- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00967837
Effects of Pulsatile Intravenous (IV) Insulin on Wound Healing in Diabetics (wounds)
Effects of Pulsatile Intravenous Insulin Therapy on Diabetic Subjects With Non Healing Wounds
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Diabetes can produce complications including the inability for wounds to heal despite participating in a traditional wound care therapy program.
At times of reduced tissue oxygen, such as when circulation is decreased, there is anecdotal evidence that pulsed IV insulin (by enabling the production of energy from glucose) may permit heart, skeletal muscle, skin, and other organs to function more normally and even to repair damage and heal. By tracking the progress in diabetic patients that have failed traditional wound care therapy who are monitored by their podiatrist or other health care professional to objectively determine the effect of pulsatile IV therapy on the rate of healing.
Independent evaluation of the wound is provided including visual examination, pictures and measurements on a weekly to bi-weekly basis.
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
Study Type
Enrollment (Actual)
Phase
- Phase 2
- Phase 3
Contacts and Locations
Study Locations
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Florida
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Boca Raton, Florida, United States, 33487
- Florida Atlantic University
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- diagnosed with type 1 or type 2 diabetes
- taking oral and/or insulin for diabetes control
- endocrinologist must assess and approve pt for participation in study
- ability to swallow without difficulty
- ability to meet weekly time and testing requirements for this study
Exclusion Criteria:
- inability to do testing required for study including regular scheduled visits for independent review of non healing wound including assessment, pictures and measurements
- lack of intravenous access
- alcohol abuse, drug addiction or the use of illegal drugs
- positive HIV
- active liver disease
- in active treatment for cancer including radiation or chemotherapy
- inability to breathe into machine for respiratory quotients to monitor progress
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Diabetes with non healing wounds
To determine and monitor progress of diabetic patients with non healing wounds that have failed conventional 60 day treatment respond to pulsatile intravenous insulin therapy in improving and completing healing in non healing wounds
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Diabetic pts that meet trial criteria referred by an endocrinologist are given Pulsatile intravenous insulin therapy on a weekly basis.
Weekly orders for insulin dosage is based upon pt response to therapy monitored by RQ and insulin resistance.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
To measure progress of wound healing in subjects that have failed conventional wound care healing treatments for 60 days
Time Frame: Monitoring of wound is done at baseline and weekly follow up visits including visual examination, pictures of wound and measurements
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Monitoring of wound is done at baseline and weekly follow up visits including visual examination, pictures of wound and measurements
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Betty Tuller, PhD, Florida Atlantic University
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- H09-66
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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