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Pulsatile insulin
Pulsatile insulin, sometimes called metabolic activation therapy, or cellular activation therapy describes in a literal sense the intravenous injection of insulin in pulses versus continuous infusions. Injection of insulin in pulses mimics the physiological secretions of insulin by the pancreas into the portal vein which then drains into the liver. In healthy, non-diabetic individuals, pancreatic secretions of insulin correspond to the intake of food. The pancreas will secrete variable amounts of insulin based upon the amount of food consumed (basically speaking, the more food that is consumed, the more insulin the pancreas will secrete) among other factors. The majority of available experimental evidence suggests a more potent hypoglycemic effect of pulsatile insulin in comparison to continuous insulin infusion. Continuous exposure to insulin and glucagon is known to decrease the hormones’ metabolic effectiveness on glucose production in humans due to the body developing an increased tolerance to the hormones. Down-regulation at the cellular level may partially explain the decreased action of steady-state levels of insulin, while pulsatile hormone secretion may allow recovery of receptor affinity and numbers for insulin. Intermittent intravenous insulin administration with peaks of insulin concentrations may enhance suppression of gluconeogenesis and reduce hepatic glucose production.
== Background==
Dr. Thomas Aoki, former Head of Metabolism Research at the Joslin Diabetes Center in Boston, Massachusetts, and a former Professor of Medicine at the University of California, Davis, was the pioneer of using pulsatile insulin in the treatment of diabetes. Dr. Aoki’s work focused on the role of liver dysfunction in diabetic metabolism. He theorized that end organ damage in diabetes is caused by abnormal hepatic glucose metabolism, inadequate insulin delivery, and insulin resistance. His approach consisted of an ever-increasing baseline of insulin using Respiratory Quotient to determine the efficiency of treatment (US Patent 4,826,810).
By Administrative Law Determination, following a lengthy trial, the State of California CalPers was ordered to pay for the treatment as it was adjudicated not to be experimental, investigational and was medically necessary for those patients who appealed. That order was not appealed and became final.
抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』
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