<prompt> What is the dose adjustment required for insulin in a patient who is diagnosed as stage IV CKDIncreased insulinDecreased insulinNo changeAdd DPP-4 inhibitor  <response>: During the later phase of declining renal function, insulin requirements may fall as kidney is a site of insulin degradation. some glucose lowering agentssulphonylureas and metformin are contraindicated in advanced renal insufficiency Ref:Harrison 20th edition pg no 2878 