Optimization of glycemic control with continuous glucose monitoring in a patient with type 1 diabetes mellitus undergoing maintenance hemodialysis

Abstract

Patients with type 1 Diabetes Mellitus (T1DM) on renal replacement therapy with maintenance hemodialysis (MHD) are prone to develop hypoglycemia, as well as high glycemic variability on both dialysis and non-dialysis days. Reliability of glycated hemoglobin in dialysis patients with DM as a marker of carbohydrate metabolism compensation is reduced due to the influence of anemia, uremia, mechanical damage of erythrocytes during diffusion through the dialyzing membrane. Continuous glucose monitoring (CGM) is one of the methods for monitoring and correction glycemic variability in dialysis patients with DM.This article presents a description of a clinical case of the patient with T1DM on MHD receiving insulin therapy using an insulin pump in combination with CGM (FreeStyle Libre portable system) and highlights the difficulties of correcting insulin therapy on dialysis and non-dialysis days.The discussion section presents the JBDS-IP 2022 (UK) recommendations for the correction of insulin therapy in patients with DM on dialysis (it is recommended to reduce the insulin dose by 25% on dialysis days, immediately after the start of the HD procedure). Particular attention is focused on the need for a personalized approach to the correction of insulin therapy in dialysis patients with DM due to the comorbidity of this group of patients and the difficulties in extrapolating recommendations into real clinical practice.

Keywords

• renal replacement therapy
• hemodialysis
• chronic kidney disease
• glycemic variability
• diabetes mellitus
• continuous glucose monitoring