A known case of chronic kidney disease stage 4 is on insulin therapy. What adjustment in insulin dosage is required?
Some of the insulin is cleared by the kidneys. No dose adjustment is required if GFR is more than 50 mL/min. If GFR is less than 50 mL/min, then insulin dose should be reduced. As in CKD stage 4 GFR is <15mL/min so the dose of insulin should be decreased.
Increase dose of insulin
Decrease dose of insulin
Variable
No alteration in dose
Pancreas