Speech:

Control of delta (d) glucose with intensive insulin therapy is fundamental to renal preservation in diabetes

Abstract
This presentation encompasses background information on no attention to glycemic control with sparse use of insulin therapy, but on the contrary more interest in controlling microalbuminuria with excessive use of angiotensin converting enzyme inhibitor (ACEI) and or angiotensin receptor blocker (ARB) drugs.

The results are high incidence of acute renal failure associated with cumulative high risk of end stage renal disease (ESRD) and dialysis. Steps are taken by the author to reveal that glycemic control with insulin therapy and complete exclusion of ACEI/ARB drugs are fundamental to renal preservation in diabetes. Prior to testing this hypothesis basic research was done to examine the response of vascular endothelial cells (ECS) to high glucose (30mmol or 540mg) environment for 2, 6 or 10 days. ECS are progressively injured with longer duration of exposure to high glucose but ECS injury is preventable by addition of insulin with high glucose in the culture plate. Even when glucose level in the culture plate did not change, ECS morphology remained intact.

Thus the hypothesis testing has confirmed that insulin treatment is capable of preventing microvascular diseases which are characteristics of diabetes. Our continuous investigations confirm that renal preservation is attainable with insulin treatment and complete exclusion of the use of ACEI/ARB drugs. We have innovated the factor of delta (d) glucose (2h postprandial glucose-fasting glucose) to test close relationship between 2-h post prandial hyperglycemia and renal function changes. We have found the dglucose over 50mg/dL is associated with significant risk of renal function deterioration.