Diabetes and Hemodialysis

摘要

Patients on dialysis often requirelowor no antidiabetic medication. They are proneto develop hypoglycemia during dialysis. The dose ofantidiabetic medications should bereduced to avoid complications.However, other systemiccomplications of diabetes may continueeven aftera patient has reached ESRD. Glucosecontroland monitoringmayretard or prevent othercomplications.1. Werecommend education ofESRDpatientsabout diabetes management with an emphasis on howto recognizeand treat hypoglycemia.2. Werecommend thatall patients should havea baseline measurement oftheir blood sugar levels (fasting and postprandial)and glycatedhemoglobin (HbA1c)at thetime ofinitiation of dialysis therapy.3. Werecommend individualization oftherapy forcontrol of blood sugar.4. Werecommend thefollowing targets:HbA1c ~7%, fasting blood sugar 140 mg%,and postprandial blood sugar 200 mg%.5. Werecommend the use ofinsulin for diabetescontrol over oral hypoglycemicagents (OHAs).6. Werecommend using acombination oflong-acting insulin for basalrequirementsalongwith rapid acting insulin before meals two to threetimes daily.7. Werecommend thefollowing starting insulin dosage:a)Type 1 diabetes: 0.5 IU/kgb)Type 2 diabetes: 0.25 IU/kg8. Furtheradjustments to theregimen should beindividualized based on theself-monitored blood glucosetesting. Table 1 lists theadjustmentsrequired in Insulin dosagesaccording to renalfunction.