The Author Replies:
In the Letter to the Editor submitted by McKee et al.,1 the authors provide a vital perspective concerning judicious dosing of insulin at initiation of therapy for persons with type 1 diabetes or type 2 diabetes and chronic kidney disease. Within the context of our review, Table 3 was not designed to be a guide to starting doses of insulin. Our intent was to provide examples of proportional reductions in total daily doses along with commonly used doses in persons with type 1 diabetes or type 2 diabetes who have been treated with insulin across different levels of estimated glomerular filtration rate.2 Accordingly, we fully agree that insulin initiation in the setting of chronic kidney disease should be cautious to avoid hypoglycemia and align with guidance from the American Diabetes Association and the American Association of Clinical Endocrinology.3,4 We thank the authors of the Letter and the Editors for the opportunity to clarify this important point.
References
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