title: Improvement of glycemic control by CAPD with intraperitoneal insulin in a child with IDDM and ESRD.
abstract: Use of intraperitoneal insulin in diabetic end-stage renal disease (ESRD) patients receiving continuous ambulatory peritoneal dialysis (CAPD) is known to result in improved glycemic control. This route of insulin administration, although standard in adult diabetic CAPD patients, has not previously been reported in children. A 12-year old boy with ESRD from renal dysplasia who also had insulin-dependent diabetes mellitus (IDDM) was treated with CAPD and intraperitoneal insulin prior to renal transplantation. Diabetes and renal dysplasia were both diagnosed at 11 weeks of age. When he reached end-stage he was initially started on hemodialysis via a central line but was switched to CAPD because of recurrent line sepsis. His IDDM had been poorly controlled up to that time. CAPD was performed using 4 exchanges per day of 1.5% dialysate with a fixed dose of insulin added to each bag and with adjustments made based on blood glucose. His glycemic control markedly improved, with a fall in his glycosylated hemoglobin from 13.6% to 6%. CAPD was continued for 7 months until a living-related renal transplant was performed. Two episodes of peritonitis occurred while the patient received CAPD (1 episode/3.5 patient-months). We conclude that the use of intraperitoneal insulin in children with IDDM and ESRD leads to improved glycemic control. The rate of peritonitis, however, may be increased in these children.
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Flynn
authors.forename: D B
authors.initials: DB
authors.lastname: Kershaw
authors.forename: A B
authors.initials: AB
authors.lastname: Sedman
authors.forename: W E
authors.initials: WE
authors.lastname: Smoyer
authors.forename: T E
authors.initials: TE
authors.lastname: Bunchman
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D007668:Kidney / Q000002:abnormalities; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin