Just want to find out if it’s only the regular insulin ( humulin R or novolin R) that can be added to the PD bag ( IP). If so, what’s the rationale? Thanks

Questions About PD

Mary anne, Nurse from Illinois asked
Just want to find out if it’s only the regular insulin ( humulin R or novolin R) that can be added to the PD bag ( IP). If so, what’s the rationale? Thanks

1 answer

Nurse Canada with members of the ISPD Nurse Committee February 25, 2022

We thank you for your question. It is only regular, short-acting insulin that is added intraperitoneally (IP) to the dialysate for a patient with diabetes on CAPD or APD. This is because the aim is to maintain “euglycemia” or near normal levels of glucose in the blood.
We should point out to you, however, that, while blood glucose levels in patients with diabetes on peritoneal dialysis can be controlled with IP short-acting insulin, today this practice is not nearly as common as it used to be (1). Disadvantages with IP insulin have been found to include: potential for bacterial contamination of the dialysate resulting in peritonitis; need for higher doses of insulin, due to losses of insulin in the dialysis effluent/insulin binding to the dialysis fluid bag, thus increased cost for the patient; increased total cholesterol and triglycerides with possible increased cardiovascular risk; plus, of more serious concern, the risk of hepatic subcapsular steatosis (1,2,3).
 
An informal poll of a small group of nurses from different countries (Australia, Brazil, Canada, New Zealand, United Kingdom, United States) with all nurses belonging to the ISPD Nursing Committee, found that for the past multiple years their local practice has been not to use IP insulin for patients with diabetes on peritoneal dialysis. Moreover, today, with the use of the newer diabetic technologies, they find it so much easier to manage these patients’ blood glucose levels than before.
 
1.Leehey DJ, Emanuele MJ, Emanuele L. Diabetes. In: Daugirdas JT, Blake PG, Ing TS, editors. Handbook of Dialysis, 5th edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2015. p. 555 – 577.
2.Huang CC. Treatment targets for diabetic patients on peritoneal dialysis: any evidence? Peritoneal dialysis international. 2007 Jun;27(2_suppl):176-9.
3.Torun D, Oguzkurt L, Sezer S, Zumrutdal A, Singan M, Adam FU, Ozdemir FN, Haberal M. Hepatic subcapsular steatosis as a complication associated with intraperitoneal insulin treatment in diabetic peritoneal dialysis patients. Peritoneal dialysis international. 2005 Nov;25(6):596-600.
 

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