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Removal of excess insulin via dialysis

Image credit: https://medcitynews.com/2011/02/home-dialysis-machine-market-heats-up-with-fresenius-entry/

Shubhankar Kulkarni
Shubhankar Kulkarni Aug 07, 2020
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In patients with type 2 diabetes and renal failure, dialysis improves insulin sensitivity as well as insulin clearance. Several groups have suggested and also demonstrated that hyperinsulinemia (higher than normal insulin levels in the blood) precedes and is also causal to insulin resistance. Therefore, the improvement in insulin sensitivity is probably due to the clearance of insulin from the blood.

However, in these cases, dialysis is not targetted towards insulin. A therapy to treat type 2 diabetes can be designed that involves targetting insulin and its clearance via dialysis to maintain healthy blood insulin levels.

[1]Amico JA, Klein I : Diabetic management in patients with renal failure. Diabetes Care 1981; 4: 430–434

[2]Watve M. Doves, diplomats and diabetes: a Darwinian interpretation of type 2 diabetes and related disorders. New York: Springer, 2013

[3]Corkey B. Banting Lecture 2011: Hyperinsulinemia: Cause or Consequence? Diabetes. 2011;61:4–13. doi: 10.2337/db11-1483.

[4]Insulin Resistance and Hyperinsulinemia Is hyperinsulinemia the cart or the horse? Michael H. Shanik, Yuping Xu, Jan Škrha, Rachel Dankner, Yehiel Zick, and Jesse Roth. Diabetes Care 2008 Feb; 31(Supplement 2): S262-S268. https://doi.org/10.2337/dc08-s264

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General comments

Darko Savic
Darko Savic4 years ago
How could this kind of solution be made practical, given that insulin spikes multiple times per day (after meals)?
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Shubhankar Kulkarni
Shubhankar Kulkarni4 years ago
In diabetics, the baseline (fasting) insulin levels are higher than normal. Dialysis may be helpful in bringing down these baseline levels. Frequency of dialysis can be kept similar to that of patients with renal dysfunction.
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