I have been in dialysis for over 10 years and have been taught that blood sugars once on dialysis are elevated because of the baths, containing dextrose, we never used to take their glucose levels and cover their insulin because of this fact. Coverage of insulin would cause them to have hypoglycemia or a lower level post dialysis.

Now I have relocated and the facility that I work for feels that this is not appropriate, and there is no evidence of this..

What is your opinion on this issue.
I would like some feedback, I am starting to doubt my knowledge about this.

Thanks

I've been on hemo for over six years, and even though I don't have diabetes, I have very low blood sugar post-dialysis. If I don't eat immediately after getting home, I break out in a sweat and get weak and dizzy. I was tested for diabetes and it was negative, but I'm very sensitive to changes in blood sugar and dialysis causes a rapid shift in electrolytes.

Some of our diabetic patients eat lunch while on the machine, because between transport and treatment, they'd have to go too long between meals. I am sure that if I'm having the blood-sugar problem and I'm not even diabetic, the diabetic patients must also be affected by it.

I have always tested diabetic patients blood sugars pre and post treatment and treated as necessary. True, the baths do contain dextrose, but when coupled with a blood sugar that may be out of control, you may have problems during treatment.

I would only recommend treating with regular insulin. Certainly faster acting, but also has a limited half life so the blood sugar 'after' treatment becomes less of a worry.

Does that help?

Thank Carol For your response, we dialyze inhouse hospital patients. What about during dialysis..See our patients come to us, and while they are being dialyzed, lets say the patient gets on at 600am, is on dialysis and 0800 needs a glucose level while on dialysis, would the level be increased? Would it be safe to say to that we would do the glucose pre dialysis as opposed to intradialysis..and coverage insulin on the predialysis level as opposed to the intradialysis.

We are trying to write a policy as a group, but the old timers in the dialysis unit, do not agree with this. What I need is information that would substantiate the facts..

Thanks
Leah RN...

Leah,

This is probably not much help but I think you need to treat the blood sugar whenever it is done. I have seen many BS's of 50 when the dextrose in the dialysate is 200...I have also seen many sustained at 300 or greater for an entire treatment with a dialysate level of 100.

I agree 100% with Carol that only regular insulin should be used when the BS warrants it but you also must treat the low levels with D50 and not rely on the dialysate to bring them up.

Thanks Chuck for your response, what about qam Insulin, with longacting and short acting insulins, should we give them during dialysis or should they be given pre-dialysis and make sure they get their breakfast before arriving to dialysis.

Thanks so very much for your input. Yes, I have seen bs as high as 300 and low in the 50s, and we have treated them on dialysis. One makes you wonder what the blood sugar is without the added dextrose in the bath.

Thanks again,
Leah RN

I went through a similiar situation in an acute program that I helped manage for a short time about 3 years ago.

All parties decided to come to the table to work out something that everyone could live with. The hospital staff wanted the dialysis (contract) staff to do all blood sugars and treat appropriately; the dialysis staff didn't want to treat with insulin if food wasn't available; neither party could get the MDs to agree on either side. The one thing we all did agree on was that the pateint was indeed the one caught in the middle of this turf battle.

After much teeth gnashing and hair pulling (maybe a slight exaggeration, but not by much...) this is what we finally agreed upon:

All diabetic patients would be served breakfast prior to receiving dialysis in the dialysis room. The hospital staff would be responsible for ensuring that this occured.

Blood sugars would be performed at the initiation and discontinuation of treatment for all diabetic patients. The dialysis staff would perform these blood glucose checks. The hospital would be responsible for certifying the dialysis staff on proper use of the hospital blood glocometers.

Blood glucose levels that were less than 60 or greater than 130 would be treated by an MD order (we developed standing orders for treatment). Blood glucose levels less than 40 or greater than 220 would be immediately telephoned to the appropriate attending MD.

Treatment for abnormal blood glucose levels would be done by the dialysis staff and documented in the medical record, as well as on the dialysis flow sheet.

During the course of dialysis, 'routine' blood glucose testing would be suspended. Upon return to the patient room, the patient would resume 'routine' blood glucose testing as ordered by the attending MD.

Results of blood glucose testing and any interventions would be shared with staff during report from dialysis to floor staff.

I hope this helps some. Good luck,
Carol

Carol,

I recently came upon your post regarding blood sugars while on HD. I am currently going through a similar situation at the the two acute hospitals where I work. I posted a similar question here about a year ago and received no responses. I don't know how I missed yours. How do you now feel about taking CBGs while on HD? Do you have a policy that could be posted or emailed to me?

Thanks
Michael
emmens@charter.net