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Diabetic Hypoglycemia - an independent electronic journal dedicated to the advancement of hypoglycemia research and clinical management
Diabetic Hypoglycemia Volume 6, Issue 3, January 2014

Clinical Case Study

Severe hypoglycemia in end-stage renal disease in a patient with type 1 diabetes on hemodialysis

Sheila Cook, Ali Sharafi and Louise Moran

Diabetic Hypoglycemia January 2014, Volume 6, Issue 3: page 7-10

Diabetic nephropathy is the principal cause of end-stage renal disease (ESRD) in patients requiring renal replacement therapy. Insulin-treated patients with diabetes on hemodialysis (HD) have a higher rate of severe hypoglycemia compared with non-insulin treated patients. This results from multiple factors, such as increased sensitivity to insulin. In addition, most patients with long-term type 1 diabetes have diminished counter-regulatory responses to hypoglycemia; HD therefore poses a major challenge to their management. Different therapeutic strategies (eg use of glucose-containing solutions for dialysis and strict monitoring of blood glucose during and after dialysis sessions) are recommended to reduce the risk of developing hypoglycemia. However, little evidence is available to help clinicians optimize the dose of insulin before, during and after dialysis sessions. The pharmacokinetics of insulin preparations are complicated and not well described in the setting of glomerular filtration rate <15 ml/min/1.73 m2. The difficulties encountered in managing patients with type 1 diabetes and ESRD who are receiving HD are illustrated in this case report.


Keywords: hemodialysis, hypoglycemia, intra-peritoneal insulin, peritoneal dialysis, type 1 diabetes