What is the dose adjustment required for insulin in a patient who is diagnosed as stage IV CKD: (A) Increased insulin, (B) Decreased insulin, (C) No change, (D) Add DPP-4 inhibitor
Answer is B. During the later phase of declining renal function, insulin requirements may fall as kidney is a site of insulin degradation. some glucose lowering agents(sulphonylureas and metformin) are contraindicated in advanced renal insufficiency Ref:Harrison 20th edition pg no 2878