Angiography, Acute Renal Failure, and Decreased Insulin Requirements in Diabetes Mellitus

Weinrauch et al have reported on decreased insulin requirements associated with hypoglycemia in 11 of 12 diabetic patients who developed an acute exacerbation of their chronic renal failure following coronary angiography elsewhere in this issue (p 399). The progression of the renal failure necessitated dialysis in 50% of the patients.¹ A 13th patient, who did not experience acute renal failure after angiography, did not manifest hypoglycemia. The smaller amount of dye that this patient received and his higher hemoglobin level may have prevented the superimposed acute renal failure. This 92% incidence of acute renal failure after coronary angiography, compared with a much lower incidence following intravenous infusion pyelography, and the additional problem of hypoglycemia indicate that the risks of the procedure must be carefully weighed against the benefits. Although it is well recognized that fluid deprivation may be an important factor in the genesis of acute renal failure following