rafeedahnik

4 years

My father is on hemodialysis

Hi Doctor, my father is on hemodialysis and usually the morning before his dialysis he will eat a lot and he has diabetes as well. Will the dialysis reduce his sugar level and will he need to take his usual morning insulin on the day of his dialysis? Thank you.

Hi, thank you for your question. Insulin requirment decreases as estimated glomerular filtration rate (eGFR) (measures how well the kidney functions) decreases. Hemodialysis has a huge impact on blood glucose control:

·Removes glucose (dialysate should contain glucose)
·Removes glucoregulatory (regulation of blood glucose) hormones (insulin, C-peptide, glucagon)
·Removes antidiabetic medications (insulin)
· Modulates insulin action secondary to improved acidosis, uremia, and phosphate metabolism

Therefore, glucose control on the day of hemodialysis varies from that on normal days, resulting in unstable blood glucose levels. Most patients still need antidiabetic medications, but medication dosage may need to be lowered to prevent hypoglycemia (low blood glucose levels), especially on the day of hemodialysis when blood glucose levels are lower.

On the day of hemodialysis, patients should bring their own insulin with them to the dialysis centre. Blood glucose levels have to be checked before hemodialysis and just before hemodialysis ends. Blood glucose levels may fluctuate during hemodialysis and is likely to drop in the last hour of hemodialysis. Hence, insulin dose should be reduced by 10-15% during and immediately after hemodialysis.

Hemodialysis patients are at risk of hypoglycemia, especially within the first 24 hours of hemodialysis. Patients are recommended to consume 10-20 g of a low glycemic index carbohydrate in the 2nd hour of hemodialysis. If blood glucose level is <7mmol/L before the start of hemodialysis, 20-30g of carbohydrates should be consumed at the start of hemodialysis. If patients experience hypoglycemic symptoms, they have to consume 15-20g of carbohydrate (1 slice of bread or 2 biscuits).

Please click on this link (DoctorOnCall) to talk to us privately online and discuss further about your inquiries. Thank you.

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