Effects of Pulsed Intravenous (IV) Insulin on Brittle and Uncontrolled Diabetes
|Diabetes Mellitus||Procedure: Pulsatile Intravenous Insulin Therapy (Humulin, Humulog, Novolog )||Phase 3|
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Effects of Pulsatile Intravenous Insulin on Brittle Diabetes and Glucose Control|
- Evaluate the effectiveness of Pulsed IV Insulin Therapy on the stabilization of blood glucose levels on patients with brittle or uncontrolled diabetes [ Time Frame: Blood sugar diaries are collected weekly and HA1c labs are collected at baseline and quarterly to assess progress ]
|Study Start Date:||March 2007|
|Study Completion Date:||March 2012|
|Primary Completion Date:||March 2011 (Final data collection date for primary outcome measure)|
Brittle diabetic patients or patients with uncontrolled blood sugars will complete blood sugar diaries weekly and have hemoglobin A1c lab tests performed quarterly to evaluate progress in stabilizing blood sugars.
Procedure: Pulsatile Intravenous Insulin Therapy (Humulin, Humulog, Novolog )
Patients receive weekly treatments of Pulsatile Intravenous insulin therapy. The patient's Endocrinologist determines the insulin dosage each week based upon the patient's response to treatment RQ levels and their insulin resistance.
It is known that the glucose metabolic pathway (glycolysis) is the primary fuel generator in the brain and nerve tissue, the heart and vascular tissue, the eye, the kidney and the liver Deficient metabolic states such as seen in the glucose metabolism of diabetics can lead to sequelae. These damaging effects are exacerbated by altered cellular metabolites, specifically the increase in catabolic and decrease in anabolic factors. It has been shown over the past twenty years that normalization of metabolism in diabetic patients can be accomplished by mimicking the normal endogenous insulin pattern (i.e., in pulses). Pulsatile intravenous insulin infusion has been demonstrated to stabilize the erratic wide swings in blood glucose levels and the overall stabilization of hyperglycemic and hypoglycemic events in Type 1 diabetic patients. This study was established to evaluate the effect of providing pulsatile intravenous insulin therapy on both type 1 and type 2 diabetes to determine the effect on improving diabetic control on patients with high blood glucose levels in spite of multiple insulin injections and wide swings in blood sugar despite good control.
The RQ is determined by the use of a metabolic cart. Individuals breathe into a mask for 3-5 minutes after a rest period of 30 or more minutes. The ratio of exhaled volume of CO2 to the inhaled volume of O2 is determined as the RQ. The physiologic range is 0.7 to1.3. Individuals using fat as a primary fuel have a ratio of 0.7, protein or mixed fuels is 0.8-0.9 and carbohydrate is 0.9-1.0. Those taking excessive calories will have RQ's higher than 1.05. The RQ can be followed serially and this is done before and after each pulsatile IV insulin treatment, during the 3 successive sessions on a single treatment day. The amount of intravenous insulin and oral glucose given is determined by the RQ changes during the previous session.pulsatile IV insulin therapy encourages the glucose metabolism in diabetics to normalize in multiple organs, especially muscle, retina, liver, kidney and nerve endings. The process fundamentally requires the administration of high dose insulin pulses similar to those found in non diabetic humans by their pancreas into the surrounding portal circulation. Oral carbohydrates are given simultaneously to augment the process and prevent hypoglycemia. The process is monitored by frequent glucose levels and respiratory quotients (RQ). RQ is measured by a metabolic cart which determines the ratio VCO2/ VO2. This ratio is specific for the fuel used at any one time by the body. The glucose levels are monitored to keep glucose levels appropriate and the RQ determines the need to readjust the infusion protocol in each patient for subsequent insulin infusion sessions.Patient is evaluated post session and discharged when stable.
Frequent monitoring of RQ is necessary as these levels change rapidly, depending on the fuel being utilized by the body. Pulsatile IV insulin therapy shifts metabolism from primarily fatty acid metabolism to primarily glucose metabolism. This shift is reflected by the increase in respiratory quotient. However during rest periods the RQ may fall back to lower levels. Therefore RQ's are done at the beginning and at the end of each insulin infusion session of 1 hour in order to appropriately monitor and adjust insulin and carbohydrate loads to reach optimal activation in each session
Please refer to this study by its ClinicalTrials.gov identifier: NCT01029444
|United States, Florida|
|Florida Atlantic University|
|Boca Raton, Florida, United States, 33421|
|Study Director:||Betty Tuller, PhD||Florida Atlantic University|