Pulsatile Intravenous Insulin Therapy (PIVIT) is a form of Metabolic Activation Therapy. It utilizes pulsed insulin doses, balanced by glucose, to activate the metabolism. The protocol helps to retrain the signaling and communication of pancreas and liver and restore metabolic function. Ideal for patients with diabetes and its complications, metabolic syndrom and chronic inflammatory disease.
Sugar is a source of energy for our body. Imagine this sugar, also known as glucose, as the fuel of our body’s engine. A consistent fuel supply is needed for an engine to run smoothly and efficiently. Insulin is a hormone responsible to move blood sugar from your blood into your cells. Consequently, maintaining healthy blood sugar and insulin levels is important for your cellular health and overall wellbeing.
Stress, an unbalanced diet, chronic illness, and insufficient physical activity are some of the reasons why the balance between insulin and blood sugar levels can get out of control and organ function can become impaired. This can lead to hyperglycemia (high blood sugar) damaging the vessels that supply blood to vital organs, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems. Symptoms can include headaches, trouble concentrating and fatigue. Long term patients can develop diabetes and neuropathy.
The liver and the pancreas have a crucial function in controlling the glucose levels in the blood and avoiding the hyperglycemic state. A healthy pancreas delivers insulin directly into the portal vein which supplies blood to the liver. The liver requires certain levels of insulin to metabolize dietary glucose properly and store glucose in the form of glycogen thereby keeping blood glucose levels in balance. In the case of the pancreas not secreting enough insulin a bulk of the cells in the body become unable to take up glucose and begin a switch to using alternative energy fuels like fatty acids. Neurons, on the other hand, require a constant supply of glucose. Therefore, they are short term dependent on glycogen reserves in the liver. This is just one example that shows how important a healthy sugar metabolism is for a healthy organism.
Insulin injections and conventional insulin pumps are used to balance sugar levels for acute hyperglycemia. Those methods don’t expose the liver to high concentrations of insulin in a pulsed fashion, nor do they keep blood glucose levels in the normal range as precisely as a healthy pancreas can. Therefore, the goal of a sustaining therapy approach should be to reestablish the organ function.
The PIVIT protocol delivers a higher, more physiologic concentration of insulin to the liver than is delivered by traditional subcutaneous injections. This higher level of insulin available to the liver with metabolic activation therapy stimulates liver cells to synthesize glucokinase and other insulin-dependent enzymes necessary for normal dietary glucose processing and homeostasis.
During a controlled session, glucose levels are frequently monitored and insulin is pulsed over 3 hours with the aim of achieving high portal-vein concentrations during and after a glucose meal. This process can retrain the pancreas and the liver and restore their function.
When repeated over a period of several days or weeks, the body is given the chance to recover from a chronic imbalance and alleviate symptoms that come with a hyperglycemic state. At the same time organ function of the pancreas and liver can be retrained to control the glucose insulin balance. This process can also have a systemic effect on the whole body.
The insulin pulses may alter and improve the metabolism of other organs besides the liver as the pulses are registered by the entire body, not just the liver. In both normal and diabetic individuals, almost all organs rely on the metabolism of fatty acids for their energy fuel. However, the breakdown of fatty acids requires more oxygen at the cellular level than the breakdown of glucose for a given energy output.
PIVIT with pulsed insulin may allow organs to use glucose as an energy source temporarily to a significantly greater extent than usual and thus decrease the organ’s oxygen requirements. This state may permit heart, skeletal muscle, skin, and other organs to function more normally and even to repair damage and heal.
Studies have shown that over the following days and weeks into therapy certain conditions can gradually improve, including blood glucose control, hypoglycemia unawareness, and symptoms of peripheral neuropathy. Studies also show that pulsatile insulin therapy may stop or greatly delay the progression of diabetic kidney disease to end-stage renal disease.
PIVIT may benefit patients that are unable to achieve a balanced glucose control because of severe hypoglycemic episodes due to hypoglycemia unawareness. Other Patients work with their endocrinologist and, despite vigorous attempts to control their glucose levels, are still experiencing diabetic complications. Those patients may benefit from the treatment as well.
It has been observed that PIVIT can reduce hypoglycemic attacks (dangerously low blood sugar) by improving hypoglycemia unawareness and can reduce or delay many complications of diabetes such as damage to kidneys and eyes, abnormal blood pressure, painful neuropathy of the feet and legs, gastroparesis, and foot ulcers.
With each session there appears to be a step-wise improvement in metabolic function. After the first 10 days of treatments patients usually report of better sleep quality and improved ability to concentrate. Patients also note higher energy levels and improved wound healing and a more balanced blood pressure. Often those with “brittle” diabetes notice an improvement in glucose control. However, other complications such as peripheral neuropathy, diabetic complications of the eye, kidney and heart. may take longer to see symptomatic improvements. Because each patient is different and may deal with multiple complications at the same time, improvement in some are noticed earlier than others. To support the continued healing and adaption progress a repeat treatment may be recommended in some cases depending on the symptoms and their severity,
In contrast to usual insulin therapy, insulin pulses imitate the body’s own natural insulin release patterns and appear to enhance the liver’s ability to store, mobilize and utilize glucose. The higher level of insulin available to the liver during PIVIT stimulates liver cells to synthesize glucokinase and other insulin-dependent enzymes necessary for normal dietary glucose processing and homeostasis.
The principles of PIVIT are also used in therapies known as Metabolic Activation Therapy (MAT) or chronic intermittent intravenous insulin infusion Therapy (CIIIT). This potentially important therapy and its research began several years ago, but it has been lost as a mainstream approach of investigation and treatment in patients with diabetes. Currently clinical studies are under way, published articles and scientific papers featuring case studies have shown promising results.
Closed-Loop Insulin Delivery for Glycemic Control in Noncritical Care
Pulsatile insulin secretion, impaired glucose tolerance and type 2 diabetes
“Closing in on the Mechanism of Pulsatile Insulin Secretion” (Diabetes Mar 2018)
Chronic intermittent intravenous insulin therapy: a new frontier in diabetes therapy.
Effects of pulsatile intravenous insulin therapy on the progression of diabetic nephropathy.
Utilization of an abbreviated diabetes impact management scale to assess change in subjective disability during a trial of pulsatile insulin delivery demonstrates benefit.
Effect of i.p. insulin administration on IGF1 and IGFBP1 in type 1 diabetes
Evidence for restoration of hepatic glucose processing in type I diabetes mellitus.
