Vinod Nikhra
Scientific Tracks Abstracts: J Diabetes Metab
Diabetes mellitus is a leading cause of chronic renal insuffi ciency and later endstage renal failure; on the other hand, chronic renal disease has been linked with alterations in carbohydrate and insulin metabolism. Th e pharmacokinetics of various insulin preparations has not been well studied in patients with varying degrees of renal dysfunction. Th ere exist sparse guidelines regarding appropriate dosing adjustment of insulin. Further, chronic renal insuffi ciency is associated with variably impaired insulin sensitivity. Th ese patients may show about 2.5-fold increase of insulin elimination halfl ife. Th ere are erratic insulin secretory patterns, as well. In summary, CRF is associated with a complex disruption of the processes of insulin release and resistance; its metabolism and elimination. Th ese facts are important while treating the diabetic patients suff ering from a variable chronic renal defi ciency, because they will entail adequate therapy adjustments in a patient with declining renal function decline. Th e rational insulin therapy will improve glycaemic control, a reduced incidence of hypoglycaemia and a retarded progression to end-stage renal disease. Th e adequate glycaemic control has also been associated with a reduced cardiovascular morbidity and mortality in these patients. Th ere exists opinion that in patients with end-stage renal disease, long-acting insulin preparations should be avoided because of increased hypoglycaemic events. A rapid acting insulin preparation on the other hand may entail less than desirable uniform blood sugar control. In this background, treating the diabetic patients with chronic renal disease using premixed insulin preparations having a higher proportion of soluble (rapid acting) insulin may be most plausible option.
Vinod Nikhra, M.D. is Fellow of International Medical Sciences Academy and Fellow of Royal Society of Medicine. He is trained in endocrinology and clinical nephrology. He has authored 4 books and contributed more than 30 papers in reputed journals and has been a reviewer for International Journal of Obesity (the Nature group) and Family Practice (the Oxford group). He is a senior consultant physician and on teaching faculty at Hindu Rao Hospital, Delhi, India. He can be found on www.vinodnikhra.com.
