Insulin therapy during peritoneal dialysis: pros and cons of various forms of administration.

Major fluctuations of blood glucose, hyperinsulinemia, and the formation of insulin antibodies can be prevented by intraperitoneal insulin administration during peritoneal dialysis in patients with diabetic nephropathy. The reduction in insulin requirement is most pronounced compared with subcutaneous administration when insulin is instilled into the empty abdominal cavity. If insulin is instilled into the abdominal cavity along with the dialysis fluid, there are losses of activity due to delayed absorption consequential to dilution by the fluid and adsorption to the plastic surface of the dialysis solution delivery systems. These may be so pronounced as to make intraperitoneal administration uneconomical. The effectiveness of peritoneal dialysis is not affected by intraperitoneal insulin administration. The frequency of peritonitis during intraperitoneal insulin administration increases slightly only in continuous ambulatory peritoneal dialysis, but not in intermittent peritoneal dialysis.