For many diabetics in end-stage renal failure, the initial therapy they receive will be continuous ambulatory peritoneal dialysis (CAPD) together with i.p. insulin. To date, all published protocols rely on empirical dosages based upon predialysis insulin requirements. A practical regimen for the institution of i.p. insulin administration during CAPD is described. The only endpoints used to determine insulin dosage were fasting plasma glucose 5 to 10 mmol/L and 2 h postprandial plasma glucose 8 to 15 mmol/L. An initial protocol related to body weight, dextrose content, volume, and timing of dialysate was based on a retrospective analysis of the results in our first 10 patients. Subsequently, a prospective assessment in an additional 22 patients confirmed the effectiveness of the regimen. The following protocol is recommended for the institution of i.p. insulin therapy in patients undergoing CAPD: Preprandial exchanges 1.36% dextrose-0.175 U/L dialysate/kg body weight 3.86% dextrose-0.25 U/L/kg Overnight exchanges 1.36% dextrose-0.1 U/L/kg 3.86% dextrose-0.15 U/L/kg Further adjustment of insulin dosage is then made on the basis of four hourly plasma glucose profiles. Self-monitoring of capillary blood glucose is recommended.
Serum fructosamines and glycosylated haemoglobin have been examined in groups of patients with (n = 27) and without (n = 39) diabetes mellitus and chronic renal failure, or undergoing renal replacement therapy. Elevated values of fructosamines were found in nondiabetic haemodialysis patients as compared to the other non-diabetic patients. The relationship between fructosamines and glycosylated haemoglobin appeared to be attenuated by uraemia. Successful pancreatic transplantation returned fructosamine and glycosylated haemoglobin values to normal.
We have investigated the effect of the administration of small doses of intraperitoneal insulin (mean 2.7 ± 1.45 u/L) on the hyperlipidemia associated with continuous ambulatory peritoneal dialysis (CAPD) in nine non-diabetic patients. Despite significant lowering of both fasting (6.21 ± 0.9 → 4.2 ± 0.5 mmoI/L) and postprandial (9.74 ± 1.1 → 7.4 ± 1.06 mmol/L) blood glucose levels, we saw no effect on serum total cholesterol, triglycerides or B lipoproteins.
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