Clinical Nursing Protocols for Insulin Resistance Research

Posted on Aug 16, 2026 in Medicine

CLEAR Study Objectives

The study is trying to determine why skeletal muscle becomes insulin resistant in obesity.

Researchers compare three groups:

  1. Lean insulin-sensitive
  2. Obese insulin-sensitive
  3. Obese insulin-resistant

The key study procedures are:

  • ✅ OGTT
  • ✅ DEXA
  • ✅ VO2 Max
  • ✅ Hyperinsulinemic-Euglycemic Clamp
  • ✅ Muscle Biopsies
  • ✅ Blood/urine collection

The clamp and biopsies are the most important nurse-related procedures.

Essential Nursing Knowledge

Screening Eligibility Criteria

Know these key criteria:

Included

  • Age 30-65
  • Sedentary
  • Non-smoker
  • Stable weight
  • BP ≤ 150/95

Excluded

  • Type 1 or Type 2 diabetes
  • Pregnancy
  • Active smoking, nicotine, or THC use
  • GLP-1 medications (Ozempic, Wegovy, Trulicity, etc.)
  • Metformin
  • Steroids
  • Blood thinners
  • Significant cardiac disease [POINTS 2.0 Protocol]

OGTT and Group Assignment

2-Hour Glucose:

140-199 mg/dL = Insulin Resistant

This is very important because it determines whether a participant belongs in Group B or Group C. [POINTS 2.0 Protocol], [POINTS Summary Sheet]

Visit 1 Clinical Procedures

Typical nursing involvement includes:

NIRS Test

  • Cuff inflation to 220 mmHg
  • Monitor participant comfort

DEXA

  • Verify pregnancy testing is complete, if applicable

VO2 Max

  • Ensure ECG monitoring
  • Watch for symptoms:
    • Chest pain
    • Dizziness
    • Arrhythmias
    • Shortness of breath

Activity Monitor

  • Educate the participant
  • Ensure wear instructions are given

The Hyperinsulinemic-Euglycemic Clamp Visit

Night Before

Participant:

  • Admitted overnight
  • Receives a standardized dinner
  • Begins fasting

Nurse responsibilities:

  • ✅ Review medications
  • ✅ Verify fasting status
  • ✅ Collect urine
  • ✅ Pregnancy test if needed
  • ✅ Prepare for morning clamp

Clamp Setup and IV Access

Requirements:

Two IVs Minimum

IV #1:

  • Insulin
  • Glucose
  • Tracer infusion

IV #2:

  • Blood sampling

Monitor access carefully because frequent blood draws occur throughout the study.

Clamp Procedure Timeline

Baseline

Tracer starts first.

After 2 Hours

Insulin infusion begins at 40 mU/m²/min.

Goal

Maintain glucose at 🎯 ~90 mg/dL (using D20 adjustments).

Monitoring

Fingersticks/NOVA performed every 5-10 minutes.

Monitoring for Hypoglycemia

This is the most important safety concern. Watch for:

  • Sweating
  • Tremors
  • Palpitations
  • Hunger
  • Anxiety
  • Dizziness
  • Change in mental status

If glucose is falling:

  • ✅ Increase D20
  • ✅ Increase monitoring frequency
  • ✅ Notify provider

A study physician/provider is available during the procedure.

Muscle Biopsy Procedures

The study uses the Vastus lateralis.

Biopsies occur at:

  • ✅ Baseline
  • ✅ Post-clamp
  • ✅ Optional 30-minute biopsy

Nursing responsibilities:

  • Assist the provider
  • Maintain a sterile field
  • Monitor for bleeding
  • Reinforce dressing
  • Assess pain
  • Monitor for post-procedure complications

Common complications include:

  • Bruising
  • Hematoma
  • Bleeding
  • Infection

Respiratory Hood and Metabolic Monitoring

Performed twice during the clamp. Purpose:

  • Measure fat oxidation
  • Measure carbohydrate utilization

Nurse Pearl: Participants sometimes feel claustrophobic, hot, or anxious. Provide reassurance and monitor tolerance.

Specimen Collection and Priorities

This study is extremely specimen-driven. Specimens include:

  • ✅ Blood
  • ✅ Urine
  • ✅ Muscle tissue

The muscle tissue is the entire reason for the study. Always verify:

  • Correct participant ID
  • Correct labeling
  • Appropriate processing pathway
  • Timely transport

Adverse Events and Safety Monitoring

Clamp

  • Hypoglycemia
  • IV infiltration
  • Vasovagal events

Biopsy

  • Bleeding
  • Infection
  • Hematoma

VO2 Max

  • Arrhythmias
  • Chest pain
  • Syncope

Venipuncture

  • Hematoma
  • Infection

Post-Procedure Follow-Up Visit

Within 24-72 hours after biopsy, assess for:

  • ✅ Pain
  • ✅ Bleeding
  • ✅ Drainage
  • ✅ Infection
  • ✅ Bruising
  • ✅ Any AE/SAE

This visit can be virtual.

POINTS: Nursing Memory Sheet

P: Pregnancy test before DEXA or clamp

O: OGTT determines group

I: Insulin clamp at ~90 mg/dL

N: Need two IVs

T: Tissue biopsies are critical

S: Safety = watch for hypoglycemia & biopsy complications

Summary of your role: Your primary responsibilities are participant safety during the hyperinsulinemic-euglycemic clamp, support of muscle biopsy procedures, specimen integrity, and monitoring for hypoglycemia, bleeding, and procedure-related adverse events.