Effects of Diabetes and PD

Question 1

What is diabetes?

Answer 1

Diabetes Mellitus (DM) influences the frequency and cost of therapies for ESRD more than any other disease process in the industrialized countries.

Diabetes results in excess of 50,000 amputations, 8,000 new cases of blindness and 3 million hospitalizations per year, in the US alone.

Diabetes is one of the two major causes of ESRD in the United States. Diabetes may lead kidney failure.

Assess for proteinuria, hypoalbuminemia, edema and hypercholesterolemia.

Question 2

What are the advantages of peritoneal dialysis for a diabetic patient?

Answer 2

-Better preservation of residual renal function.
-Continuous therapy and steady state of biochemical parameters.
-Gradual ultrafiltration.
Fewer episodes of hypotension.
-Better blood pressure control.
-No need for vascular access.
-Better control of anemia.
-No requirements for systemic -anticoagulation.
-More liberal diet.
-Intraperitoneal administration of insulin.
-Lifestyle advantages.

Question 3

Are there changes in how to monitor glucose for DM patients?

Answer 3

Regular and frequent monitoring of blood glucose, frequent and effective adjustment of SQ doses along with early diagnosis and treatment of intercurrent illnesses is essential. If glycemia becomes hard to control, temporary discontinuation of PD, transfer to hemodialysis and the use of sliding scale insulin dosing are recommended.

Question 4

How does peritonitis and infection affect DM?

Answer 4

During episodes of peritonitis and other infectious processes, glycemic control may deteriorate due to an increase in peritoneal transport rates, resulting in rapid absorption of glucose through the peritoneum.

Consequently, there is reduced ultrafiltration an increase in hyperglycemia.

Question 5

How is insulin doses affected with PD?

Answer 5

Insulin requirements increase by approximately 15% after the initiation of peritoneal dialysis.

Question 6

How is insulin administered with PD patients?

Answer 6

In addition to receiving insulin SQ, some patients receive insulin intraperitoneally or inside the peritoneum.

Only Regular Insulin
(clear) can be used intraperitoneal.

NPH should not be used because it mixes poorly, and has been known to precipitate and diffuse slowly across the membrane as do other intraperitoneally administered drugs.

It is estimated that as much as 50% of the insulin is discarded in the peritoneal effluent unused.

Another 15% will bind to the plastic bag and tubing.