A new treatment!?: Therapeutic hypoglycemia with CancerDialysis
Author: Sture Hobro
Today’s dialyzer is permeable to molecules up to 40-50 kD (kilo Daltons), and the insulin molecule is around 6 kD. Therefore, both insulin and glucose are largely removed with modern dialyzers.
In a study from 1961, Leonards et al. performed dialysis on a mongrel dog that had fasted overnight and started dialysis during fasting conditions. It must be mentioned that in this study, they used an older dialysis membrane that is not permeable to larger solutes such as insulin, and therefore only small solutes such as glucose could be removed. Therefore, the insulin levels in blood are not directly affected by dialysis. If insulin had been removed, as will happen with today’s dialyzers, gluconeogenesis would have been reinforced, and glucose levels would have been upheld in another way.
When the glucose infusion started in Leonards study, it was because the dog got cramps due to enthralling low levels of glucose (~13 mg/dl or 0.7 mmol/l). To avoid the risk of cramps at such extreme low glucose levels, it will be important to ensure that other potential energy fuels than glucose are present in abundance (e.g. ketones). Obviously, the border where cramps can start must be carefully researched, and when glucose levels is reduced below 50 mg/l (2.8 mmol/L), the patient must be carefully supervised.
To perform hashtagCancerdialysis with modern dialysis membrane and achieve the same result on glucose decrease during the treatment, it is suggested to infuse small amounts of insulin to balance the loss of insulin over the dialyzer. If compensating for the loss of insulin through the dialyzer, it is likely that therapeutic hypoglycemia levels to treat cancer can be achieved. Before inducing therapeutic hypoglycemia during CancerDialysis, it will be important to secure high ketone levels to avoid hypofuelemia in blood and hypofulemic condition in the brain (see post 32). Therefore, we suggest taking means to secure high ketones during CancerDialysis, such as infusing or orally taking ketones or MCT oils during the treatment to support the liver to uphold sufficient levels of energy fuels especially for the brain. It will be key to secure high ketone levels in the blood before therapeutic hypoglycemia is induced. That said, the dog in Leonard’s study showed remarkable resilience towards very low glucose levels during dialysis without glucose, even without the security measure we suggest taking during CancerDialysis.
Figure: The dialysis started with 100 mg/dl in the dialysate. After 60 minutes, a dialysis with 0 glucose in the dialysate was started. Glucagon administration did not reduce the glucose decrease more than temporarily; however, glucose infusion quickly increased blood glucose levels.
