Dosage of insulin and analysis of glucose metabolism characteristics in the patients during the process of diabetic nephropathy
10.3969/j.issn.1009-0754.2016.05.014
- VernacularTitle:糖尿病肾病不同阶段胰岛素使用量以及糖代谢特征分析
- Author:
Cuilan LIU
1
;
Hua LIU
;
Jifang LU
;
Jiali FENG
;
Shengjun LIU
Author Information
1. 河北北方学院附属第一医院肾内科
- Keywords:
Diabetic nephropathy;
Insulin dosage;
Serum glucose level
- From:
Journal of Navy Medicine
2016;37(5):417-420
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe dosage of insulin and analysis of glucose metabolism characteristics in the patients during the process of diabetic nephropathy (DN).Methods A total of 84 cases of diabetic nephropathy admitted into the Department of Nephrology of the hospital for treatment from January 2013 to December 2015 were chosen for the study.In accordance with the chronic kidney disease ( CKD) stages standards, as specified in the National Kidney Foundation′s Kidney Disease Treatment Guidelines, the DN process in the same patient was divided into 5 different stages:stage 1 ( CKD phase Ⅰand Ⅱ) , stage 2 ( CKD phase Ⅲ and Ⅳ) , stage 3 ( CKD phaseⅤand prior to dialysis therapy) , stage 4 ( CKD phase Ⅴand dialysis therapy for 1 to 3 months) , stage 5 ( CKD phase Ⅴand dialysis therapy for over 6 months) .Data pertaining to body mass, body mass index( BMI) , dosage of insulin and hemo-globin A1c(HbA1c), glomerular filtration rate (GFR), hemoglobin(Hb), fasting plasma glucose(FBG), postprandial blood glucose ( PBG) after 2 hours and albumin( ALB) were collected during the 5 stages, then were compared and analyzed statistically.Results During the first 3 stages, there were significant differences in the levels of GFR, Hb and ALB, as well as in dosage of insulin in the 84 patients(P<0.01), and the levels of GFR, Hb and ALB were all significantly higher than those of the second and third stages(P<0.01).The dosage of insulin during the first stage was (0.62 ±0.20) U/kg, which was significantly higher than those of the second and third stages〔(0.44 ±0.17) U/kg, (0.42 ±0.20) U/kg〕.However, no statistical significance could be seen in the dosage of in-sulin in the patients during the second and third stages(P>0.05).There were significant differences in the levels of GFR, Hb, ALB, and the dosage of insulin during the third, fourth and fifth stages for the 84 patients(P<0.01 or P<0.05).And the dosage of insulin during the third stage was significantly higher than those of the fourth and fifth stages (P<0.01).However, no statistical significance could be noted in the dosage of insulin during the fourth and fifth stages (P>0.05).The rates of hypoglycemia during the fourth and fifth stages were respectively 10 cases and 11 cases, which were all significantly higher than that of the third stage (2 cases) (P<0.05).Conclusion When the disease status of the DN patients developed from CKD Ⅰ~Ⅱphase to CKD Ⅲ~Ⅳ, the dosage of in-sulin should be reduced, and when it developed from CKD Ⅲ~Ⅳto CKD Ⅴ before the implementation of dialysis, the dosage could still remain at relatively stable level.However, when dialysis therapy was implemented for 1 to 3 months, the dosage of insulin should further be reduced.From then onwards, the dosage of insulin could remain basically unchanged.At the same time, for those patients with DN, measures should be taken for the prevention of hypoglycemia during dialysis therapy.
