A Mechanistic Framework for Modeling Insulin-Glucose-Glucagon Dynamics Under Malaria Co-Infection

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Abstract Malaria and diabetes represent two globally significant metabolic disorders whose co-occurrence leads to complex, poorly understood pathophysiological interactions. Plasmodium infection disrupts glucose homeostasis through parasite-driven glucose consumption, inflammatory cytokine production, and pancreatic α / β -cell dysfunction, while diabetes impairs host immunity and increases malaria susceptibility. To date, no mathematical framework has captured the bidirectional coupling between these systems. Here we extend the insulin-glucose-glucagon (IGG) model of Dalton et al. (2026) by introducing a fourth state variable representing parasite load, incorporating malaria-induced insulin suppression, parasite-driven glucose consumption, inflammatory gluconeogenesis, bidirectional glucagon dysregulation, and insulin-dependent immune enhancement of parasite clearance. We establish positivity, boundedness, existence and uniqueness of steady states, local stability via Routh-Hurwitz criteria, global stability via Lyapunov functions, and sensitivity analysis of parameters driving hypoglycemia risk. Numerical simulations characterise the model across healthy, diabetic, and co-infected states. They show that parasite-driven glucose consumption and inflammatory gluconeogenesis act antagonistically on circulating glucose, that insulin-enhanced immunity lowers peak parasitemia through a saturating clearance term, and that increasing the half-life of exogenous insulin raises hypoglycemia risk in all host states. These mechanisms provide testable hypotheses for the clinical management of malaria-diabetes patients and identify potential therapeutic targets (TNF- α blockade, glucagon analogues) for mitigating co-infection morbidity.

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