Effect of Intranasal Insulin on LH Concentrations in Man

Study Overview
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Brief Summary
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Over the last few years, studies have shown that men with type 2 diabetes sometimes develop a condition called hypogonadotrophic hypogonadism (HH). People with this condition produce little or no sex hormones. Obesity and metabolic syndrome are also associated with HH. Research suggests that insulin in the brain may benefit the glands that release these hormones. During this study, subjects will spray a small amount of insulin into their nose.This will increase insulin concentrations in the brain. The purpose of this study is to find out the effect of one dose of intranasal insulin on release of LH (a sex hormone) in obese diabetic men with HH.

Detailed Description
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Studies over the last few years have clearly established that at least 25% of men with type 2 diabetes have subnormal free testosterone (T) concentrations in association with inappropriately low leutinizing hormone (LH) and FSH (follicle stimulating hormone) concentrations. These patients thus suffer from hypogonadotrophic hypogonadism (HH). Obesity and metabolic syndrome are also associated with HH. Animal studies and in vitro data have shown that insulin action and insulin responsiveness in the brain are necessary for the maintenance of the functional integrity of the hypothalamo-hypophyseal-gonadal axis. Insulin concentrations can be increased in the brain by delivering insulin intranasally with vianase device. The aim of this project is to study the effect of one dose of intranasal insulin on release of LH in obese diabetic men with HH. 15 obese men with type 2 diabetes and low free T along with normal LH concentrations will be recruited for the study. The study will be carried out at the clinical center of Texas Tech (Odessa campus). There will be two study visits, each comprising of blood tests every 15 minutes over 6 hours. 40 IU of intranasal insulin or saline will be given after a baseline period of blood sampling of 2 hours. Student's t-test will be used to compare the change in LH concentrations after intranasal saline or insulin.

Official Title
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Effect of Intranasal Insulin on LH Concentrations in Man

Conditions
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Hypogonadotropic Hypogonadism

Intervention / Treatment
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* Drug: intranasal insulin
* Drug: placebo (intranasal saline)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Males age 18 to 75 years Obesity (BMI ≥30 kg/m2) Type 2 diabetes Hypogonadotropic hypogonadism defined as calculated free testosterone concentrations below 7 ng/dl along with normal or low LH concentrations Exclusion Criteria: HbA1c>8.5% Use of preprandial insulin therapy Use of testosterone currently or in the past 4 months Use of over the counter health supplements which contain androgens Use of corticosteroids or narcotics in the past 3 months Coronary event or procedure(myocardial infarction, unstable angina, coronary artery bypass, surgery or coronary angioplasty) in the previous twelve weeks Type I Diabetes Currently suffering from foot ulcer, significant periodontal disease or any other chronic infectious or inflammatory condition Hepatic disease (transaminase > 3 times normal) or cirrhosis Renal impairment (defined as glomerular filtration rate<30) HIV or Hepatitis C positive status Any other life-threatening, non-cardiac disease History of untreated severe obstructive sleep apnea(defined as apnea-hypopnea index ≥30) currently suffering from symptomatic depression, with or without treatment Use of an investigational agent or therapeutic regimen within 30 days of study Participation in any other concurrent clinical trial Pituitary tumor/damage/ other trophic hormone deficiency

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: diabetes<br>All patient will receive insulin at one visit and saline at another visit | Drug: intranasal insulin<br>* insulin<br>Drug: placebo (intranasal saline)<br>* saline<br>|
| Active Comparator: control<br>All patient will receive insulin at one visit and saline at another visit | Drug: intranasal insulin<br>* insulin<br>Drug: placebo (intranasal saline)<br>* saline<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| LH | Luteinizing hormone (LH) concentrations after intranasal insulin as compared to placebo (intranasal saline). This endpoint was measured in both arms | 4 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hypogonadotropic hypogonadism