Nephrology Dialysis Transplantation, Vol 12, Issue 1 145-150, Copyright © 1997 by Oxford University Press
P Nevalainen, J Lahtela, J Mustonen and A Pasternack
Background. Intraperitoneally administered insulin is
regarded as the most physiological replacement therapy, leading to lower
peripheral insulin concentrations and equal or better glycaemic control
than subcutaneous insulin. This two-part study was undertaken to evaluate
the effect of CAPD, as well as the use of subcutaneous vs. intraperitoneal
insulin on insulin sensitivity, glycaemic control and serum lipids in type
1 diabetes. Methods. Eleven patients with type 1
diabetes mellitus and chronic renal failure participated the studies.
Glycated haemoglobin (HbA1c), euglycaemic hyperinsulinaemic clamp, serum
lipids, and patient well-being were measured. During CAPD all patients were
first treated with subcutaneous insulin and then with intraperitoneal
insulin. The metabolic studies were repeated after both treatment periods
for at least 3 months. Metabolic studies were performed on six of the
patients also before initiation of CAPD. Results.
HbA1c rose after the initiation of CAPD (from 8.85±0.54% to
9.58±0.66%, NS) and improved after changing from subcutaneous to
intraperitoneally administered insulin (from 9.49±0.43% to
8.13±0.39%, P<0.01). Insulin dose increased by 15% after
initiation of CAPD and 128% after switching for subcutaneous to
intraperitoneal insulin. Glucose disposal rate enhanced by 39% (P=0.05) and
14% respectively (P <0.01). Initiation of CAPD had no significant
effects on serum lipids but intraperitoneally administered insulin reduced
HDL cholesterol and increased LDL/HDL ratio significantly.
Conclusions. Intraperitoneal insulin therapy offers
better glycaemic control and insulin sensitivity than subcutaneous insulin.
Deterioration of HbA1c after initiation of CAPD while patients remained on
subcutaneous insulin may be partly due to absorbed energy from the
dialysate. Intraperitoneal insulin therapy seems to have detrimental
effects on serum lipids. The clinical significance in modifying the risk of
atherosclerosis remains unclear. Keywords: CAPD,
glucose metabolism; intraperitoneal insulin; insulin-dependent diabetes
mellitus; lipoproteins; uraemia
ORIGINAL ARTICLES
The influence of peritoneal dialysis and the use of subcutaneous and intraperitoneal insulin on glucose metabolism and serum lipids in type 1 diabetic patients
Department of Medicine, University of Tampere, and Tampere University Hospital, Tampere, Finland; Corresponding author at: Department of Medicine, University of Tampere, PO Box 607, FIN-33101 Tampere, Finland
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