Intraperitoneal versus subcutaneous insulin in patients on nighttime IPD

For the diabetic patient on peritoneal dialysis, the intraperitoneal administration of insulin can lead to improvement in glycemic control while eliminating uncomfortable subcutaneous injections. Furthermore, the relatively higher portal vein concentrations of insulin compared to peripheral levels is reminiscent of the physiologic state in which the portal vein carries the insulin secreted by the pancreas. The pharmacokinetics of intraperitoneal insulin depends upon whether the insulin is administered along with the usual volume of dialysis fluid or is given undiluted. This variability has important implications for glycemic control in the patient receiving cycler peritoneal dialysis, particularly if the abdomen is dry for prolonged periods during the day. Recommendations are made based on the known pharmacokinetics of intraperitoneal insulin in both the dry and filled peritoneal cavity.