Pulsatile insulin of Medicine at the University of California, Davis, led the field as a pioneer of using pulsatile insulin in the treatment of diabetes. Dr. Aoki’s work focused on the role of liver dysfunction in diabetic metabolism. He theorized that end organ damage in diabetes is caused by abnormal hepatic glucose metabolism, inadequate insulin delivery, and insulin resistance. He called his approach Metabolic Activation Therapy (MAT), which consisted of an ever-increasing baseline of insulin using Respiratory Quotient to determine the efficiency of treatment (US Patent 4,826,810). Normally, insulin is secreted from the pancreas in pulses into the portal vein which brings
NPH insulin action, which is the primary reason NPH remains on the market today, because manufacturers sell a variety of premixed insulin formulations. Eventually all animal insulins made by Novo Nordisk were replaced by synthetic, recombinant 'human' insulin. Synthetic 'human' insulin is also complexed with protamine to form NPH. It has an intermediate duration of action, meaning longer than that of regular and rapid-acting insulin, and shorter than long acting insulins (ultralente, glargine or detemir). NPH insulin may be combined with faster acting insulin to allow more accurate dosing and better blood sugar level control. When administered this way, the two insulin