Insulin Kinetics during Hyper-Insulinemia Euglycemia Therapy (HIET)

Hyper-insulinemia euglycemia therapy (HIET) is a supra-physiological insulin dosing protocol
used in acute cardiac failure to reduce dependency on inotropes to augment or generate cardiac output,
and is based on the inotropic effects of insulin at high doses up to 45-250x normal daily dose. Such high
insulin doses are managed using intravenous glucose infusion to control glycemia and prevent
hypoglycemia. However, both insulin dosing and glycemic control in these patients is managed ad-hoc.
This research examines a selection of clinical data to determine the effect of high insulin dosing on renal
clearance and insulin sensitivity, to assess the feasibility of using model-based methods to control and
guide these protocols. The results show that the model and, in particular, the modeled renal clearance
constant are adequate and capture measured data well, although not perfectly. Equally, insulin sensitivity
over time is similar to broader critical care cohorts in level and variability, and these results are the first
time they have been presented for this cohort. While more data is needed to confirm and further specify
these results, it is clear that the model used is adequate for controlling HIET in a model-based
framework.