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Does Requirement Of Insulin Reduce Greatly In Kidney Failure Patients?

Posted on Mon, 30 Nov 2015

Question: I have an 81 year old mother who was on 51 units of insulin BD and I think she is type 2 diabetic, she has heart failure and kidney failure. She was unwell 2 weeks ago and the drs put her on strong painkillers and stopped her insulin and stopped taking blood sugar readings. Which we all thought was in her best interests.She is still eating small amounts and now seems a bit brighter. How long can someone survive without insulin in these cases? We thought we were saying our goodbyes 2 weeks ago and now are not sure what will happen. She is in a nursing home and well cared for.

Answered by Dr. Pavan Kumar Gupta (46 minutes later)

Brief answer....requirement of insulin reduces greatly in kidney failure patients.
Detailed answer...
Hello,
Thanks for the query.
I have read your query and understand your point.
There is nothing unusual in kidney failure patients to need less amount of insulin doses and in some cases, no need for any injectable insulin.
You see insulin is cleared by kidneys during it's metabolism in body.
Once the kidney is damaged,the amount of insulin cleared by kidneys get diminished tremendously, resulting in high levels of circulating insulin in body and consequently low requirement of injection insulin.
In some cases a person can do well even without use of injection insulin because in those cases,the amount of endogenous insulin ( natural insulin produced by your pancreas ) produced is sufficient to take care of blood sugar levels. This is what is happening with your mother.
Her sugar levels are controlled well due to the insulin produced by her body and hence no need to take any external injection insulin.
Such type of patients are well cared in a hospital set up because of regular and constant monitoring.
I hope it helps,however you are most welcome to revert to me for any further query.
Best of luck
Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pavan Kumar Gupta (18 minutes later)

Thank you that is most interesting. I am a bit confused though: When my mother was injecting these quite high doses of insulin( which she had been for many years), her blood sugar levels ran normally high averaging at 12-18mmols on a good day, and she was eating slightly better than she is now. As the insulin has now stopped completely, should she not be having hyperglyceamic effects even if the body is producing some of its own insulin?

Answered by Dr. Pavan Kumar Gupta (50 minutes later)

Brief Answer:
Insulin resistance responsible for high requirement of insuin

Detailed answer:
Hello,
I think you have not understood what I wrote.

You see the clearance of insulin by way of filtration through kidneys is grossly affected because kidneys have been damaged completely. With the result there is lot of insulin circulating in the body (endogenously produced by pancreas ).
This amount of circulating insulin is enough to take care of blood sugar levels.
More over weightloss also results in lesser amount of insulin requirement.
Another reason is that dialysis improves insulin resistance which is hall mark of type 2 diabetes.
This insulin resistance was primarily responsible for high requirement of insulin before the advent of kidney failure.
Once the blood sugar levels are properly controlled,then there is no reason for HYPERGLYCEMIA effects.

Thanks

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Pavan Kumar Gupta (16 hours later)

Thank you. It seems likely then that her kidney failure and heart failure will be more the cause of her deteriorating further and not her diabetes.
Many Thanks for your answer.

Answered by Dr. Pavan Kumar Gupta (2 hours later)

Hello,
Longstanding uncontrolled diabetes results in various complications like kidney failure and heart failure which in turn is now responsible for continuous deterioration of her condition.
Longstanding diabetes is responsible for various types of micro as well as macro vascular complications in the body.
Thanks

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Above answer was peer-reviewed by : Dr. Prasad