PubMed · 9697484
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M E Wood. 1998. Responsible purchasing information.... https://pubmed.ncbi.nlm.nih.gov/9697484/
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Diabetes is a disease of the glucose regulatory system that is associated with increased morbidity and early mortality. The primary variables of this system are beta-cell mass, plasma insulin concentrations, and plasma glucose concentrations. Existing mathematical models of glucose regulation incorporate only glucose and/or insulin dynamics. Here we develop a novel model of beta -cell mass, insulin, and glucose dynamics, which consists of a system of three nonlinear ordinary differential equations, where glucose and insulin dynamics are fast relative to beta-cell mass dynamics. For normal parameter values, the model has two stable fixed points (representing physiological and pathological steady states), separated on a slow manifold by a saddle point. Mild hyperglycemia leads to the growth of the beta -cell mass (negative feedback) while extreme hyperglycemia leads to the reduction of the beta-cell mass (positive feedback). The model predicts that there are three pathways in prolonged hyperglycemia: (1) the physiological fixed point can be shifted to a hyperglycemic level (regulated hyperglycemia), (2) the physiological and saddle points can be eliminated (bifurcation), and (3) progressive defects in glucose and/or insulin dynamics can drive glucose levels up at a rate faster than the adaptation of the beta -cell mass which can drive glucose levels down (dynamical hyperglycemia).
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We generalize the principle of integral rein control to include other systems which partition in such a way that the equilibrium values of some variables are not dependent on the equations governing those variables. Instead, they are determined by the dynamics of other, "regulator" variables. We improve our earlier model for the control of glucose by insulin and glucagon by relaxing the condition necessary for it to operate. The two hormones do not have to be inhibited in the same way; they need only respond to the same combination of their concentrations. We also present a model for the control of ionized calcium by PTH and calcitonin and suggest that the role of chromogranin A may be to stabilize an otherwise unstable system.