In the clinical management of maintenance hemodialysis (MHD) patients, hypoglycemia is becoming an “invisible killer” that threatens lives. Data shows that the incidence of hypoglycemia among hemodialysis patients is as high as 40.62%, with diabetic nephropathy patients being particularly at high risk. The all-cause mortality rate of patients with frequent hypoglycemia (≥3 times) increases nearly fourfold. What is even more alarming is that approximately 35.8% of dialysis patients experience at least one asymptomatic hypoglycemia each year, which is like a “silent time bomb”. To break through this crisis, it is necessary to first deeply understand the occurrence mechanism of dialysis-related hypoglycemia, and then build a systematic prevention and control system through precise blood glucose monitoring (BGM) management.
1. The triple mechanism of hypoglycemia during dialysis
Dialysis-related hypoglycemia is not caused by a single factor, but is the result of the combined effect of triple disorders in glucose metabolism, hormone regulation and drug metabolism:
1.1 The “unidirectional loss” mechanism of glucose
Dialysate removes 20 to 30 grams of glucose per hour, which is equivalent to one quarter of the daily intake for adults. The use of sugar-free dialysis fluid increases the blood glucose clearance rate by 30%, while insulin, as a macromolecular substance, cannot be dialyzed away, resulting in an imbalance of “sugar loss – insulin retention”. This one-way clearance mode accelerates the rate of blood sugar drop during dialysis by 2 to 3 times, just like “draining water from a pool but not taking in water”, which can easily lead to a rapid drop in blood sugar. blood glucose test
1.2 The “double failure” mechanism of hormone regulation
Renal failure leads to a reduction in the secretion of hypoglycemic hormones such as cortisol. Meanwhile, dialysis improves insulin resistance, increasing the uptake of glucose by peripheral tissues. This dual effect of “insufficient blood sugar increase and excessive blood sugar decrease” reduces the blood sugar regulation ability of dialysis patients to one-third of the normal level. Research shows that the blood sugar fluctuation range of patients undergoing dialysis is 4 to 5 times that of healthy people, and the recovery speed is significantly slower.
1.3 The “accumulation effect” mechanism of drug metabolism
Sulfonylurea drugs have a half-life that is 3 to 5 times longer in patients with renal failure, and long-acting insulin has a significant accumulation effect after dialysis. Diabetic patients who have not adjusted their hypoglycemic regimens have a 70% increased risk of hypoglycemia during dialysis. Moreover, the sudden improvement in insulin sensitivity after dialysis further intensifies the hypoglycemic effect of drugs, creating a vicious cycle of “drug overdose – hypoglycemia”.
2. Core Strategy One: Personalized BGM solution design
The traditional blood glucose monitoring protocols are difficult to meet the individualized needs of dialysis patients. It is necessary to establish a stratified monitoring strategy based on patient characteristics:
2.1 “Risk Prediction” Before Dialysis
Patients with diabetic nephropathy, the elderly (≥65 years old), low body weight (<50kg), and pre-dialysis blood glucose <5.75mmol/L are marked as high-risk groups for hypoglycemia and require intensive monitoring. Before dialysis, indicators such as blood glucose, hemoglobin and albumin were measured to establish individualized blood glucose early warning thresholds. Studies show that patients with albumin <37.35g/L have a 2.8 times higher risk of hypoglycemia.
2.2 “Dynamic Adjustment” in Dialysis digital glucose meter
After dialysis begins, blood glucose is monitored every 30 minutes, and after 2 hours of dialysis, it is monitored every 15 minutes, forming a dynamic management model of “intensive monitoring – timely intervention”. The blood glucose warning threshold during dialysis for diabetic patients was raised to 4.5mmol/L (the conventional one was 3.9mmol/L), and intervention measures were initiated in advance to prevent severe hypoglycemia.
2.3 “Continuing Management” after Dialysis
Blood glucose should be monitored every 30 minutes within 2 hours after dialysis, and the monitoring should continue at night until the next morning, covering the “golden four hours” when hypoglycemia is highly prevalent. Record the blood glucose change curve of each dialysis session, analyze the blood glucose fluctuation pattern, and provide a basis for the subsequent adjustment of the dialysis plan.
3. Core Strategy Two: Construction of a Multi-dimensional Intervention System
Simple blood glucose monitoring cannot solve the problem of hypoglycemia during dialysis. It is necessary to establish a closed-loop management system of “monitoring – intervention – feedback” :
3.1 “Precise Supplementation” in Dietary Intervention
Supplementing 20-30g of carbohydrates (such as 4 soda crackers or 1 small cup of juice) 1.5 hours before dialysis can reduce the incidence of hypoglycemia by 40%. After 2 hours of dialysis, 15-20g of carbohydrates are administered to form a “dynamic equilibrium” with the rate of glucose clearance in the dialysis fluid, maintaining stable blood sugar levels. A diet plan should be formulated based on the patient’s weight, dialysis duration, and the characteristics of blood sugar fluctuations to avoid insufficient or excessive food intake before dialysis.
3.2 “Intelligent Adjustment” of Drug Regimens
On the day of dialysis, reduce insulin dosage by 25% to 50%, give priority to short-acting insulin, and avoid using long-acting insulin analogues. Replace sulfonylurea drugs with DPP-4 inhibitors (such as sitagliptin), which have a low risk of hypoglycemia and are not affected by dialysis. For patients using insulin, insulin levels should be regularly measured before and after dialysis, and the administration time and dosage should be adjusted accordingly.
3.3 “Innovative Application” of Dialysis Technology
The use of 5.55mmol/L glucose dialysis fluid can reduce the incidence of acute hypoglycemia by 58%, and is particularly suitable for patients with diabetic nephropathy. The clearance rate of glucose by hemofiltration is 20% to 30% lower than that of conventional hemodialysis, which can reduce glucose loss during dialysis. Reducing the dialysis fluid temperature to 35.5℃ can decrease the degree of improvement in insulin sensitivity and lower the risk of hypoglycemia.
4. Core Strategy Three: Construction of an intelligent management platform
With the development of medical information technology, intelligent management platforms have provided new solutions for the prevention and control of hypoglycemia during dialysis:
4.1 Real-time Early Warning System
Integrate multi-dimensional information such as the patient’s age, gender, history of diabetes, dialysis parameters, and blood glucose data to establish a hypoglycemic risk prediction model and issue an early warning 30 minutes in advance. Establish a personalized hypoglycemic symptom database, such as “hand tremors + cold sweats = blood glucose <3.5mmol/L”, to achieve two-way verification of symptoms and values. glucose machine
4.2 Application of Continuous Glucose Monitoring (CGM)
CGM records blood glucose levels every five minutes and can continuously monitor blood glucose fluctuations for 24 hours, capturing asymptomatic hypoglycemic events. Through the blood sugar change trend chart, signs of blood sugar decline can be detected in advance to achieve “predictive intervention”. Medical staff can view patients’ blood sugar data in real time and adjust treatment plans promptly, which is especially suitable for patients undergoing dialysis at home.
4.3 Empowerment of Patient Self-management
Patients record data such as blood sugar, diet and exercise through their mobile phones. The system automatically analyzes and provides personalized suggestions. It is equipped with popular science knowledge and video tutorials on hypoglycemia prevention and treatment to enhance patients’ self-management ability. Patients can consult medical staff at any time to achieve an integrated “online-offline” management.
The prevention and control of hypoglycemia during hemodialysis is a systematic project, which requires the organic combination of precise BGM monitoring, individualized intervention plans and intelligent management platforms. By establishing a closed-loop management system of “risk prediction – dynamic monitoring – timely intervention – continuous improvement”, we can reduce the incidence of dialysis hypoglycemia by more than 60%, significantly improving the survival rate and quality of life of patients.
Post time: Jan-30-2026