Decreased insulin requirement in acute renal failure in diabetic nephropathy.
Twelve of 13 diabetics with azotemic nephropathy experienced exacerbation of renal failure and decreased insulin requirement after coronary angiography utilizing radiographic contrast material. The single patient who did not develop acute renal failure had no evidence of decreased insulin requirement. Eleven of 12 patients had decreased insulin requirement: mean  decrement in insulin dose, 40%; mean decrement in fasting blood glucose level, 33%; mean decrement in peak blood glucose level, 42%. The 12th patient underwent peritoneal dialysis against hypertonic glucose without need of an increased insulin dose. Eight of 11 patients experienced a total of 19 insulin reactions; one patient was hypoglycemic continuously, despite infusion of glucose and discontinuation of insulin. The decrement of insulin requirement was not proportional to the rise in either serum creatinine or potassium concentrations. We suggest that when acute renal failure occurs in diabetics, decreased insulin requirement should be anticipated and the insulin dose lowered.
D058186:Acute Kidney Injury / Q000139:chemically induced*; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000188:drug therapy*; D003973:Diatrizoate / Q000009:adverse effects; D003974:Diatrizoate Meglumine / Q000009:adverse effects; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D014511:Uremia / Q000139:chemically induced
D001786:Blood Glucose; D003287:Contrast Media; D007328:Insulin; D003973:Diatrizoate; D003974:Diatrizoate Meglumine