Insulin therapy in uremic diabetic patients on continuous ambulatory peritoneal dialysis; comparison of intraperitoneal and subcutaneous administration.
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.


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-hour 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.
Scarpioni
L
L
Department of Internal Medicine, Piacenza Hospital, Italy.
Ballocchi
S
S
Castelli
A
A
Scarpioni
R
R
D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000628:therapy*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D014511:Uremia / Q000628:therapy*
D001786:Blood Glucose; D007328:Insulin