Continuous ambulatory peritoneal dialysis in diabetic patients with end-stage renal disease: experience with intraperitoneal insulin therapy.

Continuous ambulatory peritoneal dialysis (CAPD) is a valuable alternative to hemodialysis in treating uremic diabetics, and insulin can be injected directly into dialysate and absorbed intraperitoneally (IP). We evaluated the effect of IP supply of insulin in 9 uremic diabetics undergoing CAPD therapy. The 9 patients included 5 males and 4 females, with a mean age of 57 +/- 12 years old. The study showed that serum biochemistry was stationary during the treatment period except for the variable elevations of serum triglyceride and cholesterol. Hypertension was easily controlled in most patients. The insulin requirements ranged from 50 to 180 (129 +/- 34) units/day, which was 4.2 +/- 1.6 times higher than the subcutaneous doses before dialysis. Insulin added to the dialysate showed a high percentage of adsorption (55% to 65%) onto the plastic bag. The blood glucose levels varied less after an IP supply of insulin. The overall incidence of peritonitis was 8 episodes in 135 patient months (one episode every 16.9 patient months), and the average duration of hospitalization was 14.9 +/- 11.2 days/year. The cumulative survival rates were 89% in the first year and 74% in the second year. Our experience indicates that CAPD is an ideal treatment modality for uremic diabetics, and IP supply of insulin results in a good control of diabetes.