Pulsatile Intravenous Insulin Therapy (PIVIT)

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A treatment for difficult-to-treat cases of diabetes, involving weekly six-hour sessions in which a special pump delivers insulin in programmed pulses. This treatment, which more closely mimics insulin delivery from the pancreas than traditional subcutaneous injections or conventional insulin pumps do, can help improve blood glucose control and lower the risk of diabetic complications.

Normally, in people who don’t have diabetes, the pancreas delivers insulin directly into the portal vein, the vein that supplies blood to the liver, so the liver is exposed to high concentrations of insulin. In fact, the liver needs high levels of insulin to function properly in metabolizing dietary glucose and keeping blood glucose levels in balance. Certain enzymes in the liver require high concentrations of insulin to function properly. Insulin injections and conventional insulin pumps don’t expose the liver to high concentrations of insulin, nor do they keep blood glucose levels in the normal range as precisely as a healthy pancreas can.

PIVIT, which is also referred to as metabolic activation therapy (MAT), chronic intravenous insulin therapy (CIIT), hepatic activation, and pulsatile therapy, is designed to help improve the liver’s ability to regulate blood glucose. It is usually recommended only for people with diabetes who have serious difficulty controlling blood glucose levels or are developing diabetic complications in spite of their best efforts on intensive insulin therapy, the current standard of care for diabetes.

The pulsatile treatments are carried out in weekly six-hour sessions in an inpatient or outpatient health-care setting. A pump sends intermittent pulses of insulin through an intravenous catheter placed in a peripheral vein in the person’s hand or arm. The insulin pulses are controlled by a computer program that determines how frequently to give insulin pulses based on a number of factors, including the person’s blood glucose levels during the treatment and the timing of glucose loads the person consumes. The entire procedure is monitored by a physician.

Over the ensuing weeks, studies show, certain conditions gradually improve, including blood glucose control, hypoglycemia unawareness, and symptoms of peripheral neuropathy. Studies also show that PIVIT may stop or greatly delay the progression of diabetic kidney disease to end-stage renal disease. The therapy needs to be given over the long term to sustain the benefits, and it costs about $25,000 a year. (Some, but not all, third-party payers will reimburse for the treatment.)

For more information about PIVIT, ask your doctor, or visit the Aoki Diabetes Research Institute’s Web site at www.adri.org/faqs.html. The Web site provides a directory of locations in the United States that offer the treatment.

Originally Published November 24, 2009

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