Severe Hypoglycemia in Type I Diabetic Patients With Impaired Kidney Function

Mühlhauser, Ingrid; Tóth, G; Sawicki, Peter T.; Berger, Michael

doi:10.2337/diacare.14.4.344

Cited by 63 publications

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“…nsulin therapy in type 1 diabetic patients with overt diabetic nephropathy is characterized by two features: while suffering from a considerably increased risk of severe hypoglycemic episodes (1,2), they show poorer metabolic control than diabetic patients with normal renal function (3). The increased hypoglycemic risk may be partially explained by the decline in renal insulin clearance, as 30 -80% of systemically circulating insulin is removed by the kidneys (4).…”

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Impact of Diabetic Nephropathy on Pharmacodynamic and Pharmacokinetic Properties of Insulin in Type 1 Diabetic Patients

et al. 2001

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OBJECTIVE -To quantify pharmacokinetic and pharmacodynamic properties of regular insulin and insulin lispro in type 1 diabetic patients with and without overt diabetic nephropathy.RESEARCH DESIGN AND METHODS -In this double-blind, two-way cross-over, euglycemic (5 mmol/l) glucose clamp study, we investigated the metabolic response to subcutaneous injections of regular insulin and insulin lispro (0.2 U/kg) in 12 type 1 diabetic patients with overt diabetic nephropathy (proteinuria Ͼ500 mg/24 h and/or serum creatinine Ͼ1.5 mg/dl; NP group) and in a control group of 12 type 1 diabetic patients with normal renal function (DC group). [DC]). The overall metabolic effect of regular insulin but not of insulin lispro was lower in patients with diabetic nephropathy than in diabetic control patients (967 vs. 1,510 mg/kg, respectively). RESULTSCONCLUSIONS -Although insulin levels are higher in patients with overt diabetic nephropathy, the metabolic response to regular insulin is reduced. Insulin lispro maintains its characteristic pharmacokinetic and pharmacodynamic properties in patients with overt diabetic nephropathy. Diabetes Care 24:886 -890, 2001I nsulin therapy in type 1 diabetic patients with overt diabetic nephropathy is characterized by two features: while suffering from a considerably increased risk of severe hypoglycemic episodes (1,2), they show poorer metabolic control than diabetic patients with normal renal function (3). The increased hypoglycemic risk may be partially explained by the decline in renal insulin clearance, as 30 -80% of systemically circulating insulin is removed by the kidneys (4). A reduction of insulin clearance has been described in nondiabetic patients with end-stage renal failure (5,6) and mild to moderate renal impairment (7); however, until now, it has not been studied in patients with diabetic nephropathy.Insulin sensitivity, on the other hand, is attenuated in patients with renal impairment, not only in those with endstage renal failure, but also in patients in earlier stages of renal impairment (7-9). However, to date the metabolic consequences of reduced insulin clearance and diminished insulin sensitivity on pharmacokinetic and pharmacodynamic properties of regular insulin or rapid acting insulin analogues have never been studied in type 1 diabetic patients.In view of the diminished clearance of insulin in patients with altered renal function, the use of a rapid-acting insulin analogue might theoretically be advantageous because of its shorter duration of action, leading to a reduced incidence of hypoglycemic episodes (10,11). Therefore, the aim of this study was to quantify pharmacokinetic and pharmacodynamic summary measures for regular insulin and insulin lispro in type 1 diabetic patients with and without overt diabetic nephropathy. RESEARCH DESIGN AND METHODS PatientsFor this study, 12 type 1 diabetic patients fulfilling the following inclusion criteria were recruited: age 20 -50 years; GHb Ͻ10%; overt diabetic nephropathy (defined according to the modified Mogensen criteria...

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Impact of Diabetic Nephropathy on Pharmacodynamic and Pharmacokinetic Properties of Insulin in Type 1 Diabetic Patients

et al. 2001

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“…Patients with impaired awareness of hypoglycaemia could run a particularly high risk of SH [5±7]. Several clinical conditions predispose to SH such as renal insufficiency and early pregnancy [8,9].In the intensively treated patients of the Diabetes Control and Complications Trial (DCCT), however, less than 8 % of the variation in SH could be explained by biological characteristics including HbA 1 c values [2]. Recently, a bio-psycho-behavioural model was proposed to integrate the diverse and complex Diabetologia (1998) Summary The objective of this study was to identify possible risk factors of severe hypoglycaemia (SH) in a prospective population based study of adult Type I (insulin-dependent) diabetic patients.…”

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Risk factors of severe hypoglycaemia in adult patients with Type I diabetes - a prospective population based study

et al. 1998

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Identification of risk factors of severe hypoglycaemia (SH) is necessary to understand, predict and reduce the frequency of SH in Type I (insulin-dependent) diabetic patients. Several predictors of SH have been described in laboratory and clinical investigations. The most consistently identified risk factor is a previous event of SH [1±3]. Less consistent predictors of SH are lower HbA 1 c values, higher insulin dosages, C-peptide negativity, and longer diabetes duration [1±5]. Patients with impaired awareness of hypoglycaemia could run a particularly high risk of SH [5±7]. Several clinical conditions predispose to SH such as renal insufficiency and early pregnancy [8,9].In the intensively treated patients of the Diabetes Control and Complications Trial (DCCT), however, less than 8 % of the variation in SH could be explained by biological characteristics including HbA 1 c values [2]. Recently, a bio-psycho-behavioural model was proposed to integrate the diverse and complex Diabetologia (1998) Summary The objective of this study was to identify possible risk factors of severe hypoglycaemia (SH) in a prospective population based study of adult Type I (insulin-dependent) diabetic patients. A representative sample of 684 patients (41 % women, mean ± SD age 36 ± 11, diabetes duration 18 ± 11 years), living in the district of Northrhine (9.5 million inhabitants), Germany, were examined in their homes using a mobile ambulance. A comprehensive baseline assessment of possible predictors of SH included sociodemographic and disease related variables, hypoglycaemia awareness, diabetes management, and attitudes and behavioural aspects as expressed by the patients. After a mean of 19 ± 6 months 669 (98 %) patients were interviewed about events of SH since the baseline examination. Using the multiple Cox proportional hazards model, five risk factors of SH were identified: SH during the preceding year [hazard ratio (HR) 2.7, 95 % confidence intervals (CI) 1.8±4.2], any history of SH (HR 1.9, CI 1.1±3.4), C-peptide negativity (HR 4.0, CI 1.2±12.7), social status (HR 0.8 for a difference of 5 units for a value range of 0±24, CI 0.6±0.9), and patients' determination to reach normoglycaemia (HR 0.7 for a difference of 1 unit for a value range of 1±6, CI 0.5±0.9), indicating that the lower the social status and the higher the patients' determination to reach normoglycaemia, the higher the risk of SH. After eliminating the history of hypoglycaemia from the model, impaired hypoglycaemia awareness and patients' inappropriate denial of SH as their particular problem became additional significant risk factors of SH. In conclusion, in this population based study of adult Type I diabetic patients, C-peptide negativity, a previous event of SH, patients' determination to reach normoglycaemia and social class were risk factors of SH. [Diabetologia (1998

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“…Debemos tener en cuenta que a medida que progresa la ERC el riesgo de hipoglucemia está incrementado por la disminución en el aclaramiento de la insulina y otros antidiabéticos orales, y por la reducción de la gluconeogénesis secundaria a disminución de la masa renal (10,12).…”

Section: Factores De Riesgo Modificables En La Progresión Hacia Erc Eunclassified

Abordaje nutricional del paciente con diabetes mellitus e insuficiencia renal crónica: a propósito de un caso

Beatriz¹

2017

Nutr Hosp

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The prevention and treatment of chronic kidney disease (CKD) in diabetes through diet and lifestyle have been a topic of much interest over the years. Consideration of the type and amount of carbohydrate, protein and fat is required for optimal blood glucose control, for clinical outcomes related to renal function and for consideration of risk reduction for cardiovascular disease. Depending on the CKD stage different dietary changes should be considered protein-calorie malnutrition is common in chronic kidney disease patients and is a powerful predictor of morbidity and mortality. We review the nutritional management of a diabetic patient throughout the progression of their CKD.Abordaje nutricional del paciente con diabetes mellitus e insufi ciencia renal crónica, a propósito de un caso ResumenLa prevención y el tratamiento de la enfermedad renal crónica (ERC) en pacientes con diabetes ha sido un tema de gran interés a lo largo de los años. Para conseguir un adecuado control glucémico, una función renal estable y una reducción del riesgo cardiovascular, es fundamental un correcto aporte de hidratos de carbono, lípidos y proteínas. Las medidas dietéticas realizadas se irán modifi cando a lo largo de la evolución de la ERC. La malnutrición energético-proteica es muy frecuente en pacientes con ERC y diabetes y es un importante predictor de morbimortalidad. Revisamos el manejo nutricional de un paciente diabético a lo largo de la progresión de su ERC.

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Severe Hypoglycemia in Type I Diabetic Patients With Impaired Kidney Function

Abstract: Type I diabetic patients with impaired kidney function are at an excessively high risk of severe hypoglycemia. In addition to low HbA1c levels, a low body mass index appears to be a risk indicator for this adverse effect of insulin therapy.

Cited by 63 publications

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Impact of Diabetic Nephropathy on Pharmacodynamic and Pharmacokinetic Properties of Insulin in Type 1 Diabetic Patients

Impact of Diabetic Nephropathy on Pharmacodynamic and Pharmacokinetic Properties of Insulin in Type 1 Diabetic Patients

Risk factors of severe hypoglycaemia in adult patients with Type I diabetes - a prospective population based study

Abordaje nutricional del paciente con diabetes mellitus e insuficiencia renal crónica: a propósito de un caso

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