FAQs - Frequently Asked Questions about CIIIT

Metabolic activation therapy (MAT) - because CIIIT improves metabolism in many other tissues.
Hepatic activation - because CIIIT improves liver metabolism.
PIVIT - pulsatile intravenous insulin therapy
Pulsatile therapy

2. When is CIIIT recommended?

The addition of chronic intermittent intravenous insulin therapy, to the American Diabetes Association recommended treatment program can reduce hypoglycemic attacks (dangerously low blood sugar) and reduce or delay many complications of diabetes.
Diabetic complications such as kidney damage, progressive damage to the retina of the eye, orthostatic hypotension (low blood pressure), foot ulcers, and painful neuropathy of the feet and legs, have been stabilized or dramatically improved by adding CIIIT.

3. What is a CIIIT weekly treatment session?
For a 6-hour period in an outpatient (or inpatient) healthcare setting, the patient receives intermittent pulses of insulin through an intravenous catheter in a peripheral vein in the hand or arm. The intermittent pulses are controlled by a complex computerized program that produces the desired geometric waveforms and the doses are adjusted based on frequent monitoring of blood glucose levels, respiratory quotient(RQ) response, and the timing of a glucose load ingested by the patient. The session is under the direction of a physician. Patients relax in big lounge chairs and read, watch TV, sleep, do their own crafts or even business projects for the 6 hours.

Because the beneficial effects of the 6-hour session gradually decrease over the week, the patient must return once a week for the 6-hour sessions to get the long term benefits of CIIIT.

4. Why does CIIIT need to be done weekly?

Because the metabolic improvements resulting from a 6-hour CIIIT session only persist for approximately one week after the treatment day. To see measurable improvement in glucose control, hypertension or any of the other diabetic complications, the 6-hr sessions must be repeated at weekly intervals. CIIIT is a chronic therapy for diabetes, a chronic disease.

5. How soon does improvement occur on CIIIT?

With each 6-hour session there appears to be a step-wise improvement in metabolic function. Despite this gradual improvement in metabolic function, usually no changes in symptoms are reported in the first two months of weekly therapy. However, after approximately 2 months of weekly sessions those with "brittle" diabetes notice an improvement in glucose control. After 3 months, improvements in blood pressure control are seen. After approximately 6 months of weekly sessions, patients begin to note improvements in peripheral neuropathy, hypoglycemia unawareness and other complications are noticed by the patients. Patients also note higher energy levels, and improved wound healing. After 3 to 12 months of therapy, many patients report stabilization of diabetic complications of the eye, kidney, and heart. CIIIT has been shown to slow deterioration of renal function as measured by monthly creatinine clearance levels. (Medical literature references are listed in Research Results)

6. What happens in-between the weekly CIIIT sessions?

During the week between the 6-hour CIIIT sessions, the patient follows the American Diabetes Association (ADA) recommendations of intensive insulin therapy -usually the "four shot regimen". The patient, the patient's private physician and the CIIIT physician all work in partnership to optimize health with attention to diet, exercise, and aggressive treatment of other medical problems such as hypertension and lipid abnormalities.

7. How does CIIIT work?
CIIIT involves delivering insulin intravenously in a pulsatile fashion using a special pump over a 6-hour period. The pulses deliver a higher, more physiologic concentration of insulin to the liver than are delivered by traditional subcutaneous injections. This higher level of insulin available to the liver with CIIIT stimulates liver cells to synthesize glucokinase and other insulin-dependent enzymes necessary for normal dietary glucose processing and homeostasis. (Production and activity of these enzymes requires high local concentrations of insulin.)

These metabolic improvements in the liver are often collectively called hepatic activation. This improved metabolism is measured by the patient's respiratory quotient (RQ). RQ is a measure of the success of tissues in using oxygen and burning fuel. During the 6-hour CIIIT session, the RQ increases toward normal levels. (See Physiology )

Over many months hepatic glucose metabolism returns to a more normal pattern and is maintained there by weekly CIIIT sessions. The metabolism of many other tissues also improves, permitting more normal glucose control, more normal blood pressure control, and the repair of some complications of diabetes.

8. Why can't an insulin pump or other insulin produce the same improvements as CIIIT?
Insulin shots or insulin pumps that inject insulin subcutaneously (under the skin) have two drawbacks"

1) they provide lower-than-normal insulin concentrations to the liver and

2) they can only gradually increase or decrease in the concentration of insulin.

In short, insulin pumps and insulin subcutaneous injections can not produce the high-level insulin pulses in the vein to the liver such as are produced by a normal pancreas. Because of this, the liver does not optimally process glucose while on these treatment programs.

Because CIIIT injects insulin intravenously (IV), it raises the insulin level to the liver to a normal range and because it delivers pulses of insulin it closely mimics the high-level pulses seen in "normal" people who do not have diabetes. This close imitation of the normal pancreas is what leads to the metabolic improvements seen with CIIIT.(see chart in #15)

Note: IV insulin must only be given under a doctor's care because it can rapidly decrease blood sugar to dangerously low levels. CIIIT is done under a doctor's supervision, with close monitoring, and includes glucose administration in planned amounts.

9. Why is CIIIT recommended as a long term continuing program?

Some improvements such as improved hypoglycemia awareness, reversal of polyneuropathy, and improvement in other complications are seen only after several months of weekly CIIIT sessions and these improvements have persisted in many cases for years provided the patient continues the weekly sessions. See also #5 How soon improvements occur on CIIIT.

When CIIIT weekly sessions are discontinued for any reason, patients find that their complications, fatigue, and hypoglycemia unawareness gradually return.

10. List some of the benefits patient's have reported with CIIIT?
Improved blood glucose control.
Reduced the severity of swings in blood glucose levels in patients with "brittle" diabetes.
Restored hypoglycemia awareness.
Decreased episodes of severe hypoglycemia by approximately 98 percent.
Slowed progression of diabetic kidney and eye disease.
Lowered high blood pressure in diabetic patients.
Eliminated dizziness/ blackouts due to orthostatic hypotension.
Accelerated wound healing.
Improved heart metabolism.
Marked improvement of peripheral neuropathy.
Marked improvement of gastroparesis.

11. Does every patient with diabetes need CIIIT?

CIIIT is usually recommended only for patients with diabetes who, despite carefully following ADA recommended therapy (or treatment by an Endocrinologist), continue to have serious problems with glucose control or diabetic complications. Most of these patients have Type 1 diabetes, but some have Type 2. CIIIT has improved the quality of life in patients with either type of diabetes who had problems with glucose control, hypoglycemic unawareness, or other complications.

12. Where is CIIIT available?

CIIIT is available at several locations in the United States. However, please check with ADRI to be sure that the location you plan to use is a licensed location to insure that you will actually receive the correct therapy. Because the therapy involves intravenous (IV) insulin it is very important that you receive the therapy from a health care provider with a license and special training for CIIIT.

13. Why can't I try CIIIT at home myself?
Just reading this website does not give enough information on how to do CIIIT to allow you to safely try it at home. CIIIT is a complex patented methodology done under a doctor's care. Do NOT try to imitate CIIIT at home. Insulin should not be given intravenously without a doctor's supervision. Insulin can cause severe disability, coma, and death.

14. How much does CIIIT cost?
The cost for one patient for chronic intermittent intravenous insulin therapy (CIIIT) is approximately $25,000 per year. This is in addition to a patient's usual medical bills. CIIIT is not an experimental procedure, however, it may not be covered by some types of health insurance. In cases in which payment was originally denied for CIIIT and a court hearing was held, the judges have all ruled that the insurer must pay for CIIIT. For some seriously ill patients CIIIT has not only improved quality of life, it has also been cost-saving, by preventing some of the high costs related to diabetic complications such as bills for hospitalization, surgery or dialysis.

15. How does metabolic function improve with CIIIT?

In contrast to usual insulin therapy, CIIIT 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 with CIIIT stimulates liver cells to synthesize glucokinase and other insulin-dependent enzymes necessary for normal dietary glucose processing and homeostasis.

16. What are CIIIT's pharmacologic effects?

• First phase. The pulses of high dose insulin seen by the liver during CIIIT sessions are very similar to those of the first phase of pancreatic insulin secretion in non-diabetics after ingestion of a meal. Approximation of first phase insulin is never achieved with subcutaneous insulin injections, but is seen to some degree with the new oral insulins.
• Enzyme activation. CIIIT apparently restores glucose homeostasis by increasing the production and activity of glucokinase in the liver and other tissues.
• Glycogen Storage and Glucose oxidation. CIIIT has been shown to improve glycogen storage and glucose oxidation by the liver, a function of enhanced liver enzyme activity. Increased glycogen storage and glucose oxidation helps normalize blood glucose by preventing wide "swings" or rapid hypoglycemia.
• Respiratory Quotient.  CIIIT produces a more normal respiratory quotient due to more efficient oxidation of fuels by the liver and other tissues. In both normal and diabetic individuals, most organs, e.g. muscle, heart, skin, rely on the metabolism of fatty acids for 70 percent to 80 percent of their fuel. However, the breakdown of fatty acids requires more oxygen at the cellular level than the breakdown of glucose for a given energy output. Pulsed insulin therapy may permit these organs to use glucose as an energy source to a significantly greater extent than usual (due to increased pyruvate dehydrogenase activity) and thus decrease the organ's oxygen requirements.
•  Healing/Repair.  At times of reduced tissue oxygen, such as when circulation is decreased, chronic intermittent intravenous insulin (by enabling the production of energy from glucose, a process requiring less oxygen ) may permit heart, skeletal muscle, skin, and other organs to function more normally, thus permitting them to repair damage and heal.

17. What scientific theory about metabolic processes might explain CIIIT's ability to improve diabetic complications?
Because the insulin pulses are "seen" by the entire body, not just the liver, the pulses may alter and improve the metabolism of other organs besides the liver. In both normal and diabetic individuals, most organs rely on the metabolism of fatty acids for 70 percent to 80 percent of their fuel. However, the breakdown of fatty acids requires more oxygen at the cellular level than the breakdown of glucose for a given energy output. Pulsed insulin therapy may permit organs to use glucose as an energy source to a significantly greater extent than usual (due to increased pyruvate dehydrogenase activity) and thus decrease the organ's oxygen requirements.

At times of reduced tissue oxygen, such as when circulation is decreased, chronic intermittent intravenous insulin (by enabling increased production of energy from glucose, thus requiring less oxygen) may permit heart, skeletal muscle, skin, and other organs to function more normally and even to repair damage and heal. Research studies are planned to determine the effect of CIIIT on the rate of healing in situations of reduced tissue oxygen levels.

18. What do published Scientific Research Studies show about CIIIT?

CIIIT has been shown to be effective in halting the progression of diabetic kidney disease, reducing serious hypoglycemic attacks, improving blood pressure control. For research published by ADRI and others on CIIIT and other topics, see Research Reports

Results with CIIIT (MAT)

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Physiology of CIIIT (MAT)

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