1. Insulin requirement in diabetes is reduced with advancing renal insufficiency
due to reduced rate of degradation of insulin and excretion of insulin binding antibodies in the urine.
2. as blood sugar came 9.3 i.e. between 165-170 mg/dl, thus insulin dose has to be 0.5 units [and not ml] / kg body weight and since weight is not mentioned thus nothing ca be said for sure.
3. It can be possible that insulin dose might have been on the higher side, thus causing hypoglycemia features [giddiness], so check with blood sugar level and consult with nephrologist
again for dose adjustment.
. occasional complications with dialysis include infection and hyperosmolar state in diabetics [which can be one of the cause for hospitalization].
. also long term dialysis can result in poor clearance of phosphates leading to hyper parathyroidism, abnormal vitamin D metabolism, renal osteodystrophy
. administration of double dose of hepatitis B vaccine
can prevent hepatitis problem associated with dialysis.
. since he is on dialysis for 5 years, thus it will perform some of the excretory functions but cannot perform the synthetic functions of the kidney, hence erythropoietin
and vitamin D metabolism remain abnormal despite dialysis.