<prompt> A known case of chronic kidney disease stage 4 is on insulin therapy. What adjustment in insulin dosage is required?Increase dose of insulinDecrease dose of insulinVariableNo alteration in dose  <response>: Some of the insulin is cleared by the kidneys. No dose adjustment is required if GFR is more than 50 mLmin. If GFR is less than 50 mLmin, then insulin dose should be reduced. As in CKD stage 4 GFR is 15mLmin so the dose of insulin should be decreased. 