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REVIEWS AND ORIGINAL ARTICLES |
Unit, Sefton General Hospital, Liverpool, United Kingdom
Correspondence and reprint requests to: R. Ahmad, Sefton General Hospital, Smithtown Road, Liverpool L15 2HE, United Kingdom.
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-O.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.
KEY WORDS: Intraperitoneal; insulin; diabetes; continuous ambulatory peritoneal dialysis (CAPD).
Received 16 November 1987; accepted 8 February 1988.
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