Insulin therapy in renal disease

Abstract

Diabetes mellitus (DM) is the main cause of end-stage renal disease (ESRD). Conversely, chronic renal failure (CRF) is also associated with diverse alterations in carbohydrate and insulin metabolism. CRF-induced metabolic disorders should be borne in mind when treating diabetic patients, to ensure the introduction of adequate therapy adjustments that are in line with the onset of renal function decline. Moreover, several specific therapies employed in CRF may also influence pharmacological therapy of DM in uraemic patients. Adequate glycaemic control has also been associated with a reduction in the onset and progression of diabetic nephropathy as well as in the morbidity and mortality in uraemic diabetic patients during dialysis. Intensive insulin therapy can notably improve glycemic control and it should be considered part of the management of insulin-treated CRF diabetic patients. Insulin analogues have been recently evaluated in CRF diabetic patients, with encouraging results. In this study, we review the more relevant aspects related to insulin therapy in diabetic patients with different degrees of renal failure and in patients with ESRD, both in conservative therapy and dialysis.

Insulin requirements in patients with diabetes and declining kidney function: differences between insulin analogues and human insulin?

“…Development of diabetic nephropathy is therefore commonly accompanied by a difficult metabolic control, particularly an increased risk of hypoglycemia [Iglesias and Díez, 2008]. Besides the intrinsic clinical relevance, hypoglycemic episodes constitute an independent cardiovascular risk factor [Zoungas et al 2010].…”

Lineamientos para el control de la glucemia y albuminuria en pacientes con nefropatía diabética en primer y segundo nivel de atención en Colombia. Panel nacional de expertos

“…Por lo tanto, la individualización de los pacientes es esencial en el tratamiento insulínico 42,43 .…”

“…Como desventajas se encuentra que existe poca evidencia sobre la seguridad de estas insulinas en pacientes renales y su costo es mucho más elevado; además, su uso está restringido cuando la ingesta de alimentos es baja (anorexia) o cuando la absorción es retardada (gastroparesia), situaciones que pueden aumentar el riesgo de hipoglucemia 42 .…”

Metabolic Syndrome Associated Kidney Damage

“…Insulin analogues, whose main objective is to stimulate physiologic insulin secretion, has opened new therapeutic possibilities in diabetic CRF patients. [111] Although only a few studies have evaluated the clinical efficacy and safety profile of insulin analogues in CRF patients, preliminary results appear hopeful. There is another concern of insulin injection for long term might be unfavourable, as ectogenous insulin may inhibit endogenous insulin secretion and results in the lack of the co-secretion of other beneficial substances such as C-peptide which is just now known to be potential in the treatment of diabetic nephropathy.…”