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

Cook, Shiela, Sharafi, Ali and Moran, Louise (2014) Severe hypoglycemia in end-stage renal disease in a patient with type 1 diabetes on hemodialysis. Diabetic Hypoglycemia, 6 3: 7-10.

Author Cook, Shiela
Sharafi, Ali
Moran, Louise
Title Severe hypoglycemia in end-stage renal disease in a patient with type 1 diabetes on hemodialysis
Journal name Diabetic Hypoglycemia
ISSN 1757-2428
Publication date 2014-01-01
Sub-type Article (original research)
Open Access Status Not Open Access
Volume 6
Issue 3
Start page 7
End page 10
Total pages 4
Place of publication Crowthorne, Berkshire, United Kingdom
Publisher E S P Bioscience
Subject 2712 Endocrinology, Diabetes and Metabolism
2724 Internal Medicine
Formatted abstract
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.
Keyword Hemodialysis
Hypoglycemia
Intra-peritoneal insulin
Peritoneal dialysis
Type 1 diabetes
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Mon, 15 Feb 2016, 20:19:14 EST by Jacky Cribb on behalf of Learning and Research Services (UQ Library)