Blood glucose fluctuations in Diabetic and non Diabetic hemodialysis patients

Background: Glucose homeostasis and insulin metabolism are complex in patients with chronic kidney disease. Though most uremic patients are insulin-resistant with associated glucose intolerance, hypoglycemia occurs in some patients undergoing hemodialysis (HD). Blood sugar levels can fluctuate widely due to various and opposing effects in end stage renal disease and dialysis. The aim of this study was to characterize the fluctuations in glucose levels during and after HD in diabetic and non diabetic patients that might be asymptomatic. Subjects and methods: This cross-sectional observational prospective study included seventy patients with end stage renal disease (ESRD), who underwent maintenance HD therapy three times per week at Nephrology and Dialysis Unit, Zagazig, Egypt. The included subjects were divided into two groups; Group I: 35 control ESRD (non-diabetic) patients on regular HD, and Group II: 35 ESRD (Type II diabetic) patients on regular HD. All subjects of this study were subjected to full history taking, through physical examination, routine laboratory investigations, measurement of weight and height (for BMI calculation) and blood glucose level measurement before beginning of HD session, after 2 hours of beginning and at the end of dialysis and also measurement of glucose level in the dialysate passed out from patients 2 hours after the beginning and at the end of HD session. Results: Among all 70 patients, 47 patients (67.2%) did not have hypoglycemia, and 23 patients (32.8%) had hypoglycemia {17 patients (24.3%) were asymptomatic and 6 patients (8.5%) were symptomatic}. In group 1 (35 non diabetic patients), 25 patients (71.4%) did not have hypoglycemia, and 10 patients (28.6%) had hypoglycemia {9 patients (25.7%) were asymptomatic and 1 patient (2.9%) was symptomatic}. In group 2 (35 diabetic patients), 22 patients (62.9%) did not have hypoglycemia, and 13 patients (37.1%) had hypoglycemia {8 patients (22.8%) were asymptomatic and 5 patients (14.3%) were symptomatic. Symptoms of hypoglycemia included; generalized body weakness in 5 cases (8.6%), hunger in 4 cases (5.7%), cold sweats in 3 cases (4.2%), shaking in 2 cases (2.9%), and confusion in one case (1.4%). Hypoglycemia improved when we encouraged non diabetic patients to eat carbohydrate rich meals before or during HD, and diabetic patients to omit or reduce insulin dose before the HD session. Most patients who developed hypoglycemia had normal BMI, or chronic energy deficiency grade 1 or 2. Only 5 of 35 diabetic patients (14.2%) developed hyperglycemia at the end of HD session, and required and increase in insulin dose. Moreover, a positive correlation was found between glucose levels in blood and dialysate fluid outflow in diabetic patients at the end of HD session. Conclusion: We conclude that during HD, blood glucose tends to decrease in most patients; diabetic and non diabetic and some of them develop hypoglycemia, which may be symptomatic or asymptomatic, and dialysate glucose tends to increase during HD session. Thus, blood glucose should be monitored carefully during HD sessions.