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Managing diabetes in hemodialysis patients: Observations and recommendations
Cleveland Clinic Journal of Medicine, 11/04/09

Shrishrimal K et al. – Diabetes is challenging to manage in patients who have end–stage renal disease (ESRD), as both uremia and dialysis can complicate glycemic control by affecting the secretion, clearance, and peripheral tissue sensitivity of insulin. The authors summarize the available evidence and make practical recommendations.

• Blood glucose levels can fluctuate widely due to various and opposing effects of ESRD and dialysis.
• The hemoglobin A1c level can be falsely high in ESRD, but it is still a reasonable measure of glycemic control in this population.
• Most diabetes drugs are excreted at least in part by the kidney, so that patients in ESRD are at greater risk of hypoglycemia.
• Insulin is the cornerstone of treatment, since most oral diabetes drugs are contraindicated or not recommended in this population. Insulin doses should be lowered in those with low glomerular filtration rates.

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