The mechanism of hypoglycemia caused by hemodialysis

Takahashi, A; Kubota, Tetsuaki; Shibahara, Nobuhisa; Terasaki, Jungo; Kagitani, Maki; Ueda, Hirotaka; Inoue, Takashi; Katsuoka, Yoji

doi:10.5414/cnp62362

Cited by 43 publications

(43 citation statements)

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“…A recent study suggests that during hemodialysis, erythrocyte glucose consumption is increased, caused by high concentrations of bicarbonate in the dialysate fluid. High bicarbonate concentrations would initiate changes in cytoplasmic pH, which in turn would increase anaerobic glycolysis in erythrocytes (14). Moreover, lactate can serve as a substrate for gluconeogenesis whereas bicarbonate cannot.…”

Section: Discussionmentioning

confidence: 99%

Predisposing factors for hypoglycemia in the intensive care unit*

Vriesendorp

Santen

DeVries

et al. 2006

Critical Care Medicine

250

136

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Section: Discussionmentioning

confidence: 99%

Predisposing factors for hypoglycemia in the intensive care unit*

Vriesendorp

Santen

DeVries

et al. 2006

Critical Care Medicine

250

136

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“…The large difference in glucose levels between plasma and the dialysate affects the change in glucose levels during HD: the higher the glucose level at HD initiation, the greater the decrease during HD. The possible mechanisms for this decrease include glucose loss in the dialytic effluent fluid and excessive consumption of glucose as a result of accelerated anaerobic metabolism in HD patients [11][12][13][14]. The postprandial hyperglycemia after HD may be caused by increased secretion of counter-regulatory hormones, such as glucagon, adrenocorticotrophic hormone, and cortisol, which restore glycemic levels after recovery from hypoglycemia or lowering of blood pressure during HD [15].…”

Section: Discussionmentioning

confidence: 99%

Continuous Glucose Monitoring Effects on Blood Glucose Management in Diabetic Patients on Hemodialysis-Results in the Patients from Single Hospital

Kimura¹,

Toyoda²,

Saito³

et al. 2017

J Diabetes Metab

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Objective: Diabetic patients on hemodialysis (HD) are prone to develop treatment-related serious hypoglycemia due to poor renal clearance of insulin and augmented drug efficacy, often resulting in withdrawal of insulin. Consequently, many patients are erroneously switched to oral glucose-lowering agents or diet therapy alone, without self-monitoring of blood glucose (SMBG). Therefore, we hypothesized that continuous glucose monitoring (CGM) may be useful for optimizing glycemic control and clinical management in diabetic patients on HD. Methods:In this study, 8 type 2 diabetic patients on HD who did not use SMBG after withdrawal of insulin and start of oral glucose-lowering agents, were recruited to measure and evaluate blood glucose with CGM. These patients thought to be controlled within glycemic control target proposed by the Japanese Society for Dialysis Therapy. Predialysis casual plasma glucose level (or 2-h postprandial plasma glucose level) of <180-200 mg/dL and GA level <20.0%. Results:Although the levels of glycated albumin (GA) and blood glucose measured just before HD were within the provisional target values recommended by the Japanese Society for Dialysis Therapy in all eight patients, seven patients developed postprandial hyperglycemia (>200 mg/dl) after HD. Conclusions:Diabetic patients on HD require careful monitoring with SMBG, CGM, and direct measurement of postprandial blood glucose level during HD before any decision is made regarding withdrawal of insulin and cessation of SMBG.

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“…3. Physicians should consider that studies reveal significant changes in glucose concentration during and after hemodialysis, including an influence by the dialysate itself, which can lead to a life-threatening event by glucose disturbance (Sobngwi et al, 2010;Takahashi et al, 2004). 4.…”

Section: Discussionmentioning

confidence: 99%

Corticotrophin deficiency in end-stage renal failure led to recurrent hypoglycemia: A case report

Wagner¹,

Kann²

2015

Med. Case Stud.

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Reactive hypoglycemia caused by an insulinoma, pre-diabetic metabolic state, fluctuations in diabetic metabolic situation and antidiabetic medication is commonly known. We report on the case of an unusual multi-factorial occurrence of a woman with recurrent hypoglycemia, which cannot be explained adequately by a single commonly known cause. We refer to a cachectic non-diabetic 52-year-old German woman, admitted to our clinic for clarification of an insulinoma. The possibility of an insulinoma could be excluded as well as co-morbidities linked to non-diabetic hypoglycemia like sepsis, alcohol dependence liver disease, cancer or self-harm with hypoglycaemic agents. However, our diagnostics revealed a corticotrophic insufficiency as a result of longtime cortisol medication. Still, further causes have additionally to be considered, including dysfunctional elimination of glucose, renal and hepatic gluconeogenesis and glucose regulation on dialysis. These reasons are assumed as the pathological factors. Although insulinoma is a possible cause of hypoglycemia, it is not the only pathogenesis. Here, various alternatives factors are defined, examined and in part treated specifically. As therapy, besides nutritional counselling, the patient received cortisol. After a 20 month follow-up symptoms of symptomatic hypoglycemia were absent.

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The mechanism of hypoglycemia caused by hemodialysis

Cited by 43 publications

References 0 publications

Predisposing factors for hypoglycemia in the intensive care unit*

Predisposing factors for hypoglycemia in the intensive care unit*

Continuous Glucose Monitoring Effects on Blood Glucose Management in Diabetic Patients on Hemodialysis-Results in the Patients from Single Hospital

Corticotrophin deficiency in end-stage renal failure led to recurrent hypoglycemia: A case report

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