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Nakadate Y, Kawakami A, Oguchi T, Omiya K, Nakajima H, Yokomichi H, Sato H, Schricker T, Matsukawa T. Safety of intranasal insulin administration in patients undergoing cardiovascular surgery: An open-label, nonrandomized, dose-escalation study. JTCVS Open 2024; 17:172-182. [PMID: 38420553 PMCID: PMC10897660 DOI: 10.1016/j.xjon.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/19/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024]
Abstract
Objective This study aimed to determine the maximum safe dose of intranasal insulin administration during cardiac surgery. Methods This open-label, Phase 1, single-center, dose-escalation clinical trial recruited patients scheduled to undergo elective cardiac surgery or major vascular surgery requiring cardiopulmonary bypass between February and September 2021. They were grouped into 5 dose-escalation cohorts and administered 0, 40, 80, 160, and 240 IU insulin (n = 6 in each group) via a metered nasal dispenser after the induction of general anesthesia. Blood samples were collected at 10-minute intervals for the first 60 minutes and at 30-minute intervals thereafter. Hypoglycemia was defined as a blood glucose level <70 mg/dL. Patient recruitment was terminated after hypoglycemia was observed in 2 patients in any of the groups. Results In total, 27 of 29 enrolled patients were administered intranasal insulin or saline. Hypoglycemia was not observed after the administration of intranasal insulin in the 0, 40, 80, or 160 IU groups; however, it was observed in 2 of 3 patients in the 240 IU group. The serum insulin concentration was elevated in the 160-IU group, but the C-peptide concentration was not elevated in any of the groups. Conclusions The administration of up to 160 IU intranasal insulin did not induce clinically significant hypoglycemia. However, 160 IU intranasal insulin should be administered cautiously because insulin can enter the systemic circulation in a dose-dependent manner.
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Affiliation(s)
- Yosuke Nakadate
- Faculty of Medicine, Department of Anesthesiology, University of Yamanashi, Chuo, Yamanashi, Japan
- Department of Anesthesiology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Akiko Kawakami
- Faculty of Medicine, Department of Anesthesiology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Takeshi Oguchi
- Faculty of Medicine, Department of Anesthesiology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Keisuke Omiya
- Faculty of Medicine, Department of Anesthesiology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroyuki Nakajima
- Faculty of Medicine, Department of Surgery 2, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Yokomichi
- Faculty of Medicine, Department of Epidemiology and Environmental Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroaki Sato
- Department of Anesthesia, Royal Victoria Hospital, McGill University Health Centre Glen Site, Montreal, Canada
| | - Thomas Schricker
- Department of Anesthesia, Royal Victoria Hospital, McGill University Health Centre Glen Site, Montreal, Canada
| | - Takashi Matsukawa
- Faculty of Medicine, Department of Anesthesiology, University of Yamanashi, Chuo, Yamanashi, Japan
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Yokoyama H, Takeda R, Kawai E, Ota A, Morita E, Imai D, Suzuki Y, Morioka T, Emoto M, Inaba M, Okazaki K. Inhibitory Effects of Intranasal Administration of Insulin on Fat Oxidation during Exercise Are Diminished in Young Overweight Individuals. J Clin Med 2018; 7:E308. [PMID: 30274197 DOI: 10.3390/jcm7100308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 01/22/2023] Open
Abstract
It remains unknown whether the high insulin (INS) levels in the brain affect fat oxidation during exercise. We examined the effects of the intranasal administration of INS, which increases the INS concentration in the cerebrospinal fluid when peripheral effects are lacking, on the maximum fat oxidation rate (maxFOR) and its intensity (FATmax) during exercise in 15 young normal-weight (N group) and eight young overweight (O group) individuals. On two separate days, either INS or placebo (PL) was randomly administered intranasally before a graded exercise test. Indirect calorimetry was used to assess maxFOR and FATmax during exercise. Blood INS and glucose levels did not change after INS administration. In the N group, maxFOR and FATmax were significantly smaller in the INS trial than in the PL trial. MaxFOR was significantly smaller in the O group than in the N group and was not influenced by INS administration. Exercise-induced elevation in blood epinephrine levels tended to be reduced by INS administration only in the N group. Intranasal INS administration reduces fat oxidation during exercise without any peripheral effects, possibly by suppressing sympathetic nerve activity. This inhibitory effect is diminished in overweight subjects, suggesting that cerebral insulin effects are attenuated in this population.
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