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  Table of Contents  
CHAPTER 17
Year : 2020  |  Volume : 30  |  Issue : 7  |  Page : 73
 

Diabetes and hemodialysis



Date of Web Publication15-Jul-2020

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.289821

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How to cite this article:
. Diabetes and hemodialysis. Indian J Nephrol 2020;30, Suppl S1:73

How to cite this URL:
. Diabetes and hemodialysis. Indian J Nephrol [serial online] 2020 [cited 2020 Dec 1];30, Suppl S1:73. Available from: https://www.indianjnephrol.org/text.asp?2020/30/7/73/289821





  Introduction Top


Patients on dialysis often require low or no antidiabetic medication. They are prone to develop hypoglycemia during dialysis. The dose of antidiabetic medications should be reduced to avoid complications.

However, other systemic complications of diabetes may continue even after a patient has reached ESRD. Glucose control and monitoring may retard or prevent other complications.

  1. We recommend education of ESRD patients about diabetes management with an emphasis on how to recognize and treat hypoglycemia.
  2. We recommend that all patients should have a baseline measurement of their blood sugar levels (fasting and postprandial) and glycated hemoglobin (HbA1c) at the time of initiation of dialysis therapy.
  3. We recommend individualization of therapy for control of blood sugar.
  4. We recommend the following targets: HbA1c ~7%, fasting blood sugar <140 mg%, and postprandial blood sugar <200 mg%.
  5. We recommend the use of insulin for diabetes control over oral hypoglycemic agents (OHAs).
  6. We recommend using a combination of long-acting insulin for basal requirements along with rapid acting insulin before meals two to three times daily.
  7. We recommend the following starting insulin dosage:


  8. a) Type 1 diabetes: 0.5 IU/kg

    b) Type 2 diabetes: 0.25 IU/kg

  9. Further adjustments to the regimen should be individualized based on the self-monitored blood glucose testing. [Table 1] lists the adjustments required in Insulin dosages according to renal function.
  10. The use of OHAs should be limited to repaglinide, glipizide, gliclazide, sitagliptin, saxagliptin, linagliptin, and teneligliptin with appropriate dose modifications for ESRD. [Table 2] lists the adjustments required in oral antidiabetic drug dosages according to renal function.
  11. We recommend that diabetic ESRD patients should follow a fixed schedule for dialysis as the blood sugars are affected by dialysis.
  12. We suggest consulting an endocrinologist with expertise in managing diabetes in ESRD, in difficult-to-manage cases.
Table 1: Insulin preparations

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Table 2: Oral hypoglycemic agents

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    Tables

  [Table 1], [Table 2]



 

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Indian Journal of Nephrology
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Online since 20th Sept '07