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This will make it feasible to infuse an adaptive bolus that changes its shape and integral dose based on the measured performance of the bolus in progress
The adaptive bolus could start with an assumption of a typical proportions and a bolus shape like the combination bolus. This could include:
- a prebolus of pramlintide (optional perhaps, but resolves issue with insulin timing)
- initiation of a combination bolus with the initial spike sized in proportion to the present blood glucose level and trends in the change of blood glucose level,
- modification to the square wave portion of the bolus, increasing or extending if blood sugar is increasing, and decreasing or limiting in duration when blood sugar is decreasing.
The benefits of an automatic bolus delivery might include:
- increased accuracy in the total insulin delivered relative to what was needed,
- freedom to the user of the artificial pancreas,
- elimination of glycemic excursions due to user error (such as forgetting to bolus in conventional pump therapy),
- adaptability to changes in digestion of carbohydrates based on food choices,
- adaptability to variable metabolic needs due to stress, illness, or exercise.