Pre-dialysis insulin: a new concept to treat an old problem

Abstract

Diabetes and chronic kidney disease are two disease processes that remain with the patient from diagnosis to the end of their lives. The field of diabetes and renal failure is a complex area, merging together these two chronic diseases, each a speciality in its own right. Patients with diabetes need to start dialysis much earlier than those without diabetes due to the cumulative effect of proteinuria and its associated symptoms.The single largest cause of end-stage renal disease continues to be diabetes and within the field of renal nursing, we have seen an increase in the number of patients with diabetes entering the dialysis programme in recent years. The author's personal experience is that once on haemodialysis, we have seen traditional treatments fail to meet the individual needs of this cohort and have devised a programme of insulin delivery that appears to fill this gap.