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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Breathing Difficulty, Dizziness. Taking Insulin, On Dialysis. Symptoms Due To Excessive Insulin?

My dad is on dialysis for the last five years. Was recently admitted to hospital for breathing difficulty and giddiness. Was treated and discharged yesterday - was told that he was using too much insulin and his nephroligist monitored that in hospital. Blood sugar level in the morning was 9.3. He gave himself 10ml of insulin then. He is now complaining that he is very giddy again and wants to go back to hospital.What do you suggest?
Fri, 18 Oct 2013
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Ayurveda Specialist,  's  Response
**
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.

PS

. 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.
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Breathing Difficulty, Dizziness. Taking Insulin, On Dialysis. Symptoms Due To Excessive Insulin?

** 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. PS . 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.