Intraperitoneal administration of insulin during peritoneal dialysis of diabetics with terminal renal failure

The effect on plasma glucose and serum insulin of varying amounts of insulin added to the dialysis fluid was studied in a total of 10 diabetic patients on chronic peritoneal dialysis (PD). The studies were carried out in a 3-day and a 14-day model, using dialysis fluid with two different concentrations of glucose (75 mmol/l (isotonic and 200 mmol/l (hypertonic)) and with addition of either 0, 6, 12 or 24 U/l of immunoreactive insulin (IRI) to the dialysis fluid. Plasma glucose and serum insulin were determined before, during and after dialysis. Dialysate concentrations of glucose and insulin were determined for each cycle. Addition of 12 and 24 U of IRI/I resulted in a significant rise in serum insulin. With the isotonic dialysis fluid no insulin was required to control plasma glucose during PD. With the hypertonic dialysis fluid addition of 12 U of IRI/I was optimal for the control of plasma glucose, while 24 U/I produced post-dialytic hypoglucemia.