In case anyone is wondering, when an individual who is also diabetic progresses to stages 3-5 of kidney disease, their requirements for insulin injections decrease. Why? Because there is a decreased degradation of insulin in the kidneys. (Apparently insulin is degraded in the kidneys. Even one of my preceptors who worked as a renal dietitian for 15 years didn't know that. p.s. why did we never learn about the catabolism of insulin in our classes???) Turns out, most insulin is reabsorbed in the kidneys and recycled, but 10-30% of the insulin is degraded and excreted. In those with decreased GFR, they don't degrade the insulin as quickly and there is more insulin remaining in the bloodstream. So, in individuals with DM requiring insulin who also reach ESRD, insulin regimens need to be adjusted to prevent hypoglycemia.
And a question- do your hospitals use metformin in the clinical setting? or are all pts with DM put on insulin?
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