Insulin Captopril

In the treatment of diabetic nephropathy associated with type I insulin-dependent diabetes mellitus, captopril decreases the rate of progression of renal insufficiency and retards the worsening of renal function. 

The combination of diabetes mellitus and hypertension inexorably leads to diabetic nephropathy and is the major cause of end-stage renal failure. In numerous animal studies and in several small clinical trials, ACE inhibitors have been shown to significantly retard the loss of kidney function associated with diabetic nephropathy. A large, prospective, placebo-controlled study has clearly established that captopril slows the progression of diabetic nephropathy in patients with insulin-... 

Sharma K, Eltayeb BO, McGowan TA, Dunn SR, Alzahabi B, Rohde R, Ziyadeh FN, Lewis EJ. Captopril-induced reduction of serum levels of transforming growth factor-betal correlates with long-term renoprotection in insulin-dependent diabetic patients. American Journal of Kidney Diseases 1999, 34, 818-823. 

Mechanism uncertain. ACE inhibitors possibly t insulin sensitivity and glucose utilization. Altered renal function may also be factor. ACE inhibitors may t bradykinin levels, which i production of glucose by the liver. Hypoglycaemia is reported as a (rare) side-effect of ACE inhibitors. Suggested that occurrence of hypoglycaemia is greater with captopril than enalapril. Captopril and enalapril are used in the treatment of diabetic nephropathy... 

Parving HH, Hommel E, Kamkjaer M, Gieses NJ. Effect of captopril on blood pressure and kidney function in normotensive insulin-dependent diabetics with nephropathy. Brit Med J 1989 299 533-536. 

A 47-year-old woman with multiple medical problems stabilised on warfarin (and also taking azathioprine, captopril, furosemide, insulin, capto-pril, prednisone, levothyroxine, valproic acid and zolpidem) had all her teeth removed under general anaesthetic. Sixteen days later she needed a dental abscess drained and was given oral clindamycin 300 mg four times daily with ibuprofen 600 mg for any discomfort. On day 17 she needed a suture to stop some bleeding and her INR was found to be 3.5. By day 20 she had developed more severe oral bleeding, which needed emergency room treatment. Her INR was found to have risen to 13 and her haemat-ocrit decreased to 18%. She was treated successfully with a blood transfusion and vitamin K. ... 

Not understood. An increase in glucose utilisation and increased insulin sensitivity have been suggested. Other possibilities (e.g. altered renal function) are discussed in a series of letters in The Lancet. There is also an isolated report of persistent severe hypoglycaemia in a non-diabetic patient associated with both captopril and ramipril therapy. Conversely, high natural ACE activity has been associated with a higher risk of severe hypoglycaemia. ... 

Ferriere M, Lachkar H, Richard J-L, Brii er J, Oraetti A, Mirouze J Captopril and insulin... 

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