| Theme | Glycemic Control and Diabetes with Chronic Kidney Disease | |
|---|---|---|
| Title | Insulin treatment for patients with diabetic nephropathy | |
| Publish Date | 2012/02 | |
| Author | Masao Toyoda | Division of Nephrology and Metabolism, Tokai University School of Medicine |
| Author | Daisuke Suzuki | Division of Nephrology and Metabolism, Tokai University School of Medicine |
| [ Summary ] | In patients with renal impairment due to diabetic nephropathy, most oral hypoglycemic agents are contraindicated. As a result, glycemic control based on insulin treatment should be used. As renal failure progresses, the amount of insulin needed must often be reduced. Therefore, in cases of renal failure it is important to adjust the amount of insulin by making full use of arbitrary blood glucose self-measurement. In day to day conditions related to insulin treatment, proactive intervention with intensive insulin treatment is important in order to suppress the progression of nephropathy. However, in terms of safety, intensive insulin treatment using regular insulin or rapid-acting insulin analogues before every meal, rather than 1-2 daily administrations of NPH (neutral protamine Hagedorn) or mixed insulin, is recommended to prevent hypoglycemia in cases which have already progressed to renal failure. Reductions in hypoglycemia frequency and improvements in control, by the prolonged administration of long acting insulin analogues in dialysis patients, including those with renal failure, have begun to be reported. Observation of positive data concerning treatment options is expected. |
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