Bio-behavioral control, glucose variability, and hypoglycemia-associated autonomic failure in type 1 diabetes (T1DM)

In this paper we present a mathematical model and a computer simulation of the relationship between behavioral control of Type 1 diabetes (T1DM), blood glucose (BG) variability and hypoglycemia-associated autonomic failure (HAAF). A stochastic behavioral self-control process was coupled with a dynamical system simulation of the dampening effect of counterregulation on BG oscillations. The resulting bio-behavioral control system was able to reproduce characteristics of hypoglycemic events in the field, such as temporal clustering of hypoglycemic episodes associated with HAAF and occurrence of severe hypoglycemia as a result of periods of HAAF augmented by increased BG variability.