INSULIN THERAPY IN UREMIC DIABETIC-PATIENTS ON CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS - COMPARISON OF INTRAPERITONEAL AND SUBCUTANEOUS ADMINISTRATION

objective: To compare, in diabetic uremic patients on continuous ambul atory peritoneal dialysis (CAPD), the effects of two patterns of insul in administration, four times daily subcutaneous (SC) injections and i ntraperitoneal (IP) route, on blood glucose, insulin, lactate, beta-hy droxybutyrate and glycerol levels. Patients and Methods: We examined 6 uremic insulin-dependent diabetic patients on CAPD. The two insulin r egimens, SC and IP, were tested successively in randomized sequence in each patient. At the end of each treatment period we determined the 2 4-hour profiles of blood glucose, free insulin, lactate, beta-hydroxyb utyrate, and glycerol. Results: Mean blood glucose over 24 hours (SC 7 .21+/-0.61 mmol/L, IP 7.49+/-0.93 mmol/L), Schlichtkrull's M value, an index of glycemic control and stability (SC 10+/-3, IP 10+/-5), and t he blood intermediate metabolites beta-hydroxybutyrate, lactate, and g lycerol were similar in both groups. Mean serum free insulin was signi ficantly higher during subcutaneous treatment (SC 257.4+/-127.2 pmol/L , IP 170.4+/-83.4 pmol/L , p < 0.001). Insulin requirements were 2.5 t imes greater for the intraperitoneal route (SC 51+/-4 U/24 hours, IP 1 30+/-43 U/24 hours). Conclusions: In uremic diabetic patients on CAPD, good glycemic control may be achieved either with subcutaneous intens ive insulin therapy or with intraperitoneal insulin administration. Th e latter method allows reduction of circulating free insulin levels, b ut requires a higher dose of insulin per day.