| Theme |
Glycemic Control and Diabetes with Chronic Kidney Disease |
| Title |
Hypoglycemic mechanisms in diabetic patients with impaired kidney function |
| Author |
Masanori Abe |
Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine |
| Author |
Masayoshi Soma |
Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine / Division of General Medicine, Department of Internal Medicine, Nihon University School of Medicine |
| [ Summary ] |
A major risk for patients in attaining adequate glycemic control is an increased likelihood of developing hypoglycemia. Patients with decreased kidney functions (CKD stages 3 to 5) and who are receiving dialysis therapy are at increased risk of hypoglycemia for two reasons: (1) decreased clearance of insulin associated with some oral agents used to treat diabetes and (2) impaired kidney gluconeogenesis. This reduction in gluconeogenesis may reduce the ability of patients who become hypoglycemic as a result of excessive insulin/oral agent dosage or lack of food intake to defend themselves against hypoglycemia. It is imperative that patients being treated intensively monitor their glucose levels closely and reduce doses of medicines (insulin and oral agents) as needed to avoid hypoglycemia. Patients who are treated with dialysis therapy experience longer duration of diabetes. Therefore, caution is needed to guard against the risk of asymptomatic hypoglycemia due to diabetic autonomic neuropathy. |