diabetics on hemodialysis

[smokinbeaver]

My husband has recently started having dialysis at a center here where we live. He has been a type 2 diabetic since his early 30's (he is 58). Several yrs ago he started taking insulin which caused a tremendous weight gain on him very quickly. About 2 yrs ago he started taking Byetta which helped him lose a lot of weight and control his appetite. We figure it had a part in bringing on the sudden need to start dialysis, but it was also a big help in controling his blood sugar. Now that he has started dialysis, he has been told he can no longer take Byetta. He also says he has been told dialysis does not remove the insulin he needs to inject to control his blood sugars. He has always controled his diet and took great care of himmself while taking insulin. He kept hisself in such tight control he often had low blood sugars.
He is very conserned he will have higher blood sugars, gain a lot of weight that he has fought so hard to lose (he has lost over 100 lbs) and have a lot of trouble with his blood sugar now that he is on dialysis. He has been very carefull with his diet and blood sugar control all these yrs, and we are scared what will happen now. How does the body break down insulin if it is not removed at the hemodialysis center? Is there anything we can do together to help? We know its another big bump in the road, being on dialysis is often another complication with diabetes. Jon (brokenpole) is a moderator and greeter on the site tudiabetes. Hes been posting a blog there of his experience going on dialysis to help other people there. We've found a great support system there. One of the ladies on that site suggested ihatedialysis to help us cope. Glad you guys are all here and we hope to find friends here like we found at tudiabetes. Just so many conserns going through our mind. My husband is very upset about our dr saying he will not re new his perscription for Byetta. It was such a big help for him, and we know his blood sugar could go higher...

Sharon

[Pam]

I've been type 1 for almost 30 yrs. I've been on hemo dialysis for 3 yrs. I can't tell that dialysis does anything as far as blood sugar is controlled. My biggest problem is the difference in the diets. I want whole grain bread etc. I hope you can find your answers.
Pam

[Chris]

When I was on dialysis I use to monitor my blood sugar throughout the process and kept a log of it in part to show doctors, see how low or high it would get, and to eat something if t started to go down since I could not feel hypos coming on. I am type 1 tho and with type 2 diabetes, depending on severity of it, there tends to be residual pancreatic function of insulin production.
 
Has your husband tried other insulin types? and you probably did do this, but did you ask the doctor why he would not if your husband is having such good contol?
 
I can't remember off hand if your husband is going on pd, home hemo. or incenter hemo, but if pd then there is a different type of solution to use that has a lower glucose count. It was color coded, but when I read about that it was a few years ago on here.
 
Hopefully his diabetes will not be harder to control once he goes full steam ahead with dialysis in center. My control became really difficult with dialysis.

[smokinbeaver]

My husband is going to a hemodialysis center. Was told he wasn't a candidate for PD. He has been taking Lantus insulin for some time which had his sugars in great control. He started having lows regularly and found another endocronologist. Thats where he found out his kidneys had suddenly taken a nose dive. The dr said the kidneys weren't filtering right and the insulin staying longer was causing the lows. He is doing pretty good sugar wise now that he started dialysis. He told me yesterday that insulin is a protein and "too large" for dialysis to eliminate it. He has been using less insuling lately. I wonder what happens to the insulin in your blood if dialysis doesn't remove it? He is still urinating so I wonder if thats why he has been doing better. So your control became more difficult Chris? We are wondering if we will be seeing this. He has always taken really good care of himself and the AC1 whatever tests show that. Just something else to be conserned about. Trying to follow a diet for diabetes and kidney failure is going to be a challenge I am sure. Thankyou Chris and Pam for responding.

Sharon

[malaka]

My story.  Hyperthyroidism 1997,  type 2 diabetes 2001, intially controlled by medication.  In 2009 diagnosis of membraneous nephritis with nephrotic syndrome.  Doc put me on corticosteroids.  Oops, they appear to fight the metformin med I was taking.  Sugar was creeping up.  So I was switched to insulin (Lantus every day and quick acting type as needed per meter results). 

Before dialysis, I gained weight -- mostly water.  Which meant I needed more insulin. Started dialysis in January 2012.  Insulin requirements went down substantially.  I've been floating around 100 in morning readings which is fine. 

Part of the deal is that if your husband's urinary output has declined, he'll "keep" the insulin in circulation longer.  That's what happened to me, accorinding to endocronologist. 

Insulin turns glucose into energy = calories.  Before insulin, diabetics effectively starved to death as I am told.  Higher sugars = less sugar available for calories, so there can be weight gain on insulin.  When my sugar was sky high (pre insulin) I'd lost a significant amount of weight.  Started insulin, started gaining weight.  So calorie intake becomes important.  I hope your husband likes boiled chicken without salt!   At least he won't be eating potatoes any more.  Believe me, you get used to it. 

[Chris]

I'll respond more when I'm home at my pc. Just wanted to say malaka is right about early diabetes. I did a history report on diabetes for my anatomy class a few years ago and there is some interesting and somewhat gross facts.

[Chris]

So your control became more difficult Chris? We are wondering if we will be seeing this. He has always taken really good care of himself and the AC1 whatever tests show that. Just something else to be conserned about. Trying to follow a diet for diabetes and kidney failure is going to be a challenge I am sure. Thankyou Chris and Pam for responding.

Sharon

My problems were usually on the days after dialysis, so I was making quite a few visits to the ER. I was a regular at my local hospital, but did become slightly less when I finally got an insulin pump. I first was just on two types of insulin with no sliding scale, then when I was on dialysis and got a endo, I was put on a sliding scale for the first time. I got rid of the endo, put on 3 diferent insulins throughout the day and finally the pump with only one fast acting insulin (Humalog/ Novalog) to get some sort of control. The endo I got rid of did not want to get me on the pump till after I had my kid/pancreas transplant. So if that was the doctors thinking of a pancreas transplant, time to move on to a different and more educated doctor. Your husband may not have problems tho, we all react differently.
 
The HbA1c test in a basic sense is a median timeline of blood sugar average of a certain range (forgot if it is 30 days, 2 months, or something to that effect) that is usually done every six months to once a year. Yes the diet was awful, plain and then awful! A real challenge when going out to eat. Of course  could been overdoing the strictness of the diet since I had no lab numbers to go by.