New Delhi: Diabetic patients on dialysis face unique health challenges, and managing diabetes while undergoing dialysis requires careful attention to both blood sugar control and dialysis-related concerns.
Ahead of World Diabetes Day, Dr Saurabh Pokhariyal, Chief Medical Director, VitusCare, shared pro tips for diabetics on dialysis.
Monitor Blood Glucose Regularly: Frequent blood glucose checks help prevent both hyperglycaemia and hypoglycemia. Dialysis can affect glucose levels—either increasing them due to stress or medication or lowering them if the patient is on insulin. Monitoring helps prevent dangerous fluctuations. In general, a fasting blood glucose of 80-130 mg/dL and post-meal glucose of less than 180 mg/dL are recommended, but individual goals may vary. If possible, using a Continuous Glucose Monitor (CGM) may provide real-time data, making it easier to detect trends and respond to changes in glucose levels in these patients.
Nutrition and Diet: Carbohydrate Control: Balancing carbohydrate intake is crucial for blood sugar control. Limit refined sugars and high glycemic foods that cause rapid spikes in blood glucose. Opt for complex carbohydrates (whole grains, vegetables) that offer steady energy release.
Electrolyte and Fluid Restrictions: Dialysis patients often need to limit sodium, potassium, and phosphorus intake to prevent electrolyte imbalances and fluid overload.
Protein Management: Dialysis patients need higher protein intake due to the loss of protein during dialysis, but this should be balanced with blood sugar goals. Small, Frequent Meals: Eating smaller, well-balanced meals throughout the day can help maintain more stable blood sugar levels, especially if you are on haemodialysis where blood sugar can fluctuate more due to fluid shifts during treatment.
Fluid Management: Strict Fluid Restrictions: Diabetic patients on dialysis should follow fluid limits which helps prevent complications like swelling, high blood pressure, and heart failure. Fluid restriction can vary based on the type of dialysis (haemodialysis or peritoneal dialysis) and residual kidney function. (For
Peritoneal Dialysis): For patients on peritoneal dialysis, tracking urine output is essential. Decreased urine output or changes in volume should be promptly discussed with your healthcare team to adjust fluid intake and dialysis prescriptions.
Medication Management: Insulin Adjustment: Dialysis can alter insulin requirements. The clearance of insulin during hemodialysis may lower insulin levels in the body, necessitating adjustments to insulin doses. Patients may need adjustments to their insulin doses, particularly after dialysis sessions, due to changes in fluid and electrolyte balance. Certain oral medications used for diabetes, such as metformin, are not safe for patients with kidney disease. Always follow your doctor’s guidance on the suitability of diabetes medications. Most medications need dose adjustments for the degree of renal function and all new medications need medications prescribed by non nephrologists should be checked by your treating nephrologist before being taken.
Dialysis Access Care: Proper Dialysis Access Maintenance: It’s essential to care for the access site (fistula, graft, or catheter). Keep it clean to reduce the risk of infection and check for any signs of clotting or decreased blood flow. Never use the access site for anything other than dialysis-related purposes (like taking blood samples or administering injections ). Any changes in the appearance or function of your dialysis access site should be reported to your nephrologist immediately.
Foot Care: Routine Foot Checks: Diabetes increases the risk of neuropathy (nerve damage) and poor circulation (peripheral vascular disease), leading to an increased risk of foot ulcers and infections. Check your feet daily for any cuts, blisters, or infections, and seek immediate medical care if any issues arise. Protective Footwear: Wear shoes that fit well and provide adequate protection to prevent injury. Avoid walking barefoot, especially on hard or hot surfaces.
Exercise and Physical Activity: Moderate Exercise: Regular physical activity can improve blood sugar control, cardiovascular health, and overall well-being. Avoid Exercising Right Before or After Dialysis. It’s generally advised to exercise when you are feeling well and hydrated. Flu vaccination annually and Pneumonia Vaccination periodically. Vaccinations reduce the risk of respiratory infections, which can be more severe in dialysis patients and complicate diabetes management.
Emotional and Mental Health: Mental Health Support: Living with both diabetes and kidney disease can be emotionally challenging. Stress, anxiety, and depression are common in dialysis patients, and they can negatively impact both blood sugar control and overall health. Seek counseling or join a support group to help manage the emotional aspects of living with chronic disease. Focus on self-care, which includes both physical health and mental well-being. Practicing relaxation techniques, mindfulness, or engaging in hobbies can help manage stress.
Living with both diabetes and kidney disease can be emotionally challenging. Stress, anxiety, and depression are common in dialysis patients, and they can negatively impact both blood sugar control and overall health Health News Health News: Latest News from Health Care, Mental Health, Weight Loss, Disease, Nutrition, Healthcare
