A Glance at Insulin in Diabetic Kidney Disease


Patients with chronic Diabetes Mellitus (DM) who have uncontrolled blood sugar and those with blood sugar difficult to control with diabetes pills are certainly familiar with the term insulin injection. Insulin is a normal hormone in human body, which is produced and released by pancreatic cells in sufficient quantities to help the cells in our bodies absorb sugar in the blood. With insulin, our body is able convert sugar into energy with minimal metabolic waste.

In a person with DM, due to several reasons, the amount of insulin the body produces is inadequate to carry out its functions, both in quantity and/or quality. Some of the possible causes are damage to pancreatic beta cells (insulin-producing cells) as in type I diabetes and the inability of the body cells to recognize the hormone insulin as in type II diabetes.

For patients with type I DM, insulin is a necessity, not an option. Meanwhile, for patients with type II diabetes, in contrast to type I diabetes, the use of insulin must be based on clinical needs. This means that insulin, as a very effective way to lower blood sugar, is better used only if needed. Thus, in the context of insulin use, it is very different from those with type I DM. Individuals with type II diabetes who need insulin are those who cannot control their blood sugar despite taking several different diabetes pills. However, if insulin is taken before the inability to control blood sugar, the function of the pancreatic cells (insulin-producing cells) can be maintained for a longer time. The longer we keep our pancreas producing our own natural insulin, the longer we are able to survive on a less complicated insulin regimen, perhaps with a minimum of one injection a day. Insulin is a very safe therapy, and patients should not hesitate to use it if needed according to their clinical condition.

In general, patients with chronic DM have several complications that may occur, for example, complications in large blood vessels such as those in heart, brain, legs, and complications in small blood vessels such as those in the eyes, nerves, and kidneys. In the case of kidney damage, if not treated properly, it has the potential to cause Chronic Kidney Failure (CKF) which can interfere with the body's ability to remove toxic substances from the body and require the patient to undergo dialysis therapy with hemodialysis (HD) or Continuous Ambulatory Peritoneal Dialysis (CAPD) as well as kidney grafts.

It can be concluded that exogenous insulin therapy (from outside the body) as a substitute for endogenous insulin (from within the body) is expected to prevent and repair the occuring kidney damage, as those in cases of diabetic complications in other important organs. The following is a brief explanation of some of the benefits of insulin for kidney health in DM patients.

One of the benefits of insulin injections is to prevent hyperglycemia or too high sugar levels. If oral medications (pills) for diabetes are no longer able to lower blood sugar, then insulin injections are automatically required. Fast-acting insulin can lower blood sugar levels within 5-15 minutes and the peak is reaching in 30-90 minutes after injection. Too high sugar level can damage, among others, the blood vessels of the kidneys, so insulin (injection) is our kidney's savior agent (Hahr, 2015).

Patients with CKD stages IV to V and those undergoing dialysis are prone to delayed gastric emptying. Insulin in patients who have diabetic gastropathy or gastric disorders due to diabetes can be administered with insulin after meals to match the peak time of insulin action with peak blood sugar. Patients on peritoneal dialysis also obtain large amounts of calories from dialysis fluids, so insulin can help digest these nutrients.

Sometimes, patients diagnosed with Diabetes Mellitus are afraid to use insulin because they feel that their disease is already severe. However, it is insulin that is the only savior so that the condition of the kidneys can be protected/saved. We have to regularly check our blood sugar level as advised by the doctor, so that the best treatment can be given to save our kidneys.

 

Reference:
Hahr, A.J., Molitch, M.E. Management of diabetes mellitus in patients with chronic kidney disease. Clin Diabetes Endocrinol 1, 2 (2015). https://doi.org/10.1186/s40842-015-0001-9

 

Djoko Santoso
Professor, Faculty of Medicine, Universitas Airlangga
Chairman of Health Department, Indonesian Council of Ulama, East Java

 

 



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