Intraperitoneal Insulin for Control of Blood Sugar in Diabetic Patients during Peritoneal Dialysis

Abstract

SummaryWe have added insulin to peritoneal dialysis fluid in three uraemic diabetic patients. The hyperglycaemia and pronounced fluctuations in blood glucose which complicate peritoneal dialysis in diabetic subjects have not occurred with this technique. Studies with l3nI-labelied insulin showed that less than 5% of the intraperitoneally administered insulin was absorbed during a one-hour exchange. While the physiology of the procedure needs further evaluation, this procedure has reduced the morbidity of peritoneal dialysis in diabetic patients and made its management easier.

Absorption and Action of Insulin Added to Peritoneal Dialysate in Dogs

“…25,26] and it has been withdrawn from clinical use: present experience with xylitol and fructose is limited. As an alternative, the addition of insulin to glucose-containing peritoneal dial ysate has been suggested [6,[9][10][11], The concentrations used have ranged from 5 to 60U/1 of dialysate, and few data are available regarding the absorption or kinetics of insulin added to peritoneal dialysate. Crossley and Kjellstrand [9] added 11,1 l-insulin to dialysate during peritoneal dialysis of a single patient and calculated that approximately 5% of the insulin was absorbed.…”

“…As an alternative, the addition of insulin to glucose-containing peritoneal dial ysate has been suggested [6,[9][10][11], The concentrations used have ranged from 5 to 60U/1 of dialysate, and few data are available regarding the absorption or kinetics of insulin added to peritoneal dialysate. Crossley and Kjellstrand [9] added 11,1 l-insulin to dialysate during peritoneal dialysis of a single patient and calculated that approximately 5% of the insulin was absorbed. The present study, undertaken in dogs to evaluate the movement and action of inlraperitoneal insulin, indicates that insulin is absorbed from the peritoneal fluid in a relatively predictable manner.…”

“…There fore. the addition of insulin to peritoneal dialysate has been suggested as a method for controlling hyperglycemia during peritoneal dialysis [6,[9][10][11]. Little is known about the transperitoneal movement of insulin and its consequent biologic action.…”

Short-Term Effect of 4% Hypertonic Glucose as Compared to 4% Mixed Hypertonic Mannitol Solution in Conventional Peritoneal Dialysis

“…Intraperitoneal insulin for the control of blood sugar in diabetic patients during peritoneal dialysis has been reported [18]. However, there was a requirement for frequent blood glucose determinations and insulin injec tions with wide fluctuations of blood glucose level.…”

Current Concepts in Peritoneal Dialysis

“…Since standard dialysate contains high concentrations of glucose, hyperglycemia is a frequent complication of this therapy. Intraperitoneal insulin has been used to control blood glucose concentrations [33][34][35]. Hyperglycemia, hyperosmolality, and nonketotic coma have complicated such dialysis treatments [36.37], In a recent study in dogs, Shapiro et al [38] found that intra peritoneal insulin induces a slow rise in plasma immunoreactive insulin concentrations, which continue to rise for several hours, possibly caused by mesenteric binding and subsequent release of insulin.…”