Managing High Blood Sugar in Dialysis Patients: A Case Study

I would like to inquire about my father's issue of elevated blood sugar levels before meals, three months after starting dialysis?

Hello Doctor, my father is 75 years old and has been on dialysis for about 5 months.
When he started dialysis, his fasting blood sugar was around 100 mg/dL, but after 3 months, the levels began to rise.
Now, after 5 months of dialysis, his fasting blood sugar is 379 mg/dL, and the nephrologist has prescribed Glipizide extended-release tablets, but his levels are still over 300 mg/dL, with postprandial readings of 430 mg/dL.
The dialysis center suggested that the nutritional supplements might be too sweet.
My father has a very poor appetite and eats very little, and he is experiencing uremia.
He is consuming Quaker dialysis formula, about 2-3 bottles a day, with each bottle containing 237 mL and 6.3 grams of sugar.
Other brands have sugar content ranging from 4.1 to 5.7 grams.
However, the pharmacist believes that the nutritional supplements are not likely the direct cause of such high levels.
I would like to ask the doctor if this is indeed the issue, or if there could be other reasons for this sudden spike in blood sugar.
What should we do? Thank you.

Tina Lin, 30~39 year old female. Ask Date: 2024/03/30

Dr. Gao Peiyi reply Traditional Chinese Medicine

It is recommended to visit the hospital's metabolic department for a detailed examination.
In addition to stabilizing blood sugar levels with medication, it is important to investigate whether there are other underlying causes of hyperglycemia.

Reply Date: 2024/03/30

More Info

Managing high blood sugar in dialysis patients is a complex issue that requires careful consideration of various factors, including diet, medication, and the underlying health conditions of the patient. In your father's case, several elements may be contributing to his elevated blood sugar levels, which have risen significantly since he began dialysis.

Firstly, it is important to understand that diabetes management in patients undergoing dialysis can be particularly challenging. Dialysis itself can affect blood sugar levels due to changes in metabolism and the body's ability to process insulin. In your father's case, his fasting blood sugar levels have escalated from around 100 mg/dL to 379 mg/dL, and postprandial levels have reached 430 mg/dL. These numbers indicate poor glycemic control, which can lead to further complications, especially in a dialysis patient.

One potential factor contributing to the high blood sugar levels could be the nutritional supplements he is consuming. While the dialysis formula from Quaker may contain a relatively small amount of sugar (6.3 grams per 237 mL), if he is consuming multiple bottles daily, the cumulative sugar intake could be significant. Additionally, if he is consuming other foods or drinks high in carbohydrates, this could further exacerbate his blood sugar levels. It is crucial to monitor his total carbohydrate intake and ensure that it aligns with his dietary needs and diabetes management plan.

Moreover, the medications prescribed, such as the oral hypoglycemic agent (糖漸平膜衣錠), may not be sufficient alone to control his blood sugar levels, especially if his insulin sensitivity is altered due to kidney disease. It may be necessary for his healthcare team to reassess his medication regimen. This could include adjusting the dosage of his current medications or considering the addition of insulin therapy if oral medications are not achieving the desired effect.

Another important aspect to consider is your father's overall health status. The presence of uremia (尿毒症) can complicate diabetes management. Uremia can lead to insulin resistance, making it more difficult to control blood sugar levels. Additionally, if he has any infections or other acute illnesses, these can also cause blood sugar levels to spike.

Given that your father has a poor appetite and is eating very little, it is essential to ensure that he is receiving adequate nutrition. Malnutrition can lead to further complications and may also affect blood sugar control. A registered dietitian specializing in renal nutrition can provide valuable guidance on how to balance his dietary needs while managing his diabetes.

In summary, managing high blood sugar in dialysis patients like your father requires a multifaceted approach. Here are some steps you can take:
1. Dietary Review: Work with a dietitian to evaluate his current diet, including the nutritional supplements he is consuming. Ensure that his carbohydrate intake is appropriate for his diabetes management.

2. Medication Assessment: Consult with his nephrologist or endocrinologist to review his current diabetes medications. Adjustments may be necessary to improve glycemic control.

3. Monitor Blood Sugar: Keep a close eye on his blood sugar levels, both fasting and postprandial. This data can help his healthcare team make informed decisions about his treatment plan.

4. Address Uremia: Ensure that any underlying issues related to uremia are being managed effectively, as this can significantly impact blood sugar levels.

5. Regular Follow-ups: Schedule regular follow-ups with his healthcare team to monitor his condition and make necessary adjustments to his treatment plan.

By taking these steps, you can help your father achieve better control of his blood sugar levels while managing his dialysis treatment effectively.

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