4.1.1 A summary-

Within this website is a description of the insulin stress response theory that proposes a novel endocrine response to injury involving the hormone insulin. This description outlines the endocrine features of the insulin stress response and postulates important functions for insulin that have not previously been recognised. In summary, the insulin stress response theory proposes that insulin functions as a stress response hormone following life threatening injury. This insulin stress response includes a characteristic pattern of secretory response over time which is similar to other stress hormones.

In the different sections of this website are descriptions of the properties of the insulin stress response, its functions to assist recovery of the host following injury and its underlying regulatory mechanisms. An explanation of how the insulin stress response is integrated within the stress response to injury is also described. The insulin stress response theory proposes a new role for insulin as a “active” rather than as a “passive” hormone within the stress response to injury. Current knowledge of the role of insulin following life threatening injury assumes that GSIS by the pancreas continues similarly to the unstressed state and that there is no mediated changes to enhance GSIS.  

The proposal that insulin is a stress response hormone is a fundamentally different approach to understanding the role of insulin in response to injury. Given the wide range of medical conditions that involve tissue injury as well as the increasing prevalence of diabetes and obesity within the population this theory proposes a new  paradigm approach to understanding this hormone and its function within the body. Therefore the potential benefits of this research are wide ranging and includes, for example, the recognition of the importance of the insulin stress response in the activation of the innate immune system. The potential benefits of this research are not limited to tissue injury but also include the discovery of a new endocrine stress mechanisms and their relevance to metabolic diseases such as obesity and diabetes.

This website also outlines the development of the insulin stress response theory from preliminary clinical research investigating the role of adipose tissue within the stress response to injury. This preliminary research has identified a highly regulated pattern of changes in fasting insulin concentrations in the blood following injury which have characteristic features of a stress repsonse. In addition, these changes in fasting insulin concentration in the blood are highly correlated with changes in mediators that are known to regulate insulin secretion from the pancreas. These research findings support the changes in fasting insulin concentration within the bloodstream are mediated by these hormones which regulate GSIS following injury.

4.1.2 The next steps-

The next stage in the development of the insulin stress response theory is to undertake a clinical research study that will evaluate the features described within this website. The preliminary research findings need to be confirmed in a prospective clinical research study. This is important as these preliminary research results were obtained with ad hoc analysis. The nature of preliminary (exploratory) research may necessitate this mode of ad hoc analysis, where it may not be possible to predict the results in advance as there are few previous research studies performed on this subject. In these circumstances a power analysis is not feasible and a small preliminary study is required to obtain results with which to plan a more detailed confirmatory study.   

In order for the insulin stress response theory to be accepted within clinical medical practice it is necessary to conduct a proof of concept study to fully evaluate this hypothesis. This proof of concept clinical research study will be designed to evaluate the different components of this theory that are required to fully establish the theory as a new scientific principle. If the proof of concept study confirms the insulin stress response theory, the next stages of developing this theory would include a research study of therapeutic intervention targeted at particular components of the insulin stress response to achieve improvements in wound healing and host recovery. These are the intended stages in developing the insulin stress response theory within clinical medicine.