 140 6.4.1 Définition d'une référence variable

.. .. Conclusion,

, Dynamic Bolus Calculator 145

, Glucides actifs résiduels -Carbohydrates on Board

L. Loi-de-commande-dynamic-bolus-calculator and .. .. ,

. .. Propriétés-du-dynamic-bolus-calculator, 149 7.3.1 Positivité de l'état et de la commande

. .. Mise-en-oeuvre,

D. .. Bolus-calulator-et-gastroparésie,

.. .. Conclusion,

, Dynamic Bolus Calculator

, Glucides actifs résiduels -Carbohydrates on Board

L. .. Loi-de-commande-dynamic-bolus-calculator, , p.148

. .. Propriétés-du-dynamic-bolus-calculator, 149 7.3.1 Positivité de l'état et de la commande

. .. Mise-en-oeuvre,

D. .. Bolus-calulator-et-gastroparésie,

.. .. Conclusion,

, Cette loi de commande permet, en période de jeûne et dans le cas nominal, de corriger l'hyperglycémie en assurant la positivité de la commande et l'absence d'hypoglycémie. Cette commande a été adaptée pour fonctionner dans une boucle hybride où le patient administre lui même ses bolus aux moments des repas

C. Dans-ce, nous introduisons la notion de Glucides actifs résiduels (COB) et montrons qu'ils peuvent s'écrire comme une combinaison de l'état. Les COB seront utilisés avec l'IOB dans la loi de commande Dynamic Bolus Calculator (DBC)

, Glucides actifs résiduels -Carbohydrates on Board

, Les Glucides actifs résiduels (Carbohydrates on Board) représentent la quantité totale de La loi de commande Hypo-Free Hyper-Minimizer est protégée par un brevet international et le Dynamic Bolus Calculator fait l'objet d'une rédaction de brevet en cours. Les perspectives de ce travail sont multiples : ? proposition d'un critère pour diagnostiquer la gastroparésie (? 3 < ? 5 ), ? enrichissement du modèle avec des phénomènes non décrits et grâce à de nouvelles données cliniques : -modélisation du foie (effet de la concentration d'insuline sur la glycogénolyse), -modélisation des hormones de contre-régulation, Les Glucides actifs résiduels sont à la digestion ce qu'est l'insuline active résiduelle (IOB) à la diffusion de l'insuline

, ? Développement d'un simulateur accessible à tous pour l'éducation à l'IF et le test de loi de commande ? Pour la toute première fois une loi de commande qui prend explicitement en compte la pathologie de gastroparésie est présentée. Nous avons fait la conjecture que cette version aménagée du Dynamic Bolus Calculator présente les mêmes propriétés

, On pourra tester la loi de commande Dynamic Bolus Calculator sur le patient virtuel dont les paramètres varient dans le temps avant d'envisager des essais cliniques avec la boucle fermée. Cependant, il sera également pertinent de considérer un algorithme adaptatif pour ajuster la

, Ce travail a montré que notre modèle était un bon candidat sur ce point. Nous avons engagé une collaboration avec des collègues d'Argentine, spécialistes en commande prédictive, afin de mesurer l, La commande prédictive reste la plus populaire dans les systèmes de pancréas artificiel mais afin

, Pour les systèmes n'utilisant que l'insuline, c'est actuellement une annonce par le patient quelques heures avant l'activité physique qui permet d'éviter l'hypoglycémie. Pour les systèmes fonctionnant avec le contrôle bi-hormonal le risque est plus limité, L'activité physique est un des points qui reste difficile à gérer

, Un des verrous qui subsiste est la durée du pic d'action de l'insuline. A l'heure actuelle cela dresse une limite pour les performances de la régulation automatique de glycémie. La simulation dans le cas de gastroparésie a permis de voir qu'avec une insuline plus rapide que la digestion il sera possible d'obtenir des performances comparables à ce que fait naturellement le corps humain

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