Insulin Therapy in Uremic Diabetic Patients on Continuous Ambulatory Peritoneal Diaysis; Comparison of Intraperitoneal and Subcutaneous Administration

Author:

Scarpioni Lino1,Ballocchi Sergio1,Castelli Aurelio1,Scarpioni Roberto1

Affiliation:

1. Renal Unit, Department of Internal Medicine, Piacenza Hospital, Piacenza, Italy

Abstract

Objective To compare, in diabetic uremic patients on continuous ambulatory peritoneal dialysis (CAPD), the effects of two patterns of insulin administration, four times daily subcutaneous (SC) injections and intraperitoneal (IP) route, on blood glucose, insulin, lactate, beta-hydroxybutyrate and glycerol levels. Patients and Methods We examined 6 uremic insulin-dependent diabetic patients on CAPD. The two insulin regimens, SC and IP, were tested successively in randomized sequence in each patient. At the end of each treatment period we determined the 24-our profiles of blood glucose, free insulin, lactate, beta-hydroxybutyrate, and glycerol. Results Mean blood glucose over 24 hours (SC 7.21 ±0.61 mmol/L, IP 7.49±0.93 mmol/L), Schlichtkrull's M value, an index of glycemic control and stability (SC 10±3, IP 10±5), and the blood intermediate metabolites beta-hydroxybutyrate, lactate, and glycerol were similar in both groups. Mean serum free insulin was significantly higher during subcutaneous treatment (SC 257. 4±127.2 pmol/L, IP 170.4±83.4 pmol/L, p < 0.001). Insulin requirements were 2.5 times greater for the intraperitoneal route (SC 51 ±4 U/24 hours, IP 130±43 U/24 hours). Conclusions In uremic diabetic patients on CAPD, good glycemic control may be achieved either with subcutaneous intensive insulin therapy or with intraperitoneal insulin administration. The latter method allows reduction of circulating free insulin levels, but requires a higher dose of insulin per day.

Publisher

SAGE Publications

Subject

Nephrology,General Medicine

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1. Intraperitoneal Chemotherapy;Nolph and Gokal's Textbook of Peritoneal Dialysis;2023

2. When ESKD complicates the management of diabetes mellitus;Seminars in Dialysis;2020-04-09

3. Insulin and glucose-lowering agents for treating people with diabetes and chronic kidney disease;Cochrane Database of Systematic Reviews;2018-09-24

4. Oral Insulin: The Rationale for This Approach and Current Developments;Journal of Diabetes Science and Technology;2009-05

5. Intraperitoneal Chemotherapy;Nolph and Gokal’s Textbook of Peritoneal Dialysis;2009

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