by Chris Duffield, January 31, 2002  (updated 6/17/2004)

        Please read the Warning and Disclaimer below.

        The currently taught IPT protocol has evolved to provide a great degree of safety, repeatability, and control.  However, it does require trained medical supervision, and a certain quantity of supplies (syringes, IV bag and tubes, etc.).

        Most of the people in the world are not rich, and have minimal access to doctors and medical supplies.  The IPT protocol as it exists today works superbly, and with the best control and safety.  But is there a way to get many of the benefits of IPT and preserve safety, while drastically reducing costs for supplies, and reducing the need for medically-trained personnel?  Here are some ideas for a simplified IPT protocol, based in part on methods used in the past by Drs. Perez Garcia 1 and 2.

        The first level of simplification would be to replace the expensive IV bag with a less costly butterfly needle/port.  This is a device which provides continuous access to a vein.  However, supplies and a certain degree of medical training are needed to find a vein, maintain a sterile field, and insert the butterfly.  Sterile glucose is needed, and a large glucose syringe.

The proposed simplest protocol would be something like this:

1. Fasting.  The patient comes for treatment in fasting condition.  (About 8 to 12 hour fast, no food, drinking only water.)

2. Insulin injection.  The dose of insulin, typically 0.4 units per kilogram,  is determined from the patient's weight and build, using a table or a calculator.  The skin should be swabbed with alcohol first.  Then insulin is injected intramuscularly (IM) or intravenously (IV) using a small syringe and sterile needle.  (If IV, a butterfly needle can be used, allowing for later delivery of IV drugs and/or glucose.)  Any type of insulin may be used.  Humalog acts faster.  Depending on patient response, insulin dose can be increased or decreased in subsequent treatments.

3. Oral and IM drugs.  Five or ten minutes after insulin injection, oral drugs and nutrients are taken by mouth with water, and intramuscular drugs and nutrients are injected by syringe and needle.  The choice of drugs and nutrients depends on the patient's condition and needs.  Generally, IPT drug doses are 1/10 (for chemotherapy and other toxic drugs) to 1/2 (for antibiotics and other less toxic drugs) of normal doses without IPT.   
Caution:  In some cases, smaller than normal doses with IPT can cause side effects or toxicity comparable to an overdose without IPT.   Professional medical expertise is highly recommended for carefully choosing drugs and doses.

4. Wait and Observe.  The patient is carefully observed as hypoglycemic symptoms develop.  Typical symptoms of hypoglycemia include:  hunger, thirst, feeling warm, sweating, faster heartbeat, seeing spots of light, light-headedness, mild difficulty speaking, mild euphoria, and drowsiness.  For safety, do not allow the patient to drift into disorientation, sleep, or coma before giving sugar water, in the next step.

5. Therapeutic moment -- give IV drugs and sugar water.  When hypoglycemic symptoms have developed to the desired stage, IV drugs can be given, if the practitioner has that skill, and appropriate supplies. Then 16 oz or more of very sweet sugar water is given by mouth, as the patient desires.  Glucose (dextrose) absorbs fastest, but sucrose (standard cane sugar) and honey (mixture of glucose and fructose) should work fine.  This solution could, and maybe should, for more rapid absorption, also include electrolytes, as in oral rehydration mixtures (often available in developing regions in dry packets  for dilution), or commercial products like Gatorade®. 

6. Recover and observe.  The patient is observed, as hypoglycemic symptoms go away, and is given fruit or more sweet drinks, as needed.

Glucagon as safety backup:   There is a very small risk that the patient might over-respond to the insulin, or that the caregiver will not recognize hypoglycemic symptoms until they have progressed too far (disorientation or coma).  If this happens, and the patient is still conscious, or can be awakened sufficiently, sugar water should be given immediately to end the hypoglycemic symptoms.  In no case should the patient be allowed to slip into coma.  According to Dr. Perez Garcia (personal communication), when the patient feels hot, or has other noticeable symptoms, the hypoglycemia is deep enough for the full IPT effect.

        It is very unlikely that hypoglycemia will proceed to the stage of coma.  But just in case this should happen, and the patient is unconscious or disoriented, and is unable to swallow sugar water safely, there needs to be a way to end hypoglycemia quickly.  It is an emergency situation, and action must be taken quickly.

        In the standard "high-tech" IPT method, this is easy because an intravenous line is already installed, and intravenous glucose is available.  After glucose injection, the patient recovers quickly, usually in seconds.  But in a remote area with personnel who are not trained to find and inject into a vein, an alternative method is needed.

        All sources I've seen say that sugar or sugar water should never be given orally to a comatose or disoriented patient, as it may cause choking or asphyxiation.  Injecting glucose into a vein is very quick and effective, but may be difficult and require some experience. 

        Probably the best emergency method to end hypoglycemia is to use a glucagon administration kit.  This is an inexpensive kit that can be stored for a long time at temperatures below 90 degrees F (28 degrees C).  It should only be used for emergencies, as it can have side effects such as nausea and vomiting.  When the patient returns to conscious, quickly give oral glucose, because the effect of glucagon may be only temporary.

Other hypoglycemia ending possibilities:  Intraperitoneal injection of glucose (through the abdominal wall)?  A sugar water enema?  I don't know if either would work.

        If you have any suggestions or comments about this proposed technique, or if you try it and have any experiences to share, please email email me, Chris Duffield..

Warning and Disclaimer:  Even though this proposed "Low-Tech IPT" procedure is relatively simple, and could be done by an untrained person, it should only be done with professional medical supervision, except perhaps in case of a great emergency, or total isolation from civilization.  Chris Duffield and IPTQ are not responsible for any use or misuse of this proposed method, or any negative consequences that may come from it.