Treatment of diabetes mellitus in dialysis patients
Diabetes mellitus is a key cause of chronic kidney disease (CKD) in developed contries. Disorders of glucose metabolism regulation in CKD are explained by insulin resistance, decreased insulin clearance, weak hormonal response to hypoglycemia. These disturbances appear in inhibition of glomerular fi...
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"Consilium Medicum" Publishing house
2011-12-01
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Online Access: | https://ter-arkhiv.ru/0040-3660/article/view/30965 |
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doaj-1928cf6aef494c9785d3fabd9d0dd29d2020-11-25T03:12:42Zrus"Consilium Medicum" Publishing houseТерапевтический архив0040-36602309-53422011-12-018312737727981Treatment of diabetes mellitus in dialysis patientsIrina Arkad'evna Bondar'Vadim Valer'evich KlimontovI A Bondar0V V Klimontov1State Medical University, NovosibirskState Medical University, NovosibirskDiabetes mellitus is a key cause of chronic kidney disease (CKD) in developed contries. Disorders of glucose metabolism regulation in CKD are explained by insulin resistance, decreased insulin clearance, weak hormonal response to hypoglycemia. These disturbances appear in inhibition of glomerular filtration rate under 60 ml/min. Hemodialysis treatment raises the risk of hypoglycemic conditions due to glucose elimination from blood circulation during the sessions and improvement of sensitivity to insulin. Use of glucose-containing solutions for dialysis, step-by-step achievement of normoglycemia, monitoring of blood glucose during dialysis sessions are recommended for reducing the risk of hypoglycemic conditions in DM patients on dialysis. Insulin is the most common preparation in the treatment with use of hemodialysis in diabetics. Tiasolidindions (pioglitason, rosiglitason) and analogues of dipeptidilpeptidase of type IV (sitagliptin, saxagliptin) can be administered in type 2 diabetics without insulin insufficiency. As solutions for peritoneal dialysis contain glucose, such dialysis may entail such metabolic complications as fat accumulation, metabolic syndrome. Intraperitoneal introduction of insulin allows avoiding hyperinsulinemia and in some cases to decrease the risk of hypoglycemia. Side effects of intraperitoneal insulin administration are significant absorption of insulin on the surface of the systems for intraperitoneal dialysis, higher rate of peritonitis, subcapsular hepatic steatosis. In the absence of controlled studies the mode of insulin administration in patients on peritoneal dialysis should be chosen individually basing on potential risk and benefit for the patient and experience of the dialysis center. It should be remembered that adequate sugar-reducing treatment is necessary for prevention of complications and prolongation of survival of diabetics on dialysis.https://ter-arkhiv.ru/0040-3660/article/view/30965diabetes mellituschronic disease of the kidneyshemodialysisperitoneal dialysissugar-reducing therapy |
collection |
DOAJ |
language |
Russian |
format |
Article |
sources |
DOAJ |
author |
Irina Arkad'evna Bondar' Vadim Valer'evich Klimontov I A Bondar V V Klimontov |
spellingShingle |
Irina Arkad'evna Bondar' Vadim Valer'evich Klimontov I A Bondar V V Klimontov Treatment of diabetes mellitus in dialysis patients Терапевтический архив diabetes mellitus chronic disease of the kidneys hemodialysis peritoneal dialysis sugar-reducing therapy |
author_facet |
Irina Arkad'evna Bondar' Vadim Valer'evich Klimontov I A Bondar V V Klimontov |
author_sort |
Irina Arkad'evna Bondar' |
title |
Treatment of diabetes mellitus in dialysis patients |
title_short |
Treatment of diabetes mellitus in dialysis patients |
title_full |
Treatment of diabetes mellitus in dialysis patients |
title_fullStr |
Treatment of diabetes mellitus in dialysis patients |
title_full_unstemmed |
Treatment of diabetes mellitus in dialysis patients |
title_sort |
treatment of diabetes mellitus in dialysis patients |
publisher |
"Consilium Medicum" Publishing house |
series |
Терапевтический архив |
issn |
0040-3660 2309-5342 |
publishDate |
2011-12-01 |
description |
Diabetes mellitus is a key cause of chronic kidney disease (CKD) in developed contries. Disorders of glucose metabolism regulation in CKD are explained by insulin resistance, decreased insulin clearance, weak hormonal response to hypoglycemia. These disturbances appear in inhibition of glomerular filtration rate under 60 ml/min. Hemodialysis treatment raises the risk of hypoglycemic conditions due to glucose elimination from blood circulation during the sessions and improvement of sensitivity to insulin. Use of glucose-containing solutions for dialysis, step-by-step achievement of normoglycemia, monitoring of blood glucose during dialysis sessions are recommended for reducing the risk of hypoglycemic conditions in DM patients on dialysis. Insulin is the most common preparation in the treatment with use of hemodialysis in diabetics. Tiasolidindions (pioglitason, rosiglitason) and analogues of dipeptidilpeptidase of type IV (sitagliptin, saxagliptin) can be administered in type 2 diabetics without insulin insufficiency. As solutions for peritoneal dialysis contain glucose, such dialysis may entail such metabolic complications as fat accumulation, metabolic syndrome. Intraperitoneal introduction of insulin allows avoiding hyperinsulinemia and in some cases to decrease the risk of hypoglycemia. Side effects of intraperitoneal insulin administration are significant absorption of insulin on the surface of the systems for intraperitoneal dialysis, higher rate of peritonitis, subcapsular hepatic steatosis. In the absence of controlled studies the mode of insulin administration in patients on peritoneal dialysis should be chosen individually basing on potential risk and benefit for the patient and experience of the dialysis center. It should be remembered that adequate sugar-reducing treatment is necessary for prevention of complications and prolongation of survival of diabetics on dialysis. |
topic |
diabetes mellitus chronic disease of the kidneys hemodialysis peritoneal dialysis sugar-reducing therapy |
url |
https://ter-arkhiv.ru/0040-3660/article/view/30965 |
work_keys_str_mv |
AT irinaarkadevnabondar treatmentofdiabetesmellitusindialysispatients AT vadimvalerevichklimontov treatmentofdiabetesmellitusindialysispatients AT iabondar treatmentofdiabetesmellitusindialysispatients AT vvklimontov treatmentofdiabetesmellitusindialysispatients |
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