ADMINISTRATION OF INSULIN BY CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

Many patients with diabetic nephropathy undergoing continuous ambulato ry peritoneal dialysis (CAPD) use their peritoneal access to administe r insulin. Compared with the subcutaneous route, intraperitoneal (IP) insulin may display more consistent absorption, produce more physiolog ic insulin concentrations, and be more convenient to administer. Howev er, there are no well-controlled trials that have demonstrated a clini cally significant difference in glycemic control between IP and subcut aneous administration. For patients who choose to begin IP insulin at the time CAPD is initiated, the starting dose is 2-3 times the previou s subcutaneous dose. For patients previously stabilized on CAPD, the c onversion factor may be less. Doses are divided equally between bags. Some authors recommend adding more insulin to bags with a higher conce ntration of dextrose. In addition, the dose should be decreased when a dded to a bag used for an overnight dwell. Exchanges performed during the day may be timed to start 30 minutes before a meal. Unless clinica l trials demonstrate a difference in efficacy between subcutaneous and peritoneal insulin administration, the route will remain a matter of patient preference.