Victoria Socha

DocwireNews

Dallas&mdash;To answer the question &ldquo;How can nurses manage the care for preventing hypoglycemia for patients on insulin drip wile on hemodialysis?,&rdquo;&nbsp;Margaret Shegog, BSN, RN, and colleagues conducted a literature review. They reported results of the review at the 2019 ANNA National Symposium in a presentation titled,&nbsp;Rebound Hypoglycemia Post Hemodialysis Related to Intradialytic Insulin Titration.Patients have a false glucose level during hemodialysis due to the dextrose content of the dialysate. In patients with a history of diabetes, the need for up-titration of insulin infusion is increased. Concerns associated with hemodialysis in patients with diabetes include the possibility of hypoglycemia at hemodialysis termination; the safe level of serum dextrose for patients on simultaneous hemodialysis and insulin drip; and possible drops in blood glucose levels when hemodialysis is terminated.The literature review revealed that dialysate contains 200 mg/dL dextrose, increasing the blood sugar level during hemodialysis treatment and increasing the need to titrate up insulin infusion. A portion of insulin does get dialyzed out, also increasing the need to increase the insulin drip. Patients do tend to experience hypoglycemia following hemodialysis due to endogenous insulin surge [Jamaludin et al., 2015]. To prevent hypoglycemic episodes, a 2014 study by Dickerson et al. suggested that patients with end-stage renal disease on dialysis benefit from less stringent blood sugar control algorithms.In conclusion, the authors of the current literature review said, nurses should &ldquo;continue hourly glucose check per protocol. Hemodialysis nurses will do a 30-minute glucose check after the patients off the hemodialysis machine while awaiting transplantation back to the patient&rsquo;s room. A nurse will accompany patients back to their room, and will provide a face-to-face handoff report to the primary nurse. Any abnormal blood glucose level will be reported to the physician.&ldquo;A proposal was approved with the nephrologist and endocrinologist to not increase the insulin drip in the orders while the patient is on hemodialysis to minimize the risk of rebound hypoglycemia,&rdquo; they added.Source: Shegog M, Lin K-T. Rebound hypoglycemia post hemodialysis related to intradialytic insulin titration. Abstract of a presentation at the 2019 American Nephrology Nurses Association National Symposium, April 14-17, 2019, Dallas Texas.

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Patients with History of Diabetes Require Hourly Glucose Checks during Hemodialysis

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To answer the question “How can nurses manage the care for preventing hypoglycemia for patients on insulin drip wile on hemodialysis?,” Margaret Shegog, BSN, RN, and ...

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