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Improvement of glycemic control by CAPD with intraperitoneal insulin in a child with IDDM and ESRD
J T Flynn1, D B Kershaw, A B Sedman
1Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, USA.
Insights
Intraperitoneal insulin improved glycemic control in a pediatric patient with end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD). While effective, this treatment may increase peritonitis risk in children.
Area of Science:
- Pediatric Nephrology
- Diabetology
- Renal Replacement Therapy
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a renal replacement therapy for end-stage renal disease (ESRD).
- Intraperitoneal insulin administration is standard for glycemic control in adult diabetic CAPD patients.
- Pediatric data on intraperitoneal insulin during CAPD is limited.
Observation:
- A 12-year-old boy with ESRD and insulin-dependent diabetes mellitus (IDDM) was treated with CAPD and intraperitoneal insulin.
- The patient had a history of poorly controlled IDDM and recurrent line sepsis on hemodialysis.
- CAPD involved 4 daily exchanges with insulin added to the dialysate bags.
Findings:
- Intraperitoneal insulin significantly improved glycemic control, reducing glycosylated hemoglobin from 13.6% to 6%.
- The patient underwent CAPD for 7 months before a successful renal transplant.
- Two episodes of peritonitis occurred during CAPD treatment (1 episode/3.5 patient-months).
Implications:
- Intraperitoneal insulin is an effective method for improving glycemic control in pediatric patients with IDDM and ESRD on CAPD.
- Increased peritonitis risk should be considered when using this treatment in children.
- This case highlights a viable treatment option prior to renal transplantation in pediatric ESRD patients with diabetes.
Abstract:
Use of intraperitoneal insulin in diabetic end-stage renal disease (ESRD) patients receiving continuous ambulatory peritoneal dialysis (CAPD) is known to result in improved glycemic control. This route of insulin administration, although standard in adult diabetic CAPD patients, has not previously been reported in children. A 12-year old boy with ESRD from renal dysplasia who also had insulin-dependent diabetes mellitus (IDDM) was treated with CAPD and intraperitoneal insulin prior to renal transplantation. Diabetes and renal dysplasia were both diagnosed at 11 weeks of age. When he reached end-stage he was initially started on hemodialysis via a central line but was switched to CAPD because of recurrent line sepsis. His IDDM had been poorly controlled up to that time. CAPD was performed using 4 exchanges per day of 1.5% dialysate with a fixed dose of insulin added to each bag and with adjustments made based on blood glucose. His glycemic control markedly improved, with a fall in his glycosylated hemoglobin from 13.6% to 6%. CAPD was continued for 7 months until a living-related renal transplant was performed. Two episodes of peritonitis occurred while the patient received CAPD (1 episode/3.5 patient-months). We conclude that the use of intraperitoneal insulin in children with IDDM and ESRD leads to improved glycemic control. The rate of peritonitis, however, may be increased in these children.