Possible causes of normoglycemia or hypoglycemia in dialysis patients who previously required insulin
| Decreased renal clearance of insulin |
| Decreased hepatic clearance of insulin |
| Impaired renal insulin degradation |
| Increased insulin half-life for reasons other than renal or hepatic conditions |
| Decline in renal gluconeogenesis |
| Deficient catecholamine release |
| Other impacts of uremia on glucose homeostasis |
| Diminished food intake because of problems such as anorexia, diabetic gastroparesis |
| Protein-energy wasting (malnutrition-inflammation complex) |
| Loss of body weight and fat mass |
| Comorbid conditions |
| Hypoglycemia during hemodialysis treatments |
| Effects of peritoneal dialysis on glucose metabolism |
| Prescribed medications |
| Imposed dietary restrictions |
| Low hemoglobin A1c owing to confounding by uremia or anemia |
Kovesdy CP, Park JC, Kalantar-Zadeh K. Glycemic control and burnt-out diabetes in ESRD. Semin Dial 2010; 23:148–156. Copyright John Wiley and Sons, 2010; used with permission.