الفهرس 
GLUCOSE HOMEOSTASISOnly 14 pages are availabe for public view
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Abstract
Diabetic nephropathy is the leading cause of end stage renal failure (ESRF), representing 30 – 40 % of the U.K. and U.S populations undergoing long-term maintenance hemodialysis.
Diabetic patients have a high mortality rate, mainly attributed to cardiovascular disease. This is particularly marked in diabetic patients on chronic hemodialysis. These patients have a poorer outcome than non-diabetic subjects.
Although preventing diabetic kidney disease clearly is not a goal in patients with CKD stage 5, many of the other deleterious effects of hyperglycemia might still be averted, even at such an advanced stage.
The continuous interstitial glucose monitoring system (CGMS) can detect unrecognized hypoglycemia and other patterns requiring insulin adjustment, not detected with intermittent blood glucose monitoring.
The continuous glucose monitoring system (CGMS) has been validated as a reliable and accurate measure of blood glucose in home use.
This cross-sectional study was conducted on fifteen diabetic patients with chronic kidney disease on regular hemodialysis, their age ranging from 45-58 years old, and five were subsequently excluded because of CGM technical failure.
All patients were subjected to the following:
-Full medical history taking (including family history, drug history).
-Full clinical examination including Body Mass Index (BMI) and blood pressure. Body mass index was calculated by dividing weight in kilograms by height in meters squared. Blood pressure was measured in triplicate with a standard mercury manometer.
Laboratory Investigations:
• Complete blood count.
• Fasting and post prandial blood sugar.
• Serum creatinine, blood urea nitrogen, serum calcium, serum phosphorus and serum albumin.
• HbA1c.
The patients may suffer from:
• Hypotension.
• Leg Cramps.
• Symptoms of hypoglycemia.
• The need for hypertonic glucose.
-Continuous glucose monitoring system (CGMS) for 3 days [the day before hemodialysis (day 1), the day of dialysis (day 2) and the day after dialysis (day 3)].
Aim of this study:
3. To evaluate glycemic state in diabetic patients with chronic kidney disease on regular hemodialysis using continuous glucose monitoring system (CGMS).
4. Comparison of glycemic state in relation to dialysis as follow:
o Day off dialysis before (day 1).
o Day on dialysis (day 2).
o Day off dialysis after (day 3).
The results:
CGMS showed a statistically significant reduction of blood sugar on day of dialysis (day 2) compared to day before dialysis (day 1) (p=0.034) and day after dialysis (day 3) (p=0.035).
However no statistically significant difference between (day 1) and (day 3) (p=0.846).
Blood sugar by sensor was highly significant low 12 hours after dialysis on (day 2) compared to (day 1) (p=0.0001).
Blood sugar by sensor was highly significant low 12 hours after dialysis on (day 2) compared to (day 3) (p=0.0001).
There was no significant difference between blood sugar 12 hours on day before dialysis (day 1) and blood sugar 12 hours on day after dialysis (day 3) by sensor (p=0.056).
CGMS but not glucometer detected 4 subjects (40 %) having hypoglycemia (blood sugar≤70 mg/dL for ≥20 min) during dialysis. However, no subject reported any symptomatic hypoglycemia. In addition no subject reported changes in medication either dosing or frequency of insulin.
As regarding meter, blood sugar was significant low on day of dialysis (day 2) compared to day before dialysis (day 1) (p=0.017). Blood sugar was significant low on (day 2) compared to (day 3) (p=0.041). There was no significant difference between blood sugar on (day 1) and blood sugar on (day 3) (p=0.601).
There was no statistically significant difference between sensor and meter blood sugar readings on day before dialysis (day 1), day on dialysis (day 2) or day after dialysis (day 3).
There was a high statistically significant correlation between sensor and meter blood sugar readings on day before dialysis (day 1), day on dialysis (day 2) or day after dialysis (day 3).