Analysis of the Causes of Hypoglycemic Reactions in Patients with Diabetic Nephropathy during the Peri-dialysis Period

Abstract

Objective: To provide clinical evidence for controlling the incidence of hypoglycemia in patients with diabetic nephropathy during the peri-dialysis period by analyzing the causes of hypoglycemic reactions in diabetic patients during this period in the hospital. Methods: A total of 56 patients with diabetic nephropathy in the peri-dialysis period (i.e., glomerular filtration rate eGFR < 15ml/(min*1.73 m²) up to three months after dialysis) who received outpatient, inpatient, and hemodialysis treatments in the hospital from June 2022 to December 2023 were selected as the research subjects. The occurrence of hypoglycemia in the non-dialysis period and the initial dialysis period of the patients was collected (hypoglycemia was judged according to Whipple’s triad as follows. Clinical manifestations: symptoms such as palpitation, sweating, blurred vision, dizziness, etc.; Blood glucose index ≤ 3.9 mmol/L; Hypoglycemic symptoms were relieved after sugar supply or food supplementation. The nutritional status, diabetes duration, fasting blood glucose (FBG), random blood glucose (RBC), glycated albumin (GA), glycated hemoglobin (HbAlc), blood cell analysis, renal function, regular diet, body mass index (BMI), oral hypoglycemic drugs, and injection hypoglycemic drugs of the patients with hypoglycemia were monitored. The influencing factors of hypoglycemia in the non-dialysis stage and the initial dialysis stage were analyzed respectively. Results: The incidence of hypoglycemia in patients in the non-dialysis stage was 5.3%, and that in the initial dialysis stage was 21%. The incidence of hypoglycemia in these two stages was negatively correlated with nutritional status, regular diet, fasting blood glucose (FBG), random blood glucose (RBC), glycated albumin (GA), glycated hemoglobin (HbAlc), and the dosage of hypoglycemic drugs, and was positively correlated with anemia and albumin (ALB). Among them, in the initial dialysis stage, glycated albumin (GA), random blood glucose (RBC), anemia, the dosage of injected hypoglycemic drugs, and the eating situation on the day of dialysis could predict the occurrence of hypoglycemic reactions. Conclusion: The incidence of hypoglycemic reactions in the initial dialysis stage was significantly higher than that in the non-dialysis stage, especially the hypoglycemia that occurred during the dialysis process seriously affected the dialysis effect of patients. Therefore, by improving the nutritional status of patients, regular diet, improving anemia, monitoring random blood glucose (RBC), glycated albumin (GA), and timely adjusting the dosage of hypoglycemic drugs, the occurrence of hypoglycemic reactions in patients with diabetic nephropathy during the peri-dialysis period can be minimized.